AIDS Research and Therapy最新文献

Background: Disclosing HIV status to children with HIV (CWHIV) is associated with improved antiretroviral therapy (ART) adherence, quality of life, and psychosocial well-being in many sub-Saharan Africa. However, little is known about this in Tanzania. We determine the prevalence of HIV status disclosure and its association with health-related quality of life (HRQOL) and depressive symptoms in CWHIV in the Tanga Region, Tanzania.

Methods: A cross-sectional study was conducted in 11 public HIV clinics among caregiver-CWHIV pairs in 2023. Data were collected on socio-demographic, child's HIV disclosure, depressive symptoms, ART adherence, and HRQOL. Multiple linear and negative binomial regression analyses assessed associations between independent variables (HIV disclosure/other factors) and HRQOL (primary outcome), and depressive symptoms (secondary outcome), respectively.

Results: Two hundred and seventy-eight CWHIV aged 8-14 years and their caregivers were enrolled. Most caregivers (80.58%) were female. Three-quarters (75.90%) of CWHIV knew their HIV status. Two-thirds (68.71%) of CWHIV reported adherence to ART. HIV disclosed versus non-disclosed CWHIV had 4.57 units higher HRQOL (coefficient = 4.57, 95% CI: 0.87, 8.27; p = 0.016). Higher depression scores (coefficient = -1.09, 95% CI: -1.30, -0.87; p < 0.001 and ART non-adherence (coefficient = -4.27, 95% CI: -7.07, -1.48, p = 0.003) were inversely associated with HRQOL. There was no significant association between HIV disclosure and depressive symptoms, whereas ART non-adherence was significantly associated with higher depressive symptom scores (coefficient = 0.28, 95% CI: 0.06, 0.49, p = 0.013).

Conclusion: HIV disclosure was associated with better HRQOL but not with any worsened depressive symptoms. Interventions that promote HIV status disclosure at the recommended age are therefore important in the care of CWHIV.

Background: As a chronic disease, effective HIV self-management is crucial for men who have sex with men (MSM) living with HIV. Psychosocial factors, including perceived stress and self-regulatory fatigue, have been shown to negatively impact self-management behaviors. However, research on the relationships among perceived stress, self-regulatory fatigue, and self-management behaviors remains limited. This study aimed to explore the mediating effect of self-regulatory fatigue in the relationship between perceived stress and self-management behaviors among MSM living with HIV in China.

Methods: From December 2024 to March 2025, cross-sectional data were collected from 328 MSM living with HIV at an HIV-designated hospital in Jiangsu Province using convenience sampling. Data were collected using the Perceived Stress Scale, Self-Regulatory Fatigue Scale, and HIV Self-Management Scale. Descriptive statistics, univariate analysis, and Pearson correlation analysis were performed in this study. The mediating effect of self-regulatory fatigue in the relationship between perceived stress and self-management behaviors was assessed using Model 4 of the PROCESS macro for SPSS.

Results: Among 328 MSM living with HIV, the average score of perceived stress was 30.67 ± 7.87, the average self-regulatory fatigue score was 43.99 ± 8.76, and the average HIV self-management score was 36.65 ± 7.88. Perceived stress was positively related to self-regulatory fatigue (r = 0.544, p<0.05), whereas self-management behaviors were proven to be negatively associated with perceived stress (r = -0.486, p<0.05) and self-regulatory fatigue (r = -0.504, p<0.05). Self-regulatory fatigue partially mediated the association between perceived stress and self-management behaviors, accounting for 34.39% of the total effect.

Conclusion: This study demonstrated that self-regulatory fatigue partially mediated the relationship between perceived stress and self-management behaviors and underscored the importance of designing targeted interventions aimed at reducing perceived stress and self-regulatory fatigue to improve self-management behaviors among MSM living with HIV in China. Multidimensional strategies, achieved through collaborative efforts among patients, healthcare providers, government, and community, should incorporate personalized mental care and stress management, available social support, trained peer navigation, and consistent health education.

Background: Adolescents living with HIV experience persistent challenges in achieving optimal adherence to antiretroviral therapy (ART), threatening viral suppression and long-term treatment success. In sub-Saharan Africa, including Ethiopia, developmental transitions, limited resources, and socio-cultural factors further complicate adherence. This study aims to develop and validate a model of antiretroviral therapy (ART) adherence determinants among Ethiopian adolescents living with HIV by extending the information-motivation-behavioral skills (IMB) model through the integration of HIV-related stigma as an additional construct, given its significant influence on adherence in this population.

Methods: A cross-sectional study was conducted from March to October 2024 among 219 adolescents living with HIV in ALERT hospital, Addis Ababa. The data were analyzed via SPSS and the lavaan 0.6-18 package in R. The pathways through which the study constructs influenced ART adherence were estimated via the diagonally weighted least squares (DWLS) method. Model fit was evaluated via the chi-square to degrees of freedom ratio (χ²/df), comparative fit index (CFI), Tucker-Lewis index (TLI), and root mean square error of approximation (RMSEA).

Results: A total of 210 adolescents were included in the final analysis, of whom 68.6% were adherent to ART. The proposed model demonstrated excellent fit to the data (χ²/df = 1.23, CFI = 0.99, TLI = 0.98, RMSEA = 0.033). Treatment self-efficacy mediated the effects of ART knowledge and ART attitude on ART adherence. While social support exerted both significant direct (β = 0.20, p = .029) and indirect effects via treatment self-efficacy, resulting in a significant total effect on ART adherence (β = 0.26, p = .004), HIV-related stigma did not demonstrate significant direct or indirect effects on ART adherence.

Conclusion: Interventions that strengthen ART-related knowledge, foster positive treatment attitudes, enhance social support, and build treatment self-efficacy may substantially improve ART adherence among adolescents living with HIV.

Second-line antiretroviral therapy (ART) failure remains a challenge in HIV Programs. We conducted a cross-sectional study among people living with HIV on second-line ART in Eastern Uganda to determine the prevalence and associated factors of virological failure and to assess elevated serum bilirubin as a surrogate marker of adherence. The prevalence of virological failure was 7.5%. Elevated bilirubin showed poor sensitivity and specificity for predicting adherence or virological failure. The findings highlight the need for routine viral load monitoring, as bilirubin is not a reliable surrogate marker of treatment adherence or virological failure.

Background: People with HIV (PWH) have disproportionately high hospitalization rates, the reasons for which are incompletely understood. Hospitalization reasons based on International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) discharge codes may lead to misclassification. We evaluated the performance of ICD-based reason for hospitalization with adjudication in PWH.

Methods: We randomly sampled 302 of 1428 hospitalizations (21%) between 2016 and 2019 among PWH in the UNC CFAR Clinical Cohort Study (UCHCC). ICD-based reason was defined as first-listed ICD discharge diagnosis, or second if the principal diagnosis was HIV. We contrasted ICD-based reason and adjudication with four outcomes: complete agreement (same category and diagnosis), partial agreement (same category, different diagnosis), disagreement (different category and diagnosis), and inadequate ICD coding (no single ICD-10-CM code was appropriate).

Results: Overall the 302 hospitalizations occurred among 204 PWH, 69% of whom were male, with median age 51 years (interquartile range [IQR], 40-58), and CD4 count 539 (IQR, 242-789), at time of hospitalization. Adjudication completely agreed with ICD-based reason in 73% hospitalizations, partially agreed in 14%, disagreed in 8%, and ICD codes were inadequate in 6%. Patient characteristics associated with lower proportion of complete or partial agreement were recent CD4 count < 200, nadir CD4 < 50, ≥ 15 discharge diagnoses, length of stay ≥ 4 days, and HIV as a principal diagnosis.

Conclusions: Overall ICD codes performed well in capturing reason for hospitalization in most cases. However, adjudications are needed among certain groups of patients, including those with poorly controlled HIV and complex hospitalization course.

Introduction: Despite global efforts to reduce HIV-related stigma, discriminatory attitudes toward people living with HIV/AIDS (PLHIV) remain widespread, especially in Sub-Saharan Africa. This study aimed to assess the prevalence and determinants of discriminatory attitudes toward PLHIV in five East African countries using Demographic and Health Survey (DHS) data from 2019 to 2023.

Methods: A cross-sectional, secondary data analysis was conducted using DHS data from Kenya, Madagascar, Mozambique, Rwanda, and Tanzania. A total weighted sample of 106,639 sexually active individuals aged 15-49 was included. Discriminatory attitudes were assessed based on responses to two standard DHS questions. Multilevel logistic regression models were used to identify factors associated with discriminatory attitudes at both individual and community levels.

Results: The overall prevalence of discriminatory attitudes toward PLHIV was 34.03% (95% CI 33.74, 34.31). Country-specific prevalence ranged from 12.98% in Rwanda to 76.18% in Madagascar. Key factors significantly associated with discriminatory attitudes included lower wealth status (AOR = 2.12, CI 1.73, 3.80), having multiple sexual partners (AOR = 2.11, CI 1.97, 2.60), and being unemployed (AOR = 3.10, CI 2.06, 3.70).

Conclusion: Discriminatory attitudes toward PLHIV remain high in East Africa, particularly among economically disadvantaged, unemployed individuals and have multiple sexual partners. Integrated interventions targeting socio-economic inequalities, sexual health education, and employment opportunities help reduce discriminatory attitudes toward PLHIV.

Background: The role of body mass index (BMI) as an effect modifier for readmission risk in people with HIV (PWH) remains underexplored.

Objective: To compare factors associated with two-year all-cause readmission in PWH, stratified by baseline BMI.

Methods: A retrospective matched (1:1 by age/sex) cohort study was conducted at a major public infectious diseases hospital in Shenzhen, China, serving a diverse urban population including migrants and low-income individuals. Adults admitted (Jan-Jun 2020) were stratified into underweight (BMI < 18.5 kg/m², n = 80) and normal/overweight (BMI 18.5-<28 kg/m², n = 231) groups. Multivariable logistic regression and ROC analysis were performed within each stratum.

Results: The readmission rate was higher in the underweight group (61.3% vs. 46.8%, p = 0.023). For underweight PWH, unemployment (adjusted Odds Ratio [aOR] = 8.11, 95% CI 1.82-36.16) and lower nadir CD4 + count (aOR = 0.994 per cell/µL decrease, 95% CI 0.989-0.999) were independent risk factors. For normal/overweight PWH, unemployment (aOR = 2.21, 95% CI 1.12-4.38) and longer time since diagnosis (> 5 vs. 0-1 years, aOR = 4.28, 95% CI 2.02-9.07) were risk factors, while being widowed/divorced was protective (aOR = 0.30, 95% CI 0.10-0.86). Predictive models showed good to excellent accuracy (AUCs: 0.820 and 0.748, respectively).

Conclusions: Risk factors for readmission differ markedly by baseline BMI, confirming its role as an effect modifier. Interventions should be tailored: integrated nutritional and immunological support for underweight PWH, and chronic disease management with attention to social determinants for others.

Background: Adolescent girls and young women (AGYW) in sub-Saharan Africa face socio-economic and gender-related factors that heighten risk of HIV infection. We examined HIV risks and vulnerabilities among AGYW enrolled in the Determined Resilient Empowered AIDS-free Mentored and Safe (DREAMS) program in Zambia.

Methods: AGYW aged 10-24 years were screened at enrollment in DREAMS using a standardized tool assessing exposure to sexual and reproductive health risks, gender-based violence, and orphanhood. We analyzed 24 months of data (October 2020-September 2022) from six centers in Southern and Western Provinces. We characterized age-disaggregated risks and used multivariable logistic regression to examine associations with engagement in HIV-related clinical services.

Results: Among 63,118 AGYW screened, 34.9% were aged 10-14 years, 50.7% aged 15-19 years, and 14.4% aged 20-24 years. Emotional or physical violence (78.0%) and orphanhood (22.3%) were most common among girls aged 10-14 years. Among AGYW 15-19 years, top risks included no/irregular condom use (58.1%), orphanhood (29.2%), multiple partners (23.5%), and transactional sex (20.1%). In the 20-24 years group, 83.5% reported no/irregular condom use, with 29.9% reporting multiple partners and 23.0% transactional sex. Clinical service engagement was positively associated with being out of school, sexually active, using drugs/alcohol, and reporting prior pregnancy, STIs, or multiple sexual partners.

Conclusion: Socio-economic vulnerabilities were common among younger AGYW in Zambia, while older AGYW reported high levels of behavioral HIV risk. DREAMS reached vulnerable and at-risk AGYW in Zambia, representing an opportunity to reduce HIV acquisition through targeted prevention services.