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Your search keyword '"Pett, Sarah L."' showing total 2 results
Start Over Author "Pett, Sarah L." Topic hiv infections Topic raltegravir
2 results on '"Pett, Sarah L."'

1. No overall impact on rate of weight gain with integrase inhibitor‐containing regimens in antiretroviral‐naïve adults.

Author

Burns, James E., Stirrup, Oliver, Waters, Laura, Dunn, David, Gilson, Richard, and Pett, Sarah L.

Subjects
HIV infections, HIV-positive persons, RALTEGRAVIR, HIV integrase inhibitors, PROTEASE inhibitors, CONFIDENCE intervals, VIRAL load, RETROSPECTIVE studies, WEIGHT gain, DESCRIPTIVE statistics
Abstract

Objectives: Integrase strand transfer inhibitors (INSTIs) are commonplace in modern antiretroviral therapy (ART). Increased weight gain with their use is increasingly scrutinized. We evaluated weight changes in treatment‐naïve adults with HIV‐1 attending a UK centre who started regimens including raltegravir or dolutegravir. Methods: A retrospective cohort study of adults prescribed an INSTI between January 2015 and March 2020 were categorized as having started an ART regimen containing raltegravir, dolutegravir, a protease inhibitor or a nonnucleoside reverse transcriptase inhibitor. Individuals with one or more weight measurement ≤ 5 years both pre‐ and post‐ART initiation, who started a three‐drug regimen with ≥ 6 months duration and achieved virological suppression (< 50 copies/mL) within 6 months were included. A random effects model with linear slope pre‐ and post‐ART was used, adjusting for age, gender, ethnicity, ART regimen, backbone and year of initiation. Results: The cohort included 390 adults; 88.7% were male, 66.4% were of white ethnicity, their median age was 40 years, there was a median of six weight measurements, 2.2 years from diagnosis to ART initiation, 2.9 years from ART to the last weight measurement, and weight and body mass index at initiation were 75 kg and 24.1 kg/m2 respectively. Of these, 254 (65%) started an INSTI. The average pre‐ART rate of weight gain was 0.44 kg/year [95% confidence interval (CI): 0.19–0.70], increasing to 0.88 kg/year (0.63–1.10, p = 0.04) after ART initiation. Our adjusted model found no evidence of an association between ART regimen and rate of weight gain. Conclusions: Weight increased in the cohort both pre‐ and post‐ART. We found no evidence of a higher rate of weight gain following ART initiation with an INSTI compared with other regimens. [ABSTRACT FROM AUTHOR]

Published
2022
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2. Enhanced Prophylaxis plus Antiretroviral Therapy for Advanced HIV Infection in Africa

Author

Hakim, James, Musiime, Victor, Szubert, Alex J., Mallewa, Jane, Siika, Abraham, Agutu, Clara, Walker, Simon, Pett, Sarah L., Bwakura-Dangarembizi, Mutsa, Lugemwa, Abbas, Kaunda, Symon, Karoney, Mercy, Musoro, Godfrey, Kabahenda, Sheila, Nathoo, Kusum, Maitland, Kathryn, Griffiths, Anna, Thomason, Margaret J., Kityo, Cissy, Mugyenyi, Peter, Prendergast, Andrew J., Walker, A. Sarah, Gibb, Diana M., REALITY Trial Team, O'Hare, Bernadette Ann-Marie, DiFDMRCWellcome Trust, University of St Andrews. School of Medicine, and University of St Andrews. Infection and Global Health Division

Subjects
Male, REALITY Trial Team, 0301 basic medicine, Placebo-controlled study, CHILDREN, HIV Infections, Kaplan-Meier Estimate, law.invention, DOUBLE-BLIND, 0302 clinical medicine, Anti-Infective Agents, Randomized controlled trial, WORLDWIDE, law, Medicine, 030212 general & internal medicine, Child, 11 Medical and Health Sciences, Medicine(all), education.field_of_study, Mortality rate, Pyridoxine, General Medicine, Middle Aged, OPEN-LABEL, 3. Good health, Anti-Retroviral Agents, Chemoprophylaxis, Drug Therapy, Combination, Female, Life Sciences & Biomedicine, medicine.drug, Adult, medicine.medical_specialty, Tuberculosis, Adolescent, 030106 microbiology, Population, NDAS, R Medicine, TUBERCULOSIS, Article, Young Adult, 03 medical and health sciences, Medicine, General & Internal, Pharmacotherapy, SDG 3 - Good Health and Well-being, PEOPLE, General & Internal Medicine, Internal medicine, Trimethoprim, Sulfamethoxazole Drug Combination, Isoniazid, Humans, Intensive care medicine, education, Africa South of the Sahara, Aged, Science & Technology, AIDS-Related Opportunistic Infections, business.industry, MORTALITY, ADULTS, Raltegravir, medicine.disease, CD4 Lymphocyte Count, HIV-1, business, CRYPTOCOCCAL MENINGITIS
Abstract

Supported by the Joint Global Health Trials Scheme of the Medical Research Council (MRC), the U.K. Department for International Development, and the Wellcome Trust through a grant (G1100693),with additional support from the PENTA Foundation. The MRC Clinical Trials Unit at University College London is supported by grants from the MRC (MC-UU-12023/23 and MC-UU-12023/26). Dr. Prendergast is funded by a grant (108065/Z/15/Z) from the Wellcome Trust, which also funds the Malawi–Liverpool–Wellcome Trust Clinical Research Program at the University of Malawi College of Medicine through a grant (101113/Z/13/Z) and the Kenya Medical Research Institute (KEMRI)–Wellcome Trust Research Program through a grant (077092). Background: In sub-Saharan Africa, among patients with advanced human immunodeficiency virus (HIV) infection, the rate of death from infection (including tuberculosis and cryptococcus) shortly after the initiation of antiretroviral therapy (ART) is approximately 10%. Methods: In this factorial open-label trial conducted in Uganda, Zimbabwe, Malawi, and Kenya, we enrolled HIV-infected adults and children 5 years of age or older who had not received previous ART and were starting ART with a CD4+ count of fewer than 100 cells per cubic millimeter. They underwent simultaneous randomization to receive enhanced antimicrobial prophylaxis or standard prophylaxis, adjunctive raltegravir or no raltegravir, and supplementary food or no supplementary food. Here, we report on the effects of enhanced antimicrobial prophylaxis, which consisted of continuous trimethoprim-sulfamethoxazole plus at least 12 weeks of isoniazid-pyridoxine (coformulated with trimethoprim-sulfamethoxazole in a single fixed-dose combination tablet), 12 weeks of fluconazole, 5 days of azithromycin, and a single dose of albendazole, as compared with standard prophylaxis (trimethoprim-sulfamethoxazole alone). The primary end point was 24-week mortality. Results: A total of 1805 patients (1733 adults and 72 children or adolescents) underwent randomization to receive either enhanced prophylaxis (906 patients) or standard prophylaxis (899 patients) and were followed for 48 weeks (loss to follow-up, 3.1%). The median baseline CD4+ count was 37 cells per cubic millimeter, but 854 patients (47.3%) were asymptomatic or mildly symptomatic. In the Kaplan-Meier analysis at 24 weeks, the rate of death with enhanced prophylaxis was lower than that with standard prophylaxis (80 patients [8.9% vs. 108 [12.2%]; hazard ratio, 0.73; 95% confidence interval [CI], 0.55 to 0.98; P = 0.03); 98 patients (11.0%) and 127 (14.4%), respectively, had died by 48 weeks (hazard ratio, 0.76; 95% CI, 0.58 to 0.99; P = 0.04). Patients in the enhanced-prophylaxis group had significantly lower rates of tuberculosis (P = 0.02), cryptococcal infection (P = 0.01), oral or esophageal candidiasis (P = 0.02), death of unknown cause (P = 0.03), and new hospitalization (P = 0.03). However, there was no significant between-group difference in the rate of severe bacterial infection (P = 0.32). There were nonsignificantly lower rates of serious adverse events and grade 4 adverse events in the enhanced-prophylaxis group (P = 0.08 and P = 0.09, respectively). Rates of HIV viral suppression and adherence to ART were similar in the two groups. Conclusions: Among HIV-infected patients with advanced immunosuppression, enhanced antimicrobial prophylaxis combined with ART resulted in reduced rates of death at both 24 weeks and 48 weeks without compromising viral suppression or increasing toxic effects. Publisher PDF

Published
2017

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