• Resistance profiles after different periods of exposure to a first-line antiretroviral regimen in a Cameroonian cohort of HIV type-1-infected patients.

      Soria, A; Porten, K; Fampou-Toundji, J; Galli, L; Mougnutou, R; Buard, V; Kfutwah, A; Vessière, A; Rousset, D; Teck, R; Calmy, A; Ciaffi, L; Lazzarin, A; Gianotti, N; Department of Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy. a.soria@hsgerardo.org (2009-08)
      BACKGROUND: The lack of HIV type-1 (HIV-1) viral load (VL) monitoring in resource-limited settings might favour the accumulation of resistance mutations and thus hamper second-line treatment efficacy. We investigated the factors associated with resistance after the initiation of antiretroviral therapy (ART) in the absence of virological monitoring. METHODS: Cross-sectional VL sampling of HIV-1-infected patients receiving first-line ART (nevirapine or efavirenz plus stavudine or zidovudine plus lamivudine) was carried out; those with a detectable VL were genotyped. RESULTS: Of the 573 patients undergoing VL sampling, 84 were genotyped. The mean number of nucleoside/nucleotide reverse transcriptase inhibitor (NRTI) mutations increased with the duration of ART exposure (P=0.02). Multivariable analysis showed that patients with a CD4+ T-cell count < or =50 cells/mm(3) at ART initiation (baseline) had a higher mean number of both NRTI and non-NRTI (NNRTI) mutations than those with a baseline CD4+ T-cell count >50 cells/mm(3) (2.10 versus 0.56; P<0.0001; and 1.65 versus 0.76; P=0.005, respectively). A baseline CD4+ T-cell count < or =50 cells/mm(3) predicted > or =1 NRTI mutation (adjusted odds ratio [AOR] 7.49, 95% confidence interval [CI] 2.20-32.14), > or =1 NNRTI mutation (AOR 4.25, 95% CI 1.36-15.48), > or =1 thymidine analogue mutation (AOR 8.45, 95% CI 2.16-40.16) and resistance to didanosine (AOR 6.36, 95% CI 1.49-32.29) and etravirine (AOR 4.72, 95% CI 1.53-15.70). CONCLUSIONS: Without VL monitoring, the risk of drug resistance increases with the duration of ART and is associated with lower CD4+ T-cell counts at ART initiation. These data might help define strategies to preserve second-line treatment options in resource-limited settings.
    • Responding to HIV Infection Associated with Drug Injecting in Eastern Europe.

      Burrows, D; Rhodes, T; Trautmann, F; Bijl, M; Stimson, G; Sarankov, Y; Ball, A; Fitch, C; Harm Reduction Training Programme, Russian Federation, Médecins Sans Frontières, Moscow, Russian Federation. (1998-12)
    • Response to Comment on "Alert, but not Alarmed" - A Comment on "Towards More Accurate HIV Testing in Sub-Saharan Africa: A Multi-Site Evaluation of HIV RDTs and Risk Factors for False Positives (Kosack et al. 2017)"

      Kosack, C; Page, A; Beelaert, G; Benson, T; Savane, A; Ng'ang'a, A; Andre, B; Zahinda, J; Shanks, L; Fransen, K (International AIDS Society, 2017-06-19)
    • Response to highly active antiretroviral therapy among severely immuno-compromised HIV-infected patients in Cambodia.

      Madec, Y; Laureillard, D; Pinoges, L; Fernandez, M; Prak, N; Ngeth, C; Moeung, S; Song, S; Balkan, S; Ferradini, L; Quillet, C; Fontanet, A; Unité d'Epidémiologie des Maladies Emergentes, Institut Pasteur, 25-28 rue du Docteur Roux, 75015 Paris, France. (2007-01-30)
      BACKGROUND: HAART efficacy was evaluated in a real-life setting in Phnom Penh (Médecins Sans Frontières programme) among severely immuno-compromised patients. METHODS: Factors associated with mortality and immune reconstitution were identified using Cox proportional hazards and logistic regression models, respectively. RESULTS: From July 2001 to April 2005, 1735 patients initiated HAART, with median CD4 cell count of 20 (inter-quartile range, 6-78) cells/microl. Mortality at 2 years increased as the CD4 cell count at HAART initiation decreased, (4.4, 4.5, 7.5 and 24.7% in patients with CD4 cell count > 100, 51-100, 21-50 and < or = 20 cells/microl, respectively; P < 10). Cotrimoxazole and fluconazole prophylaxis were protective against mortality as long as CD4 cell counts remained < or = 200 and < or = 100 cells/microl, respectively. The proportion of patients with successful immune reconstitution (CD4 cell gain > 100 cells/microl at 6 months) was 46.3%; it was lower in patients with previous ART exposure [odds ratio (OR), 0.16; 95% confidence interval (CI), 0.05-0.45] and patients developing a new opportunistic infection/immune reconstitution infection syndromes (OR, 0.71; 95% CI, 0.52-0.98). Similar efficacy was found between the stavudine-lamivudine-nevirapine fixed dose combination and the combination stavudine-lamivudine-efavirenz in terms of mortality and successful immune reconstitution. No surrogate markers for CD4 cell change could be identified among total lymphocyte count, haemoglobin, weight and body mass index. CONCLUSION: Although CD4 cell count-stratified mortality rates were similar to those observed in industrialized countries for patients with CD4 cell count > 50 cells/microl, patients with CD4 cell count < or = 20 cells/microl posed a real challenge to clinicians. Widespread voluntary HIV testing and counselling should be encouraged to allow HAART initiation before the development of severe immuno-suppression.
    • Retention and attrition during the preparation phase and after start of antiretroviral treatment in Thyolo, Malawi, and Kibera, Kenya: implications for programmes?

      Zachariah, R; Tayler-Smith, K; Manzi, M; Massaquoi, M; Mwagomba, B; van Griensven, J; van Engelgem, I; Arnould, L; Schouten, E J; Chimbwandira, F M; Harries, A D; Médecins sans Frontières, Medical Department (Operational Research), Brussels Operational Center, 68 Rue de Gasperich, L-1617, Luxembourg, Luxembourg. zachariah@internet.lu (2011-08)
      Among adults eligible for antiretroviral therapy (ART) in Thyolo (rural Malawi) and Kibera (Nairobi, Kenya), this study (a) reports on retention and attrition during the preparation phase and after starting ART and (b) identifies risk factors associated with attrition. 'Retention' implies being alive and on follow-up, whilst 'attrition' implies loss to follow-up, death or stopping treatment (if on ART). There were 11,309 ART-eligible patients from Malawi and 3633 from Kenya, of whom 8421 (74%) and 2792 (77%), respectively, went through the preparation phase and started ART. In Malawi, 2649 patients (23%) were lost to attrition in the preparation phase and 2189 (26%) after starting ART. Similarly, in Kenya 546 patients (15%) were lost to attrition in the ART preparation phase and 647 (23%) while on ART. Overall programme attrition was 43% (4838/11,309) for Malawi and 33% (1193/3633) for Kenya. Restricting cohort evaluation to 'on ART' (as is usually done) underestimates overall programme attrition by 38% in Malawi and 36% in Kenya. Risk factors associated with attrition in the preparation phase included male sex, age <35 years, advanced HIV/AIDS disease and increasing malnutrition. Considerable attrition occurs during the preparation phase of ART, and programme evaluations confined to on-treatment analysis significantly underestimate attrition. This has important operational implications, which are discussed here.
    • Retention and Risk Factors for Attrition in a Large Public Health ART Program in Myanmar: A Retrospective Cohort Analysis.

      Thida, Aye; Tun, Sai Thein Than; Zaw, Sai Ko Ko; Lover, Andrew A; Cavailler, Philippe; Chunn, Jennifer; Aye, Mar Mar; Par, Par; Naing, Kyaw Win; Zan, Kaung Nyunt; Shwe, Myint; Kyaw, Thar Tun; Waing, Zaw Htoon; Clevenbergh, Philippe (Public Library of Science, 2014-09-30)
      The outcomes from an antiretroviral treatment (ART) program within the public sector in Myanmar have not been reported. This study documents retention and the risk factors for attrition in a large ART public health program in Myanmar.
    • Retention in care among clinically stable antiretroviral therapy patients following a six-monthly clinical consultation schedule: findings from a cohort study in rural Malawi

      Wringe, A; Cawley, C; Szumilin, E; Salumu, L; Amoros Quiles, I; Pasquier, E; Masiku, C; Nicholas, S (Wiley Open Access, 2018-11)
      Longer intervals between clinic consultations for clinically stable antiretroviral therapy (ART) patients may improve retention in care and reduce facility workload. We assessed long-term retention among clinically stable ART patients attending six-monthly clinical consultations (SMCC) with three-monthly fast-track drug refills, and estimated the number of consultations "saved" by this model of ART delivery in rural Malawi.
    • Retention on ART and predictors of disengagement from care in several alternative community-centred ART refill models in rural Swaziland

      Pasipamire, L; Nesbitt, RC; Ndlovu, S; Sibanda, G; Mamba, S; Lukhele, N; Pasipamire, M; Kabore, SM; Rusch, B; Ciglenecki, I; Kerschberger, B (Wiley, 2018-09-21)
      A broad range of community-centred care models for patients stable on anti-retroviral therapy (ART) have been proposed by the World Health Organization to better respond to patient needs and alleviate pressure on health systems caused by rapidly growing patient numbers. Where available, often a single alternative care model is offered in addition to routine clinical care. We operationalized several community-centred ART delivery care models in one public sector setting. Here, we compare retention in care and on ART and identify predictors of disengagement with care.
    • A Retrospective Survey of HIV Drug Resistance Among Patients 1 Year After Initiation of Antiretroviral Therapy at 4 Clinics in Malawi

      Wadonda-Kabondo, N.; Hedt, B. L.; van Oosterhout, J. J.; Moyo, K.; Limbambala, E.; Bello, G.; Chilima, B.; Schouten, E.; Harries, A.; Massaquoi, M.; Porter, C.; Weigel, R.; Hosseinipour, M.; Aberle-Grasse, J.; Jordan, M. R.; Kabuluzi, S.; Bennett, D. E. (2012-05)
    • Review of the safety, efficacy, and pharmacokinetics of elvitegravir with an emphasis on resource-limited settings

      Lee, Janice Soo Fern; Calmy, Alexandra; Andrieux-Meyer, Isabelle; Ford, Nathan; 1Médecins Sans Frontières; HIV/AIDS Unit, Infectious Disease Service, Geneva University Hospital, Geneva, Switzerland; Centre for Infectious Disease Epidemiology and Research, University of Cape Town, South Africa (DovePress, 2012-01-11)
      Integrase inhibitors represent an important new class of antiretroviral drugs. Elvitegravir, the second available integrase inhibitor to be submitted for regulatory approval appears to be a promising once-daily agent when combined with other antiretroviral drugs. Elvitegravir has demonstrated good efficacy and safety, with minimal side effects and no specific requirements in terms of laboratory monitoring. In addition, elvitegravir is available as a fixed-dose combination. However, the drug requires boosting and this leads to a number of drug-drug interactions and necessary dose adjustment when dosing with certain drugs, including dose reduction in the presence of atazanavir, lopinavir, rifabutin, and ketoconazole, and dose increase for ethinyl estradiol when co-administered with boosted elvitegravir. The main advantage of elvitegravir lies in its potential to be administered as a once-daily, single pill. Limitations include dose adjustment requirements, a relatively low genetic barrier to resistance, high price, and lack of data for use in children. Clinical trials addressing specific challenges encountered in resources-limited settings should be encouraged.
    • 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.
    • Risk factors and mortality associated with resistance to first line antiretroviral therapy: multicentric cross-sectional and longitudinal analyses

      Pinoges, Loretxu; Schramm, Birgit; Poulet, Elisabeth; Balkan, Suna; Szumilin, Elisabeth; Ferreyra, Cecilia; Pujades-Rodríguez, M (Lippincott Williams & Wilkins, 2015-01-12)
      Understanding the factors associated with HIV drug resistance development and subsequent mortality is important to improve clinical patient management.
    • Risk Factors for High Early Mortality in Patients on Antiretroviral Treatment in a Rural District of Malawi.

      Zachariah, R; Fitzgerald, M; Massaquoi, M; Pasulani, O; Arnould, L; Makombe, S D; Harries, A D; Medecins sans Frontieres, Operational Research, Brussels Operational Center, Belgium. zachariah@internet.lu (2006-11-28)
      OBJECTIVES: Among adults started on antiretroviral treatment (ART) in a rural district hospital (a) to determine the cumulative proportion of deaths that occur within 3 and 6 months of starting ART, and (b) to identify risk factors that may be associated with such mortality. DESIGN AND SETTING: A cross-sectional analytical study set in Thyolo district, Malawi. METHODS: Over a 2-year period (April 2003 to April 2005) mortality within the first 3 and 6 months of starting ART was determined and risk factors were examined. RESULTS: A total of 1507 individuals (517 men and 990 women), whose median age was 35 years were included in the study. There were a total of 190 (12.6%) deaths on ART of which 116 (61%) occurred within the first 3 months (very early mortality) and 150 (79%) during the first 6 months of initiating ART. Significant risk factors associated with such mortality included WHO stage IV disease, a baseline CD4 cell count under 50 cells/mul and increasing grades of malnutrition. A linear trend in mortality was observed with increasing grades of malnutrition (chi for trend = 96.1, P
    • Risk Factors for Mortality During Antiretroviral Therapy in Older Populations in Resource-Limited Settings

      O'Brien, D; Spelman, T; Greig, J; McMahon, J; Ssonko, C; Casas, E; Mesic, A; Du Cros, P; Ford, N (International AIDS Society, 2016-01-14)
      An increasing proportion of adult patients initiating antiretroviral therapy (ART) in resource-limited settings are aged >50 years. Older populations on ART appear to have heightened risk of death, but little is known about factors influencing mortality in this population.
    • Risk factors for mortality in AIDS-associated Kaposi sarcoma in a primary care antiretroviral treatment program in Malawi

      Chu, Kathryn; Misinde, Dalitso; Massaquoi, Moses; Pasulani, Olesi; Mwagomba, Beatrice; Ford, Nathan; Zachariah, Rony (2010-04)
    • Risk Factors for Unstructured Treatment Interruptions and Association with Survival in Low to Middle Income Countries

      McMahon, JH; Spelman, T; Ford, N; Greig, J; Mesic, A; Ssonko, C; Casas, EC; O'Brien, DP (BioMed Central, 2016-07-11)
      Antiretroviral therapy (ART) treatment interruptions lead to poor clinical outcomes with unplanned or unstructured TIs (uTIs) likely to be underreported. This study describes; uTIs, their risk factors and association with survival.
    • Risk factors for virological failure and subtherapeutic antiretroviral drug concentrations in HIV-positive adults treated in rural northwestern Uganda

      Ahoua, L; Guenther, G; Pinoges, L; Anguzu, P; Chaix, M L; Le Tiec, C; Balkan, S; Olson, D; Olaro, C; Pujades-Rodriguez, M; Epicentre, Paris, France; Médecins Sans Frontières, Arua, Uganda; Laboratory of Virology, Paris Descartes University, Paris, France; Laboratory of Toxicology, Bicêtre Hospital, Kremlin Bicêtre, France; Médecins Sans Frontières, Paris, France; Medical and Administrative Hospital Direction, Arua Regional Hospital, Arua, Uganda; International and Environmental Health, Institute of Social and Preventive Medicine, Bern, Switzerland (2009-06-03)
      ABSTRACT: BACKGROUND: Little is known about immunovirological treatment outcomes and adherence in HIV/AIDS patients on antiretroviral therapy (ART) treated using a simplified management approach in rural areas of developing countries, or about the main factors influencing those outcomes in clinical practice. METHODS: Cross-sectional immunovirological, pharmacological, and adherence outcomes were evaluated in all patients alive and on fixed-dose ART combinations for 24 months, and in a random sample of those treated for 12 months. Risk factors for virological failure (>1,000 copies/mL) and subtherapeutic antiretroviral (ARV) concentrations were investigated with multiple logistic regression. RESULTS: At 12 and 24 months of ART, 72% (n=701) and 70% (n=369) of patients, respectively, were alive and in care. About 8% and 38% of patients, respectively, were diagnosed with immunological failure; and 75% and 72% of patients, respectively, had undetectable HIV RNA (<400 copies/mL). Risk factors for virological failure (>1,000 copies/mL) were poor adherence, tuberculosis diagnosed after ART initiation, subtherapeutic NNRTI concentrations, general clinical symptoms, and lower weight than at baseline. About 14% of patients had low ARV plasma concentrations. Digestive symptoms and poor adherence to ART were risk factors for low ARV plasma concentrations. CONCLUSIONS: Efforts to improve both access to care and patient management to achieve better immunological and virological outcomes on ART are necessary to maximize the duration of first-line therapy.
    • Risk of death among those awaiting treatment for HIV infection in Zimbabwe: adolescents are at particular risk

      Shroufi, Amir; Ndebele, Wedu; Nyathi, Mary; Gunguwo, Hilary; Dixon, Mark; Saint-Sauveur, Jean F; Taziwa, Fabian; Viñoles, Mari C; Ferrand, Rashida A (International AIDS Society, 2015-02-23)
      Mortality among HIV-positive adults awaiting antiretroviral therapy (ART) has previously been found to be high. Here, we compare adolescent pre-ART mortality to that of adults in a public sector HIV care programme in Bulawayo, Zimbabwe.
    • Routine immediate eye examination at the point of care for diagnosis of AIDS-related Cytomegalovirus Retinitis among patients with a CD4-count < 100 in Myanmar

      Ei, WLSS; Soe, KP; Hilbig, A; Murray, J; Heiden, D (Oxford University Press, 2019-06-14)
      A retrospective review of diagnosis of cytomegalovirus retinitis (CMVR) before and after introduction of routine immediate eye examination among AIDS patient in Myanmar with an absolute CD4 T cell count <100 cells/microliter demonstrated an increased detection of CMVR from 1.1% (14/1233) to 10.7% (65/608), an improvement of approximately ten-fold. Diagnosis of CMVR was achieved a mean of 2 days after clinic enrollment.
    • Safety of efavirenz in first-trimester of pregnancy: a systematic review and meta-analysis of outcomes from observational cohorts.

      Ford, Nathan; Mofenson, Lynne; Kranzer, Katharina; Medu, Lanre; Frigati, Lisa; Mills, Edward J; Calmy, Alexandra; Médecins Sans Frontières, South Africa Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa cPediatric, Adolescent and Maternal AIDS Branch, Center for Research for Mothers and Children, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA dLondon School of Hygiene and Tropical Medicine, London, UK eFaculty of Health Sciences, Simon Fraser University, Vancouver, Canada fRed Cross Children's hospital, Cape Town, South Africa gFaculty of Health Sciences, University of Ottawa, Canada hGeneva University Hospital, HIV Unit, Service of Infectious Diseases, Geneva, Switzerland. (2010-05-14)
      INTRODUCTION