Factors Associated with Virological Failure and Suppression after Enhanced Adherence Counselling, in Children, Adolescents and Adults on Antiretroviral Therapy for HIV in Swaziland

This study explores factors associated with virological detectability, and viral re-suppression after enhanced adherence counselling, in adults and children on antiretroviral therapy (ART) in Swaziland

Long-term outcomes of a pediatric HIV treatment program in Maputo, Mozambique: a cohort study

Objective: To describe long-term treatment outcomes of a pediatric HIV cohort in Mozambique. Design: Retrospective analysis of routine monitoring data. Setting: Secondary health care facilities in the Chamanculo Health District of Maputo. Subjects: A total of 1,335 antiretroviral treatment (ART) naïve children <15 years of age enrolled in HIV care between 2002 and 2010. Intervention: HIV care, ART (since 2003), task shifting to lower cadre nurses, counseling by lay counselors, active patient tracing, nutritional support, support by a psychologist, targeted viral load testing, and switch to second-line treatment. Main outcome measures: Kaplan–Meier estimates for retention in care (RIC), CD4 cell percentage, body mass index for age z-score, and adjusted incidence rate ratios for attrition (death or loss to follow-up) as calculated by Poisson regression. Results: The RIC at 6 years in the pre-ART cohort was 44% (95% confidence interval: 38–49), and the one at 8 years in the ART cohort was 70% (64–75). Risk factors for attrition included young age, low CD4 percentage, underweight, active tuberculosis, and enrollment/treatment initiation after 2006. The mean CD4 percentage increased strongly at 1 year on treatment and remained high thereafter. The body mass index for age z-score sharply increased at 1 year after treatment initiation before stabilizing at pre-ART levels thereafter. Conclusions: Good clinical and immunological treatment outcomes up to 8 years of follow-up on ART can be achieved in a context of shortage of health workers and a high level of task-shifting approach

CCDC 1510318: Experimental Crystal Structure Determination

Related Article: Jiawei Rong, Juan F. Collados, Pablo Ortiz, Ravindra P. Jumde, Edwin Otten, Syuzanna R. Harutyunyan|2016|Nat.Commun.|7|13780|doi:10.1038/ncomms13780,An entry from the Cambridge Structural Database, the world’s repository for small molecule crystal structures. The entry contains experimental data from a crystal diffraction study. The deposited dataset for this entry is freely available from the CCDC and typically includes 3D coordinates, cell parameters, space group, experimental conditions and quality measures.

CCDC 1510319: Experimental Crystal Structure Determination

Related Article: Jiawei Rong, Juan F. Collados, Pablo Ortiz, Ravindra P. Jumde, Edwin Otten, Syuzanna R. Harutyunyan|2016|Nat.Commun.|7|13780|doi:10.1038/ncomms13780,An entry from the Cambridge Structural Database, the world’s repository for small molecule crystal structures. The entry contains experimental data from a crystal diffraction study. The deposited dataset for this entry is freely available from the CCDC and typically includes 3D coordinates, cell parameters, space group, experimental conditions and quality measures.

Numbers and proportions of viral load tests included and excluded at each stage of the analysis of predictors of virological outcomes, Swaziland, 2012–2013.

<p>Numbers and proportions of viral load tests included and excluded at each stage of the analysis of predictors of virological outcomes, Swaziland, 2012–2013.</p

Factors associated with detectable viral load (viral load >100 copies/ml) in patients on antiretroviral therapy for more than six months in Swaziland, 2012–2013.

<p>¹ The adjusted ORs are those from the final model, and include control for clustering by health facility.</p><p>²ART = antiretroviral therapy.</p><p>³ Median time on ART in undetectable group was 2.7 years (95% CI 1.4–4.4).</p><p>⁴ WHO = World Health Organisation.</p><p>⁵ ‘Unknown’ categories are included when >1% of values are missing. Having a missing value for time on ART, WHO Clinical Stage, last C4 count, TB co-infection status or ART regimen was associated with increased likelihood of detectable VL. These patients were excluded from the final regression model (see <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0116144#sec003" target="_blank">methods</a> and <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0116144#pone.0116144.s001" target="_blank">S1 Table</a>).</p><p>Factors associated with detectable viral load (viral load >100 copies/ml) in patients on antiretroviral therapy for more than six months in Swaziland, 2012–2013.</p

Factors associated with viral re-suppression (viral load<100 copies/ml, or 2 log reduction) after planned adherence counselling in patients with detectable viral load on antiretroviral therapy in Swaziland, 2012–2013.

<p>¹ The adjusted ORs are those from the final model, and include control for clustering by health facility.</p><p>²ART = antiretroviral therapy.</p><p>³ Median time on ART in undetectable group was 3.2 years (95% CI 18–4.9).</p><p>⁴ WHO = World Health Organisation.</p><p>⁵ ‘Unknown’ categories are included when >1% of values are missing. On regression analysis, no association was seen between likelihood of re-suppression and having unknown missing value for time on ART, WHO Clinical Stage, last C4 count, TB co-infection status or ART regimen.</p><p>Factors associated with viral re-suppression (viral load<100 copies/ml, or 2 log reduction) after planned adherence counselling in patients with detectable viral load on antiretroviral therapy in Swaziland, 2012–2013.</p

Consensus-based management protocol (CREVICE protocol) for the treatment of severe traumatic brain injury based on imaging and clinical examination for use when intracranial pressure monitoring is not employed

Globally, intracranial pressure (ICP) monitoring use in severe traumatic brain injury (sTBI) is inconsistent and susceptible to resource limitations and clinical philosophies. For situations without monitoring, there is no published comprehensive management algorithm specific to identifying and treating suspected intracranial hypertension (SICH) outside of the one ad hoc Imaging and Clinical Examination (ICE) protocol in the Benchmark Evidence from South American Trials: Treatment of Intracranial Pressure (BEST:TRIP) trial. As part of an ongoing National Institutes of Health (NIH)-supported project, a consensus conference involving 43 experienced Latin American Intensivists and Neurosurgeons who routinely care for sTBI patients without ICP monitoring, refined, revised, and augmented the original BEST:TRIP algorithm. Based on BEST:TRIP trial data and pre-meeting polling, 11 issues were targeted for development. We used Delphi-based methodology to codify individual statements and the final algorithm, using a group agreement threshold of 80%. The resulting CREVICE (Consensus REVised ICE) algorithm defines SICH and addresses both general management and specific treatment. SICH treatment modalities are organized into tiers to guide treatment escalation and tapering. Treatment schedules were developed to facilitate targeted management of disease severity. A decision-support model, based on the group's combined practices, is provided to guide this process. This algorithm provides the first comprehensive management algorithm for treating sTBI patients when ICP monitoring is not available. It is intended to provide a framework to guide clinical care and direct future research toward sTBI management. Because of the dearth of relevant literature, it is explicitly consensus based, and is provided solely as a resource (a “consensus-based curbside consult”) to assist in treating sTBI in general intensive care units in resource-limited environments