Implementation and Operational Research

Ahn, Jin Young; Boettiger, David; Law, Matthew; Kumarasamy, Nagalingeswaran; Yunihastuti, Evy; Chaiwarith, Romanee; Lee, Man Po; Sim, Benedict Lim Heng; Oka, Shinichi; Wong, Wing‐Wai; Kamarulzaman, Adeeba; Kantipong, Pacharee; Phanuphak, Praphan; Ng, Oon Tek; Kiertiburanakul, Sasisopin; Zhang, Fujie; Pujari, Sanjay; Ditangco, Rossana; Ratanasuwan, Winai; Merati, Tuti Parwati; Saphonn, Vonthanak; Sohn, Annette H.; Choi, Jun Yong; Databases, Treat Asia Hiv Observational

doi:10.1097/qai.0000000000000634

Cited by 17 publications

(9 citation statements)

References 26 publications

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“…According to national guidelines, these tests have to be done on a 6-month basis [ 24 , 25 ]. Recent findings showed that annual monitoring of CD4 instead of every 6 months in persons with a CD4 above 250 cells/mm 3 was sufficient to detect any clinical problem early enough [ 26 ]. Such results, associated with the fact that new guidelines suggest starting HAART when CD4 reaches 500 cells/mm 3 [ 1 ], instead of previously indicated levels of 250 or 350 cells/mm 3 , will probably reduce the frequency of CD4 tests in PLWHA in their routine follow-up.…”

Section: Discussionmentioning

confidence: 99%

Quality of life in persons living with HIV in Burkina Faso: a follow-up over 12 months

et al. 2015

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BackgroundIn Burkina Faso, very little is known about the quality of life of persons living with HIV through their routine follow- up. This study aimed to assess the quality of life of persons living with HIV, and its change over a 1-year period.MethodsFour hundred and twenty four (424) persons living with HIV were monitored during twelve (12) months from September 2012 to September 2013 in Ouagadougou, the capital city of Burkina Faso. Three interviews were conducted in order to assess the quality of life of patients and its change over time, using the World Health Organization Quality of Life assessment brief scale in patients with Human Immunodeficiency Virus infection (WHOQOL HIV-BREF). The Friedman test was used to assess significant differences in quantitative variables at each of the three follow-up interviews. Groups at baseline, at 6 months and at 12 months were compared using Wilcoxon signed rank test for quantitative data and McNemar test for qualitative variables. Pearson Chi2 was used when needed. Multivariable logistic regression models were fit to estimate adjusted odds ratio (OR) and 95 % confidence intervals (95 % CI). Trends in global quality of life score and subgroups (status related to Highly Active Anti Retroviral Treatment (HAART) using univariate repeated measures analysis of variance were assessed. A p-value less than 0.05 was considered significant.ResultsAt baseline, quality of life scores were highest in the domain of spirituality, religion and personal beliefs (SRPB) and lowest in the environmental domain. This trend was maintained during the 12-month follow-up. The global score increased significantly from the beginning up to the twelfth month of follow-up. Over the 12 months, the baseline factors that were likely to predict an increase in the global quality of life score were: not having support from relatives for medical care (P = 0.04), being under HAART (P = 0.001), being self-perceived as healthy (P = 0.03), and having a global quality of life score under 77 (P < 0.001).ConclusionsOur findings suggest the need to promote interventions to empower people living with HIV/AIDS through income generating activities. Such activities will enhance the quality of life of persons living with HIV in Burkina Faso. This could focus mostly on treatment-naïve HIV patients, lacking support from relatives and those who perceive themselves as ill.

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Section: Discussionmentioning

confidence: 99%

Quality of life in persons living with HIV in Burkina Faso: a follow-up over 12 months

et al. 2015

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“…From a total of 1117 titles screened, 12 published studies [3–5,12–20] were included, representing 20,297 patients. Investigators on one study among adults [20] provided additional data on children (Figure 1).…”

Section: Resultsmentioning

confidence: 99%

“…Investigators on one study among adults [20] provided additional data on children (Figure 1). A large initial number of titles were screened because no highly sensitive search strategy could be reliably used to identify the studies of interest.…”

Section: Resultsmentioning

confidence: 99%

CD4 changes among virologically suppressed patients on antiretroviral therapy: a systematic review and meta‐analysis

Ford

Stinson

Gale

et al. 2015

Journal of the International AIDS Society

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IntroductionThe effectiveness of antiretroviral therapy (ART) is assessed by measuring CD4 cell counts and viral load. Recent studies have questioned the added value of routine CD4 cell count measures in patients who are virologically suppressed.MethodsWe systematically searched three databases and two conference sites up to 31 October 2014 for studies reporting CD4 changes among patients who were on ART and virologically suppressed. No geographic, language or age restrictions were applied.Results and discussionWe identified 12 published and 1 unpublished study reporting CD4 changes among 20,297 virologically suppressed patients. The pooled proportion of patients who experienced an unexplained, confirmed CD4 decline was 0.4% (95% CI 0.2–0.6%). Results were not influenced by duration of follow-up, age, study design or region of economic development. No studies described clinical adverse events among virologically suppressed patients who experienced CD4 declines.ConclusionsThe findings of this review support reducing or stopping routine CD4 monitoring for patients who are immunologically stable on ART in settings where routine viral load monitoring is provided.

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“…Importantly, however, when we repeated our analysis using only one data point for each patient, we found essentially the same results: 2 years after entering the cohort, 72.2%, 93.4%, and 98.3% (vs. 71.6%, 93.4%, and 98.1%) of those with initial CD4 cell counts of 200–349, 350–499, and ≥500 cells per cubic millimeter, respectively, maintained CD4 ≥200 cells per cubic millimeter. Also, in contrast with at least 1 other previous analysis, 15 we used a single CD4 drop to <200 as an endpoint. However, in an additional analysis (not shown) using a “confirmed” CD4 drop <200 (ie, 2 CD4 cell counts <200), the findings are even more robust: 2 years after entering the cohort, 94.9%, 99.2%, and 99.8% of those with initial CD4 cell counts of 200–349, 350–499, and ≥500 cells per cubic millimeter, respectively, maintained CD4 ≥200 cells per cubic millimeter.…”

Section: Discussionmentioning

confidence: 99%

“…Even more recently, in an observational cohort in the Asia–Pacific region, there was no significant difference in time to a confirmed CD4 <200 cells per cubic millimeter between biannual and annual CD4 measurement cohorts. 15 This mounting evidence was reflected in 2014 US guidelines proposing that CD4 count monitoring for stable virologically suppressed patients with CD4 counts consistently between 300 and 500 be conducted annually; the guidelines considered CD4 count monitoring for stable virologically suppressed patients with CD4 counts consistently >500 cells per cubic millimeter to be optional. 2…”

Section: Introductionmentioning

confidence: 99%

Implementation and Operational Research

Myers

Xia

Torian

et al. 2016

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Introduction:The evidence has begun to mount for diminishing the frequency of CD4 count testing. To determine whether these observations were applicable to an urban US population, we used New York City (NYC) surveillance data to explore CD4 testing among stable patients in NYC, 2007–2013.Methods:We constructed a population-based retrospective open cohort analysis of NYC HIV surveillance data. HIV+ patients aged ≥13 years with stable viral suppression (≥1 viral load the previous year; all <400 copies per milliliter) and immune status (≥1 CD4 the previous year; all ≥200 cells per cubic millimeter) entered the cohort the following year beginning January 1, 2007. Each subsequent year, eligible patients not previously included entered the cohort on January 1. Outcomes were annual frequency of CD4 monitoring and probability of maintaining CD4 ≥200 cells per cubic millimeter. A multivariable Cox model identified factors associated with maintaining CD4 ≥200 cells per cubic millimeter.Results:During 1.9 years of observation (median), 62,039 patients entered the cohort. The mean annual number of CD4 measurements among stable patients was 2.8 and varied little by year or characteristic. Two years after entering, 93.4% and 97.8% of those with initial CD4 350–499 and CD4 ≥500 cells per cubic millimeter, respectively, maintained CD4 ≥200 cells per cubic millimeter. Compared to those with initial CD4 ≥500 cells per cubic millimeter, those with CD4 200–349 cells per cubic millimeter and CD4 350–499 cells per cubic millimeter were more likely to have a CD4 <200 cells per cubic millimeter, controlling for sex, race, age, HIV risk group, and diagnosis year.Conclusions:In a population-based US cohort with well-controlled HIV, the probability of maintaining CD4 ≥200 cells per cubic millimeter for ≥2 years was >90% among those with initial CD4 ≥350 cells per cubic millimeter, suggesting that limited CD4 monitoring in these patients is appropriate.

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Implementation and Operational Research

Cited by 17 publications

References 26 publications

Quality of life in persons living with HIV in Burkina Faso: a follow-up over 12 months

Quality of life in persons living with HIV in Burkina Faso: a follow-up over 12 months

CD4 changes among virologically suppressed patients on antiretroviral therapy: a systematic review and meta‐analysis

Implementation and Operational Research

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