HIV AIDS-Research and Palliative Care最新文献

Aim: To develop and conduct a preliminary evaluation of a digital salutogenic intervention-"Towards the Sun"-aimed at enhancing sense of coherence (SOC) and improving health outcomes among newly diagnosed HIV-positive men who have sex with men (MSM).

Methods: The initial intervention draft was developed using the systematic Intervention Mapping (IM) process, informed by preliminary research, literature review, and evidence-based needs assessment. Two rounds of expert panel review were then conducted to refine the draft, followed by a feasibility assessment among newly diagnosed HIV-positive MSM.

Results: The final digital intervention consisted of a five-stage, eight-week program, focusing on stress management, resource activation, and meaning exploration to strengthen the three dimensions of SOC. After review by 8 experts, the mean importance ratings of the intervention items were all above 4 and the coefficients of variation (CV) were less than 0.20, indicating consensus. A pilot study involving 7 newly diagnosed MSM demonstrated feasibility: SOC-13 scores increased, levels of stress and depression decreased, and participants reported high satisfaction with the overall content, especially the modules on self-acceptance and resource orientation.

Conclusion: This digital salutogenic intervention demonstrated good feasibility, user acceptance, and preliminary effectiveness among newly diagnosed HIV-positive MSM. As a strengths-based and innovative digital solution, it warrants further validation and dissemination in larger samples and randomized controlled designs.

Reporting guidelines: The study followed the TIDieR (Template for Intervention Description and Replication) Checklist.

Background: Bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) is a single-tablet regimen recommended as first-line HIV treatment in international guidelines. This analysis aimed to assess the effectiveness and safety of B/F/TAF in real-world Spanish clinical practice.

Methods: This was an analysis of the Spanish subset from the BICSTaR study in treatment-naïve (TN) and treatment-experienced (TE) people with HIV who started treatment between November 2019 and July 2021 (European study registration: EUPAS22185). The primary endpoint was virologic suppression (HIV-1 RNA <50 copies/mL); additional endpoints included CD4 cell count changes, treatment persistence, adverse events, weight changes, and the 36-Item Short Form Survey mental and physical component summary (MCS/PCS) scores at 12 months.

Results: In total, 249 people with HIV initiated B/F/TAF treatment (62 TN, 187 TE). At 12 months, virologic suppression was achieved by 86% of TN and 98% of TE participants, with 91% of those TE participants with baseline HIV-1 RNA ≥50 copies/µL achieving suppression. Median CD4 count increased by 296 cells/µL in TN (p<0.001) and 12 cells/µL in TE (p=0.302) participants. Persistence at 12 months was high in all participants, with 95% still on treatment. Overall, none of TN and less than 3% of TE participants discontinued B/F/TAF due to drug-related adverse events, all of which were mild or moderate. Median weight increase was 2.9 kg in TN (p<0.001) and 1.0 kg in TE (p<0.001) participants. Median MCS scores improved in the TN group (8.4-point increase, p<0.001) but not in the TE group (0.4-point increase, p=0.767), while PCS scores remained stable both among TN and TE.

Conclusion: These real-world findings strongly support B/F/TAF use in TN and TE people with HIV in Spain, demonstrating high 12-month persistence and effectiveness, and mental health benefits in TN participants, with minimal adverse events.

Anogenital warts (AGW) are a common manifestation of human papillomavirus (HPV) infection, primarily caused by strains 6 and 11. According to results, mucosal HPV is transmitted through sexual contact, with risk factors including immunodeficiency, such as Human Immunodeficiency Virus (HIV). Individuals with HIV experience a higher incidence of AGW due to impaired immune function that hinders HPV clearance. There is currently no specific antiviral therapy available for HPV, although several management options exist. However, some of these treatments may cause pain and discomfort. Glycyrrhizinic acid (GA) has demonstrated potential in managing HPV infection because of its antiviral properties and minimal side effects. Despite these promising results, GA is not yet recognized as a standard therapy for AGW. This case report describes the effectiveness of Glizigen^® (topical GA) combined with Viusid^® (oral GA) in managing genital warts in a 28-year-old homosexual male living with HIV. The patient, examined by a dermatologist at Dr. Hasan Sadikin General Hospital, Bandung, Indonesia, presented with perianal warts that had developed over 3 months. According to the physical examination carried out, multiple flesh-colored papules were reported, while histopathological analysis showed koilocytes, and polymerase chain reaction (PCR) confirmed HPV types 6 and 11. The treatment process, carried out using topical and oral GA, was administered from August to October 2024. The improvement was reported only in smaller lesions, while larger ones persisted, leading to electrocautery scheduling. The limited response observed in this case might be influenced by the patient's low CD4+ count, which potentially affects HPV clearance. Factors such as age, number of sexual partners, circumcision status, HPV type, and anatomical location of the lesions may also have played a role.

Introduction: The Joint United Nations Programme on HIV and AIDS (UNAIDS) aims for 95% ART adherence to achieve global viral suppression against HIV/AIDS, which is a major health issue worldwide, especially in southern Africa. This study investigated ART non-adherence among adult HIV-positive clients in the Amahlathi sub-district of the Eastern Cape, South Africa.

Methods: A cross-sectional study of 400 HIV/AIDS-positive persons (PLWHA) was undertaken at multiple facilities. A Survey was used to collect data, while medical records were used to ascertain the viral load. Responses were captured on an ordinal adherence scale and triangulated with viral load records from patient files. Univariate, bivariate, and multiple logistic regression analyses were performed to determine factors associated with ART non-adherence, and 95% CIs reported.

Results: The ART non-adherence rate was 28%. In the bivariate analysis (odds ratio [OR]), living with children (OR = 2.59), living with parents (OR = 4.12), alcohol use (OR = 2.08), HIV non-disclosure to family (OR = 0.31), non-sharing of HIV status to partner (OR = 0.41), staying with partners (OR = 0.41), taking treatment regimen II (OR = 5.74), taking ART doses twice a day (OR = 4.80), use of traditional medicine (OR = 2.83), and missed dosage (OR = 3.98) were associated with non-ART adherence. Multivariate analysis revealed that young age (<30-40 years) (AOR = 0.95; 95% CI: 0.93-0.98), female sex (AOR = 0.41; 95% CI: 0.21-0.77), partner HIV disclosure (AOR = 0.49; 95% CI: 0.26-0.92), and use of traditional medicine (AOR = 2.45; 95% CI: 1.05-5.68) were independent predictors of ART adherence.

Conclusion: ART adherence remains below UNAIDS targets in the study area. Tailored interventions that address traditional medicine use, strengthen partner disclosure support, and provide adherence counseling for young adults and men are urgently needed. Future programs could integrate digital adherence monitoring and reminder systems as practical tools to enhance treatment outcomes.

Purpose: HIV infection is one of the most important health, social, and economic issues of humanity today and one of the greatest concerns and dilemmas in many countries around the world. It is a multifaceted issue with biological, social, and psychological consequences that affect the individual and social lives of those infected. The aim of this study was to investigate the palliative needs of people living with HIV in Illness trajectory in Iran.

Patients and methods: This study was of qualitative type. Purposeful sampling was used to select the participants from the People living with HIV, their caregivers, and professionals in this field. 27 participants were interviewed. The main data collection instrument was semi-structured interview with open questions. Additionally, the collected data were analyzed via inductive content analysis method.

Results: Data analysis resulted in 4 main categories, including providing essential information, social facilities, psychological rehabilitation, and healthcare services.

Conclusion: People living with HIV and their caregivers face diverse needs on the path of living with this disease. Therefore, controlling HIV infection is impossible without understanding the needs of patients and their caregivers and planning to meet these needs. Study findings provide an opportunity for HIV planners and policymakers.

Background: Dolutegravir (DTG), an integrase-strand transfer inhibitor approved by WHO in 2019 as part of first-line HIV treatment, has been linked to weight gain; however, data on this and its associated factors remain limited.

Objective: This study aimed to determine the prevalence of weight gain and associated factors among people living with HIV (PLHIV) on DTG-based antiretroviral therapy (ART) regimens.

Methods: We conducted a retrospective cohort study of PLHIV at St. Mary's Hospital Lacor between January 2020 and December 2021. Charts were reviewed for demographic and clinical data at baseline, at 6 months and at 12 months. Weight gain was defined as a ≥5% increase in weight from baseline at 6 months. Bivariate analysis followed by stepwise multivariable logistic regression was used to identify independent predictors of weight gain. Data were analyzed using STATA 17.

Results: A total of 432 participants were included, 83.8% of whom were female. The median age was 44 years (IQR: 37.0-49.5). Most (97.0%) programmatically switched to DTG-based regimens. The prevalence of weight gain (defined as ≥5% increase from baseline) at 6 months was 7.4% (n=32/432) and 16.5% (n=31/187) at 12 months. Mean weight at baseline and 6 months was comparable (61.0 kg vs 60.0 kg, p=0.108), but a statistically significant increase in weight (p<0.001) and BMI (p<0.001) was observed from baseline to 12 months. On bivariate analysis, lower baseline WHO stage (p=0.048) and viral load <1000 copies/mL (p=0.009) were associated with weight gain; however, no factor remained significantly associated in multivariable analysis.

Conclusion: Weight gain occured in approximately 1 in 14 participants at 6 months and 1 in 6 participants at 12 months post-DTG initiation. WHO stage I and lower viral load were associated with weight gain on bivariate analysis, though not independently on multivariable analysis. Routine weight and cardiovascular risk monitoring is recommended. A prospective study is warranted.

Purpose: Oral candidiasis remains prevalent in HIV patients, with growing concern over antifungal resistance. This study aimed to identify Candida species in HIV patients with oral candidiasis and assess the antifungal susceptibility of the predominant species.

Materials and methods: A cross-sectional study was conducted at a referral hospital in West Java, Indonesia, involving 30 HIV patients aged ≥18 years, with no prior antifungal therapy and a confirmed diagnosis of oral candidiasis. Oral rinse samples were collected and cultured on CHROMagar Candida for species identification and CFU/mL quantification. Antifungal activity was assessed using disk diffusion against nystatin, fluconazole, itraconazole, and voriconazole. Inhibition zone diameters were recorded, while categorical susceptibility interpretation was applied only to fluconazole and voriconazole based on CLSI guidelines. The Friedman test and Fisher's exact test were used, with p < 0.05 considered statistically significant.

Results: Candida (C). albicans was the predominant species (100%), consistent with previous findings. Non-Candida albicans Candida (NCAC) species, including C. glabrata (10%), C. krusei (3.3%), and C. tropicalis (3.3%), were also identified, aligning with reports of emergence. Inhibition zone diameters varied significantly (p < 0.001). Voriconazole had the widest zone (34.0 ± 10.7 mm), followed by fluconazole (33.0 ± 9.3 mm), itraconazole (29.5 ± 5.5 mm), and nystatin (27.9 ± 5.0 mm). For fluconazole and voriconazole, categorical interpretation showed 90.0% and 86.7% susceptibility, respectively, with no significant difference (p = 1.00). Since no interpretive breakpoints exist for nystatin and itraconazole, only inhibition zone diameters were reported.

Conclusion: C. albicans predominated, with fluconazole and voriconazole showing high susceptibility, while nystatin and itraconazole demonstrated inhibition zones but could not be categorically interpreted due to the absence of established breakpoints. Routine species identification and susceptibility testing remain essential to guide therapy and monitor emerging resistance in immunocompromised populations, highlighting the need for further validation studies.

Background: Mail-in saliva samples are a participant-centered means of monitoring patients' oral and overall health that may help to reduce unnecessary medical trips and more efficiently use provider time. The use and acceptability of mail-in saliva samples have been studied in high-risk populations; however, it has not been studied in cohorts of people living with HIV (PLWH).

Objective: To investigate the feasibility of PLWHs' willingness to provide mail-in saliva samples, 900 saliva collection kits were mailed to a randomized sample of PLWH across two urban and diverse clinics in the Northeast United States in 2019-2020.

Results: 73/900 (8%) packages were returned to study personnel, with 100% (73/73) containing saliva deemed usable for analysis. 55/900 (6%) of packages were returned to the study team undeliverable. Further information may be gained from investigating the influence of personalized test results, health literacy, the requirement of the oral health survey, and study compensation that may affect an individual's motivation to participate in the study.

Conclusion: While findings suggest limited feasibility of mail-in saliva collection without personalized test results in a cohort of PLWH in terms of response rate, all returned saliva samples were usable for analysis suggesting that addressing potential barriers may improve response rates and the feasibility of using mail-in salivary diagnostics to monitor disease progression in PLWH in future studies.

Introduction: There is limited research on factors impacting viral load suppression among children and adolescents living with HIV (CALHIV) in low-income countries. The objective of the study was to determine and analyze factors affecting HIV viral suppression levels among CALHIV enrolled in the Integrated Child Health and Social Services Activity (ICHSSA 4) Orphans and Vulnerable Children (OVC) project in Northeast Nigeria.

Methodology: The study adopted a descriptive cross-sectional research design for the study. The study involved collecting data among 847 CALHIV aged 0 to 17 years, enrolled in USAID-supported healthcare facilities across 9 Local Government Areas (LGAs) in Adamawa, Bauchi, and Taraba States. Prevalence of viral load suppression was described by child/adolescent, caregiver-related factors. Mixed-effects multivariable logistic regression models were fitted to explore the factors associated with viral load suppression.

Results: CALHIV enrolled on the ICHSSA-4 project >2 years (92.7%) had better suppression levels compared to those 1 year and less (7.1%). About 94.5% of CALHIV who adhered to prescribed ARV medication were transitioned to pediatric ARV optimal regimen achieved viral suppression. Psychosocial factors such as the presence of treatment support person, enrolment in an age-appropriate support group, and positive HIV disclosure status also impacted viral load suppression positively. The sociodemographic, health/clinical, and psychosocial factors affecting viral load in CALHIV enrolled on the project were found to be statistically significant (p < 0.05).

Conclusion: The study found that factors such as CSO OVC services provided to households, adherence support, food sufficiency in the household, attendance at support groups, treatment literacy and other social services influence viral load suppression. Identifying these factors can help monitor and improve treatment outcomes among CALHIV enrolled in an OVC programs and surely accelerate progress towards achieving the UNAIDS 3rd 95 goal.

Background: In recent years, China has seen a rapid rise in the HIV epidemic, especially among college students. However, the uptake of HIV testing was low. This study aimed to explore the factors influencing the acceptance of voluntary counseling and testing (VCT) among sexually active college students, in order to provide scientific evidence for the prevention and control of HIV infection on campus.

Methods: A cross-sectional study was completed at 13 colleges in 11 cities by stratified cluster random sampling. We formulated a questionnaire to collect information on demographic characteristics, sexual behaviors, sexual attitudes, HIV-relevant knowledge, and HIV/AIDS interventions. The chi-square test was performed to compare composition ratios. Single-factor logistic regression and multivariate regression analyses were performed to determine the influencing factors.

Results: This study included 3873 college students with sexual experience, of whom 199 had received VCT, accounting for 5.14%. The results of the multivariate logistic regression analysis demonstrated that the participants who were age ≥ 22 (OR = 2.11, 95% CI: 1.36-3.29), had casual sex in the past year (OR = 1.75, 95% CI: 1.21-2.52), had received a lecture or health education class on HIV/AIDS at school (OR = 1.80, 95% CI: 1.07-3.02), had received school information on HIV testing (OR = 2.15, 95% CI: 1.32-3.50), and had received a school-based HIV risk self-assessment in the last year (OR = 3.47, 95% CI: 2.40-5.03) were inclined to receive VCT.

Conclusion: The findings revealed that college students who had received health education about AIDS or acquired HIV testing information on campus were inclined to receive VCT, especially those who had engaged in high-risk sexual behaviors. Regarding HIV prevention among college students, it is recommended that health education related to AIDS be conducted regularly on campus and that HIV testing be promoted to increase the testing rate.