Current HIV Research最新文献

Introduction: People with limited English proficiency (LEP) experience barriers to healthcare access and optimal outcomes. Language interpretation services can facilitate clear communication- which is key to effective HIV care and treatment.

Methods: We analyzed weighted data from the 2019 cycle of the Medical Monitoring Project (MMP), a cross-sectional, complex sample survey of U.S. adults with diagnosed HIV, and data from the 2021 MMP Facility Survey, a survey of facilities providing care to 2019 MMP respondents. We estimated the percentage of people with HIV (PWH) with LEP who received care at facilities offering language interpretation services and facilities providing language interpretation services, overall and by selected characteristics.

Results: Overall, 89.9% of PWH with LEP received care at a facility with language interpretation services, and 83.6% of facilities provided language interpretation services. PWH with LEP who were unemployed were less likely than those who were employed to receive care at a facility with language interpretation services. Facilities that were Federally Qualified Health Centers, were not private practices, received Ryan White HIV/AIDS Program funding, and accepted public health care coverage were more likely to provide language interpretation services than facilities without these characteristics.

Discussion: Most PWH with LEP obtained HIV care at health care facilities providing language interpretation services, a positive finding as language is a common barrier to accessing care for people with LEP. Most facilities also provided language interpretation services, an important step towards ensuring meaningful access for people with LEP, as required by law.

Conclusion: Our findings demonstrate that most HIV care facilities are providing access to language services to PWH with LEP in the United States.

Background: Tuberculosis (TB), caused by Mycobacterium tuberculosis, often becomes a comorbidity in individuals infected with Human Immunodeficiency Virus (HIV), the cause of Acquired Immunodeficiency Syndrome (AIDS). HIV-positive individuals have a 30- fold higher risk of contracting TB compared to non-HIV individuals. Assessment of HIV-TB disease progression commonly relies on measuring CD4 cell counts. However, in areas with limited access, the World Health Organization (WHO) recommends using Total Lymphocyte Count (TLC) ≤ 1200 cells/μL as an alternative. Additionally, chest X-rays, a widely accessible radiological method, aid in diagnosing TB in HIV-positive patients, complementing TLC in assessing disease progression in limited facilities.

Objective: The objective of this study was to analyze the differences in the location and characteristics of TB lesions based on HIV status and TLC levels.

Methods: A case-control study was conducted at Adam Malik Central Hospital on pulmonary TB patients from December 2021 to December 2022, meeting inclusion criteria. Evaluation of TB lesion locations and characteristics was performed by two researchers, while HIV status and TLC data were extracted from medical records.

Results: The study involved 154 subjects, including 77 HIV-positive and 77 non-HIV individuals. The percentage of male participants was 81.8%, with a mean age of 43.4 ± 14.4 years. The significant differences in the characteristics and locations of lesions (cavities, miliary lesions, fibrosis, atelectasis, and upper and lower lung) were revealed in HIV-positive and HIV-negative patients. Similarly, significant differences in the characteristics and locations of lesions (cavities, miliary lesions, fibrosis, atelectasis, and upper and lower lung) were revealed in a patient with TLC ≤ 1200 and TLC > 1200.

Conclusion: The study highlights significant differences in the characteristics and locations of tuberculosis lesions about HIV status and total lymphocyte count levels among pulmonary TB patients. HIV-positive individuals exhibited distinct patterns of TB lesions compared to their HIV-negative counterparts, indicating the impact of HIV on TB disease progression. Furthermore, variations in lesion characteristics were also observed based on TLC levels, with notable differences between patients with TLC ≤ 1200 cells/μL and those with TLC > 1200 cells/μL. These findings underscore the importance of considering both HIV status and TLC in the assessment and management of TB in affected individuals. TLC can serve as an alternative to CD4 measurement in situations where access to CD4 testing is limited.

Objective: Patients living with HIV (PLHIV) have a higher cardiovascular risk than others, which is why the early detection of atherosclerosis in this population is important. The present study reports predictive models of subclinical atherosclerosis for this population of patients, made up of variables that are easily collected in the clinic.

Methods: The study design is a cross-sectional observational study. PLHIV without established cardiovascular disease were recruited for this study. Predictive models of subclinical atherosclerosis (Doppler ultrasound) were developed by testing sociodemographic variables, pathological history, data related to HIV infection, laboratory parameters, and capillaroscopy as potential predictors. Logistic regression with internal validation (bootstrapping) and machine learning techniques were used to develop the models.

Results: Data from 96 HIV patients were analysed, 19 (19.8%) of whom had subclinical atherosclerosis. The predictors that went into both machine learning models and the regression model were hypertension, dyslipidaemia, protease inhibitors, triglycerides, fibrinogen, and alkaline phosphatase. Age and C-reactive protein were also part of the machine learning models. The logistic regression model had an area under the receiver operating characteristic curve (AUC) of 0.91 (95% CI: 0.84-0.99), which became 0.80 after internal validation by bootstrapping. The machine learning techniques produced models with AUCs ranging from 0.73 to 0.86.

Conclusion: We report predictive models for subclinical atherosclerosis in PLHIV, demonstrating relevant predictive performance based on easily accessible parameters, making them potentially useful as a screening tool. However, given the study's limitations-primarily the sample size-external validation in larger cohorts is warranted.

Background: Modern antiretroviral therapy (ART) prevents disease progression in people living with HIV. Due to the increasing age of people living with HIV, the detection and management of comorbidities has become more important.

Objective: In this study, we aimed to detect the prevalence of nonalcoholic fatty liver disease (NAFLD) and associated risk factors among people living with HIV followed up in our center.

Methods: This single-center, cross-sectional study included people living with HIV, on ART for ≥1 year and virologic suppression for ≥6 months, presenting for routine follow-up between October 1, 2021, and April 1, 2022. Participants with a concurrent etiology for hepatic steatosis were excluded. Transient elastography (TE) was performed. NAFLD was defined as a controlled attenuation parameter (CAP) ≥248 dB/m; significant fibrosis (≥F2) was defined as liver stiffness measurement ≥7.1 kPa.

Results: A total of 102 people living with HIV (84% men; median age, 39 years (IQR 33-52.5)) were enrolled. The treatment regimen of all participants included a nucleos(t)ide reverse transcriptase inhibitor and an integrase strand transfer inhibitor. TE analysis indicated NAFLD in 28 (27.5%) and fibrosis in 9 (8.8%; 6 with NAFLD) participants. In multivariable analysis, type two diabetes (OR:5.7 (95% CI 1.4-22.2), p=0.013), larger waist circumference (OR:1.1 (95% CI 1.03-1.16), p=0.007), higher alanine aminotransferase (OR:1.05 (95% CI 1.01-1.09), p=0.018), and higher thyroid stimulating hormone (OR:3.1 (95% CI 1.4-6.8), p=0.005) were independently associated with NAFLD.

Conclusion: We observed a significant prevalence of NAFLD among people living with HIV followed up in our center. The high prevalence of NAFLD in our sample mirrors that of the general population, likely due to rising rates of metabolic dysfunction. Our findings highlight the importance of timely screening and implementation of management strategies for NAFLD in this population.

Introduction: The COVID-19 pandemic caused disruptions in the diagnosis, followup and treatment of non-COVID-19 patients due to the burden on the healthcare system. This may lead to missed early diagnosis opportunities in people living with HIV (PLWH). This study aimed to investigate the effects of the COVID-19 pandemic on the demographic characteristics, clinical and laboratory findings, diagnosis, follow-up, and treatment processes of PLWH, and the frequency of opportunistic infections (OIs), AIDS-defining malignancies (ADMs), and late diagnosis (LD).

Methods: In this study, 246 PLWH were identified. During the pandemic period, the mean age of PLWH was lower (p=0.025), the use of 2 nucleoside reverse transcriptase inhibitor (NRTI) + protease inhibitor (PI/r) decreased (p=0.026) and antiretroviral therapy (ART) adher-ence was higher (p=0.015). LD (48.8% vs. 47.5%) was similar for the two periods, OIs rate (22.6% vs. 18.5%) was lower and ADMs rate (4.8% vs. 6.2%) was higher in the pandemic period. Our study was designed as a retrospective cohort study. Individuals over the age of 18 years who were newly diagnosed with HIV infection in our hospital between 2018 and 2023 were included in the study.

Results: During the quarantine period, OIs rate (p=0.008) and hospitalization (p=0.002) decreased significantly. Compared to the pre-pandemic period, there was a decrease in primary school graduates (p=0.043) and Centers for Disease Control and Prevention (CDC) category C applicants (p=0.029) and an increase in university graduates (p=0.027) in the quarantine period. After the quarantine period, there was an increase in hospitalization (p=0.002), CDC category C admissions (p=0.021) and ART adherence (p=0.016). Other data were similar for the three periods.

Conclusion: In summary, while the COVID-19 pandemic led to notable changes in patients' characteristics and HIV-related clinical characteristics and treatment, the incidence of LD, OIs and ADMs did not increase significantly. Continued monitoring and adaptation of healthcare services are crucial to managing PLWH effectively in the context of global health crises.

Human Immunodeficiency Virus (HIV) remains a significant global health challenge, necessitating rapid, sensitive, and accessible diagnostic tools. We examined recent advancements in electrochemical sensors for HIV gene detection, focusing on various sensing strategies, nanomaterial integration, and novel platform designs. Electrochemical sensors have demonstrated remarkable progress in HIV detection, offering high sensitivity and specificity. DNA/RNA-based sensors, aptamer approaches, and nanostructured platforms have detection limits as low as attomolar concentrations. Innovative signal amplification techniques, such as branched DNA amplification and toehold strand displacement reactions, have further enhanced sensitivity. Multiplexed detection systems enable simultaneous quantification of multiple HIV targets and related biomarkers. Integration of microfluidic technologies has improved sample processing and detection efficiency. Paper-based sensors show promise for low-cost, disposable testing platforms suitable for resource-limited settings. While challenges remain in terms of selectivity in complex biological samples and point-of-care applicability, electrochemical sensors hold great potential for revolutionizing HIV diagnostics. Future developments in recognition elements, artificial intelligence integration, and combined sensing modalities are expected to address current limitations and expand the capabilities of these sensors, ultimately contributing to improved HIV management and epidemic control strategies.

Background: Circulating recombinant form (CRF) 01_AE and subtype C are two HIV-1 subtypes. In recent years, novel HIV-1 recombinant forms have become more and more prevalent in China; however, new HIV-1 CRF01_AE/C recombinant forms are less prevalent nationwide.

Objective: Our study aimed to investigate new recombinant forms between different HIV-1 subtypes and evaluate their transmission risk among men who have sex with men (MSM) in Hebei, China.

Methods: The near full-length genome (NFLG) of HIV-1 was identified using the analyses of the phylogenetic tree and gene breakpoints.

Results: In the present work, we have reported a novel HIV-1 recombinant form composed of CRF01_AE and subtype C. The NFLG of this CRF01_AE/C form contained eight gene subregions, with four subtype C gene segments inserted into the CRF01_AE backbone, consisting of I CRF01_AE (790-1,171 nt), Ⅱ subtype C (1,172-1,840 nt), Ⅲ CRF01_AE (1,841-5,089 nt), Ⅳ subtype C (5,090-5,666 nt), Ⅴ CRF01_AE (5,667-6,317 nt), Ⅵ subtype C (6,318-8,586 nt), Ⅶ CRF01_AE (8,587-9,246 nt), and Ⅷ subtype C (9,247-9,409 nt). This new recombinant form was identified as CRF140_0107.

Conclusion: The study suggested that it is important to monitor HIV-1 diversity to reduce HIV- 1 transmission in China.

Background: The concept of designer exosomes involves developing engineered exosomes to overcome the limitations of natural exosomes in targeted drug delivery and vaccine development.

Methods: In this study, the multiepitope constructs were designed based on immunogenic regions of mutant Nef protein of Human Immunodeficiency Virus-1 (HIV-1 Nef^mut) that were prone to high Post-Translational Modifications (PTMs), such as palmitoylation and myristoylation. These constructs with high scores in PTMs were selected for interactions with molecules involved in exosome biogenesis, anchoring of a protein in membranes, and enzymes involved in PTMs (e.g., the mutant enzyme ZDHHC21 p.T209S). Moreover, the selected multiepitope construct with the highest PTM score and stable linkage with these molecules was fused to the first exon of the HIV- 1 Tat protein as an antigen candidate, and to GFP as a tracking tool for evaluating their effects on the PTM scores and affinity binding with various molecules.

Results: Our data demonstrated that the multiepitope construct No.13 had better scores for incorporation into exosomes compared to the whole sequences of Nef^mut and wild-type Nef protein (Nef^wt). Furthermore, the linkage of Tat protein to construct No. 13 did not hinder its loading in exosomes compared to GFP, suggesting the use of this construct in vaccine development.

Conclusion: The multiepitope construct No.13 harboring potent Nef^mut epitopes can be applied for linkage with other viral antigens, enhancing their delivery into exosomes for therapeutic applications.

Background: The concept of same-day antiretroviral therapy (ART) initiation entails initiating HIV treatment promptly upon diagnosis, ideally during the initial clinic visit or even on the same day as diagnosis. This study explores the factors leading to patient loss to follow-up after same-day ART initiation and the benefits and challenges associated with this approach.

Methods: A qualitative research design was employed to investigate healthcare providers' perspectives regarding same-day ART initiation and its contribution to patient loss to follow-up following same-day ART initiation, benefits, and challenges. It is a qualitative study conducted in the form of in-depth cell phone interviews with physicians and nurses who are providing ART services within healthcare facilities in Ethiopia. Data collection was conducted from April 30, 2021, to March 22, 2022.

Results: The findings revealed that same-day ART initiation offers both advantages and drawbacks. Findings show benefits such as shifts in perceptions and attitudes towards HIV, reduced transmission rates, enhanced service utilization, and viral suppression. However, disadvantages included its inappropriateness for critically ill patients' refusal to accept results and suboptimal adherence, leading to increased risk of patient loss to follow-up.

Conclusion: Same-day ART initiation presents a dual nature, offering immediate benefits in HIV management and transmission reduction, yet facing challenges regarding suitability for critically ill patients and adherence issues. The authors recommend addressing factors such as patient education, stigma reduction, and tailored interventions, which are crucial in optimizing the effectiveness of this approach and minimizing patient loss to follow-up.

Coronavirus Disease 2019 (COVID-19), caused by the highly contagious severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), emerged in late 2019 in Wuhan, China. Designated as an epidemic by the World Health Organization (WHO) on January 30, 2020, the virus quickly escalated to a global emergency, officially declared a pandemic in March 2020. With over 6 million recorded deaths and more than 200 identified symptoms in diverse individuals, the impact of COVID-19 is substantial. COVID-19 poses a greater risk to individuals with advanced HIV, while those with well-managed HIV are not at increased risk. Although COVID-19 vaccines are generally effective for people with HIV, some may experience reduced vaccine effectiveness and breakthrough infections due to suboptimal immune responses. Long COVID, affecting at least 65 million individuals, adds a layer of complexity. The virus's rapid mutation has led to diverse symptomatology, prompting adjustments in treatment guidelines. This review comprehensively examines repurposed antiviral drug candidates against COVID-19, explores immune responses across different age groups, delves into the mechanisms of COVID-19 vaccines, and discusses potential immunosuppressants. Additionally, the focus extends to Intravenous Immunoglobulin (IVIG), steroids, and anti-cytokine therapy as promising avenues to address cytokine release syndrome (CRS), a critical condition in COVID-19 patients.