HIV AIDS-Research and Palliative Care最新文献

Background: In pregnant women, HIV infection warrants special attention due to the high risk of complications during pregnancy and the increased likelihood of fetal HIV exposure. Consequently, screening for HIV in pregnant women within the community and identifying associated risk factors are essential.

Objective: The study aims to investigate the prevalence of HIV infection and the associated risk factors in pregnant women.

Materials and methods: This is a cross-sectional study that utilized convenience sampling and was conducted between 2018 and 2020 at 107 commune health stations, 8 district health centers, and the Obstetrics Department of Vinh Long Provincial General Hospital.

Results: A total of 18,034 pregnant women, with a median age of 28 years. Fifty-one cases (0.3%) tested positive for HIV. The risk factors associated with an increased likelihood of HIV infection included having multiple sexual partners, drug addiction, smoking, and engaging in unprotected sex. In the multivariate model, only multiple sexual partners, drug addiction and alcohol consumption were independent factors that significantly increased the risk of HIV infection among pregnant women.

Conclusion: The study among pregnant women indicated that the HIV exposure rate within the community is below 1.0%. Unsafe sexual behaviors with multiple partners were identified as the most significant risk factor for HIV exposure among pregnant women.

Background: Disruptions to the health sector in Uganda during the COVID 19 pandemic affected health services in the early phases of the pandemic. Not much data exists on their effect on these same services during the later stages of the pandemic especially for children. To fill this gap, we set out to study missed appointments and their associated factors during the lockdown for children receiving Anti-Retroviral Therapy (ART).

Methods: This was a retrospective cohort study from January 2022 to May 2022. We included all children aged 0-15 and adolescents aged 15-19 years who were on ART. Electronic Medical Records (EMR) for the participants in the last 12 months were extracted. Descriptive statistics are presented. Binary logistic regression was performed, and odds ratios were reported.

Results: Out of the 382 participants, 26 (6.8%) missed appointments during the study period. The likelihood of missing appointments was increased when drugs were given to last 4 months than when they were given to last one month (COR 3.207, P value 0.026, 95% CI 1.150-8.943). Patients were also more likely to miss appointments if their mode of receiving drugs was Facility based group (COR 3.174, P = 0.043, 95% CI 1.037-9.713). Not having a viral load in the last 12 months increased the likelihood of missing an appointment (COR 2.309, P = 0.049, CI 1.004-5.306).

Conclusion: A drug refill of 4 months and being scheduled to receive drugs by Facility-based group model predisposed the participants to missing the next appointment. Home- or community-based ART delivery to clients as well as drug prescriptions for a longer period could reduce missed appointments. Timely viral load testing should be encouraged as it correlates with adherence to appointments. More research is needed on the safety, storage practices and efficacy of ART given to last more than 2 months.

HIV co-infection is a risk factor for the development of COPD. HIV enhances the deleterious effects of exposures such as tobacco smoking, as well as interacting with other drivers of COPD such as pulmonary tuberculosis, air pollution and biomass fuel burning. Recent work demonstrates that HIV also contributes independently to COPD pathogenesis by promoting oxidative stress, chronic inflammation, abnormal innate and adaptive immune responses, microbial dysbiosis, and epigenetic alterations within the lung. Consequently, people with HIV develop COPD younger, more often, and with faster rates of lung function decline compared to seronegative individuals. They may also have distinct patterns of lung function abnormalities compared to other etiotypes of COPD. Understanding the natural and pathogenetic history of HIV-associated COPD is important as its assessment, prevention and treatment are currently extrapolated from the general population. Whilst smoking cessation remains vital, further understanding may help guide unique management strategies for HIV-associated COPD. In this review, we explore its epidemiology and pathophysiology and discuss prevention and treatment approaches in this increasingly common disease.

Background: Autopsy is a valuable diagnostic tool utilized to identify causes of death and to confirm ante-mortem diagnoses of opportunistic infections among people living with HIV (PLHIV). We assessed acceptance of full or minimally invasive hospital (non-medicolegal) autopsies.

Methods: We conducted a multicentre, observational, cross-sectional study between October 2023 and January 2024 in four large HIV clinics in Northern Uganda among adult PLHIV and their caregivers, using a structured questionnaire. We conducted multivariable logistic regression to assess for association between acceptance of autopsy and selected exposures among PLHIV and caregivers with results expressed as adjusted odds ratios (aOR) and 95% confidence intervals (CI).

Results: A total of 310 participants, including 232 PLHIV and 78 caregivers were enrolled. Most participants (77.4%, n=240) had heard of autopsy. Overall, 132 (42.6%) participants reported that they would accept autopsy; 38/78 (48.7%) of the caregivers versus 94/232 (40.5%) of PLHIV. Most (81.3%, n=252) cited desire for accurate cause of death as their reason for accepting autopsy. However, 133 (42.9%) reported fear of body disfigurement, 77 (24.8%) lack of perceived benefit, 35 (11.3%) religiously unacceptable, and 52 (16.8%) culturally/traditionally forbidden as reasons for autopsy refusal. Autopsy acceptance among PLHIV was associated with being an inpatient (aOR: 4.6; 95% CI: 2.04-10.4), autopsy awareness (aOR: 5.1; 95% CI: 1.2-22.0), and inversely with having a primary education level (aOR: 0.44; 95% CI: 1.61-3.18). Among caregivers, no education was associated with acceptance of autopsy (aOR: 0.09; 95% CI: 0.02-0.55).

Conclusion: In Uganda, less than half of PLHIV or their caregivers would accept having an autopsy when they die. There is need for public sensitization about the relevance of autopsies in this population, with emphasis that the clinical diagnosis may not necessarily be the cause of death.

Introduction: Mediastinal diseases in HIV patients show complex diagnostic challenges due to opportunistic infections and rare neoplasms. While Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a key technique, its effectiveness is limited as it only provides cytological samples. Endobronchial ultrasound-guided mediastinal cryobiopsy (CryoEBUS) emerges as a promising alternative, yielding larger and higher-quality samples. This study, the first in Mexico and the first worldwide in HIV patients, evaluates its diagnostic efficacy compared to EBUS-TBNA, highlighting its potential to improve disease management in immunocompromised populations.

Materials and methods: A prospective cross-sectional study has been conducted from April 2023 to October 2023 at a tertiary center for respiratory diseases in Mexico, evaluating the usefulness of the endobronchial ultrasound-guided mediastinal cryobiopsy (CryoEBUS) diagnostic in HIV-positive patients with mediastinal lymphadenopathy ≥1cm. Patients underwent CryoEBUS, with outcomes assessed via pathology and microbiology reports.

Results: Eleven patients were included (64% male, mean age 39.1 years). CryoEBUS yielded diagnostic results in 82% of cases compared to 72% for bronchoalveolar lavage (BAL) and 50% for EBUS alone. Combined CryoEBUS and BAL demonstrated the highest yield (91%).

Conclusion: In patients with HIV and mediastinal lymphadenopathy, mediastinal cryobiopsy has proven to be a useful, effective technique with a high diagnostic yield, especially for benign pathologies. It has also proven to be a safe technique and when combined with other lung sampling techniques, it improves the diagnostic yield of infectious diseases and rare neoplasms.

Background: HIV is a significant public health issue in Uganda, particularly among young people (15-24 years), with an estimated 150,000 living with the virus. This study examines the paradoxes of autonomy and vulnerability experienced by young people living with HIV (YPLHIV) in Tororo District, Uganda. It explores how stigma, social support, and healthcare systems shape their experiences, influencing both their autonomy and vulnerability.

Methods: This qualitative study in Tororo District explored the autonomy and vulnerability of young people living with HIV, using 18 in-depth interviews and 3 focus group discussions to examine personal, social, and healthcare influences.

Results: Findings reveal how stigma, social isolation, and dependence on family support impact autonomy. Participants highlighted the importance of peer support, healthcare empowerment, and resilience in managing HIV. While struggling with medication adherence and gendered expectations, many expressed a desire for independence while acknowledging the critical role of support systems in maintaining their well-being.

Conclusions and recommendations: This study explores the tension between autonomy and vulnerability among young people living with HIV in Uganda, emphasizing the roles of stigma, social support, and healthcare providers. Recommendations include stigma reduction, peer support integration, and family involvement in care.

Background: Globally, non-communicable diseases (NCDs), including hypertension, are the leading cause of mortality. People Living with HIV (PLHIV) on antiretroviral therapy (ART) have a higher prevalence of hypertension, risk of cardiovascular events, and all-cause mortality than HIV-uninfected individuals. We describe the implementation of an integrated hypertension screening initiative in a routine program setting and assessed the prevalence of hypertension and its associated factors among PLHIV accessing services at ART centers in Mumbai, India.

Methods: From November 2021 to October 2022, we implemented hypertension screening across 21 ART centers in Mumbai, India. An expert committee developed a clinical protocol for hypertension management among PLHIVs aged ≥18 years, and ART center staff were trained on hypertension screening and management. We measured the prevalence of hypertension and determined the relationship between hypertension and various factors using univariable and multivariable modified poisson regression.

Results: We screened 92% (36,098/39,402) of eligible adult PLHIV for hypertension; 23.8% (8,604/36,098) had hypertension (56.7% were newly identified, and 43.3% known cases), factors such as age ≥60 years, male gender, being overweight or obese were significantly associated with hypertension (p<0.05). The HIV-related factors such as CD4 cell count of 200 cells/mm³ or higher, suppressed viral load (<1000 copies/mL), and longer duration of ART were also significantly associated with hypertension.

Conclusion: About one in every four PLHIV enrolled in the Mumbai ART program was hypertensive, reflecting hypertension prevalence in the general population. The findings highlight the increasing concern of NCDs among PLHIV, driven by longer life expectancies due to effective ART. This underscores the need for healthcare systems to evolve and adopt comprehensive and integrated care models that address HIV and non-communicable diseases. Integration of hypertension screening into routine HIV care can accelerate the early identification and management of hypertension.

Purpose: In recent years, People Living with HIV (PLHIV) in sub-Saharan Africa have experienced a growing burden of non-communicable diseases (NCDs), straining already limited health systems. Identifying behavioural risk factors for NCDs in both PLHIV and HIV-negative individuals is essential for designing targeted interventions. This study aimed to identify common risk factors for NCDs in these groups and determine their predictors.

Patients and methods: A comparative cross-sectional study was conducted among 250 PLHIV and 250 age- and sex-matched HIV-negative individuals attending the Antiretroviral Therapy (ART) and General Out-Patient clinics of Jos University Teaching Hospital from March 1-12, 2021. Participants aged 18-65 years were enrolled. Data were collected using a semi-structured questionnaire and blood pressure measurements. Multivariable logistic regression was used to identify predictors of behavioural risk factors while adjusting for potential confounders.

Results: While both groups had similar age and gender distributions, significant differences were observed in education level, marital status, employment, residence, income, ethnicity, and household size (p<0.05). Among PLHIV, long-term ART use reduced smoking by 93%. In HIV-negative individuals, urban residence and non-harmful alcohol use reduced smoking by 94% and 99%, respectively. Problematic alcohol use was significantly lower in women and non-smokers among PLHIV and HIV-negative individuals, respectively. Low physical activity was associated with poor self-rated health status in both groups, with gender and age playing additional roles among PLHIV and HIV-negative participants, respectively. Among the HIV-negative, unhealthy diets were linked to lower income.

Conclusion: Predictors of behavioural risk factors among PLHIV included ART duration, gender, and self-rated health. In the HIV-negative group, age, gender, residence, income, and self-rated health were key predictors. The notable overlap between smoking and alcohol use underscores the need for integrated interventions targeting these behaviours in both populations.

Background: HIV-positive pregnant women in refugee settings face significant barriers to accessing quality maternal healthcare. In Uganda, Kiryandongo Settlement Camp, one of the largest refugee settlements, exemplifies these challenges with limited healthcare infrastructure, stigma, and socio-economic constraints affecting healthcare delivery. This study explores the healthcare experiences and service delivery gaps for HIV-positive pregnant women in the camp.

Materials and methods: An exploratory qualitative research design was employed in Kiryandongo Settlement Camp, involving purposive sampling of 30 pregnant women living with HIV, 10 healthcare providers, and 5 key informants. Data were collected through in-depth interviews and key informant interviews.

Results: The findings revealed multiple barriers to healthcare access, categorized into three sub-themes: inadequate healthcare infrastructure, long waiting times and staff shortages, and stigma and discrimination. Participants reported frustration with the lack of medical supplies, inadequate facilities, and the impact of stigma on their willingness to seek care. Healthcare providers also acknowledged these challenges, noting limited resources and strained personnel as contributing factors. The most significant finding was the pervasive impact of stigma, which not only hindered service access but also contributed to a reluctance to engage with healthcare services, further affecting ART adherence.

Conclusion: This study highlights the critical need for improvements in healthcare infrastructure, policy interventions to reduce stigma, and increased support for healthcare providers in Kiryandongo Settlement Camp. Addressing these gaps is essential for enhancing ART adherence, maternal health outcomes, and the effectiveness of PMTCT programs in refugee settings. Despite the focus on a single site, the findings have broader implications for refugee health policy and service delivery in similar contexts.

Background: Low physical activity and unhealthy diets are among the key modifiable risk factors for non-communicable diseases (NCDs), often initiated in adolescence. Little is known about the underlying factors influencing these two behaviors, particularly in adolescents living with HIV (ALHIV). This study aimed at qualitatively exploring the factors perceived to influence physical activity and diet consumption in this vulnerable population.

Methods: Semi-structured in-depth interviews were conducted with ALHIV aged 15 to 19 years (N=22) and their parents and caregivers (N=10) to explore the lived experiences and perceptions regarding physical activity and diet consumption. The interviews were carried out from May to July 2024 at the Chronic Diseases Clinic in Ifakara (CDCI) in Tanzania. Thematic content analysis was performed aided by NVivo software version 14. Three levels of the socio-ecological model (intrapersonal, interpersonal, and community levels) guided the theoretical categorization of findings.

Results: Factors reported to influence physical activity in ALHIV were intrapersonal factors (time constraints, insufficient knowledge); interpersonal (encouragement from family members and peers); and community level aspects (gender and social norms, negative beliefs, inadequate facilities). On the other hand, intrapersonal factors (lack of autonomy, weight gain concerns, food preferences); interpersonal factors (low family income, large family size); and community level factors (increased availability of fast foods) were reported to influence diet consumption among ALHIV. The adolescents' parents and caregivers similarly shared some of these views.

Conclusion: The findings suggest that both physical activity and diet consumption in ALHIV are influenced by multiple factors in the socio-ecological system. The community, parents and caregivers need to be engaged to provide support systems to address barriers to physical activity and diet consumption in ALHIV. Physical activity and nutrition education need to be integrated into HIV care programs and guidelines to emphasize these health behaviors in this population.