AIDS Research and Therapy最新文献

Co-infection with human immunodeficiency virus (HIV) and syphilis creates a clinical and diagnostic challenge due to overlapping transmission routes and immunosuppression secondary to HIV. We describe a case concerning possible serological rebound in syphilis, which may be attributed to delayed initiation of antiretroviral therapy (ART), although this was not confirmed by a repeat non-treponemal test. A 40-year-old man with HIV and symptomatic secondary syphilis delayed ART initiation in the setting of poor treatment adherence for three months after syphilis diagnosis. During that three-month delay, his toluidine red unheated serum test (TRUST) titer was noted to rebound from 1:32 to 1:128. After ART initiation, he achieved sustained viral suppression (< 20 cp/mL) and immune recovery (CD4 + T cell count: 577/µL) within eight months of ART initiation; however, his syphilis titer did stabilize at 1:32. There is a need for caution in evaluating whenever possible when two diseases share a diagnosis. Our case highlights may highlight possible effects of deferral of ART initiation on immunologic recovery and the serological response for syphilis, and a need for ongoing comprehensive follow-up and circumspection in evaluation of serological change overall. Interpretation was limited by the absence of parallel repeat TRUST testing and being unable to entirely rule out possible reinfection.

Objective: Women with HIV (WWH) have up to five times higher risk for cardiovascular disease compared to age-matched women without HIV, and this risk is pronounced in reproductive-aged women. Pregnancy promotes systemic inflammation, leading to remodeling of the heart's structure and changes in function during and after pregnancy; therefore, we sought to examine the association of pregnancy history and number of live births with changes in cardiac structure and function in women with and without HIV (WWoH).

Methods: Cross-sectional data from the Multicenter AIDS Cohort Study/Women's Interagency HIV Study Combined Cohort Study (MWCCS) were analyzed using univariate and multivariable logistic and linear regression models. Data from participants with echocardiograms conducted during or after their last pregnancy were included. The association between echocardiographic parameters and ever having had a live birth and number of live births was examined by HIV status.

Results: Of 1,646 women (1,156 WWH and 490 WWoH), 83% (n = 1,369) had a history of live births. Among WWH, ever having a live birth was associated with decreased left ventricular ejection fraction (β=-1.33, p = 0.014) and number of live births was associated with increased odds of diastolic dysfunction (OR = 1.14, p = 0.009). In WWoH, live births were significantly associated with increased left ventricular end-diastolic volume index (β = 0.64, p = 0.029).

Conclusion: In this study, live birth history was associated with small but significant changes in cardiac structure and function, with WWH showing greaterlikelihood of adverse echocardiographic changes. This highlights differential cardiac remodeling patterns by HIV status. Longitudinal studies are needed to assess the progression and clinical implications of these findings.

Introduction: Fundamental progress has been made in HIV care, and one of the major advances was the implementation of Differentiated Service Delivery (DSD) models. DSD models are important in reducing cost in resource-limited countries. However, evidence on the effectiveness of DSD models on stable Persons Living with HIV (PLWH) in comparison with conventional HIV care is limited. Thus, a systematic review and meta-analysis of randomized controlled trials was conducted to assess whether DSD models are more effective than conventional care in improving viral suppression, retention in care, and adherence among stable PLWH in Africa.

Methods: A comprehensive search was conducted using PubMed, Embase, Scopus, Cochrane, Research4Life, and Google Scholar. In this study, randomized controlled trials conducted on stable PLWH and reporting at least one of the patient's treatment outcomes (viral suppression, failure, attrition, retention in care, and adherence) were included. The quality of studies was assessed using the revised Cochrane risk of bias tool, and the heterogeneity among studies was assessed using forest plot and Cochran's Q test.

Results: This study showed that there was no difference in the viral non-suppression (Risk Ratio (RR) = 0.89, 95% CI: 0.74-1.07, I² = 7.47%, p = 0.37), non-retention in care (RR = 1.03, 95% CI: 0.68-1.57, I² = 90.37%, p < 0.001), and lost to follow-up (RR = 0.80, 95% CI: 0.31-2.06) between PLWH who enrolled in the DSD models and conventional care.

Conclusion: The DSD models have a comparable effect to the conventional care in maintaining sustained viral suppression and care engagement of PLWH.

Background: Loss to follow-up (LTFU) remains a major challenge in achieving sustained HIV care. Understanding individual and structural factors influencing disengagement is essential to improve retention, particularly in low- and middle-income settings. This study aimed to identify predictors of LTFU among adults receiving antiretroviral therapy (ART) in western Mexico.

Methods: A case-control study was conducted among adults with HIV treated at a tertiary hospital. Cases met the national definition of LTFU (≥ 90 days beyond the expected clinic visit or pharmacy refill), while controls were retained patients during the same period. A total of 919 participants were included (148 LTFU, 771 retained). Multivariable logistic regression identified factors associated with LTFU.

Results: Median age was 42 years (IQR 34, 51) and 88% were male. The multivariable analysis identified that age was associated with lower risk of LTFU (adjusted odds ratio [aOR] per year, 0.94; 95% CI, 0.91-0.96). Secondary ART resistance (aOR, 4.03; 95% CI, 1.59-9.99), hard-drug use (aOR, 2.57; 95% CI, 1.68-3.93), psychiatric disorders (aOR, 3.58; 95% CI, 2.23-5.72), lower educational level (≥ upper secondary vs. no formal education/primary: aOR, 2.30; 95% CI, 1.34-3.94), emergency department visits (aOR, 2.63; 95% CI, 1.72-4.04), and years living with HIV (aOR per year, 1.06; 95% CI, 1.02-1.10) were associated with higher odds of LTFU.

Conclusions: These findings highlight the role of psychosocial and structural determinants of LTFU, underscoring the need for integrated interventions addressing education, mental health, and substance use to improve retention in HIV care in Mexico.

To diagnose HIV-associated neurocognitive disorders (HAND), several neuropsychological test batteries have been used in various studies and countries. In Japan, the Co-developing Comprehensive Neuropsychological Test Battery (CoCoBattery) was developed during a nationwide study conducted between 2014 and 2016 (the J-HAND study) to explore the prevalence of HAND and has been widely used thereafter. It consists of 14 tests covering eight key cognitive domains: language, attention/working memory, executive function, learning, memory, information-processing speed, visuospatial construction, and motor skills. However, some cases have been difficult to classify in terms of HAND severity due to the lack of subjective impairment assessments in CoCoBattery. Therefore, we added cognitive screening questions to CoCoBattery (CoCoBattery-Plus) and compared the results among 103 HIV-positive individuals. Using the original battery, 10 cases were diagnosed with HIV-associated dementia (HAD), 13 with mild neurocognitive disorder (MND), 39 with asymptomatic neurocognitive impairment (ANI), and 41 with no HAND. In contrast, using the new battery, four individuals who were previously unaware of cognitive impairment reported subjective complaints in response to the questions, leading to diagnostic changes: one case from ANI to HAD and three from ANI to MND. The final diagnoses were 11 HAD, 16 MND, and 35 ANI, corresponding to a reclassification rate of 3.9%. Subjective complaints are a crucial component in determining the severity of HAND, and we anticipate that CoCoBattery-Plus will enable more accurate HAND diagnosis.

Background: The rising prevalence of extramarital sexual networking has led to increasing susceptibility to HIV infection among married couples. This study aimed to determine the prevalence of extramarital sex among married individuals in Mbarara Regional Referral Hospital, the factors linked to it and its relationship with HIV.

Methods: Data were collected using an interviewer-administered questionnaire. Participants were clients seeking HIV testing at a tertiary hospital in southwestern Uganda between June and September 2025. All clients received standard pre- and post-test counselling. Data was analyzed using Stata version 17.

Results: The study included a sample of 384 participants, with an almost equal distribution across the genders (50.3% female; 49.7% male). The prevalence of extramarital sex was 58.1% (95% CI: 0.51-0.65) among men and 8.2% (95% CI: 0.05-0.13) in women. Among those who reported extramarital sex, the prevalence of HIV was 10.5% (95% CI: 0.07-0.16) and 5.1% (95% CI: 0.03-0.13) for men and women respectively. An equal number (8) of men and women who denied involvement in extramarital sex were also diagnosed with HIV. The results suggested no relationship between extramarital sex and HIV (OR 0.9, 95% CI: 0.38-1.90, p = 0.7). However, women were found to be at an increased risk of acquiring HIV (RR = 2.02, 95% CI: 0.91-4.47) compared to men. Multivariate logistic regression identified the following factors to be linked to extramarital sex: being male (aOR = 16.4, 95% CI: 9.13-29.41, p < 0.001), monogamous marriage status (aOR = 3.2, 95% CI: 1.51 - 6.93, p = 0.002), marital duration exceeding 19 years (aOR = 3.8, 95% CI: 1.92 - 7.56, p < 0.001), being Muslim (aOR = 2.4, 95% CI: 1.04 - 5.49, p = 0.04), alcohol consumption (aOR = 3.5, 95% CI: 2.14 - 5.58, p < 0.001), sexual dissatisfaction among females (aOR = 11.1, 95% CI: 3.82-15.14, p < 0.001) and sharing workplace (aOR = 7.6, 95% CI: 0.96-61.01, p = 0.05). Conversely, factors negatively linked to extramarital sex in this study included identifying as female (aOR = 0.7, 95% 0.03-0.14, p < 0.001), and having no formal education (aOR = 0.3, 95% CI: 0.09 - 0.63, p = 0.003).

Conclusion: The study observed a high rate of extramarital sex in the study setting. This was a baseline study. Therefore, subsequent research is needed to identify the underlying reasons for seeking extramarital affairs in Southwestern Uganda.

Background: Central nervous system (CNS) infections are an important cause of morbidity and mortality among people living with HIV (PLWHIV), particularly in resource-limited settings. Cryptococcosis, toxoplasmosis and cerebral malaria often present with overlapping neurological symptoms, complicating diagnosis where confirmatory tests are unavailable. This study aimed to determine the prevalence and associated signs and symptoms of parasitic and fungal infections with neurological tropism in PLWHIV hospitalized in Libreville.

Methods: A retrospective review was conducted at the Infectious Diseases Ward of the Centre Hospitalier Universitaire de Libreville (IDW-CHUL) between April and September 2021. Data were recorded from the medical files of PLWHIV hospitalised for suspected cryptococcal meningoencephalitis presenting with fever and headache alone or associated with other neurological signs. Diagnoses of cryptococcosis, toxoplasmosis, and malaria were based on microscopy, cryptococcal antigen testing, and brain CT scan. Cases of tuberculosis, other bacterial or viral meningitis were not included. Sociodemographic, clinical, and immunological data were analysed, and associations between symptoms and CNS infections were assessed.

Results: Among 255 hospitalised PLHIV, most were aged under 55 years (86.3%, n = 220), female (72.5%, n = 185), and severely immunosuppressed (CD4 < 200 cells/mm³, 57.2%, n = 127). Parasitic or fungal infections were identified in 32.9% (n = 84) of cases: cryptococcosis (14.5%), cerebral toxoplasmosis (13.7%), and complicated malaria (9.8%), with 5.1% presenting co-infections. Advanced HIV disease (WHO stage III-IV) was significantly associated with cryptococcosis and toxoplasmosis (p < 0.01). Fever and headache (81.2%, n = 207) were the most common symptoms. According to diagnosis, fever, headache, seizures, and/or focal deficits were more suggestive of toxoplasmosis (cOR 3.5, 95%CI [1.0-12.4], p = 0.05), while prostration was more frequent in malaria (cOR 2.9, 95%CI [0.98-9.0], p = 0.05), and neck stiffness was characteristic of cryptococcosis.

Conclusion: Parasitic and fungal CNS infections remain frequent and severe in hospitalised PLWHIV in Libreville, mainly in advanced disease with profound immunosuppression. In the absence of diagnostic tools, recognition of symptom clusters may guide syndromic triage and empirical therapy.

Background: Meningovascular neurosyphilis is a rare but treatable cause of ischemic stroke, typically affecting younger individuals without traditional vascular risk factors. Diagnosis is often missed because of nonspecific presentations, coexisting conditions, and delayed diagnostic confirmation. In people living with HIV, it may progress despite antiretroviral therapy, creating further uncertainty in clinical evaluation.

Case presentation: We report a A 48-year-old man with well-controlled HIV presented with acute focal deficits following a short prodrome of headache and fever. Neurological examination revealed right-sided weakness (MRC grade 2/5) and NIHSS score of 11. Initial laboratory testing and CT imaging were unrevealing. MRI suggested a vasculitic process, and cerebrospinal fluid studies confirmed neurosyphilis.

Discussion: This case illustrates the diagnostic challenge of stroke in an HIV-positive patient with viral suppression and no conventional vascular risks. In a resource-limited setting, timely use of MRI and CSF analysis guided appropriate management. The patient improved markedly on a 14-day course of intravenous ceftriaxone when penicillin was unavailable.

Conclusion: Clinicians should maintain suspicion for meningovascular neurosyphilis in HIV-positive patients presenting with stroke-like deficits regardless of virologic suppression or absence of conventional vascular risk factors. MRI and CSF evaluation are crucial where diagnostic uncertainty persists, and ceftriaxone is an effective alternative when penicillin cannot be accessed. Despite significant neurological recovery, management conclusions cannot be generalized from a single case.