AIDS Research and Therapy最新文献

Introduction: Hospitalized people living with HIV (PLWH) experienced extremely high mortality rates in the first year after an index hospitalization in the pre-Dolutegravir (DTG) era. We conducted a multi-center study in Mwanza, Tanzania to (1) describe causes of hospitalization for PLWH on DTG; (2) determine in-hospital and 3-month post-hospital mortality; (3) examine factors associated with overall mortality; and (4) determine changes in trends and predictors of mortality pre- and post-DTG era.

Methods: Between August 2020 and February 2021, hospitalized PLWH on dolutegravir-based antiretroviral therapy were enrolled and followed for three months after hospitalization. The primary outcome was mortality within 3-months of hospitalization. Cox regression analysis was used to calculate hazard ratios to identify predictors of mortality.

Results: Of the 154 enrolled patients, the median [interquartile range] age was 42 [33-50] years and 57% were female. Suspected immune reconstitution inflammatory syndrome (IRIS) and antiretroviral therapy (ART) non-adherence leading to an HIV-associated admission were common. The overall all-cause mortality was 42%. Male sex, using DTG-based regimen for < 3 months, diagnosis of suspected IRIS, diagnosis of ART side effect, advanced WHO clinical stage, CD4 count < 200 cells/mm³, hemoglobin level 7-11.9 gm/dl and hemoglobin level < 7 gm/dl were all independent risk factors for death.

Conclusion: In conclusion, the mortality rate of hospitalized PLWH in Africa remains high in the DTG era. Clinical trials are urgently needed to test novel interventions for improving survival in this high-risk group. In the meantime, hospital clinicians should be aware of the very high mortality among PLWH with IRIS and those with ART side effect to ensure that all possible diagnostic and therapeutic options are explored.

Background: In January 2021, the United States (US) Food and Drug Administration (FDA) approved the first long-acting injectable antiretroviral therapy (LAI ART) regimen for the treatment of HIV providing an alternative to daily oral regimens. We analyzed electronic health records (EHRs) to provide real-world evidence of demographic and clinical characteristics associated with the receipt of LAI ART among people with HIV (PWH).

Methods: Leveraging EHRs from a large clinical research network in the Southern US - OneFlorida + linked with Medicaid (updated to 08/2022) - we identified a cohort of PWH who have been prescribed at least one dose of LAI ART since January 2021 and characterized their demographics, clinical characteristics, and HIV care outcomes.

Results: A total of 233 LAI ART recipients were identified: 56.7% female, 45.1% aged 30 to 44, 51.3% non-Hispanic Black, 78.1% on Medicaid and 4.7% on private insurance. Approximately three-quarters of injections (71.2%) were received within 37 days of the previous dose, and 84.4% were received within 67 days. About 8% of LAI ART recipients did not have optimal care engagement the year before LAI ART initiation; one in five recipients had a diagnosis of alcohol or substance use disorder in lifetime. All achieved viral suppression (< 50 copies/mL) before starting LAI ART. Of a subset of patients with HIV viral load test records, only 1 record of virologic failure (viral load > 200 copies/ml) was observed after the initiation of LAI ART.

Discussion: There has been an increasing trend of LAI ART initiation since approval. People with suboptimal care engagement and with substance use disorder in lifetime were not excluded from LAI ART treatment.

Over the years, Nigeria has recorded significant progress in controlling the HIV epidemic in the country. HIV prevalence has reduced from 4.1% in 2010 to 1.4 in 2019. The number of people acquiring new HIV infections decreased from 120,000 in 2010 to 74,000 in 2021, and HIV-related deaths decreased from 82,000 in 2010 to 51,000 in 2021. However, the country still faces challenges such as high HIV transmission among key populations (KP) who account for 11% of new HIV infections. Over the years, the government and development partners involved in HIV response efforts in Nigeria have been establishing and scaling up access to services to help address the needs of KPs. Initially, services for KPs as with the general population in Nigeria were largely preventive. Treatment of PLHIV in Nigeria commenced in 2002 and has increased from about 15,000 to more than 1.78 million PLHIVs in 2023. Despite this progress in treatment coverage, however, KPs are not equitably covered. To address this gap, the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) launched an ambitious initiative-the Key Population Investment Fund (KPIF)-to target the unaddressed HIV-related needs of key populations (KPs) who are disproportionately affected by HIV. The KPIF initiative was implemented through partner organizations such as the Society for Family Health (SFH), a KP-friendly and indigenous non-governmental organization. Earlier, the program implemented by SFH was largely an HIV prevention program. SFH's transformation, transition, and growth to a comprehensive HIV prevention, care, and treatment service provider was necessary to bridge the gap in the needed expansion of HIV services to adequately meet the care needs of KPs and scale up programs. Therefore, this paper's aim is to share experiences in the transformation of SFH into a comprehensive HIV prevention, treatment, and care service provider in the hope that it may serve as a lesson for organizations with similar objectives.

The global HIV epidemic remains a major public health challenge, with DTG playing a key role in ART regimens due to its efficacy and tolerability. This study evaluated virological outcomes and resistance mutations in patients on DTG in Mozambique through a retrospective cohort study in seven DREAM centers. Data from 29,601 patients (98.1% on DTG) revealed a virological suppression rate of 95% (27,622/29,051). Factors positively associated with suppression included age > 50, longer ART duration, and being female. Of 17 resistance tests, 8 showed major mutations, including G118R and E138K. Results highlight DTG's effectiveness and the need for resistance surveillance.

Introduction: Dietary diversity is the utilization of food and food groups consumed by individuals over 24 h, which is an indicator of a diet's micronutrient adequacy. Dietary management in people with HIV patients is the key to sustaining their day-to-day activities and contributing to their lively hood. The level of dietary diversity among HIV-positive patients in Ethiopia shows considerable variation, ranging from 29 to 71.3%. This study aimed to assess the pooled prevalence of low dietary diversity and associated factors among HIV-positive patients attending ART clinics in Ethiopia.

Method: Multiple international database searching methods (articles found in PubMed/MEDLINE, Google scholar Africa, Hinari journal online, Embase, Scopus) and Ethiopian university repository online have been covered in this systemic review and meta-analysis. Data were extracted using Microsoft excel and analyzed by using the Stata version 14 software program. The heterogeneity between studies and publication bias was detected by using the I² test and a funnel plot test respectively.

Results: The pooled prevalence of low dietary diversity among People with HIV patients on antiretroviral therapy in Ethiopia was 55.9% 95% CI (45.73, 66.09) based on the random effect analysis. This systemic review and meta-analysis showed that only HIV positive patients with an antiretroviral therapy duration of less than one year (AOR = 2.3, 95% CI 1.3, 4.1), and having low wealth quintile (AOR = 2.5, 95% CI 1.5, 4.4) were factors significantly associated with low dietary diversity among People with HIV patients on ant-retroviral therapy clinics of Ethiopia.

Conclusion and recommendation: The overall pooled prevalence of low dietary diversity among People with HIV patients attending antiretroviral therapy clinics in Ethiopia was high. We strongly recommend holistic nutritional interventions to address nutritional problems and promote the overall health status of HIV-positive patients in Ethiopia.

Background: Early detection and initiation of care is crucial to the survival and long-term well-being of children living with HIV (CLHIV). However, there remain challenges regarding early testing and linking of CLHIV for early treatment. This study examines the progress made towards achieving the 95-95-95 HIV indicators and associated factors among CLHIV < 15 years in South Africa.

Methods: The data was collected as part of the 2017 cross-sectional, multistage cluster randomized population-based household National HIV survey. Age-appropriate structured questionnaires were utilized to gather sociodemographic data, HIV-related knowledge, risk behaviours, and health-related information. Blood samples were collected to test for HIV serology, viral load suppression, and antiretroviral usage. Backward stepwise multivariable generalized linear regression models were fitted to identify factors associated with the 95-95-95 HIV indicators. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) are shown, and p < 0.05 indicates statistical significance.

Results: A total of 12,237 CLHIV < 15 years were included (median 8 years, interquartile range 4-11 years). HIV prevalence was 2.8% (95% CI: 2.4-3.3). Overall, 40.0% of the CLHIV were tested and knew their status (first 95%), and among these, 72.6% (95% CI: 61.7-81.3) were on antiretroviral therapy (ART) (second 95%), and 95.0% (95% CI: 88.4-97.9) of these were virally suppressed (third 95%). Among CLHIV, the odds of testing and knowing the HIV-positive status were significantly higher among children whose health was rated as fair/poor than excellent/good [AOR = 1.32 (95%CI: 1.05-1.67), p = 0.022], and were significantly lower among females than males [AOR = 0.82 (95% CI: 0.71-0.95), p = 0.009], and were significantly lower among those attending private healthcare facilities than public health facilities [AOR = 0.64 (95% CI:0.57-0.74), p < 0.001]. Among those who knew their HIV-positive status, the odds of being on ART were significantly higher among children residing in farm areas than urban areas [AOR = 1.40 (95% CI:1.05-1.86), p = 0.017], and were significantly lower among children attending private healthcare facilities [AOR = 0.44 (95% CI:0.36-0.54), p < 0.001].

Conclusions: Awareness of HIV status and initiation of treatment in children was low. The findings highlight the need to improve HIV status awareness and disclosure to children. The findings underscore the need for targeted interventions and programs tailored for CLHIV in urban areas.

Over the past decade, Venezuela has experienced a political and economic crisis that has affected the country's scientific research development. Currently, the state of HIV research in Venezuela remains unknown. We conducted a systematic review identifying 683 articles over the last 20 years of which only 101 met our inclusion criteria. A decrease in national scientific production was observed starting in 2017, although there was an increase in foreign research on the Venezuelan migrant population. Knowledge gaps were identified in areas such as epidemiology, efficacy and resistance to antiretroviral therapy, and HIV in pregnancy.

Introduction: Female sex workers (FSWs) in Uganda experience numerous barriers to antiretroviral therapy (ART) adherence. We used the planned behavior theory to help explore the enablers and barriers to ART adherence among FSWs. Understanding the barriers to ART adherence may help contribute to the development of interventions to improve ART adherence among the FSWs.

Materials and methods: A descriptive qualitative study was conducted in Fort portal City. We conducted 30 in-depth interviews among FSWs who had been taking ART for at least six months. Furthermore, six key informant interviews were conducted with healthcare workers and leaders of the FSWs initiative. Data collection lasted for two months. Thematic deductive analysis was applied to analyse the data through the lens of the theory of planned behavior.

Findings: The attitudes, subjective norms, and perceived behavioral control influenced adherence to ART. Positive attitudes including perceived benefits of ART, and experiencing positive outcomes from taking ART were seen to enable its adherence. Subjective norms such as social support, disclosure of HIV status, seeing others take ART, and aspirations of longer life enabled ART adherence. Taking ART in the morning, responsive and respectful healthcare workers, and availability of food/basic needs facilitated compliance with ART adherence. Negative attitudes such as misconceptions and fear of side effects hindered ART adherence. Social disapproval of sex work and or HIV, lack of social support, gender-based violence, non-disclosure, stigma, and abandonment hindered the use of ART among FSWs. Socio-economic constraints (e.g., food scarcity), and occupation-related factors (substance use, incarceration, busy and predictable schedules, and abrupt migrations) were the additional barriers to ART adherence.

Conclusion: ART adherence among FSWs was influenced by attitudes, subjective norms, and perceived behavioral control. Addressing these barriers in ART adherence through targeted interventions could facilitate ART adherence and improve health outcomes among FSWs.

Introduction: The introduction of the HIV self-test kit in the early 2000s was a major breakthrough in combating HIV. This study determines the social demographic and sexual behaviour driving the use of HIV self-test kits.

Method: The study used secondary data obtained from Tanzania DHS-MIS 2022. The survey uses a stratified two-stage sample design. The first stage involved the selection of clusters consisting of enumeration areas, and in the second stage of sampling, 26 households were selected from each cluster.

Results: The mean age = 28.6 years. Usage of HIV self-test kits was found to be low (3.9%). The odds of using HIV self-test kits were 2.2 and 6.6 times more likely among those with primary (aOR = 2.2, 95%CI = 2.2-2.3) and secondary (aOR = 6.6, 95%CI 6.6-6.7) education compared to those without education respectively. As age increases, the odds of using HIV self-test kits increases. Men residing in rural areas were about 40% less likely to use HIV self-test kits compared to those dwelling in urban areas (aOR = 0.6, P < 0.0001).

Conclusion: Significant demographic and sexual behaviour factors associated with the usage of HIV self-test kits include sex of household head, education level, marital status, wealth status, age, ever heard of sexually transmitted infection and condom use during sexual intercourse. HIV self-test kits were used more in urban areas than in rural areas. It is essential to raise awareness and improve access to HIV self-test kits for less informed populations, such as those living in rural areas.

Background: Thyroid disorders have significant clinical sequelae, including impaired growth in children, metabolic abnormalities, and impaired cognitive function. However, available studies on burden of thyroid diseases in people with human immunodeficiency virus (HIV), particularly its prevalence and its interaction with HIV related factors (like CD4 count), are controversial. This review aimed to provide a comprehensive summary and analysis on the extent of thyroid dysfunctions in this population.

Methods: Following Preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines, a comprehensive search was done through Medline/PubMed, Web of Science, Science Direct, and World Health Organization Virtual Health Library Regional Portal. Using Comprehensive Meta-Analysis Software version 3.3, we calculated the pooled prevalence and standardized mean difference (SMD) estimates with 95% confidence intervals (CIs).

Results: A total of 30 studies met the eligibility criteria and were further included for the analyses. The most common types of thyroid dysfunction identified among HIV patients were subclinical hypothyroidism (7.7%), overt hypothyroidism (2.7%), sick euthyroid syndrome (2.47%), isolated low FT4 (1.80%), and overt hyperthyroidism (0.7%). Hypothyroidism among HIV patients was significantly associated with lower CD4 count (p < 0.001). The analysis revealed that only FT4 levels had significant differences between patients with HIV and healthy people (p = 0.013).

Conclusion: Individuals with HIV are at risk of developing variable manifestations of thyroid abnormalities. While being not abundant in the HIV population, monitoring of thyroid dysfunction is essential due to the potential for progression to overt hypothyroidism and associated adverse health outcomes.