The association between the ratio of monocytes: lymphocytes and risk of tuberculosis among HIV-infected postpartum women.

CAPRISA, 2014.Abstract available in pdf

Population‑based Prevalence and Associated Risk Factors of Hypertension among Adults in Benue State, Nigeria

Background: The increasing prevalence of hypertension in low‑ and middle‑income countries is associated with increased morbidity and mortality. Aim: To determine the prevalence of hypertension and associated risk factors in Benin state, Nigeria. Materials and Methods: A population‑based cross‑sectional study was conducted among 1265 adults selected by multistage sampling technique. The World Health Organization (WHO) STEPwise approach was used to collect data. Data were analyzed using Statistical Package for the Social Sciences (SPSS) software program, version 23.0 (IBM). We estimated prevalence and odds of hypertension at 5% level of significance. Results: The prevalence of hypertension was 35.6%. The odds of hypertension was higher among age 30–39 (aOR: 2.0; 95% CI: 1.3–3.1) compared to age 18–29 years, males (aOR: 1.4; 95% CI: 1.1–2.0) compared to females, overweight (aOR: 2.3; 95%CI: 1.6–3.2), and obesity (aOR: 4.9; 95%CI: 3.2–7.7) compared to normal weight, and high cholesterol (aOR: 1.6; 95% CI: 1.1–2.3) compared to normal cholesterol. Conclusion: The prevalence of hypertension was high among young adults in Benue State. The associated risk factors for hypertension were age, sex, overweight, obesity, and high total cholesterol. Keywords: Community, hypertension, Nigeria, population‑based, risk factor

The association between the ratio of monocytes: lymphocytes and risk of tuberculosis among HIV-infected postpartum women.

Recent human studies support historical animal studies that suggested an association between peripheral blood monocyte:lymphocyte (ML) ratio and tuberculosis (TB) disease. To evaluate generalizability of this finding, we modeled the association between peripartum ML ratio and incident TB disease within 18 months postpartum among 1202 HIV-infected women in South Africa, Tanzania, Uganda, and Zimbabwe. The ML ratio was associated with increased risk of TB disease independently to combination antiretroviral therapy, World Health Organization stage, or CD4 count (adjusted hazard ratio = 1.22, 95% confidence interval: 1.07 to 1.4, P = 0.003 per 0.1 unit increase in ML ratio)

Slow acceptance of universal antiretroviral therapy (ART) among mothers enrolled in IMPAACT PROMISE studies across the globe

CITATION: Stranix‑Chibanda, L., et al. 2019. Slow acceptance of universal antiretroviral therapy (ART) among mothers enrolled in IMPAACT PROMISE studies across the globe. AIDS and Behavior, 23:2522-2531, doi:10.1007/s10461-019-02624-3.The original publication is available at https://link.springer.comThe PROMISE trial enrolled asymptomatic HIV-infected pregnant and postpartum women not eligible for antiretroviral treatment (ART) per local guidelines and randomly assigned proven antiretroviral strategies to assess relative efficacy for perinatal prevention plus maternal/infant safety and maternal health. The START study subsequently demonstrated clear benefit in initiating ART regardless of CD4 count. Active PROMISE participants were informed of results and women not receiving ART were strongly recommended to immediately initiate treatment to optimize their own health. We recorded their decision and the primary reason given for accepting or rejecting the universal ART offer after receiving the START information. One-third of participants did not initiate ART after the initial session, wanting more time to consider. Six sessions were required to attain 95% uptake. The slow uptake of universal ART highlights the need to prepare individuals and sensitize communities regarding the personal and population benefits of the “Treat All” strategy.https://link.springer.com/article/10.1007/s10461-019-02624-3Publisher's versio

Maternal health outcomes among HIV-infected breastfeeding women with high CD4 counts: results of a treatment strategy trial

BackgroundIMPAACT PROMISE 1077BF/FF was a randomized study of antiretroviral therapy (ART) strategies for pregnant and postpartum women with high CD4+ T-cell counts. We describe postpartum outcomes for women in the study who were randomized to continue or discontinue ART after delivery.MethodsWomen with pre-ART CD4+ cell counts ≥350 cells/mm3 who started ART during pregnancy were randomized postpartum to continue or discontinue treatment. Women were enrolled from India, Malawi, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe. The primary outcome was a composite of progression to AIDS-defining illness or death. Log-rank tests and Cox regression models assessed treatment effects. Incidence rates were calculated per 100 person-years. A post hoc analysis evaluated WHO Stage 2/3 events. All analyses were intent-to-treat.Findings1611 women were enrolled (June 2011-October 2014) and 95% were breastfeeding. Median age at entry was 27 years, CD4+ count 728 cells/mm3 and the majority of women were Black African (97%). After a median follow-up of 1.6 years, progression to AIDS-defining illness or death was rare and there was no significant difference between arms (HR: 0·55; 95%CI 0·14, 2·08, p = 0.37). WHO Stage 2/3 events were reduced with continued ART (HR: 0·60; 95%CI 0·39, 0·90, p = 0.01). The arms did not differ with respect to the rate of grade 2, 3, or 4 safety events (p = 0.61).InterpretationSerious clinical events were rare among predominately breastfeeding women with high CD4+ cell counts over 18 months after delivery. ART had significant benefit in reducing WHO 2/3 events in this population

Enhanced infection prophylaxis reduces mortality in severely immunosuppressed HIV-infected adults and older children initiating antiretroviral therapy in Kenya, Malawi, Uganda and Zimbabwe: the REALITY trial

Meeting abstract FRAB0101LB from 21st International AIDS Conference 18–22 July 2016, Durban, South Africa. Introduction: Mortality from infections is high in the first 6 months of antiretroviral therapy (ART) among HIV‐infected adults and children with advanced disease in sub‐Saharan Africa. Whether an enhanced package of infection prophylaxis at ART initiation would reduce mortality is unknown. Methods: The REALITY 2×2×2 factorial open‐label trial (ISRCTN43622374) randomized ART‐naïve HIV‐infected adults and children >5 years with CD4 <100 cells/mm3. This randomization compared initiating ART with enhanced prophylaxis (continuous cotrimoxazole plus 12 weeks isoniazid/pyridoxine (anti‐tuberculosis) and fluconazole (anti‐cryptococcal/candida), 5 days azithromycin (anti‐bacterial/protozoal) and single‐dose albendazole (anti‐helminth)), versus standard‐of‐care cotrimoxazole. Isoniazid/pyridoxine/cotrimoxazole was formulated as a scored fixed‐dose combination. Two other randomizations investigated 12‐week adjunctive raltegravir or supplementary food. The primary endpoint was 24‐week mortality. Results: 1805 eligible adults (n = 1733; 96.0%) and children/adolescents (n = 72; 4.0%) (median 36 years; 53.2% male) were randomized to enhanced (n = 906) or standard prophylaxis (n = 899) and followed for 48 weeks (3.8% loss‐to‐follow‐up). Median baseline CD4 was 36 cells/mm3 (IQR: 16–62) but 47.3% were WHO Stage 1/2. 80 (8.9%) enhanced versus 108(12.2%) standard prophylaxis died before 24 weeks (adjusted hazard ratio (aHR) = 0.73 (95% CI: 0.54–0.97) p = 0.03; Figure 1) and 98(11.0%) versus 127(14.4%) respectively died before 48 weeks (aHR = 0.75 (0.58–0.98) p = 0.04), with no evidence of interaction with the two other randomizations (p > 0.8). Enhanced prophylaxis significantly reduced incidence of tuberculosis (p = 0.02), cryptococcal disease (p = 0.01), oral/oesophageal candidiasis (p = 0.02), deaths of unknown cause (p = 0.02) and (marginally) hospitalisations (p = 0.06) but not presumed severe bacterial infections (p = 0.38). Serious and grade 4 adverse events were marginally less common with enhanced prophylaxis (p = 0.06). CD4 increases and VL suppression were similar between groups (p > 0.2). Conclusions: Enhanced infection prophylaxis at ART initiation reduces early mortality by 25% among HIV‐infected adults and children with advanced disease. The pill burden did not adversely affect VL suppression. Policy makers should consider adopting and implementing this low‐cost broad infection prevention package which could save 3.3 lives for every 100 individuals treated