AIDS Research and Treatment最新文献

Background: Overweight and obesity have arisen as major public health challenges, affecting not just the general population but also people living with human immunodeficiency virus (HIV) (PLWH). Obesity and being overweight are both risk factors for heart disease and other related complications. However, little is known in our setting. As a result, this study was conducted to evaluate the prevalence of overweight and obesity and its associated factors among PLWH on dolutegravir (DTG)- and efavirenz (EFV)-based therapies. Methods: An institution-based comparative cross-sectional study was carried out from June 30, 2021, to August 30, 2021. We purposively recruited 128 participants who have been on DTG (n = 64)- and EFV (n = 64)-based regimens for ≥ 6 months. Demographic, anthropometric, laboratory, and clinical data were collected using a structured questionnaire. The data were entered into EpiData Version 4.6 and analyzed using SPSS Version 26.0. Multivariable logistic regression was utilized to identify the factors that are associated with being overweight or obese, and the significance level was set at p < 0.05. Result: The prevalence of overweight and obesity was 28.1% in the DTG-prescribed participants and 15.6% in the EFV-prescribed participants. Age ≥ 40 years (adjusted odd ratio (AOR) = 3.86; 95% confidence interval (CI): 1.08-13.73; and p=0.037), cluster of differentiation 4 (CD4) T-cell counts ≥ 500 cells/mm³ (AOR = 2.95; 95% CI: 1.01-8.59; and p=0.029), and insufficient physical activity (AOR = 4.6; 95% CI: 1.53-13.84; and p=0.007) were predictors of overweight and obesity. Conclusion: Overweight and obesity are not uncommon among PLWH on ART. While the difference was statistically insignificant, the prevalence of overweight and obesity was higher in patients treated with DTG compared with those treated with EFV. Older age, higher CD4 cell counts, and insufficient physical activity were associated with overweight and obesity. As a result, healthcare providers must understand the health implications of obesity and consider incorporating targeted weight control programs into standard HIV treatment.

Despite access to antiretroviral therapy (ART), South Africa has a high human immunodeficiency virus (HIV) burden. Treatment outcomes among individuals on highly active ART (HAART) in KwaZulu-Natal, with a higher incidence of HIV, are not fully known. This study evaluated the impact of HAART outcomes and identified and analyzed the factors associated with the outcomes in people living with HIV and AIDS (PLWHA) in the high-incidence region of KwaZulu-Natal Province, South Africa. This retrospective medical record review was conducted at King Edward VIII Hospital in South Africa. Data analysis was performed using STATA software Version 18.0 and Microsoft Excel 2021. The estimates used were 95% confidence intervals, and a p value < 0.05 was considered statistically significant. A total of 707 clinical records of PLWHA were examined and analyzed; less than half of them (44.98%, n = 318) achieved the benchmark of two consecutive instances of suppressed viral loads. The CD4 greater than or equal to 500 cells/mm³ at baseline average of 22.91% (n = 162) registered an increase to 48.94% (n = 346) in the 6^th month and further escalated to 79.49% (n = 562) by the 12^th month following ART initiation. A total of 160 deaths (mortality rate of 22.63%) were recorded within the study period. The percentage of HIV-infected patients attaining viral suppression at 6 and 12 months after initiating the treatment was respectively 44.98% and 67.04%, below the 90% target established by the Joint United Nations Program on HIV/AIDS (UNAIDS). The proportion of favorable immunological responses for individuals on ART increased over time.

Background: Following the 2018 World Health Organization's (WHO) guidelines on HIV treatment and management, the Zimbabwean government has embraced dolutegravir (DTG)-based regimens as the preferred first-line treatment for people living with HIV (PLWH). Despite this implementation, there remains a paucity of knowledge on the potential associations between DTG-based regimens, body weight and blood lipid levels among PLWH in Zimbabwe. Thus, the aim of this study was to investigate variances in body weight and blood lipid levels at two distinct timepoints-baseline and 6-month post-DTG initiation. Methods: We conducted this study between November 2021 and April 2023 among ART-naïve individuals initiating a DTG-based regimen. Participants were recruited from a tertiary clinic in Zimbabwe. Body weight, standing height and blood lipid levels were measured at baseline and 6-month post-DTG. Changes in weight, body mass index (BMI) and lipids levels were assessed using the paired Student's t-test and Wilcoxon signed rank test. Multivariable logistic and linear regression analysis was used to assess risk factors associated with changes in weight, BMI and lipid levels. Results: A cohort comprising 130 study participants, characterised by a mean (±SD) age of 40.0 (±11.0) years at baseline, was subjected to a 6-month regimen of DTG-based therapy. The outcomes revealed statistically significant alterations in various physiological parameters. Specifically, post the DTG-based intervention, there were substantial increases observed in body weight (p < 0.001), BMI (p=0.003), total cholesterol (TC) levels (p=0.002) and high-density lipoprotein cholesterol (HDL-C) levels (p < 0.001) in comparison to their baseline values. Intriguingly, the corresponding triglyceride (TG) levels exhibited a noteworthy decrease (p < 0.001). Notably, individuals aged 40 years or older exhibited a positive association (p=0.022) with increased TC levels and concurrent weight gain. Furthermore, current employment emerged as another factor positively linked to increased TC levels and weight gain. Conclusions: Upon the initiation of DTG, discernible elevations were observed in body weight, BMI and lipid levels. This study represents the first comprehensive assessment of lipid profiles and weight gain among this population in Zimbabwe, filling a critical gap in the existing literature. These findings, while indicative of short-term effects, underscore the imperative for further investigative efforts aimed at elucidating the prolonged consequences associated with DTG-induced weight gain and increased lipid levels and its underlying mechanisms.

Objectives: The primary objective of this study was to characterize women living with HIV (WLWH) in Belgium. The secondary objective was an exploratory analysis comparing women and men living with HIV (MLWH).

Methods: This was a cross-sectional, observational, multicenter study. Inclusion criteria for the primary objective were all adult treatment-naïve and experienced WLWH actively being treated at one of the participating centers. For the secondary objective, inclusion criteria were all adult naïve and experienced women and MLWH, actively being treated at a single participating center. Data were collected between December 2022 and March 2023. A multivariable analysis was performed on all women included to evaluate for associations with having hypertension (HTN) or being virologically nonsuppressed (HIV-1 VL ≥200 copies/mL). In the exploratory analysis of women and MLWH, a multivariable analysis was carried out to evaluate whether female gender was associated with having HTN or being virologically nonsuppressed.

Results: Overall, 2797 WLWH were included. The majority were Black (73.5%) and 48.5% were aged ≥50 years. The most common comorbidity was HTN (17.3%) and most individuals were virologically suppressed (HIV-1 VL <50 copies/mL; 85.6%). Black race was associated with having HTN (p < 0.0001). Prior AIDS-defining illness (p = 0.02) and a CD4⁺ T-cell count <500 cells/µL (p < 0.0001) were associated with being nonsuppressed. A total of 1094 WLWH and 1878 MLWH were included in the exploratory analysis. HTN was higher among WLWH (20.2% vs. 12% MLWH). Female gender was not found to be associated with having HTN (p = 0.86) or being nonsuppressed (p = 0.14).

Conclusion: In this analysis of WLWH in Belgium, the results depict an ageing population that is predominantly Black. The most common comorbidity observed was HTN. Women had a low rate of virologic nonsuppression, and female gender was not associated with being nonsuppressed.

Objectives: We aimed to study self-rated health and psycho-neuroimmunological responses during the initial 6 months after testing positive for human immunodeficiency virus (HIV) and its relationship to health literacy, that is, the ability to take in and understand information about one's illness. Health literacy plays a critical role in patients' ability to adhere to antiretroviral treatment (ART). However, there is a lack of studies on the possible impact of HIV-induced proinflammatory processes on health literacy.

Methods: Twelve patients with newly diagnosed HIV attending an urban Ryan White-funded HIV clinic responded to a questionnaire and had blood samples drawn at baseline (first visit) and after 1, 3, and 6 months, respectively. The questionnaire measured stress, depression, and health literacy. Blood was analyzed for HIV RNA plasma viral load, CD4 cell count, pro- and antistress, and inflammatory markers.

Results: Complete data for the entire 4 collection periods were available for nine patients. Over the 6-month period, mean viral load decreased from 353,714.83 (standard deviation 870,334.61) to 35.89 (14.04) copies/mL (p < 0.001). CD4 cell count increased from 321.08 (167.96) to 592.44 (300.06) cells/mm³ (p < 0.001). Self-rated stress decreased from a baseline mean of 7.33 (2.29) to 3.56 (3.21), on a 0-10 visual analogue scale, at the 6-month follow-up (p < 0.01). C-reactive protein (CRP) decreased from 5757.05 (3146.86) to 2360.84 (2277.33) ng/mL (p < 0.05). Mean health literacy score at baseline was 17.67 (3.50; scale range 0-20) and did not change during the follow-up period. However, increased stress and decreased CRP (p = 0.05) during the 6-month follow-up predicted higher health literacy scores at 6 months.

Conclusion: Both stress and proinflammatory processes in newly diagnosed HIV-infected patients might adversely impact patients' health literacy and thus their capacity to align with treatment guidance.

Introduction: Though people living with HIV/AIDS require a good combination of antiretroviral therapy and healthy dietary habits for a quality life and positive medical outcomes, little is, however, known regarding the dietary practices of HIV-positive patients who receive antiretroviral therapy (ART) in the Lawra Municipality.

Objective: This study assessed the magnitude and factors associated with dietary diversity among HIV-positive patients on antiretroviral therapy (ART).

Methods: This study was a facility-based cross-sectional study of 269 study participants recruited using a systematic random sampling technique. Bivariate and multivariable logistic regression analyses were performed to identify factors associated with their dietary diversity.

Results: This study shows that only 36 (13.4%) of the sample consumed a diversified diet with a mean dietary diversity score of 3.7 ± 0.99. Starchy staple foods (96.7%) and flesh food (92.9%) were the most consumed foods. Being a nonfarmer employee (AOR = 10.76, 95% CI = 1.03-112.35), not taking cotrimoxazole prophylaxis (AOR = 3.76, 95% CI = 1.02-14.37) and adults of age 18-27 years (AOR = 5.95, 95% CI = 1.18-30.07) were significant predictors of high dietary diversity.

Conclusion: This study revealed that dietary diversity was a significant nutritional problem among HIV-positive adults in Lawra Municipal Hospital. Starchy staple foods and flesh food were the most consumed foods, while organ meats, dairy products, and eggs were eaten less. Having a secured salary paid job, not taking cotrimoxazole prophylaxis, and being a young adult were strong predictors of a high dietary diversity score. Therefore, efforts should be made to strengthen and improve the economic status and to educate these vulnerable groups on the need to adhere to cotrimoxazole prophylaxis uptake.

Background: The magnitude of on-time appointment keeping among HIV-positive adult patients was not identified in Ethiopia. Hence, this study aimed to assess on-time appointment keeping and associated factors among human immunodeficiency virus-positive patients accessing antiretroviral therapy in the East Gojjam Zone, Northwest Ethiopia.

Methods: A community-based cross-sectional study was performed on 830 HIV-positive patients from April 1 to May 10, 2019, in East Gojjam Zone. A systematic random sampling technique was used to include study subjects, and data were collected through face-to-face interviews. Bivariable and multivariable binary logistic regression analyses were performed. Independent variables with a P value of <0.05 were considered statistically significant cut points.

Results: The prevalence of on-time appointment keeping was 62.1%. Being >24 years old (adjusted odds ratio (AOR) = 2.13; 95% confidence interval (CI) = 1.54-4.25), being unmarried (AOR = 0.59; 95% CI = 0.45-0.82), taking a drug regimen of tenofovir + lamivudine (3TC) + efavirenz (EFV) (AOR = 2.11; 95% CI = 1.84-3.62), taking ART ≥12 months (AOR = 4.32; 95% CI = 2.22-8.40), having a mobile (AOR = 2.22; 95% CI = 1.44-3.64), and getting adherence support (AOR = 1.83; 95% CI = 1.16; 95% 1.16-3.50) were significant factors.

Conclusion: On-time appointment keeping was low. Adherence support and appointment reminders should be strengthened.

Current U.S. guidelines recommend integrase strand transfer inhibitor (INSTI)-based antiretroviral therapy (ART) as initial treatment for people with HIV (PWH). We assessed long-term effects of INSTI use on lipid profiles in routine HIV care. We analyzed medical record data from the HIV Outpatient Study's participants in care from 2007 to 2021. Hyperlipidemia was defined based on clinical diagnoses, treatments, and laboratory results. We calculated hyperlipidemia incidence rates and rate ratios (RRs) during initial ART and assessed predictors of incident hyperlipidemia by using Poisson regression. Among 349 eligible ART-naïve PWH, 168 were prescribed INSTI-based ART (36 raltegravir (RAL), 51 dolutegravir (DTG), and 81 INSTI-others (elvitegravir and bictegravir)) and 181 non-INSTI-based ART, including 68 protease inhibitor (PI)-based ART. During a median follow-up of 1.4 years, hyperlipidemia rates were 12.8, 22.3, 22.7, 17.4, and 12.6 per 100 person years for RAL-, DTG-, INSTI-others-, non-INSTI-PI-, and non-INSTI-non-PI-based ART, respectively. In multivariable analysis, compared with the RAL group, hyperlipidemia rates were higher in INSTI-others (RR = 2.25; 95% confidence interval (CI): 1.29-3.93) and non-INSTI-PI groups (RR = 1.89; CI: 1.12-3.19) but not statistically higher for the DTG (RR = 1.73; CI: 0.95-3.17) and non-INSTI-non-PI groups (RR = 1.55; CI: 0.92-2.62). Other factors independently associated with hyperlipidemia included older age, non-Hispanic White race/ethnicity, and ART without tenofovir disoproxil fumarate. PWH using RAL-based regimens had lower rates of incident hyperlipidemia than PWH receiving non-INSTI-PI-based ART but had similar rates as those receiving DTG-based ART, supporting federal recommendations for using DTG-based regimens as the initial therapy for ART-naïve PWH.

Background: Depression is a common mental disorder and is a leading cause of disability globally. Depressive symptoms among people living with HIV can be a significant barrier to ART initiation and thus lead to poor ART adherence. Global studies have found the prevalence of depressive symptoms among people living with HIV ranges from 12 to 63%. The real scenario of Nepal still needs to be explored. Thus, this study aimed to identify the prevalence and predictors of depression in individuals with HIV.

Methods: An institutional-based cross-sectional study was carried out from August to December 2020 among 406 people living with HIV attending ART centers in Lumbini province. Participants were selected using a systematic random sampling technique and surveyed with a structured questionnaire consisting of sociodemographic variables, HIV AIDS-related variables, and 21 items Beck Depression Inventory tool. The odds ratio was used as the ultimate measure of association, with a 95% confidence interval computed to establish statistical significance. A multivariate regression analysis was carried out to identify the final predictors of depressive symptoms.

Results: The study found that 26.8% of the respondents had depressive symptoms. Those who were literate (AOR = 0.24, 95% CI: 0.10-0.61), in the poorest wealth quintile (AOR = 7.28, 95% CI: 2.22-23.87), initiated ART within 12 months (AOR = 1.88, 95% CI: 1.03-3.42), had CD4 cell counts below 200 (AOR = 2.50, 95% CI: 1.54-4.06), and had a time difference of 3 months or less between HIV diagnosis and ART initiation (AOR = 0.50, 95% CI: 0.29-0.86) were independently associated with depressive symptoms.

Conclusion: Routine screening for depressive symptoms should be integrated into national HIV prevention and control programs for people living with HIV. An enabling environment should be created to facilitate the rapid enrollment of individuals newly diagnosed with HIV in ART services, thereby reducing the time gap between HIV diagnosis and ART initiation.

Purpose: The study aimed to gain an in-depth understanding of how theatre nurses are being affected when they render perioperative care to patients living with HIV in a South African tertiary hospital.

Background: There is a scarcity of studies that focus solely on the wellbeing of theatre nurses who render perioperative care to HIV patient due to the ramifications of the nurses' fear of contracting HIV. Patients living with HIV often receive substandard care.

Objectives: To establish how theatre nurses are being impacted when rendering perioperative care to patient living with HIV, the study followed a qualitative approach using an interpretative phenomenological analysis design. Data were collected through in-depth individual interviews from ten theatre nurses who were purposively selected according to specific criteria. They voluntarily agreed to participate. An interpretive phenomenological analysis framework was used to analyse the data. Two main themes emerged from the data analysis, namely, the negative effect on nurses' wellbeing and the impact that it had on them professionally.

Results: The study revealed that the perioperative care of patients living with HIV had a negative impact on physical, mental, and social wellbeing of theatre nurses. Their compromised wellbeing in turn led to poor patient care, which put nurses at risk of losing their jobs and even potentially having to face litigation. The study further indicated that nurses did not receive psychological support from the management which further affected their health and professional performance.

Conclusion: The study proposes that theatre nurses rendering perioperative care to people living with HIV should receive proper training and support; staff shortages should also be addressed. There is also an urgent need for appropriate and sufficient protective equipment. Such changes will be essential in order to mitigate the negative impact that their jobs have on their wellbeing and on them in their professional capacity.