Comparison of the Declines in CD4 Counts in HIV-1-Seropositive Female Sex Workers and Women From the General Population in Nairobi, Kenya

Bwayo, JJ; Nj, Nagelkerke; Moses, Stephen; Embreé, Joanne; Ngugi, EN; Mwatha, Anthony; Kimani, Joshua; Anzala, AO; Choudhri, S. H.; Jo, Achola

doi:10.1097/00042560-199512000-00009

Cited by 12 publications

(8 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…After data argumentation, the five-staged semiparametric time homogenous multistate Markov model was fitted in R software (25) using the msm package. We fitted a model with reversible transitions (26); therefore, states 1–4 were transient states, while state 5 was non-transient as depicted in Figure 1.…”

Section: Methodsmentioning

confidence: 99%

HIV Disease Progression Among Antiretroviral Therapy Patients in Zimbabwe: A Multistate Markov Model

Matsena-Zingoni

Chirwa

Todd

et al. 2019

Front. Public Health

View full text Add to dashboard Cite

Background: Antiretroviral therapy (ART) impact has prolonged survival of people living with HIV. We evaluated HIV disease progression among ART patients using routinely collected patient-level data between 2004 and 2017 in Zimbabwe.Methods: We partitioned HIV disease progression into four transient CD4 cell counts states: state 1 (CD4 ≥ 500 cells/μl), state 2 (350 cells/μl ≤ CD4 < 500 cells/μl), state 3 (200 cells/μl ≤ CD4 < 350 cells/μl), state 4 (CD4 < 200 cells/μl), and the absorbing state death (state 5). We proposed a semiparametric time-homogenous multistate Markov model to estimate bidirectional transition rates. Covariate effects (age, gender, ART initiation period, and health facility level) on the transition rates were assessed.Results: We analyzed 204,289 clinic visits by 63,422 patients. There were 24,325 (38.4%) patients in state 4 (CD4 < 200) at ART initiation, and 7,995 (12.6%) deaths occurred by December 2017. The overall mortality rate was 3.9 per 100 person-years. The highest mortality rate of 5.7 per 100 person-years (4,541 deaths) was from state 4 (CD4 < 200) compared to other states. Mortality rates decreased with increase in time since ART initiation. Health facility type was the strongest predictor for immune recovery. Provincial or central hospital patients showed a diminishing dose–response effect on immune recovery by state from a hazard ratio (HR) of 8.30 [95% confidence interval (95% CI), 6.64–10.36] (state 4 to 3) to HR of 3.12 (95% CI, 2.54–4.36) (state 2 to 1) compared to primary healthcare facilities. Immune system for male patients was more likely to deteriorate, and they had a 32% increased mortality risk (HR, 1.32; 95% CI, 1.23–1.42) compared to female patients. Elderly patients (45+ years) were more likely to immune deteriorate compared to 25–34 years age group: HR, 1.35; 95% CI, 1.18–1.54; HR, 1.56; 95% CI, 1.34–1.81 and HR, 1.53; 95% CI, 1.32–1.79 for states 1 to 2, state 2 to 3, and states 3 to 4, respectively.Conclusion: Immune recovery was pronounced among provincial or central hospitals. Male patients with lower CD4 cell counts were at a higher risk of immune deterioration and mortality, while elderly patients were more likely to immune deteriorate. Early therapeutic interventions when the immune system is relatively stable across gender and age may contain mortality and increase survival outcomes. Interventions which strengthen ART services in primary healthcare facilities are essential.

show abstract

Section: Methodsmentioning

confidence: 99%

HIV Disease Progression Among Antiretroviral Therapy Patients in Zimbabwe: A Multistate Markov Model

Matsena-Zingoni

Chirwa

Todd

et al. 2019

Front. Public Health

View full text Add to dashboard Cite

show abstract

“…We also compared the rate of decline of CD4 T cells among women employed as sex workers and HIV-1-positive women from the general population in Nairobi by use of Markov models [11]. The first transition time to a CD4 count of median incubation time to clinical disease, whereas the first transition time for women from the general Kenyan population was similar to that described in cohorts from industrialized countries [10].…”

mentioning

confidence: 87%

Acute Sexually Transmitted Infections Increase Human Immunodeficiency Virus Type 1 Plasma Viremia, Increase Plasma Type 2 Cytokines, and Decrease CD4 Cell Counts

et al. 2000

Self Cite

View full text Add to dashboard Cite

In Kenya, the median incubation time to AIDS in seroconverting sex workers is 4 years; this incubation time is specific to female sex workers. We studied the influence of acute sexually transmitted infections (STIs) on several immunologic parameters in 32 human immunodeficiency virus type 1 (HIV-1)-positive and 10 HIV-1-negative women sex workers who were followed for 1-5 months. Plasma cytokines, soluble cytokine receptors, CD4 and CD8 T cell counts, and HIV-1 plasma viremia were quantitated before, during, and after episodes of STI. Increases in interleukin (IL)-4, IL-6, IL-10, soluble tumor necrosis factor (TNF)-alpha, and viremia and a decline in CD4(+) T cell counts occurred during gonococcal cervicitis and returned to baseline after treatment. Increases in viremia correlated with increased IL-4 and decreased IL-6 concentrations. Similar changes were seen among women with acute pelvic inflammatory disease. Acute bacterial STI resulted in increased HIV-1 viremia. This may be mediated through increased inflammatory cytokines or through modulation of immune responses that control HIV-1 viremia.

show abstract

“…35,36 Although the number of patients included in this study is too small to generalize the significance of the results, these findings are consistent with previous reports on African populations, which suggested that HIV-1 infection in Sub-Saharan Africa is more virulent than in industrialized countries. [25][26][27][28]37 It has been hypothesized that this is due to the environmental factors such as the exposure to numerous pathogens leading to high prevalence of HIV-associated diseases and an insufficient access to health care. [38][39][40] CCR5 was the main chemokine receptor used by CAR primary HIV-1 isolates similar to reported viruses of other origin.…”

Section: Discussionmentioning

confidence: 99%

“…24 Other studies suggest that the progression to AIDS in African populations may be more rapid than in industrialized countries. [25][26][27][28] Because there are relatively few studies on the incident cohorts in African countries, information about the changes in coreceptor usage during infection in African HIV-1 patients is still limited. Thus, we studied the evolution of HIV-1 infection and of coreceptor usage of the HIV-1 viruses from an incident cohort of men in Bangui, Central African Republic (CAR).…”

Section: Introduction H Uman Immunodeficiency Virus Type 1 (Hiv-1) Usmentioning

confidence: 99%

Broad Spectrum of Coreceptor Usage and Rapid Disease Progression in HIV-1–Infected Individuals from Central African Republic

Begaud

Feindirongai

Versmisse

et al. 2003

AIDS Research and Human Retroviruses

View full text Add to dashboard Cite

To study the progression of HIV-1 infection and coreceptor usages in Central African Republic, clinical data, plasma viral load, and coreceptor usage of sequential HIV-1 isolates were analyzed in a seroincident prospective cohort (PRIMOCA). Twenty-three HIV-1 infected individuals from the Central African Armed Forces were followed from 1995 to 2000. Viruses were isolated from 17 patients at various time points after seroconversion and their coreceptor usage was examined using GHOST cells expressing CD4 and one of the HIV-1 chemokine coreceptors CCR5, CXCR4, BOB/GPR15, and Bonzo/STRL33/CXCR6. Eleven patients died from AIDS. Eight of them died between 2 and 5 years after seroconversion, after a brief symptomatic stage. Patients who rapidly progressed to AIDS and death displayed the highest viral loads after seroconversion. All isolates obtained soon after seroconversion used CCR5, albeit, in some cases, CXCR4, BOB, or Bonzo were also used. Most isolates remained R5 (59 out of 61 isolates), although viruses using CXCR4 appeared in some cases of progression to AIDS. In several cases, a broad tropism was observed during the course of infection, with a frequent usage of BOB and Bonzo in addition to CCR5. Rapid progression to disease and short survival time among Central African HIV-1 patients appear more frequent than those reported in industrialized countries. Viral coreceptor used was mainly CCR5, but, interestingly, a large part of isolates also used BOB and Bonzo. However, there was no strict correlation between the clinical outcome and extended viral tropism.

show abstract

Comparison of the Declines in CD4 Counts in HIV-1-Seropositive Female Sex Workers and Women From the General Population in Nairobi, Kenya

Cited by 12 publications

References 0 publications

HIV Disease Progression Among Antiretroviral Therapy Patients in Zimbabwe: A Multistate Markov Model

HIV Disease Progression Among Antiretroviral Therapy Patients in Zimbabwe: A Multistate Markov Model

Acute Sexually Transmitted Infections Increase Human Immunodeficiency Virus Type 1 Plasma Viremia, Increase Plasma Type 2 Cytokines, and Decrease CD4 Cell Counts

Broad Spectrum of Coreceptor Usage and Rapid Disease Progression in HIV-1–Infected Individuals from Central African Republic

Contact Info

Product

Resources

About