Characterization of malaria episodes among people with HIV (PWH) is lacking since shifts to HIV test-and-treat and adoption of integrase-strand inhibitors. Improvements in HIV care may have minimized previously seen impacts of malaria on HIV outcomes.Table 1.Clinical characteristics of PLWH participants at closest visit to first positive malaria testFigure 1.A) Predicted probability of viral non-suppression (>=200 copies/mL) across months from acute malaria visit. B) Growth Mixture modeling of the 2 identified clusters. i) consistent suppressors, and ii) non-suppressors and the probability of viral non-suppression prior-to and after the malaria event. Malaria event is noted at time “0”. PWH and people without HIV (PWoH) from Uganda, Kenya, Tanzania and Nigeria who enrolled in the African Cohort Study (AFRICOS) in 2013-2023 were considered (n=4,262). Alternate infectious diagnoses were excluded and participants with a febrile visit and a positive malaria smear or PCR were included (n=584). Demographic and clinical characteristics at prior visit closest to positive malaria smear were compared. Complete case analyses were utilized for missing data. Growth mixture modeling (GMM) of PWH by viral load (VL) was performed before and after an acute malarial episode (AME) to elucidate trajectories of VL around the episode. Clusters were further compared by clinical parameters including ART status, and CD4 count.Table 2.Clinical characteristics of participants at visit closest to acute malaria visit, by cluster A total of 220/468 (47.0%) PWH and 74/116 (63.8%) PWoH tested positive during the study period. At first positive test, PWH had significantly higher ALT (median [M]=20.1U/L, interquartile range [IQR]=15.7-28.7 vs. M=16.0, IQR=12.2-22.9) and lower white blood cell count (WBC; M=4.4 x 103 cells/μL, IQR=3.6-5.4 vs. M=4.9, IQR=4.5-6.3) than PWoH. Most PWH positive for malaria were virally suppressed < 200 copies/mL (88.5%) and on ART for 5 years (M=5.3; Table 1). The GMM of PWH (n=219 with 2 timepoints) revealed 2 clusters: consistent VL suppressors (VS; n=189, 86.3%) and VL non-suppressors (VNS; n=30, 13.6%). Probability of VL non-suppression increased 6 months before and 3 months after AME (Figure 1). VNS were younger (M=35.1 years), had less time since HIV onset and on ART (M=3.8 years), less likely to be ever on dolutegravir (DTG), and had lower CD4 counts compared to VS (60% vs 35.7% with < 500 cells/mm3)(Table 2). PWH had generally comparable baseline clinical parameters to PWoH at acute malaria visit. Among PWH, a longitudinal cluster of VNS emerged among younger and newly HIV-diagnosed individuals not on DTG. VNS remains low overall, showing the benefits of continued HIV care engagement. Future studies are needed to elucidate facets of care surrounding HIV outcomes and malaria. All Authors: No reported disclosures
Human Leukocyte Antigen (HLA) loci have been implicated in several diseases from different world populations, including HIV-1. It is necessary to characterize HLA allele variation at the population level prior to investigating associations linked to human diseases. In global databases, limited high-resolution HLA allele types generated by next-generation sequencing (NGS) have been described for populations from African countries. We sought to expand our HLA NGS database to include a total of 1023 participants from multiple HIV clinical studies using full-length HLA genotyping by NGS. Collectively we describe HLA genotypes of individuals from Kenya (n=375), Uganda (n=338), Nigeria (n=139), Tanzania (n=89), and Mozambique (n=82). Overall, we identified 371 unique HLA alleles across 11 loci with the most frequent at each locus being A*02:01:01, B*53:01:01, C*04:01:01, C*06:02:01, DPA1*01:03:01, DPB1*01:01:01, DQA1*01:02:01, DQB1*06:02:01, DRB1*15:03:01, DRB3*02:02:01, DRB4*01:03:01, and DRB5*01:01:01. A total of 25 novel alleles were identified, including 4 with non-synonymous changes affecting the peptide binding groove of HLA molecules. This expansion of NGS based HLA data at the African population level will improve our understanding of human genetic variation and provide insights for vaccine development and targeted personalized therapies.
Future efficacy testing of candidate vaccines and other interventions to prevent HIV will require engagement of vulnerable populations. Here, we assessed willingness to participate in future clinical trials among participants recruited for an HIV incidence study in western Kenya. From February 2017 to May 2018, we recruited people living without HIV who reported multiple sexual partners into a 24-month HIV incidence cohort study in Kisumu County, Kenya. At screening for study eligibility and study exit, participants completed comprehensive sociobehavioral questionnaires. They were also provided a general definition of a clinical trial and asked if they would be willing to participate in a future clinical trial of a candidate HIV vaccine. At enrollment, participants were also asked about facilitators and barriers to participation in such a clinical trial. Among 940 individuals screened for enrollment into the HIV incidence study, 919 (97.8
BACKGROUND:Adherence to study visits enhances safety and validity of human research studies. We identified characteristics associated with missed visits in a Kenyan HIV incidence study to inform retention strategies. METHODS:We enrolled volunteers 18-35 years of age, without HIV, who reported 2+ sex partners into a study with visits every 3 months for 24 months. We used zero-inflated Poisson regression to assess sociobehavioral and demographic characteristics associated with missed visits and loss-to-follow-up. Latent class analysis (LCA) identified clusters of characteristics associated with each outcome. RESULTS:Among 619 participants without HIV, 278 (44.9%) were women with median age of 24 years (interquartile range: 21-28). During follow-up, 134 (21.6%) missed 1+ and 84 (13.6%) missed 2+ visits. Missed visits were more common among participants with 3+ sexual partners than among 2 partners (adjusted risk ratio: 1.50, 95% confidence interval: 1.13 to 1.97) and less common in participants who completed secondary school (aRR: 0.74, 95% CI: 0.56 to 0.99, compared with some primary school or less). Women were more likely to be lost to follow-up (aRR: 1.85, 95% CI: 1.05 to 3.26). LCA showed that missed visits were more likely among women aged 24+ years with less than secondary education who reported transactional sex than among largely younger unmarried men with less than secondary education and 3+ sexual partners (RR: 1.24, 95% CI: 1.01 to 1.54) and poorly educated, largely older married men (RR: 1.41, 95% CI: 1.05 to 1.90). CONCLUSION:Older unmarried women with less education, more sexual partners, and transactional sex may benefit from targeted retention strategies such as optimizing accessibility to testing and prevention services and frequent visit reminders.
INTRODUCTION:Epstein-Barr virus (EBV) affects greater than 95% of the global population, and when acquired at an early age, results in poor control of viral replication and increased risk to subsequent chronic illnesses. OBJECTIVE:To analye the association between EBV and early cardiac dysfunction. METHODS:A cross-sectional echocardiographic study on children, adolescent and young adults living with human immunodeficiency virus (HIV) in Eldoret, Kenya. We collected echocardiograms, viral copy levels, and inflammatory markers. We compared EBV-positive participants to EBV-negative participants. RESULTS:The majority of patients with EBV copies detected were male, median (25-75%) age of 15 (11-19) years and did not have signs of early cardiac dysfunction. No significant differences were observed in cardiac function between individuals with detectable and undetectable EBV copies (p = 0.472; p = 0.6140; p = 0.382 respectively). CONCLUSIONS:In this population of individuals, no significant difference in cardiac function between individuals with detectable and undetectable EBV copies was observed.
