Impact of HIV-1 infection on the IGF-1 axis and angiogenic factors in pregnant Cameroonian women receiving antiretroviral therapy.

Although mother-to-child transmission of HIV has dramatically declined, the number of in utero HIV-exposed, uninfected infants is on the increase. HIV-exposed infants are at an increased risk of mortality, morbidity and slower early growth than their non-HIV exposed counterparts. Maternal HIV increases the risk of having preterm deliveries, intrauterine growth restriction and low birth weight babies. However, the mechanism underlying dysregulation of fetal growth in HIV-infected pregnant women is unknown. We sought to determine whether maternal HIV is associated with dysregulation of the insulin-like growth factor (IGF) axis, some angiogenic factors or other related biomarkers that regulate fetal growth. A total of 102 normotensive pregnant women were enrolled in a small cross-sectional study. Amongst these were thirty-one HIV-1 positive women receiving combination antiretroviral therapy (cART) (Mean age: 30.0 ± 5.1 years; % on ART: 83.9%; median plasma viral load: 683 copies/ml; median CD4 count: 350 cells/ul) and 71 HIV uninfected women (mean age: 27.3 ± 5.8) recruited at delivery. A panel of biomarkers including IGF1 and IGF binding proteins (IGFBP1, IGFBP3), angiopoietins (ANG) 1 and 2, matrix metalloproteinases (MMP) 2 and 9, and galectin 13, was measured in plasma collected from the placental intervillous space. The levels of IGF1, IGFBP1, ANG1, ANG2, MMP2, MMP9 and Gal-13 were not affected by maternal HIV, even when adjusted for maternal factors in linear regression models (all p>0.05). It was observed that HIV-infection in pregnancy did not significantly affect key markers of the IGF axis and angiogenic factors. If anything, it did not affect women. These findings highlight the importance of the use of ART during pregnancy, which maintains factors necessary for fetal development closer to those of healthy women. However, decrease in IGF1 levels might be exacerbated in women con-infected with HIV and malaria

Factors Associated with Death during Tuberculosis Treatment of Patients Co-Infected with HIV at the Yaoundé Central Hospital, Cameroon: An 8-Year Hospital-Based Retrospective Cohort Study (2006–2013)

<div><p>Background</p><p>Contributors to fatal outcomes in TB/HIV co-infected patients actively undergoing TB treatment are poorly characterized. The aim was to assess factors associated with death in TB/HIV co-infected patients during the initial 6 months of TB treatment.</p><p>Methods</p><p>We conducted a hospital-based retrospective cohort study from January 2006 to December 2013 at the Yaoundé Central Hospital, Cameroon. We reviewed medical records to identify hospitalized co-infected TB/HIV patients aged 15 years and older. Death was defined as any death occurring during TB treatment, as per the World Health Organization's recommendations. We conducted logistic regression analysis to identify factors associated with a fatal outcome. Magnitudes of associations were expressed by adjusted odds ratio (a<i>OR</i>) with 95% confidence interval.</p><p>Results</p><p>The 337 patients enrolled had a mean age of 39.3 (standard deviation 10.3) years and 54.3% were female. TB treatment outcomes were distributed as follows: 205 (60.8%) treatment success, 99 (29.4%) deaths, 18 (5.3%) not evaluated, 14 (4.2%) lost to follow-up, and 1 (0.3%) failed. After exclusion of patients lost to follow-up and not evaluated, death in TB/HIV co-infected patients during TB treatment was associated with a TB diagnosis made before 2010 (a<i>OR</i> = 2.50 [1.31–4.78]; <i>p</i> = 0.006), the presence of other AIDS-defining diseases (a<i>OR</i> = 2.73 [1.27–5.86]; <i>p</i> = 0.010), non-AIDS comorbidities (a<i>OR</i> = 3.35 [1.37–8.21]; <i>p</i> = 0.008), not receiving cotrimoxazole prophylaxis (a<i>OR</i> = 3.61 [1.71–7.63]; <i>p</i> = 0.001), not receiving antiretroviral therapy (a<i>OR</i> = 2.45 [1.18–5.08]; <i>p</i> = 0.016), and CD4 cells count <50 cells/mm³ (a<i>OR</i> = 16.43 [1.05–258.04]; <i>p</i> = 0.047).</p><p>Conclusions</p><p>The TB treatment success rate among TB/HIV co-infected patients in our setting is low. Mortality was high among TB/HIV co-infected patients during TB treatment and is strongly associated with clinical and biological factors, highlighting the urgent need for specific interventions focused on enhancing patient outcomes.</p></div

Socio-demographic, clinical, and biological characteristics of 337 patients co-infected with TB and HIV, Yaoundé Central Hospital, 2006–2013, Cameroon.

<p>Data are % (n), mean (standard deviation) or median (interquartile range).</p><p>TB: tuberculosis.</p><p>*SPP: smear positive pulmonary, SNP: smear negative pulmonary, EP: extra pulmonary.</p>1<p>Data missing: there were 36 (10.7%) records without recorded weights.</p>2<p>Data missing: there were 18 (5.3%) records without recorded white blood cell counts.</p>3<p>Data missing: there were 18 (5.3%) records without recorded hemoglobin values.</p>4<p>Data missing: there were 28 (8.3%) records without recorded CD4 cell counts.</p><p>Socio-demographic, clinical, and biological characteristics of 337 patients co-infected with TB and HIV, Yaoundé Central Hospital, 2006–2013, Cameroon.</p

Factors associated with death/lost to follow-up during TB treatment among TB/HIV co-infected patients, Yaoundé Central Hospital, 2006–2013, Cameroon.

§<p>From the 337 patients, we have excluded all patients who were <i>not evaluated</i> (n = 18).</p><p>*SPP: smear positive pulmonary, SNP: smear negative pulmonary, EP: extra pulmonary.</p><p>LTFU: lost to follow-up, TB: tuberculosis.</p><p>All missing data were imputed.</p><p>Factors associated with death/lost to follow-up during TB treatment among TB/HIV co-infected patients, Yaoundé Central Hospital, 2006–2013, Cameroon.</p

Enrollment of study participants.

<p>Enrollment of study participants.</p

Trend of TB treatment outcomes by year in TB/HIV co-infected patients from 2006 to 2013.

<p>Trend of TB treatment outcomes by year in TB/HIV co-infected patients from 2006 to 2013.</p