Browsing by Author "Kuniholm MH"

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    Association of cardiovascular disease risk with liver steatosis and fibrosis in people with HIV in low- and middle-income countries.
    (2025-Jan-01) Kuniholm MH; Murenzi G; Shumbusho F; Brazier E; Plaisy MK; Mensah E; Wandeler G; Riebensahm C; Chihota BV; Samala N; Diero L; Semeere AS; Chanyachukul T; Borse R; Nguyen DTH; Perazzo H; Lopez-Iniguez A; Castilho JL; Maruri F; Jaquet A; Department of Infectious Diseases, Inselspital, Bern University Hospital.; Graduate School of Public Health and Health Policy, City University of New York, New York, New York, USA.; Research for Development (RD Rwanda).; Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University, Indianapolis, Indiana, United States of America.; Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Mexico City, Mexico.; Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.; Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda.; AMPATH, Moi University, Eldoret, Kenya.; Institute for Implementation Science in Population Health.; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.; TREAT Asia/amfAR - The Foundation for AIDS Research, Bangkok, Thailand.; Department of Infectious Diseases, National Hospital for Tropical Diseases, Hanoi, Vietnam.; B.J. Government Medical College & Sassoon General Hospitals, Pune, Maharashtra, India.; Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, New York, USA.; Espoir Vie-Togo, Lome, Togo.; Evandro Chagas National Institute of Infectious Diseases -Oswaldo Cruz Foundation (INI/FIOCRUZ), Rio de Janeiro, Brazil.; National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, University of Bordeaux, Bordeaux Population Health Centre, Bordeaux, France.; Rwanda Military Hospital, Kigali, Rwanda.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
    OBJECTIVE: The aim of this study was to understand the relationship between cardiovascular disease (CVD) risk and liver steatosis and fibrosis among people with HIV (PLWH) at least 40 years of age on antiretroviral therapy (ART) in low and middle-income countries (LMIC). DESIGN: We used cross-sectional behavioral and clinical data collected during study enrollment visits in 2020-2022 for the Sentinel Research Network of International epidemiology Databases to Evaluate AIDS (SRN of IeDEA). METHODS: Ten-year CVD risk was calculated using 2019 WHO nonlaboratory and laboratory models. Transient elastography was used to assess liver disease. Presence of steatosis and significant fibrosis were defined by controlled attenuation parameter (CAP) at least 248 dB/m and liver stiffness measurement (LSM) at least 7.1 kPa, respectively. Participants with viral hepatitis, hazardous alcohol consumption, and unsuppressed HIV viral load were excluded from the analysis. Logistic regression was used to estimate odds ratios, adjusting for study site, CD4 +  T cell count, stavudine and didanosine exposure, and in models stratified by sex and geographic region. RESULTS: There were 1750 participants from nine LMIC. Median CVD risk was 3% for both nonlaboratory and laboratory-based models. Adjusted odds ratios (ORs) for steatosis and significant fibrosis associated with laboratory CVD risk (≥10 vs. <5%) were OR = 1.83 [95% confidence interval (95% CI) = 1.21-2.76; P  = 0.004] and OR = 1.62 (95% CI = 0.85-3.07; P  = 0.14), respectively. Associations of CVD risk with steatosis were stronger in men and among participants at study sites outside Africa. CONCLUSION: Higher CVD risk was associated with steatosis but not with significant fibrosis in PWH in our LMIC cohort.
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    Trends in hepatitis B virus testing practices and management in HIV clinics across sub-Saharan Africa.
    (2017-Nov-01) Coffie PA; Egger M; Vinikoor MJ; Zannou M; Diero L; Patassi A; Kuniholm MH; Seydi M; Bado G; Ocama P; Andersson MI; Messou E; Minga A; Easterbrook P; Anastos K; Dabis F; Wandeler G; Global Hepatitis Programme, HIV Department, World Health Organization, Geneva, Switzerland.; Département de Dermatologie et d'Infectiologie, UFR des Sciences Médicales, Université Félix Houphouët Boigny, Abidjan, Côte d'Ivoire. ahuatchi@gmail.com.; ISPED, Université de Bordeaux, Bordeaux, France.; Centre de Prise en charge de Recherche et de Formation. CePReF-Aconda-VS, Abidjan, Côte d'Ivoire.; Centre Médical de Suivi de Donneurs de Sang/ CNTS/PRIMO-CI, Abidjan, Côte d'Ivoire.; Department of Medicine, Moi University, College of Health Sciences, School of Medicine, Eldoret, Kenya.; Programme PACCI, CHU Treichville, Site de Recherche ANRS, Abidjan, Côte d'Ivoire. ahuatchi@gmail.com.; Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.; Service des Maladies Infectieuses et de Pneumologie, CHU Sylvanus Olympio, Lomé, Togo.; Division of Medical Virology, Department of Pathology, University of Stellenbosch and Tygerberg Academic Hospital, Cape Town, South Africa.; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland. gilles.wandeler@ispm.unibe.ch.; Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA.; INSERM U1219, Bordeaux Population Health, Bordeaux, France.; Centre for Infectious Disease Epidemiology and Research (CIDER), University of Cape Town, Cape Town, South Africa.; Hôpital de Jour, Service des Maladies Infectieuses et Tropicales, CHU Souro Sanou, Bobo Dioulasso, Burkina Faso.; Infectious Diseases Institute, Kampala, Uganda.; Department of Infectious Diseases, Fann University Hospital, Dakar, Senegal.; Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, NY, USA.; Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland. gilles.wandeler@ispm.unibe.ch.; Service de Médecine Interne, CNHU Hubert Maga, Cotonou, Benin.; Département de Dermatologie et d'Infectiologie, UFR des Sciences Médicales, Université Félix Houphouët Boigny, Abidjan, Côte d'Ivoire.; Department of Medicine at University of Alabama, Birmingham, AL, USA.; Department of Infectious Diseases, Fann University Hospital, Dakar, Senegal. gilles.wandeler@ispm.unibe.ch.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
    BACKGROUND: Approximately 8% of HIV-infected individuals are co-infected with hepatitis B virus (HBV) in sub-Saharan Africa (SSA). Knowledge of HBV status is important to guide optimal selection of antiretroviral therapy (ART) and monitor/prevent liver-related complications. We describe changes in testing practices and management of HBV infection over a 3-year period in HIV clinics across SSA. METHODS: A medical chart review was conducted in large urban HIV treatment centers in Côte d'Ivoire (3 sites), Benin, Burkina Faso, Cameroon, Kenya, Senegal, South Africa, Togo, Uganda and Zambia (1 site each). Of the patients who started ART between 2010 and 2012, 100 per year were randomly selected from each clinic. Demographic, clinical and laboratory information as well as individual treatment histories were collected using a standardized questionnaire. We examined changes over time in the proportion of patients screened for HBV infection (HBV surface antigen [HBsAg]-positivity), identified predictors of HBV testing using logistic regression, and assessed the proportion of patients initiating a tenofovir (TDF)-containing ART regimen. RESULTS: Overall, 3579 charts of patients initiating ART (64.4% female, median age 37 years) were reviewed in 12 clinics. The proportion of patients screened for HBsAg increased from 17.8% in 2010 to 24.4% in 2012 overall, and ranged from 0.7% in Kenya to 96% in South Africa. In multivariable analyses, age and region were associated with HBsAg screening. Among 759 individuals tested, 88 (11.6%; 95% confidence interval [CI] 9.4-14.1) were HBV-infected, of whom 71 (80.7%) received a TDF-containing ART regimen. HBsAg-positive individuals were twice as likely to receive a TDF-containing first-line ART regimen compared to HBsAg-negative patients (80.7% vs. 40.3%, p < 0.001). The proportion of patients on TDF-containing ART increased from 57.9% in 2010 to 90.2% in 2012 in HIV/HBV-co-infected patients (Chi-2 test for trend: p = 0.01). Only 114 (5.0%) patients were screened for anti-HCV antibodies and one of them (0.9%, 95% CI 0.02-4.79) had a confirmed HCV infection. CONCLUSIONS: The systematic screening for HBV infection in HIV-positive patients before ART initiation was limited in most African countries and its uptake varied widely across clinics. Overall, the prescription of TDF increased over time, with 90% of HIV/HBV-coinfected patients receiving this drug in 2012.