N KumarasamyVHS Infectious Diseases Medical CentreVoluntary Health Services Multi-Specialty Hospital and Research Institute · Infectious Diseases Medical Centre
N Kumarasamy
Dr.
About
639
Publications
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Introduction
Additional affiliations
Position
- Managing Director
January 1994 - December 2018
YRGCARE Medical Centre
Position
- Chief Medical Officer
Education
January 1999 - December 2001
December 1996 - August 2000
January 1996 - December 1996
Publications
Publications (639)
Objective
Data on the impact of COVID-19 in people living with HIV (PWH) are lacking in resource-constrained settings. We utilised existingrandomised clinical trials (RCTs) on antiretroviral therapies (ART) in HIV-1 infection to conduct a SARS-CoV-2 serosurvey, between January and March 2021, while characterising participants’ features.
Design
Cro...
Background:
While people with HIV (PWH) start antiretroviral treatment (ART) regardless of CD4 count, CD4 measurement remains crucial for detecting advanced HIV disease and evaluating ART programmes. We explored CD4 measurement (proportion of PWH with a CD4 result available) and prevalence of CD4 <200 cells/µL at ART initiation within the Internat...
Objective
We described mortality and loss to follow‐up (LTFU) in children and adolescents who were under care for more than 5 years following initiation of antiretroviral therapy (ART).
Methods
Patients were followed from 5 years after ART until the earlier of their 25th birthday, last visit, death, or LTFU. We used Cox regression to assess predic...
HCV RNA test determines current active infection and is a requirement prior to initiating HCV treatment. We investigated trends and factors associated with post‐diagnosis HCV RNA testing rates prior to HCV treatment, and risk factors for first positive HCV RNA among people living with HIV (PLHIV) with HCV in the Asia‐Pacific region. PLHIV with posi...
Introduction
Toxoplasma gondii can cause symptomatic toxoplasmosis in immunodeficient hosts, including in people living with human immunodeficiency virus (PLWH), mainly because of the reactivation of latent infection. We assessed the prevalence of toxoplasmosis and its associated risk factors in PLWH in the Asia-Pacific region using data from the T...
In this randomised, controlled study in 14 low- and middle-income countries, individuals taking dolutegravir with darunavir/ritonavir for 48 weeks had a greater increase in systolic and diastolic blood pressure than individuals taking two nucleoside reverse transcriptase with darunavir/ritonavir. The difference remained significant after controllin...
The first Bangkok International Symposium on HIV Medicine was launched in January 1998 with the aim to provide up-to-date information on HIV to professional heathcare workers in Thailand and surrounding countries who cannot afford to attend conferences abroad. After several virtual conferences during the COVID-19 pandemic, this is the second face-t...
Objective
To describe changes in atherosclerotic cardiovascular disease (ASCVD) risk over time among people living with HIV (PLHIV).
Methods
We used data from the TREAT Asia HIV Observational Database (TAHOD) and the Australian HIV Observational Database (AHOD). Five-year ASCVD risk was calculated using the D:A:D equation. Individuals were eligibl...
Primary To estimate the levels of salivary cytokines and chemokines in COVID-19 and periodontitis subjects and explore any association between the two groups. Secondary 1. To explore any association between periodontal status and COVID-19 prevalence and severity. 2. To explore any association between the salivary cytokine levels in White British an...
Despite improvements in HIV testing and earlier antiretroviral therapy (ART) initiation in children living with HIV through the years, a considerable proportion start treatment with advanced disease. We studied characteristics of children and adolescents living with HIV and their level of immunodeficiency at ART initiation using data from a multi-c...
Background:
Children living with HIV (CLHIV) on prolonged antiretroviral therapy (ART) are at risk for lipid and glucose abnormalities. Prevalence and associated factors were assessed in a multicentre, Asian longitudinal paediatric cohort.
Methods:
CLHIV were considered to have lipid or glucose abnormalities if they had total cholesterol ≥200 mg...
Chronic obstructive pulmonary disease (COPD) is among the leading causes of death worldwide and HIV is an independent risk factor for the development of COPD. However, the etiology of this increased risk and means to identify persons with HIV (PWH) at highest risk for COPD have remained elusive. Biomarkers may reveal etiologic pathways and allow be...
Background
Understanding factors associated with prevalent Mycobacterium tuberculosis infection and prevalent TB disease in household contacts of patients with drug-resistant tuberculosis (TB) may be useful for TB program staff conducting contact investigations.
Methods
Using data from a cross-sectional study that enrolled index participants with...
Background:
For people with HIV and CD4+ counts >500 cells/mm3, early initiation of antiretroviral therapy (ART) reduces serious AIDS and serious non-AIDS (SNA) risk compared with deferral of treatment until CD4+ counts are <350 cells/mm3. Whether excess risk of AIDS and SNA persists once ART is initiated for those who defer treatment is uncertain...
Disclosure of HIV status is an important part of pediatric care. We studied disclosure and clinical outcomes in a multi-country Asian cohort of children and adolescents with HIV. Those 6-19 years of age who initiated combination antiretroviral therapy (cART) between 2008 and 2018, and who had at least one follow-up clinic visit were included. Data...
Background:
We evaluated trends in CD4/CD8 ratio among people living with HIV (PLWH) starting antiretroviral therapy (ART) with first-line integrase strand transfer inhibitors (INSTI) compared with non-INSTI-based ART, and the incidence of CD4/CD8 ratio normalization.
Methods:
All PLWH enrolled in adult HIV cohorts of IeDEA Asia-Pacific who star...
Introduction
Chronic lung disease is common among people living with HIV (PLWH). We hypothesised that PLWH receiving antiretroviral therapy (ART) have faster lung function decline than matched controls.
Methods
We performed a prospective matched cohort study by including ART-treated PLWH from the Copenhagen Co-morbidity in HIV Infection Study (n=7...
Introduction
Interruptions in treatment pose risks for people with HIV (PWH) and threaten progress in ending the HIV epidemic; however, the COVID‐19 pandemic's impact on HIV service delivery across diverse settings is not broadly documented.
Methods
From September 2020 to March 2021, the International epidemiology Databases to Evaluate AIDS (IeDEA...
Background
At the peak of the coronavirus disease 2019 (COVID-19) pandemic, the need for an orally administered agent to prevent the progression of acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection became increasingly evident, which was the impetus behind our investigations with molnupiravir. Molnupiravir has been shown to be effectiv...
Knowledge is limited on mucosal immunity induction and longitudinal responses to vaccination against SARS CoV2. Here, we determined serum and salivary antibodies and cytokines after three Covishield vaccine doses. Sera from 205 healthcare workers, HCWs one month after first dose; one, three and six months after second dose; paired sera and stimulat...
Introduction:
Viral load (VL) testing is still challenging to monitor treatment responses of antiretroviral therapy (ART) for HIV treatment programme in Asia. We assessed the association between routine VL testing and virological failure (VF) and determine factors associated with switching to second-line regimen.
Methods:
Among 21 sites from the...
Purpose:
Notwithstanding well-established clinical features of Immune Recovery Uveitis (IRU), specific diagnostic tools to identify at-risk patients are lacking. Identification of biomarkers for IRU prediction can allow high-risk patients to benefit from specific preventive strategies, development of therapies, and elucidate immune reconstitution...
Objective:
To characterize diet quality across a global cohort of people with HIV (PWH).
Design:
Cross-sectional analysis.
Methods:
Leveraging REPRIEVE data from baseline across five Global Burden of Disease (GBD) regions, we analyzed participant responses to the Rapid Eating Assessment for Participants questionnaire. An overall diet quality s...
The exclusion of pregnant and breastfeeding women (PBW) from clinical research has precipitated critical knowledge gaps, thereby delaying PBW’s access to better treatment or preventive agents, and drug delivery technologies. The current status quo of blanket exclusion of PBW on precautionary grounds is inequitable and unethical. Instead, exclusion...
A rapidly changing landscape of antiretrovirals and their procurement at scale has permitted the evaluation of new optimised second-line antiretroviral therapy (ART) in low- and middle-income countries. D2EFT is an open-label randomised controlled non-inferiority phase IIIB/IV trial in people living with HIV-1 (PWH) whose first-line non-nucleoside...
Background
Non‐Asian body mass index (BMI) classifications are commonly used as a risk factor for high fasting blood glucose (FBG). We investigated the incidence and factors associated with high FBG among people living with HIV in the Asia‐Pacific region, using a World Health Organization BMI classification specific to Asian populations.
Methods
T...
Introduction:
ACTG A5288 was a strategy trial conducted in diverse populations from multiple continents of people living with HIV (PLWH) failing second-line protease inhibitor (PI)-based antiretroviral therapy (ART) from 10 low- and middle-income countries (LMICs). Participants resistant to lopinavir (LPV) and/or multiple nucleotide reverse transc...
Abstract Background Understanding the immune correlates of cardiovascular disease (CVD) risk in HIV infection is an important area of investigation in the current era of aging with HIV infection. Less is known about CVD risk and HIV infection in developing nations where additional risk factors may be playing a role in the CVD development. In this s...
Objective:
MSM in India are at a high risk for HIV infection given psychosocial challenges, sexual orientation stress, and stigma. We examined the cost-effectiveness of a novel resilience-based psychosocial intervention for MSM in India.
Design:
We parameterized a validated microsimulation model (CEPAC) with India-specific data and results from...
The use of holding regimens for people living with HIV (PLWH) without effective antiretroviral options can have effects on outcomes and future treatment options. We aimed to investigate the use of holding regimens for PLWH in Asian countries. Data from adults enrolled in routine HIV care in IeDEA Asia-Pacific cohorts were included. Individuals were...
Objective
To review the data presented in the 2021 WHO global TB report and discuss the current constraints in the global response.
Introduction and methods
The WHO global TB reports, consolidate TB data from countries and provide up to date assessment of the global TB epidemic. We reviewed the data presented in the 2021 report.
Results
We noted...
Background:
Bacterial pneumonia imparts a major morbidity and mortality burden on children living with HIV, yet effective prevention and treatment options are underutilized. We explored clinical factors associated with severe recurrent bacterial pneumonia among children living with HIV.
Methods:
Children enrolled in the TREAT Asia Pediatric HIV...
Objective:
To assess recent trends in the monitoring of antiretroviral therapy (ART) and detection of ART failure in adult and pediatric HIV clinics.
Methods:
We used data collected from 21 adult and 17 pediatric sites (across 13 and 6 countries/territories, respectively) in the International Epidemiology Databases to Evaluate AIDS - Asia-Pacifi...
Background:
Although the prevalence and mortality of hepatitis is high in the Asia-Pacific region, few studies are available on the diagnosis, treatment, and cure rates for viral hepatitis among people living with HIV in this area. This study aims to report the cascade of care (CoC) for hepatitis B (HBV) and C (HCV) among people living with HIV re...
Background
As countries move towards the UNAIDS's 95-95-95 targets and with strong evidence that undetectable equals untransmittable, it is increasingly important to assess whether those with HIV who are receiving antiretroviral therapy (ART) achieve viral suppression. We estimated the proportions of children and adolescents and adults with viral s...
Objectives
We investigated weight changes following antiretroviral therapy (ART) initiation, the development of metabolic syndrome (MetS) and its association with all‐cause mortality among Asian adults living with HIV.
Methods
Participants enrolled in a regional Asian HIV‐infected cohort with weight and height measurements at ART initiation were e...
In order to design effective strategies to eradicate the HIV, an understanding of persistent viral reservoirs is needed. Many studies have demonstrated HIV residual viremia prevalence in high income countries, data from low- and middle-income countries (LMIC) are limited. We assessed the prevalence, and factors associated with residual viremia in p...
Covishield (same as ChAdOx1) vaccine was rolled out in January 2021 against SARS-CoV2 in India. Although studies show good efficacy after two doses, there is limited data on the fate of the elicited antibody responses over time in groups with or without prior exposure to SARS-CoV2. Therefore, in this study we proposed to test naïve or previously ex...
Indian economy is a fifth largest developing economy. It has been grown in between the periods of time (1991 – 2016) India’s GDP stood at Rs 5,862,120 million in 1991 and in 2016 it was at Rs 1,35,760,860 million economy with 2, 216 percent growth. At the same time, global disparities are growing with industrially and technologically more advanced...
Introduction:
Data on HIV treatment outcomes in people who inject drugs (PWID) in the Asia-Pacific are sparse despite the high burden of drug use. We assessed immunological and virological responses, AIDS-defining events and mortality among PWID receiving antiretroviral therapy (ART).
Methods:
We investigated HIV treatment outcomes among people...
Background:
Less frequent follow-up visits may reduce the burden on people living with HIV (PLHIV) and health facilities. We aimed to assess trends in follow-up visits and survival outcomes among PLHIV in Asia and Australasia.
Settings:
PLHIV enrolled in TAHOD or AHOD from 2008-2017 were included.
Methods:
Follow-up visits included laboratory...
Objective:
Association of SARS-CoV2 burden in the aerodigestive tract with the disease is sparsely understood. We propose to elucidate the implications of SARS-CoV2 copies in concurrent nasopharyngeal swab (NPS), whole mouth fluid (WMF) and respiratory droplet (RD) samples on disease pathogenesis/transmission.
Methods:
SARS-CoV2 copies quantifie...
Objective:
To evaluate associations between hair antiretroviral (ARV) hair concentrations as an objective, cumulative adherence metric, with self-reported adherence and virologic outcomes.
Design:
Analysis of cohort A of the ACTG-A5288 study. These patients in resource-limited settings were failing second-line PI-based ART, but were susceptible...
SARS-CoV2 is transmitted primarily through oral mouth secretions and respiratory droplets. Commercial mouthwashes, povidone iodine (PI), hydrogen peroxide (HP) and chlorhexidine (CHX) have been tested in cell culture and RT-PCR studies for their efficacy to reduce SARS-CoV2 burden. Here, we evaluated SARS-CoV2 burden in whole mouth fluid (WMF) and...
Background:
Human papillomavirus (HPV)-associated cervical cancer is a leading cause of death among Indian women. Indian women living with HIV (WLWH) may be at especially high risk. The quadrivalent HPV vaccine (qHPV) is effective in prevention of initial infection with HPV-6/11/16/18 in HIV-negative women. Little is known about previous exposure...
Purpose:
Re-emergent ocular syphilis in patients with Human immunodeficiency virus (HIV) co-infection has both diagnostic and management difficulties because of the overlapping risk factors. The clinical manifestations described in non-HIV may not be the same in patients with HIV coinfection. Immune recovery uveitis (IRU) may also alter the course...
Importance
The nasopharyngeal swab (NPS) is considered the ideal diagnostic specimen for Covid-19, while WMF is recently promoted due to collection simplicity and importance in disease transmission. There is limited knowledge on the relative viral load in these samples – NPS, whole mouth fluid (WMF) and respiratory droplets (RD; another important s...
Background:
Tuberculosis (TB) is a common infection in people living with HIV. However, the risk factors for HIV/TB co-infection in second-line HIV therapy are poorly understood. We aimed to determine the incidence and risk factors for TB co-infection in SECOND-LINE, an international randomised clinical trial of second-line HIV therapy.
Methods:...
Groundwater resources plays important role in agro-biodiversity and environmental conservation perspectives. Surface and groundwater have played a significant role in the agrarian economics in the developing economics particularly in India. At the same time, the tropical and sub-tropical India is the largest groundwater user in the world through un...
Introduction
SARS-CoV2, the aetiological agent of the current COVID-19 pandemic, has been detected in saliva and recently implicated in several oral diseases. Collection of nasopharyngeal swabs (NPS) and detection by reverse transcriptase-polymerase chain reaction (RT-PCR) requires medical / technical expertise. A reliable and easy to handle point-...
Objective:
Pediatric antiretroviral therapy (ART) for children with HIV (CHIV) must be dosed appropriately for children's changing weights as they grow. To inform accurate estimates of ART formulations and doses needed, we described weight-for-age distributions among CHIV on ART in the IeDEA global pediatric collaboration between 2004 and 2016, us...
Objectives
We conducted a longitudinal cohort analysis to evaluate the association of pre‐treatment body mass index (BMI) with CD4 recovery, virological failure (VF) and cardiovascular risk disease (CVD) markers among people living with HIV (PLHIV).
Methods
Participants who were enrolled between January 2003 and March 2019 in a regional Asia HIV c...
Objectives:
To assess second-line antiretroviral therapy (ART) virological failure and HIV drug resistance-associated mutations (RAMs), in support of third-line regimen planning in Asia.
Methods:
Adults > 18 years of age on second-line ART for ≥ 6 months were eligible. Cross-sectional data on HIV viral load (VL) and genotypic resistance testing...
Background:
The World Health Organisation recommends continuation with the failing second-line regimen if third-line option is not available. We investigated treatment outcomes among people living with HIV in Asia who continued with failing second-line regimens compared to those who had treatment modifications after failure.
Methods:
Treatment m...
Background:
Patterns of antiretroviral therapy (ART) use and immunologic correlates vary globally, and contemporary trends are not well described.
Methods:
The REPRIEVE trial (Randomized Trial to Prevent Vascular Events in HIV) enrolled persons with human immunodeficiency virus (HIV) who were aged 40-75 years, receiving ART, and had low-to-moder...
Introduction
The clinical relevance of low‐level viraemia (LLV) and virological outcomes among children living with HIV (CLHIV) remains controversial. This study aimed to determine the impact of LLV on virological failure (VF) among Asian CLHIV on first‐line combination antiretroviral therapy (cART).
Methods
CLHIV aged <18 years, who were on first...
Background:
Comprehensive treatment and clinical management are central to improving outcomes for people living with HIV (PLHIV). We explored trends in HIV clinical care, treatment outcomes, and chronic kidney disease (CKD) and diabetes monitoring.
Methods:
We included patients ≥18 years in care at ten clinical sites in eight Asian countries. Pr...
Background:
Combination antiretroviral therapy (cART) failure is a major threat to HIV programs, with implications for individual- and population-level outcomes. Adolescents with perinatally-acquired HIV infection (PHIVA) should be a focus for treatment failure given their poorer outcomes compared to children and adults.
Methods:
Data (2014-2018...
In India, there is little evidence on reasons for high rates of loss to HIV care. We conducted a clinic-based qualitative study at the YR Gaitonde Centre for AIDS Research and Education to explore factors that influence loss to care. In all, 17 men and 14 women were interviewed; median age was 42 (interquartile range [IQR], 36-48) and median CD4 co...
Objective:
To implement a standardized cause of death (CoDe) reporting and review process in order to systematically disaggregate causes of HIV-related deaths in a cohort of Asian children and adolescents.
Design:
Death-related data were retrospectively and prospectively assessed in a longitudinal regional cohort study.
Methods:
Children under...
Background
Women living with HIV (WLWH) are at higher risk of acquisition and progression of human papillomavirus (HPV) infection. Evidence on effect of HPV vaccination in this population is limited.
Methods
This phase IV randomized controlled observer-blind study assessed immunogenicity and safety of two HPV vaccines (AS04-HPV-16/18 vs. 4vHPV) gi...
Background:
HIV-associated neurocognitive disorder persists in some people living with HIV despite optimal antiretroviral therapy. Latent tuberculosis infection (LTBI) may cause systemic inflammation and immune activation that may impair brain function. We assessed cognition and biomarkers of inflammation in both HIV+ and HIV- South Indians with a...
Background:
This study investigated survival in people living with HIV being followed-up from five and ten years after antiretroviral therapy (ART) initiation in a multi-country Asian cohort.
Methods:
We included patients in follow-up >5 years after ART initiation. Factors associated with mortality beyond five and ten years on ART were analysed...
Objectives:
Integration of HIV and non-communicable disease services improves the quality and efficiency of care in low- and middle-income countries (LMICs). We aimed to describe current practices for the screening and management of atherosclerotic cardiovascular disease (ASCVD) among adult HIV clinics in Asia.
Methods:
Sixteen LMIC sites includ...
Background: Women living with HIV (WLWH) are at higher risk of acquisition and progression of human pap-illomavirus (HPV) infection. Evidence on effect of HPV vaccination in this population is limited. Methods: This phase IV randomized controlled observer-blind study assessed immunogenicity and safety of two HPV vaccines (AS04-HPV-16/18 vs. 4vHPV)...
In India, many people living with HIV (PLHIV) do not successfully initiate antiretroviral therapy (ART) after diagnosis. We conducted a clinic-based qualitative study at the Y.R. Gaitonde Centre for AIDS Research in Chennai, Tamil Nadu to explore factors that influence ART non-initiation. We interviewed 22 men and 15 women; median age was 42 (IQR,...
Background:
Phylogenetic analysis can be used to assess HIV transmission in populations. We inferred the direction of HIV transmission using whole-genome HIV sequences from couples with known linked infection and known transmission direction.
Methods:
Complete next generation sequencing (NGS) data were obtained for 105 unique index-partner sampl...
BACKGROUND: Perinatally HIV-infected adolescents (PHIVA) are an expanding population vulnerable to loss to follow-up (LTFU). Understanding the epidemiology and factors for LTFU is complicated by varying LTFU definitions.
SETTING: Asian regional cohort incorporating 16 pediatric HIV services across 6 countries.
METHODS: Data from PHIVA (aged 10-19 y...
Objectives:
Early mortality among those still initiating antiretroviral therapy (ART) with advanced stages of HIV infection in resource-limited settings remains high despite recommendations for universal HIV treatment. We investigated risk factors associated with early mortality in people living with HIV (PLHIV) starting ART at low CD4 levels in t...