International Journal of STD & AIDS最新文献

BackgroundHIV continues to be a significant health concern across the world. Combination antiretroviral therapy (cART) comprising of three-drug regimens has improved clinical outcome but involves long-term toxicity concerns. Hence, to reduce drug exposure, interest in two-drug regimens has increased. This study evaluates the real-world efficacy and safety of a two-drug regimen that is a fixed-dose combination (FDC) of Dolutegravir 50 mg and Lamivudine 300 mg tablets in people living with HIV (PLHIV) in India.MethodsThe retrospective data included PLHIV aged ≥18 years, virally suppressed at baseline, and switched to DTG/3TC between November 2021 and April 2022. Patients were followed for 96 weeks, with routine clinical and laboratory assessments. Virological failure was defined as viral loads >1000 copies/mL, while safety assessments tracked adverse events (AEs), weight gain, and metabolic parameters.ResultsAmong 218 patients (mean age 48.08 ± 10.58 yrs), 97.8% achieved virological suppression at 96 weeks with sustained virological suppression at key time points (24, 48, 72, and 96 weeks). CD4 counts improved significantly (p = .002), specifically in females. Body weight increased moderately, with 16.28% experiencing ≥10% weight gain by 96 weeks. Minor statistically significant variations in cholesterol, triglycerides, and creatinine levels were observed. Nine patients discontinued DTG/3TC due to AEs, primarily weight gain and gastrointestinal issues.ConclusionThe study demonstrates that the DTG/3TC FDC is an effective, safe, and well-tolerated regimen for maintaining virological suppression in real-world settings, supporting its viable use as a switching strategy in reducing drug exposure and managing long-term toxicity.

BackgroundMalawi Defence Force (MDF) implemented test-and-start strategy in 2016 to expedite initiation of antiretroviral therapy (ART) for HIV diagnosed individuals. However, key indicators for the 95-95-95 targets, namely retention and viral load suppression, remained sub optimal. To address this, MDF introduced community-based peer navigators (PNs) in 2020 to support ART adherence. We sought to assess impact of this intervention.MethodsA mixed methods study was conducted where ART programmatic data was collected retrospectively from seven MDF health facilities. The analysis compared treatment interruption (ITT), return to treatment (RTT) and viral suppression rates 18 months before and after the intervention.ResultsThe median numbers IIT and RTT was 308 (IQR = 96) and 99 (IQR = 67) pre intervention respectively, while the median IIT and RTT was 145 (IQR = 47) and 160 (IQR = 46) post intervention respectively. Treatment current increased by 36.5% through back to care (BTC) and by 10.4% through new initiations. Out of 1,073 clients due for VL flagged on patient cards, 953 (88.9%) had their blood samples taken compared to 61.8% in pre intervention period (p < 0.01).ConclusionsThe involvement of PNs led to notable improvements in program outcomes. Expanding the peer navigator model within the BTC initiative is recommended to sustain and build upon these gains.

BackgroundThe global burden of syphilis has remained persistently high with globally prevalent cases of syphilis, estimated to be 49.71 million in 2019. In India, where rates of syphilis screening remain sub-optimal, an accurate point-of-care (POC) test is convenient to carry out and guide immediate treatment. Here, we sought to evaluate the performance of an indigenous rapid POC test (Syphicheck -WB).MethodsThis study was carried out in the serology laboratory of our tertiary care center over 2 months. Five hundred serum samples were chosen randomly. Performance parameters of the POC test were calculated in comparison to the Treponema pallidum hemagglutination test, which was considered the reference standard.ResultsOne hundred and six samples (21.2%) were reactive for syphilis by the reference method (TPHA). The sensitivity and specificity of the POC test, were 81.13% and 98.48% respectively. The sensitivity and specificity of the reverse algorithm using POC test for screening, were 81.13% and 99.75% respectively, and of the traditional algorithm using VDRL were 77.36% and 100% respectively.ConclusionThis POC test is a promising candidate as a rapid treponemal screening test. It is likely to improve screening for syphilis under both laboratory as well as field conditions.

BackgroundKaposi sarcoma in people living with HIV and AIDS usually involves slowly progressive skin lesions. Cases of Kaposi sarcoma complicated by hemophagocytic lymphohistiocytosis are rare. In this report, we present the first series of hemophagocytic lymphohistiocytosis cases from Türkiye associated with AIDS and Kaposi sarcoma.MethodsCases of hemophagocytic lymphohistiocytosis in people living with HIV and AIDS and Kaposi sarcoma who met the HLH-2004 diagnostic criteria recommended by the "Histiocyte Society" were included in the study. The patient's demographic, clinical, and laboratory characteristics were recorded retrospectively.ResultsFour patients presented with fever, cytopenia, peripheral lymphadenomegaly, splenomegaly, and hepatomegaly. Fever persisted throughout their hospitalization. At the time of HLH diagnosis, Kaposi sarcoma was detected in the lymph node biopsies of one patient and in the skin biopsies of three patients. Hemophagocytosis was observed in bone marrow aspirations from all patients. Three patients received dexamethasone and etoposide for hemophagocytic lymphohistiocytosis treatment, while one received dexamethasone alone. All four patients died.ConclusionsCases of hemophagocytic lymphohistiocytosis associated with Kaposi sarcoma and AIDS are rare in the literature. In conclusion, high fever may appear in the early stages of Kaposi sarcoma in people living with HIV and AIDS. Since hemophagocytic lymphohistiocytosis has a high mortality rate, early diagnosis and prompt initiation of appropriate treatment are crucial.

BackgroundTubal infertility and ectopic pregnancies are serious, but rare, complications of chlamydia infections. It is unclear whether chlamydia screening in women has an impact on these complications. Chlamydia incidence rates between European countries vary by orders of magnitude, which largely reflects different intensities of screening.MethodsWe used chlamydia diagnoses rates as a proxy for chlamydia screening rates to assess if differences in screening intensity were associated with differences in the frequency of ectopic pregnancy and the prevalence of infertility in women. We used mixed effects linear regression to assess for an association between chlamydia screening intensity in European countries and two outcomes: (1) the incidence of ectopic pregnancy and (2) the prevalence of infertility in women, while controlling for year, income and quality of health services.ResultsThe number of countries with available data increased from 3 in 1990 to 23 in 2019, before slightly declining to 22 in 2020. CT incidence varied across countries, from a median of 207 cases per 100,000 in 1990 (IQR: 59-313) to 33 cases per 100,000 in 2021 (IQR: 3-179). There was less variation in ectopic pregnancy incidence (median: 208 and 33 per 100,000 in 1990 and 2021, respectively), and female infertility prevalence (median 1,224 and 1,587 per 100,000 in 1990 and 2021, respectively). No association was found between screening intensity and ectopic pregnancy incidence or infertility prevalence after adjusting for year, GDP per capita, and universal health coverage index.ConclusionsOur results are compatible with other types of data that suggest that the intensity of screening for chlamydia is not associated with a large effect on the population-level frequency of all ectopic pregnancies and female infertility.

BackgroundThanks to the great advance in antiretroviral therapy (ART), people living with HIV (PLWH) nowadays have a normal life expectancy. Due to chronic (subclinical) inflammation and long-term intake of potentially nephrotoxic medication, PLWH are at an elevated risk for CKD. Urinary Dickkopf 3 (uDKK3) acts as a noninvasive marker of renal tubular damage and predictor of progressive CKD. It has not been investigated in PLWH.MethodsThis observational study included 427 PLWH from the HIV outpatient clinic of the Department of Dermatology at the University Hospital Essen. We examined uDKK3-to-creatinine levels in PLWH with and without CKD. Renal function evolution was retrospectively assessed in order to investigate the relation between uDKK3 and CKD progression.ResultsUrinary DKK3-to-creatinine concentrations were significantly higher in PLWH with CKD and were associated with lower eGFR according to cystatin C (p = 0·009) and creatinine (p = 0·003). There was a trend towards higher uDKK3-to-creatinine concentrations in progressive CKD compared to non-progressive CKD, without reaching significance (OR 1·27; 95%-CI 0·33-2·08; p = 0·33).ConclusionsUrinary DKK3, a noninvasive marker, not only detects CKD in PLWH, but could also indicate its progression. This could help to identify PLWH with progressive CKD in need of effective treatment.

BackgroundThis study was conducted to assess the prevalence of HIV and its associated risk factors among people who inject drugs in the four states of Central Zone of India (Bihar, Delhi, Uttar Pradesh and Uttarakhand), based on the data collected during the 17th round of HIV Sentinel Surveillance (HSS) during January to March, 2020.MethodsThe data was used from the 17th round of HSS which was collected through a paper-based survey among participants who were identified as people who inject drugs (PWIDs), followed by blood sample collection. Random sampling method was used to identify 250 PWIDs from each sentinel site.ResultsThe key demographic findings show that 60.1% of the participants were of age >=30 years and primarily urban residents (84.5%). Most participants have been tested for HIV previously (97.5%). With almost two-thirds of the participants injecting drugs daily, 89.5% of them reported to have used sterile needles each time. One-third of the participants had avoided health care services due to stigma and discrimination and they are significantly at higher odds of being HIV seropositive (1.83 times).ConclusionsThe study highlights the risk behaviour association with higher odds of being HIV seropositive were high risk occupation, sharing of needles, PWIDs on OST therapy, HIV testing and avoidance of healthcare services - due to stigma. Better programmatic approach is needed to protect the PWIDs.

IntroductionCystic echinococcosis, or hydatidosis, is a parasite infection that can occur in humans. It can affect all organs, mostly the liver and the lungs. The number, size and evolution of those cysts is mediated by the immune system. Herein we report an unusual presentation of hydatidosis in an immunocompromised woman who lives with HIV.Case presentationOur patient was a 40-year-old female with a 2-decade history of HIV and echinococcal infection. She was in AIDS stage due to poor medical adherence. She presented a medullar toxicity to Albendazole, a medication she had been taking for years to control the echinococcal cysts, which were stable then. Upon stopping the Albendazole, she presented an enlargement of those cysts. Surgery was mandatory, and revealed five liver cysts, a 12cm-large kidney cyst, and a gigantic 20 cm-large retroperitoneal cyst. They were treated successfully, and the patient has been asymptomatic during the last 4 years since surgery, along with maintained HIV suppression.ConclusionHydatidosis can be negatively affected by immunosuppression such as HIV infection. However, the scarcity of the cases studying this association makes it difficult to fully grasp the possible interactions between those two diseases.

BackgroundDespite Antiretroviral Therapy (ART) progress, Human Immunodeficiency Virus (HIV) remains a major issue in Tanzania (4.65% prevalence). World Health Organization (WHO) introduced Enhanced Adherence Counselling (EAC) in 2016 to improve adherence, but many patients still struggle to suppress viral load after EAC.ObjectiveThis study evaluated the effectiveness of Enhanced Adherence Counselling for people living with HIV with unsuppressed viral load in Ilala, Dar es Salaam.MethodsA cross-sectional study was conducted in eight Ilala Care and Treatment Clinic (CTCs), selected using multistage sampling based on patient volume, for this study, patient volume was defined as the number of CTC clients, with high-volume facilities referring to those serving more than 1000 patients. Records of patients with unsuppressed viral load (≥1000 copies/mL) in 2023 were reviewed. Data were analysed in STATA SE 14 using descriptive, ordered, and multivariable logistic regression, with significance set at p < 0.05.ResultsOut of 361 people living with HIV with high viral load, 86.2% enrolled in EAC and 70.9% completed it. Among completers, 68.4% achieved viral suppression. Viral load suppression was significantly associated with age and initial viral load, with younger individuals being less likely to achieve suppression, while those with lower initial viral load (VL) had a higher likelihood of suppression. Median EAC initiation time was 27 days, with most completing it within 3 months.ConclusionThe study reveals gaps in transitioning people living with HIV with unsuppressed viral load to EAC enrolment and completion, undermining EAC's effectiveness. While 68% viral load suppression among those who completed EAC is promising, low enrolment and retention into EAC may impact overall success. Further research is needed to explore barriers to full participation into EAC sessions and its impact on viral load suppression.