Last data update: May 20, 2024. (Total: 46824 publications since 2009)
Records 1-5 (of 5 Records) |
Query Trace: Upadhyaya S [original query] |
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A review of Tenofovir Disoproxil Fumarate associated nephrotoxicity among People Living with HIV: Burden, risk factors and solutions
Asirvatham ES , Ranjan V , Garg C , Sarman CJ , Periasamy M , Yeldandi V , Upadhyaya S , Rao B . Clin Epidemiol Global Health 2024 25 Background: Tenofovir Disoproxil Fumarate (TDF) is one of the first-line antiretroviral therapy (ART) recommended for all treatment naïve People Living with HIV (PLHIV). However, evidence indicates increasing TDF-associated nephrotoxicity among PLHIV due to longer duration of treatment and longevity that raises clinical and programmatic concerns. This review aims to understand the extent of TDF-induced nephrotoxicity and associated factors. Methods: The article is based on a comprehensive scoping review of journal articles, reports and guidelines related to the use of TDF-based ART regimens in electronic databases such as the National Library of Medicine (PubMed), Google Scholar, Web of Science, Scopus and other relevant search engines. Results: The review provides evidence on the burden of nephrotoxicity due to TDF among PLHIV and its variations across geographic regions and population groups. The review highlights the key factors associated with TDF-induced nephrotoxicity which include age, gender, nutrition status (BMI), duration of treatment with TDF, baseline creatinine, baseline CD4 count, WHO HIV stage of disease and presence of comorbid conditions. The review also emphasizes the importance of baseline and regular renal monitoring and early detection of TDF-induced nephrotoxicity to avoid irreversible tubulointerstitial damage through simple laboratory investigations such as glomerular filtration rate (GFR), blood urea nitrogen, serum creatinine and creatinine clearance. Conclusion: The burden of TDF-associated nephrotoxicity is well documented. It is critical to consider the risk factors associated with nephrotoxicity while initiating TDF. The review provides evidence for calibrating the dosage of TDF based on body weight and BMI. Considering the high burden of PLHIV in India, prevention of nephrotoxicity through targeted and regular monitoring, early diagnosis and initiation of appropriate clinical management is crucial to reduce avoidable morbidity and mortality. © 2023 |
Implementation of point-of-care testing and prevalence of cryptococcal antigenaemia among patients with advanced HIV disease in Mumbai, India
Acharya S , Allam RR , Karanjkar VK , Rathod D , Mahajan R , Deshpande P , Palkar A , Todmal S , Koli S , Dhande S , Dale J , Yeldandi VV , Harshana A , Agarwal R , Upadhyaya S , Nyendak M . BMJ Open 2023 13 (6) e070500 OBJECTIVES: To describe the implementation of screening for cryptococcal antigenaemia by point-of-care (POC) serum cryptococcal antigen (CrAg) lateral flow assay, measure the prevalence and factors associated with serum cryptococcal antigenaemia in the routine programmatic setting. DESIGN: Cross-sectional study. SETTING: Seventeen publicly funded antiretroviral therapy (ART) centres in Mumbai, India. PARTICIPANTS: Serum CrAg screening was offered to all adolescents (>10 years of age) and adults with advanced HIV disease (AHD) (CD4 <200 cells/mm(3) or with WHO clinical stage III/IV) regardless of symptoms of cryptococcal meningitis. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was to describe the implementation of serum CrAg screening and secondary outcome was to measure the prevalence of serum cryptococcal antigenaemia and its risk factors. RESULTS: A total of 2715 patients with AHD were tested for serum CrAg by POC assay. Of these, 25 (0.9%) had a CrAg positive result. Among CrAg-positive patients, only one had symptoms. Serum CrAg positivity was 3.6% (6/169) and 1.6% (6/520) among those presenting with CD4 <100 cells/mm(3) in the treatment naïve and treatment experienced group, respectively. On multivariable analysis, CD4 count <100 cells/mm(3) (OR: 2.3, 95% CI 1.01 to 5.3; p=0.05) and people living with HIV who were treatment naïve (OR: 2.5, 95% CI 1.04 to 6.0; p=0.04) were significantly associated with a positive serum CrAg result. Lumbar puncture was obtained in 20/25 patients within 4 days (range: 1-4 days) of positive serum CrAg result and one person was confirmed to have meningitis. All serum CrAg-positive patients who had a negative cerebrospinal fluid CrAg were offered pre-emptive therapy. CONCLUSIONS: Implementation of a POC CrAg assay was possible with existing ART centre staff. Initiation of pre-emptive therapy and management of cryptococcal antigenaemia are operationally feasible at ART centres. The Indian National AIDS Control Programme may consider reflexive CrAg screening of all AHD patients with CD4 <100 cells/mm(3). |
Utility of the lateral flow urine lipoarabinomannan tuberculosis assay in patients with advanced HIV disease at antiretroviral therapy centres in Mumbai, India
Acharya S , Deshpande P , Asirvatham ES , Palkar A , Sarman CJ , Laxmeshwar C , Setia MS , Rathod D , Koli S , Dale J , Yeldandi V , Allam R , Agarwal R , Verma S , Upadhyaya S , Nyendak M . PLoS One 2022 17 (9) e0273970 BACKGROUND: People with Advanced HIV Disease (AHD) are at higher risk of TB coinfection and mortality. However, there are challenges in TB diagnosis with the currently recommended diagnostic tools. WHO recommends lateral flow urine lipoarabinomannan (LF-LAM) assay to assist TB diagnosis among AHD patients. We assessed the utility and acceptability of using urine LF-LAM assay for TB diagnosis among patients at public Antiretroviral Therapy (ART) Centres in Mumbai. METHODS: The cross-sectional study was conducted among adult AHD patients accessing care from 17 ART centres during November,2020-June, 2021. Urine LF-LAM was offered as routine care for eligible patients in combination with standard diagnostic tests. We calculated the proportion of positive LF-LAM results by CD4 categories and TB symptoms and performed multivariable logistic regression to determine the factors associated with LF-LAM positivity. RESULTS: Among 2,390 patients, the majority (74.5%) had CD4 between 101-200 cells/mm3. The mean age was 43.7 years (SD:10.6), 68.6% were male, 8.4% had TB symptoms and 88.0% were on ART. The overall proportion of patients with urine LF-LAM positive results was 6.4%. Among PLHIV with CD4≤100 cells/mm3, the positivity was 43.0% and 7.7% in symptomatic and asymptomatic patients, respectively. Among PLHIV with a CD4>100 cells/mm3, the positivity was 26.7% and 2.7% in symptomatic and asymptomatic patients respectively. Urine LF-LAM positivity was higher among inpatients, ART naïve, patients on treatment for <6 months, symptomatic and in WHO clinical stage III/IV of HIV disease as compared to the reference categories. We detected an additional 131 TB cases with urine LF-LAM in combination with the standard diagnostic tests. CONCLUSION: The study demonstrated the utility of urine LF-LAM for TB diagnosis among AHD patients and the simple, user-friendly test was acceptable as part of routine care. Inclusion of urine LF-LAM test in the current diagnostic algorithm may facilitate early TB diagnosis among AHD patients. |
A national level estimation of population need for blood in India
Mammen JJ , Asirvatham ES , Lakshmanan J , Sarman CJ , Mani T , Charles B , Upadhyaya S , Rajan S . Transfusion 2021 61 (6) 1809-1821 BACKGROUND: The population need for blood is the total volume required to transfuse all the individuals who need transfusion in a defined population over a defined period. The clinical demand will arise when people with a disease or condition who require transfusion, access healthcare services, and subsequently the clinicians request blood. Essentially, the conversion of need to demand must be maximum to avoid preventable mortality and morbidity. The study estimated the population need for blood in India. METHODS: The methodology included a comprehensive literature review to determine the diseases and conditions requiring transfusion, the population at risk, and prevalence or incidence; and Delphi method to estimate the percentage of people requiring transfusion, and the quantum. RESULTS: The estimated annual population need was 26.2 million units (95% CI; 17.9-38.0) of whole blood to address the need for red cells and other components after the separation process. The need for medical conditions was 11.0 million units (95% CI:8.7-14.7), followed by surgery 6.6 million (95% CI:3.8-10.0), pediatrics 5.0 million (95% CI:3.5-7.0), and obstetrics and gynecology 3.6 million units (95% CI:1.9-6.2). The gap between need and demand which depends upon the access and efficiency of healthcare service provision was estimated at 13 million units. CONCLUSION: The study brings evidence to highlight the gap between need and demand and the importance of addressing it. It cannot be just the responsibility of blood transfusion or health systems, it requires a multi-sectoral approach to address the barriers affecting the conversion of need to clinical demand for blood. |
Assessment of performance of blood banks in India: A national level cross sectional study
Asirvatham ES , Mammen JJ , Lakshman J , Sarman CJ , Charles B , Upadhyaya S , Rajan S . Indian J Hematol Blood Transfus 2021 37 (4) 640-647 India lacks comprehensive information about blood transfusion systems, which could help ensure universal access to safe blood through evidence-based strategies and programs. We conducted the first national assessment of blood bank systems, services, practices, and performance in India. We conducted a cross-sectional survey of all 2626 blood banks and assessed the administrative, technical, and quality aspects in 2016. In addition to descriptive analysis, we compared the means of different variables using independent t-test or ANOVA and a generalized linear model. We performed linear regression analysis between the collection of blood per 100 people and the number of blood banks per million people. The disaggregated mean score of quality management system and overall performance are presented by different groups. Besides, we graded the performance based on tertile classification, as low, medium and high-performance blood banks. Of the 2493 blood banks that participated in the study, most were public (38%) or not-for-profit(38%), and 51% had component separation facilities. Of the 11.65 million units of blood collected annually, 72% was through voluntary blood donation. There were 2.2 blood banks per one million people, collecting around one unit per 100 persons annually with wide variation between states. The mean overall performance score was 62(95% confidence interval [CI]:61.6–62.5), and the mean quality management system score was 57.4(95% CI:56.8–58.0), with significant variation across different categories of blood banks. This assessment provides critical information for developing evidence-based policies, programs, and monitoring systems to improve the performance of blood transfusion services in India. |
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