Cargando…

Determinants of Survival of HIV Patients Receiving Dolutegravir: A Prospective Cohort Study in Conflict-Affected Bunia, Democratic Republic of Congo

This study aims to determine the factors influencing HIV-related mortality in settings experiencing continuous armed conflict atrocities. In such settings, people living with HIV (PLHIV), and the partners of those affected may encounter specific difficulties regarding adherence to antiretroviral the...

Descripción completa

Detalles Bibliográficos
Autores principales: Buju, Roger T., Akilimali, Pierre Z., Tran, Nguyen-Toan, Kamangu, Erick N., Mesia, Gauthier K., Kayembe, Jean Marie N., Situakibanza, Hippolyte N.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9407849/
https://www.ncbi.nlm.nih.gov/pubmed/36011850
http://dx.doi.org/10.3390/ijerph191610220
_version_ 1784774463560089600
author Buju, Roger T.
Akilimali, Pierre Z.
Tran, Nguyen-Toan
Kamangu, Erick N.
Mesia, Gauthier K.
Kayembe, Jean Marie N.
Situakibanza, Hippolyte N.
author_facet Buju, Roger T.
Akilimali, Pierre Z.
Tran, Nguyen-Toan
Kamangu, Erick N.
Mesia, Gauthier K.
Kayembe, Jean Marie N.
Situakibanza, Hippolyte N.
author_sort Buju, Roger T.
collection PubMed
description This study aims to determine the factors influencing HIV-related mortality in settings experiencing continuous armed conflict atrocities. In such settings, people living with HIV (PLHIV), and the partners of those affected may encounter specific difficulties regarding adherence to antiretroviral therapy (ART), and retention in HIV prevention, treatment, and care programs. Between July 2019 and July 2021, we conducted an observational prospective cohort study of 468 PLHIV patients treated with Dolutegravir at all the ART facilities in Bunia. The probability of death being the primary outcome, as a function of time of inclusion in the cohort, was determined using Kaplan–Meier plots. We used the log-rank test to compare survival curves and Cox proportional hazard modeling to determine mortality predictors from the baseline to 31 July 2021 (endpoint). The total number of person-months (p-m) was 3435, with a death rate of 6.70 per 1000 p-m. Compared with the 35-year-old reference group, older patients had a higher mortality risk. ART-naïve participants at the time of enrollment had a higher mortality risk than those already using ART. Patients with a high baseline viral load (≥1000 copies/mL) had a higher mortality risk compared with the reference group (adjusted hazard ratio = 6.04; 95% CI: 1.78–20.43). One-fourth of deaths in the cohort were direct victims of armed conflict, with an estimated excess death of 35.6%. Improving baseline viral load monitoring, starting ART early in individuals with high baseline viral loads, the proper tailoring of ART regimens and optimizing long-term ART, and care to manage non-AIDS-related chronic complications are recommended actions to reduce mortality. Not least, fostering women’s inclusion, justice, peace, and security in conflict zones is critical in preventing premature deaths in the general population as well as among PLHIV.
format Online
Article
Text
id pubmed-9407849
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-94078492022-08-26 Determinants of Survival of HIV Patients Receiving Dolutegravir: A Prospective Cohort Study in Conflict-Affected Bunia, Democratic Republic of Congo Buju, Roger T. Akilimali, Pierre Z. Tran, Nguyen-Toan Kamangu, Erick N. Mesia, Gauthier K. Kayembe, Jean Marie N. Situakibanza, Hippolyte N. Int J Environ Res Public Health Article This study aims to determine the factors influencing HIV-related mortality in settings experiencing continuous armed conflict atrocities. In such settings, people living with HIV (PLHIV), and the partners of those affected may encounter specific difficulties regarding adherence to antiretroviral therapy (ART), and retention in HIV prevention, treatment, and care programs. Between July 2019 and July 2021, we conducted an observational prospective cohort study of 468 PLHIV patients treated with Dolutegravir at all the ART facilities in Bunia. The probability of death being the primary outcome, as a function of time of inclusion in the cohort, was determined using Kaplan–Meier plots. We used the log-rank test to compare survival curves and Cox proportional hazard modeling to determine mortality predictors from the baseline to 31 July 2021 (endpoint). The total number of person-months (p-m) was 3435, with a death rate of 6.70 per 1000 p-m. Compared with the 35-year-old reference group, older patients had a higher mortality risk. ART-naïve participants at the time of enrollment had a higher mortality risk than those already using ART. Patients with a high baseline viral load (≥1000 copies/mL) had a higher mortality risk compared with the reference group (adjusted hazard ratio = 6.04; 95% CI: 1.78–20.43). One-fourth of deaths in the cohort were direct victims of armed conflict, with an estimated excess death of 35.6%. Improving baseline viral load monitoring, starting ART early in individuals with high baseline viral loads, the proper tailoring of ART regimens and optimizing long-term ART, and care to manage non-AIDS-related chronic complications are recommended actions to reduce mortality. Not least, fostering women’s inclusion, justice, peace, and security in conflict zones is critical in preventing premature deaths in the general population as well as among PLHIV. MDPI 2022-08-17 /pmc/articles/PMC9407849/ /pubmed/36011850 http://dx.doi.org/10.3390/ijerph191610220 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Buju, Roger T.
Akilimali, Pierre Z.
Tran, Nguyen-Toan
Kamangu, Erick N.
Mesia, Gauthier K.
Kayembe, Jean Marie N.
Situakibanza, Hippolyte N.
Determinants of Survival of HIV Patients Receiving Dolutegravir: A Prospective Cohort Study in Conflict-Affected Bunia, Democratic Republic of Congo
title Determinants of Survival of HIV Patients Receiving Dolutegravir: A Prospective Cohort Study in Conflict-Affected Bunia, Democratic Republic of Congo
title_full Determinants of Survival of HIV Patients Receiving Dolutegravir: A Prospective Cohort Study in Conflict-Affected Bunia, Democratic Republic of Congo
title_fullStr Determinants of Survival of HIV Patients Receiving Dolutegravir: A Prospective Cohort Study in Conflict-Affected Bunia, Democratic Republic of Congo
title_full_unstemmed Determinants of Survival of HIV Patients Receiving Dolutegravir: A Prospective Cohort Study in Conflict-Affected Bunia, Democratic Republic of Congo
title_short Determinants of Survival of HIV Patients Receiving Dolutegravir: A Prospective Cohort Study in Conflict-Affected Bunia, Democratic Republic of Congo
title_sort determinants of survival of hiv patients receiving dolutegravir: a prospective cohort study in conflict-affected bunia, democratic republic of congo
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9407849/
https://www.ncbi.nlm.nih.gov/pubmed/36011850
http://dx.doi.org/10.3390/ijerph191610220
work_keys_str_mv AT bujurogert determinantsofsurvivalofhivpatientsreceivingdolutegraviraprospectivecohortstudyinconflictaffectedbuniademocraticrepublicofcongo
AT akilimalipierrez determinantsofsurvivalofhivpatientsreceivingdolutegraviraprospectivecohortstudyinconflictaffectedbuniademocraticrepublicofcongo
AT trannguyentoan determinantsofsurvivalofhivpatientsreceivingdolutegraviraprospectivecohortstudyinconflictaffectedbuniademocraticrepublicofcongo
AT kamanguerickn determinantsofsurvivalofhivpatientsreceivingdolutegraviraprospectivecohortstudyinconflictaffectedbuniademocraticrepublicofcongo
AT mesiagauthierk determinantsofsurvivalofhivpatientsreceivingdolutegraviraprospectivecohortstudyinconflictaffectedbuniademocraticrepublicofcongo
AT kayembejeanmarien determinantsofsurvivalofhivpatientsreceivingdolutegraviraprospectivecohortstudyinconflictaffectedbuniademocraticrepublicofcongo
AT situakibanzahippolyten determinantsofsurvivalofhivpatientsreceivingdolutegraviraprospectivecohortstudyinconflictaffectedbuniademocraticrepublicofcongo