Impact of Drug Stock-Outs on Death and Retention to Care among HIV-Infected Patients on Combination Antiretroviral Therapy in Abidjan, Côte d'Ivoire

To evaluate the type and frequency of antiretroviral drug stock-outs, and their impact on death and interruption in care among HIV-infected patients in Abidjan, Côte d'Ivoire.We conducted a cohort study of patients who initiated combination antiretroviral therapy (cART) in three adult HIV clinics between February 1, 2006 and June 1, 2007. Follow-up ended on February 1, 2008. The primary outcome was cART regimen modification, defined as at least one drug substitution, or discontinuation for at least one month due to drug stock-outs at the clinic pharmacy. The secondary outcome for patients who were on cART for at least six months was interruption in care, or death. A Cox regression model with time-dependent variables was used to assess the impact of antiretroviral drug stock-outs on interruption in care or death. Overall, 1,554 adults initiated cART and were followed for a mean of 13.2 months. During this time, 72 patients discontinued treatment and 98 modified their regimen because of drug stock-outs. Stock-outs involved nevirapine and fixed-dose combination zidovudine/lamivudine in 27% and 51% of cases. Of 1,554 patients, 839 (54%) initiated cART with fixed-dose stavudine/lamivudine/nevirapine and did not face stock-outs during the study period. Among the 975 patients who were on cART for at least six months, stock-out-related cART discontinuations increased the risk of interruption in care or death (adjusted hazard ratio [HR], 2.83; 95%CI, 1.25-6.44) but cART modifications did not (adjusted HR, 1.21; 95%CI, 0.46-3.16).cART stock-outs affected at least 11% of population on treatment. Treatment discontinuations due to stock-outs were frequent and doubled the risk of interruption in care or death. These stock-outs did not involve the most common first-line regimen. As access to cART continues to increase in sub-Saharan Africa, first-line regimens should be standardized to decrease the probability of drug stock-outs

Les infections de prothèses vasculaires (aspects diagnostiques, thérapeutiques et pronostiques)

LILLE2-BU Santé-Recherche (593502101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Fluctuating Anaemia in Treated HIV Patients: Could be a Pica?

HIV infected patients are frequently exposed to anaemia, due to antiretroviral agents and/or prophylactic treatment of opportunistic infections. Anemia due to PICA, unusually evoked in our western countries, could be a more frequent situation than imagined. We report two cases of fluctuating anemia with no HIV or iatrogenic origin, observed in two HIV infected women, 47 years old and 33 years old respectively, coming from Africa and treated with antiretroviral agents. The anemia was explained by a culturally sanctioned practice of kaolin ingestion, in the broader context of PICA and resolved after the withdrawal of kaolin ingestion. PICA, and in particular kaolin ingestion, must be investigated when HIV infected patients came from Africa and presented significative unexplained anemia

Community-Based Care in the ANRS-IPERGAY Trial: The Challenges of Combination Prevention

International audienceANRS-IPERGAY was a community-based randomized trial investigating the efficacy of sexual activity-based HIV pre-exposure prophylaxis (PrEP) in a population of males and transgender females who had sex with men and were at high risk of HIV infection. We qualitatively analyzed the support provided to participants by community-based health workers (CBHW) throughout the trial's double-blind and open-label extension phases. In particular, we showed that the relationship between participants and CBHW strongly influenced self-managed pill intake. The delicate construction of this relationship, balanced between trust and dependence, played an important role in PrEP adherence. CBHW had to deal with various issues surrounding participants' feelings of empowerment regarding their role in the trial, as well as related tensions between various logics and rationalities. They were essential to participants' continued involvement

Evaluation of Drug Abuse by Hair Analysis and Self-Reported Use Among MSM Under PrEP: Results From a French Substudy of the ANRS-IPERGAY Trial

International audienc

Hypogonadism: A neglected comorbidity in young and middle-aged HIV-positive men on effective combination antiretroviral therapy

International audienceObjective: Male hypogonadism is poorly characterized in young-to-middle-aged people with HIV (PWH). We used a reliable free testosterone assay to assess the prevalence and predictive factors for male hypogonadism in PWH on effective combined antiretroviral therapy (cART).Design:A French cross-sectional study from January 2013 to June 2016.Methods:We included HIV-1-infected men aged between 18 and 50years with HIV loads of 50 RNA copies/ml or less, on effective cART for at least 6 months. Hypogonadism was defined, according to guidelines, as a mean calculated serum free testosterone concentration less than 70pg/ml (Vermeulen equation). Sociodemographic, anthropo-metric, bone-densitometry, hormonal, immunovirological, metabolic, and therapeutic parameters were collected. The IIEF-5, HAM-D, and AMS scales, respectively, assessed erectile function, depression, and quality of life.Results:Overall, 240 patients were enrolled, 231 were analyzed. Low free testosterone concentrations (<70pg/ml) were recorded in 20 patients (8.7%), and were exclusively of secondary origin. In multivariable analysis, the risk factors predictive of male hypogonadism were age more than 43 years [adjusted odds ratio (aOR) 3.17, 95% confidence interval (95% CI) 1.02-9.86;P = 0.04], total fat percentage more than 19% (aOR3.5, 95% CI 1.18-10.37; P = 0.02), and treatment including efavirenz (aOR3.77, 95% CI 1.29-10.98;P=0.02). A nadir CD4+ T-cell count more than 200 cells/μl (aOR 0.22, 95% CI 0.07-0.65;P < 0.01) were protective.Conclusion:Male hypogonadism remains common in young-to-middle-aged PWH with stably suppressed viral replication. Treatment including efavirenz, being over 43 years old, and having a total body fat percentage greater than 19% could be used as criteria for identifying PWH at risk. Early screening for male hypogonadism might improve care by identifying patients requiring testosterone replacement. Copyrigh

Factors independently associated with interruption in care or death among 975 HIV-infected patients in care 6 months after cART initiation, Abidjan, Côte d'Ivoire; basecase and sensitivity analysis on drug stock-out definition.

<p>HR: hazard ratio, adjusted for all variables in the table;</p><p>CNTS: HIV clinic affiliated with the National Center for Blood Transfusion;</p><p>ZDV: zidovudine; 3TC: lamivudine; d4T: stavudine; EFV: efavirenz; NVP: nevirapine.</p><p>Other cART regimens: zidovudine-lamivudine-indinavir/ritonavir, lamivudine-stavudine-indinavir/ritonavir, or stavudine-abacavir-efavirenz.</p><p>Other reasons for modifications are: adverse events, tuberculosis, pregnancy and treatment failure. The reason for modification was unknown for 18 patients (6%).</p><p>Other reasons for discontinuations are: travel, adverse events, funeral, treatment with traditional remedies, or inability to pay for drugs. The reason for discontinuation was unknown for 657patients (79%).</p><p>Virologic failure: plasma HIV RNA>300 copies/ml.</p><p>*Overall p value.</p><p>**The sensitivity analysis uses an expanded definition of drug stock-out, which includes any treatment discontinuation that lasted more than one month, was not accompanied by an explanation in the medical record, occurred when the pharmacy reported a shortage of at least one of the drugs in the patient's cART regimen.</p

Diagram of main drugs affected by stock-outs in the Aconda program, February 2006–February 2008.

<p>CNTS: HIV care center affiliated with the National Center for Blood Transfusion. NVP: Nevirapine. ZDV-3TC: Zidovudine/lamivudine. * Proportion of patients who interrupt antiretroviral therapy = number of patients who interrupt therapy due to drug stock-outs/number on that therapy during this period. ¥ Month/day/year.</p

Factors independently associated with interruption in care or death among 405 HIV-infected patients whose initial cART regimen was affected by drug stock-outs, Abidjan, Côte d'Ivoire.

<p>HR: hazard ratio, adjusted for all variables in the table;</p><p>CNTS: HIV clinic affiliated with the National Center for Blood Transfusion;</p><p>ZDV: zidovudine; 3TC: lamivudine; d4T: stavudine; EFV: efavirenz; NVP: nevirapine.</p><p>Other cART regimens: zidovudine-lamivudine-indinavir/ritonavir, lamivudine-stavudine-indinavir/ritonavir, or stavudine-abacavir-efavirenz.</p><p>Other reasons for modifications are: adverse events, tuberculosis, pregnancy and treatment failure. The reason for modification was unknown for 18 patients (6%).</p><p>Other reasons for discontinuations are: travel, adverse events, funeral, treatment with traditional remedies, or inability to pay for drugs. The reason for discontinuation was unknown for 657patients (79%).</p><p>Virologic failure: plasma HIV RNA>300 copies/ml.</p><p>*Overall p value.</p><p>**The sensitivity analysis uses an expanded definition of drug stock-out, which includes any treatment discontinuation that lasted more than one month, was not accompanied by an explanation in the medical record, occurred when the pharmacy reported a shortage of at least one of the drugs in the patient's cART regimen.</p