International Journal of STD & AIDS最新文献

BackgroundPromoting health and quality of life for people living with HIV (PLHIV) in low-resource settings is vital. Understanding perceptions of physical activity (PA) and factors influencing participation can guide culturally appropriate interventions. This study explored how PLHIV in Central Uganda perceive PA, factors affecting its acceptability, and views on integrating PA into antiretroviral treatment (ART) services.MethodsA qualitative exploratory design was used. Semi-structured interviews were conducted with 12 adults (7 women, 5 men) on ART for at least 1 year. Data were analysed using content analysis, guided by the socio-ecological model.ResultsPerceptions of PA were shaped by intersecting factors across multiple levels. Individual factors included perceived weakness, comorbidities, fear of health risks, low awareness of PA benefits, body image concerns, competing demands, and seasonal food insecurity. Family and community-level barriers included stigma, gender norms, and lack of support. Institutional barriers involved limited health worker engagement and absence of PA-related incentives.ConclusionsReshaping perceptions and improving PA acceptability requires stronger health system involvement. Embedding PA promotion into routine HIV care and engaging health workers can help address barriers across levels. A multi-level public health approach is needed to integrate PA into biopsychosocial HIV care.

BackgroundSexual Health Hounslow completed targeted outreach in local asylum seeker populations. The methods and results of STI and BBV screening in this population are described.MethodsA dedicated clinic 0.4 miles from the largest contingency hotel opened in January 2023, advertised through targeted hotel-based outreach. A hotel-based clinic opened in 2024.A retrospective case-note review of all asylum seekers attending sexual health services in Hounslow between 01/02/2011 and 01/12/2023 was conducted.Results192 asylum seekers were included. 80 (41.7%) required translators. 111 (57.8%) were not registered with a GP. Thirty-three (17.2%) had a safeguarding concern. Eleven (9.2%) service users tested positive for HIV, two (1.7%) had a positive Hepatitis B surface antigen and three (2.5%) had a positive Hepatitis C antibody. Three (2.5%) required treatment for syphilis, six (4.5%) tested positive for gonorrhoea and 17 (12.7%) tested positive for chlamydia.ConclusionsRates of STIs in this cohort were high: 9.2% HIV and 12.7% Chlamydia prevalence versus 0.17% and 0.29% respectively in England. Patterns of STIs in this cohort differed from national trends. Targeted outreach can improve engagement, testing and care in excluded populations.

BackgroundGenital herpes, primarily caused by herpes simplex virus type 2 (HSV-2), is a chronic sexually transmitted infection with significant psychosocial implications. While cross-sectional studies have documented elevated depression, anxiety, and stigma among affected individuals, longitudinal data on the psychological burden of recurrent outbreaks remain scarce. In this study, recurrent genital herpes was defined as laboratory-confirmed HSV-2 infection with ≥2 symptomatic recurrences in the preceding year, and diagnosis was confirmed using polymerase chain reaction (PCR) from lesion swabs and/or type-specific serology at the initial episode; subsequent recurrences were diagnosed clinically with virological confirmation in a subset.ObjectivesThis study aimed to prospectively evaluate the longitudinal psychological burden of recurrent genital herpes, including depression, anxiety, stigma, and quality of life (QoL), and to identify modifiable risk factors influencing these outcomes.MethodsA prospective cohort study was conducted at a tertiary healthcare center in Punjab from January 2023 to December 2024. Participants included 100 adults with recurrent HSV-2 (≥2 outbreaks/year) and 100 matched controls. Clinical and psychological outcomes were assessed at baseline, 6, 12, and 24 months using validated tools such as the Hospital Anxiety and Depression Scale (HADS), STIGMA Scale for Herpes, and Herpes Quality of Life (HQoL) Questionnaire. Data on suppressive versus episodic antiviral therapy use, adherence measured by both self-report (MMAS-8) and pharmacy refill records, and relationship status (single, partnered, or in a serodiscordant relationship) were also collected. Statistical analyses included repeated measures ANOVA and multivariate regression.ResultsParticipants with recurrent HSV-2 exhibited higher baseline depression (29% vs 8%, p < .001) and anxiety (mean HADS: 11.2 vs 7.5, p < .001) compared to controls. Over 12 months, stigma (STIGMA mean: 38.2 vs 22.7, p < .001) and sexual distress (FSDS mean: 24.1 vs 15.8, p < .001) remained elevated in cases. Frequent outbreaks (≥5/year), low antiviral adherence, female gender, being in a serodiscordant relationship, and lack of social support independently predicted worse psychological outcomes (p < .01). Social support (MSPSS ≥60) was associated with improved QoL (p = .003).ConclusionsRecurrent genital herpes imposes a persistent psychological burden, particularly among individuals with frequent outbreaks, those in serodiscordant relationships and inadequate social support. Asymptomatic HSV-2-positive individuals and those on effective suppressive therapy demonstrated lower anxiety and stigma scores, suggesting a protective role of virological control. Integrated care models combining antiviral therapy with mental health interventions are needed to address stigma, gender disparities, and QoL impairments in this population.

BackgroundMother-to-Child Transmission (MTCT) of HIV continues to be a critical public health issue, particularly in high-prevalence regions. This study examines the rates of MTCT in relation to antenatal booking, parity, antiretroviral (ARV) use, delivery mode, CD4 counts, and infant feeding practices.MethodsA retrospective cross-sectional study was conducted at the Federal Medical Centre, Asaba, Nigeria, involving pregnant women living with HIV attending the Prevention of Mother-to-Child Transmission (PMTCT) program. Data on demographics, antenatal booking, ARV use, delivery mode, CD4 count, and infant feeding were collected. Ethical approval was obtained from the hospital's ethics committee. MTCT rates were analysed based on these variables.ResultsMTCT rates dropped from 1.2% in 2018 to 0% in 2019, with an overall rate of 0.7%. Early antenatal booking and ARV adherence were critical in reducing MTCT. Vaginal delivery with ARV use showed lower MTCT rates than emergency caesarean sections. Higher MTCT rates were associated with CD4 counts below 200 cells/mm³, emphasizing the importance of early ART initiation. Exclusive breastfeeding with ARV prophylaxis was the most effective practice.ConclusionThe PMTCT program at FMC Asaba significantly reduced MTCT rates, highlighting the importance of early booking, ARV adherence, and appropriate delivery methods in improving maternal-child health in high HIV prevalence areas.

BackgroundMale genital lichen sclerosus (MGLSc) is a chronic inflammatory dermatosis presenting as balanoposthitis, with potential for irreversible scarring, sexual and urinary dysfunction, and malignant transformation. Inflammation and architectural disruption from MGLSc may predispose to secondary colonisation or infection with microbial organisms. This can confuse non-specialist clinicians, who may misattribute clinical signs and positive microbiological results to primary infection, thereby overlooking the underlying MGLSc as the root cause of disease.ObjectiveTo evaluate systematically published reports of infective balanitis and balanoposthitis for clinical features suggestive of MGLSc.MethodsFollowing PRISMA 2020 guidelines, we searched MEDLINE and EMBASE for English-language articles reporting cases of non-sexually-transmitted infectious balanitis or balanoposthitis. Eligible studies were required to include adequate clinical photography. Clinical images were reviewed for signs of MGLSc.ResultsOut of 978 identified records, 15 studies met inclusion criteria, yielding 19 clinical images. All images exhibited clinical features consistent with MGLSc, despite being attributed to infections such as candida or bacterial pathogens. Histological confirmation, where performed, was frequently non-specific. Many cases reported incomplete resolution following antimicrobial therapy.ConclusionThis review underscores a recurring problem in the literature viz. the misattribution of MGLSc to microbial infections. Attributing a named diagnosis to positive microbiological results without specialist input can lead to delays in accurate diagnosis and effective management, create fallacious diagnoses and erroneously perpetuate non-existent diagnoses. Improved awareness of the clinical features of MGLSc, and careful interpretation of microbiological data within the broader clinical context, will support more accurate patient care but also enhance the reliability of the literature.

BackgroundWe aimed to determine the effect of combined antiretroviral therapy (cART) on hepatic steatosis and fibrosis in people living with human immunodeficiency virus (PLwHIV).MethodsIn this single-center and prospective cohort study, PLwHIV were evaluated longitudinally by transient elastography at the initiation and 7 months (±1 month) after the cART.ResultsOf the 81 PLwHIV, 28.3% had hepatic steatosis, 40.7% had fibrosis (≥F1), and 24.7% had significant fibrosis (≥F2). In multivariate analysis, body mass index (BMI) (p = .005) and albumin (p = .045) were independent predictors for hepatic steatosis, while aspartate aminotransferase (AST) (p = .041) was an independent predictor for hepatic fibrosis. Control transient elastography was performed in 66 (81.5%) PLwHIV after treatment. Among these patients, the rate of hepatic fibrosis decreased significantly after treatment (43.9% vs 24.2%, p = .017). In the tenofovir alafenamide (TAF)-based regimen, weight (p < .001), BMI (p < .001), waist circumference (p < .001), and total cholesterol (p = .012) increased, while kPA value (p = .002) decreased. In the tenofovir disoproxil fumarate (TDF)-based regimen, controlled attenuation parameter (CAP) value (p = .017) and waist circumference (p = .006) increased. In the lamivudine (LAM)-based regimen, there was no statistically significant change (p > .05).ConclusionHepatic fibrosis regressed with antiretroviral treatments (especially with TAF-based), while the degree of hepatosteatosis progressed (especially with TDF-based). Additionally, weight gain occurred after cART in PLwHIV (especially with TAF-based). Therefore, hepatic steatosis and weight gain in PLwHIV should not be disregarded. In conclusion, PLwHIV on cART need close follow-up for the development of metabolic complications.

BackgroundRestless Leg Syndrome (RLS) is a common neurological disorder with a prevalence of 5-10% in Western countries. Emerging evidence suggests a higher prevalence among people living with HIV (PWHIV), though comprehensive studies are lacking. RLS may be exacerbated in PWHIV due to chronic neuro-inflammation and nutritional deficiencies. This study aimed to determine the prevalence of RLS in a Greek PWHIV population and identify associated demographic, clinical and laboratory risk factors.MethodsThis was a cross-sectional study of 194 PWHIV and 200 non-HIV controls. Data were collected via clinical interviews, validated questionnaires and medical records. We assessed RLS prevalence, clinical characteristics, sleep quality and psychological distress. Statistical analysis included Mann-Whitney U tests, Chi-square tests, and a stepwise logistic regression model to identify independent predictors of RLS.ResultsRLS prevalence was significantly higher in the PWHIV group (31%; 95% CI: 25.3-38.3%) compared to controls (15%; 95% CI: 10.2-20.2%, p < 0.001). In PWHIV, RLS was associated with shorter duration of HIV/HAART, lower CD4 cell counts at diagnosis and currently, and detectable viral load. Detectable viral load was the strongest independent predictor of RLS (OR 15.49, p < 0.001). RLS was also independently associated with poor sleep quality (OR 15.48), anxiety (OR 5.18), and depression (OR 9.22).ConclusionsRLS is a prevalent comorbidity in Greek PWHIV, strongly associated with active viral replication and a state of advanced immunosuppression. The findings highlight the need for systematic RLS screening in this population to improve clinical outcomes and psychosocial well-being.