Browsing by Author "Fawzi, Wafaie W."

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    Depressive and Anxiety Symptoms Predict Sustained Quality of Life Deficits in HIV-Positive Ugandan Adults Despite Antiretroviral Therapy
    (Medicine, 2016) Ezeamama, Amara E.; Woolfork, Makhabele N.; Guwatudde, David; Bagenda, Danstan; Manabe, Yukari C.; Fawzi, Wafaie W.; Fawzi, Mary C. Smith
    : The impact of psychosocial status at onset of antiretroviral therapy on changes in quality of life (QOL) and subjectively rated health (SRH) among adults on ART in resource-limited settings is poorly understood. Therefore, we evaluate the association between stigma, anxiety, depression, and social support and change in QOL and SRH in HIV-infected Ugandan adults during an 18-month period. Psychosocial indicators were assessed at enrollment using structured questionnaires. QOL and SRH measures were assessed at months 0, 6, 12, and 18 using the Medical Outcomes Survey-HIV. Linear mixed models determined risk estimated differences in QOL and SRH in relation to quartiles of each psychosocial status indicator. Repeated measures generalized estimating equations modeling was implemented to assess differences inlikelihood ofimproved versus nonimproved SRH during follow-up. QOL scores and SRH improved significantly for all participants over 18 months (P< 0.0001). The gain in QOL increased dose-dependently as baseline depressive symptoms (time depression P< 0.001) and anxiety levels (time anxiety P< 0.001) declined. Lower social support was associated with worse QOL at baseline (P¼ 0.0005) but QOL improvement during follow-up was not dependent on baseline level of social support (time social support P¼ 0.8943) or number of stigmatizing experiences (time stigma P¼ 0.8662). Psychosocial determinants did not predict changes in SRH in this study. High levels of depression and anxiety symptoms at HAART initiation predicts lower gains in QOL for HIV-positive patients for as long as 18 months. Long-term QOL improvements in HIV-infected adults may be enhanced by implementation of psychosocial interventions to reduce depression and anxiety in HIV-infected adults
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    Dietary Micronutrients and Gender, Body Mass Index and Viral Suppression Among HIV-Infected Patients in Kampala, Uganda
    (International Journal of Maternal and Child Health and AIDS, 2020) Isabirye, Nathan; Ezeamama, Amara E.; Kyeyune-Bakyayita, Rachel; Bagenda, Danstan; Fawzi, Wafaie W.; Guwatudde, David
    HIV/AIDS is a hallmark of immune suppression. Micronutrient deficiencies in diet and recurrent opportunistic infections play major roles in the lives of people living with HIV. Although benefits of providing adequate diet to HIV positive persons are well documented, the demand for key elements still remain unclear in particular settings, especially in low and middle-income countries. Methods: This was a cross sectional analysis of baseline data collected from HIV-infected adults initiating antiretroviral therapy, and who were enrolled in a multivitamin supplementation trial. A food frequency questionnaire was used and intake were obtained as a product of quantities consumed. Adequacy was calculated as the proportion of Recommended Dietary Allowances (RDA). A chi square test and logistic regression analysis were used at p-value 0.05 to show significant associations. Results: Mean intakes were above minimum requirements for analyzed micronutrients with the exception of Calcium and Iron. Participants who met RDA intakes were as follows: highest (≥ 80%) for Magnesium, Selenium, Zinc and Vitamins B2, B6, B9, C and E; moderate (50% to <80%) for Vitamins B3, and A; and lowest (≤50%) for Iron (30%), Calcium (14.9%), Vitamins B12 and B1. Gender differences in met RDA were observed for Iron, Selenium, Zinc, Vitamins A, B1, B3 and E. In multivariable analyses, nutritional status and CD4 count had no influence on meeting RDA for majority of micronutrients such as magnesium, Selenium, B class vitamins (B1, B2, B3, B6, B9, B12), vitamin (A, C, and E), Zinc and Calcium, but not including iron. Conclusion and Global Health Implications: Diets consumed by the study participants were low in most protective nutrients (Iron, Calcium, Zinc, Vitamin A, B1, B3, and B12). This deficiency was more common among females than males, and irrespective of BMI or CD 4 count. Findings warrant further investigation on the impact and cost implications for suplementation interventions that target the elements lacking in the diets of people living with HIV in similar low-resourced settings.
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    The effect of standard dose multivitamin supplementation on disease progression in HIV infected adults initiating HAART: a randomized double blind placebo-controlled trial in Uganda
    (BMC infectious diseases, 2015) Guwatudde, David; Wang, Molin; Ezeamama, Amara E.; Bagenda, Danstan; Kyeyune, Rachel; Wamani, Henry; Manabe, Yukari C.; Fawzi, Wafaie W.
    Efficacy trials investigating the effect of multivitamin (MV) supplementations among patients on Highly Active Antiretroviral Therapy (HAART) have so far been inconclusive. We conducted a randomized, double blind, placebo controlled trial to determine the effect of one recommended daily allowance (RDA) of MV supplementation on disease progression in patients initiating HAART. Methods: Eligible subjects were randomized to receive placebo or MV supplementation including vitamins Bcomplex, C and E. Participants were followed for up to 18 months. Primary endpoints were: change in CD4 cell count, weight and quality of life (QoL). Secondary endpoints were: i) development of a new or recurrent HIV disease progression event, including all-cause mortality; ii) switching from first- to second-line antiretroviral therapy (ART); and iii) occurrence of an adverse event. Intent-to-treat analysis, using linear regression mixed effects models were used to compare changes over time in the primary endpoints between the study arms. Kaplan-Meier time-toevent analysis and the log-rank test was used to compare HIV disease progression events and all-cause mortality. Results: Four hundred participants were randomized, 200 onto MV and 200 onto placebo. By month 18, the average change in CD4 cell count in the MV arm was 141 cells/uL compared to 147 cells/uL in the placebo arm, a mean difference of −6 · 17 [95 % CI −29 · 3, 16 · 9]. The average change in weight in the MV arm was 3 · 9 kg compared to 3 · 3 kg in the placebo arm, a mean difference of 0 · 54 [95 % CI −0 · 40, 1 · 48]; whereas average change in QoL scores in the MV arm was 6 · 8 compared to 8 · 8 in the placebo arm, a mean difference of −2.16 [95 % CI −4 · 59,0 · 27]. No significant differences were observed in these primary endpoints, or in occurrence of adverse events between the trial arms. Conclusions: One RDA of MV supplementation was safe but did not have an effect on indicators of disease progression among HIV infected adults initiating HAART.
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    Multivitamin supplementation in HIV infected adults initiating antiretroviral therapy in Uganda: the protocol for a randomized double blinded placebo controlled efficacy trial
    (BMC Infectious Diseases, 2012) Guwatudde, David; Ezeamama, Amara E.; Bagenda, Danstan; Wabwire-Mangen, Fred; Wamani, Henry; Mugusi, Ferdinand; Spiegelman, Donna; Kyeyune, Rachel; Wang, Molin; Manabe, Yukari C.; Fawzi, Wafaie W.
    Use of multivitamin supplements during the pre-HAART era has been found to reduce viral load, enhance immune response, and generally improve clinical outcomes among HIV-infected adults. However, immune reconstitution is incomplete and significant mortality and opportunistic infections occur in spite of HAART. There is insufficient research information on whether multivitamin supplementation may be beneficial as adjunct therapy for HIV-infected individuals taking HAART. We propose to evaluate the efficacy of a single recommended daily allowance (RDA) of micronutrients (including vitamins B-complex, C, and E) in slowing disease progression among HIV-infected adults receiving HAART in Uganda. Methods/Design: We are using a randomized, double-blind, placebo-controlled trial study design. Eligible patients are HIV-positive adults aged at least 18 years, and are randomized to receive either a placebo; or multivitamins that include a single RDA of the following vitamins: 1.4 mg B1, 1.4 mg B2, 1.9 mg B6, 2.6 mcg B12, 18 mg niacin, 70 mg C, 10 mg E, and 0.4 mg folic acid. Participants are followed for up to 18 months with evaluations at baseline, 6, 12 and 18 months. The study is primarily powered to examine the effects on immune reconstitution, weight gain, and quality of life. In addition, we will examine the effects on other secondary outcomes including the risks of development of new or recurrent disease progression event, including all-cause mortality; ARV regimen change from first- to second-line therapy; and other adverse events as indicated by incident peripheral neuropathy, severe anemia, or diarrhea. Discussions: The conduct of this trial provides an opportunity to evaluate the potential benefits of this affordable adjunct therapy (multivitamin supplementation) among HIV-infected adults receiving HAART in a developing country setting.
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    Plasma n-6 Fatty Acid Levels Are Associated With CD4 Cell Counts, Hospitalization, and Mortality in HIV-Infected Patients
    (Journal of acquired immune deficiency syndromes, 2016) Kabagambe, Edmond K.; Ezeamama, Amara E.; Guwatudde, David; Campos, Hannia; Fawzi, Wafaie W.
    Fatty acids, including n-6 series, modulate immune function, but their effect on CD4 cell counts, death, or hospitalization in HIV-infected patients on antiretroviral therapy is unknown. Methods: In a randomized trial for effects of multivitamins in HIVinfected patients in Uganda, we used gas chromatography to measure plasma n-6 fatty acids at baseline; determined CD4 counts at baseline, 3, 6, 12, and 18 months; and recorded hospitalization or death events. The associations of fatty acids with CD4 counts and events were analyzed using repeated-measures analysis of variance and Cox regression, respectively. Results: Among 297 patients with fatty acids measurements, 16 patients died and 69 were hospitalized within 18 months. Except for linoleic acid, n-6 fatty acids levels were positively associated with CD4 counts at baseline but not during follow-up. In models that included all 5 major n-6 fatty acids, age; sex; body mass index; anemia status; use of antiretroviral therapy, multivitamin supplements, and alcohol; and the risk of death or hospitalization decreased significantly with an increase in linoleic acid and gamma-linolenic acid levels, whereas associations for dihomo-gamma-linolenic acid, arachidonic acid, and aolrenic acid were null. The hazard ratios (95% confidence intervals) per 1 SD increase in linoleic acid and gammalinolenic acid were 0.73 (0.56–0.94) and 0.51 (0.36–0.72), respectively. Gamma-linolenic acid remained significant (hazard ratio = 0.51; 95% confidence interval: 0.35 to 0.68) after further adjustment for other plasma fatty acids. Conclusions: Lower levels of gamma-linolenic acid are associated with lower CD4 counts and an increased risk of death or hospitalization. These results suggest a potential for using n-6 fatty acids to improve outcomes from antiretroviral therapy.
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    Sexual behaviours among adolescents in a rural setting in eastern Uganda: a cross-sectional study
    (Tropical Medicine & International Health, 2020) Nnakate Bukenya, Justine; Nakafeero, Mary; Ssekamatte, Tonny; Isabirye, Nathan; Guwatudde, David; Fawzi, Wafaie W.
    Globally as adolescents transition into adulthood, some engage in risky sexual behaviours. Such risky behaviours expose adolescents to unintended pregnancy and sexually transmitted infections (STIs), including HIV infection. Our objective was to examine sexual practices of adolescents (aged 10–19 years) in eastern Uganda and identify factors associated with having ever had sexual intercourse. methods Face-to-face interviews were conducted using a standardised questionnaire among randomly selected adolescents residing within the Iganga-Mayuge Health and Demographic Surveillance Site in eastern Uganda. Crude and adjusted prevalence rate ratios (PRR) were estimated using the Modified Poisson regression model to identify factors associated with adolescents having ever had sex. results Of the 598 adolescents studied, 108 (18.1%) reported ever having had sexual intercourse, of whom 20 (18.5%) had ever gotten pregnant. Adolescents who reported to be out of school, 76 (12.7%), were more likely to have ever had sexual intercourse (PRR = 1.82, CI = 1.09–3.01). Females were less likely to ever have had sexual intercourse (PRR 0.69 (0.51–0.93) than males. History of ever having had sexual intercourse was associated with adolescents sexting (PRR = 1.54, CI: 1.14–2.08), watching sexually explicit films (PRR = 2.29 Cl: 1.60 - 3.29) and experiencing verbal jokes about sexual intentions (PRR = 1.76, Cl: 1.27 - 2.44). conclusions A majority of participants reported not being sexually active; however, interventions should be required for both sexually active and not sexually active adolescents. Programmes targeted at adolescents in this and similar communities should include comprehensive sex education, and contraceptive distribution among adolescents. In particular, urgent interventions are needed to guide adolescents as they use social media.