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1.
JAMA Netw Open ; 5(6): e2215934, 2022 Jun 01.
Article in English | MEDLINE | ID: covidwho-1877538

ABSTRACT

Importance: Recommendations for additional doses of COVID-19 vaccines for people with HIV (PWH) are restricted to those with advanced disease or unsuppressed HIV viral load. Understanding SARS-CoV-2 infection risk after vaccination among PWH is essential for informing vaccination guidelines. Objective: To estimate the rate and risk of breakthrough infections among fully vaccinated PWH and people without HIV (PWoH) in the United States. Design, Setting, and Participants: This cohort study used the Corona-Infectious-Virus Epidemiology Team (CIVET)-II (of the North American AIDS Cohort Collaboration on Research and Design [NA-ACCORD], which is part of the International Epidemiology Databases to Evaluate AIDS [IeDEA]), collaboration of 4 prospective, electronic health record-based cohorts from integrated health systems and academic health centers. Adult PWH who were fully vaccinated prior to June 30, 2021, were matched with PWoH on date of full vaccination, age, race and ethnicity, and sex and followed up through December 31, 2021. Exposures: HIV infection. Main Outcomes and Measures: COVID-19 breakthrough infections, defined as laboratory evidence of SARS-CoV-2 infection or COVID-19 diagnosis after a patient was fully vaccinated. Results: Among 113 994 patients (33 029 PWH and 80 965 PWoH), most were 55 years or older (80 017 [70%]) and male (104 967 [92%]); 47 098 (41%) were non-Hispanic Black, and 43 218 (38%) were non-Hispanic White. The rate of breakthrough infections was higher in PWH vs PWoH (55 [95% CI, 52-58] cases per 1000 person-years vs 43 [95% CI, 42-45] cases per 1000 person-years). Cumulative incidence of breakthroughs 9 months after full vaccination was low (3.8% [95% CI, 3.7%-3.9%]), albeit higher in PWH vs PWoH (4.4% vs 3.5%; log-rank P < .001; risk difference, 0.9% [95% CI, 0.6%-1.2%]) and within each vaccine type. Breakthrough infection risk was 28% higher in PWH vs PWoH (adjusted hazard ratio, 1.28 [95% CI, 1.19-1.37]). Among PWH, younger age (<45 y vs 45-54 y), history of COVID-19, and not receiving an additional dose (aHR, 0.71 [95% CI, 0.58-0.88]) were associated with increased risk of breakthrough infections. There was no association of breakthrough with HIV viral load suppression, but high CD4 count (ie, ≥500 cells/mm3) was associated with fewer breakthroughs among PWH. Conclusions and Relevance: In this study, COVID-19 vaccination, especially with an additional dose, was effective against infection with SARS-CoV-2 strains circulating through December 31, 2021. PWH had an increased risk of breakthrough infections compared with PWoH. Expansion of recommendations for additional vaccine doses to all PWH should be considered.


Subject(s)
Acquired Immunodeficiency Syndrome , COVID-19 , HIV Infections , Acquired Immunodeficiency Syndrome/complications , Adult , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Testing , COVID-19 Vaccines/therapeutic use , Cohort Studies , HIV Infections/complications , HIV Infections/epidemiology , Humans , Male , Prospective Studies , SARS-CoV-2 , United States/epidemiology
2.
Int J Environ Res Public Health ; 19(10)2022 05 12.
Article in English | MEDLINE | ID: covidwho-1875623

ABSTRACT

Acquired immune deficiency syndrome (AIDS) is a serious public health problem. This study aims to establish a combined model of seasonal autoregressive integrated moving average (SARIMA) and Prophet models based on an L1-norm to predict the incidence of AIDS in Henan province, China. The monthly incidences of AIDS in Henan province from 2012 to 2020 were obtained from the Health Commission of Henan Province. A SARIMA model, a Prophet model, and two combined models were adopted to fit the monthly incidence of AIDS using the data from January 2012 to December 2019. The data from January 2020 to December 2020 was used to verify. The mean square error (MSE), mean absolute error (MAE), and mean absolute percentage error (MAPE) were used to compare the prediction effect among the models. The results showed that the monthly incidence fluctuated from 0.05 to 0.50 per 100,000 individuals, and the monthly incidence of AIDS had a certain periodicity in Henan province. In addition, the prediction effect of the Prophet model was better than SARIMA model, the combined model was better than the single models, and the combined model based on the L1-norm had the best effect values (MSE = 0.0056, MAE = 0.0553, MAPE = 43.5337). This indicated that, compared with the L2-norm, the L1-norm improved the prediction accuracy of the combined model. The combined model of SARIMA and Prophet based on the L1-norm is a suitable method to predict the incidence of AIDS in Henan. Our findings can provide theoretical evidence for the government to formulate policies regarding AIDS prevention.


Subject(s)
Acquired Immunodeficiency Syndrome , Acquired Immunodeficiency Syndrome/epidemiology , China/epidemiology , Forecasting , Humans , Incidence , Models, Statistical
3.
AIDS Res Hum Retroviruses ; 38(5): 399-400, 2022 05.
Article in English | MEDLINE | ID: covidwho-1864938

ABSTRACT

A 38-year-old male patient presented to the emergency department with fever and dyspnea. Hospitalization was warranted and soon coronavirus disease 2019 (COVID-19) was diagnosed based on a positive SARS-CoV-2-PCR. Over the following weeks his condition gradually worsened, leading to admission at the intensive care unit. Because of unexplained weight loss before admission, a HIV screening was performed. HIV was confirmed and additional tests showed an undetectable CD4+ T cell count, alongside a number of co-infections. Convalescent plasma therapy, which has been shown to be effective in severe humoral immunodeficiency was tried, but was not effective. One week after the HIV diagnosis, antiretroviral therapy was started and finally, 3 months after the initial positive test and after partial recovery of cellular immunity, the COVID-19 virus was cleared. In the end, the patient made a full recovery. Our case demonstrates a prolonged COVID-19 infection in a patient with undiagnosed HIV with severely impaired cellular immunity.


Subject(s)
Acquired Immunodeficiency Syndrome , COVID-19 , Coinfection , HIV Infections , Adult , COVID-19/diagnosis , COVID-19/therapy , Coinfection/diagnosis , HIV Infections/complications , Humans , Immunization, Passive , Male , SARS-CoV-2
4.
Epidemiol Infect ; 150: e112, 2022 May 26.
Article in English | MEDLINE | ID: covidwho-1864714

ABSTRACT

India has the third-largest burden of human immunodeficiency virus (HIV) infection in the world. The coronavirus disease 2019 (COVID-19) pandemic has only exposed the cracks in the Indian healthcare infrastructure concerning HIV. The prevalence of HIV in India is more among the destitute or sections of society shrouded by years of social stigma such as prostitutes, truck drivers, transsexuals and intravenous drug users. National AIDS Control Organisation and The Joint United Nations Programme on HIV/AIDS (UNAIDS) organisation have many several efforts over the years to set up counselling and testing centres all over the country and spread awareness about HIV among the masses. COVID-19 pandemic has reversed years of progress made by the same. HIV patients are biologically more susceptible to COVID-19, and the lockdown has led to the loss of jobs, economic crises, shortage of drugs and necessities such as food and housing among this vulnerable population, which can result in lowered CD4-T cell counts in the coming months and make way for dangerous opportunistic infection outbreaks in this population increasing the overall HIV burden of India. This article explores how COVID-19 has impacted India's already existing HIV epidemic and tries to put forth recommendations based on the evidence found to be better prepared in treating the HIV-positive population in India in the face of another catastrophe like the COVID-19.


Subject(s)
Acquired Immunodeficiency Syndrome , COVID-19 , HIV Infections , Acquired Immunodeficiency Syndrome/epidemiology , COVID-19/epidemiology , Communicable Disease Control , Delivery of Health Care , HIV Infections/epidemiology , Humans , India/epidemiology , Pandemics
5.
Am J Case Rep ; 23: e936257, 2022 May 25.
Article in English | MEDLINE | ID: covidwho-1863324

ABSTRACT

BACKGROUND The iceberg phenomenon (in which the most of a problem is invisible) of people living with HIV/AIDS, particularly those with unknown HIV status, has been epidemiologically challenging. Central nervous system (CNS) opportunistic infections in patients with HIV/AIDS are one of the leading causes of morbidity and mortality in people living with HIV/AIDS. There are currently limited data on the immunogenicity, safety, and efficacy of COVID-19 vaccines in people living with HIV/AIDS with its associated opportunistic CNS infections as well as those without antiretroviral treatment. CASE REPORT Two young men with previously unknown HIV status and its related opportunistic infections received their first doses of COVID-19 vaccine (Vero Cell), inactivated. Both patients had the risk factor of having sex with men (men who have sex with men). Fever and first neurological symptoms occurred within the first few days after vaccination. Both patients were hospitalized and were tested positive for HIV for the first time. Both were further diagnosed from brain imaging as having CNS opportunistic infections. A presumptive diagnosis of cerebral toxoplasmosis was established as the working diagnosis according to the laboratory and epidemiological factors. Despite the treatment, neurological and clinical deficits worsened and eventually led to death in both patients. CONCLUSIONS The causality analyses showed that both adverse events had a possible inconsistent causal relationship to COVID-19 vaccination. Our cases may reflect the need for further studies on the safety of COVID-19 vaccines in people with HIV/AIDS-associated CNS opportunistic infection as well as people with HIV/AIDS who never receive antiretroviral treatment (ART).


Subject(s)
AIDS-Related Opportunistic Infections , Acquired Immunodeficiency Syndrome , COVID-19 Vaccines , COVID-19 , HIV Infections , Sexual and Gender Minorities , AIDS-Related Opportunistic Infections/complications , AIDS-Related Opportunistic Infections/diagnosis , Acquired Immunodeficiency Syndrome/complications , Brain/diagnostic imaging , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Central Nervous System/physiopathology , HIV Infections/complications , Homosexuality, Male , Humans , Incidence , Male , Vaccination/adverse effects
6.
Int J STD AIDS ; 33(7): 734-735, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1854656
7.
PLoS One ; 17(5): e0268280, 2022.
Article in English | MEDLINE | ID: covidwho-1833664

ABSTRACT

BACKGROUND: COVID-19 is a global public health problem causing high mortality worldwide. This study aimed to assess time to death and predictors of mortality among patients hospitalized for COVID-19 in the Arsi zone treatment center. METHOD: We performed a retrospective observational cohort study using medical records of laboratory-confirmed COVID-19 cases hospitalized at Bokoji Hospital COVID-19 treatment center from 1st July 2020 to 5th March 2021. We extracted data on the patients' sociodemographic and clinical characteristics from medical records of hospitalized patients retrospectively. We carried out Kaplan Meier and Cox regression analysis to estimate survival probability and investigate predictors of COVID-19 death 5% level of significance. The Adjusted Hazard Ratio (aHR) with 95% Confidence Interval (CI) was estimated and interpreted for predictors of time to death in the final cox model. RESULT: A total of 422 COVID-19 patients treated were analyzed, of these more than one tenth (11.14%) deaths, with a mortality rate of 6.35 cases per 1000 person-days. The majority (87.2%) of deaths occurred within the first 14 days of admission, with a median time-to-death of nine (IQR: 8-12) days. We found patients that age between 31 and 45 years (aHR = 2.55; 95% CI: (1.03, 6.34), older than 46 years (aHR = 2.59 (1.27, 5.30), chronic obstructive pulmonary disease (aHR = 4.60, 95%CI: (2.37, 8.91), Chronic kidney disease (aHR = 5.58, 95%CI: (1.70, 18.37), HIV/AIDS (aHR = 3.66, 95%CI: (1.20, 11.10), admission to the Intensive care unit(aHR = 7.44, 95%CI: (1.82, 30.42), and being on intranasal oxygen care (aHR = 6.27, 95%CI: (2.75, 4.30) were independent risk factors increasing risk of death from COVID-19 disease than their counterparts. CONCLUSION: The risk of dying due to COVID-19 disease was higher among patients with HIV/AIDS, chronic obstructive pulmonary disease, and chronic kidney diseases. We also found that older people, those admitted to ICU, and patients who received intranasal oxygen care had a higher risk of dying due to COVID-19 disease. Therefore, close monitoring hospitalized patients that are old aged and those with comorbidities after hospitalization is crucial within the first ten days of admission.


Subject(s)
Acquired Immunodeficiency Syndrome , COVID-19 , Pulmonary Disease, Chronic Obstructive , Adult , Aged , COVID-19/drug therapy , COVID-19/epidemiology , Ethiopia/epidemiology , Hospitals , Humans , Middle Aged , Oxygen , Proportional Hazards Models , Pulmonary Disease, Chronic Obstructive/epidemiology , Retrospective Studies , Risk Factors
8.
BMC Health Serv Res ; 22(1): 622, 2022 May 09.
Article in English | MEDLINE | ID: covidwho-1833312

ABSTRACT

BACKGROUND: The COVID-19 pandemic thrust people living with HIV (PLWH) and HIV/AIDS service organizations into an environment ripe with uncertainty. This study examined Indiana HIV/AIDS service provider perceptions of how COVID-19 affected the overall health and access to care of their clients, and how the organizations prepared for, adapted, and responded to the needs of PLWH during the pandemic. METHODS: Guided by the socioecological model, fifteen semi-structured interviews were conducted with ten different HIV/AIDS service organizations across the state of Indiana. RESULTS: Despite the profound disruptions experienced by HIV programs, HIV/AIDS service organizations responded quickly to the challenges posed by the COVID-19 pandemic through myriad innovative strategies, largely informed by prior experiences with the HIV epidemic. CONCLUSIONS: The lessons provided by HIV/AIDS service organizations are invaluable to informing future pandemic response for PLWH. Service delivery innovations in response to the COVID-19 crisis may provide insights to improve HIV care continuity strategies for vulnerable populations far beyond the pandemic.


Subject(s)
Acquired Immunodeficiency Syndrome , COVID-19 , HIV Infections , Acquired Immunodeficiency Syndrome/epidemiology , COVID-19/epidemiology , HIV Infections/epidemiology , HIV Infections/therapy , Humans , Indiana/epidemiology , Pandemics , SARS-CoV-2
9.
Comput Math Methods Med ; 2022: 1556025, 2022.
Article in English | MEDLINE | ID: covidwho-1822100

ABSTRACT

Due to the proliferation of COVID-19, the world is in a terrible condition and human life is at risk. The SARS-CoV-2 virus had a significant impact on public health, social issues, and financial issues. Thousands of individuals are infected on a regular basis in India, which is one of the populations most seriously impacted by the pandemic. Despite modern medical and technical technology, predicting the spread of the virus has been extremely difficult. Predictive models have been used by health systems such as hospitals, to get insight into the influence of COVID-19 on outbreaks and possible resources, by minimizing the dangers of transmission. As a result, the main focus of this research is on building a COVID-19 predictive analytic technique. In the Indian dataset, Prophet, ARIMA, and stacked LSTM-GRU models were employed to forecast the number of confirmed and active cases. State-of-the-art models such as the recurrent neural network (RNN), gated recurrent unit (GRU), long short-term memory (LSTM), linear regression, polynomial regression, autoregressive integrated moving average (ARIMA), and Prophet were used to compare the outcomes of the prediction. After predictive research, the stacked LSTM-GRU model forecast was found to be more consistent than existing models, with better prediction results. Although the stacked model necessitates a large dataset for training, it aids in creating a higher level of abstraction in the final results and the maximization of the model's memory size. The GRU, on the other hand, assists in vanishing gradient resolution. The study findings reveal that the proposed stacked LSTM and GRU model outperforms all other models in terms of R square and RMSE and that the coupled stacked LSTM and GRU model outperforms all other models in terms of R square and RMSE. This forecasting aids in determining the future transmission paths of the virus.


Subject(s)
Acquired Immunodeficiency Syndrome , COVID-19 , COVID-19/epidemiology , Forecasting , Humans , India/epidemiology , Pandemics , SARS-CoV-2
11.
Glob Health Sci Pract ; 10(2)2022 Apr 28.
Article in English | MEDLINE | ID: covidwho-1818691

ABSTRACT

INTRODUCTION: The coronavirus disease (COVID-19) pandemic and resulting lockdowns have disrupted health care service delivery globally. This includes disruptions in harm reduction and HIV service delivery for people who inject drugs (PWID), a population at high risk for not only COVID-19 but also poor HIV and drug-treatment access. However, little is known about these issues in Kazakhstan. We examined harm reduction provider experiences with delivering services and regulatory changes during the COVID-19 pandemic. METHODS: We conducted in-depth interviews with 24 nurses, social workers, and doctors serving both HIV-positive and HIV-negative PWID at 13 needle and syringe programs (NSPs) and 4 AIDS Centers (HIV treatments centers) in Kazakhstan from May to August 2020. Participants were asked how the COVID-19 pandemic had impacted their PWID clients' risks, their organizational environment, and the services offered to PWID over the prior 3-6 months. Thematic content analysis was used to elicit findings. FINDINGS: The COVID-19 pandemic considerably impacted NSP and AIDS Center operations. Participants perceived high risks of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection for themselves and their clients, as well as pandemic-related increases in substance use and HIV risks for clients. Organizations instituted several policy and regulatory changes to adapt to the pandemic, most notably tasking NSPs with delivering HIV medications; these changes necessitated new roles and responsibilities for many providers. Despite this stressful changing environment and increased service demands, participants still shared examples of persistence and resilience as they worked to meet client needs during these challenging times. DISCUSSION: NSPs in Kazakhstan are well-positioned to reach key populations with crucial information and flexible services during the COVID-19 pandemic. However, they need recognition as essential organizations and additional equipment and staff support to protect staff and clients, maintain pandemic-related regulatory changes, and address additional challenges such as overdose prevention among clients.


Subject(s)
Acquired Immunodeficiency Syndrome , COVID-19 , Drug Users , Substance Abuse, Intravenous , COVID-19/epidemiology , Communicable Disease Control , Continuity of Patient Care , Humans , Kazakhstan/epidemiology , Pandemics , Pharmaceutical Preparations , SARS-CoV-2 , Substance Abuse, Intravenous/complications , Substance Abuse, Intravenous/therapy
13.
BMC Public Health ; 22(1): 871, 2022 05 02.
Article in English | MEDLINE | ID: covidwho-1817211

ABSTRACT

BACKGROUND: During a fast-moving epidemic, timely monitoring of case counts and other key indicators of disease spread is critical to an effective public policy response. METHODS: We describe a nonparametric statistical method, originally applied to the reporting of AIDS cases in the 1980s, to estimate the distribution of reporting delays of confirmed COVID-19 cases in New York City during the late summer and early fall of 2020. RESULTS: During August 15-September 26, the estimated mean delay in reporting was 3.3 days, with 87% of cases reported by 5 days from diagnosis. Relying upon the estimated reporting-delay distribution, we projected COVID-19 incidence during the most recent 3 weeks as if each case had instead been reported on the same day that the underlying diagnostic test had been performed. Applying our delay-corrected estimates to case counts reported as of September 26, we projected a surge in new diagnoses that had already occurred but had yet to be reported. Our projections were consistent with counts of confirmed cases subsequently reported by November 7. CONCLUSION: The projected estimate of recently diagnosed cases could have had an impact on timely policy decisions to tighten social distancing measures. While the recent advent of widespread rapid antigen testing has changed the diagnostic testing landscape considerably, delays in public reporting of SARS-CoV-2 case counts remain an important barrier to effective public health policy.


Subject(s)
Acquired Immunodeficiency Syndrome , COVID-19 , Acquired Immunodeficiency Syndrome/epidemiology , COVID-19/epidemiology , Humans , New York City/epidemiology , SARS-CoV-2 , Time Factors
14.
Glob Public Health ; 17(6): 827-842, 2022 06.
Article in English | MEDLINE | ID: covidwho-1795459

ABSTRACT

As COVID-19 continues to persist, there is a need to examine its impact among sexual and gender minority individuals, especially those with intersecting vulnerabilities. We conducted a cross-sectional survey with a global sample of sexual and gender minority individuals (n = 21,795) from October 25, 2020 to November 19, 2020, through a social networking app. We characterised the HIV prevention and HIV treatment impacts of COVID-19 and the COVID-19 mitigation response and examined whether subgroups of our study population are disproportionately impacted by COVID-19. Many sexual and gender minority individuals reported interruptions to HIV prevention and HIV care and treatment services. These consequences were significantly greater among people living with HIV, racial/ethnic minorities, immigrants, individuals with a history of sex work, and socio-economically disadvantaged groups. These findings highlight the urgent need to mitigate the negative impacts of COVID-19 among sexual and gender minority individuals.


Subject(s)
Acquired Immunodeficiency Syndrome , COVID-19 , HIV Infections , Sexual and Gender Minorities , COVID-19/epidemiology , Cross-Sectional Studies , HIV Infections/epidemiology , HIV Infections/prevention & control , Humans , Minority Groups , SARS-CoV-2 , Sexual Behavior
15.
BMC Health Serv Res ; 22(1): 503, 2022 Apr 14.
Article in English | MEDLINE | ID: covidwho-1793944

ABSTRACT

BACKGROUND: Across Sub-Saharan Africa, adolescents and young people (AYP) aged 15-24 have limited access to sexual and reproductive health (SRH) services, including HIV testing services (HTS). In response, the Yathu Yathu study was implemented in two high-density communities in Lusaka, Zambia. Yathu Yathu provides comprehensive, community-based, peer-led SRH services, including differentiated HTS (finger-prick and HIV self-testing) and comprehensive sexuality education (CSE). We describe adaptations to the Yathu Yathu intervention in response to the COVID-19 epidemic, and implications on uptake of HTS among AYP. METHODS: Yathu Yathu provides SRH services through community-based peer-led spaces. AYP in study communities were offered prevention points cards (PPC), which incentivizes and tracks service use. Social media (WhatsApp©/Facebook©) is used to engage and inform AYP about SRH. Due to COVID-19, hubs closed from April-June 2020. We describe adaptations in response to COVID-19 and, using routinely collected PPC data, describe uptake of HTS before (September 2019-March 2020) and after (July-December 2020) adaptations in response to COVID-19. We describe reach of the Yathu Yathu Facebook page and use qualitative data to describe AYP experiences of SRH service access. RESULTS: During hub closures, CSE was delivered via video on social media, resulting in an increase in Facebook page followers from 539(April) to 891(June). WhatsApp groups evolved as a platform to deliver CSE and COVID-19 information, with higher participation among young people aged 20-24. Key service delivery adaptations included: reducing the number of participants in hubs, mandatory handwashing before entry, use of personal protective equipment by staff and provision of facemasks to AYP. HTS were provided as normal. Adaptations led to fewer AYP attending hubs. Uptake of HTS among AYP visiting hubs for the first time after COVID-19-related closures was higher (73.2%) compared to uptake before adaptations (65.9%; adjOR=1.24 95%CI 0.99, 1.56, p=0.06). Despite disappointments with some aspects of service delivery, AYP expressed happiness that hubs had reopened. CONCLUSIONS: Social media can be a useful additional platform to reach AYP with HIV prevention information during COVID-19. With proper infection control in place, HTS can safely be provided to, accessed and accepted by AYP in community-based settings during COVID-19. TRIAL REGISTRATION: National Clinical Trials NCT04060420,19th August 2019. Current Controlled Trials ISRCTN75609016 , 14th September 2021, retrospectively registered.


Subject(s)
Acquired Immunodeficiency Syndrome , COVID-19 , HIV Infections , Reproductive Health Services , Adolescent , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/prevention & control , Community Health Services , HIV Infections/diagnosis , HIV Infections/epidemiology , HIV Infections/prevention & control , HIV Testing , Humans , Reproductive Health , Young Adult , Zambia/epidemiology
16.
Braz J Infect Dis ; 25(4): 101608, 2021.
Article in English | MEDLINE | ID: covidwho-1788010

ABSTRACT

BACKGROUND: People living with HIV (PLH) under combined antiretroviral therapy (cART) are at risk of developing type 2 diabetes mellitus (T2DM). OBJECTIVE: We examined the incidence of T2DM, associated factors and mean time to outcome in PLH under cART. METHOD: Data for this multicenter cohort study were obtained from PLH aged over 18, who started cART in 13 Brazilian sites from 2003 to 2013. Factors associated with incident T2DM were evaluated by Cox multiple regression models. RESULTS: A total of 6724 patients (30,997.93 person-years) were followed from January 2003 to December 2016. A T2DM incidence rate of 17.3/1000 person-years (95%CI 15.8-18.8) was observed. Incidence of isolated hypertriglyceridemia and impaired fasting glucose (IFG) were 84.3 (95%CI 81.1-87.6) and 14.5/1000 person-years (95%CI 13.2-15.9), respectively. Mean time to T2DM onset was 10.5 years (95%CI 10.3-10.6). Variables associated with incident T2DM were age 40-50 [Hazard Ratio (HR) 1.7, 95%CI 1.4-2.1] and ≥ 50 years (HR 2.4, 95%CI 1.9-3.1); obesity (HR 2.1, 95%CI 1.6-2.8); abnormal triglyceride/HDL-cholesterol ratio (HR 1.8, 95%CI 1.51-2.2). IFG predicted T2DM (HR 2.6, 95%CI 1.7-2.5) and occurred on average 3.3 years before diabetes onset. Exposure to stavudine for ≥ 2 years was independently associated with incident T2DM [HR 1.6, 95%CI 1.0-2.2). CONCLUSION: Brazilian PLH under cART are at significant risk of developing T2DM and share risk factors for diabetes onset with the general population, such as older age, obesity, and having metabolic abnormalities at baseline. Moreover, stavudine use was independently associated with incident T2DM. Identifying PLH at a higher risk of T2DM can help caretakers trigger health promotion and establish specific targets for implementation of preventive measures.


Subject(s)
Acquired Immunodeficiency Syndrome , Diabetes Mellitus, Type 2 , Adult , Aged , Cohort Studies , Diabetes Mellitus, Type 2/epidemiology , Humans , Incidence , Middle Aged , Risk Factors
17.
Cancer Epidemiol ; 78: 102154, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1767944

ABSTRACT

BACKGROUND: The Environmental Determinants of KSHV transmission in rural Uganda (ENDKU) study began enrollment in February 2020 with the purpose of defining the relationship between malaria, primarily caused by Plasmodium falciparum in sub-Saharan Africa, and KSHV susceptibility and reactivation. Uganda is an ideal study site, because both malaria and KSHV are endemic and widespread, even among young children. METHODS: ENDKU is a longitudinal cohort study of infants enrolled at six months of age and followed until three years of age. The main study, and one smaller sub-study, is nested within the General Population Cohort (GPC), a long-standing population cohort in rural Uganda. The ENDKU study was created to test the hypothesis that P. falciparum malaria increases an infant's susceptibility to KSHV infection. A sub-study to evaluate the effects of P. falciparum on KSHV reactivation involves an additional cohort of 5-10-year-old children with and without acute malaria who presented to the GPC study clinic. For each study, participants provided demographic and behavioral data through administered questionnaires and blood and saliva samples. RESULTS: Despite barriers presented by the COVID-19 pandemic, the study team was able to leverage the long-standing relationship of the UK Medical Research Council and the Uganda Virus Research Institute (MRC/UVRI) with the community, a strong commitment to research, and a multi-disciplinary team of experts to successfully implement the ENDKU study. CONCLUSION: The results of this multi-pronged approach will answer important questions about the etiology and transmission of KSHV in sub-Saharan Africa and the data and samples collected will be an important future resource for scientific research in the region.


Subject(s)
Acquired Immunodeficiency Syndrome , COVID-19 , Herpesvirus 8, Human , Malaria , Sarcoma, Kaposi , Acquired Immunodeficiency Syndrome/epidemiology , Child , Child, Preschool , Humans , Infant , Longitudinal Studies , Malaria/epidemiology , Pandemics , Sarcoma, Kaposi/epidemiology , Uganda/epidemiology
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