Journal of AIDS & Clinical Research

Introduction: Metabolic syndrome complications are the leading causes of morbidity and mortality among non-communicable diseases in the world. The onset of these diseases can be attributed to factors such as genetic susceptibility, poor diets, and chronic medications. Antiretroviral (ARVs) for Human Immunity Immunodeficiency Virus (HIV) have been previously associated with complications such as central obesity which is a risk factor for the onset of the metabolic syndrome. This protocol outlines the process for conducting a systematic review to investigate the association between chronic ARVs treatment and the onset of metabolic syndrome complications.

Methodology and analysis: The studies included in the systematic review are selected according to the inclusion and exclusion criteria. These studies are searched using search engines or databases such as PubMed, Google Scholar, Medline, Science direct, and Embase Database. Articles will be screened against inclusion and exclusion criteria in two stages, first by the title and abstract, and second by the full article. The articles that remained after full article screening will be assessed for bias and the data will be extracted. The heterogeneity test will be conducted using both x² and I² tests, meta-analysis and data will be presented in forest plots, odds of ratio, and standard error of a mean.

Dissemination and registration: The current protocol paper narrates the methods that will be followed when conducting a systematic review and meta-analysis about the risks of ARVs in the development of metabolic diseases, focusing on ARV regimen one and regimen two. The results intend to give an insight about the ARVs as one of the risk factors of metabolic diseases and further elaborate on the regimen that possesses a high risk between the first and second regimens. This protocol has been registered on PROSPERO Database # CRD42022316038.

Background: The use of structural equation modeling and latent variables remains unusual in epidemiology despite its potential usefulness and assessment of causal relations. Measuring the direct and indirect effect of latent variables helps with proper intervention and for the ART program to be effective. The main objective of the current investigation was to assess causal inference of assessment of the direct and indirect effect of latent covariates on CD4 cell count change for HIV positive adults under HAART.

Methods: Based on the repeated measures of CD4 cell count change data obtained in the ART section at Felege Hiwot teaching and specialized hospital, AMOS software was used for parameter estimation. The study was conducted on 792 randomly selected HIV positive adults. The data were collected by the health staff after a brief orientation of the variables under study.

Results: CD4 cell count change was directly and indirectly affected by the latent variables. The powers of effects of observed variables with and without latent variables were a little bit different from each other. Hence, the powerful effect of observed variables with latent variables was lower as compared to those without latent variables. The direct effect of latent variables on the response variable was a little bit greater than the indirect effect.

Conclusion: The power of the effects of observed variables was stronger than their effects with latent variables. Hence, the latent variables had significant contributions to the progress of CD4 cell count change. Health related education about the direct and indirect effects of latent variables should be given to patients under HAART. Knowledge of direct and indirect effects on the variable of interest is important for proper intervention in ART programs.

Background: The main objective of this study was to investigate joint predictors of pulse rate and time to first recovery among diabetes mellitus patients under treatment.

Method: A retrospective cohort study design was conducted in this study. Linear mixed model and cox-proportional hazard model for separate analysis and joint model for the two responses were used.

Results: Among the participants, 66.7% of patients were female, and 19% of the patients had a family disease history. The time needed to reach the first recovery among male patients was significantly longer compared to female patients. The time needed to reach the first recovery among patients with no other related disease was significantly shorter as compared with patients with other related diseases (HR=0.0893).The estimated association parameter (α) in the joint model was -1.5108, with a p-value<0.001. The result indicates that the higher the pulse rate was associated with the lower time to the first recovery.

Conclusion: The variable age, residence area, other related diseases, and hypertension significantly and jointly affected both of the two responses. Due attention should be given to aged patients, patients with family disease history, patients with other related diseases, and rural patients.

Background: World Health Organization (WHO) recommends viral load monitoring to ensure viral load suppression is achieved and maintained, there by decreased morbidity and mortality, but large gaps remain particularly in low and middle income countries. Virologic failure and treatment failure remained a major problem in Addis Ababa. Identifying the factors for virologic failure has benefits in controlling transmission and reducing disease burden.

Objectives: To identify the determinants of virologic failure in people living with HIV on antiretroviral therapy in two selected public health facilities in Addis Ababa, Ethiopia

Methods: A hospital based case control study was to identify determinants of virologic failure among HIV/AIDS patients who are on ART in Saint Peter’s specialized hospital and Zewditu memorial hospital. A total of 350 participants were recruited with 117 cases and 233 controls with 1:2 ratios of cases to controls. Those who have viral suppression (VL<1000 copies/ml) was taken as controls and those who don’t have viral load suppression were classified as cases. Epi info version 7.2.4 and SPSS version 25 were used for data entry and analysis respectively. Bivariate and multivariable regression analysis were conducted to identify factors associated with viral load non-suppression

Results: The majority of the study participants (62.6%) were female while 38.4% were male. Factors associated with viral load non-suppression included younger age (AOR=8.883), disclosure status (AOR=9.123), poor adherence (AOR=21.953), history of chronic disease (AOR=0.14), less duration on treatment (AOR=0.193), 2^nd line regimen (AOR=7.611), and treatment failure as a reason for regimen change (AOR=16.381).

Conclusion: Being in the younger age group, poor adherence, long duration on treatment, being on second line regimen were the factors which increase chance of virologic failure. Behavioral intervention to prevent treatment interruption is required to sustain human immunodeficiency virus treatment adherence by focusing on age and treatment duration.

Introduction: Antiretroviral Therapy (ART) shows a great impact on immunological restoration and viral load suppression in individuals living with the Human Immune Deficiency Virus (HIV). Currently, among 38.4 million individuals living with HIV in the globe, around 28.7 million are under ART. Good adherence and follow-up of ART treatment decrease the morbidity and mortality rates of HIV positive individuals and increase the quality of life. Although it is a retrospective cohort study, we aimed to assess how ART regimens influence the restoration of immunological and hematological parameters, and the clinical progression after 2 and half years of ART treatment and follow-up.

Methodology: Retrospectively, we reviewed the medical records of HIV patients. Based on our follow-up requirements, we collected the medical records of 320 HIV patients retrospectively and followed them for 2 and half years. All the socio-demographic data with immunological, hematological, BIM, and clinical data of HIV patients under follow-up were collected every six months for 30 months period. Data were entered into SPSS version 23 and graph pad prism version 5.1 (graph pad software, San Diego, CA). The data were described and statistically analyzed with simple frequency and repeated measures of ANOVA.

Result: Among the 320 HIV patients who followed, 61.9% were females. In this study, The CD4 T cell count showed significant improvement from the baseline to the 12^th, 18^th, 24^th, and 30^th month follow-up; from the 6^th to 18^th, 24^th, and 30^th month follow-up, and from 12^th month to 24^th and 30^th month, indicating that ART significantly restored the immune response in HIV patients across the follow-up periods. The Body Mass Index (BMI) also showed similar significant improvement patterns with the CD4 T cell count. There was a significant improvement in the World Health Organization (WHO) clinical stage of HIV patients after follow-up as indicated by our result that the majority of HIV patients at baseline were at WHO stage III 168 (58.5%), however, after 2 and half year follow-up, only 16.3% remained at WHO stage III. In addition, at baseline (before initiation of ART), the proportion of HIV patients at WHO clinical stage I was only 12.8%, and that was increased to 44% at the end of the follow-up period. The burden of opportunistic infections also significantly decreased from 413.1% at baseline to 0.9% after follow-up. The hematological parameters such as total WBC count, platelet count, and hemoglobin levels were also significantly improved through the course of the follow-up periods.

Conclusion: Our study showed that good ART treatment and good follow-up of HIV management in patients with HIV can bring indispensable progress in their immunological, hematological, and clinical parameters.