Browsing by Author "Ehmer J"

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Effect of antiretroviral therapy care interruptions on mortality in children living with HIV.
(2022-Apr-01) Davies C; Johnson L; Sawry S; Chimbetete C; Eley B; Vinikoor M; Technau KG; Ehmer J; Rabie H; Phiri S; Tanser F; Malisita K; Fatti G; Osler M; Wood R; Newton S; Haas A; Davies MA; Newlands Clinic, Harare, Zimbabwe.; Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, South Africa.; Red Cross War Memorial Children's Hospital and Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.; Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town.; School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.; Department of Paediatrics and Child Health, Tygerberg Academic Hospital, University of Stellenbosch, Stellenbosch, South Africa.; Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Harriet Shezi Children's Clinic, Chris Hani Baragwanath Academic Hospital, Soweto, South Africa.; Institute of Social and Preventive Medicine, University of Bern, Switzerland.; Queen Elizabeth Central Hospital, Blantyre, Malawi.; Kheth'Impilo AIDS Free Living.; Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University.; Gugulethu HIV Programme and Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa.; SolidarMed, Lucerne, Switzerland.; Lighthouse Trust Clinic, Kamuzu Central Hospital, Lilongwe, Malaysia.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
OBJECTIVE: To evaluate the characteristics and outcomes of HIV-infected children that have care interruptions, during which the child's health status and use of medication is unknown. DESIGN: We included data on children initiating ART between 2004 and 2016 at less than 16 years old at 16 International Epidemiologic Databases to Evaluate AIDS Southern Africa cohorts. Children were classified as loss to follow up (LTFU) if they had not attended clinic for more than 180 days. Children had a care interruption if they were classified as LTFU, and subsequently returned to care. Children who died within 180 days of ART start were excluded. METHODS: The main outcome was all cause mortality. Two exposed groups were considered: those with a first care interruption within the first 6 months on ART, and those with a first care interruption after 6 months on ART. Adjusted hazard ratios were determined using a Cox regression model. RESULTS: Among 53 674 children included, 23 437 (44%) had a care interruption, of which 10 629 (20%) had a first care interruption within 6 months on ART and 12 808 (24%) had a first care interruption after 6 months on ART. Increased mortality was associated with a care interruption within 6 months on ART [adjusted hazard ratio (AHR) = 1.52, 95% CI 1.12-2.04] but not with a care interruption after 6 months on ART (AHR = 1.05, 95% CI 0.77-1.44). CONCLUSION: The findings suggest that strengthening retention of children in care in the early period after ART initiation is critical to improving paediatric ART outcomes.
Hepatitis B Infection, Viral Load and Resistance in HIV-Infected Patients in Mozambique and Zambia.
(2016) Wandeler G; Musukuma K; Zürcher S; Vinikoor MJ; Llenas-García J; Aly MM; Mulenga L; Chi BH; Ehmer J; Hobbins MA; Bolton-Moore C; Hoffmann CJ; Egger M; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.; Nucleo do investigacão Operational de Pemba, Pemba, Mozambique.; Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa.; Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, United States of America.; Institute for Infectious Diseases, University of Bern, Bern, Switzerland.; Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland.; SolidarMed, Ancuabe, Mozambique.; Department of Infectious diseases, University of Dakar, Dakar, Senegal.; Department of Medicine at University of Alabama, Birmingham, United States of America.; SolidarMed, Lucerne, Switzerland.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; Johns Hopkins University School of Medicine, Baltimore, United States of America.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
BACKGROUND: Few data on the virological determinants of hepatitis B virus (HBV) infection are available from southern Africa. METHODS: We enrolled consecutive HIV-infected adult patients initiating antiretroviral therapy (ART) at two urban clinics in Zambia and four rural clinics in Northern Mozambique between May 2013 and August 2014. HBsAg screening was performed using the Determine® rapid test. Quantitative real-time PCR and HBV sequencing were performed in HBsAg-positive patients. Risk factors for HBV infection were evaluated using Chi-square and Mann-Whitney tests and associations between baseline characteristics and high level HBV replication explored in multivariable logistic regression. RESULTS: Seventy-eight of 1,032 participants in Mozambique (7.6%, 95% confidence interval [CI]: 6.1-9.3) and 90 of 797 in Zambia (11.3%, 95% CI: 9.3-13.4) were HBsAg-positive. HBsAg-positive individuals were less likely to be female compared to HBsAg-negative ones (52.3% vs. 66.1%, p<0.001). Among 156 (92.9%) HBsAg-positive patients with an available measurement, median HBV viral load was 13,645 IU/mL (interquartile range: 192-8,617,488 IU/mL) and 77 (49.4%) had high values (>20,000 UI/mL). HBsAg-positive individuals had higher levels of ALT and AST compared to HBsAg-negative ones (both p<0.001). In multivariable analyses, male sex (adjusted odds ratio: 2.59, 95% CI: 1.22-5.53) and CD4 cell count below 200/μl (2.58, 1.20-5.54) were associated with high HBV DNA. HBV genotypes A1 (58.8%) and E (38.2%) were most prevalent. Four patients had probable resistance to lamivudine and/or entecavir. CONCLUSION: One half of HBsAg-positive patients demonstrated high HBV viremia, supporting the early initiation of tenofovir-containing ART in HIV/HBV-coinfected adults.
No Impact of Hepatitis B Virus Infection on Early Mortality Among Human Immunodeficiency Virus-Infected Patients in Southern Africa.
(2018-Sep-28) Hector J; Vinikoor M; Chilengi R; Ehmer J; Egger M; Wandeler G; Institute of Social and Preventive Medicine, University of Bern, Switzerland.; Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland.; SolidarMed, Ancuabe, Mozambique.; Centre for Infectious Disease Research in Zambia, Lusaka.; School of Public Health and Family Medicine, University of Cape Town, South Africa.; Department of Medicine at University of Alabama, Birmingham.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)