Journal of the International Association of Providers of AIDS Care最新文献

BackgroundDolutegravir (DTG)-based antiretroviral treatment is now the recommended regimen because of its high efficacy and fewer adverse effects. Nonetheless, hyperglycemia as adverse effect of DTG was reported in few clinical observations.MethodsA case-control study was carried out among DTG-based antiretroviral therapy (ART) users during the study period. EPI Info version 4.8 and SPSS version 26 were used for data entry and analysis, respectively. Binary logistic regression model was used to determine association between risk factors and outcome measures. The associated factors of hyperglycemia were identified using the odds ratio. A P-value <.05 was used to test significance.ResultsThis study contained 42 cases (DTG-based ART users who developed hyperglycemia) and 84 controls (DTG-based ART users who didn't develop hyperglycemia). On bivariable analysis, lower base-line CD4 count, greater body mass index, and lower grade school attendees were significant at P-value <.25. On multivariable analysis, overweight/obesity (body mass index ≥25) plausibly approached statistical significance but did not reach conventional threshold (P-value<.05) as risk factor for hyperglycemia among DTG-based ART users.ConclusionOverweight/obesity-driven hyperglycemia secondary to insulin resistance might be the explanation for hyperglycemia among DTG-based ART users. Further studies with larger sample sizes and prospective designs are needed to confirm these findings.

BackgroundPeer support is an important intervention to achieve increased quality of life for people with HIV. We set out to understand the perceptions and experiences of HIV nurses with peer support in the Netherlands.MethodsWe conducted 21 semi-structured interviews which were analysed using thematic analysis.ResultsRegarding referral to peer support services, we found that nurses favoured patients with the larger presumed burden of living with HIV. Nurses identified logistical and personal barriers with referrals: additional workload, lack of belief in peer support programs, concerns about the impact on their patients because of earlier unfavourable experiences with peer support. Patients are often considered not being ready for peer support and are fearful of unwanted disclosure by others. A good personal connection with peers and having peers in active care facilitated linkage to peer support by increasing visibility and proximity.ConclusionsWe suggest that closer integration of peer support into formal care is a possible solution to the existing barriers.

ObjectivesWe examined associations between extreme weather events (EWE), resource insecurities, and HIV vulnerabilities among a purposive sample of adolescent girls and young women (AGYW) aged 16 to 24 in Nairobi and Kisumu, Kenya.MethodsWe conducted multivariable logistic/linear regression on cross-sectional survey data to assess associations between EWE exposure, food insecurity (FI), water insecurity (WI), and sanitation insecurity (SI) with HIV vulnerabilities (transactional sex [TS], intimate partner violence [IPV], sexual relationship power [SRP], and preexposure prophylaxis [PrEP] awareness and acceptability).ResultsAmong participants (n = 597; mean age: 20.13 years; standard deviation = 2.5), in adjusted analyses, SI and WI were associated with increased TS. Increased cumulative EWEs and eco-anxiety were associated with increased IPV. EWE frequency, FI, and SI were associated with reduced SRP. EWE frequency and SI were associated with reduced, and WI with increased, PrEP awareness. EWE frequency and SI were associated with PrEP acceptability.ConclusionResource scarcities and EWEs were associated with HIV vulnerabilities and PrEP acceptability among AGYW.

In August 2012, a 47-year-old male patient was diagnosed with human immunodeficiency virus (HIV) infection, with no other underlying disease or opportunistic infection. Baseline measurements revealed an HIV RNA count of 79 400 copies/mL and a CD4+ T-lymphocyte count of 8 cells/μL. Despite successful viral suppression with HIV RNA levels remaining below the detectable threshold for 9 consecutive years following the initiation of antiretroviral therapy, the patient's CD4+ T lymphocyte count persistently remained below 200 cells/μL. Resistance testing of the viral reservoir (HIV DNA) was conducted, which revealed proviral resistance. Based on these results, the antiviral treatment regimen was adjusted. One year later, the patient's immune function had significantly improved, with the CD4+ T lymphocyte count having increased to 319 cells/μL.

BackgroundYouth with HIV disproportionately experience psychological trauma, but implementation methods for trauma-informed care are lacking.MethodsTo identify potential processes and determinants of trauma-informed care implementation, we conducted process mapping and qualitative interviews and thematically applied the organizational trauma resilience framework to elicit perceived safety, stability, and nurturance in a pediatric HIV clinic.ResultsForty-three personnel and 8 patient representatives engaged in process mapping; 20 completed qualitative interviews. Clinic culture was described as supportive, cohesive, and equity-focused, but requiring workflow improvements for patient autonomy. Trauma screening, assessment, and interventions were limited/inconsistently applied, with duplicative risk assessments. Support for professional quality of life was limited, despite burnout/attrition reports. Some personnel had trauma-focused training, but ongoing education and culturally responsive policies were needed.ConclusionsProcess mapping presented as a low-burden tool for unveiling gaps and care standards; alongside qualitative interviews, these methods provided practical insights for trauma-informed HIV care.

BackgroundLate diagnosis of HIV remains a critical barrier to effective treatment and improved long-term outcomes. Individuals presenting with low CD4+ T cell counts at diagnosis are at greater risk for opportunistic infections, hospitalization, and mortality. This study aimed to compare clinical, immunological, and virological outcomes among early and late presenters, and to identify factors associated with virologic failure.MethodsWe conducted a retrospective cohort study of 200 patients newly diagnosed with HIV between 2012 and 2019. Participants were categorized into three diagnostic groups based on baseline CD4+ T cell counts: early diagnosis (>350 cells/mm³), late diagnosis 1 (200-350 cells/mm³), and late diagnosis 2 (<200 cells/mm³). Baseline demographics, laboratory markers, clinical outcomes, and treatment responses were compared. Logistic regression was used to evaluate predictors of virologic failure at 6 months.ResultsLate presenters accounted for 71% of the cohort and were more likely to be older, female, unmarried, and have lower education levels. They exhibited significantly lower CD4+ counts, CD4/CD8 ratios, and higher HIV RNA levels at diagnosis (P < .001). Opportunistic infections, hospitalization, and mortality were significantly more common in the late diagnosis 2 group (P < .001). Although virologic suppression was achieved in most patients, immune recovery was significantly impaired in those diagnosed late. Antiretroviral therapy (ART) initiation after 2015 was independently associated with lower risk of virologic failure (OR: 0.39; P = .039).ConclusionLate HIV diagnosis is associated with increased clinical morbidity and impaired immune reconstitution, even in virologically suppressed individuals. Early detection, prompt ART initiation, and routine CD4/CD8 monitoring are essential to optimize outcomes. Public health interventions targeting social determinants may help reduce delays in diagnosis and improve equity in HIV care.