AIDS Research and Treatment最新文献

Introduction: We aimed to evaluate the clinical presentation and diagnosis process of all newly diagnosed human immunodeficiency virus (HIV) patients and conduct a 'look back' for barriers to care to aid a greater understanding of interventions to reduce late presentation. Methods: We evaluated 102 patients with newly diagnosed HIV who were referred to Melaka Hospital's infectious disease (ID) team from January 2021 to December 2022 via retrospective case record review. They were categorised into late presenters (LPs) and nonlate presenters (NLPs). LP is defined as persons presenting for care with a cluster of differentiation 4 (CD4) count below 350 cells/μL or presenting with an acquired immunodeficiency syndrome (AIDS) defining event, regardless of the CD4 cell count. Demographic characteristics, individual and healthcare system barriers and treatment outcomes were evaluated. Results: There were 89.2% of LPs, with 56.9% presenting with opportunistic infection (OI). Median CD4 for LPs upon diagnosis was 53 cells/μL. Pneumocystis jirovecii pneumonia was the most common presenting OI. Most were men who had sex with men (MSM) with more university graduates among the NLPs compared to LPs (36.4% vs. 8.8%, p 0.02). 9.9% of LPs experienced pitfalls during healthcare consultation, leading to late presentation, which was labelled as adverse events. LP's median time from diagnosis to first ID consultation was 7 days, and all patients' median duration of antiretroviral therapy (ART) initiation was 24 days. 82.4% of the patients were still on follow-up, with 69.6% achieving virological suppression at 6 months of ART. The mortality rate was 5.9%, all of which were LPs, and most were MSM. Conclusions: Late presentation remains challenging, with 9.9% of potent preventable adverse events. Morbidity meetings are crucial for immediate feedback to involved healthcare providers. Community-based organisations also play an essential role in identifying and providing linkage of high-risk groups to early HIV screening and diagnosis.

Background: Human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) continues to be a major public health issue, particularly among women of reproductive age. This study was conducted to examine the factors that influence HIV awareness and knowledge among women in Somaliland. Methods: The data used in this study were obtained from the Somaliland Demographic and Health Survey conducted between 2019 and 2020, which included a representative sample of women aged 15-49 years. Descriptive statistics and multivariable binary logistic regression analyses were performed to investigate the connections between various sociodemographic factors and HIV awareness and knowledge among the women. Results: The investigation uncovered that the level of HIV awareness and knowledge among women in Somaliland was inadequate, with only a small percentage possessing accurate information about HIV transmission and prevention. The multivariate logistic regression analysis showed that the education level (AOR = 1.58, 95% CI: 1.23-2.03), age (AOR = 0.82, 95% CI: 0.71-0.94), marital status (AOR = 1.32, 95% CI: 1.09-1.61), and media exposure (AOR = 1.49, 95% CI: 1.19-1.87) were significantly linked to higher levels of HIV awareness and knowledge among women. Conclusions: The research findings highlight the need for tailored interventions aimed at increasing HIV awareness and knowledge among women in Somaliland. To achieve this, it is essential to improve educational opportunities, conduct media campaigns, and eliminate cultural and socioeconomic obstacles that hinder the dissemination of precise information about HIV/AIDS. Collaboration between healthcare professionals, community leaders, and policymakers is vital for the development and implementation of successful interventions aimed at improving HIV awareness and knowledge among women in Somaliland.

Introduction: In recent decades, AIDS-related illnesses have declined due to the widespread use of highly active antiretroviral therapy (HAART). Despite the numerous benefits that HAART provides, it causes significant challenges for users in the form of adverse drug reactions (ADRs). Therefore, this systematic review and meta-analysis was conducted to explore the pooled incidence of antiretroviral therapy-related adverse drugs in Ethiopia. Methods: A systematic review and meta-analysis was conducted on cohort studies conducted among HIV patients living in Ethiopia. The study was reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A random-effects meta-analysis was used to determine the pooled incidence of ADR. Heterogeneity was assessed, and the source of variation was analyzed using subgroup and sensitivity analyses. Funnel plots and Egger's regression tests were used to investigate publication bias. Results: Based on the random effects model from 10 extracted studies, the pooled incidence rate of adverse effects of ART drugs was 5.09 (95% CI: 3.86-6.71) per 100 person-years, with significant heterogeneity (I ² = 96.4%, p < 0.0001). It was also observed to be higher in subgroups from multicenter study areas, studies employing both prospective and retrospective designs, and among children. Discussion: The findings of this systematic review and meta-analysis revealed disparities in ADR incidence rates. In addition, the findings of this review showed that the occurrence of ART-related ADR in people living with HIV is common in the healthcare system. Conclusion: This systematic review and meta-analysis highlighted the significant incidence of adverse effects among individuals diagnosed with HIV in ART clinics in Ethiopia. A comprehensive strategy and coordinated collaboration among health planners, policymakers, and the community are essential to address this issue and integrate pharmacovigilance into service provision.

Objective: There is evidence of geographical variation in HIV coverage and antiretroviral therapy (ART) adherence, and studies have investigated how the place of residence of people living with HIV (PLWH) influences ART adherence. Where people reside influences their access to health care. Studies on the influence of place of residence on ART adherence among PLWH in Nigeria have been reported in the literature. However, no review has synthesized these findings. Against this backdrop, this review seeks to determine whether adherence to ART differs by place of residence in Nigeria. Methods: In May 2024, we searched four databases (CINAHL Plus, PubMed, Scopus, and Web of Science). Only empirical studies with a test of association between place of residence (i.e., urban and rural) and adherence to ART were included. We performed a fixed-effect meta-analysis with the meta package on R Studio Version 4.2.0. Results: We included six of the 91 articles across the four databases. Most studies (n = 5) were conducted in the Southern region. The assessment of place of residence and adherence varies across the studies. We found that PLWH who reside in urban areas were 20% more likely to adhere to ART compared to those who live in rural areas (odds ratio: 1.20; 95% confidence interval: 1.01-1.43). Similarly, PLWH in the South-South region of Nigeria and reside in the urban areas were 1.27 (95% CI: 1.01-1.58) more likely to adhere to ART than those living in the rural areas. This observation was insignificantly true for the South-East region. Conclusion: PLWH who reside in urban areas may better adhere to ART than their counterparts living in rural areas. Non-governmental organizations and government agencies working with PLWH should prioritize those living in rural areas because they are more likely to face greater barriers to adherence.

Background: Globally, an estimated 1.7 million people were newly infected with human immunodeficiency virus (HIV), and approximately 37.9 million people were living with the virus. The prevalence of HIV remains high in sub-Saharan African countries, including Ethiopia. Consequently, enhancing the awareness of HIV risk is crucial for prevention efforts, as studies have shown that increased risk perception is strongly linked to condom utilization among youths. Objective: This study aimed to assess HIV risk perception and condom utilization among youths and associated factors in Gashena town, Northeast Ethiopia. Method: Community-based cross-sectional study involving 422 youths (15-24 years old) was conducted from June 01 to 30, 2022. Participants were selected using a systematic random sampling technique, and data analysis was conducted using Statistical Package for the Social Sciences (SPSS) Version 25 software. Logistic regression analysis was employed to determine the odds ratios for variable associations, with statistical significance set at p < 0.05. Result: The present study revealed that 50% (95% CI: 42.7-57.3) of youths utilized condoms, while 19.4% (95% CI: 15.8-23.5) had a perception of being at risk for HIV. Factors significantly associated with both condom utilization and HIV risk perception included being 18 years old or older (AOR: 95% CI: 0.2 [0.10-0.40]), having completed primary education or higher (AOR: 95% CI: 6.23 [3.44-11.29]), and being employed (AOR: 95% CI: 1.96 [1.09-3.53]). Conclusion: This study found a low prevalence of condom utilization and HIV risk perception among youths. Being 18 years old or older, having completed primary education or higher, and being employed were factors significantly linked to both condom use and HIV risk perception. Therefore, raising awareness about the implications of unprotected sexual intercourse and HIV risk perception among youths of varying ages, educational status, and occupational statuses could potentially enhance condom utilization among this demographic group.

The effects of ignoring survey designs during the analysis of complex survey data may lead to biased estimates. This has been a common practice for most researchers. It is more critical for public health data which involve the clinical decisions that decide the fate of people's lives. This analysis compares the estimates of factors of viral load suppression (VLS) with and without including survey designs using the Tanzania HIV Impact Survey (THIS). This survey reveals factors associated with VLS among Tanzanians living with HIV/AIDS. The correlates of VLS were examined using multivariable logistic regression models in both cases with and without including survey design. The study unveils significant correlates such as age, middle wealth quintile, CD4, adherence, and antiretroviral (ARV) detection status of a patient. Furthermore, the study emphasizes the essence of properly accounting for CSD. Failure to do so may result in biased parameter estimates and incorrect variances; hence, incorrect inferences. Thus, the study's findings on VLS determinants have significant practical implications that allow government agencies and stakeholders to establish targeted and successful HIV/AIDS prevention and treatment initiatives. Consequently, this study suggests a complex design as an approach for obtaining unbiased estimates on the national representative surveys.

Background: Longitudinal measures of viral load (VL) are critical in monitoring the HIV status. While multiple lab indicators exist for monitoring measures of VL, research on clustering historical/longitudinal VL measures is limited. Analyzing longitudinal VL patterns rather than aggregated measures offers deeper insights into HIV status. This study uses functional data clustering to classify longitudinal VL patterns and characterize each cluster by demographics, comorbidities, social behaviors, and CD4 count. Methods: Adult PWH diagnosed from 2005 to 2015 in South Carolina with a 5-year minimum follow-up were included. We compared functional principal component analysis (FPCA), K-means, hierarchical clustering, and Gaussian mixture models for classification and found FPCA yielded the best results. ANOVA was used to compare VL characteristics, demographics, comorbidities, substance uses, and longitudinal CD4 count across clusters. Results: Results obtained from FPCA could best distinguish the characteristics and patterns into four clusters. A total of 5916 PWH were grouped into long-term VS group (Cluster 1, 17.3%), short-term VS group (Cluster 2, 29.8%), suboptimal VS group (Cluster 3, 28.3%), and viral failure group (Cluster 4, 24.9%). In the long-term VS group with an average of 11-year follow-up, PWH displayed sustained VS (95.3%) and lower mean CD4 count (95.3%) than other clusters. The short-term VS group had shorter follow-up (6 years), more comorbidities (31.4%), and lower percentage of time with low CD4 count (79.9%). In suboptimal VS group, PWH were mostly under 30 years old (44.8%) and Black (77.2%), with relatively lower mean VL (92.9%) and lower VR history (18.4%). In the viral failure group, PWH had higher mean VL (40.6%) and lower mean CD4 count (34.7%). Discussion: The findings highlight the impact of continuous clustering in understanding the distinct viral profiles of PWH and emphasize the importance of tailored treatment and insights to target interventions for all PWH.

This study explored relationships between neurocognitive impairment (NCI), engagement in HIV care, and functional disability among sexual minority men aged 50 years or older living with HIV, chronic pain, and recent substance use. Sixty-three participants completed cross-sectional assessments including a neurocognitive screening measure, self-reported HIV medication adherence, past-year attendance at HIV-care appointments, and indices of pain and functional impairment. Mean participant age was 57.2 years; most identified as White (55%), followed by Black/African American (42%). On average, participants reported moderate pain; 66.7% met DSM-5 criteria for a substance use disorder. Average Montreal Cognitive Assessment (MoCA) performance reflected mild NCI. Regression analyses indicated an association between poorer MoCA performance and past-year missed HIV-care appointments (B = -0.09, t (59) = -3.10, p = 0.004). Self-reported cognitive impairment was associated with more missed HIV-care visits (B = 0.20, t (59) = 4.82, p < 0.001) and greater functional disability, whereas poorer semantic fluency was associated with fewer missed HIV-care visits (B = -0.49, t (59) = -3.99, p < 0.001). Increased brief neuropsychological assessment and linkage to tailored interventions for HIV-care engagement and substance use mitigation are warranted to support PLWH with NCI in clinical care.

Background: Atherogenic index of plasma (AIP) and high-sensitivity C-reactive protein (hsCRP) levels which are strong predictors of the risk of cardiovascular disease (CVD) seen elevated in the serum of people living with HIV (PLWH) on HAART and in those with low cluster of differentiation-4 (CD4) cell counts. Thus, this study aimed to evaluate AIP and hsCRP levels among PLWH on dolutegravir (DTG) and ritonavir-boosted atazanavir-based (ATV/r) antiretroviral therapy (ART) and their correlations to CD4 cell counts. Methods: The study design was an institutional-based comparative cross-sectional study conducted from November 4, 2021, to January 4, 2022. The total sample size was 172 with equal number of DTG and ritonavir-boosted atazanavir-treated PLWH. Participants were recruited by a consecutive sampling method. The data were entered into EpiData Version 4.6, then exported to SPSS Version 25.0, and analyzed using Chi-square, Student's t-test, and Pearson correlation. Statistical significance was set at p < 0.05. Results: AIP was significantly higher among individuals on ATV/r, with levels in the range of 0.1-0.24 at 44.2% and > 0.24 at 31.4%, compared with those on DTG-based regimens of ART, which showed levels of 39.5% and 9.3%, respectively. Similarly, the higher hsCRP level of ≥ 2 mg/L was observed among patients on ATV/r (44.2%) than in DTG-based (24.4%) regimens of ART. AIP and hsCRP were negatively correlated with CD4 cell counts with Pearson correlation coefficients of -0.46 and -0.38, respectively. Conclusion: From the study conducted, it can be concluded that the higher levels of AIP and hsCRP were seen in patients treated by ATV/r than in DTG-based regimens of ART and in PLWH with low CD4 cell counts. Therefore, routine monitoring of both AIP and hsCRP levels was a good marker of HIV disease progression and cardiovascular disease risk assessment in PLWH, particularly in developing countries where CD4 cell count testing is expensive and not easily available.

Background: Depression in women living with HIV (WLWHIV), is one of the most common public health concerns worldwide. Depression has a negative impact on antiretroviral therapy (ART) adherence, quality of life, poor HIV treatment outcomes, and mortality. However, there is a paucity of evidence in low-income countries such as Ethiopia in WLWHIV. Objective: The aim of this study is to assess the magnitude of depression and related factors, and how social support mediates HIV-related stigma and depression in WLWHIV. Method: A cross-sectional study was conducted among 1043 patients in a health institution, employing a systematic random sampling technique to select the study participants. The structured Patient Health Questionnaire (PHQ-9), Oslo Social Support Scale, Perceived HIV-related stigma scale, Household Food Insecurity Access Scale (HFIAS), and Violence Against Women Scale were used to measure depression, social support, stigma, food insecurity, and intimate partner violence, respectively. Descriptive statistics were computed, and multivariate logistic regression and mediation analyses were conducted to identify factors associated with depression and how they mediate it. Results: The prevalence of depression among WLWHIV was 41.7% (95% CI: 38.7% and 44.5%). Being single (AOR = 1.80, 95% CI: 1.09-2.99), divorced (AOR = 1.56, 95% CI: 1.11-2.19), widowed (AOR = 1.93, 95% CI: 1.31-2.84), experiencing medical illness comorbidity (AOR = 2.74, 95% CI: 1.75-4.30), having a high viral load (AOR = 1.86, 95% CI: 1.00-3.45), receiving social support (AOR = 0.90, 95% CI: 0.84-0.96), experiencing perceived HIV-related stigma (AOR = 1.04, 95% CI: 1.02-1.06), experiencing food insecurity (AOR = 1.07, 95% CI: 1.03-1.11), and experiencing psychological violence (AOR = 2.05, 95% CI: 1.30-3.23) were significantly associated with depression. Social support partially mediated the relationship between perceived HIV-related stigma and depression. Conclusion: More than two of five WLWHIV developed depression. Depression is indirectly affected by perceived HIV-related stigma through social support. Social support enhances mental health well-being.