A packaged intervention to improve viral load monitoring within a deeply rural health district of South Africa

Brijkumar, Jaysingh; Johnson, Brent A.; Zhao, Yuqi; Edwards, Johnathan A.; Moodley, Pravi; Pathan, Khairoonisa; Pillay, Sureshnee; Castro, Kenneth G.; Sunpath, Henry; Kuritzkes, Daniel R.; Moosa, Mohamed Y. S.; Marconi, Vincent C.

doi:10.1186/s12879-020-05576-5

Cited by 11 publications

(9 citation statements)

References 12 publications

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“…HIV viral load (VL) is significantly associated with the degree of active HIV replication, and a high VL predicts faster disease progression to AIDS and death (7). Monitoring of the VL level after ART initiation to assess effectiveness of treatment has been used increasingly in recent years (8,9). However, baseline VL testing has remained under-utilized in resource-limited settings because of its high cost.…”

Section: Introductionmentioning

confidence: 99%

Higher Risk of Mortality and Virologic Failure in HIV-Infected Patients With High Viral Load at Antiretroviral Therapy Initiation: An Observational Cohort Study in Chongqing, China

Zhou¹,

Zhang²,

Lu³

et al. 2022

Front. Public Health

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BackgroundViral load (VL) is a strong predictor of human immunodeficiency virus (HIV) disease progression. The aim of this study was to evaluate the effect of high baseline VL on antiretroviral therapy (ART) outcomes among HIV-infected patients.MethodsThis retrospective study observed HIV-infected patients who had baseline VL test at ART initiation between 2015 and 2019 in Chongqing, China. Cox proportional hazards regression and logistic regression models were used to evaluate the effects of baseline VL on Acquired immunodeficiency syndrome (AIDS)-related mortality and virologic failure, respectively.ResultsThe cohort included 7,176 HIV-infected patients, of whom 38.7% had a baseline VL ≥ 100,000 copies/mL. Of the patients who died during follow-up, 58.9% had a baseline VL ≥ 100,000 copies/mL. Compared with a baseline VL < 10,000 copies/mL, ART initiation at VL ≥ 100,000 copies/mL was significantly associated with the AIDS-related death (adjusted hazard ratio, AHR = 1.4) and virologic failure (adjusted odds ratio, AOR = 2.4). Compared with patients with a baseline VL < 10,000 copies/mL, patients on the recommended first-line regimen with a VL ≥ 100,000 copies/mL at ART initiaition had higher mortality rate (5.1 vs. 1.7 per 100 person-years), but there was no significant difference in the mortality accoding to the initial VL level among patients on second-line ART (2.8 vs. 2.7 per 100 person-years). ART initiation ≤ 30 days after HIV diagnosis was associated with a lower risk of AIDS-related death (AHR = 0.6).ConclusionsART initiation with VL ≥ 100,000 copies/mL was associated with a significantly greater risk of mortality and virologic failure. Optimizing the ART regimen and initiating ART early may help to reduce mortality effectively among patients with a high baseline VL. VL testing for all HIV patients is recommended at HIV diagnosis or on ART initiation.

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Section: Introductionmentioning

confidence: 99%

Higher Risk of Mortality and Virologic Failure in HIV-Infected Patients With High Viral Load at Antiretroviral Therapy Initiation: An Observational Cohort Study in Chongqing, China

Zhou¹,

Zhang²,

Lu³

et al. 2022

Front. Public Health

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“…Our study was based on a sub‐cohort from the KwaZulu‐Natal (KZN) HIV AIDS Drug Resistance Surveillance Study (ADReSS), which was a prospective study of PWH in care at urban (RK Khan) and rural (Bethesda) HIV clinics in South Africa [17]. Ethical approval from the Biomedical Research Ethics Committee of University of KZN, Emory University, and Mass General Brigham institutional review boards was obtained prior to the start of the study.…”

Section: Methodsmentioning

confidence: 99%

Associations of inflammation‐related proteome with demographic and clinical characteristics of people with HIV in South Africa

Chen,

Hui,

Liu

et al. 2023

Proteomics Clinical Apps

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PurposeElevated levels of inflammation associated with human immunodeficiency virus (HIV) infection are one of the primary causes for the burden of age‐related diseases among people with HIV (PWH). Circulating proteins can be used to investigate pathways to inflammation among PWH.Experimental designWe profiled 73 inflammation‐related protein markers and assessed their associations with chronological age, sex, and CD4+ cell count among 87 black South African PWH before antiretroviral therapy (ART).ResultsWe identified 1, 1, and 14 inflammatory proteins significantly associated with sex, CD4+ cell count, and age respectively. Twelve out of 14 age‐associated proteins have been reported to be associated with age in the general population, and 4 have previously shown significant associations with age for PWH. Furthermore, many of the age‐associated proteins such as CST5, CCL23, SLAMF1, MMP‐1, MCP‐1, and CDCP1 have been linked to chronic diseases such as cardiovascular disease and neurocognitive decline in the general population. We also found a synergistic interaction between male and older age accounting for excessive expression of CST5.Conclusions and clinical relevanceWe found that advanced age may lead to the elevation of multiple inflammatory proteins among PWH. We also demonstrated the potential utility of proteomics for evaluating and characterizing the inflammatory status of PWH.

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“…This study was based on a sub-cohort from the ADReSS participants recruited from KwaZulu-Natal, South Africa. The recruitment was conducted in 2014–2016 at two participating clinical sites, the RK Khan Hospital and Bethesda Hospital in KwaZulu-Natal, South Africa [ 40 ]. A total of 490 participants from the study with both genomics and metabolomics data available were included in the analysis.…”

Section: Methodsmentioning

confidence: 99%

Crosstalk between Host Genome and Metabolome among People with HIV in South Africa

et al. 2022

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Genome-wide association studies (GWAS) of circulating metabolites have revealed the role of genetic regulation on the human metabolome. Most previous investigations focused on European ancestry, and few studies have been conducted among populations of African descent living in Africa, where the infectious disease burden is high (e.g., human immunodeficiency virus (HIV)). It is important to understand the genetic associations of the metabolome in diverse at-risk populations including people with HIV (PWH) living in Africa. After a thorough literature review, the reported significant gene–metabolite associations were tested among 490 PWH in South Africa. Linear regression was used to test associations between the candidate metabolites and genetic variants. GWAS of 154 plasma metabolites were performed to identify novel genetic associations. Among the 29 gene–metabolite associations identified in the literature, we replicated 10 in South Africans with HIV. The UGT1A cluster was associated with plasma levels of biliverdin and bilirubin; SLC16A9 and CPS1 were associated with carnitine and creatine, respectively. We also identified 22 genetic associations with metabolites using a genome-wide significance threshold (p-value < 5 × 10−8). In a GWAS of plasma metabolites in South African PWH, we replicated reported genetic associations across ancestries, and identified novel genetic associations using a metabolomics approach.

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A packaged intervention to improve viral load monitoring within a deeply rural health district of South Africa

Cited by 11 publications

References 12 publications

Higher Risk of Mortality and Virologic Failure in HIV-Infected Patients With High Viral Load at Antiretroviral Therapy Initiation: An Observational Cohort Study in Chongqing, China

Higher Risk of Mortality and Virologic Failure in HIV-Infected Patients With High Viral Load at Antiretroviral Therapy Initiation: An Observational Cohort Study in Chongqing, China

Associations of inflammation‐related proteome with demographic and clinical characteristics of people with HIV in South Africa

Crosstalk between Host Genome and Metabolome among People with HIV in South Africa

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