Browsing by Author "Muula GK"

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    Hepatitis B viral replication markers and hepatic fibrosis in untreated chronic hepatitis B virus infection with and without HIV coinfection in Zambia.
    (2023-Nov-01) Muula GK; Bosomprah S; Sinkala E; Nsokolo B; Musonda T; Hamusonde K; Bhattacharya D; Lauer G; Chung RT; Mulenga LB; Wandeler G; Vinikoor MJ; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.; Division of Infectious Diseases, University of California at Los Angeles, Los Angeles, California.; Department of Medicine, Levy Mwanawasa Medical University, Lusaka, Zambia.; School of Public Health, University of Ghana, Accra, Ghana.; Department of Medicine, University of Zambia.; Division of Gastroenterology, Massachusetts General Hospital, Boston, USA.; Department of Infectious Diseases, Bern University Hospital.; Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, USA.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; University Teaching Hospital, Zambian Ministry of Health.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
    BACKGROUND: To inform novel therapies, a more nuanced understanding of HIV's impact on hepatitis B virus (HBV) natural history is needed, particularly in high burden countries. METHODS: In Lusaka, Zambia, we compared prospectively recruited adults (18+ years) with chronic HBV infection, with and without HIV. We excluded those with prior antiviral treatment experience or HBV diagnosis due to clinical suspicion (rather than routine testing). We assessed HBV DNA levels, hepatitis B e antigen (HBeAg), CD4 + (if HIV coinfection), and liver disease (transient elastography, serum alanine aminotransferase). In multivariable analyses, we evaluated the association of HIV overall and by level of CD4 + count on these markers. RESULTS: Among 713 adults analyzed, median age was 33 years, 63% were male, and 433 had HBV/HIV coinfection. Median CD4 + count was 200 cells/μl. HBV DNA was greater than 2000 IU/ml for 311 (51.0%) and 227 (32.5%) were HBeAg-positive. 15.5% had advanced fibrosis or cirrhosis. HIV coinfection was associated with five-fold increased HBV DNA levels [adjusted geometric mean ratio, 5.78; 95% confidence interval (CI), 2.29-14.62] and two times the odds of HBeAg-positivity (adjusted odds ratio, 2.54; 95% CI, 1.59-4.08). These associations were significant only at CD4 + counts 100-350 and <100 cells/μl. HIV was not associated with markers of fibrosis or ALT. DISCUSSION: HIV's impact on HBV natural history likely depends on the degree and duration of immune suppression. There is strong rationale to monitor HBV DNA in people with HBV/HIV coinfection and immune suppression. A better understanding is needed of mechanisms of increased liver-related mortality in people with HBV/HIV coinfection.
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    The Social Construction of Aging Among a Clinic-Based Population and Their Healthcare Workers in Zambia.
    (2024) Sharma A; Mwamba C; St Clair-Sullivan N; Chihota BV; Pry JM; Bolton-Moore C; Vinikoor MJ; Muula GK; Daultrey H; Gittelsohn J; Mulenga LB; Siyumbwa N; Wandeler G; Vera JH; Medical Faculty, Institute for Infectious Diseases, University of Bern, Bern, Switzerland.; School of Medicine, University of California, Davis, Sacramento, CA, United States.; Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States.; Brighton and Sussex Medical School, Brighton, United Kingdom.; Center for Human Nutrition, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; Department of Preclinical Medicine, Faculty of Medicine, Institute for Social and Preventive Medicine, University of Bern, Bern, Switzerland.; Ministry of Health, Lusaka Zambia, Lusaka, Zambia.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
    OBJECTIVES: We sought to understand the social construction of aging in a clinic-based population, with and without HIV, to address gaps in care for older individuals living with HIV in Zambia. METHODS: Our exploratory qualitative study included 36 in-depth interviews with clinic clients and four focus group discussions with 36 professional and lay healthcare workers providing services to the clients. We identified themes based on social construction theory. RESULTS: At the individual level, aging was multidimensional, perceived both as an achievement in the HIV era and as a period of cognitive, physical, and economic decline. In social interactions, older individuals were often stereotyped and treated as helpless, poor, and "witches." Those living with HIV faced the additional stigma of being labeled as promiscuous. Some of the participants living without HIV refused to take daily medication for non-communicable diseases to avoid being mistaken for taking antiretroviral therapy for HIV. Older individuals wanted quality healthcare and family support to address the intersectional stigma of aging, poverty, and chronic illness. CONCLUSION: Multifaceted interventions are required to combat age-related prejudice, intersectional stigma, and discriminatory practices, particularly for people living with HIV.