International Journal of STD & AIDS最新文献

BackgroundBiopsychosocial comorbidities are common in chronic illnesses like HIV, often resulting in complex clinical presentations. The Clinical Complexity Rating Scale for HIV (CCRS-HIV) was developed to identify these factors. This study examined whether complexity, as measured by the CCRS-HIV, could change over time.MethodsPatients at The Albion Centre in Sydney were assessed at two time points (T₁ and T₂) using the CCRS-HIV. Changes in total and subscale scores were analysed, along with the odds of scoring in the complex range (40+ or 45+). The impact of age and time between assessments was also evaluated.ResultsResults showed a significant decrease in total complexity scores from T₁ to T₂, with improvements across four subscales-two psychological/behavioural, one social, and one biomedical. The proportion of complex cases declined, and participants were nearly twice as likely to be complex at T₁ compared to T₂. Longer intervals between assessments were linked to greater improvements, while age and sex had no effect.ConclusionsThese findings suggest that complexity in people living with HIV (PLHIV) is modifiable and support the CCRS-HIV as a valuable tool for screening and tracking changes in clinical complexity.

BackgroundIntegrase strand transfer inhibitor (INSTI)-based regimens, such as dolutegravir/lamivudine/abacavir (DTG/3TC/ABC) and bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF), are recommended as first-line antiretroviral therapy (ART) for people living with HIV (PLH). This study compares their efficacy and safety in ART-naïve men living with HIV (MLH) in a real-world setting over 48 weeks.MethodsThis open-label, randomized clinical trial (February 2021-October 2024) at Hospital de Infectología "La Raza" enrolled ART-naïve MLH with HIV-1 RNA ≥500 copies/mL and creatinine clearance >30 mL/min. Participants were randomized 1:1 to BIC/FTC/TAF or DTG/3TC/ABC. The primary endpoint was undetectable viral load (<50 copies/mL) at week 48, with safety assessed by adverse events (AEs) per DAIDS criteria.ResultsOf 311 participants, 153 received BIC/FTC/TAF and 158 DTG/3TC/ABC. Virologic suppression was achieved in 90% of the BIC/FTC/TAF group and 86% of the DTG/3TCC/ABC group (p = 0.32). Median CD4+ counts were 649 cells/µL (BIC/FTC/TAF) and 723 cells/µL (DTG/3 TC/ABC) (p = 0.18). DTG/3TC/ABC had higher gastrointestinal AEs (21.5% vs 14.3%; p = 0.04) and grade 3 neuropsychiatric AEs. BIC/FTC/TAF showed higher insomnia rates. Abacavir-related hypersensitivity occurred in 0.6%.ConclusionBoth regimens showed high efficacy. BIC/FTC/TAF was more effective in patients with low baseline CD4 + counts, while DTG/3TC/ABC performed better with higher viral loads. DTG/3TC/ABC had more neuropsychiatric AEs and rare hypersensitivity reactions.

BackgroundEgypt has fastest-growing HIV rate in the Middle East and North Africa. This study aimed to determine the prevalence of late diagnosis (LD) and examine the associated epidemiological and clinical characteristics in a cohort of Egyptian individuals living with HIV.MethodsA cross sectional study included newly diagnosed people living with HIV (PLHIV) who presented to the Cairo University HIV Clinic between September 2022 and May 2023. People with a CD4 + cell count <350 cells/µL or an AIDS-defining event were classified as Late disease (LD), while those who presented with a CD4 + cell count <200 cells/µL or an AIDS-defining event were classified as LD with advanced HIV disease (LDAD). Descriptive statistics were used to characterize the study population. Chi-square test and independent t-test were employed to compare categorical and continuous variables between groups. Logistic regression analysis was performed to identify factors associated with late diagnosis. Statistical significance was set at p < 0.05.ResultsOut of 402 newly diagnosed individuals, 65 (16.2%) had LDAD and 172 (42.8%) had LD. The mean age of LD patients was 36.8 ± 10.5 years, and 82.6% were male. The majority (57.4%) had a viral load more than 10,000-100,000 copies/ml. AIDS-related conditions were observed in 52 patients (30.2%), with wasting syndrome (27%), lymphoma (19%), recurrent bacterial infections (19%), and tuberculosis (15%), being the most common..ConclusionThe high prevalence of LD among newly diagnosed PLHIV emphasizes the need for interventions for early HIV testing, and enhancing prevention programs to facilitate early diagnosis and timely initiation of treatment.

Background: Chlamydia trachomatis is the most prevalent bacterial sexually transmitted infection (STI) worldwide, often asymptomatic in women and associated with severe reproductive complications. In Brazil, population-based screening is not routinely implemented. This study aimed to evaluate the cost-effectiveness of Chlamydia trachomatis screening among asymptomatic women in different age groups. Methods: A hypothetical cohort of 10,000 women was simulated in a Markov model over 10 years, stratified into three age groups: 14-25, 26-30, and 31-35 years. We compared three screening strategies: annual screening, screening every three to 4 years, and no screening. Clinical outcomes included pelvic inflammatory disease (PID), infertility, ectopic pregnancy, and chronic pelvic pain. Costs were presented in Brazilian Reals (BRL) and U.S. Dollars (USD), and the main outcome was the incremental cost-effectiveness ratio (ICER) per significant case averted. Results: Annual screening in women aged 14-25 was the most cost-effective strategy, preventing 7,274 significant health outcomes at a total cost of R$ 7.39 million (USD 1.48 million), resulting in an ICER of R$ 1,015 (USD 203) per case averted. For women aged 26-30, screening every 3 years was more cost-effective, while for those aged 31-35, screening every 4 years yielded the best value for money. Conclusions: targeted chlamydia screening strategies by age group are cost-effective in Brazil. Annual screening of women aged ≤25 years, in particular, offers substantial health benefits at acceptable costs and should be prioritized in STI control programs.

Few effective treatments exists for the elimination of persistant genital warts and recurrences are common. We report the cases of two healthy HIV negative and immunocompetent men with a longstanding history of refractory to treatment and recurrent genital warts were treated with intralesional nonvalent HPV vaccine together with CO2 laser to prevent relapses. One patient developed a severe flare of the disease with multiple tiny lesions and both developed movable, asymptomatic and painless nodules at the sites of injection still present 2 months after treatment. Those are the first reported cases of this adverse reaction after intralesional treatment of HPV vaccine.

A 19 year old man was diagnosed newly acquired HIV and prescribed bictegravir/emtricitabine/tenofovir alafenamide at his initial visit for HIV care. The genotype results from that initial visit returned two weeks later, showing high-level multi-class transmitted drug resistance, including multiple resistance-associated mutations (RAM) in the integrase gene. Although he had an initial substantial decline in viremia in the first 4 weeks, it was felt that the risk of subsequent failure was too high, and his antiretroviral treatment (ART) regimen was therefore changed to daily dolutegravir and darunavir/cobicistat/emtricitabine/tenofovir alafenamide, plus injected lenacapavir. He had durable virologic suppression on this new regimen for 12 months as of his last follow-up. This case of high-level multi-class transmitted drug resistance, in the context of rapid emergence of resistance to dolutegravir where it has been used as part of a salvage regimen, suggests that assessing for RAM in the integrase gene should be added to the currently recommended resistance testing for all patients with newly acquired HIV prior to initiating ART.

BackgroundFemale sex workers (FSWs) face a disproportionately high risk of HIV acquisition, yet uptake of pre-exposure prophylaxis (PrEP) remains low in many settings. We examined PrEP awareness, utilization, and adherence, and identified predictors of uptake among FSWs engaged through One-Stop-Shop (OSS)-linked urban venues in Nigeria.MethodsA cross-sectional survey was conducted among 146 FSWs using venue-based time-location sampling. Structured, interviewer-administered questionnaires assessed socio-demographic characteristics, PrEP knowledge and use, and exposure to HIV prevention services. Multivariate logistic regression was used to identify independent predictors of PrEP uptake.ResultsPrEP awareness was high (76.7%), and among those aware, 92.0% had ever used PrEP. However, adherence was inconsistent: only 41.7% reported daily use, while the majority reported irregular or on-demand use. Peer educators and community-based HIV prevention workers were the most common information sources (69.6%). After adjusting for potential confounders, only participation in group sessions remained a significant independent predictor of PrEP uptake (adjusted Odds Ratio, aOR = 14.22; 95% confidence interval, CI: 1.44-31.61).ConclusionsFSWs linked to urban OSS platforms in Nigeria demonstrated high levels of PrEP awareness and use. The emergence of group HIV prevention sessions as an independent predictor of PrEP uptake reinforces the value of peer-led, community-based behavioral interventions in this setting.

BackgroundDepression care in Kenya has limited access due to a shortage of specialists and inadequate finances for mental health services. This study aimed to determine the prevalence and barriers to accessing depression care among people living with HIV in Juja Sub-County, Kiambu County, Kenya.MethodsA quantitative analytical cross-sectional study was used. A total of 329 people living with HIV receiving comprehensive care at six public health facilities in Juja Sub-County were selected using a stratified sampling technique. Data were collected using interviewer-administered questionnaires after obtaining informed consent from each study participant. The prevalence of depression was assessed using the PHQ-9 scale. Data analysis was done using R. Descriptive statistics were computed. An ordinal logistic regression model was used to determine the factors associated with the prevalence of depression. A binary logistic regression model was used to determine the individual barriers to accessing depression care. Adjusted odds ratios (AORs) with a 95% confidence interval were used to measure the association, and a p-value of less than 0.05 was considered statistically significant.ResultsThe prevalence of depression was 27.4% (95% CI: 22.7-32.6), and 84.4% of affected participants did not access depression care. Depression was significantly associated with poor adherence to HIV medication (AOR = 2.42; 95% CI: 1.53-3.85), poor social support (AOR = 0.57, 95% CI: 0.33-0.99), and high perceived HIV stigma (AOR = 1.85; 95% CI: 1.18-2.93). Additionally, poor adherence to HIV medication (AOR = 0.21; 95% CI: 0.04-0.76) emerged as a significant barrier to accessing depression care.ConclusionsA severe treatment gap exists, with 84.4% of depressed people living with HIV not receiving needed care despite a high depression prevalence of 27.4%.

Syphilis is a multi-system disease caused by Treponema pallidum. Apart from congenital syphilis, it is seen exclusively in sexually active populations, as it has a sexual route of transmission. Children experiencing sexual abuse can acquire syphilis. We report a 12-year-old male child who was a victim of sexual abuse and had presented with a perianal verrucous mass. Immediate surgical resection was opted for to relieve constipation caused by the obstructing mass. The case was managed under the POCSO Act 2012.