Browsing by Author "Navis A"

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    Clinical characteristics and outcomes after new-onset seizure among Zambian children with HIV during the antiretroviral therapy era.
    (2022-Jun) Ravishankar M; Dallah I; Mathews M; Bositis CM; Mwenechanya M; Kalungwana-Mambwe L; Bearden D; Navis A; Elafros MA; Gelbard H; Theodore WH; Koralnik IJ; Okulicz JF; Johnson BA; Belessiotis C; Ciccone O; Thornton N; Tsuboyama M; Siddiqi OK; Potchen MJ; Sikazwe I; Birbeck GL; Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.; Weill Cornell Medicine, New York, New York, USA.; University of Michigan, Ann Arbor, Michigan, USA.; Tufts School of Medicine, Medford, Massachusetts, USA.; Epilepsy Care Team, Chikankata Hospital, Mazabuka, Zambia.; National Institute of Health, Bethesda, Maryland, USA.; Icahn School of Medicine, New York, New York, USA.; University College London, London, UK.; University of Zambia, Lusaka, Zambia.; University Teaching Hospitals Children's Hospital, Lusaka, Zambia.; Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.; Boston Children's Hospital, Boston, Massachusetts, USA.; Center for Infectious Disease Research in Zambia, Lusaka, Zambia.; Epilepsy Division, Department of Neurology, University of Rochester, Rochester, New York, USA.; Center for Health + Technology, University of Rochester Medical Center, Rochester, New York, USA.; University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.; Zambian College of Medicine & Surgery, Lusaka, Zambia.; US Army Brooke Army Medical Center, Fort Sam Houston, Texas, USA.; University of Rochester Medical Center, Rochester, New York, USA.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
    OBJECTIVE: This study describes clinical profiles including human immunodeficiency virus (HIV) disease history and seizure etiology among children living with HIV presenting with new-onset seizure during the era of antiretroviral therapy (ART) in Zambia. 30-day mortality and cause of death are also reported. METHODS: Children living with HIV (CLWHIV) with new-onset seizures were prospectively evaluated at one large urban teaching hospital and two non-urban healthcare facilities. Interviews with family members, review of medical records, and where needed, verbal autopsies were undertaken. Two clinicians who were not responsible for the patients' care independently reviewed all records and assigned seizure etiology and cause of death with adjudication as needed. RESULTS: From April 2016 to June 2019, 73 children (49 urban, 24 rural) were identified. Median age was 6 years (IQR 2.2-10.0) and 39 (53%) were male children. Seizures were focal in 36 (49%) and were often severe, with 37% presenting with multiple recurrent seizures in the 24 hours before admission or in status epilepticus. Although 36 (49%) were on ART at enrollment, only 7 of 36 (19%) were virally suppressed. Seizure etiologies were infectious in over half (54%), with HIV encephalitis, bacterial meningitis, and tuberculous meningitis being the most common. Metabolic causes (19%) included renal failure and hypoglycemia. Structural lesions identified on imaging accounted for 10% of etiologies and included stroke and non-accidental trauma. No etiology could be identified in 12 (16%) children, most of whom died before the completion of clinical investigations. Twenty-two (30%) children died within 30 days of the index seizure. SIGNIFICANCE: Despite widespread ART roll out in Zambia, new-onset seizure in CLWHIV occurs in the setting of advanced, active HIV disease. Seizure severity/burden is high as is early mortality. Enhanced programs to assure early ART initiation, improve adherence, and address ART failure are needed to reduce the burden of neurological injury and premature death in CLWHIV.
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    Evaluating the impact of antiretroviral and antiseizure medication interactions on treatment effectiveness among outpatient clinic attendees with HIV in Zambia.
    (2020-Dec) Navis A; Dallah I; Mabeta C; Musukuma K; Siddiqi OK; Bositis CM; Koralnik IJ; Gelbard HA; Theodore WH; Okulicz JF; Johnson BA; Sikazwe I; Bearden DR; Birbeck GL; Department of Biostatistics, Center for AIDS Research, University of Rochester, Rochester, NY, USA.; National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA.; Department of Neurology, University of Rochester, Rochester, NY, USA.; Department of Internal Medicine, Center for Vaccines and Virology Research, Beth Israel Deaconess Medical Center, Boston, MA, USA.; University Teaching Hospitals Children's Hospital, Lusaka, Zambia.; Infectious Disease Service, Brooke Army Medical Center, Joint Base San Antonio-Ft Sam Houston, Houston, TX, USA.; Center for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia.; Global Neurology Program, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA.; Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia.; Greater Lawrence Family Health Center, Lawrence, MA, USA.; Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.; Departments of Neurology, Pediatrics, Neuroscience and Microbiology and Immunology, University of Rochester Medical Center, Rochester, NY, USA.; Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.; Chikankata Epilepsy Care Team, Mazabuka, Zambia.
    OBJECTIVE: Interactions between enzyme-inducing anti-seizure medications (EI-ASMs) and antiretroviral drugs (ARVs) can lead to decreased ARV levels and may increase the likelihood of viral resistance. We conducted a study to determine if co-usage of ARVs and EI-ASMs is associated with ARV-resistant human immunodeficiency virus (HIV) among people living with HIV in Zambia. METHODS: Eligible participants were ≥18 years of age and concurrently taking ASMs and ARVs for at least 1 month of the prior 6-month period. Data were obtained regarding medication and HIV history. CD4 counts, plasma viral loads (pVLs), and HIV genotype and resistance profile in participants with a pVL >1000 copies/mL were obtained. Pearson's test of independence was used to determine whether treatment with EI-ASM was associated with pVL >1000/mL copies. RESULTS: Of 50 participants, 41 (82%) were taking carbamazepine (37 on monotherapy), and all had stable regimens in the prior 6 months. Among the 13 ARV regimens used, 68% had a tenofovir/lamivudine backbone. The majority (94%) were on a stable ARV regimen for >6 months. Median CD4 nadir was 205 cells/mm SIGNIFICANCE: EI-ASMs are commonly used in sub-Saharan Africa. Despite concurrent use of EI-ASMs and ARVs, the majority of participants showed CD4 counts >200 cells/mm