Research Papers

@article{Aibibula2016,
title = {Food insecurity and low CD4 count among HIV-infected people: a systematic review and meta-analysis.},
author = {Wusiman Aibibula and Joseph Cox and Anne-Marie Hamelin and Hiroshi Mamiya and Marina B. Klein and Paul Brassard},
url = {https://www.ncbi.nlm.nih.gov/pubmed/27306865},
doi = {10.1080/09540121.2016.1191613},
year = {2016},
date = {2016-06-16},
journal = {AIDS Care},
abstract = {Abstract
Food insecurity is defined as a limited or uncertain ability to acquire acceptable foods in socially acceptable ways, or limited or uncertain availability of nutritionally adequate and safe foods. While effective antiretroviral treatment can significantly increase CD4 counts in the majority of patients, there are certain populations who remain at relatively low CD4 count levels. Factors possibly associated with poor CD4 recovery have been extensively studied, but the association between food insecurity and low CD4 count is inconsistent in the literature. The objective is to systematically review published literature to determine the association between food insecurity and CD4 count among HIV-infected people. PubMed, Web of Science, ProQuest ABI/INFORM Complete, Ovid Medline and EMBASE Classic, plus bibliographies of relevant studies were systematically searched up to May 2015, where the earliest database coverage started from 1900. Studies that quantitatively assessed the association between food insecurity and CD4 count among HIV-infected people were eligible for inclusion. Study results were summarized using random effects model. A total of 2093 articles were identified through electronic database search and manual bibliographic search, of which 8 studies included in this meta-analysis. Food insecure people had 1.32 times greater odds of having lower CD4 counts compared to food secure people (OR = 1.32, 95% CI: 1.15-1.53) and food insecure people had on average 91 fewer CD4 cells/µl compared to their food secure counterparts (mean difference = -91.09, 95% CI: -156.16, -26.02). Food insecurity could be a potential barrier to immune recovery as measured by CD4 counts among HIV-infected people.},
keywords = {CD4, Food insecurity, HIV, Natural history, Nutrition/wasting},
pubstate = {published},
tppubtype = {article}
}

@article{Hull2012,
title = {Factors associated with discordance between absolute CD4 cell count and CD4 percentage in HIV/Hepatitis C (HCV) co-infected patients},
author = {Mark Hull and Kathleen C. Rollet-Kurhajec and Adefowope Odueyungbo and Sahar Saeed and Martin Potter and Joseph Cox and Curtis Cooper and John Gill and Marina B. Klein},
url = {https://www.ncbi.nlm.nih.gov/pubmed/22460964},
doi = {10.1093/cid/cis289},
year = {2012},
date = {2012-06-15},
journal = {Clinical Infectious Diseases},
volume = {54},
number = {12},
pages = {1798-1805},
abstract = {BACKGROUND:
Liver cirrhosis has been associated with decreased absolute CD4 cell counts but preserved CD4 cell percentage in human immunodeficiency virus (HIV)-negative persons. We evaluated factors associated with discordance between the absolute CD4 cell count and the CD4 cell percentage in a cohort of patients coinfected with HIV and hepatitis C virus (HCV).
METHODS:
Baseline data from 908 participants in a prospective, Canadian, multisite cohort of individuals with HIV-HCV coinfection were analyzed. Absolute CD4 cell count and CD4 cell percentage relationships were evaluated. We defined low and high discordance between absolute CD4 cell count/CD4 cell percentage relationships as CD4 cell percentages that differed from the expected CD4 cell percentage, given the observed absolute CD4 cell count, by ±7 percentage points; we defined very low and very high discordance as differences of ±14 percentage points. Factors associated with high or very high discordance, including either end-stage liver disease or aspartate transaminase to platelet ratio index (APRI) of >1.5, were analyzed using multivariate logistic regression models and compared to groups with concordant and low discordant results.
RESULTS:
High/very high discordance was seen in 31% (n = 286), while 35% (n = 321) had concordant values. Factors associated with very high discordance at baseline included history of end-stage liver disease (adjusted odds ratio [aOR], 6.52; 95% confidence interval [CI], 2.27-18.67) and APRI of >1.5 (aOR 4.69; 95% CI, 1.64-13.35). Compared with those with detectable HCV RNA, those who cleared HCV spontaneously were less likely to have very high discordance.
CONCLUSIONS:
Discordance between absolute CD4 cell count and CD4 cell percentage is common in an HIV/HCV-coinfected population and is associated with advanced liver disease and ongoing HCV replication.},
keywords = {CD4, CD4 cell percentage, HIV-HCV co-infection},
pubstate = {published},
tppubtype = {article}
}

@article{Potter2010,
title = {Impact of Hepatitis C viral replication on CD4+ T-lymphocyte progression in HIV-Co-infection before and after antiretroviral therapy},
author = {Martin Potter and Adefowope Odueyungbo and Hong Yang and Sahar Saeed and Marina B. Klein},
url = {https://www.ncbi.nlm.nih.gov/pubmed/20479633},
doi = {10.1097/QAD.0b013e32833adbb5},
year = {2010},
date = {2010-07-31},
journal = {AIDS},
volume = {24},
number = {12},
pages = {1857-1865},
abstract = {OBJECTIVE:
HIV is known to have a negative impact on the progression of hepatitis C virus (HCV) infection, whereas the reverse remains unclear. We examined the impact of spontaneous clearance of HCV on CD4(+) T-lymphocyte count progression before and after initiation of antiretroviral therapy (ART) in HIV-HCV coinfected adults.
METHODS:
Data were analysed from participants in a Canadian, multisite prospective cohort of HIV-infected adults with serologic evidence of HCV infection. The rate of CD4(+) T-lymphocyte change was determined using multivariate mixed linear regression comparing chronically HCV RNA+ with spontaneous clearers (persistently HCV RNA- without HCV therapy).
RESULTS:
Baseline characteristics of the 271 participants analysed did not differ between individuals whose HCV RNA cleared (n = 35) and those whose HCV RNA persisted (n = 236) except with respect to markers of liver disease. HCV RNA+ individuals had on average seven-times slower recovery of CD4(+) T-cells on chronic ART compared with HCV RNA-: (adjusted change in absolute CD4 cell T-lymphocyte count per year: 4 (95% confidence interval, -0.6 to 8) cells/microl vs. 26 (95% confidence interval, 12 to 41) cells/microl; P < 0.001. Analyses restricted to individuals initiating ART showed similar results. There was also a trend to greater CD4 decline prior to ART initiation among those HCV RNA+, although this did not reach statistical significance.
CONCLUSION:
We found that CD4 cell progression is negatively affected by the presence of ongoing HCV replication in coinfected individuals initiating ART which persisted throughout stable ART suggesting active HCV infection affects immune restoration even after years of ART exposure.},
keywords = {Antiretroviral therapy, CD4, HIV-HCV co-infection, T-lymphocyte progression, Viral replication},
pubstate = {published},
tppubtype = {article}
}