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1.
Medicine (Baltimore). 2019 Aug;98(32):e16721. doi: 10.1097/MD.0000000000016721.

Safety and efficacy of elvitegravir, dolutegravir, and raltegravir in a real-world cohort of treatment-naïve and -experienced patients.

Author information

1
Division of Infectious Diseases, I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg.
2
German Center for Infection Research (DZIF), Partner Site Hamburg/Lu[Combining Diaeresis]beck/Borstel/Riems, Germany.
3
Department of Medicine, College of Medicine, Blantyre, Malawi.
4
Division of Tropical Medicine, I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Abstract

The aim of this retrospective cohort study was to compare safety, efficacy and rates and reasons of discontinuation of the 3 currently approved integrase strand transfer inhibitors (INSTIs) elvitegravir (EVG), dolutegravir (DTG), and raltegravir (RAL) in HIV-infected treatment-naïve and -experienced patients in a real-world cohort. One hundred four treatment-naïve patients were prescribed an INSTI-based combined antiretroviral therapy (cART)-regimen (first-line group) and 219 patients were switched to an INSTI-based cART-regimen from another treatment regimen (switch group) at our institution between May 2007 and December 2014. Twelve months after initiation of treatment, 92% of patients in the first-line group (EVG: 96%, n = 22/23; DTG: 92%, n = 34/37; RAL: 90%, n = 28/31) and 88% of patients in the switch group (EVG: 94%, n = 32/34; DTG: 90%, n = 69/77; RAL: 85%, n = 67/79) showed full virological suppression (viral load <50 copies/mL). Side effects of any kind occurred in 12% (n = 12/104) of patients in the first-line group, and 10% (n = 21/219) of patients in the switch group. In the switch group neuropsychiatric side effects (depression, vertigo, and sleep disturbances) occurred more frequently in patients treated with DTG (11%, n = 10) compared to the 2 other INSTI-based cART-regimen (EVG: 2%, n = 1; RAL: 1%, n = 1). Side effects only rarely led to discontinuation of treatment (first-line-group: 2%, n = 2/104; switch-group: 1%, n = 3/219). In this real-world setting, INSTI-based ART-regimens were highly efficacious with no significant differences between any of the 3 INSTIs. Overall, side effects were only rarely observed and generally mild in all subgroups. In light of a slightly higher incidence of vertigo and sleep disturbances in patients switched to DTG, awareness of the potential onset of psychiatric symptoms is warranted during follow-up in those patients.

PMID:
31393378
DOI:
10.1097/MD.0000000000016721
[Indexed for MEDLINE]
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2.
BMJ. 2019 Aug 5;366:l4479. doi: 10.1136/bmj.l4479.

Unmasking the vulnerabilities of uninfected children exposed to HIV.

Author information

1
Health Systems Research Unit, South African Medical Research Council, South Africa vundli.ramokolo@mrc.ac.za.
2
Health Systems Research Unit, South African Medical Research Council, South Africa.
3
Department of Paediatrics, University of Pretoria, South Africa.
4
HIV Prevention Research Unit, South African Medical Research Council, South Africa.
5
Department of Paediatrics and Child Health and Ukwanda Centre for Rural Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Worcester, South Africa.
6
Massachusetts General Hospital, Departments of Medicine and Pediatrics, USA.
7
Harvard T H Chan School of Public Health, Department of Immunology and Infectious Diseases, USA.
8
Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.
PMID:
31383646
DOI:
10.1136/bmj.l4479
[Indexed for MEDLINE]
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Conflict of interest statement

Competing interests: We have read and understood BMJ policy on declaration of interests and declare no competing interests. This article was funded by the South African Medical Research Council and Unicef. Research reported in this publication was also supported by the Fogarty International Center of the National Institutes of Health under Award Number 1K43TW010683 to ALS and the Eunice Kennedy Shriver National Institute of Child Health and Human Development under Award Number 1R21HD093531 to KMP. ALS receives salary support through the CIPHER Grantee Programme of the International AIDS Society (2017/518-SLO) while VR receives support from the SAMRC Intramural Postdoctoral Fellowship Programme. The content of this paper is the sole responsibility of the authors and does not necessarily represent the official views of the organisations and funders.

3.
Medicine (Baltimore). 2019 Aug;98(31):e16681. doi: 10.1097/MD.0000000000016681.

Status and associated characteristics of HIV disclosure among people living with HIV/AIDS in Liangshan, China: A cross-sectional study.

Author information

1
West China School of Nursing and Department of Nursing, West China Hospital, Sichuan University, Chengdu, Sichuan, China.

Abstract

Human immunodeficiency virus (HIV) disclosure is a prerequisite to get access to antiretroviral therapy (ART) and social support. Increased disclosure of HIV status has been shown to reduce mother-to-child transmission and high-risk sexual behaviors. Limited studies were conducted to get an insight into HIV disclosure among people living with HIV/acquired immune deficiency syndrome (AIDS) (PLWHA) in Liangshan.Our study aimed to investigate the status and associated characteristics of HIV disclosure among PLWHA in Liangshan.We conducted a cross-sectional study using a stratified, convenience sampling method from August to December in 2017. All of the participants were from Liangshan, a typical impoverished mountainous area which also has a long history of drug production and drug trade. Each participant completed a structured questionnaire including HIV disclosure status, demographic and HIV-related characteristics, social support, and perceived HIV-related stigma. We performed a binary regression analysis to detect associated characteristics of HIV disclosure among PLWHA in Liangshan.A final sample size of 318 participants was included in this study. The overall prevalence of HIV disclosure was 83.6% (266/318). In binary logistic regression analysis, PLWHA who had higher educational levels, and got infected by sexual transmission were less likely to disclose their HIV status (both P < .05). HIV nondisclosure was correlated with a higher level of perceived HIV-related stigma (P < .01).The prevalence of HIV disclosure was relatively low in Liangshan. Healthcare workers are suggested to conduct more counseling and education to promote safe sexual behaviors and reduce perceived stigma among PLWHA, then enhance HIV serostatus disclosure.

PMID:
31374050
DOI:
10.1097/MD.0000000000016681
[Indexed for MEDLINE]
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4.
MMWR Morb Mortal Wkly Rep. 2019 Aug 2;68(30):653-657. doi: 10.15585/mmwr.mm6830a1.

Injection Practices and Sexual Behaviors Among Persons with Diagnosed HIV Infection Who Inject Drugs - United States, 2015-2017.

Abstract

During 2016, 6% of persons in the United States who received a diagnosis of human immunodeficiency virus (HIV) infection had their HIV infection attributed to injection drug use (1). Injection practices and sexual behaviors among HIV-positive persons who inject drugs, such as injection equipment sharing and condomless sex, can increase HIV transmission risk; nationally representative estimates of the prevalences of these behaviors are lacking. The Medical Monitoring Project (MMP) is an annual, cross-sectional survey that reports nationally representative estimates of clinical and behavioral characteristics among U.S. adults with diagnosed HIV (2). CDC used MMP data to assess high-risk injection practices and sexual behaviors among HIV-positive persons who injected drugs during the preceding 12 months and compared their HIV transmission risk behaviors with those of HIV-positive persons who did not inject drugs. During 2015-2017, approximately 10% (weighted percentage estimate) of HIV-positive persons who injected drugs engaged in distributive injection equipment sharing (giving used equipment to another person for use); nonsterile syringe acquisition and unsafe disposal methods were common. Overall, among HIV-positive persons who injected drugs, 80% received no treatment, and 57% self-reported needing drug or alcohol treatment. Compared with HIV-positive persons who did not inject drugs, those who injected drugs were more likely to have a detectable viral load (48% versus 35%; p = 0.008) and engage in high-risk sexual behaviors (p<0.001). Focusing on interventions that reduce high-risk injection practices and sexual behaviors and increase rates of viral suppression might decrease HIV transmission risk among HIV-positive persons who inject drugs. Successful substance use treatment could also lower risk for transmission and overdose through reduced injection.

PMID:
31369525
DOI:
10.15585/mmwr.mm6830a1
[Indexed for MEDLINE]
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5.
MMWR Morb Mortal Wkly Rep. 2019 Aug 2;68(30):658-663. doi: 10.15585/mmwr.mm6830a2.

Threefold Increases in Population HIV Viral Load Suppression Among Men and Young Adults - Bukoba Municipal Council, Tanzania, 2014-2017.

Abstract

Reducing HIV-related morbidity and mortality, and effectively eliminating HIV transmission risk, depends on use of antiretroviral therapy (ART) to achieve and maintain viral load suppression (VLS)* (1,2). By 2020, sub-Saharan African countries are working to achieve VLS among 90% of persons using ART and 73% of all persons living with HIV infection (1). In Tanzania, a country with 1.4 million persons with HIV infection, 49.6% of HIV-positive persons aged 15-49 years had achieved VLS in 2017, including only 21.5% of men and 44.6% of women aged 25-29 years (3). To identify interventions that might increase VLS in Tanzania, and reduce VLS-associated sex and age-group disparities, the Bukoba Combination Prevention Evaluation (BCPE) scaled up new HIV testing, linkage to care, and retention on ART interventions throughout Bukoba Municipal Council (Bukoba), Tanzania, during October 2014-March 2017 (4,5). Located on the western shore of Lake Victoria, Bukoba is a mixed urban and rural municipality of 150,000 persons and capital of Kagera Region. Of the 31 regions of Tanzania, Kagera has the fourth highest prevalence of HIV infection (6.8%) among residents aged 15-49 years (3). CDC analyzed data from BCPE preintervention and postintervention surveys and found that VLS prevalence among HIV-positive Bukoba residents aged 18-49 years increased approximately twofold overall (from 28.6% to 64.8%) and among women (33.3% to 67.8%) and approximately threefold among men (20.5% to 59.1%) and young adults aged 18-29 years (15.6% to 56.7%). During 2017, BCPE facility-based testing and linkage interventions were approved as new service delivery models by the Tanzania Ministry of Health, Community Development, Gender, Elderly and Children (4,5). After a successful rollout to 208 facilities in 11 regions in 2018, BCPE interventions are being scaled up in all regions of Tanzania in 2019 with support from the United States President's Emergency Plan for AIDS Relief (PEPFAR)..

PMID:
31369522
DOI:
10.15585/mmwr.mm6830a2
[Indexed for MEDLINE]
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Conflict of interest statement

All authors have completed and submitted the ICMJE form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

6.
BMJ. 2019 Jul 31;366:l4499. doi: 10.1136/bmj.l4499.

Time to align: development cooperation for the prevention and control of non-communicable diseases.

Author information

1
Global Coordination Mechanism on the Prevention and Control of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland collinst@who.int.
2
Global Noncommunicable Diseases, RTI International, North Carolina, USA.
3
HIV, Health and Development, UN Development Programme, New York, USA.
4
Global Programme Health, Swiss Agency for Development and Cooperation, Bern, Switzerland.
5
Health, Nutrition and Population Global Practice, World Bank, Washington, DC, USA.
6
Global Coordination Mechanism on the Prevention and Control of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland.
PMID:
31366599
PMCID:
PMC6667969
DOI:
10.1136/bmj.l4499
[Indexed for MEDLINE]
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Conflict of interest statement

Competing interests: We have read and understood BMJ policy on declaration of interests and have no relevant interests to declare.

7.
Medicine (Baltimore). 2019 Jul;98(30):e16524. doi: 10.1097/MD.0000000000016524.

Antiviral therapy for HCV in hemophilia A patients with HIV-1 co-infection.

Author information

1
Department of Infectious Diseases, Shanghai Public Health Clinical Center, Fudan University Shanghai, PR China.

Abstract

Anti-hepatitis C virus (HCV) treatment for human immunodeficiency virus (HIV)/HCV co-positive patients with hemophilia A presents numerous problems in terms of safety and effectiveness. The emergence of direct-acting antiviral (DAA) regimens has led to tremendous changes in the management of HIV/HCV co-infection over the past few years, but the application of DAA in patients with hemophilia complicated with HIV/HCV co-infection has rarely been reported.We retrospectively analyzed the clinical course and outcome of hemophilia A patients with HIV/HCV co-infection receiving DAA with a focus on the virological response, changes in cluster of differentiation 4 lymphocyte (CD4) count, side effects, and impact on bleeding before and after DAA therapy.A total of 12 hemophilia A patients with HIV/HCV co-infection were included, 9 of which were severe. All the patients were in stable states with CD4 counts >200/mm and plasma HIV ribonucleic acid (RNA) suppressed (<40 IU/mL) while taking the antiretroviral regimen. Majority of the patients (n = 9, 75.0%) were infected with HCV genotype (GT) 1b, while 2 and 1 was infected with HCV GT 2i and HCV GT 3, respectively.After 12 weeks of DAA treatment, 11 patients (91.7%) obtained sustained virologic response within 24 weeks of discontinuation of treatment (SVR24), except 1 patient who was treated with sofosbuvir (SOF) + pegylated interferon + ribavirin (PR), which was then switched to daclatasvir (DCV) + asunaprevir (ASV) for 12 weeks; this patient then achieved SVR24. During DAA treatment, HIV RNA in all the patients was constantly suppressed, while CD4 counts showed no obvious change.The most common treatment-emergent adverse events were weakness and loss of appetite (generally mild). There was no evidence of an increased tendency of bleeding, and changes in response to replacement.DAA therapy offered a safe and well-tolerated management strategy for HIV/HCV co-infected patients with hemophilia A. An awareness of the potential drug-drug interactions (DDI) between DAA and combination antiretroviral therapy (cART) by clinicians is important for optimal management of co-infected patients.

PMID:
31348267
DOI:
10.1097/MD.0000000000016524
[Indexed for MEDLINE]
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8.
Medicine (Baltimore). 2019 Jul;98(29):e16376. doi: 10.1097/MD.0000000000016376.

Influence of the HIV GWG variant in the HIV infection progression in mono and HCV coinfected patients.

Author information

1
São Paulo State University (Unesp), Medical School.
2
Molecular Biology Laboratory, Blood Transfusion Center.
3
São Paulo State University (Unesp), School of Agriculture, Botucatu.
4
Laboratory of Molecular Evolution and Bioinformatics (LEMB), Biomedical Sciences Institute, University of São Paulo (USP), São Paulo, Brazil.

Abstract

The HIV subtype B is the most frequent in Brazil. The HIV subtype B' codes the amino acids glicine-tryptophan-glicine (GWG) instead of glicine-proline-glicine on the tip of gp120 V3 loop. This variant was associated to a slower HIV progression in mono-infected patients; however, there is no information in coinfected patients. This study evaluated the infection progression of HIV variant B' on the hepatitis C virus presence. RNA isolated from plasma of the 601 infected patients were used to human immunodeficiency virus (HIV) subtyping and to classify the virus according their syncytium-inducing ability. The HIV infection progression was evaluated by clinical and laboratorial data. The results showed a significant association between HIV B' variant and CD4 count and time of AIDS in HIV mono-infected patients. Notwithstanding the fact that we did not find a direct association between GWG variant and AIDS and in HIV coinfected patients no mitigating effect due to GWG presence was found. We did observe that the association between GWG variant and CD4 counts is lost in coinfected patients. This is first work showing influence of the HIV GWG variant in coinfected patients. Nevertheless, the presence of the GWG variant can indicate a better prognostic in the mono-infected patients.

PMID:
31335686
DOI:
10.1097/MD.0000000000016376
[Indexed for MEDLINE]
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9.
Medicine (Baltimore). 2019 Jul;98(29):e16375. doi: 10.1097/MD.0000000000016375.

External validation of a prediction tool to estimate the risk of human immunodeficiency virus infection amongst men who have sex with men.

Author information

1
The National Center for Acquired Immunodeficiency Syndromes and Sexually Transmitted Diseases Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing.
2
School of Nursing, Binzhou Medical University, Yantai, Shandong.
3
Center for Infectious Diseases, Beijing You'an Hospital, Capital Medical University.
4
Fudan University School of Public Health, Shanghai.
5
Blue City Holdings, Ltd. Beijing, China.

Abstract

A human immunodeficiency virus (HIV) risk assessment tool was previously developed for predicting HIV infection among men who have sex with men (MSM), but was not externally validated. We evaluated the tool's validity for predicting HIV infection in an independent cohort.The tool was assessed using data from a retrospective cohort study of HIV-negative adult MSM who were recruited in Beijing, China between January 2009 and December 2016.High-risk behaviors occurring within 6 months before the survey were evaluated. Area under curve (AUC) of the receiver operating character curve (ROC) was used to quantify discrimination performance; calibration curve and Hosmer-Lemeshow statistic were used for calibration performance valuation; and decision curve analysis (DCA) was used to evaluate clinical usage.One thousand four hundred forty two participants from the cohort were included in the analysis; 246 (17.1%) sero-converted during follow-up. External validation of the tool showed good calibration, the Hosmer-Lemeshow test showed no statistical difference between observed probability and tool-based predictive probability of HIV infection (X = 4.55, P = .80). The tool had modest discrimination ability (AUC = 0.63, 95% confidence interval [CI]: 0.61-0.66). The decision curve analysis indicated that implementing treatment measures based on the tool's predicative risk thresholds ranging from 10% to 30% might increase the net benefit of treatment when compared with treating all or no MSM.The HIV risk assessment tool can predict the actual risk of HIV infection well amongst MSM in China, but it has a moderate ability to discriminate those at high risk of HIV infection.

PMID:
31335685
DOI:
10.1097/MD.0000000000016375
[Indexed for MEDLINE]
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10.
Medicine (Baltimore). 2019 Jul;98(29):e16222. doi: 10.1097/MD.0000000000016222.

Autologous hematopoietic stem cell transplantation for human immunodeficiency virus associated gastric Burkitt lymphoma: A case report.

Author information

1
International Medical Department, Beijing Youan Hospital, Capital Medical University, Beijing, China.

Abstract

RATIONALE:

HIV-related lymphoma, especially non-Hodgkin lymphoma, is one of the most common malignant tumors in HIV/acquired immune deficiency syndrome (AIDS) patients. Autologous hematopoietic stem cell transplantation (AHSCT) for the patients with Burkitt lymphoma (BL) is needed to be further explored.

PATIENT CONCERNS:

A 57-year-old man was hospitalized with intermittent pain on upper abdomen and melena for >1 month.

DIAGNOSIS:

HIV antibody testing was positive. The upper gastrointestinal endoscopy was performed and histopathology and immunohistochemistry revealed BL.

INTERVENTIONS:

Highly effective antiretroviral therapy and sixth cycles of chemotherapy were administered, followed by autologous hematopoietic stem cell transplantation.

OUTCOMES:

The patient has had tumor-free survival for >6 years with normal CD4+ T cell counts and HIV viral load below the lowest detection LESSONS:: The patient was treated with AHSCT followed complete remission after chemotherapy and achieved long-term disease-free survival. AHSCT may be a promising way for clinical cure of HIV-related BL.

PMID:
31335672
DOI:
10.1097/MD.0000000000016222
[Indexed for MEDLINE]
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11.
N Engl J Med. 2019 Jul 18;381(3):207-218. doi: 10.1056/NEJMoa1814556.

Effect of Universal Testing and Treatment on HIV Incidence - HPTN 071 (PopART).

Author information

1
From the London School of Hygiene and Tropical Medicine (R.J.H., S. Floyd, K. Sabapathy, A.S., B.K., D.M., V.B., J.R.H., H.A.), Imperial College London (K.H., S. Fidler), and the National Institute for Health Research Imperial Biomedical Research Centre (S. Fidler), London, and the University of Oxford, Oxford (C.F.) - all in the United Kingdom; the Fred Hutchinson Cancer Research Center, Seattle (D.D., T.S., E.W., L.E.); the Desmond Tutu Tuberculosis Center, Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa (N. Mandla, B.Y., A.J., R.D., N. Makola, G.H., P.B., N.B.); Zambart, Lusaka, Zambia (J.B., M.P., A.S., B.K., M.S., V.B., K. Shanaube, H.A.); Johns Hopkins University School of Medicine, Baltimore (S.H.E., E.P.-M.), and the Division of AIDS, National Institute of Allergy and Infectious Diseases, Bethesda (D.N.B.) - both in Maryland; FHI 360, Durham, NC (A.M., S.G., N.D.S.); the Yale School of Public Health, New Haven, CT (S.H.V.); and ICAP at Columbia University, New York (W.E.-S.).

Abstract

BACKGROUND:

A universal testing and treatment strategy is a potential approach to reduce the incidence of human immunodeficiency virus (HIV) infection, yet previous trial results are inconsistent.

METHODS:

In the HPTN 071 (PopART) community-randomized trial conducted from 2013 through 2018, we randomly assigned 21 communities in Zambia and South Africa (total population, approximately 1 million) to group A (combination prevention intervention with universal antiretroviral therapy [ART]), group B (the prevention intervention with ART provided according to local guidelines [universal since 2016]), or group C (standard care). The prevention intervention included home-based HIV testing delivered by community workers, who also supported linkage to HIV care and ART adherence. The primary outcome, HIV incidence between months 12 and 36, was measured in a population cohort of approximately 2000 randomly sampled adults (18 to 44 years of age) per community. Viral suppression (<400 copies of HIV RNA per milliliter) was assessed in all HIV-positive participants at 24 months.

RESULTS:

The population cohort included 48,301 participants. Baseline HIV prevalence was 21% or 22% in each group. Between months 12 and 36, a total of 553 new HIV infections were observed during 39,702 person-years (1.4 per 100 person-years; women, 1.7; men, 0.8). The adjusted rate ratio for group A as compared with group C was 0.93 (95% confidence interval [CI], 0.74 to 1.18; P = 0.51) and for group B as compared with group C was 0.70 (95% CI, 0.55 to 0.88; P = 0.006). The percentage of HIV-positive participants with viral suppression at 24 months was 71.9% in group A, 67.5% in group B, and 60.2% in group C. The estimated percentage of HIV-positive adults in the community who were receiving ART at 36 months was 81% in group A and 80% in group B.

CONCLUSIONS:

A combination prevention intervention with ART provided according to local guidelines resulted in a 30% lower incidence of HIV infection than standard care. The lack of effect with universal ART was unanticipated and not consistent with the data on viral suppression. In this trial setting, universal testing and treatment reduced the population-level incidence of HIV infection. (Funded by the National Institute of Allergy and Infectious Diseases and others; HPTN 071 [PopArt] ClinicalTrials.gov number, NCT01900977.).

PMID:
31314965
PMCID:
PMC6587177
DOI:
10.1056/NEJMoa1814556
[Indexed for MEDLINE]
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12.
Pan Afr Med J. 2019 May 14;33:21. doi: 10.11604/pamj.2019.33.21.17728. eCollection 2019.

Maternal and foetal medical conditions during pregnancy as determinants of intrapartum stillbirth in public health facilities of Addis Ababa: a case-control study.

Author information

1
Integrated Nutrition and WASH Program, Kigali, Rwanda.
2
Department of Health Studies, University of South Africa, TvW 7-160 College of Human Sciences, Unisa, South Africa.

Abstract

Introduction:

globally, intrapartum stillbirth accounts for 1 million deaths of babies annually, representing approximately one-third of global stillbirth toll. Intrapartum stillbirth occurs due to causes ranging from maternal medical and obstetric conditions; access to quality obstetric care services during pregnancy; and types, timing and quality of intrapartum care. Different medical conditions including hypertensive & metabolic disorders, infections and nutritional deficiencies during pregnancy are among risk factors of stillbirth. Ethiopia remains one of the 10 high-burden stillbirth countries with estimated rate of more than 25 per 1000 births.

Methods:

a case-control study using primary data from chart review of medical records of women who experienced intrapartum stillbirth in 23 public health facilities of Addis Ababa during the period July 1, 2010 - June 30, 2015 was conducted. Data was collected from charts of all cases of intrapartum stillbirth meeting the inclusion criteria and randomly selected charts of controls in two to one (2:1) control to case ratio.

Results:

chronic medical conditions including diabetes, cardiac and renal diseases were less prevalent (1%) among the study population whereas only 6% of women experienced hypertensive disorder during the pregnancy in review. Moreover, 6.5% of the study population had HIV infection where being HIV negative was protective against intrapartum stillbirth (aOR 0.37, 95% CI 0.18-0.78). Women with non-cephalic foetal presentation during last ANC visit were three times more at risk of experiencing intrapartum stillbirth whereas singleton pregnancy had strong protective association against intrapartum stillbirth (p<0.05).

Conclusion:

untreated chronic medical conditions, infection, poor monitoring of foetal conditions and multiple pregnancy are among important risk factors for intrapartum stillbirth.

KEYWORDS:

ANC; Addis Ababa; foetal; infection; intrapartum stillbirth; maternal; medical condition; pregnancy

PMID:
31312337
PMCID:
PMC6615772
DOI:
10.11604/pamj.2019.33.21.17728
[Indexed for MEDLINE]
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13.
Pan Afr Med J. 2019 May 10;33:15. doi: 10.11604/pamj.2019.33.15.17500. eCollection 2019.

Factors influencing use of modern contraception among married women in Ho West district, Ghana: descriptive cross-sectional study.

Author information

1
Department of Population and Behavioural Science, School of Public Health, University of Health and Allied Sciences, PMB 31, Ho, Ghana.
2
HIV/AIDS Prevention Research Network Cameroon (HIVPREC) Kumba, Kumba, Cameroon.

Abstract

Introduction:

the use of modern contraception helps couples and individuals realize their basic right to decide freely and responsibly if, when and how many children to have. The current study assessed the factors influencing the use of modern contraception among married women in Ho West District, Ghana.

Methods:

the study adopted a descriptive cross-sectional design, using a standardized validated pretested interviewer-administered questionnaire adapted from previous studies to collect data from a systematic sample of 225 married women and analyzing them using Stata version 14 software program at the level 0.05.

Results:

the majority, 202 (89.8%) had used modern contraception before, and the proportion currently using some form of family planning (FP) was 130 (64.4%), majority (46.2%) of whom were currently using injectable. Majority (66.1%) used modern contraception in order to ensure proper care of children. Most (64.2%) of the women who were not using modern contraception were not doing so because of their partner's disapproval. Private employees were 0.20 times less likely to use modern contraception (AOR=0.20 (95% CI: 0.04-0.91); p=0.038) compared to housewives, while women who did not have problems with decision-making were 4 times more likely to use modern contraception (AOR=4.40 (95% CI: 1.25-14.44); p=0.021) compared to their counterparts who had problems with decision-making at home.

Conclusion:

the use of modern contraception is low. Health promotion interventions to increase modern contraception use among married women in Ho West District of Ghana should focus on the privately employed and those with problems in decision-making at home.

KEYWORDS:

Ghana; Ho West district; Modern contraception use; married women

PMID:
31312331
PMCID:
PMC6620060
DOI:
10.11604/pamj.2019.33.15.17500
[Indexed for MEDLINE]
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14.
Pan Afr Med J. 2019 Apr 30;32:216. doi: 10.11604/pamj.2019.32.216.18310. eCollection 2019.

Predictors of loss to follow-up among children attending HIV clinic in a hospital in rural Kenya.

Author information

1
Department of Paediatrics and Child Health, Chuka County Referral Hospital, Tharaka Nithi KE, Kenya.
2
Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya.
3
Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi, Kenya.
4
Department of Internal Medicine, Kenya Methodist University, Nairobi, Kenya.

Abstract

Introduction:

African studies have reported high rates of loss to follow up (LTFU) among children in HIV care and treatment centres. Factors associated with LTFU may vary across populations. Few studies have been conducted among HIV infected children in care in rural areas of Kenya.

Methods:

this involved children aged less than 15 years on follow up at Kangundo Level 4 Hospital HIV clinic from January 2010 to December 2015. We obtained sociodemographic and clinical information from patient files and electronic databases. Univariate and multivariate regression analyses were conducted to identify factors predictive of LTFU.

Results:

a total of 261 HIV-infected children were followed up. The mean age was 10.0 years (IQR, 7-13) and median CD4 count of 582cells/ul (IQR 314-984). By December 2015, 171 children (65.5%) remained in active care, 32 (12.3%) transferred out, 13 (5%) died, while 45 (17.2%) were classified as LTFU. Out of the 45 children presumed as LTFU, we traced 44 out of the 45 children (98%) and found that their actual current status was as follows: 33 of the 44 children (75.0%) had dropped out of care (true LTFU). Factors strongly predictive of LTFU included low caregiver level of education (HR 2.3, 1.9-3.9, P = 0.001), WHO stage I and II at enrolment (HR 1.6, 1.4-2.1, P = 0.05).

Conclusion:

LTFU of HIV infected children was common with an incidence of 32.9 per 1000 child years and occurred early in treatment and risk factors included poverty, low caregiver education, male child and early HIV disease stage.

KEYWORDS:

HIV infected; children; loss to follow up

PMID:
31312327
PMCID:
PMC6620067
DOI:
10.11604/pamj.2019.32.216.18310
[Indexed for MEDLINE]
Free PMC Article
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15.
Pan Afr Med J. 2019 Apr 26;32:206. doi: 10.11604/pamj.2019.32.206.18673. eCollection 2019.

Effect of HIV infection on TB treatment outcomes and time to mortality in two urban hospitals in Ghana-a retrospective cohort study.

Author information

1
Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Ghana.
2
Department of Medicine, School of Medicine and Dentistry, University of Ghana, Ghana.
3
Department of Medicine, College of Medicine, University of Florida, USA.

Abstract

Introduction:

Tuberculosis (TB) is currently causing more deaths than Human Immunodeficiency Virus (HIV) globally. Ghana as one of the 30 high burden TB/HIV countries has a high annual TB case-fatality rate of 10%. The study sought to assess the effect of HIV infection on TB treatment outcomes and assess the time to mortality after treatment onset.

Methods:

We conducted a review of treatment files of TB patients who were treated from January 2013 to December 2015 in two urban hospitals in the Accra Metropolis. Modified Poisson regression analysis was used to measure the association between HIV infection and TB treatment outcomes. Kaplan-Meier survival estimates were used to plot survival curves.

Results:

Seventy-seven percent (83/107) of HIV infected individuals had successful treatment, compared to 91.2% (382/419) treatment success among HIV non-infected individuals. The proportion of HIV-positive individuals who died was 21.5% (23/107) whilst that of HIV-negative individuals was 5.5% (23/419). Being HIV-positive increased the risk of adverse outcome relative to successful outcome by a factor of 2.89(95% CI 1.76-4.74). The total number of deaths recorded within the treatment period was 46; of which 29(63%) occurred within the first two months of TB treatment. The highest mortality rate observed was among HIV infected persons (38.6/1000 person months). Of the 107 TB/HIV co-infected patients, 4(3.7%) initiated ART during TB treatment.

Conclusion:

The uptake of ART in co-infected individuals in this study was very low. Measures should be put in place to improve ART coverage among persons with TB/HIV co-infection to help reduce mortality.

KEYWORDS:

TB/HIV co-infection; Tuberculosis; mortality; treatment success

PMID:
31312318
PMCID:
PMC6620068
DOI:
10.11604/pamj.2019.32.206.18673
[Indexed for MEDLINE]
Free PMC Article
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16.
Pan Afr Med J. 2019 Apr 24;32:200. doi: 10.11604/pamj.2019.32.200.12541. eCollection 2019.

Frequency of HIV status disclosure, associated factors and outcomes among HIV positive pregnant women at Mbarara Regional Referral Hospital, southwestern Uganda.

Author information

1
Mbarara University of Science and Technology, Department of Obstetrics and Gynecology, Mbarara, Uganda.
2
Mbarara University of Science and Technology, Department of Community Health, Uganda.

Abstract

Introduction:

Positive HIV results disclosure plays a significant role in the successful prevention and care of HIV infected patients. It provides significant social and health benefits to the individual and the community. Non-disclosure is one of the contextual factors driving the HIV epidemic in Uganda. Study objectives: to determine the frequency of HIV disclosure, associated factors and disclosure outcomes among HIV positive pregnant women at Mbarara Hospital, southwestern Uganda.

Methods:

A cross-sectional study using quantitative and qualitative methods among a group of HIV positive pregnant women attending antenatal clinic was done and consecutive sampling conducted.

Results:

The total participant recruitment was 103, of which 88 (85.4%) had disclosed their serostatus with 57% disclosure to their partners. About 80% had disclosed within less than 2 months of testing HIV positive. Reasons for disclosure included their partners having disclosed to them (27.3%), caring partners (27.3%) and encouragement by health workers (25.0%). Following disclosure, 74%) were comforted and 6.8% were verbally abused. Reasons for non-disclosure were fear of abandonment (33.3%), being beaten (33.3%) and loss of financial and emotional support (13.3%). The factors associated with disclosure were age 26-35 years (OR 3.9, 95% CI 1.03-15.16), primary education (OR 3.53, 95%CI 1.10-11.307) and urban dwelling (OR 4.22, 95% CI 1.27-14.01).

Conclusion:

Participants disclosed mainly to their partners and were comforted and many of them were encouraged by the health workers. There is need to optimize disclosure merits to enable increased participation in treatment and support programs.

KEYWORDS:

Disclosure; HIV/AIDS; Mbarara University; Mbarara hospital; Uganda; factors associated

PMID:
31312312
PMCID:
PMC6620078
DOI:
10.11604/pamj.2019.32.200.12541
[Indexed for MEDLINE]
Free PMC Article
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17.
Pan Afr Med J. 2019 Apr 11;32:179. doi: 10.11604/pamj.2019.32.179.16837. eCollection 2019.

Prevalence of HIV infection among siblings of HIV positive children in Calabar, Nigeria.

Author information

1
Faculty of Medicine, Department of Paediatrics, University of Calabar, Calabar, Nigeria.
2
Department of Paediatrics, University of Calabar Teaching Hospital, Calabar, Nigeria.

Abstract

Introduction:

Early diagnosis and treatment of paediatric HIV is key as mortality of untreated patients is very high in the first two years of life, and reaches 80% by four years. Case finding efforts for children especially outside Prevention of mother-to-child transmission (PMTCT) is inadequate. Targeting siblings of index HIV-exposed and infected children is an important way of improving identification and enrolment into care thereby reducing paediatric mortality. The study therefore aimed to determine the prevalence of HIV infection among siblings of HIV positive children in care in Calabar.

Methods:

This descriptive cross-sectional study was conducted among children aged six weeks to 15 years who are siblings of HIV positive children receiving care. Parental consent and child assent were obtained, the children were tested for HIV at their homes irrespective of their prior test results. Ethical clearance certificates were obtained from the health institutions.

Results:

Siblings of 401 index patients were tested for HIV, four were positive giving a prevalence rate of 1%. Three hundred and sixty-seven 367(91.5%) had been tested previously while 34(8.5%) never had HIV test. Among the siblings who were HIV positive, 1(0.3%) was a male while 3(0.7%) were females. There were more HIV positive siblings in the 11-15 years age group.

Conclusion:

All the four HIV positive siblings were from the lower socioeconomic class (p=0.022). The routine screening of siblings of HIV positive children should be sustained with focus on adolescents from the lower socioeconomic class. This will improve early identification and enrolment into care thereby reducing paediatric mortality.

KEYWORDS:

HIV; Siblings; family; health

PMID:
31312293
PMCID:
PMC6620075
DOI:
10.11604/pamj.2019.32.179.16837
[Indexed for MEDLINE]
Free PMC Article
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18.
Pan Afr Med J. 2019 Apr 8;32:159. doi: 10.11604/pamj.2019.32.159.18472. eCollection 2019.

Factors associated with unfavourable tuberculosis treatment outcomes in Lusaka, Zambia, 2015: a secondary analysis of routine surveillance data.

Author information

1
Field Epidemiology Training Programme, Lusaka, Zambia.
2
Ministry of Health, Lusaka, Zambia.
3
University of Zambia, Lusaka, Zambia.
4
Zambia National Public Health Institute, Lusaka, Zambia.
5
Zambart TB Project, Lusaka, Zambia.

Abstract

Introduction:

Focus has been put on strengthening surveillance systems in high tuberculosis (TB) burden countries, like Zambia, however inadequate information on factors associated with unfavourable TB treatment outcomes is generated from the system. We determined the proportion of tuberculosis treatment outcomes and their associated factors.

Methods:

We defined unfavourable outcome as death, lost-to-follow-up, treatment-failure, or not-evaluated and favourable outcome as a patient cured or completed-treatment. We purposively selected a 1st level hospital, an urban-clinic and a peri-urban clinic. We abstracted data from TB treatment registers at these three health facilities, for all TB cases on treatment from 1st January to 31st December, 2015. We calculated proportions of treatment outcomes and analysed associations between unfavourable outcome and factors such as age, HIV status, health facility, and patient type, using univariate logistics regression. We used multivariable stepwise logistic regression to control for confounding and reported the adjusted odds ratios (AOR) and 95% confidence intervals (CI).

Results:

We included a total of 1,724 registered TB patients, from one urban clinic 694 (40%), a 1st Level Hospital 654 (38%), and one peri-urban-clinic 276 (22%). Of the total patients, 43% had unfavourable outcomes. Of the total unfavourable outcomes, were recorded as treatment-failure (0.3%), lost-to-follow-up (5%), death (9%) and not evaluated (29%). The odds of unfavourable outcome were higher among patients > 59 years (AOR=2.9, 95%CI: 1.44-5.79), relapses (AOR=1.65, 95%CI: 1.15-2.38), patients who sought treatment at the urban clinic (AOR=1.76, 95%CI:1.27-2.42) and TB/HIV co-infected patients (AOR=1.56, 95%CI:1.11-2.19).

Conclusion:

Unfavourable TB treatment outcomes were high in the selected facilities. We recommend special attention to TB patients who are > 59 years old, TB relapses and TB / HIV co-infected. The national TB programme should strengthen close monitoring of health facilities in increasing efforts aimed at evaluating all the outcomes. Studies are required to identify and test interventions aimed at improving treatment outcomes.

KEYWORDS:

Lusaka; Surveillance; Zambia; outcome; treatment; tuberculosis

PMID:
31308862
PMCID:
PMC6609856
DOI:
10.11604/pamj.2019.32.159.18472
[Indexed for MEDLINE]
Free PMC Article
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19.
Medicine (Baltimore). 2019 Jul;98(28):e16363. doi: 10.1097/MD.0000000000016363.

Upper gastrointestinal bleeding caused by direct invasion of diffuse large B-cell lymphoma into the stomach in a patient with HIV infection: A case report.

Author information

1
Departement of Internal Medicine, Gab-Eul Jang Yu Hospital, Gimhae.
2
Department of Internal Medicine, Dongkang Medical Center, Ulsan.
3
Department of Pathology.
4
Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.

Abstract

RATIONALE:

Diffuse large B-cell lymphoma (DLBCL) is the most frequent human immunodeficiency virus (HIV)-related Non-Hodgkin's Lymphoma of the stomach. Although gastrointestinal (GI) bleeding due to primary gastric lymphoma has been previously reported in the literature, there have been no reports of stomach wall involvement of intra-abdominal lymphoma presenting as GI bleeding.

PATIENT CONCERNS:

We present a rare case of direct invasion of DLBCL to the stomach wall that presented as upper GI bleeding in a patient with HIV.

DIAGNOSIS:

Upper endoscopy showed a large ulcerofungating mass in the lesser curvature of upper stomach body. The computed tomography scan showed an about 22 × 12 cm sized huge mass that invades into the stomach wall in the abdominal cavity. A diagnosis of DLBCL was established after histological examination.

INTERVENTION:

The patient was treated with 6 courses of rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP).

OUTCOMES:

The patient achieved a complete response with 6 courses of R-CHOP treatment. No recurrence was observed during the 4-month follow-up period.

LESSONS:

Because of the high incidence of lymphoma in patients with HIV, if such patients complain of dyspepsia, epigastric soreness, or melena, malignant tumors, such as lymphomas or stomach cancers, should be suspected. As in this patient, doctors should be aware that intra-abdominal lymphoma can invade into the stomach wall and cause bleeding.

PMID:
31305432
PMCID:
PMC6641793
DOI:
10.1097/MD.0000000000016363
[Indexed for MEDLINE]
Free PMC Article
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20.
MMWR Morb Mortal Wkly Rep. 2019 Jul 12;68(27):597-603. doi: 10.15585/mmwr.mm6827a1.

Changes in HIV Preexposure Prophylaxis Awareness and Use Among Men Who Have Sex with Men - 20 Urban Areas, 2014 and 2017.

Author information

1
Nassau and Suffolk counties, New York.
2
Denver, Colorado.
3
New Orleans, Louisiana.
4
San Diego, California.
5
Chicago, Illinois.
6
Newark, New Jersey.
7
Philadelphia, Pennsylvania.
8
Detroit, Michigan.
9
New York City, New York.
10
Seattle, Washington.
11
Dallas, Texas.
12
Boston, Massachusetts.
13
Baltimore, Maryland.
14
Miami, Florida.
15
San Francisco, California.
16
Houston, Texas.
17
Washington, D.C.
18
Los Angeles, California.
19
Atlanta, Georgia.
20
San Juan, Puerto Rico.

Abstract

In February 2019, the U.S. Department of Health and Human Services proposed a strategic initiative to end the human immunodeficiency (HIV) epidemic in the United States by reducing new HIV infections by 90% during 2020-2030* (1). Phase 1 of the Ending the HIV Epidemic initiative focuses on Washington, DC; San Juan, Puerto Rico; and 48 counties where the majority of new diagnoses of HIV infection in 2016 and 2017 were concentrated and on seven states with a disproportionate occurrence of HIV in rural areas relative to other states. One of the four pillars in the initiative is protecting persons at risk for HIV infection using proven, comprehensive prevention approaches and treatments, such as HIV preexposure prophylaxis (PrEP), which is the use of antiretroviral medications that have proven effective at preventing infection among persons at risk for acquiring HIV. In 2014, CDC released clinical PrEP guidelines to health care providers (2) and intensified efforts to raise awareness and increase the use of PrEP among persons at risk for infection, including gay, bisexual, and other men who have sex with men (MSM), a group that accounted for an estimated 68% of new HIV infections in 2016 (3). Data from CDC's National HIV Behavioral Surveillance (NHBS) were collected in 20 U.S. urban areas in 2014 and 2017, covering 26 of the geographic areas included in Phase I of the Ending the HIV Epidemic initiative, and were compared to assess changes in PrEP awareness and use among MSM. From 2014 to 2017, PrEP awareness increased by 50% overall, with >80% of MSM in 17 of the 20 urban areas reporting PrEP awareness in 2017. Among MSM with likely indications for PrEP (e.g., sexual risk behaviors or recent bacterial sexually transmitted infection [STI]), use of PrEP increased by approximately 500% from 6% to 35%, with significant increases observed in all urban areas and in almost all demographic subgroups. Despite this progress, PrEP use among MSM, especially among black and Hispanic MSM, remains low. Continued efforts to improve coverage are needed to reach the goal of 90% reduction in HIV incidence by 2030. In addition to developing new ways of connecting black and Hispanic MSM to health care providers through demonstration projects, CDC has developed resources and tools such as the Prescribe HIV Prevention program to enable health care providers to integrate PrEP into their clinical care.§ By routinely testing their patients for HIV, assessing HIV-negative patients for risk behaviors, and prescribing PrEP as needed, health care providers can play a critical role in this effort.

PMID:
31298662
DOI:
10.15585/mmwr.mm6827a1
[Indexed for MEDLINE]
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