News

26

Mar, 2018

Effect of ready-to-use supplementary food on mortality in severely immunocompromised HIV-infected individuals in Africa initiating antiretroviral therapy (REALITY): an open-label, parallel-group, randomised controlled trial

 

Authors: Mallewa J, Szubert AJ, Mugyenyi P, et al. Published in: Lancet HIV. 2018;5(5):e231-e240 Background In sub-Saharan Africa, severely immunocompromised HIV-infected individuals have a high risk of mortality during the first few months after starting antiretroviral therapy (ART). We hypothesise that universally providing ready-to-use supplementary food (RUSF) would increase early weight gain, thereby reducing early mortality compared with current guidelines recommending ready-to-use therapeutic food (RUTF) for severely malnourished individuals only. Methods We did a 2 × 2 × 2 factorial, open-label, parallel-group trial at inpatient and outpatient facilities in eight urban or periurban regional hospitals in Kenya, […]

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26

Mar, 2018

Raltegravir-intensified initial antiretroviral therapy in advanced HIV disease in Africa: a randomised controlled trial

 

Authors: Kityo C, Szubert AJ, Siika A, et al. Published in: PLoS Med. 2018; 15(12):e1002706 Background In sub-Saharan Africa, individuals infected with HIV who are severely immunocompromised have high mortality (about 10%) shortly after starting antiretroviral therapy (ART). This group also has the greatest risk of morbidity and mortality associated with immune reconstitution inflammatory syndrome (IRIS), a paradoxical response to successful ART. Integrase inhibitors lead to significantly more rapid declines in HIV viral load (VL) than all other ART classes. We hypothesised that intensifying standard triple-drug ART with the integrase inhibitor, raltegravir, […]

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26

Mar, 2018

Causes and timing of mortality and morbidity among late presenters starting antiretroviral therapy in the REALITY trial

 

Authors: Post FA, Szubert AJ, Prendergast AJ, et al; for Reduction of early mortality in HIV-infected adults and children starting an antiretroviral therapy (REALITY) trial team Published in: Clin Infect Dis. 2018;66(2):S132-S139 Background In sub-Saharan Africa, 20%-25% of people starting antiretroviral therapy (ART) have severe immunosuppression; approximately 10% die within 3 months. In the Reduction of EArly mortaLITY (REALITY) randomized trial, a broad enhanced anti-infection prophylaxis bundle reduced mortality vs cotrimoxazole. We investigate the contribution and timing of different causes of mortality/morbidity. Methods Participants started ART with a CD4 count <100 cells/µL; enhanced prophylaxis comprised cotrimoxazole […]

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26

Mar, 2018

Late presentation with HIV in Africa: phenotypes, risk, and risk stratification in the REALITY Trial

 

Authors: Siika A, McCabe L, Bwakura-Dangarembizi M, et al; for REALITY Trial Team Published in: Clin Infect Dis. 2018;66(2):S140-S146 Background Severely immunocompromised human immunodeficiency virus (HIV)–infected individuals have high mortality shortly after starting antiretroviral therapy (ART). We investigated predictors of early mortality and “late presenter” phenotypes. Methods The Reduction of EArly MortaLITY (REALITY) trial enrolled ART-naive adults and children ≥5 years of age with CD4 counts <100 cells/μL initiating ART in Uganda, Zimbabwe, Malawi, and Kenya. Baseline predictors of mortality through 48 weeks were identified using Cox regression with backwards elimination (exit P > .1). Results Among […]

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25

Mar, 2018

Migrant women living with HIV in Europe: are they facing inequalities in the prevention of mother-to-child-transmission of HIV?: The European Pregnancy and Paediatric HIV Cohort Collaboration (EPPICC) study group in EuroCoord

 

Authors: Favarato G, Bailey H, Burns F, et al. Published in: Eur J Public Health. 2018;28(1):55-60 Background In pregnancy early interventions are recommended for prevention of mother-to-child-transmission (PMTCT) of HIV. We examined whether pregnant women who live with HIV in Europe and are migrants encounter barriers in accessing HIV testing and care. Methods Four cohorts within the European Pregnancy and Paediatric HIV Cohort Collaboration provided data for pooled analysis of 11 795 pregnant women who delivered in 2002–12 across ten European countries. We defined a migrant as a woman delivering in a country […]

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25

Mar, 2018

Time to switch to second-line antiretroviral therapy in children with HIV in Europe and Thailand

 

Authors: European Pregnancy and Paediatric HIV Cohort Collaboration (EPPICC) Study Group in EuroCoord. Published in: Clin Infect Dis. 2018;66(4):594-603. Background Global data on durability of first-line antiretroviral therapy (ART) in children with HIV is limited. We assessed time to switch to second-line therapy in 16 European countries and Thailand. Methods Children <18-years initiating combination ART (≥2 nucleoside reverse transcriptase inhibitor (NRTI) plus non-NRTI (NNRTI) or boosted-protease inhibitor (PI)) were included. Switch to second-line was defined as: (i) change across drug class (PI to NNRTI or vice versa) or within PI-class plus change of […]

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