AIDS Research and Treatment最新文献

Background: HIV-related discrimination remains a significant barrier to the uptake of HIV prevention and treatment services in sub-Saharan Africa among key populations (KPs). However, despite the substantial risk of HIV among peers within their social networks, there is a paucity of data on their attitudes towards people living with HIV (PLHIV). This study aimed to examine discriminatory attitudes towards PLHIV among KPs in Nigeria. Methods: This study was a secondary data analysis of the 2020 Integrated Biological and Behavioral Surveillance Survey in Nigeria, which included 17,975 KPs. We operationalized discriminatory attitudes as negative responses to questions on caring for PLHIV, buying food from PLHIV, working with PLHIV, sharing a meal with PLHIV, and a positive response to quarantining PLHIV. We conducted weighted descriptive statistics to summarize the data, and latent class analysis was used to determine the patterns of discriminatory attitudes. The predicted probabilities of the classes for each KP characteristic were estimated while holding all other characteristics in the model at their means. The data analysis was conducted using Stata 18. Results: About 13.5% of participants indicated they would not provide care for PLHIV , 29.7% would not buy food from them, 15.8% would not work with them, 27.9% would not share a meal with them,and 16.3% believed that PLHIV should be quarantined. Three latent classes of discriminatory attitudes were identified: low discriminatory attitude (65%), moderate discriminatory attitude (23%), and high discriminatory attitude (11%). The highest predicted probability of high discriminatory attitude was observed among KPs with unknown HIV status (42%), followed by those residing in the Southeast region (39.7%). Conclusion: Discriminatory attitudes towards PLHIV are common among KPs in Nigeria. Interventions aimed at reducing HIV-related discrimination should also target KPs.

Objective: Establish the effect that migration has on the epidemiology and clinical profile of human immunodeficiency virus (HIV) infection in a specialized HIV clinic of a hospital in Quito, Ecuador. Patients and Methods: A cross-sectional descriptive observational study was carried out, through a survey of 293 people living with HIV (PLWHA) between 2017 and 2019, which included sociodemographic and clinical variables that were taken from the medical records of each participant. Results: 90.4% of PLWHA were men. 74.4% reported a monthly economic income lower than the basic wave (46.8% were unemployed). 51.9% of PLWHA were from Ecuador and 39.9% of Venezuelan nationality. 39.5% of the PLWHA had a late-advanced diagnosis of the disease. And 78.2% of PLWHA had a current viral load (VL) less than 50 copies/mm³. When comparing national and foreign patients, variables with statistically significant differences were found between both groups, and no differences were found in other variables. Conclusions: In certain aspects, there are no statistical differences between Ecuadorians and Venezuelans such as sex, bisexual sexual preference, marital status, and changes in antiretroviral scheme, among others. It was found that there were higher levels of education, employment rates, and male-female ratio in the foreign population compared to the national population, where probably social dynamics are playing a key factor.

Introduction: Systematic screening for depression among adolescents and young adults living with HIV (AYALHIV) is limited or nonexistent in some settings in sub-Saharan Africa due to the lack of integration of mental healthcare into HIV program. This can increase the risk of suicidal thoughts and cause emotional distress, which can have an adverse effect on their treatment outcomes. Establishing evidence of the burden of depression among AYALHIV is key for advocacy for systematic screening. This study examined the burden of depressive symptoms and associated factors among AYALHIV in Ghana. Methods: A single-center facility-based cross-sectional study was conducted among AYALHIV at the Infectious Disease Center of the Korle Bu Teaching Hospital, Accra, Ghana, from May 2023 to March 2024. Depressive symptoms were assessed through the administration of the Patient Health Questionnaire for Adolescents (PHQ-A). The prevalence of depressive symptoms (PHQ-A score ≥ 5) and associated factors was examined using logistic regression. Results: A total of 280 AYALHIV were recruited with 50.7% being female. Sixty percent were young adults, and the rest were adolescents. About 75% were virally suppressed. The prevalence of depressive symptoms was 40.7% (95% CI: 34.9%-46.7%). Being an orphan (adjusted odds ratio [aOR] = 2.6, 95% confidence interval [95% CI]: 1.2-5.6), female (aOR = 1.8, 95% CI 1.1-3.0), and having high perceived stigma (aOR = 2.2, 95% CI: 1.3-3.7) were associated with having depressive symptoms. Viral nonsuppression was associated with depressive symptoms but likely through its association with HIV stigma. Conclusion: Depressive symptom burden was high among AYALHIV despite viral suppression in the majority of them. There is a need for the design of mental health screening integration into youth-centered HIV programs based on context for early identification, counseling, and treatment of mental health challenges to ensure good quality of life and avert other mental health challenges.

While racial disparities in HIV antiretroviral treatment (ART) adherence and viral suppression among sexual minority men (SMM) with HIV persist, resilience may serve as an important protective factor. There is, however, a dearth of research exploring the longitudinal associations between resilience and ART adherence among this group. As such, the current study examined prospective associations, including the between- and within-person effects, between resilience and ART adherence among racially diverse SMM with HIV. Data were drawn from Thrive With Me (TWM), a randomized controlled trial of an mHealth intervention targeting ART adherence among SMM. Generalized estimating equations (GEEs) models examined longitudinal associations, including between- and within-person effects, between resilience scores and self-reported 30-day ART adherence, dichotomized as optimal (≥ 90% of doses) versus suboptimal (< 90% of doses) across the 17-month study timeframe, while controlling for covariates. Among 401 SMM with HIV that completed the TWM baseline assessment (M _age = 39.1 years, Standard Deviation = 10.8), 59.9% self-identified as Black/African American. In GEE models, resilience scores were prospectively associated with optimal 30-day ART adherence (b = 0.06, β = 0.38, p < 0.001), at the between-person level, above the effects of covariates. In moderation analyses, resilience scores were associated with optimal ART adherence among Black/African American SMM but not among those identifying as White or another race. These results suggest bolstering resilience may be an important strategy for future interventions aiming to improve ART adherence over time for racially and ethnically diverse SMM with HIV.

Background: Dyslipidemia is a prevalent public health concern among individuals living with HIV who are undergoing antiretroviral therapy (ART), and it increases the risk of cardiovascular diseases. Despite the introduction of improved medications like dolutegravir, there are limited data regarding the extent of dyslipidemia in this population. Therefore, the purpose of this study was to determine the prevalence of dyslipidemia and its associated factors among people living with HIV on dolutegravir-based ART. Methods: An institutional-based cross-sectional study was carried out from December 1, 2021, to February 30, 2022. Sociodemographic, behavioral, clinical, anthropometric, and laboratory data were collected from 423 participants. Simple random sampling methods were used to recruit the participants. The collected data were entered in Epi-data Version 4.6 and analyzed via SPSS Version 26. Multivariable logistic regression was used to determine factors associated with dyslipidemia. A p value of < 0.05 was considered statistically significant. Results: The prevalence of dyslipidemia was found to be 73.8%. Low HDL-C was the most common (61.2%), followed by elevated levels of TG (40.2%), high LDL-C (26%), and high TC (24.3%). Being female (AOR = 1.77, 95% CI: 1.04-3.02, p=0.034), insufficient physical activity (AOR = 1.64, 95% CI: 1-2.67, p=0.048), being overweight (AOR = 2.25, 95% CI: 1.07-4.75, p=0.033), and being obese (AOR = 2.32, 95% CI: 0.86-6.25, p=0.045) were significantly associated with dyslipidemia. Conclusion: The prevalence of dyslipidemia among people living with HIV on a dolutegravir-based ART was high, occurring in nearly three-quarters of the participants. Being female, insufficient physical activity, and being overweight or obese were significantly associated with dyslipidemia among people living with HIV taking dolutegravir-based ART. Therefore, to avoid the disastrous effects of dyslipidemia, serum lipid profiles should be considered and evaluated in people living with HIV on a dolutegravir-based ART.

Introduction: Influence of dietary diversity is particularly concerning for individuals with human immunodeficiency virus (HIV), as they are more vulnerable to opportunistic infections. However, information on influence of dietary diversity in this study area remains scarce. Thus, this study aims to assess the influence of dietary diversity and its associated factors among HIV-infected adults receiving antiretroviral therapy (ART) in Ethiopia. Methods: An institution-based cross-sectional study was conducted among 412 participants between February and March 2023. Data were collected using an interviewer-administered structured questionnaire and a standardized checklist for ART. Data entry was performed using EpiData Version 3.1, and analysis was conducted using STATA Version 25. Multivariable logistic regression was used to identify factors associated with dietary diversity, with adjusted odds ratios (AORs) reported at a 95% confidence interval (CI) and a significance level of p < 0.05. Results: The proportion of patients with adequate dietary diversity was 218 (52.9%; 95% CI: 48.1-58). Factors significantly associated with dietary diversity included educational status (AOR: 0.414, 95% CI: 0.174-0.985), family size of 4-6 (AOR: 1.87, 95% CI: 1.18-2.95), and WHO clinical stage III or IV (AOR: 1.19, 95% CI: 1.09-2.34). Conclusions: The study found that nearly half of HIV-infected adult patients had an undiversified diet. Occupation being housewives and drivers, educational status of unable to write and read, WHO advanced HIV stage III and IV, and family size of 4-6 were statically significant factors associated with undiversified diet. We strongly recommend that policymakers, researchers, and nongovernmental organizations collaborate to implement holistic nutritional interventions to address dietary challenges and improve the overall health of people living with HIV/AIDS.

Since its identification in 1981, HIV has posed a global public health challenge, witnessing transformative advancements in treatment and prevention. This review summarizes recent novel therapeutic and preventive approaches for long-term HIV control, management, and elimination, and how global collaboration and technological innovations may advance HIV control efforts. This study highlights the progress and challenges in HIV treatment, emphasizing the effectiveness of current antiretroviral therapy (ART) in suppressing viral replication, reducing transmission, and preventing end-organ damage. However, adherence remains a significant barrier due to pill burden, side effects, and psychosocial factors affecting patients. ART-related toxicities include neuropathy, hepatotoxicity, metabolic disorders, and neuropsychiatric effects. Long-acting ART (LA-ART) offers a promising alternative to daily dosing; however, challenges such as injection site reactions persist. Broadly neutralizing antibodies (bNAbs) have shown enhanced efficacy in viral suppression and immune response activation, offering potential for treatment and vaccine design. Innovative gene-editing tools, such as CRISPR-Cas systems, are being explored for their ability to excise or silence proviral DNA; however, their clinical application is limited by off-target effects and delivery challenges. Latency-targeting strategies like "shock and kill" and "block and lock" remain experimental with limited clinical success, and nanotechnology-based drug delivery systems offer targeted, sustained, and less toxic treatment options. Despite the challenges posed by the virus's rapid mutation rate and immune evasion mechanisms, novel vaccine approaches, such as mRNA technology, vector-based platforms, and epitope-targeting strategies, are being explored. In addition, artificial intelligence and machine learning are enhancing the design of vaccines, predictive modeling, and fast-tracking progress in this area. Socio-economic bottlenecks in HIV control, such as stigma, gender disparities, and inequitable healthcare access, exacerbate the epidemic, particularly in sub-Saharan Africa. Enhancing global collaboration, providing sustainable funding, and integrating emerging and innovative technologies are critical for advancing HIV prevention and management. Achieving an AIDS-free generation and ultimately eliminating the epidemic will depend on effectively addressing the social, structural, and scientific barriers that hinder progress in this regard. Trial Registration: ClinicalTrials.gov identifier: NCT02120352, NCT02938520, NCT03639311, NCT03497676, NCT03635788.

Introduction: Early human immunodeficiency virus (HIV) testing of partners or families of the index case is an innovative type of testing which is performed within 14 days after contact elicitation using a contractual referral approach. Testing within this time is very important because it helps to identify contacts early and enroll them for intervention timely. In most health facilities, the contractual approach was not practiced; by implementing this early index case testing, most contacts could be tested early and it could prevent them from HIV-related death. Objective: This study aimed to assess the magnitude and associated factors of early index case testing among adult HIV index cases in Debre Markos town high case load health facilities. Methods: Institution-based cross-sectional study was conducted on adult index cases who started antiretroviral therapy from December 1/2018 to August 30/2022. A total of 384 index case charts were selected by the systematic random sampling technique using their medical record number from January 23/2023 up to February 28/2023. After the data were collected using a structured checklist, they were entered into EpiData Version 4.6 and then exported to SPSS software Version 25 for data cleaning, coding, categorizing, and further analysis. The Hosmer-Lemeshow test goodness of fit was checked for model fitness. Both bivariable and multivariable logistic regression analyses were used to identify significant factors with early testing of index cases' families. Finally, variables having pvalue < 0.05 with 95% CI in the multivariable logistic regression are considered as significant factors. Result: In this study, the magnitude of early index case testing among adult index patients was 28.6% (95% CI: 27.17%-30.0%). Being female (AOR = 1.89, 95% CI (1.17-3.06)), urban resident index cases (AOR = 1.88, 95% CI (1.16-3.03)), and having disclosure status (AOR = 2.34, 95% CI (1.40-3.92)) were significantly associated with early index case testing. Conclusion: This study examines the prevalence and key factors influencing early index case HIV testing among adult patients in Debre Markos town. By identifying critical determinants such as gender, residence, and disclosure status, it provides valuable insights into how early testing can be enhanced to reduce transmission and improve health outcomes.

Background: The human immunodeficiency virus (HIV) is the virus that attacks the body's functional immune system, targets the CD4 T-cells, progressing to acquired immunodeficiency syndrome (AIDS), and leading to death when improperly treated. Since, presently, HIV/AIDS has no known cure, adherence to antiretroviral therapy (ART) is crucial to minimize viral replication and improve disease outcomes. However, many factors affect medication adherence among patients, sometimes leading to treatment failure and often resulting in complications that could lead to death. This study assessed medication adherence and factors affecting medication adherence to ART in HIV/AIDS patients in Belize. Methods: The research design was a cross-sectional study conducted in Belize at public hospitals and clinics across the country at locations where ART medicines are provided to patients. The participants were purposively selected from the nine testing and ART provision sites, being 18 years and older, and actively receiving ART. The visual analog scale (VAS) survey tool was utilized to obtain data on factors influencing treatment adherence. One hundred forty-seven participants, 18 years and older, receiving ART responded to the survey. The collected data were analyzed using SPSS. Results: The study results indicated that 72.8% of the participants reported optimal adherence to the VAS assessment and 85.7% to the subjective assessment, thus reporting optimal or excellent adherence between 90% and 100%. Fear of disclosing HIV status due to discrimination and stigma was the main reason reported by participants, indicating the existence of stigma toward PLWHA among the Belizean population. Conclusion: The majority of the participants in this study reported optimal adherence to ART in Belize. The provision of more support, guidance, and counseling to patients living with HIV/AIDS is recommended. Public awareness to discourage and minimize discrimination and stigma toward HIV/AIDS patients was also recommended.

Introduction: Young people (aged 15-24) living with HIV/AIDS (YPLHIV) in sub-Saharan Africa (SSA) experience higher rates of mental health conditions compared to their uninfected peers. Research and practitioners have expressed interest in designing and implementing mental health interventions to improve the mental health and well-being of this vulnerable population. However, there is limited effort to systematically synthesize existing evidence on mental health interventions for YPLHIV to address salient questions relating to effectiveness, characteristics, practice issues among others to inform practice, and future research endeavors. This systematic review was conducted to take stock and synthesize existing data to address the above issues. Methods: This review was conducted per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search strategy was implemented, utilizing five electronic databases and gray literature repositories. Studies (1) from SSA that focused on young adults with HIV/AIDS and (2) examined the effectiveness of interventions designed to enhance mental health outcomes and treatment adherence were included. Two independent reviewers were involved in the study selection, data extraction, and quality assessment, resolving discrepancies by consensus or consultation. Data were presented using narrative syntheses. Results: Eight studies met the inclusion criteria, with a total sample size of 1510 participants, reporting on interventions from six African countries. The interventions were categorized as follows: cognitive behavioral therapy-based, family-based, peer support, and community-based. The interventions showed mixed effectiveness for depression, with three studies demonstrating significant improvements while four showed no substantial change. The only study on improving anxiety reported promising results. Four interventions positively influenced ART adherence, although with varying magnitudes. Peer support, family-based approach, and digital (mobile phone) approaches were identified as effective strategies. Conclusions: The review showed promising approaches to improve mental health in YPLHIV, namely, through peer support, family-based, and digital (i.e., mobile phone) approaches. Although the results were mixed for depression and limited but positive for anxiety, several interventions improved ART adherence. However, the modest evidence base and varied measurement approaches necessitate more research across SSA.