Effect of Viral Load and Drug Resistance on Mortality among Chinese HIV-Infected Patients Receiving Antiretroviral Treatment

Wang, Xia; Xing, Hui; Ruan, Yuhua; Liao, Lingjie; Zhou, Huaqiang; Chen, Bin; Su, Junqi; Zheng, Wei; Shao, Yiming

doi:10.4172/jaa.1000047

Cited by 4 publications

(8 citation statements)

References 33 publications

(32 reference statements)

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Section: Discussionmentioning

confidence: 84%

“…Specifically, in the study by Wang et al among Chinese adults (16–80 years old), patients having VL ≥ 10,000 copies/ml and HIV-drug resistance were two times as likely to die compared to patients with VL < 1,000 copies/ml [36]. Furthermore, individuals with VL ≥ 10,000 copies/ml and without HIV-drug resistance were also 1.7 times as likely to die [36].…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, individuals with VL ≥ 10,000 copies/ml and without HIV-drug resistance were also 1.7 times as likely to die [36]. Although we did not test for HIV resistance in our cohorts with a high pretreatment viral load, HIV-drug resistance in ART-naïve individuals with high viral load was suggested as the reason for the increased mortality in the study of Wang et al [36]. While Hogg et al [37] and Zaccarelli et al [38] also reported a high mortality in their patients with drug-resistant HIV infection with a high viral load, two other studies did not find same [39, 40].…”

Section: Discussionmentioning

confidence: 99%

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Mortality in a Cohort of HIV-Infected Children: A 12-Month Outcome of Antiretroviral Therapy in Makurdi, Nigeria

Anígilájé

Aderibigbe

2018

Advances in Medicine

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Introduction Recognizing the predictors of mortality among HIV-infected children will allow for concerted management that can reduce HIV-mortality in Nigeria. Methodology A retrospective cohort study in children aged 0–15 years, between October 2010 and December 2013, at the Federal Medical Centre, Makurdi, Nigeria. Kaplan–Meier method analysed the cumulative probability of early mortality (EM) occurring at or before 6 months and after 6 months of follow-up (late mortality-LM) on a 12-month antiretroviral therapy (ART). Multivariate Cox proportional regression models were used to test for hazard ratios (HR). Results 368 children were included in the analysis contributing 81 children per 100 child-years to the 12-month ART follow-up. A significant reduction in EM rates was noted at 17.3 deaths per 100 child-years (30 deaths) to LM rates of 3.0 deaths per 100 child-years (10 deaths), p < 0.01. At multivariate analysis, children with a high pretreatment viral load (≥10,000 copies/ml) were found to be at risk of EM (aHR; 18. 089, 95% CI; 2.428–134.77, p=0.005). Having severe immunosuppression at/or before 6 months of ART was the predictor of LM (aHR; 17.28, 95% CI; 3.844–77.700, p ≤ 0.001). Conclusions Although a lower mortality rate is seen at 12 months of ART in our setting, predictors of HIV mortality are having high pretreatment HIV viral load and severe immunosuppression. While primary prevention of HIV infection is paramount, early identification of these predictors among our HIV-infected children for an early ART initiation can reduce further the mortality in our setting. In addition, measures to ensure a good standard of care and retention in care for a sustained virologic suppression cannot be ignored and are hereby underscored.

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Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Mortality in a Cohort of HIV-Infected Children: A 12-Month Outcome of Antiretroviral Therapy in Makurdi, Nigeria

Anígilájé

Aderibigbe

2018

Advances in Medicine

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“…All patients who received treatment from 2005 onwards were chronologically contacted for recruiting to the study; detailed subject recruitment procedure has been previously described. [4] The eligibility criteria include: receiving HIV antiretroviral therapy through NFATP from 2005 to 2009, being 18 years or older, and willingness and consent to participate. Treatments in the NFATP were first-line ART regimens consisting of 2 NRTIs [azidothymidine (AZT)+didanosine (DDI) or stavudine (D4T)+lamivudine (3TC)] and one NNRTI [nevirapine (NVP) or efavirenz (EFV)].…”

Section: Methodsmentioning

confidence: 99%

“…The increasing use of ART would lead to an increase in the incidence and prevalence of drug resistance especially in developing countries under WHO guidelines [3]. Previous studies on the prevalence of HIV drug resistance (HIVDR) in China and their associated factors [4], [5] have served as assessments of the HIVDR consequences of China’s National Free Antiretroviral Treatment Program (NFATP). However, incidence of HIVDR is also a critical indicator of the future success of HAART but currently remains poorly studied in China.…”

Section: Introductionmentioning

confidence: 99%

Incidence and Associated Factors of HIV Drug Resistance in Chinese HIV-Infected Patients Receiving Antiretroviral Treatment

et al. 2013

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BackgroundA critical indicator of the future success of highly active antiretroviral therapy (HAART) is the incidence of HIV drug resistance, which has not been studied in China on the national scale.MethodsHIV drug resistance baseline survey was conducted in the eight provinces with the largest numbers of patients on HAART in 2009, and a prospective cohort study with 12-month follow-up was completed in 2010. Patients completed an interviewer-administrated questionnaire and provided blood for CD4+ T-lymphocyte count (CD4 count), HIV viral load (VL), and HIV drug resistance genotyping. Factors associated with incidence of HIVDR were identified by Cox regression analysis.ResultsThe overall prevalence of HIV RNA ≥1000 copies/ml and HIVDR at baseline was 12.4% and 5.6%, respectively. Incidence of HIVDR in the one year follow-up was 3.5 per 100 person years. Independently associated factors were started treatment with a didanosine-based regimen, received care at township hospital or village clinic, low baseline CD4 counts, and high baseline VL.ConclusionsThe incidence of HIVDR in China was higher than that of some developed countries. China urgently needs to provide comprehensive education and training to doctors at village clinics and township hospitals to improve quality community-based care and treatment.

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Long term engagement in HIV care among postpartum women with perinatal HIV infection in the United States

et al. 2017

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Despite growing literature on pregnancy in women with perinatally-acquired HIV infection (PHIV), little is known regarding HIV and reproductive health outcomes postpartum. We describe pregnancy, reproductive, and HIV care outcomes for 2 years postpartum among pregnant women with PHIV who delivered in a large urban health system in Atlanta, Georgia, USA from 2011-2016. We reviewed medical records of women with PHIV to estimate retention in HIV care (two HIV care visits or viral load measurements >90 days apart) and viral suppression (<200 copies/mL) at 12 and 24 months postpartum. Among 22 pregnant women with PHIV, 13 (59%) had a CD4 count of less than 300 cells/mm at the time of antenatal care entry; most (n = 13, 59%) women achieved viral suppression at time of delivery. Three quarters of women attended a postpartum HIV primary care visit, within an average of 193 (range 17-727) days. Only 4 (20%) women were retained and 3 (15%) virally suppressed at 12 postpartum, and 2 (12%) were retained and none virally suppressed at 24 months. Despite the unique challenges they face, multidisciplinary efforts are needed to engage women with PHIV during pregnancy and facilitate the transition to sustained HIV primary care in the postpartum period.

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Effect of Viral Load and Drug Resistance on Mortality among Chinese HIV-Infected Patients Receiving Antiretroviral Treatment

Cited by 4 publications

References 33 publications

Mortality in a Cohort of HIV-Infected Children: A 12-Month Outcome of Antiretroviral Therapy in Makurdi, Nigeria

Mortality in a Cohort of HIV-Infected Children: A 12-Month Outcome of Antiretroviral Therapy in Makurdi, Nigeria

Incidence and Associated Factors of HIV Drug Resistance in Chinese HIV-Infected Patients Receiving Antiretroviral Treatment

Long term engagement in HIV care among postpartum women with perinatal HIV infection in the United States

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