Guidelines 1 Screening før behandling med biologiske og målrettede syntetiske lægemidler (2023)
Bilag til Retningslinjer for screening og profylakse før behandling med biologiske lægemidler (2023) 2 Retningslinjer for screening og profylakse før behandling med biologiske lægemidler (2023)
Omhandler biologiske og målrettede syntetiske lægemidler (BMSL) til patienter i forhold til risiko for tuberkulose (TB), Humant Papillom Virus (HPV), Hepatitis B og C (HBV og HCV), Varicella Zoster Virus (VZV), Herpes Simplex Virus (HSV), Cytomegalovirus (CMV), Epstein Barr Virus (EBV) og Humant Immundefekt Virus (HIV) og øvrige infektioner. Vejledningen er udarbejdet af repræsentanter fra Dansk Selskab for Gastroenterologi og Hepatologi (DSGH), Dansk Reumatologisk Selskab (DRS), Dansk Dermatologisk Selskab (DDS) og Dansk Selskab for Infektionsmedicin (DSI). 3 Antiretroviral behandling af HIV-smittede personer (2024)
Udarbejdet af DSI's arbejdsgruppe vedrørende antiretroviral terapi 4 Tuberkuloseinfektion hos immunsupprimerede (2023)
Denne vejledning omhandler vurdering og behandling af tuberkuloseinfektion hos voksne, som skal behandles med immunsupprimerende medicin i form af f.eks TNF-α hæmmere eller andre immunsupprimerende biologiske lægemidler, hvor der er øget risiko for tuberkulosereaktivering. Guideline dækker ikke børn, personer med medfødt immundefekt, HIV positive, patienter i dialyse, patienter med dysreguleret diabetes, silicose, erhvervede immundefekter eller patienter i konventionel kortvarig kemoterapi. Denne guideline omhandler ikke klassisk smitteopsporing blandt tuberkuloseeksponerede eller udredning på mistanke om aktiv tuberkulose. 5 Stikuheld og anden blodeksposition (2020)
Revideret september 2020. Arbejdsgruppen bestod af Suzanne Lunding (formand), Peer Brehm Christensen, Christian Erikstrup, Terese L. Katzenstein, Henrik Krarup, Alex Lund Laursen, Birgitte Mørn og Nina Weis 6 HIV-behandling af gravide (2021)
Arbejdsgruppen bestod af: Jan Gerstoft, Ann-Brit Eg Hansen, Gitte Kronborg, Jens D. Lundgren, Henrik I. Nielsen, Olav Ditlevsen Larsen, Niels Obel og Alex Laursen 7 Pre-exposure profylakse mod HIV (2021)
Fællesregional retningslinje for udlevering af forebyggende medicin mod HIV (PrEP), udgivet af Danske Regioner. 8 HIV post exposure profylakse (PEP) 2020
Version: 3. Endelig guideline: 01.09.2020. Guideline skal revideres senest: 01.09.2023 Arbejdsgruppens medlemmer: Peer Brehm Christensen, Christian Erikstrup, Jan Gerstoft, Terese Katzenstein, Alex Laursen, Suzanne Lunding, Birgitte Mørn og Nina Weis. Links 1 Medicinrådets behandlingsvejledning om HIV
2 Medicin.dk om behandling af HIV
3 EACS European Guidelines for treatment of HIV-positive adults
4 Region Hovedstadens vejledning om rådgivning ved positiv HIV-test
5 Region Hovedstadens vejledning om behandling af HIV hos voksne patienter herunder gravide og det nyfødte barn
6 Infektionsmedicinsk afdelings (Rigshospitalet) instruks om HIV
7 Infektionsmedicinsk afdelings (Hvidovre) instruks om HIV
Nye artikler 1 Blood microbiota in HIV-infected and HIV-uninfected patients with suspected sepsis detected by metagenomic next-generation sequencing
BMC Infectious Diseases, 29.10.2024 Tilføjet 29.10.2024 Abstract Background Information on the comparison of blood microbiota between human immunodeficiency virus (HIV)-infected and HIV-uninfected patients with suspected sepsis by metagenomic next-generation sequencing (mNGS) is limited. Methods Retrospectively analysis was conducted in HIV-infected and HIV-uninfected patients with suspected sepsis at Changsha First Hospital (China) from March 2019 to August 2022. Patients who underwent blood mNGS testing were enrolled. The blood microbiota detected by mNGS were analyzed. Results A total of 233 patients with suspected sepsis who performed blood mNGS were recruited in this study, including 79 HIV-infected and 154 HIV-uninfected patients. Compared with HIV-uninfected patients, the proportions of mycobacterium (p = 0.001), fungus (p Læs mere Tjek på PubMed2 Magnitude of anemia and associated factors among HIV infected children on antiretroviral therapy in Awi zone health facilities, Northwest Ethiopia, 2023
BMC Infectious Diseases, 29.10.2024 Tilføjet 29.10.2024 Abstract Background Anemia is a common complication of HIV infected children and it is enabling HIV disease progression, and decreasing survival. In Ethiopia, there is limited evidence on the prevalence of anemia and its associated factors among HIV infected children particularly in the Awi Zone. Therefore, this study aimed to assess the magnitude and associated factors of anemia among HIV infected children on ART aged from 6 months to 15 year-old in ART Clinic, Awi-Zone, Ethiopia. Objective To assess the magnitude and associated factors of anemia among HIV infected children on antiretroviral therapy in Awi zone health facilities, Northwest, Ethiopia, 2022. Methods A facility based cross-sectional study design was conducted from October to December 2022. A simple random sampling method was used to select the study participants. Descriptive statistics, including frequencies and proportions was used to summarize the study variables and data had been entered in to Epi data 4.2 and exported to SPSS version 25. Bivariable logistic regression followed by multivariable logistic regression was performed. Degree of association between dependent and independent variables had been assessed using adjusted odds ratio with 95% CI at p value of ≤ 0.05. Result From 346 participants in the selected sample 339 (97.9%) of them responded. Prevalence of anemia was 13.3% (n = 45) among which, majority (44.4%) of them had mild anemia, while about (42.2%,) had moderate anemia and around 13.3%, of them were severely anemic. Baseline CD4 count (AOR = 6.58, 95% CI: 2.85–15.22), WHO clinical stage III or IV (AOR = 8.42, 95% CI = 3.47, 20.45), hookworm infection (AOR = 5.06, 95% CI = 2.04, 12) and malaria infection (AOR = 4.92, 95% CI (2.19–11.02) were significantly associated with anemia among children on HAART. Conclusion The prevalence of anemia among participants was relatively low in this study. However, a considerable proportion of participants had moderate to severe anemia. Lower CD4 count at enrolment, advanced HIV clinical stage, malaria and hookworm infection were significantly linked with anemia. Thus, it requires regular monitoring of anemia status in these patients for better clinical outcomes and quality of life improvements. Læs mere Tjek på PubMed3 Prevalence of medication overload among older people with HIV: a MedSafer study
BMC Infectious Diseases, 29.10.2024 Tilføjet 29.10.2024 Abstract Background Older people with HIV (PWH) are at risk of polypharmacy (taking multiple medications). Most medications may be necessary and indicated to manage HIV (e.g., antiretroviral therapy [ART]) and HIV-associated comorbidities. However, some are potentially inappropriate medications (PIMs), defined as causing greater harm than benefit, which leads to medication overload. The objective of this study was to characterize polypharmacy (taking multiple medications) and medication overload (prescription of ≥ 1 PIMs) among older PWH. Methods This retrospective study included older PWH (aged ≥ 50 years old) attending the tertiary care HIV clinic at the McGill University Health Centre (Montreal, Canada), from June 2022–June 2023. Patient characteristics, medications, and select laboratory values (e.g., CD4 count, hemoglobin A1C) were entered into the MedSafer software identifying PIMs and classifying them according to risk of adverse drug event. We measured the prevalence of polypharmacy (≥ 5 medications prescribed, both including and excluding ART) and medication overload (≥ 1 PIMs). Multivariable logistic regression identified factors associated with medication overload. Results The study included 100 patients, with a median age of 59 years (IQR = 54–63; range 50–82); 42% female. Polypharmacy affected 89% of patients when including antiretroviral therapy (ART) and 60% when excluding ART. Medication overload was present in 58% of patients, and 37.4% of identified PIMs were classified as high-risk. Polypharmacy was the sole predictor of medication overload. Conclusion Older PWH are at significant risk of medication overload and receiving higher risk PIMs. Deprescribing PIMs in this population could improve medication appropriateness while reducing the risk of ADEs. Læs mere Tjek på PubMed4 Sex differences in tuberculosis infection and disease among people with HIV
Chaisson, Lelia H.; Durovni, Betina; Umar, Nasir; Cohn, Silvia; Moulton, Lawrence H.; Scully, Eileen; Cavalcante, Solange; Golub, Jonathan E.; Chaisson, Richard E.; Saraceni, Valeria AIDS, 29.10.2024 Tilføjet 29.10.2024 Objectives: Worldwide, adult men experience an excess burden of tuberculosis (TB) disease compared to women, but few studies have examined sex differences in TB among people with HIV. In this study, we aimed to investigate sex differences in TB infection and disease among people with HIV in Rio de Janeiro, Brazil. Design: Analysis of data from a randomized controlled trial and retrospective cohort study. Methods: We analyzed data from two studies conducted between 2005 and 2017. The THRio Study (2005–2012) evaluated increasing tuberculin skin testing (TST) and TB preventive therapy (TPT) and UnivART (2010–2017) was a virtual cohort study of people with HIV and TB with data from four national electronic registries. Results: Among 4,606 people with HIV in THRio, 2,992 (65.0%) had a TST placed and read, of whom 312/1,865 (17%) males and 203/1,127 (18%) females (p = 0.37) had prevalent TB infection. TB disease incidence was higher among males compared to females overall (IRR 1.33, 95% CI 1.04–1.69), among males compared to females who did not receive TPT (IRR 1.30, 95% CI 1.01–1.67), and among males compared to females on ART (IRR 1.64, 95% CI 1.17–2.29). Among 54,957 people with HIV in UnivART, TB disease incidence rates were higher among males than females overall (IRR 1.28, 95% CI 1.18–1.39), among males compared to females on ART (IRR 1.58, 95% CI 1.40–1.77), and among males compared to females not on ART (IRR 1.11, 95% CI 0.99–1.25). Conclusions: In this medium TB and HIV burden setting, TB disease incidence was higher among males than females with HIV, despite similar prevalence of TB infection. Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved. Læs mere Tjek på PubMed5 Real-world clinical and economic outcomes from rapid start antiretroviral therapy in HIV: systematic review and meta-analysis
Duong, Khanh N.C.; Schmutz, Howard Weston; Ben-Umeh, Kenechukwu C.; Duru, Emeka E.; Rose, Natalie; Trom, Cassidy; Chaiyakunapruk, Nathorn; Willis, Connor W. AIDS, 29.10.2024 Tilføjet 29.10.2024 Objective: We aimed to synthesize clinical and economic outcomes of rapid start versus non-rapid antiretroviral therapy (ART) in people with HIV (PWH) in real-world settings. Methods: A search was conducted in PubMed, Embase, Web of Science, and ProQuest from January 2017 to January 2023, supplementing a previous search by Ford et.al, 2018. Observational studies investigating clinical or economic outcomes of rapid start ART versus non-rapid ART in PWH were included. Clinical outcomes were mortality, loss-to-follow-up (LTFU), and viral suppression. Economic outcomes were Incremental cost-effectiveness ratio (ICER) values and per patient per month (PPPM) costs. Meta-analyses using random-effects models were performed for clinical outcomes, while qualitative syntheses were conducted for economic outcomes. The quality of clinical and economic studies was assessed. Results: Sixty-two studies were included. The pooled adjusted risk ratio (aRR) for mortality demonstrated a significant reduction in risk of mortality among participants who received rapid start ART compared to non-rapid ART (0.80, 95%CI, 0.65–0.98). For LTFU at 6 and 12 months, the pooled aRR showed increased LTFU for rapid start ART (1.33, 95%CI, 1.15–1.55 and 1.18, 95%CI, 0.74–1.89 respectively). All cost-effectiveness studies reported cost-saving or cost-effective findings. The PPPM costs of rapid start ART across the first 36 months of treatment were consistently lower than non-rapid ART. Conclusions: Rapid ART is associated with reduced mortality and is cost-effective compared to non-rapid ART in real-world settings. Clinicians and policymakers should consider these findings to facilitate rapid start of ART in PWH. Further research on LTFU in PWH is needed. Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. Læs mere Tjek på PubMed6 Biomarkers of microbial translocation and generalized inflammation are associated with frailty among people with HIV
Ruderman, Stephanie A.; Hunt, Peter W.; Beck-Engeser, Gabriele; Ambayec, Gabrielle; Willig, Amanda L.; Saag, Michael S.; Napravnik, Sonia; Cachay, Edward; Bamford, Laura; Landay, Alan; Drumright, Lydia N.; Mixson, L Sarah; Whitney, Bridget M.; Nance, Robin M.; Kitahata, Mari M.; Crane, Heidi M.; Delaney, Joseph AC; Hahn, Andrew W. AIDS, 29.10.2024 Tilføjet 29.10.2024 Background: Frailty occurs at higher rates and younger ages among people with HIV (PWH) compared to the general population and is often attributed to chronic inflammation and subsequent immune exhaustion. We assessed how inflammatory biomarkers are associated with frailty among PWH. Methods: The Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort is comprised of adult PWH in care at 10 sites, and harmonizes demographic, clinical, and patient-reported outcomes (PRO) data. A panel of 13 inflammatory biomarkers was collected from a subset of virally suppressed PWH once per person between 2010–2018. Frailty was measured with a validated PRO phenotype, scored 0–4, from biomarker collection date through July 2022. With adjusted linear mixed models, we estimated longitudinal associations between standard deviation-scaled log2-transformed biomarkers and frailty score. Results: Among 273 PWH, most were male (91%), average age at baseline was 45, 42% were non-Hispanic White while 35% were non-Hispanic Black, and average follow-up time was 5.5 years. Several biomarkers were associated with higher frailty, including those linked to microbial translocation (sCD14, LBP, KT ratio) and systemic inflammation (CRP, IL-6, suPAR, sTNFR1, sTNFR2). Higher IL-6 was associated with a 0.25-point higher frailty score (95%CI:0.12–0.39). Higher sTNFR1 (0.35 [0.13–0.56]), sCD14 (0.21 [0.11–0.31]), and suPAR (0.24 [0.11–0.36]) levels were also associated with higher frailty scores over follow-up. Conclusions: Higher levels of biomarkers linked to microbial translocation and systemic inflammation are associated with higher average frailty scores over time in a cohort of virally suppressed PWH, highlighting these pathways as potential interventional targets for mitigating frailty in PWH. Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved. Læs mere Tjek på PubMed7 Impact of smoking habits on cardiovascular and neoplastic events and all-cause death in people living with HIVfrom the STOPSHIV cohort
Socio, Giuseppe Vittorio De; Ricci, Elena; Piconi, Stefania; Squillace, Nicola; Maggi, Paolo; Orofino, Giancarlo; Altobelli, Debora; Santoro, Carmen; Guastavigna, Marta; Menzaghi, Barbara; Salomoni, Elena; Di Biagio, Antonio; dell’Omo, Marco; Francisci, Daniela; Bonfanti, Paolo; For CISAI study group (Italian coordination group for the study of allergies HIV infection) AIDS, 29.10.2024 Tilføjet 29.10.2024 Objective: The study aimed to assess the impact of smoking exposure on major clinical events (MCE) in a real-life setting of people living with HIV (PWH). Design: Observational longitudinal multicentre cohort study from Italy. Methods: Consecutive 983 PWH were enrolled in “STOP Smoking in HIV people” (STOPSHIV) projects and followed from July 2014 until September 2023. The observed MCE defined as cardiovascular (CV) events, neoplastic diseases or death for any reason was assessed according smoking status and related variables (number of cigarettes smoked daily, pack-years, Fagerström test) in participants. The association between exposure variables and the event was evaluated using the Cox proportional hazard model (hazard ratios, HR, and 95% CI). Results: Over 6997.6 person-years of follow-up (PYFU), we found a total of 49 CV events, 61 neoplastic events, and 47 deaths. The overall incidence rate of MCE was 17.6 /1000 PYFU (95% confidence interval 14.7–21.0). All-cause death rate was 6.7 (95% CI 5.0–8.9)/1000 PYFU. In a multivariate analysis, older age (HR 1.07, CI 1.05–1.09), high Fagerström Test for Nicotine Dependence (HR 1.09, CI 1.03–1.15), a low nadir CD4 Læs mere Tjek på PubMed8 Perspectives of people with HIV on implementing long acting cabotegravir plus rilpivirine in clinics and community settings in the UK: results from the anti-sexist, anti-racist, anti-ageist ILANA study
Clinical Infectious Diseases, 29.10.2024 Tilføjet 29.10.2024 Abstract Introduction The equity-focused ILANA study evaluated feasibility, acceptability, appropriateness of delivering on-label two-monthly cabotegravir and rilpivirine (CAB+RPV) injections for HIV-1 therapy in clinics and community settings.Methods The study, which mandated inclusive recruitment, was conducted May-December 2022 at six UK sites. Injections were delivered in clinic (months 1-6), and in clinic or community setting according to patient choice (months 6-12). Surveys were completed at baseline, M4 and M12 using validated measures for feasibility (FIM), acceptability (AIM), and appropriateness (IAM). Primary endpoint: proportion of participants agreeing that the injection and community setting were feasible (FIM>4) at M12. Fourteen participants completed interviews at baseline and M12.Results Community settings offered by sites included: home visits (n=3), HIV support organisations (n=2), community clinic (n=1). Of 114 participants,54% were female, 70% racially minoritised and 40% aged >50. 27/114 chose to receive injections in community settings. FIM/AIM/IAM scores at M12 were high for the injection (79.0-87.4%) and lower for the community setting (44.2-47.4%) overall. Subgroup analyses indicated differences in scores by gender and ethnicity. Among those who attended the community, FIM/AIM/IAM scores for the community setting at M12 were high (73.1-80.8%). Concerns about stigma, inconvenience, and losing access to trusted clinicians negatively influenced perceptions of receiving injections at community settings, amongst other factors.Conclusion CAB+RPV injections were considered highly feasible, acceptable, and appropriate, however few chose community delivery. Those that chose community delivery found it highly acceptable and feasible. Further exploration of CAB+RPV delivery in alternative community sites not offered (e.g. primary care or pharmacies) is warranted. Læs mere Tjek på PubMed9 Discussion of HIV and Other Sexually Transmitted Infections with Sex Partners of Nigerian Men who have Sex with Men and Transgender Women: Implications for Interventions to Promote Safer Sex Practices
Tiamiyu, Abdulwasiu B.; Hu, Fengming; Kokogho, Afoke; Charurat, Manhattan E.; Ekeh, Charles; Adebajo, Sylvia; Shoyemi, Elizabeth; Iroezindu, Michael; Ake, Julie A.; Baral, Stefan D.; Nowak, Rebecca G.; Crowell, Trevor A.; for the TRUST/RV368 Study Group Journal of Acquired Immune Deficiency Syndromes, 27.10.2024 Tilføjet 27.10.2024 Background: Discussion of HIV and other sexually transmitted infections (STIs) among sex partners facilitates risk reduction. We evaluated HIV/STI-related communications, including broad assessment of any self-reported discussion of the topic and specific discussion of each partners’ HIV status, among a historically marginalized and presently criminalized community of sexual and gender minorities (SGM) in Nigeria. Methods: From 2013-2018, we enrolled SGM aged 18+ in Lagos or 16+ in Abuja who reported anal sex with men. At enrollment and 3-, 9-, and 15-month follow-up visits, participants were asked about their sexual behaviors and communications with main sexual partners (MSP) and casual sexual partners (CSP). Questions included “have you talked with your [MSP/CSP] about sexually transmitted infections and HIV?” Multivariable robust Poisson regression with generalized estimating equations was used to estimate adjusted relative risks (aRRs) and 95% confidence intervals (CIs) for factors potentially associated with HIV/STI-related communications with some or all of each type of sexual partner. Results: Among 2795 SGM enrolled with median age 23 years (interquartile range 20–27), questions about HIV/STI-related communications with MSP were answered by 2436 (87.2%) and with CSP by 2398 (85.9%). Communication with MSP was reported by 68.1% (1659/2436), of whom 897 (54.1%) discussed their own HIV status and 925 (55.8%) discussed their partner’s status. Communication with CSP was reported by 43.9% (1052/2398), of whom 389 (37.0%) discussed their own HIV status and 385 (36.6%) discussed their partner’s status. Among participants with both MSP and CSP, HIV/STI-related communication with MSP was more common among participants with higher than secondary education (aRR 1.40 [95%CI 1.24–1.58)], who were divorced/separated/widowed (aRR 1.19 [95% CI 1.06–1.33]), who discussed their HIV status with CSP (aRR 1.18 [95%CI 1.10–1.25]), discussed CSP’s HIV status (aRR 1.20 [95%CI 1.13–1.27]), and used a condom at last sex with CSP (aRR 1.16 [95%CI 1.08–1.25]). HIV/STI-related communication with CSP was more common among participants with higher than secondary education (aRR 1.36 [95%CI 1.12–1.66]); who were divorced/separated/widowed (aRR 1.38 [95%CI 1.13–1.69]), who discussed their HIV status with MSP (aRR 1.47 [95%CI 1.27–1.69]), who discussed CSP’s HIV status (aRR 1.22 [95%CI 1.06–1.40]) and used a condom at last sex with CSP (aRR 1.22 (95%CI 1.08–1.38]). Conclusion: HIV/STI-related communications with main and casual sex partners were both associated with safer sex with CSP. HIV prevention and treatment programs for SGM should promote open communications in sexual relationships and consider deployment of modern strategies to facilitate disclosure, especially in settings with criminalizing legislation. Written work prepared by employees of the Federal Government as part of their official duties is, under the U.S. Copyright Act, a “work of the United States Government” for which copyright protection under Title 17 of the United States Code is not available. As such, copyright does not extend to the contributions of employees of the Federal Government. Læs mere Tjek på PubMed10 Hepatitis C treatment and behavioural risk among men who have sex with men with HIV: comparing interferon and direct-acting antiviral eras
Kris, Hage; Anders, Boyd; Daniëla K., van Santen; Kees, Brinkman; Joop, Arends; Fanny, Lauw; Bart, Rijnders; Arne, van Eeden; Valk Marc, van der; Astrid, Newsum; Amy, Matser; Janke, Schinkel; Maria, Prins Journal of Acquired Immune Deficiency Syndromes, 27.10.2024 Tilføjet 27.10.2024 Background: Little is known about the effect of HCV treatment on sexual risk behaviour among men who have sex with men (MSM) with HIV by treatment type (IFN-based vs DAA-based). Setting: MSM with HIV and recently acquired HCV infection enrolled in the observational MOSAIC cohort. Methods: Using data from 2009-2018, we evaluated risk behaviour through a validated HCV risk score (where ≥2 indicated high risk) and its individual risk behaviours. Levels of risk behaviour before, during and after treatment were modelled for each treatment episode using linear and logistic regression with Generalized Estimating Equations adjusting for DAA availability and number of re-infections. Results: 140 MSM with a median age of 45 years (interquartile range=40-49) yielded 180 treatment episodes (n=131 IFN-based, n=49 DAA-based). Adjusted mean risk score before, during and after treatment was 2.4 (95% confidence interval (CI)=2.1-2.6), 0.9 (95%CI=0.8-1.0) and 1.7 (95%CI=1.5-1.8), respectively. Before treatment, no differences in mean HCV risk score or proportion of specific behaviours were found between the regimen groups. During treatment, MSM treated with DAAs had a higher average risk score and proportion of receptive condomless anal sex, sharing toys and unprotected fisting than those treated with IFN. After treatment, the proportion sharing straws were significantly higher in MSM treated with DAAs than IFN. Conclusions: MSM treated with DAAs, compared to IFN, had higher levels of HCV-related risk behaviour during treatment. The higher risk of HCV re-infection in the DAA-era underscores the need for ongoing HCV testing and behavioural interventions against HCV. Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved. Læs mere Tjek på PubMed11 Accuracy of alternative PHQ-9 scoring algorithms to screen for depression in people living with HIV in Sub-Saharan Africa
Bernard, Charlotte; Font, Hélène; Zotova, Natalia; Wools-Kaloustian, Kara; Goodrich, Suzanne; Kwobah, Edith Kamaru; Awoh, Ajeh Rogers; Nko'o Mbongo'o, Guy Calvin; Nsonde, Dominique Mahambu; Gandou, Paul; Minga, Albert; Tine, Judicaël Malick; Ndiaye, Ibrahima; Dabis, François; Seydi, Moussa; de Rekeneire, Nathalie; Yotebieng, Marcel; Jaquet, Antoine; on behalf of the IeDEA Cohort Collaboration Journal of Acquired Immune Deficiency Syndromes, 27.10.2024 Tilføjet 27.10.2024 Background: Screening for depression remains a priority for people living with HIV (PLWH) accessing care. The nine-item Patient Health Questionnaire (PHQ-9) is a widely used depression screening tool, but has limited accuracy when applied across various cultural contexts. We aimed to evaluate the performance of alternative PHQ-9 scoring algorithms in sub-Saharan African PLWH. Setting: five HIV programs in Cameroon, Côte d’Ivoire, Kenya, Senegal and the Republic of Congo. Methods: Adult PLWH were screened for depression during the 2018–2022 period. Diagnosis confirmation was done by psychiatrist blinded clinical evaluation (gold standard). Diagnostic performances, including sensitivity, and area under the curve (AUC)) of the traditional PHQ-9 scoring (positive screening - score≥10) was compared to alternative scoring algorithms including: i) the presence of ≥1 mood symptom (PHQ-9 items 1&2) combined with ≥2 other symptoms listed in the PHQ-9, and ii) a simplified recoding of each 4-response item into two categories (absence/presence). Results: A total of 735 participants were included (54% female, median age 42 years [IQR 34-50]). Depression was diagnosed by a psychiatrist in 95(13%) participants. Alternative scoring sensitivities (0.59 to 0.74) were higher than that of the traditional score’s (0.39). Compared to traditional scoring, AUC were significantly higher for PHQ-9 alternative scoring. Across settings, alternative scoring algorithms increased sensitivity and reduced variability. Conclusion: As a primary screening test, new scoring algorithms appeared to improve the PHQ-9 sensitivity in identifying depression and reduce heterogeneity across settings. This alternative might be considered to identify PLWH in need of referral for further diagnostic evaluations. Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. Læs mere Tjek på PubMed12 Viral load undetectable state and predictors among children and adolescents living with HIV in South Gondar, Ethiopia, 2023: an 8-year retrospective cohort study
Chanie, E. S., Feleke, D. G., Emiru, T. D., Abuhay, A. G., Hailemeskel, H. S., Baye, A. A., Bantie, B., Amare, A. T., Nega, T. D., Anley, D. T., Dessie, A. M., Asnakew, S., Moges, N., Kassahun, W. M., Diress, M. A., Asfaw, A. K., Ferede, D. A., Wondifraw, E. B., Jimma, M. S., GebreEyesus, F. A., Chanie, S. S. BMJ Open, 27.10.2024 Tilføjet 27.10.2024 ObjectivesThe objective of this study is to examine the zonal-wide load undetectable state and predictors among children and adolescents living with HIV at South Gondar health institutions, 2023. DesignA retrospective cohort study. SettingSouth Gondar Health Institutions, Northwest, Ethiopia. ParticipantsWe recruited 430 children and adolescents living with HIV who had a follow-up at the antiretroviral therapy (ART) clinic at health institutions from 1 June 2016 to 30 April 2023. Outcome measuresThe primary outcome measure of this study was the viral load undetectable state estimation. Moreover, the study assessed the median time viral load undetectable state and its predictors by the Cox-proportional hazard model. Data were entered into Epi-data V.4.2 and exported to STATA V.17 statistical software for analysis. ResultsThe mean follow-up period was 8.5 (95% CI 8.1 to 8.9)±4.4 SD months, overall yielding 9151 person-month observations. At the end of the follow-up, 369 (85.8%, 95% CI 82.6% to 88.8%) of the children and adolescents achieved the viral load undetected state. Moreover, the overall median survival time to develop viral load undetectable state was found to be 6 months. The viral load undetected state in children and adolescents who have a cluster of differentiation 4 (CD4) count above the threshold level was 2.8 times higher than those in children and adolescents with a CD4 count lower than the threshold level (adjusted HR (AHR) 2.8 (95% CI 1.5, 5.3)). Likewise, the viral load undetected state in children and adolescents who have a good level of ART adherence was 2.0 times higher than those children and adolescents with a fair/poor level of ART adherence (AHR 2.0 (95% CI 1.1, 3.9)). Moreover, children and adolescents who had nutritional status ≥–2 Z score increased a viral load undetected state by 2.3 times as compared with children and adolescents with nutritional status Læs mere Tjek på PubMed13 Magnitude of anemia and associated factors among HIV infected children on antiretroviral therapy in Awi zone health facilities, Northwest Ethiopia, 2023
BMC Infectious Diseases, 27.10.2024 Tilføjet 27.10.2024 Abstract Background Anemia is a common complication of HIV infected children and it is enabling HIV disease progression, and decreasing survival. In Ethiopia, there is limited evidence on the prevalence of anemia and its associated factors among HIV infected children particularly in the Awi Zone. Therefore, this study aimed to assess the magnitude and associated factors of anemia among HIV infected children on ART aged from 6 months to 15 year-old in ART Clinic, Awi-Zone, Ethiopia. Objective To assess the magnitude and associated factors of anemia among HIV infected children on antiretroviral therapy in Awi zone health facilities, Northwest, Ethiopia, 2022. Methods A facility based cross-sectional study design was conducted from October to December 2022. A simple random sampling method was used to select the study participants. Descriptive statistics, including frequencies and proportions was used to summarize the study variables and data had been entered in to Epi data 4.2 and exported to SPSS version 25. Bivariable logistic regression followed by multivariable logistic regression was performed. Degree of association between dependent and independent variables had been assessed using adjusted odds ratio with 95% CI at p value of ≤ 0.05. Result From 346 participants in the selected sample 339 (97.9%) of them responded. Prevalence of anemia was 13.3% (n = 45) among which, majority (44.4%) of them had mild anemia, while about (42.2%,) had moderate anemia and around 13.3%, of them were severely anemic. Baseline CD4 count (AOR = 6.58, 95% CI: 2.85–15.22), WHO clinical stage III or IV (AOR = 8.42, 95% CI = 3.47, 20.45), hookworm infection (AOR = 5.06, 95% CI = 2.04, 12) and malaria infection (AOR = 4.92, 95% CI (2.19–11.02) were significantly associated with anemia among children on HAART. Conclusion The prevalence of anemia among participants was relatively low in this study. However, a considerable proportion of participants had moderate to severe anemia. Lower CD4 count at enrolment, advanced HIV clinical stage, malaria and hookworm infection were significantly linked with anemia. Thus, it requires regular monitoring of anemia status in these patients for better clinical outcomes and quality of life improvements. Læs mere Tjek på PubMed14 Magnitude of anemia and associated factors among HIV infected children on antiretroviral therapy in Awi zone health facilities, Northwest Ethiopia, 2023
BMC Infectious Diseases, 27.10.2024 Tilføjet 27.10.2024 Abstract Background Anemia is a common complication of HIV infected children and it is enabling HIV disease progression, and decreasing survival. In Ethiopia, there is limited evidence on the prevalence of anemia and its associated factors among HIV infected children particularly in the Awi Zone. Therefore, this study aimed to assess the magnitude and associated factors of anemia among HIV infected children on ART aged from 6 months to 15 year-old in ART Clinic, Awi-Zone, Ethiopia. Objective To assess the magnitude and associated factors of anemia among HIV infected children on antiretroviral therapy in Awi zone health facilities, Northwest, Ethiopia, 2022. Methods A facility based cross-sectional study design was conducted from October to December 2022. A simple random sampling method was used to select the study participants. Descriptive statistics, including frequencies and proportions was used to summarize the study variables and data had been entered in to Epi data 4.2 and exported to SPSS version 25. Bivariable logistic regression followed by multivariable logistic regression was performed. Degree of association between dependent and independent variables had been assessed using adjusted odds ratio with 95% CI at p value of ≤ 0.05. Result From 346 participants in the selected sample 339 (97.9%) of them responded. Prevalence of anemia was 13.3% (n = 45) among which, majority (44.4%) of them had mild anemia, while about (42.2%,) had moderate anemia and around 13.3%, of them were severely anemic. Baseline CD4 count (AOR = 6.58, 95% CI: 2.85–15.22), WHO clinical stage III or IV (AOR = 8.42, 95% CI = 3.47, 20.45), hookworm infection (AOR = 5.06, 95% CI = 2.04, 12) and malaria infection (AOR = 4.92, 95% CI (2.19–11.02) were significantly associated with anemia among children on HAART. Conclusion The prevalence of anemia among participants was relatively low in this study. However, a considerable proportion of participants had moderate to severe anemia. Lower CD4 count at enrolment, advanced HIV clinical stage, malaria and hookworm infection were significantly linked with anemia. Thus, it requires regular monitoring of anemia status in these patients for better clinical outcomes and quality of life improvements. Læs mere Tjek på PubMed15 Prevalence of medication overload among older people with HIV: a MedSafer study
BMC Infectious Diseases, 27.10.2024 Tilføjet 27.10.2024 Abstract Background Older people with HIV (PWH) are at risk of polypharmacy (taking multiple medications). Most medications may be necessary and indicated to manage HIV (e.g., antiretroviral therapy [ART]) and HIV-associated comorbidities. However, some are potentially inappropriate medications (PIMs), defined as causing greater harm than benefit, which leads to medication overload. The objective of this study was to characterize polypharmacy (taking multiple medications) and medication overload (prescription of ≥ 1 PIMs) among older PWH. Methods This retrospective study included older PWH (aged ≥ 50 years old) attending the tertiary care HIV clinic at the McGill University Health Centre (Montreal, Canada), from June 2022–June 2023. Patient characteristics, medications, and select laboratory values (e.g., CD4 count, hemoglobin A1C) were entered into the MedSafer software identifying PIMs and classifying them according to risk of adverse drug event. We measured the prevalence of polypharmacy (≥ 5 medications prescribed, both including and excluding ART) and medication overload (≥ 1 PIMs). Multivariable logistic regression identified factors associated with medication overload. Results The study included 100 patients, with a median age of 59 years (IQR = 54–63; range 50–82); 42% female. Polypharmacy affected 89% of patients when including antiretroviral therapy (ART) and 60% when excluding ART. Medication overload was present in 58% of patients, and 37.4% of identified PIMs were classified as high-risk. Polypharmacy was the sole predictor of medication overload. Conclusion Older PWH are at significant risk of medication overload and receiving higher risk PIMs. Deprescribing PIMs in this population could improve medication appropriateness while reducing the risk of ADEs. Læs mere Tjek på PubMed16 Prevalence of medication overload among older people with HIV: a MedSafer study
BMC Infectious Diseases, 27.10.2024 Tilføjet 27.10.2024 Abstract Background Older people with HIV (PWH) are at risk of polypharmacy (taking multiple medications). Most medications may be necessary and indicated to manage HIV (e.g., antiretroviral therapy [ART]) and HIV-associated comorbidities. However, some are potentially inappropriate medications (PIMs), defined as causing greater harm than benefit, which leads to medication overload. The objective of this study was to characterize polypharmacy (taking multiple medications) and medication overload (prescription of ≥ 1 PIMs) among older PWH. Methods This retrospective study included older PWH (aged ≥ 50 years old) attending the tertiary care HIV clinic at the McGill University Health Centre (Montreal, Canada), from June 2022–June 2023. Patient characteristics, medications, and select laboratory values (e.g., CD4 count, hemoglobin A1C) were entered into the MedSafer software identifying PIMs and classifying them according to risk of adverse drug event. We measured the prevalence of polypharmacy (≥ 5 medications prescribed, both including and excluding ART) and medication overload (≥ 1 PIMs). Multivariable logistic regression identified factors associated with medication overload. Results The study included 100 patients, with a median age of 59 years (IQR = 54–63; range 50–82); 42% female. Polypharmacy affected 89% of patients when including antiretroviral therapy (ART) and 60% when excluding ART. Medication overload was present in 58% of patients, and 37.4% of identified PIMs were classified as high-risk. Polypharmacy was the sole predictor of medication overload. Conclusion Older PWH are at significant risk of medication overload and receiving higher risk PIMs. Deprescribing PIMs in this population could improve medication appropriateness while reducing the risk of ADEs. Læs mere Tjek på PubMed17 Spatial distribution and factors associated with HIV testing among adolescent girls and young women in Sierra Leone
BMC Infectious Diseases, 26.10.2024 Tilføjet 26.10.2024 Abstract Background Sierra Leone faces a significant challenge in addressing HIV/AIDS, particularly among adolescent girls and young women. This age group is considered highly vulnerable due to biological factors and social inequalities. Understanding the prevalence of HIV testing in this demographic is crucial for designing effective prevention and treatment strategies. This study investigated the spatial distribution of HIV testing and its associated factors among adolescent girls and young women in Sierra Leone. Methods Data from the 2019 Sierra Leone Demographic and Health Survey was used for the study. The sample comprised 6,062 adolescent girls and young women between the ages of 15 and 24. Spatial autocorrelation and Moran’s I statistic were employed to analyze the spatial distribution of HIV testing. An analysis utilising mixed-effect multilevel binary logistic regression was performed to determine the factors associated with HIV testing. The findings were presented as adjusted odds ratios (aOR) and a 95% confidence interval (CI). Results The national prevalence of HIV testing among adolescents and young women in Sierra Leone was 42.1% [40.3,43.9]. Kailahun, Kambia, Tonkolil, some parts of the Western rural area, and Bonthe districts were found to be statistically significant hotspot for HIV testing. Whereas, Karene, Falaba, Bo, kenema, and some parts of Pujuhun were statistically cold spot districts. Adolescent girls and young women aged 20–24 [aOR = 1.63, 95% CI = 1.29, 2.07] had higher odds of HIV testing than those aged 15–19. Those with secondary/higher education [aOR = 1.87, 95% CI = 1.40, 2.51] had higher odds of HIV testing than those with no education. The odds of HIV testing was higher among adolescent girls and young women who use the Internet [aOR = 1.75, 95% CI = 1.32, 2.33] than those who did not use internet. Adolescent girls and young women with one [aOR = 16.56, 95% CI = 12.31, 22.29] and two or more parity [aOR = 16.37, 95% CI = 10.86, 24.68] had higher odds of HIV testing than those with no parity. The likelihood of HIV testing was higher among adolescent girls and young women who had sex below 18 [aOR = 4.54, 95% CI = 3.25, 6.34] and those who had sex at 18+ [aOR = 5.70, 95% CI = 3.84, 8.45] compared to those who had never had sex. Adolescent girls and young women who visited health facilities in the past 12 months [aOR = 1.82, 95% CI = 1.46, 2.26] had higher odds of HIV testing than those who did not. Conclusion Despite some positive trends, HIV testing rates among adolescent girls and young women in Sierra Leone remain moderate. Spatial autocorrelation analysis consistently revealed hotspots and cold spots for HIV testing, with Kailahun, Kambia, Tonkolil, some parts of the Western rural area, and Bonthe districts remaining persistent hotspots. Age, education, internet use, sexual history, parity, and healthcare access are significant factors influencing testing behaviour. To improve testing rates, the government and policymakers should prioritize educational campaigns, expand internet access, integrate HIV testing into routine healthcare, and address stigma associated with HIV. Læs mere Tjek på PubMed18 HIV replication and tuberculosis risk among people living with HIV in Europe: A multicohort analysis, 1983–2015
Andrew Atkinson, David Kraus, Nicolas Banholzer, Jose M. Miro, Peter Reiss, Ole Kirk, Cristina Mussini, Philippe Morlat, Daria Podlekareva, Alison D. Grant, Caroline Sabin, Marc van der Valk, Vincent Le Moing, Laurence Meyer, Remonie Seng, Antonella Castagna, Niels Obel, Anastasia Antoniadou, Dominique Salmon, Marcel Zwahlen, Matthias Egger, Stephane de Wit, Hansjakob Furrer, Lukas Fenner, The Opportunistic Infections Project Working Group of the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) in EuroCoord PLoS One Infectious Diseases, 26.10.2024 Tilføjet 26.10.2024 by Andrew Atkinson, David Kraus, Nicolas Banholzer, Jose M. Miro, Peter Reiss, Ole Kirk, Cristina Mussini, Philippe Morlat, Daria Podlekareva, Alison D. Grant, Caroline Sabin, Marc van der Valk, Vincent Le Moing, Laurence Meyer, Remonie Seng, Antonella Castagna, Niels Obel, Anastasia Antoniadou, Dominique Salmon, Marcel Zwahlen, Matthias Egger, Stephane de Wit, Hansjakob Furrer, Lukas Fenner, The Opportunistic Infections Project Working Group of the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) in EuroCoord Introduction HIV replication leads to a change in lymphocyte phenotypes that impairs immune protection against opportunistic infections. We examined current HIV replication as an independent risk factor for tuberculosis (TB). Methods We included people living with HIV from 25 European cohorts 1983–2015. Individuals Læs mere Tjek på PubMed19 Determination of the mean duration of recent infection and false recency rate for the HIV triplex multiplex bead assay
Robert A. Domaoal, Jeni Vuong, Amy Zheng, Mervi Detorio, Bharat S. Parekh, Ernest L. Yufenyuy PLoS One Infectious Diseases, 26.10.2024 Tilføjet 26.10.2024 by Robert A. Domaoal, Jeni Vuong, Amy Zheng, Mervi Detorio, Bharat S. Parekh, Ernest L. Yufenyuy Background We developed the HIV Triplex multiplex bead assay to identify and serotype HIV infection with high sensitivity and specificity; and distinguish recent from long-term HIV-1 infections. It can facilitate accurate incidence estimation, while reducing the number of tests and blood collected, which is highly desirable for use in future studies and surveys. Using previously collected, treatment-naive longitudinal seroconversion HIV-1 positive panels and specimens from individuals infected for >12 months, we determined the assay’s mean duration of recent infection (MDRI) and false-recency rate (FRR) respectively, at various mean fluorescent intensity (MFI) cutoffs. Methods We tested seroconversion specimens (N = 814) from 142 individuals infected with HIV-1 subtypes B, C, or AE, and 1341 cross-sectional specimens from individuals infected >12 months. The MFI cutoffs of 1000 to 2000 were evaluated for recency classification, including an MFI of 1250 corresponding to the limiting antigen avidity enzyme immunoassay (LAg-EIA) cutoff of 1.5 normalized optical density for MDRI and FRR. We used four statistical methods: Methods 1 and 2 used the empirically balanced observation time approach. Method 2 MFI values were raised to power = 1.33, based on a repeated measures model to linearize the relationship between MFI and time points, whereas Method 1 was not linearized. Methods 3 and 4 employed quadratic and linear interpolations for each seroconversion panel. FRR was calculated by dividing the number of specimens misclassified as recent by the total number of specimens tested. Results MDRI values ranged from 135–146 days at MFI = 1000 to 229–279 days at MFI = 2000 by the 4 methods. FRR varied from 0.15%-1.27% with increasing MFI cutoff. At MFI = 1250, the average MDRI of 4 methods was 169 days and ranged from 159–183 with overlapping 95% CIs and FRR = 0.52%. Conclusion The HIV Triplex assay demonstrates a longer dynamic range compared to current HIV recency assays with a low FRR for cutoffs examined. With a longer dynamic range and low FRR, the MDRI for recent infection can be extended as appropriate to detect more recent infections, increasing the value of incidence assays benefiting public health surveillance and future surveys. Læs mere Tjek på PubMed20 HIV self-testing: A highly acceptable and feasible strategy for reconnecting street adolescents with HIV screening and prevention services in Togo (The STADOS study)
Arnold Junior Sadio, Harold Régis Kouanfack, Rodion Yao Konu, Fifonsi Adjidossi Gbeasor-Komlanvi, Gagnon Kwami Azialey, Herbert Kokou Gounon, Martin Kouame Tchankoni, Amivi Phyllis Amenyah-Ehlan, Anoumou Claver Dagnra, Didier Koumavi Ekouevi PLoS One Infectious Diseases, 25.10.2024 Tilføjet 25.10.2024 by Arnold Junior Sadio, Harold Régis Kouanfack, Rodion Yao Konu, Fifonsi Adjidossi Gbeasor-Komlanvi, Gagnon Kwami Azialey, Herbert Kokou Gounon, Martin Kouame Tchankoni, Amivi Phyllis Amenyah-Ehlan, Anoumou Claver Dagnra, Didier Koumavi Ekouevi Introduction HIV self-testing is a complementary screening strategy that could facilitate access to HIV care services for street adolescents. The objectives of this study were to assess the acceptability and feasibility of HIV self-testing and their associated factors, to estimate HIV prevalence among street adolescents in Togo, and to describe the sexual behavior of this population. Methods A cross-sectional study was conducted between July 2021 and May 2022 in Lomé and Kara (Togolese cities with the highest number of street adolescents). Street adolescents aged 13–19 years were included. An oral HIV self-test (OraQuick®) was used. Acceptability was defined as the proportion of adolescents who completed the test, and feasibility was defined as the proportion of adolescents who reported a test with a valid result. An HIV serological test was performed for all participants. A weighted logistic regression model was used to identify the factors associated with the acceptability and feasibility of HIV self-testing. Results A total of 432 street adolescents (12.3% female) with a median age of 15 years, interquartile range (IQR) [14–17], were included in this study. Of the 231 sexually active adolescents, only 30.3% (n = 70) reported having used a condom during their last sexual intercourse. HIV self-test was offered to a sub-sample of 294 street adolescents. Acceptability was 96.6% (284/294), (95%CI = [93.8–98.3]) and feasibility 98.9% (281/284), (95%CI = [97.0–100.0]). Being 16 years of age or older (aOR = 28.84; p Læs mere Tjek på PubMed |
European Congress of Immunology (ECI) 2024
Dublin, Irland
Fredag d. 1. november
Gå-hjem møde om syfilis (2024)
Hvidovre Hospital
Torsdag d. 7. november
Gentofte Hospital
Fredag d. 8. november
Glasgow, Skotland
Søndag d. 10. november
Fredericia
Torsdag d. 14. november
COVID-19 retningslinje (2024v30)
Tilføjet 28. oktober 2024
Tilføjet 27. oktober 2024
Tilføjet 22. oktober 2024
Retningslinjer for screening og profylakse før behandling med biologiske lægemidler (2023)
Tilføjet 9. januar 2024
Antiretroviral behandling af HIV-smittede personer (2024)
Tilføjet 9. januar 2024
Journal of Medical Virology
Tilføjet 29. oktober 2024
International Journal of Infectious Diseases
Tilføjet 29. oktober 2024
Prevalence of medication overload among older people with HIV: a MedSafer study
BMC Infectious Diseases
Tilføjet 29. oktober 2024
Critical Care Medicine
Tilføjet 29. oktober 2024
AIDS
Tilføjet 29. oktober 2024
Cow's Milk Containing Avian Influenza A(H5N1) Virus - Heat Inactivation and Infectivity in Mice.
Udvalgt og kommenteret af Professor Lars Østergaard
Tilføjet 9. juni 2024
Udvalgt og kommenteret af Professor Troels Lillebæk
Tilføjet 29. november 2023
Hydrocortisone in Severe Community-Acquired Pneumonia.
Udvalgt og kommenteret af Professor Lars Østergaard
Tilføjet 27. september 2023
Randomized Trial of BCG Vaccine to Protect against Covid-19 in Health Care Workers.
Udvalgt og kommenteret af Professor Niels Obel
Tilføjet 27. september 2023
Udvalgt og kommenteret af Professor Troels Lillebæk
Tilføjet 22. september 2023
Urinstix som klinisk beslutningsstøtte (2024)
Uploadet 20. september 2024
Uploadet 13. maj 2021
Akut bakteriel meningitis (2018)
Uploadet 12. maj 2021
Guidelines for diagnostik og behandling af spondylodiskitis (2018)
Uploadet 12. maj 2021
Borrelia klaringsrapport (2014)
Uploadet 12. maj 2021