HIV AIDS-Research and Palliative Care最新文献

Background: Viral load suppression remains suboptimal among adolescents and young people living with HIV in Uganda (AYPLHIV). Although Intensive Adherence Counselling is recommended for individuals who remain virally non-suppressed while on antiretroviral therapy, its contribution to suppression among AYPLHIV is not well understood. This study aimed to determine the level of viral load suppression achieved following intensive adherence counselling among previously non-suppressed AYPLHIV in east central Uganda.

Methods: We conducted a sequential explanatory mixed methods study among 580 participants aged 10-24 years receiving care at 32 health facilities. Quantitative data were abstracted covering a five-year period from 2019-2024. Suppression levels and subgroup differences were assessed using chi-square tests. A qualitative study was conducted with 12 purposively selected participants and thematic analysis were guided by the Capability, Opportunity, Motivation and Behavior framework.

Results: Participants had a median age of 16.4 years and a median ART duration of 4 years. Overall, out of the 580 participants, 313 (53.9%) achieved viral load suppression after counselling. Participants living more than 5 km compared to less than 5km from a health facility (p=0.003) and those counselled by counsellors rather than nurses (p<0.001) had significantly higher suppression level. Lower suppression level was observed among participants who had not disclosed their HIV status versus those who disclosed (p=0.011) and those reporting fear or stigma compared to those not reporting (p=0.010). Qualitative findings indicated that understanding the purpose and benefits of intensive adherence counselling (Capability), financial barriers and provider interactions (Opportunity), and non-disclosure (Motivation) influenced suppression outcomes among AYPLHIV.

Conclusion: IAC resulted in modest improvements in VL suppression among AYPLHIV. Low retention and contextual barriers, including distance, stigma and non-disclosure, limited its effectiveness. Tailored IAC strategies addressing subgroup-specific barriers are needed to improve VL suppression.

Purpose: To review published evidence on alternative administration methods for antiretroviral therapy in patients unable to swallow tablets.

Methods: We conducted a scoping review using PubMed, Web of Science, and Google Scholar databases from 2011 to 2025. We included studies reporting pharmacokinetic data, clinical outcomes, or safety data on crushed, dispersed, or enterally administered antiretroviral formulations. Four independent reviewers screened 1,474 articles after duplicate removal, with 12 studies meeting selection criteria.

Results: We identified 12 studies (8 case reports, 2 case series, 2 cohort studies) describing alternative administration of antiretrovirals. Key findings included: (1) Bictegravir/emtricitabine/tenofovir alafenamide was associated with viral suppression when dissolved and administered enterally; (2) Dolutegravir/abacavir/lamivudine crushed via nasogastric tube was associated with viral suppression within 10 months; (3) Dolutegravir requires separation from enteral feeds containing polyvalent cations to avoid chelation and reduced absorption. (4) Most nucleoside reverse transcriptase inhibitors (NRTIs) could be crushed or dissolved, while non-nucleoside reverse transcriptase inhibitors (NNRTIs) showed variable stability. (5) Therapeutic drug monitoring was recommended for integrase inhibitors administered enterally.

Conclusion: This review provides evidence suggesting the use of modified ART formulations when standard oral administration is not possible. In situations where swallowing difficulties prevent the use of whole tablets, alternative methods such as crushing, or dissolving may offer a practical approach to maintain treatment continuity. Alternative administration ART, namely INSTI-based regimens and NRTIs, may help maintain viral suppression in these settings, provided that drug-specific pharmacokinetic considerations and enteral feeding interactions are addressed. Further prospective studies with therapeutic drug monitoring are needed to establish standardized protocols.

Introduction: This study addresses a research gap in cervical cancer screening for Women Living with HIV (WLHIV) in Puerto Rico, evaluating the associations between viral load (VL) thresholds, CD4 count, HPV detection, and the benefits of co-testing with cytology.

Methods: We analyzed the HIV viral load (VL), HPV infection, CD4 counts, and cervical cytology in 354 WLHIV receiving consecutive comprehensive care, including Highly Active Antiretroviral Therapy (HAART). Retrospective data were obtained from visits from 2018 to 2023. Consecutive visits with ThinPrep co-testing for cytology and HPV were evaluated. Only one observation per woman was included to maintain a cross-sectional dataset. HPV was detected using Hologic ThinPrep Pap Test and PCR-based genotyping.

Results: The prevalence of any HPV was 27% which correlated inversely with CD4 counts: 42.9% (≤200 cells/mm³), 35.5% (201-499 cells/mm³), and 23.2% (>500 cells/mm³) (p=0.017). Multivariate analysis demonstrated that HPV positivity was significantly associated with the likelihood of having an abnormal Pap result (OR = 6.35; 95% CI: 3.22-12.52; p < 0.001). Cytologic abnormalities were more frequent with lower CD4 counts: 32.1% (≤200 cells/mm³), 11.8% (201-499 cells/mm³), and 11.2% (>500cells/mm³) (p=0.007). HPV was detected more frequently among women with detectable VL > 201 copies/mL (35.4% vs 26.1%). Abnormal cytology occurred in 22.9% of women with VL > 201 copies/mL versus 11.4% with VL ≤ 200 copies/mL (p=0.028) and among 34.8% of women with negative HPV tests, underscoring the value of co-testing.

Conclusion: WLHIV demonstrate higher HPV prevalence and abnormal cytology rates, with persistence inversely related to CD4 counts. Viral suppression correlates with lower HPV prevalence and fewer cytologic abnormalities. Co-testing identified 34.8% of WLHIV with abnormal cytology and HPV-negative results. This study supports consideration of co-testing for cervical cancer screening in WLHIV, even among those with high ART uptake. Further prospective and multi-site studies are warranted to confirm these observations and inform policy or guideline changes.

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.