HIV AIDS-Research and Palliative Care最新文献

Background: This study was carried out in East Kasai Province, DR Congo, to explore the perceptions, challenges, and barriers associated with HIV/AIDS care. The aim was to understand perceptions of HIV/AIDS, identify barriers, and analyze the factors influencing the effectiveness of care.

Methodology: This study involved semi-structured interviews with healthcare professionals and focus group discussions with PLWHA.

Results: Several contrasting perceptions of HIV/AIDS were revealed, ranging from disease stigma to some acceptance of antiretroviral treatments, although hesitation remains among the population due to cultural beliefs and misinformation. The main challenges identified include dietary problems, side effects, drop-outs, failure to keep appointments, superstition and uninformed travel of patients. Patients often have difficulty gaining access to healthcare facilities because of distance, transport costs, and a lack of financial means. In addition, drug shortages in health facilities exacerbate the situation. Sociocultural barriers also play a major role. Stigma and discrimination against PLWHA are still visible, and these negative attitudes can dissuade individuals from being tested, adhering or adhering to treatment. In addition, superstitions and myths about treatment fuel mistrust and hesitation toward treatment. Healthcare providers face difficulties in managing patients due to limited resources and a lack of ongoing training on new therapeutic approaches.

Conclusion: This study highlights the many challenges that need to be overcome to improve HIV/AIDS care, particularly in terms of accessing care and combating stigma. To improve the effectiveness of health programs, an integrated multisectoral approach involving communities, health authorities and international partners is crucial. This will help overcome existing barriers and ensure equitable access to care while reducing the impact of HIV/AIDS.

Background: Cardiometabolic diseases, including hypertension, dyslipidemia, diabetes, and obesity, increase the risk of cardiovascular disease (CVD) among people with HIV (PWH). Anthropometric measurements are widely used to estimate cardiometabolic risk, but their correlation with specific cardiometabolic biomarkers and cardiovascular risk in PWH remains unclear.

Methods: A cross-sectional study was conducted among PWH receiving care at Kiruddu National Referral Hospital in Uganda. Anthropometric measurements included body mass index (BMI), weight, mid-upper arm circumference (MUAC), waist circumference (WC), hip circumference (HC), neck circumference (NC), waist-to-height ratio (WHtR), and waist-to-hip ratio (WHR). Cardiometabolic parameters assessed included blood pressure (BP), glycated hemoglobin, fasting blood glucose (FBG), total cholesterol, LDL-C, HDL-C, triglycerides, serum uric acid, and the 10-year CVD risk score based on the Framingham Risk Score (FRS). Correlations were assessed using Pearson's correlation coefficients and Point-Biserial correlation (r).

Results: Among 396 PWH, anthropometric measurements were strongly intercorrelated. MUAC exhibited strong correlations with weight (r=0.84), BMI (r=0.81), HC (r=0.71), and WC (r=0.72) (all p<0.001). WC was strongly correlated with WHtR (r=0.93), weight (r=0.82), and BMI (r=0.78) (all p<0.001). However, correlations between anthropometric measurements and cardiometabolic biomarkers were weak. WC showed the strongest positive correlations with systolic BP (r=0.34), diastolic BP (r=0.31), total cholesterol (r=0.28), LDL-c (r=0.25), serum uric acid (r=0.25), triglycerides (r=0.22), and FBG (r=0.14). Similarly, correlations with the FRS were weak, whereby NC (r=0.37), weight (r=0.24), and WC (r=0.23) showed the strongest positive correlation, while other anthropometric indices had weak or negligible correlations with FRS.

Conclusion: Anthropometric measurements were strongly intercorrelated but demonstrated poor correlations with cardiometabolic biomarkers and the 10-year FRS among PWH in Uganda. These findings suggest that while anthropometric indices remain practical for initial screening, they may not reliably predict cardiometabolic risk or long-term CVD risk, highlighting the need for more comprehensive assessment tools in PWH.

Introduction: The advent of highly active antiretroviral therapy (HAART) has changed infection by human immunodeficiency virus (HIV) from an acute disease to a manageable chronic condition; however, pulmonary complications continue to affect patient quality of life. The goal of this research was to examine the link between CD4+ levels, viral load, and respiratory function in patients infected with HIV.

Methods: Patients were grouped as HIV-infected and non-infected (1:2 ratio). The analysis included between-group comparisons of the post-bronchodilator FEV1, FVC, FEV1/FVC ratio, forced expiratory flows at various lung volumes (FEF75, FEF50, FEF75/25), and carbon monoxide diffusion capacity (DLCO). We analyzed CD4+ counts and viral load effects on lung function using stepwise regression. For normally distributed continuous variables (presented as means ± SD), intergroup comparisons were performed using independent two-sample t-tests. Non-normal distributions (reported as medians [IQR]) were analyzed with Mann-Whitney U-tests. Categorical variables were compared using χ² or Fisher's exact tests, with statistical significance set at p < 0.05.

Results: The study enrolled 150 participants infected with HIV with a mean age of 48 (39.25, 57.75) years; 87.33% were male and 46% had a history of smoking. The DLCO was significantly lower in patients with HIV (69.37 vs 82.23, p < 0.05) compared to patients without HIV. In patients with HIV, the DLCO was positively correlated with CD4+ T lymphocyte counts (r=0.5521, p < 0.0001) and negatively correlated with the HIV viral load (r=-0.3942, p < 0.0001), and both were statistically significant. Patients with CD4+ ≥ 200 cells/μL had significantly higher VC (89.52 vs 79.31), FVC (91.80 vs 83.55), FEV1 (91.60 vs 84.40), and DLCO (74.61 vs 57.96) than those with CD4+ < 200 cells/μL. Similarly, patients with undetectable viral loads had higher VC (87.99 vs 81.08), FVC (90.90 vs 83.70), and DLCO (72.59 vs 60.62) than those with detectable viremia (all p < 0.05). The CD4+ count and FVC were significant predictors of the DLCO (p < 0.05).

Conclusion: HIV infection is significantly associated with impaired pulmonary diffusion function. Even after antiviral therapy when the viral load becomes undetectable (CD4+ T lymphocytes > 400), the impairment of pulmonary diffusion still persists. Therefore, we should strengthen the pulmonary function testing for AIDS patients, detect the risk of lung injury as early as possible, carry out timely interventions, and reduce the risk of chronic obstructive pulmonary disease (COPD).

Background: HIV/AIDS continues to pose a significant global health challenge, especially in low- and middle-income countries. Economic evaluations are essential to identify cost-effective prevention strategies and allocate limited healthcare resources efficiently.

Objective: This systematic review aimed to assess the cost-effectiveness of HIV prevention interventions across various populations and settings, and to evaluate the methodological quality of the included studies.

Methods: A comprehensive literature search was conducted in PubMed, Embase, Web of Science, and Scopus for English-language studies published between January 2003 and November 2023. The PRISMA guidelines were followed for the review process. The quality of the included studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist.

Results: Thirteen studies met the inclusion criteria, exhibiting diverse methodologies, target populations, and healthcare perspectives. The majority of studies reported that primary prevention methods-such as prenatal screening, harm reduction programs for drug users, and pre-exposure prophylaxis (PrEP) for high-risk groups-were more cost-effective than secondary or tertiary interventions. Study populations included pregnant women (38.4%), injection drug users (23.1%), men who have sex with men (23.1%), and general populations (15.4%). Overall, most studies demonstrated medium to high methodological quality.

Conclusion: Primary prevention strategies for HIV are generally cost-effective, especially when tailored to specific high-risk populations. However, more robust, context-specific evaluations are needed to support policy-making across diverse healthcare systems. Decision-makers should prioritize investment in early detection and preventive programs to optimize outcomes and resource use.

Background: Oral HIV pre-exposure prophylaxis (PrEP) has been introduced globally, but women in sub-Saharan Africa frequently experience challenges in uptake and adherence. Female barmaids are at HIV risk due to transactional sex. However, uptake and adherence to oral PrEP pills is poor. Long-acting injectable (LAI) PrEP has the potential to increase prevention by improving adherence. Nevertheless, LAI PrEP is yet to be initiated in Tanzania. We explored preferences and concerns about LAI PrEP use among female barmaids in Ubungo municipality.

Methods: We conducted in-depth interviews with 17 purposefully selected female barmaids. Interviews were conducted using a guide with semi-structured questions. We adopted an inductive approach for analyzing data.

Findings: The majority of PrEP non-users expressed no preference for any form of PrEP, while oral PrEP-users preferred LAI PrEP. Overall, LAI PrEP was preferred due to its discretion, fewer side effects, prolonged prevention, and reduced fatigue compared to oral pill PrEP with concerns about large pill size, side effects, and the burden of daily use. Most interviewees indicated a three-month PrEP injection preference, though some preferred a monthly PrEP injection for effective monitoring and control of potential side effects. Regarding the delivery model, the healthcare facility was mostly preferred for timely services, convenience more privacy and reduced stigma. Community spots were preferred for convenience and friendlier services from providers. The majority reported no major concerns about using LAI PrEP, though a few expressed concerns about its trial phase, potential links to cancer, risky sexual behaviours, and side effects such as fatigue, dizziness.

Conclusion: The majority of the interviewees expressed strong interest in LAI PrEP and reported fewer concerns, emphasizing more convenience and discretion. Our findings suggest that since LAI can address challenges of adherence associated with daily PrEP pills, it is important to introduce it to expand HIV prevention options for barmaids and other women at risk of HIV in Tanzania.

Background: Understanding barriers to viral undetectability is crucial for developing targeted interventions for populations struggling with treatment adherence. The aim of this study was to investigate the impact of race, education, economic vulnerability and HIV-related stigma on viral load detectability among people living with HIV (PLWHA) in Brazil.

Methods: This was a cross-sectional, community-based study. The sample consisted of 1767 participants. We used the Brazilian version of the HIV Stigma Index 2.0 questionnaire, the Internalized AIDS-Related Stigma Scale, and a sociodemographic questionnaire. Viral load was self-reported. Data were collected by 30 PLHV themselves in 2019, after receiving training on the Brazilian Stigma Index. Data was analyzed with both descriptive and inferential statistics using SPSS.

Results: Our generalized linear model showed that participants who were non-white, with low education and of lower economic status had a lower likelihood of reporting undetectable viral load (UVL) compared compared to their respective counterparts (white participants, those with higher education, and those of higher economic status). Key population group membership was not significantly associated with UVL. Higher internalized stigma was negatively associated with lower UVL.

Conclusion: Our findings highlight the impact of racial, educational and economic disparities and internalized stigma on HIV outcomes and underscore the need for tailored interventions that address the specific challenges faced by different racial/ethnic and more vulnerable groups. These findings challenge the dominant treatment-as-prevention framework that focuses primarily on key populations, suggesting the need to broaden our focus to include other vulnerable populations, such as non-whites and those experiencing economic hardship. Such approach is critical to avoid overlooking situations where community viral load remains high.

Background: Although all antiretroviral therapies reduce viral load, first-line regimens vary slightly in effectiveness and tolerability, often leading to treatment changes. Non-adherence is common in developing countries due to limited-resources and poor patient-provider communication. Data on HIV treatment and adherence are scarce in Iraq.

Objective: To obtain in-depth insight into treatment regimens, medication adherence, healthcare quality, and the challenges and factors influencing them among Iraqi HIV patients.

Methods: A qualitative study utilizing face-to-face interviews was conducted with HIV patients at three HIV centers in Iraq. The interview-guide was developed and validated by a panel of experts. Participants were recruited via convenience and purposive sampling. Interviews, conducted in Arabic, were audio-recorded and lasted 10-20 minutes. Data collection continued until saturation. Data analyzed manually by thematic-analysis approach.

Results: Forty-seven HIV patients were interviewed. Three themes emerged: treatment of HIV, adherence to anti-HIV medications, and accessibility and quality of care for HIV patients. All patients were on a combination pill (Tenofovir-disoproxil, lamivudine, and dolutegravir), but most had changed regimens due to medication shortages or side effects. While most began treatment immediately after diagnosis, delays occurred mainly due to administrative issues, drug unavailability, or side effects. Most patients reported transient initial side effects. Medication adherence was generally good, though many patients missed some doses due to forgetfulness, travel, or medication unavailability. Most patients rated care quality as good, valuing the physician's role in HIV-management. Barriers to accessing care included medication supply interruption and discrimination. Recommendations to improve care included establishing specialized clinics at HIV centers and ensuring continuous medication supply.

Conclusion: HIV care in Iraq largely aligns with international guidelines, but administrative delays hinder timely treatment initiation. Adherence is good, though medication supply interruptions and travel are main non-adherence factors. Ensuring continuous medication supply and establishing specialized clinics are essential for improved care.

Background: Dyslipidemia, a risk factor for cardiovascular disease (CVD), is common among people living with the human immunodeficiency virus (HIV). The interaction between HIV, dolutegravir (DTG)- based antiretroviral therapy (ART), and lifestyle factors contribute to dyslipidemia, increasing CVD risk. Rwanda has made significant progress in expanding access to ART, achieving high coverage and viral suppression rates. However, comprehensive data on dyslipidemia among people living with HIV (PLWH) in Rwanda is lacking. Therefore, this study aimed to fill this gap by examining the prevalence, types, and correlates of dyslipidemia among PLWH.

Methods: This cross-sectional study with 264 participants analyzed serum lipid profiles to estimate the prevalence of dyslipidemia and specific lipid abnormalities. Demographic and lifestyle factors were collected using a questionnaire. Differences in categorical variables between HIV-positive and HIV-negative groups were assessed using chi-square or Fisher's exact tests. Continuous variables were compared using the Wilcoxon rank-sum test. Multivariable logistic regression models, stratified by HIV status, identified factors independently associated with dyslipidemia, reported as adjusted odds ratios (aOR) and 95% confidence intervals (CI). Statistical significance was defined as p-value < 0.05.

Results: Dyslipidemia (NCEP ATP III criteria) was present in 74.2% of participants, significantly higher among PLWH (82.7%) than HIV-negative group (59.4%). Hypoalphalipoproteinemia and hyperbetalipoproteinemia were more common in PLWH (72.6% and 53.0%) vs HIV-negative (57.3% and 3.1%). Male gender reduced odds of dyslipidemia in both groups; smoking significantly increased risk among PLWH (aOR 8.8; 95% CI 1.73-44.59), while alcohol consumption was protective (aOR 0.2; 95% CI 0.07-0.55). DTG- based ART duration > 6-12 months increased odds of dyslipidemia vs ≤ 6 months (aOR 4.8; 95% CI 1.11-20.93).

Conclusion: The study found a high prevalence of dyslipidemia among PLWH on ART, linked to ART duration, age, smoking and sex, highlighting the need for regular screening, lifestyle interventions, and tailored HIV care.

Introduction: Since the mid-1990s, the adoption of combined antiretroviral therapy (cART) has significantly reduced HIV-related mortality and morbidity. Nevertheless, cancer continues to be the leading cause of death in people living with HIV (PLWH). We conducted a survey to assess the knowledge and inter-disciplinarity among the Italian oncologists and infectious disease specialists in the cancer prevention and treatment of PLWH.

Materials and methods: All the members of AIOM, SIMIT and SITA who are oncologists and infectious disease specialists were invited via email. A survey with 24 queries was administered using a web-based platform. Data were analysed with the chi-square or Fisher exact tests to explore any significant difference between the two specialist subgroups.

Results: From April to June 2023, 182 participants filled in the questionnaires. A low rate of respondents from each scientific society was reported (3% for AIOM, 8% from SIMIT and 2% from SITA). All interviewees agreed that HIV infection was a relevant risk factor for cancer (95.1%) and that PLWH had limited access to clinical trials (73.1%). More than a third of oncologists worked in a hospital without an infectious diseases department, using a remote method of communication for interdisciplinary discussion (telephone and Email were used in 64.5% of cases). Eighty-four percent of the oncologists vs 51.4% of the infectious disease specialists had in charge less than 5 patients with HIV during the previous year.

Conclusion: The results of this survey underscore the opportunity for education, interdisciplinary collaboration, and organizational support to optimize cancer care for PLWH. A Hub&Spoke model could represent a potential facilitation to build-up in the near future through inter-societal collaboration.

Purpose: Men who have sex with men are at high risk of Human immunodeficiency virus (HIV) infection and bear the highest burden of the disease in Tanzania. Although pre-exposure prophylaxis (PrEP) has demonstrated high efficacy in the prevention of HIV infection in clinical trials, challenges with retention threaten its effectiveness. Therefore, we assessed the extent and predictors of retention in PrEP care among men who have sex with men in Tanga, Tanzania.

Methods: This study included 369 men who have sex with men who were recruited using respondent-driven sampling. Baseline data were collected using structured questionnaires that captured socio-demographic and behavioral characteristics. The primary outcome was one-month retention in PrEP care. A statistical analysis using modified Poisson regression was conducted to identify independent factors associated with 1-month retention.

Results: A total of 369 men (mean age, 24.7 (± 5.5 years)) participated in the study. After one month, 87 participants (23.6%) were retained in PrEP care. Independent factors associated with retention included assuming a receptive position in anal sex (aPR 1.6, 95 CI: 1.0-2.6, p = 0.030), having initiated sexual activity with anal, oral, or thigh sex (aPR 2.1, 95% CI: 1.2-3.8, p = 0.011), and having adequate social support (aPR: 1.6, 95% CI: 1.0-2.6, p = 0.030).

Conclusion: Tailored interventions that improve social support and address the varying needs of men who have sex with men with diverse sexual behavior patterns are essential for improving retention and maximizing the effectiveness of PrEP in HIV prevention. Practically, this highlights the need to strengthen supportive environments within communities and healthcare systems to enhance retention in PrEP, reduce HIV transmission, and advance progress toward ending HIV as a public health threat by 2030.