RESUMO
OBJECTIVE: To investigate the role of early antiretroviral therapy (ART) on growth trajectories of infants with human immunodeficiency virus (IHIV) in the first year of life. STUDY DESIGN: As part of a clinical trial of early ART in Johannesburg, South Africa (2015-2018), 116 IHIV diagnosed within 48 hours of birth were started on ART as soon as possible, and 80 uninfected infants born to mothers living with HIV (IHEU) were enrolled. Both groups were followed prospectively from birth through 48 weeks and growth parameters collected. The groups were compared and risk factors for poor growth investigated, in the full cohort and among IHIV separately. RESULTS: IHIV had lower mean weight-for-age Z-scores (WAZ) than IHEU at 4 and 8 weeks (-1.17 [SE:0.14] vs -0.72 [0.14], P = .035 and -1.23 [0.15] vs -0.67 [0.14], P = .012). Although there was some closing of the gap over time, means remained lower in IHIV through 48 weeks. In length-for-age Z-scores (LAZ), differences widened over time and IHIV had lower Z-scores by 48 weeks (-1.41 [0.15] vs -0.80 [0.18], P = .011). Deficits in WAZ and LAZ in IHIV vs IHEU were most marked among girls. IHIV with pre-ART viral load ≥1000 copies/ml had significantly lower weight-for-length and mid-upper arm circumference Z-scores across all time points through 48 weeks. CONCLUSIONS: IHIV on early ART had deficits in WAZ over the first 8 weeks of life and lower LAZ at 48 weeks than IHEU. Among IHIV, higher pre-ART viral load was associated with worse anthropometric indicators through 48 weeks.
Assuntos
Infecções por HIV , Humanos , Infecções por HIV/tratamento farmacológico , Feminino , Lactente , Masculino , Recém-Nascido , África do Sul , Estudos Prospectivos , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Desenvolvimento Infantil/efeitos dos fármacos , Gravidez , Antirretrovirais/uso terapêutico , Complicações Infecciosas na Gravidez/tratamento farmacológico , Complicações Infecciosas na Gravidez/virologia , Fármacos Anti-HIV/uso terapêutico , Peso CorporalRESUMO
HIV viral load (VL) monitoring can reinforce antiretroviral therapy (ART) adherence. Standard VL testing requires high laboratory capacity and coordination between clinic and laboratory which can delay results. A randomized trial comparing point-of-care (POC) VL testing to standard VL testing among 150 adolescents and young adults, ages 10-24 years, living with HIV in Haiti determined if POC VL testing could return faster results and improve ART adherence and viral suppression. Participants received a POC VL test with same-day result (POC arm) or a standard VL test with result given 1 month later (SOC arm). POC arm participants were more likely to receive a test result within 6 weeks than SOC arm participants (94.7% vs. 80.1%; p1000 copies/ml and low self-reported ART adherence was stronger in the POC arm (OR: 6.57; 95%CI: 2.12-25.21) than the SOC arm (OR: 2.62; 95%CI: 0.97-7.44) suggesting more accurate self-report in the POC arm. POC VL testing was effectively implemented in this low-resource setting with faster results and is a pragmatic intervention that may enable clinicians to identify those with high VL to provide enhanced counseling or regimen changes sooner.Trial registration: ClinicalTrials.gov identifier: NCT03288246.
Assuntos
Fármacos Anti-HIV , Infecções por HIV , Adolescente , Adulto , Fármacos Anti-HIV/uso terapêutico , Antirretrovirais/uso terapêutico , Criança , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Haiti , Humanos , Sistemas Automatizados de Assistência Junto ao Leito , Carga Viral , Adulto JovemRESUMO
INTRODUCTION: Adolescents living with HIV have poor antiretroviral therapy (ART) adherence and viral suppression outcomes. Viral load (VL) monitoring could reinforce adherence but standard VL testing requires strong laboratory capacity often only available in large central laboratories. Thus, coordinated transport of samples and results between the clinic and laboratory is required, presenting opportunities for delayed or misplaced results. Newly available point-of-care (POC) VL testing systems return test results the same day and could simplify VL monitoring so that adolescents receive test results faster which could strengthen adherence counselling and improve ART adherence and viral suppression. METHODS AND ANALYSIS: This non-blinded randomised clinical trial is designed to evaluate the implementation and effectiveness of POC VL testing compared with standard laboratory-based VL testing among adolescents and youth living with HIV in Haiti. A total of 150 participants ages 10-24 who have been on ART for >6 months are randomised 1:1 to intervention or standard arms. Intervention arm participants receive a POC VL test (Cepheid Xpert HIV-1 Viral Load system) with same-day result and immediate ART adherence counselling. Standard care participants receive a laboratory-based VL test (Abbott m2000sp/m2000rt) with the result available 1 month later, at which time they receive ART adherence counselling. VL testing is repeated 6 months later for both arms. The primary objective is to describe the implementation of POC VL testing compared with standard laboratory-based VL testing. The secondary objective is to evaluate the effect of POC VL testing on VL suppression at 6 months and participant comprehension of the correlation between VL and ART adherence. ETHICS AND DISSEMINATION: This study is approved by GHESKIO, Weill Cornell Medicine and Columbia University ethics committees. This trial will provide critical data to understand if and how POC VL testing may impact adolescent ART adherence and viral suppression. If effective, POC VL testing could routinely supplement standard laboratory-based VL testing among high-risk populations living with HIV. TRIAL REGISTRATION NUMBER: NCT03288246.
Assuntos
Infecções por HIV , Sistemas Automatizados de Assistência Junto ao Leito , Adolescente , Adulto , Antirretrovirais/uso terapêutico , Criança , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Haiti , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Carga Viral , Adulto JovemRESUMO
This study examined behavioral functioning and quality of life in South African children living with perinatally acquired HIV. Compared with controls, children living with perinatally acquired HIV had a higher mean total difficulties score assessed by the Strengths and Difficulties Questionnaire and lower mean quality of life scores assessed by the Pediatric Quality of Life Inventory.
Assuntos
Antirretrovirais/uso terapêutico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/psicologia , Comportamento Problema , Qualidade de Vida , Adolescente , Criança , Estudos Transversais , Feminino , Humanos , Masculino , África do SulRESUMO
We evaluated bone quality among South African children with HIV over a 2-year period by quantitative ultrasound (QUS). Children with HIV have persistently lower bone quality compared with controls reflecting increased porosity, reduced strength, and possibly an increased short- and long-term risk of fracture.
Assuntos
Densidade Óssea/fisiologia , Calcâneo/diagnóstico por imagem , Infecções por HIV/fisiopatologia , Antirretrovirais/uso terapêutico , Estudos de Casos e Controles , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Estudos Longitudinais , Masculino , África do Sul/epidemiologia , UltrassonografiaRESUMO
OBJECTIVE: To describe physical activity in South African children with and without HIV. STUDY DESIGN: Study measurements were obtained in 218 children with perinatal HIV and 180 children without HIV aged 5-9 years in a study conducted in Johannesburg, South Africa. Weight-for-age z-score, height-for-age z-score, frequency and duration of moderate and vigorous physical activity, and sedentary behaviors were obtained. These measurements were compared between children with and without HIV. RESULTS: Weight-for-age z-score and height-for-age z-score were significantly lower for children with HIV compared with those without HIV. Among children who attended school, fewer children with HIV than children without HIV participated in physical education (41% vs 64%; P = .0003) and organized after-school sports (38% vs 64%; P < .001). The proportion of children in both groups meeting World Health Organization recommendations for physical activity was similar (84% overall); however, girls with HIV spent less time in vigorous physical activity than girls without HIV (420 vs 780 minutes/week; P = .001). This difference remained significant even when girls with a medical condition with the potential to limit physical activity were excluded, and after adjusting for age. Time spent in sedentary behaviors did not differ significantly between the two groups. CONCLUSION: Although children with HIV with well-controlled disease after initiating antiretroviral therapy early in life achieve high levels of physical activity, vigorous physical activity is lower in girls with HIV than in healthy controls. This finding may reflect lower participation in school-based physical education and organized after-school physical activity.