20 results on '"Laursen, Alex"'
Search Results
2. Assessing factors for loss to follow-up of HIV infected patients in Guinea-Bissau
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Nordentoft, Pernille Bejer, Engell-Sørensen, Thomas, Jespersen, Sanne, Correia, Faustino Gomes, Medina, Candida, da Silva Té, David, Østergaard, Lars, Laursen, Alex Lund, Wejse, Christian, Hønge, Bo Langhoff, Rodrigues, Amabelia, da Silva, David, da Silva, Zacarias, Medina, Candida, Oliviera-Souto, Ines, Østergaard, Lars, Laursen, Alex, Hønge, Bo, Aaby, Peter, Fomsgaard, Anders, Erikstrup, Christian, Jespersen, Sanne, Wejse, Christian, and Bissau HIV Cohort study group
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- 2017
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3. Discriminatory rapid tests cause HIV-type misclassification—evaluation of three rapid tests using clinical samples from Guinea-Bissau
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Hønge, Bo Langhoff, Jespersen, Sanne, Medina, Candida, Té, David Da Silva, Da Silva, Zacarias José, Christiansen, Mette, Kjerulff, Bertram, Laursen, Alex Lund, Wejse, Christian, Krarup, Henrik, Erikstrup, Christian, Rodrigues, Amabelia, Da Silva, David, Oliviera-Souto, Ines, Østergaard, Lars, Aaby, Peter, and Fomsgaard, Anders
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0301 basic medicine ,medicine.medical_specialty ,Human immunodeficiency virus (HIV) ,First Response ,medicine.disease_cause ,Treatment failure ,03 medical and health sciences ,Reference test ,Genie III ,0302 clinical medicine ,Internal medicine ,medicine ,Guinea-Bissau ,Bioline ,030212 general & internal medicine ,INFECTED PATIENTS ,business.industry ,Public Health, Environmental and Occupational Health ,HIV type ,virus diseases ,General Medicine ,030112 virology ,Alternative treatment ,Dna detection ,Infectious Diseases ,Guinea bissau ,HIV-2 ,Cohort ,Parasitology ,business - Abstract
BackgroundDiscrimination among HIV types is important because HIV-2 is naturally resistant to some of the first-line drugs used in the treatment of HIV-1. We evaluated three assays for HIV-type discriminatory capacity: SD Bioline HIV 1/2 3.0 (Bioline), First Response HIV 1-2-0 Card Test (First Response) and Genie III HIV-1/HIV-2 (Genie III).MethodsBased on results from the Bioline assay, samples from 239 HIV-infected patients from the Bissau HIV cohort in Guinea-Bissau were retrospectively selected for evaluation. Genie III and First Response were scored by three independent readers and compared with a reference test (INNO-LIA HIV I/II Score) confirmed by HIV RNA as well as DNA detection.ResultsThe best performing test was Genie III, with an average agreement with the reference test of 93.4%, followed by First Response (86.1%) and Bioline (72.4%). First Response and Bioline were scored with a false high number of HIV-1/2 dual infections. For both First Response and Genie III, there were discrepancies among independent readers, and some tests were scored as HIV non-reactive.ConclusionsUsing these rapid tests with a suboptimal performance will presumably result in a high rate of false HIV-1/2 dual diagnoses, depriving patients of alternative treatment options in cases of treatment failure.
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- 2019
4. Acceptance and Feasibility of Partner Notification to HIV Infected Individuals in Guinea-Bissau.
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Madsen, Tina, Jespersen, Sanne, Medina, Candida, Té, David D. S., Wejse, Christian, Laursen, Alex L., Hønge, Bo L., for the Bissau HIV Cohort Study Group, Rodrigues, Amabelia, da Silva Té, David, da Silva, Zacarias, Oliviera-Souto, Ines, Østergaard, Lars, Laursen, Alex Lund, Aaby, Peter, Fomsgaard, Anders, Erikstrup, Christian, and Hønge, Bo Langhoff
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HIV prevention ,HIV-positive persons ,CONTACT tracing ,SEXUAL partners ,CD4 lymphocyte count - Abstract
As partner notification (PN) has shown effective in increasing the number of partners of HIV infected patients being tested we aimed to evaluate the feasibility of implementing PN in the West-African country Guinea-Bissau. Patients enrolled were offered the choice of three different PN methods. Acceptance, successful referrals and HIV status of partners were evaluated. Of 697 patients offered PN, 495 (71.0%) accepted and listed 547 partners. At end of follow-up 118 (21.5%) partners had been tested of which 44 (37.3%) were HIV infected. HIV infected partners had a higher median CD4 count at diagnosis compared with index patients; 401 cells/mm
3 versus 240 cells/mm3 , p < 0.001. The results indicate that implementation of PN is feasible, effective in identifying HIV infected partners and enables initiation of earlier treatment, yet there are major barriers to bringing partners in for testing which should be addressed in order to exploit the full potential of PN. [ABSTRACT FROM AUTHOR]- Published
- 2020
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5. Life expectancy of HIV-infected patients followed at the largest hospital in Guinea-Bissau is one-fourth of life expectancy of the background population.
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Engell-Sørensen, Thomas, Rieckmann, Andreas, Medina, Candida, da Silva Té, David, Rodrigues, Amabelia, Fisker, Ane Bærent, Aaby, Peter, Erikstrup, Christian, Jespersen, Sanne, Wejse, Christian, Hønge, Bo Langhoff, for the Bissau HIV Cohort study group, da Silva, Zacarias, Oliviera-Souto, Ines, Østergaard, Lars, Laursen, Alex, and Fomsgaard, Anders
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HIV-positive persons ,HOSPITALS ,SCIENTIFIC observation ,CONFIDENCE intervals ,LIFE expectancy ,RESEARCH methodology ,CD4 antigen ,RETROSPECTIVE studies ,DESCRIPTIVE statistics ,KAPLAN-Meier estimator - Abstract
Purpose: To estimate the life expectancy (LE) of HIV-infected patients in the West African country Guinea-Bissau and compare it with the background population. Methods: Using data from the largest HIV outpatient clinic at the Hospital Nacional Simão Mendes in the capital Bissau, a retrospective observational cohort study was performed. The study included patients attending the clinic between June 2005 and January 2018. A total of 8958 HIV-infected patients were included. In the analysis of the background population, a total of 109,191 people were included. LE incorporating loss to follow-up (LTFU) was estimated via Kaplan–Meier estimators using observational data on adult HIV-infected patients and background population. Results: The LE of 20-year-old HIV-infected patients was 9.8 years (95% CI 8.3–11.5), corresponding to 22.3% (95% CI 18.5–26.7%) of the LE of the background population. (LE for 20-year-olds in the background population was 44.0 years [95% CI 43.0–44.9].) Patients diagnosed with CD4 cell counts below 200 cells/µL had a LE of 5.7 years (95% CI 3.6–8.2). No increase in LE with later calendar period of diagnosis was observed. Conclusions: LE was shown to be markedly lower among HIV-infected patients compared with the background population. While other settings have shown marked improvements in prognosis of HIV-infected patients in recent years, no improvement in Bissau was observed over time (9.8 years (95% CI 7.6–12.2) and 9.9 years (95% CI 7.6–12.1) for the periods 2005–2010 and 2014–2016, respectively). [ABSTRACT FROM AUTHOR]
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- 2021
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6. Hepatitis B and C in the adult population of Bissau, Guinea-Bissau: a cross-sectional survey.
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Hønge, Bo Langhoff, Olesen, Jens Steen, Jensen, Mads Mose, Jespersen, Sanne, Silva, Zacarias José, Rodrigues, Amabélia, Laursen, Alex Lund, Wejse, Christian, Krarup, Henrik, Aaby, Peter, Erikstrup, Christian, and da Silva, Zacarias José
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HEPATITIS B ,HEPATITIS C virus ,HEPATITIS B virus ,BLOOD transfusion ,DEMOGRAPHIC surveys - Abstract
Copyright of Tropical Medicine & International Health is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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- 2020
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7. Soluble Macrophage Mannose Receptor (sCD206/sMR) as a Biomarker in Human Immunodeficiency Virus Infection.
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Andersen, Morten N, Hønge, Bo L, Jespersen, Sanne, Medina, Candida, Té, David da Silva, Laursen, Alex, Wejse, Christian, Erikstrup, Christian, Møller, Holger J, Group, Bissau HIV Cohort Study, da Silva Té, David, and Bissau HIV Cohort Study Group
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HIV infections ,ANTIRETROVIRAL agents ,HIV-positive persons ,MACROPHAGES ,T cells - Abstract
Macrophages play important roles during human immunodeficiency virus (HIV) infection, reflected by changes in macrophage-activation biomarker soluble CD163 (sCD163). Here, we present data on the novel macrophage-activation biomarker soluble mannose receptor/CD206 (sCD206) in HIV infection. We investigated sCD206 blood levels at baseline and follow-up with/without antiretroviral therapy (ART), in 212 patients with HIV type 1 (HIV-1), HIV type 2 (HIV-2), or dual infection. At baseline, there was no difference in sCD206 level between HIV types, and sCD206 was unchanged at follow-up without ART. However, in contrast to sCD163, sCD206 levels decreased significantly for both HIV-1 and HIV-2, but not for HIV-1/2 patients, during ART. Further investigations are needed to establish sCD206 as a biomarker in HIV infection. [ABSTRACT FROM AUTHOR]
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- 2018
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8. Hepatitis B and Delta Virus Are Prevalent but Often Subclinical Co-Infections among HIV Infected Patients in Guinea-Bissau, West Africa: A Cross-Sectional Study
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Hønge, Bo Langhoff, Jespersen, Sanne, Medina, Candida, Té, David da Silva, da Silva, Zacarias José, Lewin, Sharon, Østergaard, Lars, Erikstrup, Christian, Wejse, Christian, Laursen, Alex Lund, Krarup, Henrik, and Sodemann, Morten
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Male ,Viral Diseases ,Gastroenterology and hepatology ,viruses ,lcsh:Medicine ,HIV Infections ,medicine.disease_cause ,Hepatitis ,Liver disease ,Immunodeficiency Viruses ,Risk Factors ,Hepatitis Delta ,Prevalence ,Guinea-Bissau ,lcsh:Science ,Multidisciplinary ,Coinfection ,virus diseases ,Hepatitis B ,Middle Aged ,Hepatitis D ,Infectious hepatitis ,Infectious Diseases ,Medical Microbiology ,Viral Pathogens ,Female ,Hepatitis Delta Virus ,Research Article ,Adult ,Hepatitis B virus ,Microbiology ,Virus ,Acquired immunodeficiency syndrome (AIDS) ,medicine ,Humans ,Microbial Pathogens ,Liver diseases ,Medicine and health sciences ,Hepatitis B Surface Antigens ,business.industry ,lcsh:R ,Correction ,Biology and Life Sciences ,HIV ,medicine.disease ,Virology ,digestive system diseases ,Cross-Sectional Studies ,Immunology ,Mutation ,lcsh:Q ,business - Abstract
The members of the Bissau HIV cohort study group are: Amabelia Rodrigues, David da Silva, Zacarias da Silva, Candida Medina, Ines Oliviera-Souto, Lars ∅stergaard, Alex Laursen, Morten Sodemann, Peter Aaby, Anders Fomsgaard, Christian Erikstrup, Jesper Eugen-Olsen and Christian Wejse (chair). Background: Co-infection with human immunodeficiency virus (HIV) and hepatitis B virus (HBV) may lead to accelerated hepatic disease progression with higher rates of liver cirrhosis and liver-related mortality compared with HBV mono-infection. Co or super-infection with hepatitis Delta virus (HDV) may worsen the liver disease and complicate treatment possibilities. Methods: In this cross-sectional study we included HIV-infected individuals who had a routine blood analysis performed at an HIV clinic in Bissau, Guinea-Bissau between the 28th of April and 30th of September 2011. All patients were interviewed, had a clinical exam performed and had a blood sample stored. The patients' samples were tested for HBV and HDV serology, and HBV/HDV viral loads were analyzed using in-house real-time PCR methods. Results: In total, 576 patients (417 HIV-1, 104 HIV-2 and 55 HIV-1/2) were included in this study. Ninety-four (16.3%) patients were HBsAg positive of whom 16 (17.0%) were HBeAg positive. In multivariable logistic regression analysis, CD4 cell count
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- 2014
9. Performance of 3 rapid tests for discrimination between HIV-1 and HIV-2 in Guinea-Bissau, West Africa
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Hønge, Bo Langhoff, Bjarnason Obinah, Magnús Pétur, Jespersen, Sanne, Medina, Candida, Té, David da Silva, da Silva, Zacarias José, Østergaard, Lars, Laursen, Alex Lund, Wejse, Christian, Erikstrup, Christian, and Sodemann, Morten
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Adult ,Male ,medicine.medical_specialty ,Human immunodeficiency virus (HIV) ,HIV Infections ,medicine.disease_cause ,Sensitivity and Specificity ,West africa ,Internal medicine ,medicine ,Antiretroviral treatment ,Humans ,Pharmacology (medical) ,Guinea-Bissau ,business.industry ,Coinfection ,AIDS serodiagnosis ,AIDS Serodiagnosis ,virus diseases ,Gold standard (test) ,Middle Aged ,medicine.disease ,CD4 Lymphocyte Count ,Infectious Diseases ,Guinea bissau ,HIV-2 ,HIV-1 ,Female ,business - Abstract
As HIV-2 is intrinsically resistant to nonnucleoside reverse transcriptase inhibitors, it is mandatory to discriminate between HIV types before initiating antiretroviral treatment. Guinea-Bissau has the world's highest prevalence of HIV-2 and HIV-1/HIV-2 dually infected individuals. We evaluated 3 rapid tests for discrimination between HIV-1, HIV-2, and dual infections among 219 patients from Guinea-Bissau by comparing with the gold standard (INNO-LIA). Genie III HIV-1/HIV-2 was the best performer with regard to discriminatory capacity (agreement 91.8%), followed by Immunoflow HIV1-HIV2 (agreement 90.9%) and SD Bioline HIV-1/2 3.0 (agreement 84.5%). Our results underscore the need for evaluation of tests in relevant populations before implementation.
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- 2014
10. Differential effects of sex in a West African cohort of HIV-1, HIV-2 and HIV-1/2 dually infected patients: men are worse off.
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Jespersen, Sanne, Hønge, Bo Langhoff, Esbjörnsson, Joakim, Medina, Candida, Silva Té, David, Correira, Faustino Gomes, Laursen, Alex Lund, Østergaard, Lars, Andersen, Andreas, Aaby, Peter, Erikstrup, Christian, Wejse, Christian, Rodrigues, Amabelia, Silva, David, Silva, Zacarias, Oliviera‐Souto, Ines, Laursen, Alex, Sodemann, Morten, Fomsgaard, Anders, and Eugen‐Olsen, Jesper
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COHORT analysis ,HIV infections ,SEXUAL dysfunction ,FOLLOW-up studies (Medicine) ,MEDICAL research ,ANTI-HIV agents ,COMPARATIVE studies ,HIV ,RESEARCH methodology ,MEDICAL cooperation ,MEN ,MEN'S health ,RESEARCH ,SEX distribution ,SOCIOECONOMIC factors ,EVALUATION research ,HUMAN research subjects ,PROPORTIONAL hazards models ,RETROSPECTIVE studies ,PATIENTS' attitudes ,CD4 lymphocyte count - Abstract
Copyright of Tropical Medicine & International Health is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2016
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11. Clinical presentation and opportunistic infections in HIV-1, HIV-2 and HIV-1/2 dual seropositive patients in Guinea-Bissau.
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Sørensen, Allan, Jespersen, Sanne, Katzenstein, Terese L, Medina, Candida, Té, David da Silva, Correira, Faustino Gomes, Hviid, Cecilie Juul, Laursen, Alex Lund, and Wejse, Christian
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CRYPTOCOCCOSIS ,TUBERCULOSIS diagnosis ,AGE distribution ,CHI-squared test ,CONFIDENCE intervals ,COUGH ,EXANTHEMA ,FISHER exact test ,HIV ,HIV-positive persons ,OUTPATIENT services in hospitals ,PROBABILITY theory ,REGRESSION analysis ,RESEARCH funding ,WEIGHT loss ,AIDS-related opportunistic infections ,SYMPTOMS ,BODY mass index ,CROSS-sectional method ,DATA analysis software ,DESCRIPTIVE statistics ,CD4 lymphocyte count ,KRUSKAL-Wallis Test ,DIAGNOSIS - Abstract
Background:Better understanding of HIV-2 infection is likely to affect the patient care in areas where HIV-2 is prevalent. In this study, we aimed to characterize the clinical presentations among HIV-1, HIV-2 and HIV-1/2 dual seropositive patients. Methods:In a cross-sectional study, newly diagnosed HIV patients attending the HIV outpatient clinic at Hospital Nacional Simão Mendes in Guinea-Bissau were enrolled. Demographical and clinical data were collected and compared between HIV-1, HIV-2 and HIV-1/2 dual seropositive patients. Results:A total of 169 patients (76% HIV-1, 17% HIV-2 and 6% HIV 1/2) were included in the study between 21 March 2012 and 14 December 2012. HIV-1 seropositive patients were younger than HIV-2 and HIV-1/2 seropositive patients, but no difference in sex was observed. Patients with HIV-1 and HIV-1/2 had a lower baseline CD4 cell count than HIV-2 seropositive patients (median CD4 cell count 185, 198 and 404 cells/μl, respectively (pvalue 0.001 and 0.05). HIV-1 seropositive patients had a lower BMI and a higher prevalence of weight loss, skin rash and productive cough than HIV-2 seropositive patients (pvalue 0.03, 0.002, 0.03 and 0.04). Only four cases (2%) of pulmonary tuberculosis (TB) were diagnosed. One patient (1/96, 1%) was tested positive for cryptococcal antigen. Conclusion:HIV-1 and HIV-1/2 seropositive patients have lower CD4 cell counts than HIV-2 seropositive patients when diagnosed with HIV with only minor clinical and demographic differences among groups. Few patients were diagnosed with TB and cryptococcal disease was not found to be a major opportunistic infection among newly diagnosed HIV patients. [ABSTRACT FROM PUBLISHER]
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- 2016
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12. Diabetes mellitus and impaired fasting glucose in ART-naıve patients with HIV-1, HIV-2 and HIV-1/2 dual infection in Guinea-Bissau: a cross-sectional study.
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Steiniche, Ditte, Jespersen, Sanne, Erikstrup, Christian, Krarup, Henrik, Handberg, Aase, Østergaard, Lars, Haraldsdottir, Thorny, Medina, Candida, Correira, Faustino Gomes, Laursen, Alex Lund, Bjerregaard-Andersen, Morten, Wejse, Christian, and Hønge, Bo Langhoff
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DIABETES ,HIV-positive persons ,BLOOD sugar monitoring ,DISEASE prevalence ,CROSS-sectional method - Abstract
Background: The prevalence of diabetes mellitus (DM) is expected to increase in sub-Saharan Africa. Patients with HIV are at particular risk. We investigated the DM burden among antiretroviral therapy (ART)-naıve patients with HIV in Guinea-Bissau. Methods: Patients were consecutively included. Demographic and lifestyle data were collected and one fasting blood glucose (FBG) measurement was used to diagnose DM (FBG≥7.0 mmol/L) and impaired fasting glucose (IFG) (FBG≥6.1 and, 7.0 mmol/L). Results: By June 2015, 953 newly diagnosed ART-naıve patients with HIV had been included in the study of whom 893 (93.7%) were fasting at the time of inclusion. Median age among the fasting patientswas 37 years (IQR 30-46 years) and 562 (62.9%) were women. The prevalence of DM was 5.8% (52/893) while 5.6% (50/893) had IFG. DM was associated with family history ofDM(OR 3.92, 95%CI 1.78 to 8.63), being 41-50 years (OR 2.98, 95%CI 1.18 to 7.49) or older than 50 years (OR 3.14, 95% CI 1.09 to 9.07) and Fula ethnicity (OR 2.72, 95% CI 1.12 to 6.62). Conclusions: DM prevalence was higher among younger patients compared with the background population in Bissau. Traditional risk factors for DM such as advancing age and a family history of DM apply also for ART-naıve patients with HIV. [ABSTRACT FROM AUTHOR]
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- 2016
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13. High level of HIV-1 drug resistance among patients with HIV-1 and HIV-1/2 dual infections in Guinea-Bissau.
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Jespersen, Sanne, Tolstrup, Martin, Hønge, Bo Langhoff, Medina, Candida, da Silva Té, David, Ellermann-Eriksen, Svend, Østergaard, Lars, Wejse, Christian, and Laursen, Alex Lund
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HIV infections ,ANTIRETROVIRAL agents ,VIRUS diseases ,MEDICAL microbiology - Abstract
Background: With the widespread use of antiretroviral treatment (ART) in Africa, the risk of drug resistance has increased. The aim of this study was to evaluate levels of HIV-1 resistance among patients with HIV-1 and HIV-1/2 dual infections, treated with ART, at a large HIV clinic in Guinea-Bissau. Findings: Patients were selected from the Bissau HIV cohort. All patients had HIV-1 or HIV-1/2 dual infection, a CD4 cell count performed before and 3-12 months after starting ART, and a corresponding available plasma sample. We measured viral load in patients with HIV-1 (n = 63) and HIV-1/2 dual (n = 16) infections a median of 184 days after starting ART (IQR: 126-235 days). In patients with virological failure (defined as viral load >1000 copies/ml) and with sufficient plasma available, we performed an HIV-1 genotypic resistance test. Thirty-six patients (46%) had virological failure. The CD4 cell count did not predict treatment failure. Of the 36 patients with virological failure, we performed a resistance test in 15 patients (42%), and nine patients (9/15; 60%) had resistance mutations. The most common mutation was K103N, which confers high-level resistance to non-nucleoside reverse transcriptase inhibitors (NNRTI). No major mutations against protease inhibitors (PI) were found. Conclusions: Our results showed that patients with HIV-1 and HIV-1/2 dual infections in Guinea-Bissau had a high rate of virological failure and rapid development of NNRTI resistance. It remains to be determined whether a more robust, PI-based treatment regimen might benefit this population more than NNRTIs. [ABSTRACT FROM AUTHOR]
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- 2015
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14. Lack of awareness of treatment failure among HIV-1-infected patients in Guinea-Bissau - a retrospective cohort study.
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Jespersen, Sanne, Hønge, Bo Langhoff, Medina, Candida, Silva Té, David, Correira, Faustino Gomes, Laursen, Alex Lund, Erikstrup, Christian, Østergaard, Lars, and Wejse, Christian
- Abstract
Introduction: With more people receiving antiretroviral treatment (ART), the need to detect treatment failure and switch to second-line ART has also increased. We assessed CD4 cell counts (as a marker of treatment failure), determined the rate of switching to second-line treatment and evaluated mortality related to treatment failure among HIV-infected patients in Guinea- Bissau. Methods: In this retrospective cohort study, adult patients infected with HIV-1 receiving ≥6 months of ART at an HIV clinic in Bissau were included from June 2005 to July 2014 and followed until January 2015. Treatment failure was defined as 1) a fall in CD4 count to baseline (or below) or 2) CD4 levels persistently below 100 cells/μL after ≥6 months of ART. Cox hazard models, with time since six months of ART as the time-varying coefficient, were used to estimate the hazard ratio for death and loss to follow-up. Results: We assessed 1,591 HIV-1-infected patients for immunological treatment failure. Treatment failure could not be determined in 594 patients (37.3%) because of missing CD4 cell counts. Among the remaining 997 patients, 393 (39.4%) experienced failure. Only 39 patients (9.9%) with failure were switched from first- to second-line ART. The overall switching rate was 3.1 per 100 person-years. Mortality rate was higher in patients with than without treatment failure, with adjusted hazard rate ratios (HRRs) 10.0 (95% CI: 0.9-107.8), 7.6 (95% CI: 1.6-35.5) and 3.1 (95% CI: 1.5-6.3) in the first, second and following years, respectively. During the first year of follow-up, patients experiencing treatment failure had a higher risk of being lost to follow-up than patients not experiencing treatment failure (adjusted HRR 4.4; 95% CI: 1.7-11.8). Conclusions: We found a high rate of treatment failure, an alarmingly high number of patients for whom treatment failure could not be assessed, and a low rate of switching to a second-line therapy. These factors could lead to an increased risk of resistance development and excess mortality. [ABSTRACT FROM AUTHOR]
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- 2015
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15. Protease Inhibitors or NNRTIs as First-Line HIV-1 Treatment in West Africa (PIONA): A Randomized Controlled Trial.
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Jespersen, Sanne, Hønge, Bo Langhoff, Krarup, Henrik, Medstrand, Patrik, Sørensen, Allan, Medina, Candida, Té, David da Silva, Correira, Faustino Gomes, Erikstrup, Christian, Østergaard, Lars, Wejse, Christian, and Laursen, Alex Lund
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Supplemental Digital Content is Available in the Text. Background: Nonnucleoside reverse transcriptase inhibitors (NNRTIs) are recommended as part of first-line treatment for HIV-1 in Africa. However, NNRTI-based regimens are more prone to resistance development than protease inhibitors (PIs) in a context in which drug interruptions are frequent. The aim of this study was to compare the efficacy and tolerability of NNRTIs with PIs in HIV-1–infected patients in Guinea-Bissau. Methods: This open-label randomized, 2-arm superiority trial compared the use of 2 NRTIs plus either one NNRTI (efavirenz or nevirapine) or one PI (lopinavir/ritonavir) in treatment-naive HIV-1–infected adults in the Bissau HIV Cohort (ClinicalTrials.gov, NCT0019235). The primary endpoint was HIV-1 RNA <400 copies per milliliter after 12 months of treatment. Results: Between May 5, 2011, and April 26, 2013, 400 patients were included in the study. In an intention-to-treat analysis, the proportions of patients with viral suppression were similar in the NNRTI [65/197 (33.0%)] and PI [68/203 (33.5%)] arms (P = 0.92). No PI resistance was detected, but high-level NNRTI resistance was seen in 17/30 (56.7%) of NNRTI vs. 3/26 (11.5%) of PI-treated patients, P < 0.01. After 1 year of follow-up, 65 patients died (16.3%) and 93 were lost to follow-up (23.3%). There was no difference in mortality (hazard ratio 0.84, 95% confidence interval: 0.51 to 1.36) or frequency of clinical adverse events between treatment arms [NNRTI: 73/197 (37.1%); and PI: 69/203 (34.0%); P = 0.52]. Conclusions: In patients at an HIV clinic in Guinea-Bissau, treatment with PIs led to less development of resistance compared with NNRTIs but was not superior in terms of viral suppression, CD4 cell increment, mortality, or severe adverse events. [ABSTRACT FROM AUTHOR]
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- 2018
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16. Increased mortality among HIV infected patients with cryptococcal antigenemia in Guinea-Bissau.
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Thomsen, Ditte, Hviid, Cecilie Juul, Hønge, Bo Langhoff, Medina, Candida, Da Silva Té, David, Correira, Faustino Gomes, Østergaard, Lars, Erikstrup, Christian, Wejse, Christian, Laursen, Alex Lund, and Jespersen, Sanne
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HIV-positive persons , *CRYPTOCOCCUS neoformans , *ANTIGEN analysis , *DISEASES - Abstract
Cryptococcal antigenemia may precede development of cryptococcal meningitis and death among patients with advanced HIV infection. Among 200 retrospectively and randomly selected ART-naïve patients with CD4 counts < 100 cells/µl from Guinea-Bissau, 20 (10%) had a positive cryptococcal antigen test. Self-reported headache and fever were predictors of a positive test, while cryptococcal antigenemia was a strong predictor of death within the first year of follow-up, MRR 2.22 (95% CI: 1.15-4.30). Screening for cryptococcal antigenemia should be implemented for patients with advanced HIV in Guinea-Bissau. Pre-emptive anti-fungal therapy should be initiated prior to ART-initiation if the screening is positive. [ABSTRACT FROM AUTHOR]
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- 2018
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17. High prevalence and excess mortality of late presenters among HIV-1, HIV-2 and HIV-1/2 dually infected patients in Guinea-Bissau - a cohort study from West Africa.
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Hønge, Bo Langhoff, Jespersen, Sanne, Aunsborg, Johanna, Mendes, Delfim Vicente, Medina, Candida, da Silva Té, David, Laursen, Alex Lund, Erikstrup, Christian, and Wejse, Christian
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COHORT analysis , *HIV-positive persons , *DISEASE prevalence - Abstract
Introduction: HIV infected individuals with late presentation (LP) and advanced disease (AD) have been associated with higher mortality, higher cost of medical management, impaired CD4 cell count increment and potentially ongoing risk of HIV transmission. Here we describe the proportion of patients with LP and AD at an HIV clinic in Guinea-Bissau, identify risk factors and evaluate the outcome of these patients. Methods: We included all patients >15 years diagnosed with HIV-1 and/or HIV-2 at the outpatient HIV clinic at Hospital National Simão Mendes, during June 2005 - December 2013 in a retrospective cohort study. Patients were followed until December 2014. LP and AD was defined as a baseline CD4 cell count of 200-349 cells/µL and <200 cells/µL, respectively. Results: A total of 3,720/5,562 (65.7%) patients had a CD4 cell count measured within the first 90 days of HIV diagnosis. Forty-eight percent had AD and 23% had LP. Risk factors for presentation with AD were male sex, age >30 years, Fula and Mandinga ethnicity. HIV-2 and HIV-1/2 dually infected patients had lower risk of AD compared with HIV-1 infected patients. Although antiretroviral therapy (ART) was initiated for 64.4% of patients, those with AD progression had a 3.82 times higher mortality compared to patients with non-LP. Conclusion: The majority of HIV infected patients presented late. Most of the late-presenters had advanced disease and patients with advanced disease had a very high mortality. Initiatives to enroll patients in care at an earlier point are needed and should focus on risk groups. [ABSTRACT FROM AUTHOR]
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- 2016
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18. Macrophage Activation in HIV-2--Infected Patients Is Less Affected by Antiretroviral Treatment--sCD163 in HIV-1, HIV-2, and HIV-1/2 Dually Infected Patients.
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Hønge, Bo L., Andersen, Morten N., Jespersen, Sanne, Medina, Candida, Correira, Faustino G., Jakobsen, Martin R., Laursen, Alex, Erikstrup, Christian, Møller, Holger J., and Wejse, Christian
- Abstract
The course of disease among HIV-2, HIV-1, and HIV-1/2 dually infected patients is different. We investigated the macrophage activation marker soluble CD163 (sCD163) dynamics in 212 HIV-1, HIV-2, and HIV-1/2 dually infected patients. There were no differ- ences in sCD163 levels at baseline or during follow-up without antiretroviral therapy (ART). At follow-up on ART, median sCD163 levels were decreased for HIV-1--infected patients (P, 0.001), but not among HIV-2 (P = 0.093) or HIV-1/2 dually infected patients (P = 0.145). The larger decrease in sCD163 levels among HIV-1--infected patients during ART may indicate an HIV type--dependent differential effect of ART on macrophage activation during HIV infection. [ABSTRACT FROM AUTHOR]
- Published
- 2016
19. Hepatitis C prevalence among HIV-infected patients in Guinea-Bissau: a descriptive cross-sectional study.
- Author
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Hønge, Bo Langhoff, Jespersen, Sanne, Medina, Candida, Té, David da Silva, Silva, Zacarias José da, Lewin, Sharon R., Østergaard, Lars, Laursen, Alex Lund, Krarup, Henrik, Erikstrup, Christian, and Wejse, Christian
- Subjects
- *
HEPATITIS C risk factors , *DISEASE prevalence , *HIV-positive persons , *CROSS-sectional method , *BLOOD testing , *VIRAL antibodies , *POLYMERASE chain reaction - Abstract
Summary Objectives To estimate the prevalence and determine the clinical presentation of risk factors of hepatitis C virus (HCV) among HIV-infected patients in Bissau, Guinea-Bissau. Methods In this cross-sectional study, we included individuals who had a routine blood analysis performed during the period April 28 to September 30, 2011. Patient samples were tested for HCV antibodies (anti-HCV) with a chemiluminescence test (Architect, Abbott, USA) and INNO-LIA HCV Score (Innogenetics, Belgium). HCV viral load and genotype were analyzed using an in-house real-time PCR method. Results In total, 576 patients were included (417 HIV-1, 104 HIV-2, and 55 HIV-1/2). Ten (1.7%) patients were anti-HCV-positive and eight (1.4%) patients had detectable HCV RNA; all were genotype 2. In a multivariable logistic regression analysis, age >50 years was associated with anti-HCV reactivity ( p < 0.01). No subjective symptoms or objective signs were more prevalent among patients with detectable HCV RNA compared to patients without detectable HCV RNA. Biochemically, detectable HCV RNA was associated with elevated amylase (83.3% vs. 38.6%, p = 0.03), but not with the liver enzymes alanine aminotransferase and aspartate aminotransferase. Conclusions The prevalence of anti-HCV was low and comparable to similar settings, and genotype analysis confirmed the presence of genotype 2 in West Africa. [ABSTRACT FROM AUTHOR]
- Published
- 2014
- Full Text
- View/download PDF
20. Performance of 3 Rapid Tests for Discrimination Between HIV-1 and HIV-2 in Guinea-Bissau, West Africa.
- Author
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H⊘nge, Bo Langhoff, Bjarnason Obinah, Magnús Pétur, Jespersen, Sanne, Medina, Candida, da Silva Té, David, José da Silva, Zacarias, Østergaard, Lars, Laursen, Alex Lund, Wejse, Christian, and Erikstrup, Christian
- Abstract
As HIV-2 is intrinsically resistant to nonnucleoside reverse transcriptase inhibitors, it is mandatory to discriminate between HIV types before initiating antiretroviral treatment. Guinea-Bissau has the world's highest prevalence of HIV-2 and HIV-1/HIV-2 dually infected individuals. We evaluated 3 rapid tests for discrimination between HIV-1, HIV-2, and dual infections among 219 patients from Guinea-Bissau by comparing with the gold standard (INNO-LIA). Genie III HIV-1/HIV-2 was the best performer with regard to discriminatory capacity (agreement 91.8%), followed by Immunoflow HIV1-HIV2 (agreement 90.9%) and SD Bioline HIV-1/2 3.0 (agreement 84.5%). Our results underscore the need for evaluation of tests in relevant populations before implementation. [ABSTRACT FROM AUTHOR]
- Published
- 2014
- Full Text
- View/download PDF
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