Beatrice Christian1, Emanuel Fabian1, Irene Macha1, Shida Mpangala1, Chloe L Thio2, Nzovu Ulenga1, Ferdinand Mugusi3, Lauren R Ammerman4, Wafaie Fawzi5, Richard Green6, Robert Murphy6, Claudia Hawkins6. 1. Management and Development for Health, Dar es Salaam, Tanzania. 2. Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA. 3. Department of Medicine, Muhumbili University of Health and Allied Sciences, Dar es Salaam, Tanzania. 4. Northwestern University Feinberg School of Medicine, Chicago, Illinois. 5. Departments of Nutrition, Epidemiology and Global Health and Population, Harvard T. H Chan School of Public Health, Boston, Massachusetts. 6. Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Abstract
OBJECTIVES: There is limited data on the effect of antiviral therapies on clinical outcomes in HIV and hepatitis B virus (HBV)-infected individuals in sub-Saharan Africa. DESIGN: Single center, prospective longitudinal cohort study at Management and Development for Health supported HIV Care and Treatment clinics in Dar es Salaam, Tanzania. METHODS: Between April 2014 and December 2015, HIV-infected, HBV-infected and HIV/HBV-coinfected, treatment naïve, Tanzanian adults more than 18 years of age were eligible for enrollment and followed for 10-18 months after initiating antivirals. All HIV-infected and HIV/HBV-coinfected participants received tenofovir, lamivudine and efavirenz; HBV-infected participants received lamivudine. Multivariate regression models were constructed to identify factors associated with mortality in HIV-infected and HIV/HBV-coinfected participants. RESULTS: A total of 265 HIV-infected, 165 HBV-infected and 64 HIV/HBV-coinfected participants were analyzed. At baseline, HBV-infected participants were younger and had a higher BMI than HIV-infected and HIV/HBV-coinfected participants. After a median of 371 (interquartile range 50) days on treatment, there were 40 deaths. Mortality was significantly higher among HIV/HBV-coinfected participants compared with HIV and HBV-infected participants [HIV/HBV-coinfected 12 of 64 (19%) vs. HIV-infected 26 of 265 (10%) and HBV-infected two of 265 (1%), P < 0.01]. High baseline HIV RNA and low hemoglobin levels, but not HBV coinfection were independently associated with early mortality in multivariate analyses of HIV-infected participants. CONCLUSION: High rates of early mortality were observed after treatment initiation in HIV/HBV-coinfected individuals compared with participants with HIV or HBV alone, despite robust aspartate aminotransferase to platelet ratio index declines and high rates of virologic suppression. HIV rather than HBV-related factors are more important contributors to mortality in these individuals.
OBJECTIVES: There is limited data on the effect of antiviral therapies on clinical outcomes in HIV and hepatitis B virus (HBV)-infected individuals in sub-Saharan Africa. DESIGN: Single center, prospective longitudinal cohort study at Management and Development for Health supported HIV Care and Treatment clinics in Dar es Salaam, Tanzania. METHODS: Between April 2014 and December 2015, HIV-infected, HBV-infected and HIV/HBV-coinfected, treatment naïve, Tanzanian adults more than 18 years of age were eligible for enrollment and followed for 10-18 months after initiating antivirals. All HIV-infected and HIV/HBV-coinfectedparticipants received tenofovir, lamivudine and efavirenz; HBV-infectedparticipants received lamivudine. Multivariate regression models were constructed to identify factors associated with mortality in HIV-infected and HIV/HBV-coinfectedparticipants. RESULTS: A total of 265 HIV-infected, 165 HBV-infected and 64 HIV/HBV-coinfectedparticipants were analyzed. At baseline, HBV-infectedparticipants were younger and had a higher BMI than HIV-infected and HIV/HBV-coinfectedparticipants. After a median of 371 (interquartile range 50) days on treatment, there were 40 deaths. Mortality was significantly higher among HIV/HBV-coinfectedparticipants compared with HIV and HBV-infectedparticipants [HIV/HBV-coinfected 12 of 64 (19%) vs. HIV-infected 26 of 265 (10%) and HBV-infected two of 265 (1%), P < 0.01]. High baseline HIV RNA and low hemoglobin levels, but not HBVcoinfection were independently associated with early mortality in multivariate analyses of HIV-infectedparticipants. CONCLUSION: High rates of early mortality were observed after treatment initiation in HIV/HBV-coinfected individuals compared with participants with HIV or HBV alone, despite robust aspartate aminotransferase to platelet ratio index declines and high rates of virologic suppression. HIV rather than HBV-related factors are more important contributors to mortality in these individuals.
Authors: T P Goverwa-Sibanda; C Mupanguri; C Timire; A D Harries; S Ngwenya; E Chikwati; C Mapfuma; F Mushambi; H Tweya; M Ndlovu Journal: Public Health Action Date: 2020-09-21
Authors: Tongai G Maponga; Anna L McNaughton; Marije van Schalkwyk; Susan Hugo; Chikezie Nwankwo; Jantjie Taljaard; Jolynne Mokaya; David A Smith; Cloete van Vuuren; Dominique Goedhals; Shiraaz Gabriel; Monique I Andersson; Wolfgang Preiser; Christo van Rensburg; Philippa C Matthews Journal: J Infect Date: 2020-05-01 Impact factor: 6.072
Authors: Leire Pérez-Latorre; Juan Berenguer; Rafael Micán; Marta Montero; Carmen Cifuentes; Teresa Puig; José Sanz; Oscar L Ferrero; Belén De La Fuente; Carmen Rodríguez; Sergio Reus; José Hernández-Quero; Gabriel Gaspar; Laura Pérez-Martínez; Coral García; Luis Force; Sergio Veloso; Marta De Miguel; Inmaculada Jarrín; Juan González-García Journal: Euro Surveill Date: 2021-06