Bio: Tarun Rahman is an academic researcher. The author has contributed to research in topics: Micronutrient & Hazard ratio. The author has an hindex of 2, co-authored 3 publications receiving 17 citations.
TL;DR: After surviving for 1 year on ART, a CD4 nadir was strongly predictive of longer-term mortality among patients in Uganda, and efforts to increase engagement with patients to ensure a higher CD4Nadir at initiation of treatment are argued.
Abstract: Objective Although international guidelines recommend initiating antiretroviral therapy (ART) when a patient's CD4 cell count is ≤350 cells/μL, most patients in resource-limited settings present with much lower CD4 cell counts. The lowest level that their CD4 cell count reaches, the nadir, may have long-term consequences in terms of mortality. We examined this health state in a large cohort of HIV+ patients in Uganda. Design This was an observational study of HIV patients in Uganda aged 14 years or older, who were enrolled in 10 major clinics across Uganda. Methods We assessed the CD4 nadir of patients, using their CD4 cell count at initiation of ART, stratified into categories (,50, 50-99, 100-149, 150-249, 250+ cells/μL). We constructed Kaplan-Meier curves to assess the differences in survivorship for patients left-censored at 1 year and 2 years after treatment initiation. We used Cox proportional hazards regression to model the associations between CD4 nadir and mortality. We adjusted mortality for loss-to-follow-up. Results Of 22,315 patients, 20,129 patients had greater than 1 year of treatment follow-up. Among these patients, 327 (1.6%) died and 444 (2.2%) were lost to follow-up. After left-censoring at one year, relative to lowest CD4 strata, patients with higher CD4 counts had significantly lower rates of mortality (CD4 150-249, hazard ratio [HR] 0.60, 95% confidence interval [CI]: 0.45-0.82, P = 0.001; 250+, HR 0.66, 95% CI, 0.44-1.00, P = -0.05). Male sex, older age, and duration of time on ART were independently associated with mortality. When left-censoring at 2 years, CD4 nadir was no longer statistically significantly associated with mortality. Conclusion After surviving for 1 year on ART, a CD4 nadir was strongly predictive of longer-term mortality among patients in Uganda. This should argue for efforts to increase engagement with patients to ensure a higher CD4 nadir at initiation of treatment.
TL;DR: In December, 2010, Canada’s 6 year old Assisted Human Reproduction Act was successfully challenged in the Supreme Court of Canada.
Abstract: In December, 2010, Canada’s 6 year old Assisted Human Reproduction Act was successfully challenged in the Supreme Court of Canada. There may be important implications for public health and the evolution of reproductive technologies in this country.
TL;DR: Low nadir CD4+ T-cell counts, rather than HIV-1 serostatus per se, predict the presence of gut dysbiosis in HIV- 1 infected subjects, and the microbiomes of subjects with LGC were enriched in bacterial virulence factors, as well as in genes associated with beta-lactam, lincosamide, tetracycline, and macrolide resistance.
TL;DR: Treatment interruption in recent intervention studies were more closely monitored, had more conservative thresholds to restart ART and had a shorter treatment interruption duration, compared with older treatment interruption studies that didn’t include an intervention.
Abstract: Despite the benefits of antiretroviral therapy (ART) for people living with HIV, there has been a long-standing research interest in interrupting ART as a strategy to minimize adverse effects of ART as well as to test interventions aiming to achieve a degree of virological control without ART. We performed a systematic review of HIV clinical studies involving treatment interruption from 2000 to 2017 to describe the differences between treatment interruption in studies that contained and didn't contain an intervention. We assessed differences in monitoring strategies, threshold to restart ART, duration and adverse outcomes of treatment interruption, and factors aimed at minimizing transmission. We found that treatment interruption has been incorporated into 159 clinical studies since 2000 and is increasingly being included in trials to assess the efficacy of interventions to achieve sustained virological remission off ART. Great heterogeneity was noted in immunological, virological and clinical monitoring strategies, as well as in thresholds to recommence ART. Treatment interruption in recent intervention studies were more closely monitored, had more conservative thresholds to restart ART and had a shorter treatment interruption duration, compared with older treatment interruption studies that didn't include an intervention.
TL;DR: The Six-month mortality of HIV critically ill patients with TB coinfection is high and strongly associated with the nadir CD4 cell count less than 50 cels/mm3, and Neurological dysfunction was more prevalent among nonsurvivors.
Abstract: Tuberculosis is one of the leading causes of death from infectious diseases worldwide, mainly after the human immunodeficiency virus (HIV) epidemics. Patient with HIV-related illness are more likely to present with severe TB due to immunosuppression. Very few studies have explored HIV/TB co-infection in critically ill patients. The goal of this study was to analyze factors associated with long-term mortality in critically ill patient with HIV-related disease coinfected with TB.
TL;DR: Current CD4 cell count, but not other metrics, could be an important clinical tool to predict the short-term risk of serious non-AIDS events in treated HIV-positive individuals.
Abstract: Purpose of reviewTo summarize recent findings on the relationship between CD4 cell count metrics and selected serious clinical outcomes, and to deduce implications for CD4 cell count monitoring in treated HIV infection and the timing of combination antiretroviral therapy initiation.Recent findingsIn
28 Feb 2018
TL;DR: Investigation of differences in virological response to ART, treatment adherence, and late HIV diagnosis by gender and sexual orientation among people with HIV in the UK, and whether any differences have narrowed in more recent years identified ongoing disparities in HIV outcomes between gender/sexual orientation groups.
Abstract: The effectiveness of antiretroviral therapy (ART) has led to greatly improved prognosis for people living with HIV, such that they now have a similar life expectancy to the general population. However, these improvements over time have not necessarily been seen equally among all demographic groups. The aim of this thesis was to investigate the differences in virological response to ART, treatment adherence, and late HIV diagnosis by gender and sexual orientation among people with HIV in the UK, and assess whether any differences have narrowed in more recent years. Additional analyses explored whether socio-economic factors could explain the observed differences in outcome across gender/sexual orientation groups. The analyses were based on data from two observational UK studies: the Royal Free HIV Cohort Study and the Antiretrovirals Sexual Transmission Risk and Attitudes (ASTRA) questionnaire study. Results showed that, among individuals on ART, women and men who have sex with women (MSW) had a higher prevalence of detectable viral load and lower CD4 counts than men who have sex with men (MSM). Similarly, for initial response to first-line ART, virological outcomes were less favourable for women and MSW, compared to MSM even in the most recent years, and there was no evidence that these differences in outcome were narrowing over time. Socio-economic disadvantage (financial hardship; non-employment; renting; unstable housing status; non-university education) was strongly associated with higher prevalence of ART non-adherence and poorer virological outcomes. Socio-economic status explained much of the disparities in treatment outcomes between MSM and women, but less between MSW and MSM. A considerably higher prevalence of late diagnosis was seen among women and MSW compared to MSM. In conclusion, this thesis identified ongoing disparities in HIV outcomes between gender/sexual orientation groups. Clinical management strategies should focus on demographic and socio-economic groups at risk of poorer treatment outcomes.