International Journal of STD & AIDS最新文献

The guideline provides recommendations on the management of adults with anogenital herpes in the UK. Recommendations include diagnostic tests, management of the primary or first episode of anogenital herpes and recurrences, effectiveness of therapy, prophylaxis, and prevention of transmission between partners, as well as patient centred counselling.

Background: Motor neuron disease (MND) is a well-known group of neurodegenerative diseases, with amyotrophic lateral sclerosis (ALS) being the most common form. Since 1985, a possible association between MND/ALS and HIV infection has been described.

Methods: We performed a systematic review of case reports and case series involving people living with HIV with MND/ALS through PubMed, Bireme, Embase, and Lilacs databases. The risk of bias was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Tool for Case Reports.

Results: We analyzed 36 articles presenting 88 cases. The mean age was 41.6 years. Antiretroviral therapy (ART) was used by 89.8% and riluzole by 16.9%. First signs and symptoms were similarly present on cervical/upper (25%) and lumbosacral/lower limbs (23.9%), mostly with fasciculations (69.8%) and hyperreflexia (58.8%). MND had a progressive course in 32.9% patients and a clinical improve in 54.6% following ART. The mean survival of the 32 patients who died was 12.3 months and the mean survival of the living patients was 62 months. Respiratory failure was the main cause of death (35.7%).

Conclusions: MND/ALS may present differently in the people living with HIV as a rapidly progressive disease in younger people but with the potential to improve weakness and survival through antiretroviral therapy.

Long-acting (LA) cabotegravir/rilpivirine (CAB/RPV) is primarily prescribed for virologically suppressed persons living with HIV (PLWH). Patients experiencing pill dysphagia or profound adherence challenges were excluded from the phase 3 studies, but recent reports demonstrate successful treatment in PWLH with baseline viremia. We describe two PLWH with detectable viral loads (VL) with multidrug resistance mutations. They were unable to sustain virologic suppression on oral therapy with historical poor adherence and dysphagia. Initiation of intramuscular CAB/RPV with subcutaneous lenacapavir (LEN) injections was necessary with baseline resistance. Due to anorexia and a low muscle mass, one patient received CAB/RPV injections in the vastus lateralis rather than the gluteal muscle with a 67-day delay between injections three and four due to health challenges. Both achieved viral suppression on monthly CAB/RPV with LEN. A return to health with a BMI increase from <14 kg/m² to almost 17 kg/m² resulted in the second patient. Injectable LA ART (CAB/RPV + LEN) in PLWH with detectable viremia results in sustained virologic suppression and a return to health and should now be considered a novel option for MDR patients with an inability to adhere to oral regimens.

Lipschütz ulcers (LU) represent a challenging and frequently overlooked diagnosis within the spectrum of genital ulcerations. We present the case of a 25-year-old sexually active woman with painful ulcerative lesions on her vulva, accompanied by general malaise, fatigue, and arthralgia. She had been suffering from mild COVID-19 for 1 month. Sexually transmitted infections and cytomegalovirus were excluded. A biopsy of the lesion confirmed a Lipschütz ulcer.

Background: Tuberculosis (TB) among people living with HIV/AIDS (PLWHA) contributes substantially to morbidity and mortality, particularly in high TB burden countries. Our objective is to investigate the clinical characteristics and mortality rates associated with TB among adult PLWHA over a 10-year period at an urban HIV clinic situated in a high TB burden country.

Method: A retrospective cohort study was conducted in 2022. The primary endpoints were clinical characteristics and mortality rate of TB, determined as per 100 person-years among adult PLWHA, presented with a 95% confidence interval. Univariable and multivariable Cox proportional regression analyses were performed to determine risk factors for TB mortality.

Result: From January 2012-December 2022, 155 PLWHA receiving a diagnosis of TB were enrolled. The median age was 29 (26.5-48.5) years, and the median CD4 + T cell count was 141 (41.8-252.8) cells/µL, with 60.0% of patients with TB manifesting as disseminated infection. The most involved organs were pulmonary (89.7%), lymph nodes (39.4%) and pleura (14.8%). The treatment outcomes exhibited success in 63.2% of cases, relapse in 5.2%, loss to follow up in 17.4% and death in 14.2%. The overall mortality rate was 18.8 per 100 person-years. Multivariable analyses showed significant factors affecting mortality, including lymph node involvement (adjusted HR 3.5; 95% CI 1.1-10.8) and thrombocytopenia (adjusted HR 74.2; 95% CI 10.0-551.4).

Conclusion: TB in PLWHA, commonly presenting as disseminated infection, contributes to high mortality. Lymph node involvement and thrombocytopenia are significant factors contributing to mortality. Tuberculosis preventive treatment should be considered for improved prevention strategies among PLWHA, particularly in high TB burden countries.

Background: HPV-related vulvar cancer is increasing in prevalence, especially in women living with HIV. Treatment of vulva cancer is based on evidence from HPV-independent cancers, which affect older women. The impact of HIV on vulvar cancer characteristics and treatment outcomes needs to be elucidated.

Patients and methods: A retrospective observational study compared the clinical characteristics, treatment, and outcomes of 92 HIV-positive and 131 HIV-negative women with vulvar cancer at our institution. Using descriptive statistics, HIV-positive and negative patients were compared and Cox regression models were tested for differences in mortality and recurrence.

Results: HIV-positive patients were 20 years younger than HIV-negative patients (p < 0.001). More than 50% of patients presented with advanced stage cancer, however this was independent of HIV-status. Although HIV infection was associated with poorer survival (p = 0.022); rates of cure (p = 0.933) and recurrence rates (p = 0.8) were similar in HIV-positive and negative women.

Conclusions: Vulvar cancer occurs at a much younger age in women living with HIV. Awareness among HIV-positive women and health care providers would lead to diagnosis of vulvar cancer at an earlier stage. Treatment protocols for HPV-related vulvar cancer should not be altered due to HIV status and should take into consideration the young age of the patients.

Background: Long-acting injectable (LAI) cabotegravir/rilpivirine (CAB/RPV) extends dosing intervals from daily to every 8 weeks. Equitable implementation requires anticipating and addressing barriers to use. We described LAI-CAB/RPV eligibility and initiation among persons with HIV (PWH) receiving care at a Southeastern US academic medical center. Methods: We included PWH ≥18 years, in care 01/01/2020-12/31/2021, and participating in the UNC CFAR HIV Clinical Cohort. We characterized LAI-CAB/RPV eligibility, compared those with and without recent detectable viral load (VL), and described clinical outcomes on LAI-CAB/RPV. Results: Among 1672 PWH, 425 (25.4%) had LAI-CAB/RPV drug-resistance. Among 1238 LAI-eligible PWH, 8.9% had detectable VL. Median age was 53 (interquartile range 40, 61), 54.6% were non-Hispanic Black, and 73.6% male. Over one-third lived >50 miles from clinic, one-fifth were uninsured, and 7.4% reported hazardous alcohol use. Gaps in care (prior 12-month) were more common among PWH with detectable VL versus suppressed (23.1% vs 13.9%, p = 0.03). 6/47 initiated LAI-CAB/RPV had detectable VL prior to injection; >95% sustained suppression and those with detectable VL had a rapid decline in viremia. Conclusions: Three-quarters of PWH were eligible for LAI-CAB/RPV, but equitable implementation may require addressing challenges such as distance to care, inconsistent care engagement, and other comorbid conditions, particularly for PWH with viremia.

Pneumocystis jirovecii pneumonia (PJP) is one of the leading opportunistic infections seen in people living with HIV. Bilateral infiltrations characterize PJP and miliary involvement is very rare. In this article, we report a 32-year-old person living with HIV who was followed up with a diagnosis of miliary PJP. Our patient was admitted to the hospital with complaints of cough, sputum, and weight loss. Initially, miliary tuberculosis was considered due to the presence of miliary involvement on chest radiography, but the diagnosis was made with P. jirovecii PCR positivity. This article aims to report a case of miliary PJP, a rare clinical form of PJP.

Background: People lost to follow-up (LTFU) from HIV care have an increased risk of worse health. The objective of this study is to create and validate a risk score to predict LTFU among PLWH in Catalonia and the Balearic Islands.

Methods: 6661 PLWH were included. LTFU were those without contact with HIV care for 12 months or more. Logistic regression models were used to assess the role of independent factors on LTFU. The validation included a 10-fold iteration to predict the performance of the regression model and the Area under the ROC Curve (AUC). Regression coefficients were rounded and summed to construct the score.

Results: Determinants of LTFU included being younger than 34 years (OR: 1.80, CI, 1.44-2.23), not having been born in Spain (OR: 1.32, 1.11-1.58), men who inject drugs (OR: 2.10, 1.38-3.19), having a detectable viral load (OR: 3.14, 2.47-3.99), and ≤2.5 years since HIV diagnosis (OR: 3.84, 3.10-4.75). The validation of determinants resulted in a mean AUC of 0.69 and the risk-score revealed that 28.8% had a medium and 3.4% a high risk of LTFU respectively.

Conclusions: Findings can be used to prevent LTFU in HIV care.

Introduction: HIV has transitioned from a devastating 1980s epidemic to a manageable chronic condition with antiretroviral therapy. In Brazil, challenges persist, including high detection rates and loss of medical follow-up among people living with HIV/AIDS (PLHIV). Adherence, engagement, and avoiding loss to follow-up are critical for effective HIV/AIDS prevention and care.

Objectives: This case-control study within longitudinal research on PLHIV linkage and retention in Porto Alegre aims to analyze factors associated with treatment abandonment.

Methods: The study, based on patients from the Therapeutic Care Service for HIV and AIDS at Sanatorio Partenon Hospital, involved 360 PLHIV in a retention and linkage outpatient clinic.

Results: Risk factors for loss to follow-up include cisgender women, diagnosis between 1991 and 2005, and non-adherence to antiretroviral treatment (ART). Conversely, cisgender men, diagnosis between 2015 and 2023, and good ART adherence were protective factors.

Conclusion: Gender disparities and ART non-adherence pose significant challenges in comprehensive PLHIV care. Cisgender women diagnosed before 2005 face higher risk, while cisgender men diagnosed after 2015 with good ART adherence are more protected, influencing care and prevention strategies for PLHIV.