AIDS Research and Treatment最新文献

Background: Opportunistic infections (OIs) play a crucial role in the morbidity and mortality of HIV-infected individuals. Despite the increasing use of antiretroviral therapy, there remains a lack of comprehensive data on the incidence of OIs to provide a clearer national picture. Therefore, this systematic review and meta-analysis aim to determine the pooled incidence and identify the predictors of OIs among people living with HIV in Ethiopia.

Method: A systematic search was conducted across multiple electronic databases to identify relevant studies. The degree of heterogeneity across studies was assessed using the I ² statistic. Subgroup analyses were conducted to explore sources of heterogeneity. A funnel plot and Egger's test were used to assess publication bias. Adjusted hazard ratio with 95% CI was used to assess the relationship between predictors and OIs occurrence.

Result: In total, 24 studies met the inclusion criteria and were analyzed. The pooled incidence rate of OIs among people living with HIV in Ethiopia was found to be 6.96 per 100 person-years (95% CI: 5.14-8.78) based on a random-effects model. The meta-analysis identified predictors of OIs among people living with HIV, including poor adherence (pooled AHR 1.42, 95% CI: 1.12, 1.80), CD4 count < 200 cells/mm³ (AHR 1.49, 95% CI: 1.25, 1.78), being bedridden (AHR 1.45, 95% CI: 1.10, 1.90), and advanced WHO clinical stage (AHR 1.57, 95% CI: 1.24, 1.98).

Conclusion: The burden of OIs continues to be a major health concern among people living with HIV/AIDS. Low CD4 count, poor adherence to ART, being bedridden, and advanced clinical stage were significantly associated with the occurrence of OIs.

Background: Ethiopia started the human immunodeficiency virus (HIV) case-based surveillance (CBS) system along with Research Electronic Data Capture (REDCap) in June 2021. From January to June 2022, only five out of 14 CBS implementing health facilities in Dire Dawa City, Ethiopia, reported 35 newly diagnosed HIV patients through the REDCap Database compared to 314 in the District Health Information System (DHIS-2). This study aimed to evaluate the CBS system, its usefulness, and reasons for underreporting in Dire Dawa City, Ethiopia.

Methods: We used a descriptive cross-sectional study design. We customized the data collection tools from the Centers for Disease Control and Prevention (CDC), a guideline for evaluating public health surveillance systems. Questionnaires were administered to 36 healthcare workers involved in supporting CBS. Completed HIV CBS case reporting forms were also assessed for completeness. EPI Info software was used for data entry and analysis. Descriptive statistics, such as frequencies and proportions, were used to describe the findings.

Results: Interviews were successfully conducted with 34 health workers. The lack of CBS reporting guidelines for healthcare facilities was 22 (61%). Limited coordination between technical staff and health facilities 19 (53%) and limited competency in REDCap 23 (64%) were also observed. CBS data timeliness, completeness, and validity were 89%, 87%, and 99%, respectively, in the REDCap. There is a lack of standard operating procedures during system interruption. The overall health facility representativeness was 368 of 757 (49%). Acceptability was 100%, mainly due to reduced paperwork and the ability to generate simple reports.

Conclusion: and Recommendations: The HIV CBS system was timely and acceptable. However, its representativeness was poor owing to limited competency in the REDCap. We recommend that health workers receive further training for case-based HIV surveillance.

Background: Elderly people living with HIV-1 (PLWH) are more prone to HIV-related complications.

Methods: We investigated the creatinine and blood lipids of 153 PLWHs receiving an ANV regimen and 315 PLWHs receiving an EFV regimen.

Results: The results showed that the abnormal rates of creatinine were very low in both groups, and ANV had a lower triglycerides abnormality than EFV. No evident difference in high-density lipoprotein, low-density lipoprotein, and total cholesterol was observed between the two groups. The abnormal body mass index of the ANV group aged 66 and above was much less than that of the EFV group.

Conclusion: Both the ANV and EFV regimens did not cause severe kidney damage. ANV had an advantage in controlling dyslipidemia. We strongly recommend elderly PLWHs to choose the ANV regimen.

Background: Antiretroviral therapy (ART) programs that retain people living with HIV (PLWH) in care are essential for maintaining viral suppression, improving health outcomes, and halting the spread of HIV. While ART accessibility has improved, retention in care is still low in Ghana. Although several factors account for this, there are limited data to support it. This study assessed the factors influencing retention in care of PLWH in the Upper West Region (UWR) of Ghana.

Method: The study used a retrospective cohort design to track 482 PLWH who started ART in 2019 across 14 ART clinics in the UWR of Ghana. Demographic, clinical, and psychological elements linked to retention were accessed by extracting data from the HIV electronic tracker database. The characteristics of the study participants summarized using descriptive statistics, estimates of retention rates, and relationships between presumed predictors and retention were obtained through Cox proportional hazards regression and Kaplan-Meier survival analysis.

Results: The results demonstrate that 384/482 (79.7%) participants remained in care at 6 months, 354/482(73.4%) at 12 months, 298/482 (61.8%) at 24 months, and 260/482 (53.9%) at 36 months, indicating a decline in ART retention with time. Age, HIV status disclosure, and viral load suppression are important determinants of retention. Older ages between 50 and 79 years (HR = 0.29, 95% CI: 0.13-0.61) have a 71% reduced risk of attrition compared with younger age groups. Psychosocial factors were positively associated with retention as the HIV status disclosure had HR = 0.50 (95% CI: 0.29-0.88). The unknown viral load status significantly increased the risk of attrition (HR = 6.41, 95% CI: 4.50-9.12).

Conclusion: This study has demonstrated that retention rates decrease with time and that retention was significantly predicted by age and viral load status, with better retention rates shown in older PLWH and those aware of their viral load status.

Objectives: Beyond initial antiretroviral therapy (ART), bictegravir/emtricitabine/tenofovir alafenamide 50/200/25 mg (B/F/TAF) has been evaluated as an option for the continuation of treatment for virologically suppressed individuals who switch from other regimens. While treatment-emergent resistance to bictegravir has not been observed in clinical trials, rare case reports have described resistance development during B/F/TAF therapy, typically in the context of suboptimal adherence. Its favourable safety profile, minimal drug-drug interactions and proven virological efficacy suggest that virologically suppressed individuals may benefit from switching to B/F/TAF.

Methods: Descriptive, retrospective, observational study of adults with HIV infection receiving effective non-INSTI (integrase strand transfer inhibitors)-based ART who switched to a B/F/TAF, but not all were suppressed. We compared individuals' viral loads, CD4+ lymphocyte counts, glomerular filtration rates, and lipid profiles before the switch and after 24 weeks of B/F/TAF. Safety was also assessed.

Results: Seventy-nine individuals switched from non-INSTI-based therapies to B/F/TAF. At 24 weeks after the switch, HIV-1 RNA < 50 copies/mL was reported in 96.1% and 92.4% of participants per protocol and intention-to-treat analysis, respectively, compared to 81.0% at baseline. This represents a 15.1% increase in virologic suppression (viral load < 50 copies/mL) compared to baseline. No significant changes were detected in the CD4+ lymphocyte count, glomerular filtration rate, or lipid profile. Adverse events (AEs) were reported in 5.1% of patients. Three patients discontinued treatment due to AEs.

Conclusions: The results of this study suggest that patients can switch to B/F/TAF from non-INSTI-based therapies without compromising the effectiveness or safety of ART.

Background: Adult men living with HIV are less likely than women to adhere to antiretroviral therapy (ART). This highlights the need to understand factors driving nonadherence and how adherence behaviors and barriers change with age. However, existing HIV surveillance data often collapse ages into broad groups, limiting life-course analysis. This study addresses this gap by examining the time from HIV diagnosis to ART initiation and subsequent adherence barriers among men, using women as a comparison group, in Greater Gaborone, Botswana. To explore these dynamics, we employed a cross-sectional survey design tailored to capture age-specific patterns of ART initiation and adherence.

Methods: A cross-sectional survey was conducted with a stratified random sample of 239 men and 428 women attending 21 HIV treatment clinics. Semistructured questionnaires captured life-course characteristics, including the stage of HIV disease at ART initiation and individual-level factors affecting adherence.

Results: The results showed that men (n = 239) initiated ART medication during Stage 1 (n = 165, 61.9%), early Stage 2 (n = 46, 19.2%), late Stage 2 (n = 17, 7.1%), and Stage 3 (n = 11, 4.6%). Most men (69.1%) were diagnosed in Stage 1 of HIV disease compared to early Stage 2 (19.2%), late Stage 2 (7.1%), and Stage 3 (4.6%). Majority of the men (n = 63, 38.2%) diagnosed in Stage 1 were aged 40-49 years, followed by those aged 30-39 years (n = 38, 23.0%). ART nonadherence rates were 46.0% for men and 29.1% for women. Men who were more likely to be ART nonadherent (compared to women) were aged 30-39 years (OR = 2.05, 1.06-3.56), 40-49 years (OR = 1.91, 1.06-3.45), and 50+ years (OR = 3.95, 1.73-8.97). Other risk factors for ART nonadherence were recently sick, comorbidities, and taking other medications.

Conclusion: Despite free ART and medical care in Botswana, men face barriers related to comorbidities, highlighting the need for targeted gender-specific interventions to improve ART adherence.

UNAIDS estimated that in 2023, 84% of pregnant women living with HIV were receiving antiretroviral therapy (ART) for the Prevention of Perinatal Transmission of HIV (PPT-HIV), potentially averting up to 220,000 new HIV infections in newborns. However, despite the scale-up of PPT-HIV services, approximately 160,000 children became infected with HIV in 2022 alone. This underscores the urgent need to refocus efforts on addressing the challenges of PPT-HIV to ensure that sub-Saharan Africa meets global targets for eliminating new perinatal transmission. This article examines interventions that have demonstrated positive impacts on PPT-HIV services and recommends their implementation in areas where they are needed. Among these interventions is the critical importance of enhancing community-based test-and-treat initiatives for people of childbearing age and improving access to prenatal care, HIV testing and ART for expectant mothers. Additionally, there is a need to emphasise the role of technology and involve male partners in PPT-HIV programmes to enhance effectiveness and achieve the desired outcomes.

Background: Implementation of health programs often overlooks males compared to females, and this is true even for HIV programs. Most men do not visit hospitals, and this is where, for example, most of the HIV services are delivered, including HIV testing. Self-testing can help men know their HIV status and possibly prevent the spread and increase treatment uptake.

Aim: This study aimed to assess the utilization of HIV self-testing among males in Malawi and its predictors.

Methods: This paper utilizes secondary quantitative data from the 2019-2020 Multiple Indicator Cluster Survey (MICS). The study sample included 7750 males aged 15 to 49. Data analysis used the Chi-square test to show the association between self-testing and rural/urban residence, region, radio-listenership, internet use, prior testing history, and educational level. Then, a multilevel binary logistic regression analysis was done to show the effect of predictor variables on the outcome reporting on the fixed and random effects, including the odds ratio, 95% confidence interval, and intraclass correlation coefficient. Statistical significance was determined at the p < 0.05 level.

Results: Approximately 10% of males have ever used an HIV self-test. The logistic regression model indicated that ever used the internet (OR = 1.535, CI: [1.231, 1.9150], p < 0.05), ever tested for HIV (OR = 0.181, CI: [0.122, 0.268], p < 0.001), rural residence (OR = 0.493, CI: [0.349, 0.698], p < 0.001), and region (OR = 3.619, CI: [2.120, 6.178], p < 0.001).

Conclusion: The study confirms that HIVST is affected by several sociodemographic factors, calling for targeted interventions to improve HIVST among males.

ABC transporter P-glycoprotein (P-gp) and its expression enhance elimination and reduce drug exposure. The elimination of non-nucleoside reverse-transcriptase inhibitor (NNRTIs) drugs is associated with ABCB1 gene. Drug exposure is impacted by variants in the ABCB1 gene. Hence, the aim of the study was to investigate the association of ABCB1 1236 C/T and 3435 C/T polymorphisms with the modulation of antiretroviral (ARV)-associated hepatotoxicity. This is a cross-sectional study. Genotyping of the ABCB1 1236C/T and 3435C/T polymorphisms was performed in 165 HIV-infected individuals (34 with hepatotoxicity and 131 without hepatotoxicity) and 155 healthy controls using the PCR-RFLP method. The TC haplotype was likely to be associated with a higher risk of severe hepatotoxicity (OR = 1.96, p = 0.06), while CC and TT haplotypes were associated with a reduced risk of severe hepatotoxicity (OR = 0.34, p = 0.039; OR = 0.16, p = 0.006; OR = 0.09, p = 0.003). The ABCB1 3435CT genotype along with alcohol usage revealed a risk of HIV disease progression (OR = 2.47, p = 0.12). The ABCB1 1236TT genotype along with nevirapine (NVP) usage exhibited a risk for hepatotoxicity severity (OR = 2.11, p = 0.55). The ABCB1 3435CT genotype along with alcohol + NVP usage bared a risk of acquisition of hepatotoxicity (OR = 2.04, p = 0.23). In conclusion, ABCB1 haplotypes may influence the severity of ARV-induced hepatotoxicity. While individual polymorphisms and their interaction with alcohol or drug regimen showed no significant association, the 1236TT genotype with NVP use and the TC haplotype suggested a potential risk. Protective effects were observed for CC and TT haplotypes. Larger studies are warranted to confirm these findings and assess clinical relevance.

Background: HIV/AIDS remains a major global health challenge worldwide. Adolescents, particularly those in displaced populations, are highly vulnerable to HIV infection. This study aimed to assess the knowledge, attitudes, and practices (KAP) regarding HIV/AIDS among adolescents in internally displaced persons (IDP) camps in Mogadishu, Somalia.

Methods: We conducted a descriptive cross-sectional study of adolescents aged 13-19 years living in IDP settlements in Mogadishu's Kahda and Deynile districts. Data were collected using a validated questionnaire. We constructed composite KAP indices using prespecified cutoff points, summarized outcomes descriptively, and compared groups by age and gender using χ ² tests and one-way ANOVA, with ethical approval and assent/consent procedures in place.

Results: This study included 440 adolescents with a mean age of 15 ± 2 years, 68% of whom were female. The majority (69%) demonstrated poor knowledge of HIV/AIDS, with common misconceptions about transmission, such as 75% believing that mosquito bites and 85% believing that sharing meals could transmit HIV infection. Negative attitudes toward people living with HIV/AIDS were prevalent, with 84% displaying stigmatizing views. For instance, 81% believed that HIV-positive students should not attend school, and 89% were unwilling to buy vegetables from an HIV-positive vendor. HIV testing rates were extremely low at 0.45%, and only 2.1% of sexually active participants reported condom use. Participants were primarily from the Deynile and Kahda districts, with significant representation from the Southwest State and Hirshabelle. No significant differences in knowledge and attitude scores were observed between the sex or age groups.

Conclusion: Adolescents in IDP camps in Mogadishu demonstrated poor knowledge, stigmatizing attitudes, and risky HIV/AIDS practices. These findings highlight the urgent need for culturally sensitive educational programs, improved access to testing and counselling services, and community-based stigma reduction interventions for this vulnerable population.