International Journal of STD & AIDS最新文献

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.

BackgroundThis study investigates drug-drug interactions (DDIs) in people with HIV (PWH) receiving antiretroviral therapy (ART) with comorbidities. We focus on pharmacological factors and evaluate DDI notifications from online databases, emphasizing the clinical relevance of pharmacokinetic, pharmacodynamic, and pharmacogenomic variations.MethodsA comprehensive literature search was conducted using PubMed, ScienceDirect, Google Scholar, and the Cochrane Library for studies published between January 2019 and September 2024. Newly identified DDI evidence was analyzed by comparing DrugBank, Drugs.com, and the Liverpool HIV databases.ResultsEleven studies met the inclusion criteria. The findings of these studies showed the critical importance of considering DDIs in PWH with tuberculosis (TB), malaria, and pulmonary hypertension. Severe adverse drug reactions associated with ARTs, including efavirenz, darunavir, nevirapine, and atazanavir-ritonavir, especially when combined with treatments for TB and malaria. Key interactions included reduced drug levels from rifampicin and QT prolongation from artemether-lumefantrine. Pharmacogenomic factors, such as CYP2B6 slow metabolism during pregnancy, influenced outcomes. Database discrepancies were noted, especially for riociguat interactions and ritonavir through inhibition of P-gp or OATP1B1 functions.ConclusionsDDIs in PWH receiving ART with comorbidities have highlighted the crucial need for personalized treatment. Incorporating pharmacokinetic, pharmacodynamic, and pharmacogenomic factors is essential for optimizing therapy outcomes.

We report a man in his thirties living with advanced HIV presenting with Pneumocystis pneumonia, cytomegalovirus colitis and HIV retinopathy. Initial HIV screening was positive, and immunochromatographic testing demonstrated simultaneous p24 antigen and antibody bands, an exceptionally rare finding outside the acute seroconversion phase. Despite profound immunosuppression (CD4 3 cells/µL), initiation of antiretroviral therapy led to rapid disappearance of the p24 antigen, while antibody positivity persisted. This case illustrates how severe cellular immune deficiency can allow concurrent antigen/antibody positivity, likely due to high viremia and impaired antibody responses. Clinicians should be aware that point-of-care HIV test results may vary depending on the stage of infection and the timing of therapeutic intervention.

Given limited treatment options for Trichomonas vaginalis (TV) in patients with metronidazole allergy and waiting times for desensitization leaving patients in significant discomfort, it is imperative to find alternative options. This case study highlights an example of cure of TV using 24 nightly dequalinium chloride pessaries in a patient with metronidazole allergy, thus presenting a potential treatment option for further study.

BackgroundSexually transmitted infections (STIs) continue to cause morbidity among women in resource-constrained settings, where asymptomatic infections are often overlooked due to syndromic management protocols. We investigated correlates of asymptomatic STIs among women in the Dominican Republic (DR).MethodsWe analyzed data collected from cisgender women in DR between 2015 and 2019. Classified groups included pregnant youth (PY), people with HIV (PWH), residents of bateyes (RB), and sex workers (SW). Nucleic acid amplification or rapid plasma reagin tests detected STIs (Chlamydia/Gonorrhoeae/Syphilis/Trichomonas). Asymptomatic comprised no self-reported vaginal discharge, dysuria, groin lymphadenopathy, and genital/anal pain/ulcers. Logistic regressions identified sociodemographic, clinical, and behavioral correlates.ResultsAmong 833 asymptomatic women (median age 29, IQR 19-37), 35% were PY, 27% PWH, 11% RB, and 27% SW. STI prevalence was 24%: most (61%) had Chlamydia and few (≤25%) had Gonorrhoea, Syphilis, or Trichomonas. Asymptomatic STI correlates included age ≤24 (Adjusted Odds Ratio [aOR] = 2.32, [1.65-3.28]), early (≤14) sexual debut (aOR = 1.56, [1.11-2.18]), greater mobility (aOR = 1.41, [1.01-1.97]), lack of regular doctor (aOR = 1.42, [1.01-1.99]), and drug use in last 6 months (aOR = 1.88, [1.07-3.26]).ConclusionsCorrelates of asymptomatic STIs-age, sexual debut, mobility, healthcare access, and drug use-should inform targeted screening and prevention efforts where diagnostic testing is not widely available.

Mycobacterium avium complex (MAC) is a common opportunistic infection in advanced human immunodeficiency virus (HIV), but splenic abscess formation is rare. We report a 35-year-old man with newly diagnosed HIV who presented with chronic cough, fever, abdominal discomfort, and pancytopenia. Imaging revealed a solitary splenic abscess. Cultures from sputum, stool, and abscess drainage in addition to lymph node and duodenal biopsies confirmed disseminated MAC. Additional diagnoses included cytomegalovirus viremia, esophageal candidiasis, and MAC-related granulomatous hepatitis. He was treated with rifabutin, ethambutol, and azithromycin) and started on antiretroviral therapy (ART) during admission. The patient was discharged on ongoing MAC therapy and ART. This case highlights a rare presentation of disseminated MAC as a solitary, drainable splenic abscess in severe immunosuppression, underscoring the need to consider atypical focal infections in advanced HIV.

BackgroundRecurrence of genital warts remains a significant clinical challenge despite various treatment options. Systemic inflammatory indices derived from routine blood counts, such as the systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR), have recently been investigated as potential prognostic markers in HPV-related diseases.MethodsThis retrospective study included 217 male patients who underwent electrocauterisation for penoscrotal warts between March and September 2024. Patients were classified as having primary or recurrent lesions at presentation. Preoperative neutrophil, lymphocyte, and platelet counts were used to calculate inflammatory indices, and their associations with recurrence were analysed. Primary patients were also followed for 6 months to assess post-treatment recurrence.ResultsRecurrent cases (44.2%) exhibited significantly higher SII, NLR, and PLR values compared with primary cases (p = 0.004, p = 0.011, and p = 0.047, respectively). Smoking prevalence was greater among recurrent patients (p = 0.008). Among primary patients, those who experienced recurrence at 6 months had higher SII (p = 0.006) and NLR (p = 0.014). Multivariate analysis identified SII as an independent predictor of recurrence (OR = 1.42, 95% CI 1.08-1.91, p = 0.027).ConclusionsElevated SII and NLR levels are associated with an increased risk of genital wart recurrence, and SII independently predicts recurrence among primary cases. These inexpensive and readily available markers may aid in recurrence risk stratification and follow-up planning. Longer prospective studies incorporating HPV genotyping and behavioural risk factors are warranted to confirm these findings.

BackgroundCondylomata acuminata (genital warts) are one of the most common sexually transmitted infections, mainly caused by human papillomavirus types 6 and 11. While vaccination programs have reduced the incidence in young women since 2006, the healthcare situation for men in Germany remains poorly studied. The aim of this study was to analyse the reality of care for men with condylomata acuminata in both outpatient and inpatient settings.MethodsA retrospective analysis was conducted on 239 male patients treated for condylomata acuminata between 2020 and 2024 at the Department of Dermatology, Venerology and Allergology, University Medical Center Leipzig. The data collected encompassed demographic information, comorbidities including immune status and sexually transmitted infections, prior medical consultations, the type of treatment provided (outpatient or inpatient), where applicable duration of hospitalization, our therapeutic approach, and the overall recurrences rate.ResultsThe mean age of the patients was 41.1 years. 83.3% were treated on an outpatient basis, while 16.7% received inpatient or short-term inpatient care. The average length of stay for inpatients was 4.03 days (standard deviation: 2.75). Prior diagnostics were documented in 15.1% of cases. Overall recurrences occurred in 22.2% of patients. Only 7.5% had a documented HPV vaccination status.ConclusionsThese results highlight the significant disease burden of condylomata acuminata among men in Germany, with the majority of cases managed on an outpatient basis. The insufficient vaccination rate and low rates of prior diagnostics indicate deficits in prevention and structured care. Intensifying vaccination programs and optimizing treatment pathways could reduce the disease burden and the need for inpatient care.

BackgroundSex workers are disproportionately affected by HIV and sexually transmitted infections (STI) in the Republic of Congo. We conducted a one-group pre-post test participatory mapping (PM) intervention to increase HIV/STI testing uptake with female sex professionals (FSP) in Pointe Noire, Congo.MethodsWe engaged a peer-driven sample of FSP in Pointe Noire in a 2-day PM intervention. Voluntary HIV and STI testing and treatment was offered at Time 2 (T2) (directly post-intervention) until Time 3 (T3) (8-week post intervention). To measure HIV/STI testing changes between Time 1 (T1) (baseline, lifetime HIV/STI testing), T2, and T3, we used a generalized estimating equation model with robust standard errors, using an unstructured correlation matrix to account for within-subject correlations.ResultsAmong n = 99 participants (mean age: 25.5, standard deviation = 6.5), in analyses adjusted for age and sex work duration, there were significant increases at T2 in uptake of HIV testing (adjusted Odds Ratio [aOR] = 2.42; 95% CI = 1.31-4.48) and STI testing (aOR = 2.40; 95% CI = 1.27-4.54), as well as at T3 (HIV testing: aOR = 7.37; 95% CI = 2.82-19.23, STI testing: aOR = 5.88; 95% CI = 2.82-12.24), compared to baseline.ConclusionsFindings signal the promise of community-based approaches such as participatory mapping for increasing HIV/STI testing uptake with FSP in Pointe Noire.