AIDS
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Multicenter Study
The impact of antiretroviral treatment on the age composition of the HIV epidemic in sub-Saharan Africa.
Antiretroviral treatment (ART) coverage is rapidly expanding in sub-Saharan Africa (SSA). Based on the effect of ART on survival of HIV-infected people and HIV transmission, the age composition of the HIV epidemic in the region is expected to change in the coming decades. We quantify the change in the age composition of HIV-infected people in all countries in SSA. ⋯ The HIV epidemic in SSA is rapidly ageing, implying changing needs and demands in many social sectors, including health, social care, and old-age pension systems. Health policymakers need to anticipate the impact of the changing HIV age composition in their planning for future capacity in these systems.
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Multicenter Study
Interim fluoro-2-deoxy-D-glucose-PET predicts response and progression-free survival in patients with Hodgkin lymphoma and HIV infection.
Interim PET scans in HIV-negative patients with Hodgkin lymphoma has emerged as one of the most important prognostic tools. However, equivalent studies in HIV-positive patients are yet to be performed. ⋯ A negative interim 18F-FDG PET result is highly predictive of treatment success in HIV-HL patients.
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Multicenter Study
CD4 nadir is a predictor of HIV neurocognitive impairment in the era of combination antiretroviral therapy.
Despite immune recovery in individuals on combination antiretroviral therapy (CART), the frequency of HIV-associated neurocognitive disorders (HANDs) remains high. Immune recovery is typically achieved after initiation of ART from the nadir, or the lowest historical CD4. The present study evaluated the probability of neuropsychological impairment (NPI) and HAND as a function of CD4 nadir in an HIV-positive cohort. ⋯ As the risk of NPI was lowest in patients whose CD4 cell count was never allowed to fall to low levels before CART initiation, our findings suggest that initiation of CART as early as possible might reduce the risk of developing HAND, the most common source of NPI among HIV-infected individuals.
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Randomized Controlled Trial Multicenter Study
Randomized, phase 2 evaluation of two single-tablet regimens elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil fumarate versus efavirenz/emtricitabine/tenofovir disoproxil fumarate for the initial treatment of HIV infection.
To assess the safety and efficacy of two, single-tablet regimens for the initial treatment of HIV infection. ⋯ Once-daily EVG/COBI/FTC/TDF achieved and maintained a high rate of virologic suppression with fewer central nervous system and psychiatric adverse events compared to a current standard-of-care regimen of EFV/FTC/TDF.
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Multicenter Study
Community health workers in health systems strengthening: a qualitative evaluation from rural Haiti.
Haiti is among the countries facing serious shortages in human resources for healthcare. In rural Haiti, the need for daily, long-term adherence to medication for HIV and TB was initially the driving factor for recruitment of community health workers (CHW) during scale-up of HIV services. Their role became broader over time. This qualitative study evaluated the role of CHW in the health system as a whole in both HIV and non-HIV-related services in rural Haiti and investigated the challenges and facilitating factors for their work. ⋯ CHW initially hired for HIV care represent an important part of the health system in rural Haiti in both HIV-related and primary healthcare services. CHW programmes have important potential for building capacity in the health workforce and thereby contributing to strengthening of the health system as a whole. Attention must be paid to adequate remuneration, training and provision of materials.