• Adherence to antiretroviral therapy assessed by drug level monitoring and self-report in cameroon

      Kouanfack, Charles; Laurent, Christian; Peytavin, Gilles; Ciaffi, Laura; Ngolle, Maguy; Nkene, Yvette Mawamba; Essomba, Claudine; Calmy, Alexandra; Mpoudi-Ngolé, Eitel; Delaporte, Eric; Koulla-Shiro, Sinata; Central Hospital, Yaoundé, Cameroon; Institut de recherche pour le developpement, University of Montpellier, Montpellier, France; Laboratoire de Toxicologie et de Dosage de Medicaments, Centre Hospitalier Universitaire Bichat Claude Bernard, Paris, France; Medecins Sans Frontieres, Geneva, Switzerland; Projet PRESICA (Prevention du Sida au Cameroun), Military Hospital, Yaounde, Cameroon (2008-06-01)
      OBJECTIVES: To compare adherence to antiretroviral therapy using drug level monitoring and self-report and to explore the relation between these 2 methods and viral load measurements. METHODS: Sixty patients received a fixed-dose combination of nevirapine, stavudine, and lamivudine in a clinical study in Cameroon. Adherence was assessed every 6 months until month 36 by nevirapine minimal plasma concentration and self-report. Plasma HIV-1 viral load was determined at the same time. Analyses included 159 complete observations. RESULTS: The proportion of patients labeled as "adherent" was significantly lower using nevirapine monitoring (88.7%, 95% confidence interval [CI]: 82.7 to 93.2) than self-report (97.5%, CI: 93.7 to 99.3; P = 0.002). Virologic failure was associated with the nevirapine concentration (adjusted odds ratio [aOR] = 4.43; P = 0.018) but not with the self-reported adherence (aOR = 0.84; P = 0.9). As compared with the virologic outcome, the sensitivity of nevirapine level monitoring for predicting inadequate adherence was 20.5%, the specificity was 91.7%, the positive predictive value was 44.4%, and the negative predictive value was 78.0%. For self-report, the respective values were 2.6%, 97.5%, 25.0%, and 75.5%. CONCLUSIONS: Drug level monitoring provided a more reliable estimate of adherence than self-report. This method could be used in research settings. Operational research is required to define how to improve the accuracy of the self-report method because it is the most feasible method in clinical practice.
    • Adults receiving HIV care before the start of antiretroviral therapy in sub-Saharan Africa: patient outcomes and associated risk factors

      Bastard, Mathieu; Nicolay, Nathalie; Szumilin, Elisabeth; Balkan, Suna; Poulet, Elisabeth; Pujades-Rodriguez, Mar (Lippincott Williams & Wilkins, 2013-12-15)
      Gaining understanding of the period before antiretroviral therapy (ART) is needed to improve treatment outcomes and to reduce HIV transmission. This study describes the cascade of enrollment in HIV care, pre-ART follow-up, and predictors of mortality and lost to follow-up (LTFU) before ART initiation.
    • CD4 count slope and mortality in HIV-infected patients on antiretroviral therapy: multicohort analysis from South Africa

      Hoffmann, Christopher J; Schomaker, Michael; Fox, Matthew P; Mutevedzi, Portia; Giddy, Janet; Prozesky, Hans; Wood, Robin; Garone, Daniela B; Egger, Matthias; Boulle, Andrew; Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA. choffmann@jhmi.edu (Lippincott Williams & Wilkins, 2013-05-01)
      In many resource-limited settings monitoring of combination antiretroviral therapy (cART) is based on the current CD4 count, with limited access to HIV RNA tests or laboratory diagnostics. We examined whether the CD4 count slope over 6 months could provide additional prognostic information.
    • Early mortality and loss to follow-up in HIV-infected children starting antiretroviral therapy in Southern Africa.

      Fenner, Lukas; Brinkhof, Martin W G; Keiser, Olivia; Weigel, Ralf; Cornell, Morna; Moultrie, Harry; Prozesky, Hans; Technau, Karl; Eley, Brian; Vaz, Paula; Pascoe, Margaret; Giddy, Janet; Van Cutsem, Gilles; Wood, Robin; Egger, Matthias; Davies, Mary-Ann; Institute of Social and Preventive Medicine, University of Bern, Switzerland. lfenner@ispm.unibe.ch (2010-08-15)
      BACKGROUND: Many HIV-infected children in Southern Africa have been started on antiretroviral therapy (ART), but loss to follow up (LTFU) can be substantial. We analyzed mortality in children retained in care and in all children starting ART, taking LTFU into account. PATIENTS AND METHODS: Children who started ART before the age of 16 years in 10 ART programs in South Africa, Malawi, Mozambique, and Zimbabwe were included. Risk factors for death in the first year of ART were identified in Weibull models. A meta-analytic approach was used to estimate cumulative mortality at 1 year. RESULTS: Eight thousand two hundred twenty-five children (median age 49 months, median CD4 cell percent 11.6%) were included; 391 (4.8%) died and 523 (7.0%) were LTFU in the first year. Mortality at 1 year was 4.5% [95% confidence interval (CI): 2.8% to 7.4%] in children remaining in care, but 8.7% (5.4% to 12.1%) at the program level, after taking mortality in children and LTFU into account. Factors associated with mortality in children remaining in care included age [adjusted hazard ratio (HR) 0.37; 95% CI: 0.25 to 0.54 comparing > or =120 months with <18 months], CD4 cell percent (HR: 0.56; 95% CI: 0.39 to 0.78 comparing > or =20% with <10%), and clinical stage (HR: 0.12; 95% CI: 0.03 to 0.45 comparing World Health Organization stage I with III/IV). CONCLUSIONS: In children starting ART and remaining in care in Southern Africa mortality at 1 year is <5% but almost twice as high at the program level, when taking LTFU into account. Age, CD4 percentage, and clinical stage are important predictors of mortality at the individual level.
    • Evaluation of a systematic substitution of zidovudine for stavudine-based HAART in a program setting in rural Cambodia

      Isaakidis, P; Raguenaud, M E; Phe, T; Khim, S; Kuoch, S; Khem, S; Reid, T; Arnould, L; Médecins Sans Frontières OCB, Phnom Penh, Cambodia; Chronic Diseases Clinic, Donkeo Provincial Referral Hospital, Ministry of Health, Takeo, Cambodia; Médecins Sans Frontières OCB, Brussels, Belgium (2008-09-01)
      OBJECTIVE
    • Impact and programmatic implications of routine viral load monitoring in Swaziland

      Jobanputra, Kiran; Parker, Lucy Anne; Azih, Charles; Okello, Velephi; Maphalala, Gugu; Jouquet, Guillaume; Kerschberger, Bernhard; Mekeidje, Calorine; Cyr, Joanne; Mafikudze, Arnold; Han, Win; Lujan, Johnny; Teck, Roger; Antierens, Annick; van Grievensen, Johan; Reid, Tony (Lippincott Williams & Wilkins, 2014-05-28)
      To assess the programmatic quality (coverage of testing, counselling and retesting), cost, and outcomes (viral suppression, treatment decisions), of routine viral load (VL) monitoring in Swaziland.
    • Implementing a tenofovir-based first-line regimen in rural Lesotho: clinical outcomes and toxicities after two years.

      Bygrave, Helen; Ford, Nathan; van Cutsem, Gilles; Hilderbrand, Katherine; Jouquet, Guillaume; Goemaere, Eric; Vlahakis, Nathalie; Triviño, Laura; Makakole, Lipontso; Kranzer, Katharina; Médecins Sans Frontières, Morija, Lesotho. helen.bygrave@joburg.msf.org (2011-03)
      The latest World Health Organization guidelines recommend replacing stavudine with tenofovir or zidovudine in first-line antiretroviral therapy in resource-limited settings. We report on outcomes and toxicities among patients on these different regimens in a routine treatment cohort in Lesotho.
    • Low lopinavir plasma or hair concentrations explain second-line protease inhibitor failures in a resource-limited setting.

      van Zyl, Gert Uves; van Mens, Thijs E; McIlleron, Helen; Zeier, Michele; Nachega, Jean B; Decloedt, Eric; Malavazzi, Carolina; Smith, Peter; Huang, Yong; van der Merwe, Lize; Gandhi, Monica; Maartens, Gary; Division of Medical Virology, Department of Pathology, NHLS Tygerberg and Stellenbosch University, Tygerberg, South Africa. guvz@sun.ac.za (2011-04)
      In resource-limited settings, many patients, with no prior protease inhibitor (PI) treatment on a second-line, high genetic barrier, ritonavir-boosted PI-containing regimen have virologic failure.
    • Mortality, AIDS-morbidity, and loss to follow-up by current CD4 cell count among HIV-1-infected adults receiving antiretroviral therapy in Africa and Asia: data from the ANRS 12222 collaboration

      Gabillard, Delphine; Lewden, Charlotte; Ndoye, Ibra; Moh, Raoul; Segeral, Olivier; Tonwe-Gold, Besigin; Etard, Jean-François; Pagnaroat, Men; Fournier-Nicolle, Isabelle; Eholié, Serge; Konate, Issouf; Minga, Albert; Mpoudi-Ngole, Eitel; Koulla-Shiro, Sinata; Zannou, Djimon Marcel; Anglaret, Xavier; Laurent, Christian (Lippincott Williams and Wilkins, 2013-04-15)
      In resource-limited countries, estimating CD4-specific incidence rates of mortality and morbidity among patients receiving antiretroviral therapy (ART) may help assess the effectiveness of care and treatment programmes, identify program weaknesses, and inform decisions.
    • Multi-Country Validation of SAMBA - A Novel Molecular Point-of- Care Test for HIV-1 Detection in Resource-Limited Setting

      Ondiek, J; Namukaya, Z; Mtapuri-Zinyowera, S; Balkan, S; Elbireer, A; Ushiro Lumb, I; Kiyaga, C; Goel, N; Ritchie, A; Ncube, P; Omuomu, K; Ndiege, K; Kekitiinwa, A; Mangwanya, D; Fowler, Mary G; Nadala, L; Lee, H (Lippincott Williams & Wilkins, 2017-06-09)
      Early diagnosis of HIV-1 infection and the prompt initiation of antiretroviral therapy are critical to achieving a reduction in the morbidity and mortality of infected infants. The SAMBA HIV-1 Qual Whole Blood Test was developed specifically for early infant diagnosis and prevention of mother-to-child transmission programs implemented at the point-of-care in resource-limited settings.
    • Outcomes of antiretroviral therapy over a 10-year period of expansion: a multicohort analysis of African and Asian HIV programs.

      Grimsrud, Anna; Balkan, Suna; Casas, Esther C; Lujan, Johnny; Van Cutsem, Gilles; Poulet, Elisabeth; Myer, Landon; Pujades-Rodriguez, Mar (2014-10-01)
      Little is known about the evolution of program outcomes associated with rapid expansion of antiretroviral therapy (ART) in resource-limited settings. We describe temporal trends and assess associations with mortality and loss to follow-up (LTFU) in HIV cohorts from 8 countries.
    • Pooled HIV-1 Viral Load Testing Using Dried Blood Spots to Reduce the Cost of Monitoring Antiretroviral Treatment in a Resource-Limited Setting

      Pannus, Pieter; Fajardo, Emmanuel; Metcalf, Carol; Coulborn, Rebecca M; Durán, Laura T; Bygrave, Helen; Ellman, Tom; Garone, Daniela; Murowa, Michael; Mwenda, Reuben; Reid, Tony; Preiser, Wolfgang; *Médecins Sans Frontières, Southern Africa Medical Unit, Cape Town, South Africa; †Médecins Sans Frontières, Thyolo, Malawi; ‡Ministry of Health, Health Technical Support Services, Diagnostics, District Management Office, Thyolo, Malawi; §Ministry of Health, Lilongwe, Malawi; ‖Médecins Sans Frontières, Operational Research Unit, Brussels, Belgium; and ¶Division of Medical Virology, Stellenbosch University, and National Health Laboratory Service, Tygerberg, South Africa. (Lippincott Williams & Wilkins, 2013-10-01)
      : Rollout of routine HIV-1 viral load monitoring is hampered by high costs and logistical difficulties associated with sample collection and transport. New strategies are needed to overcome these constraints. Dried blood spots from finger pricks have been shown to be more practical than the use of plasma specimens, and pooling strategies using plasma specimens have been demonstrated to be an efficient method to reduce costs. This study found that combination of finger-prick dried blood spots and a pooling strategy is a feasible and efficient option to reduce costs, while maintaining accuracy in the context of a district hospital in Malawi.
    • Prevalence, risk factors, and impact on outcome of cytomegalovirus replication in serum of Cambodian HIV-infected patients (2004-2007)

      Micol, Romain; Buchy, Philippe; Guerrier, Gilles; Duong, Veasna; Ferradini, Laurent; Dousset, Jean-Philippe; Guerin, Philippe J; Balkan, Suna; Galimand, Julie; Chanroeun, Hak; Lortholary, Olivier; Rouzioux, Christine; Fontanet, Arnaud; Leruez-Ville, Marianne; Unité d'Epidémiologie des Maladies Emergentes, Institut Pasteur, Paris, France; Laboratoire de Virologie, Universite Rene Descartes, Hopital Necker-Enfants Malades, Paris, France; Unite de virologie, Institut Pasteur du Cambodge, Phnom Penh, Cambodia; Medecins Sans Frontieres, Hopital Prea Bath Norodom Sihanouk, Phnom Penh, Cambodia; Medecins Du Monde, Hopital Kosamak, Phnom Penh, Cambodia; Epicentre, Paris, France; Medecins Sans Frontieres, Paris, France; Service des Maladies Infectieuses et Tropicales, Hopital Calmette, Phnom Penh, Cambodia; Universite Rene Descartes, Service des Maladies Infectieuses et Tropicales, Centre d’Infectiologie Necker–Pasteur, Hopital Necker–Enfants Malades, Paris, France (2009-08-01)
      BACKGROUND: In developing countries, the study of cytomegalovirus (CMV) coinfection in HIV-infected patients remains neglected. Quantitative CMV polymerase chain reaction (PCR) is the gold standard diagnostic tool for analyzing serum CMV replication and for predicting CMV disease. We estimated the prevalence of replicating CMV in sera of newly diagnosed HIV-infected Cambodian patients and examined its impact on mortality. METHODS: This cohort study was based on 2 highly active antiretroviral therapy treatment programs in Cambodia between 2004 and 2007. Quantitative CMV PCR was performed on baseline serum samples of 377 HIV-infected patients. RESULTS: The prevalence of serum CMV DNA was 55.2% (150 of 272) in patients with CD4 count <100/mm. In multivariate analysis, hemoglobin <9 g/dL, CD4 count <100/mm, and Karnofsky index <50 were independently associated with positive serum CMV DNA at baseline. During a 3-year follow-up period, CMV viral load >or=3.1 log10 copies per milliliter was significantly associated with death independently of CD4 count, other opportunistic infections, and highly active antiretroviral therapy. CONCLUSIONS: As in industrialized countries, serum CMV replication is highly prevalent among HIV-infected Cambodian patients and is associated with increased mortality. This underscores the importance of diagnostic CMV infection by PCR in sera of HIV-infected patients with CD4 count <100/mm and treating this opportunistic infection to reduce its associated mortality.
    • Relationship Between Time to Initiation of Antiretroviral Therapy and Treatment Outcomes: A Cohort Analysis of ART Eligible Adolescents in Zimbabwe

      Vogt, F; Rehman, AM; Kranzer, K; Nyathi, M; Van Griensven, J; Dixon, M; Ndebele, W; Gunguwo, H; Colebunders, R; Ndlovu, M; Apollo, T; Ferrand, RA (Lippincott Williams & Wilkins, 2017-04-01)
      Age-specific retention challenges make antiretroviral therapy (ART) initiation in adolescents difficult, often requiring a lengthy preparation process. This needs to be balanced against the benefits of starting treatment quickly. The optimal time to initiation duration in adolescents is currently unknown.
    • Revisiting long-term adherence to highly active antiretroviral therapy in Senegal using latent class analysis.

      Bastard, Mathieu; Fall, Mame Basty Koita; Lanièce, Isabelle; Taverne, Bernard; Desclaux, Alice; Ecochard, René; Sow, Papa Salif; Delaporte, Eric; Etard, Jean-François; Hospices Civils de Lyon, Service de Biostatistique, Lyon, France. mathieu.bastard@epicentre.msf.org (Wolters Kluwer, 2011-05-01)
      Adherence is one of the main predictors of antiretroviral treatment success. A governmental initiative was launched in 1998 for HIV-infected patients in Senegal to provide access to highly active antiretroviral therapy.
    • Screening and treating cervical cancer in HIV-positive women in Cambodia.

      Raguenaud, Marie-Eve; Isaakidis, Petros; Ping, Chutema; Reid, Tony (2009-08-15)
    • Similar mortality and reduced loss to follow-up in integrated compared with vertical programs providing antiretroviral treatment in sub-saharan Africa.

      Greig, Jane; O'Brien, Daniel P; Ford, Nathan; Spelman, Tim; Sabapathy, Kalpana; Shanks, Leslie; Manson Unit, Médecins sans Frontières, Saffron Hill, London, UK. jane.greig@london.msf.org (2012-04-15)
      Vertical HIV programs have achieved good results but may not be feasible or appropriate in many resource-limited settings. Médecins sans Frontières has treated HIV in vertical programs since 2000 and over time integrated HIV treatment into general health care services using simplified protocols. We analyzed the survival probability among patients receiving antiretroviral therapy (ART) from 2003 to 2010 in integrated versus vertical programs in 9 countries in sub-Saharan Africa.
    • Time to AIDS from 1992 to 1999 in HIV-1-Infected Subjects with Known Date of Infection.

      Tassie, J M; Grabar, S; Lancar, R; Deloumeaux, J; Bentata, M; Costagliola, D; Institut National de la Santé et de la Recherche Médicale SC4, Faculté de Médecine, St. Antoine Université Pierre et Marie Curie, Paris, France; Epicentre, Paris, France. (2002-05-01)
      To estimate the change in AIDS incubation time during three periods characterized by different availability of antiretroviral treatments, data from the French Hospital Database on HIV of 4702 HIV-1-positive subjects with a documented date of infection were analyzed. Times from seroconversion to AIDS were compared in three periods: period 1 from January 1992 to June 1995 (monotherapy); period 2 from July 1995 to June 1996 (dual therapy); and period 3 from July 1996 to June 1999 (triple therapy). Nonparametric survival analyses were performed to account for staggered entries in the database and during each period. From periods 1 to 3, antiretroviral treatments were initiated earlier after infection, more subjects were treated, and the nature of regimens changed (25.6% of subjects were treated with monotherapy in period 1, 34.6% were treated with dual therapy in period 2, and 53.4% were treated with triple therapy in period 3). Compared with period 1, the relative hazard (RH) of AIDS was 0.31 in period 3 (95% confidence interval [CI]: 0.24-0.39). When comparing period 3 with period 2, the RH of AIDS was 0.36 (CI: 0.29-0.45). Assuming a log normal distribution, the median time to AIDS was estimated as 8.0 years in period 1 (CI: 6.0-10.6), 9.8 years in period 2 (CI: 8.5, 11.2), and 20.0 years in period 3 (CI: 17.1-23.3). This lengthening in time to AIDS from 1992 to 1999 was particularly marked in the period after the introduction of triple therapy, including protease inhibitors.