Dataset Information

Weight change after antiretroviral therapy initiation among adults living with HIV in Northwest Ethiopia: a longitudinal data analysis.

ABSTRACT:

Objectives

The first objective was to explore weight change in the first 2 years after antiretroviral therapy (ART) initiation in adults living with HIV. The second objective was to identify the predictors of weight change over time among adults living with HIV on ART.

Design

An institution-based retrospective longitudinal study was conducted.

Setting

The study was conducted at Debre Markos Comprehensive Specialized Hospital, Northwest Ethiopia.

Participants

The study included 848 randomly selected medical charts of adults living with HIV receiving ART between June 2014 and June 2020.

Primary and secondary outcomes

The primary outcome was weight change in the first 2 years after ART initiation. The secondary outcome was to identify predictors of weight change. Association between predictor variables and weight change was assessed using an LMM. Variables with p values <0.05 in the final model were considered as statistically significant predictors of weight change.

Results

Of 844 study participants, more than half (n=499; 58.8%) were female. Participants' mean weight increased from 54.2 kg (SD ±9.6 kg) at baseline to 59.5 kg (SD ±10.7 kg) at the end of follow-up. Duration of time on ART, sex, WHO clinical disease staging, functional status, nutritional status and presence of opportunistic infections were significant predictors of weight change at ART initiation. Significant interaction effects were observed between time and sex, WHO clinical disease staging, functional status, isoniazid preventive therapy and nutritional status.

Conclusion

We found a linear increment of weight over 24 months of follow-up. Rate of weight gain over time was lower in patients with advanced disease stage and working functional status, whereas weight gain rate was higher in male and underweight patients.

SUBMITTER: Alebel A

PROVIDER: S-EPMC8808440 | biostudies-literature | 2022 Feb

REPOSITORIES: biostudies-literature

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Publications

Weight change after antiretroviral therapy initiation among adults living with HIV in Northwest Ethiopia: a longitudinal data analysis.

Alebel Animut A Demant Daniel D Petrucka Pammla Margaret PM Sibbritt David D

BMJ open 20220201 2

<h4>Objectives</h4>The first objective was to explore weight change in the first 2 years after antiretroviral therapy (ART) initiation in adults living with HIV. The second objective was to identify the predictors of weight change over time among adults living with HIV on ART.<h4>Design</h4>An institution-based retrospective longitudinal study was conducted.<h4>Setting</h4>The study was conducted at Debre Markos Comprehensive Specialized Hospital, Northwest Ethiopia.<h4>Participants</h4>The stud ...[more]

PMID: 35105589

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Project description:BACKGROUND:Effective self-management is an important consideration for adults living with HIV on therapy to enable people to maintain their health and well-being whilst living with chronic HIV. Although numerous attempts have been made to implement and improve HIV self-management practice, there is limited evidence on effective self-management strategies, particularly in sub-Saharan Africa. This study aimed to identify the level and factors influencing the self-management practice of adults living with HIV on antiretroviral therapy. METHODS:A cross-sectional survey was conducted on a sample of 415 adults living with HIV on antiretroviral therapy at a major referral hospital in Northwest Ethiopia using convenience sampling. A theory of self-management - the Individual and Family Self-Management Theory - guided the study design, analysis and presentation of the data. A face-to-face survey tool was administered for data collection, and the data were entered and analyzed using SPSS version 25.0. RESULTS:Over half (58.1%) of the respondents were female. Many of the respondents did not know their HIV stage (76.9%) but reported adequate knowledge of their treatment (79.5%). The mean self-management score was 1.94+?0.22 out of a total score of 3. Female gender was associated with decreased self-management. Contextual factors (gender, educational level, job status, income, living in a rural area, and awareness of HIV stage) explained 8.2% of the variance in self-management. The explanatory power increased by 9.2% when self-management process variables (self-efficacy, setting a goal, knowledge of antiretroviral therapy, HIV disclosure, and use of reminders) were added. Intervention-focused variables (encouraging disclosure and adherence support) increased the proportion of explained variance by 2.3%. CONCLUSIONS:The findings of the study indicate that the level of self-management practice amongst the population studied was low compared to international literature. Our study findings support the theoretical model and previously identified factors influencing HIV self-management. The most important predictors of lower self-management practice in Ethiopia were female gender, illiteracy, lack of awareness of HIV stage, low self-efficacy, absence of reminders, lack of encouragement to disclose and absence of adherence support. HIV care providers should seek ways to empower and support adults living with HIV to self-manage, particularly through enhancing self-efficacy and encouraging the use of reminders.

Project description:This is the first study to report changes in BMD and related risk factors among Chinese patients with HIV after initiation of tenofovir disoproxil fumarate (TDF)-containing antiretroviral therapy. Greater bone mineral density (BMD) loss was observed in patients treated with TDF, compared to those on non-TDF-containing regimens. Our findings provide important knowledge regarding the risk factors in the long-term clinical management of patients with HIV in China.IntroductionPersons living with HIV (PLWH) are at increased risk for osteoporosis and fracture. Tenofovir disoproxil fumarate (TDF) has been associated with higher rates of bone mineral density (BMD) loss, osteoporosis, and fracture. Few studies have studied the impact among PLWH in Asia.MethodsWe analyzed retrospectively patients from the outpatient HIV clinic of a large tertiary hospital in Beijing, China, from March 2007 to May 2016. Patients who had dual-energy X-ray absorptiometry testing prior to antiretroviral initiation and at 48 and/or 96 weeks after initiation were included in this analysis.ResultsA total of 136 patients were included (mean age 36.0 ± 10.6 years) and over 90% participants were male and Han Chinese ethnicity. We observed greater declines in BMD at the spine from baseline to week 48 (-2.94% vs. -0.74%) and at the hip from baseline to week 96 (-4.37% vs. -2.34%) in the TDF group compared with the non-TDF group. With regard to HIV-specific parameters, longer duration since HIV diagnosis and undetectable viral load over time were associated with lower BMD at the hip [relative risk (RR) 0.97, 95% confidence index (CI) (0.95, 0.99) per 1 year increase and RR 0.96, 95%CI (0.94, 0.99), respectively] and femoral neck [RR 0.97, 95%CI (0.95, 0.99) per 1 year increase and RR 0.97, 95%CI (0.95, 0.998), respectively] over 96 weeks.ConclusionsThis is the first study to report changes in BMD among PLWH after initiation of TDF-based antiretroviral therapy in China. Our findings provide important knowledge for the long-term clinical management of PLWH from this region.

Project description:BackgroundDespite antiretroviral therapy (ART) being widely available, HIV continues to cause substantial illness and premature death in low-and-middle-income countries. High rates of loss to follow-up after HIV diagnosis can delay people starting ART. Starting ART within seven days of HIV diagnosis (rapid ART initiation) could reduce loss to follow-up, improve virological suppression rates, and reduce mortality.ObjectivesTo assess the effects of interventions for rapid initiation of ART (defined as offering ART within seven days of HIV diagnosis) on treatment outcomes and mortality in people living with HIV. We also aimed to describe the characteristics of rapid ART interventions used in the included studies.Search methodsWe searched CENTRAL, the Cochrane Database of Systematic Reviews, MEDLINE, Embase, and four other databases up to 14 August 2018. There was no restriction on date, language, or publication status. We also searched ClinicalTrials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform, and websites for unpublished literature, including conference abstracts.Selection criteriaWe included randomized controlled trials (RCTs) that compared rapid ART versus standard care in people living with HIV. Children, adults, and adolescents from any setting were eligible for inclusion.Data collection and analysisTwo review authors independently assessed the eligibility of the studies identified in the search, assessed the risk of bias and extracted data. The primary outcomes were mortality and virological suppression at 12 months. We have presented all outcomes using risk ratios (RR), with 95% confidence intervals (CIs). Where appropriate, we pooled the results in meta-analysis. We assessed the certainty of the evidence using the GRADE approach.Main resultsWe included seven studies with 18,011 participants in the review. All studies were carried out in low- and middle-income countries in adults aged 18 years old or older. Only one study included pregnant women.In all the studies, the rapid ART intervention was offered as part of a package that included several cointerventions targeting individuals, health workers and health system processes delivered alongside rapid ART that aimed to facilitate uptake and adherence to ART.Comparing rapid ART with standard initiation probably results in greater viral suppression at 12 months (RR 1.18, 95% CI 1.10 to 1.27; 2719 participants, 4 studies; moderate-certainty evidence) and better ART uptake at 12 months (RR 1.09, 95% CI 1.06 to 1.12; 3713 participants, 4 studies; moderate-certainty evidence), and may improve retention in care at 12 months (RR 1.22, 95% CI 1.11 to 1.35; 5001 participants, 6 studies; low-certainty evidence). Rapid ART initiation was associated with a lower mortality estimate, however the CIs included no effect when compared to standard of care (RR 0.72, 95% CI 0.51 to 1.01; 5451 participants, 7 studies; very low-certainty evidence). It is uncertain whether rapid ART has an effect on modification of ART treatment regimens as data are lacking (RR 7.89, 95% CI 0.76 to 81.74; 977 participants, 2 studies; very low-certainty evidence). There was insufficient evidence to draw conclusions on the occurrence of adverse events.Authors' conclusionsRCTs that include initiation of ART within one week of diagnosis appear to improve outcomes across the HIV treatment cascade in low- and middle-income settings. The studies demonstrating these effects delivered rapid ART combined with several setting-specific cointerventions. This highlights the need for pragmatic research to identify feasible packages that assure the effects seen in the trials when delivered through complex health systems.

Project description:BackgroundCD4 cell counts is widely used as a biomarker for treatment progression when studying the efficacy of drugs to treat HIV-infected patients. In the past, it had been also used in determining eligibility to initiate antiretroviral therapy. The main aim of this was to model the evolution of CD4 counts over time and use this model for an early prediction of subject-specific time to cross a pre-specified CD4 threshold.MethodsHospital based retrospective cohort study of HIV-infected patients was conducted from January 2009 to December 2014 at University of Gondar hospital, Northwest Ethiopia. Fractional polynomial random effect model is used to model the evolution of CD4 counts over time in response to treatment and to estimate the individual probability to be above a pre-selected CD4 threshold. Human subject research approval for this study was received from University of Gondar Research Ethics Committee and the medical director of the hospital.ResultsA total of 1347 patients were included in the analysis presented in this paper. The cohort contributed a total of 236.58 per 100 person-years of follow-up. Later the data were divided into two periods: the first is the estimation period in which the parameters of the model are estimated and the second is the prediction period. Based on the parameters from the estimation period, model based prediction for the time to cross a threshold was estimated. The correlations between observed and predicted values of CD4 levels in the estimation period were 0.977 and 0.982 for Neverapine and Efavirenz containing regimens, respectively; while the correlation between the observed and predicted CD4 counts in the prediction period are 0.742 and 0.805 for NVP and EFV, respectively.ConclusionsThe model enables us to estimate a subject-specific expected time to cross a CD4 threshold and to estimate a subject-specific probability to have CD4 count above a pre-specified threshold at each time point. By predicting long-term outcomes of CD4 count of the patients one can advise patient about the potential ART benefits that accrue in the long-term.

Dataset Information

Weight change after antiretroviral therapy initiation among adults living with HIV in Northwest Ethiopia: a longitudinal data analysis.

Objectives

Design

Setting

Participants

Primary and secondary outcomes

Results

Conclusion

Publications

Weight change after antiretroviral therapy initiation among adults living with HIV in Northwest Ethiopia: a longitudinal data analysis.

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