AIDS Research and Therapy最新文献

Background: Viral suppression among children living with HIV remains suboptimal in sub-Saharan Africa. The marked heterogeneity in suppression rates across countries underscores the need for comparative analyses to elucidate context-specific determinants. This systematic review aims to synthesize existing evidence on factors associated with unsuppressed viral loads in paediatric populations.

Methods: A systematic review was conducted to examine viral load suppression among children under 15 years in sub-Saharan Africa. Comprehensive searches were performed across four major databases: PubMed, Google Scholar, Embase, and Web of Science. Eligible studies were published in English between 2010 and 2024, focused exclusively on paediatric populations in Africa, and available in full text. Relevant data were systematically extracted and compiled in a structured Excel database to prevent duplication and facilitate rigorous, methodologically sound analysis.

Results: Of the 161 articles initially identified, 16 met the predefined inclusion criteria for this review. These studies were conducted across multiple sub-Saharan African countries and used various methodological designs. The most frequently reported factors associated with an unsuppressed viral load among children receiving antiretroviral therapy (ART) were suboptimal treatment adherence, malnutrition, low maternal educational attainment, a high baseline viral load, and missed clinical appointments. Adherence to ART was the most extensively analysed variable, and poor adherence was consistently and strongly associated with virological failure.

Conclusion: Viral suppression among children living with HIV in sub-Saharan Africa remains unacceptably low. This review emphasized key preventable factors mostly poor adherence. Targeted, urgent interventions are needed to improve outcomes for this vulnerable population.

Background: Comprehensive HIV/AIDS knowledge is essential for prevention, yet older adults-particularly men aged 50-59 years-remain underrepresented in HIV research and programming across sub-Saharan Africa. Despite Rwanda's strong HIV response, limited evidence exists on HIV knowledge among older men. This study assessed the prevalence and determinants of comprehensive HIV/AIDS knowledge among Rwandan men aged 50-59 years. The analysis was guided by a conceptual framework incorporating predisposing, enabling, and contextual factors that shape HIV knowledge among older men.

Methods: This cross-sectional study used data from the 2019-20 Rwanda Demographic and Health Survey (RDHS), analyzing a weighted sample of 665 men aged 50-59 years. Comprehensive HIV knowledge was defined using six standard DHS indicators. Weighted descriptive statistics, bivariable analyses, and multivariable logistic regression were conducted to identify associated factors, adjusting for the survey design. Results are presented as adjusted odds ratios (AORs) with 95% confidence intervals (CIs).

Results: Overall, 69.9% (95% CI: 66.2-73.4%) of men aged 50-59 years demonstrated comprehensive HIV/AIDS knowledge. In adjusted analyses, having secondary education (AOR = 3.18; 95% CI: 1.31-7.75) and health insurance coverage (AOR = 1.71; 95% CI: 1.07-2.73) were significantly associated with higher odds of comprehensive knowledge. Other factors, including mobile phone ownership and internet use, were not significant after adjustment.

Conclusions: Comprehensive HIV knowledge among Rwandan men aged 50-59 years remains below global prevention targets. Education and health insurance coverage were the most important enabling factors, consistent with the study's conceptual framework. Integrating HIV education into aging-friendly and insurance-linked health services may strengthen awareness and support Rwanda's continued progress toward HIV prevention goals.

The Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) have remained global public health issues, especially in sub-Saharan Africa, with Nigeria having the highest number of cases. There is limited evidence on the relationship between comprehensive HIV/AIDS knowledge and behaviour change among young people. This study examined the influence of comprehensive HIV/AIDS knowledge on safe sex practices among young people in Nigeria. The study analysed pooled anonymised data from the 2008, 2013, and 2018 Nigeria Demographic and Health Surveys, using a weighted sample of 3,204 never-married but sexually active young people aged 15-24, with Stata software (version 15). Descriptive and analytical analyses, including frequency distributions and multivariate logistic regression models, were conducted. The study established that comprehensive HIV/AIDS knowledge remains low among young people, with gender disparities, and a higher proportion of young males using condoms than females between 2008 and 2018. Comprehensive HIV/AIDS knowledge is significantly linked to condom use among sexually active young people, with males 47% (aOR: 1.47) having higher odds of condom use than females 42% (aOR: 1.42). To combat HIV/AIDS, policymakers should launch targeted initiatives that boost knowledge and encourage safe sex practices, focusing on underserved communities. This could be actived through school programmes, community outreach, and digital campaigns, while also partnering with faith-based groups to reach more vulnerable populations, especially young people.

Background: This study investigated kidney dysfunction among people with HIV (PWH), comparing those with and without hepatitis B virus (HBV) co-infection. We further identified predictors of kidney dysfunction in PWH with HBV.

Methods: Adult PWH in the TREAT Asia Observational Database-Low Intensity TransfEr cohort, who were on antiretroviral therapy, with follow-up after 2010 were included. HBV co-infection was defined by positive hepatitis B surface antigen. Kidney dysfunction was determined as a single estimated glomerular filtration rate < 60mL/min/1.73m². Kaplan-Meier curves were used to evaluate cumulative incidence of kidney dysfunction, and we used Cox proportional hazards model to analyze factors associated with kidney dysfunction in PWH with HBV.

Results: Among 23,415 participants (median age = 37 years; interquartile range [IQR]: 31-43), most were male (62.2%), from lower-middle income countries (67.1%), and reported heterosexual HIV transmission (79.3%). The median follow-up time was 5.41 years (IQR: 2.05-8.67). The majority were prescribed NRTI + NNRTI (83.6%), and 4.9% had HBV co-infection. Overall, 8.0% had kidney dysfunction, with a higher proportion among PWH with HBV than those without HBV (14.8% vs. 7.6%, p < 0.001). Most cases of kidney dysfunction were stage III (84.2%). Factors associated with kidney dysfunction in PWH with HBV included older age (≥ 50 years: Hazard ratio [HR] = 6.45, 95%CI: 2.31, 18.04) compared to 18-29 years, higher income country (upper-middle income: HR = 1.78, 95%CI: 1.16, 2.74) compared to lower-middle income, low platelet counts (< 150 × 10⁹/L: HR = 2.82, 95%CI: 1.85, 4.31) compared to normal platelets, and ART regimens (NRTI + NNRTI: HR = 0.43, 95%CI: 0.27, 0.70; NRTI + PI: HR = 0.60, 95%CI: 0.36, 1.01) compared to NRTI + INSTI. Higher CD4 counts (200-349 cells/µL: HR = 0.53, 95%CI: 0.31, 0.93; 350-499 cells/µL: HR = 0.45, 95%CI: 0.26, 0.79; ≥500 cells/µL: HR = 0.33, 95%CI: 0.20, 0.56) compared to < 200 cells/µL were associated with lower risk of renal dysfunction. There was no significant difference in kidney dysfunction between those on TDF and TAF (HR = 0.55, 95%CI: 0.25, 1.23).

Conclusions: A high prevalence of kidney dysfunction was observed among PWH with HBV co-infection in the Asia-Pacific. Renal screening and monitoring should prioritize PWH with HBV with older age, low platelets and CD4 counts in low-resource settings.

Introduction: Para-Kala-Azar Dermal Leishmaniasis (para-KDL) is a rare manifestation of leishmaniasis that occurs concurrently with active Visceral Leishmaniasis (VL). It is characterized by a combination of cutaneous and systemic symptoms, posing diagnostic and therapeutic challenges. This condition is even more complex in immunocompromised patients, such as those with HIV.

Case presentation: We report a case of a 52-year-old male from south of Iran, who presented with prolonged fever, severe weight loss, pancytopenia, and massive splenomegaly. The patient was diagnosed with HIV and had been receiving antiretroviral therapy (ART). He underwent a splenectomy 1 month later and developed progressive generalized lymphadenopathy and hepatomegaly 5 months after that. Histopathological analysis of lymph node biopsies confirmed leishmaniosis, and the patient was started on Meglumine antimoniate. Shortly after, he developed widespread maculopapular skin lesions. Subsequent diagnostic evaluations, including skin biopsy, confirmed the presence of Leishman bodies. The patient was successfully treated with liposomal amphotericin B, leading to significant clinical improvement.

Conclusion: The co-existence of active VL and PKDL can make diagnosis difficult, potentially leading to misdiagnosis and treatment, particularly in immunocompromised patients. The simultaneous occurrence of VL and PKDL-like skin lesions requires heightened clinical suspicion, especially in endemic regions. Delayed or misdiagnosed cases may lead to significant morbidity. Further research is needed to understand the pathophysiology, immune response, and optimal treatment strategies for para-KDL in HIV-infected individuals.

Background: Sub-Saharan Africa has the highest prevalence of older adults with HIV worldwide, a subgroup with an increased risk of incident age-related conditions, such as frailty. We investigated the prevalence and factors linked to frailty among older people (aged ≥ 60 years) with HIV (PWH) and age- and sex-matched people without HIV (PWOH) in Kampala, Uganda.

Methods: Frailty was assessed using the frailty phenotype, proposed by Fried and colleagues, based on five criteria: unintentional weight loss, exhaustion, low physical activity, slowness, and weakness. We estimated the prevalence of frailty and pre-frailty and fitted a modified Poisson regression model to identify significantly associated factors.

Results: A total of 749 participants (371 PWH and 378 PWOH), 49.5% women, with a mean age of 67 (standard deviation 6.0) years. PWH had a median time of antiretroviral therapy (ART) use of 17 years (interquartile range 12-19), and 94.6% of PWH had viral suppression (viral load < 50 copies/ml). PWH had a similar prevalence of frailty (15.1% vs. 13.5%, P-value 0.53) and prefrailty (45.2% vs. 43.1%, P-value 0.55) compared to PWOH. Frailty was associated with older age, female sex, having no partner, being underweight, presenting food insecurity, and depressive symptoms.

Conclusion: In our study, older PWH and PWOH had a similar prevalence of frailty and prefrailty. This unexpected result may be attributable to the benefits of ART and may reflect substantial improvements in the clinical management of PWH.

Introduction: Limited knowledge about preventing mother-to-child transmission of HIV contributes to the high prevalence of pediatric HIV caused by vertical transmission. Given the lack of sufficient information, this study aimed to identify hotspot and cold spot areas as well as the factors influencing reproductive-age women's knowledge about preventing mother-to-child transmission of HIV in Ethiopia.

Method: The study utilized data from the 2016 Ethiopian Demographic and Health Survey, comprising a weighted sample of 15,683 reproductive-age women. Spatial analysis was conducted to identify significant clusters, and determinants were assessed using adjusted odds ratios with 95% confidence intervals.

Result: Significant hotspot regions were identified in Somali, Gambela, Afar, Benishangul Gumuz, the northern part of SNNP, and certain areas of Oromia. Key determinants included education level (primary: AOR = 1.19, 95% CI = 1.02-1.40; secondary: AOR = 1.41, 95% CI = 1.08-1.85; higher: AOR = 2.22, 95% CI = 1.52-3.25), religious affiliation (Muslim: AOR = 0.57, 95% CI = 0.47-0.68; Protestant: AOR = 0.76, 95% CI = 0.61-0.93; Other: AOR = 0.54, 95% CI = 0.33-0.86), having an employed partner (AOR = 1.36, 95% CI = 1.08-1.71), higher wealth index (rich: AOR = 1.35, 95% CI = 1.11-1.63), media exposure (AOR = 1.32, 95% CI = 1.12-1.57), antenatal care attendance (AOR = 1.46, 95% CI = 1.25-1.70), institutional childbirth (AOR = 1.18, 95% CI = 1.01-1.37), urban living (AOR = 1.36, 95% CI = 1.01-1.83), residence in larger central regions (AOR = 1.38, 95% CI = 1.12-1.70), and living in communities with high media exposure (AOR = 1.41, 95% CI = 1.13-1.75).

Conclusion: In Ethiopia, knowledge about preventing mother-to-child transmission of HIV among women of reproductive age varies significantly across regions. Therefore, implementing targeted interventions in the identified hotspot areas is essential to support the WHO's goal of eliminating new pediatric HIV infections by 2030.

Background: Anaemia and thrombocytopenia adversely affect adolescent HIV outcomes, yet adolescent-specific data from the tenofovir/lamivudine/dolutegravir (TLD) era remain scarce, and access to full blood count (FBC) testing is limited in Cameroon. We evaluated the prevalence, severity, and factors associated with these cytopenias among adolescents living with HIV (ADLHIV) in the TLD era.

Methods: Multicentre cross-sectional study was conducted among ADLHIV (10-19 years) receiving TLD in the CIPHER-ADOLA cohort in Cameroon. Full blood count, viral load (VL) and CD4-count were performed. Factors associated with anaemia and thrombocytopenia were ascertained.

Results: A total of 252 ADLHIV was enrolled (50.8% male, 83.3% were vertically infected, and 7.2% were underweighted). ART-duration and TLD-exposure were 10 [6-13] years and 26 [12-33] months, respectively. Concerning virological response, 71.4%, 13.1%, and 15.5% had a VL < 50, 50-999, and ≥ 1000, respectively. Overall, 102 (40.5%) were anaemic, with only 2.9% severe. Anaemia rate was twice higher in females (55.6%, p < 0.001); 64.1% with VL ≥ 1000 against 35.0% with VL < 50 (p = 0.003); 60.0% with CD4 < 200 against 35.4% with CD4 > 500 (p = 0.046). Regarding thrombocytopenia, the burden was low (6.7%), but higher among VL ≥ 1000 (p = 0.003). Multivariate analyses showed a threefold higher anaemia prevalence in females (aOR [95% CI: 3.406 [1.8952-5.940]), fivefold without formal education (0.191 [0.047-0.776]), threefold in VL ≥ 1000 copies/ml (0.338 [0.156-0.733]). Thrombocytopenia was fourfold more likely in males (aOR: 0.236 [0.072-0.774]) and sevenfold more likely in individuals with VL ≥ 1000 copies/mL (aOR: 0.140 [0.038-0.510]).

Conclusion: In the TLD era, anaemia remains common but generally mild, and thrombocytopenia is uncommon. Cytopenias were associated with unsuppressed viral load, with a stronger association for anaemia in females. These findings support programmatic targeted haemovigilance prioritising adolescents with unsuppressed viral load, particularly females, in settings where access to FBC testing is limited.

Background: HIV-related stigma harms people living with HIV (PWH), contributing to psychological distress, isolation, poor adherence, and reduced quality of life, especially in healthcare settings. The aim of the study was to assess the prevalence and characteristics of HIV-related stigma experienced by PWH in both the Infectious Diseases Unit (IDU) and other hospital departments of a tertiary-care university hospital.

Methods: A cross-sectional survey was conducted at a single center between December 2024 and February 2025 among PWH. Participants completed a self-administered 10-item questionnaire assessing perceived stigma in areas such as access to care, quality of care, and inclusion. Descriptive statistics and multivariable logistic regression were used to identify factors associated with HIV-related stigma.

Results: Six-hundred-thirty-four PWH participated in the study: 466 (73.5%) were male; median age was 56 years (IQR:45-62). Most were Caucasian (570, 89.9%) and 233 (36.8%) heterosexuals. Out of 634 individuals, 253 (39.9%) reported experiencing stigma in healthcare settings at least once. Perceived stigma was significantly lower in the IDU compared to other wards (59 versus 194 cases, p < 0.001). Multivariable analysis revealed that people who inject drugs were associated with an increased risk of stigma perception within the IDU (p = 0.037). Outside the IDU, a shorter duration of HIV infection (< 5 years) was protective against stigma perception (p < 0.001).

Conclusion: HIV-related stigma remains highly prevalent in hospital settings, particularly outside specialized care. A multifaceted strategy including staff education, anti-stigma training, and institutional policies is urgently needed to promote equitable and respectful care for PWH. Further research should incorporate measures of mental health (e.g., anxiety and depression), as perceived stigma may impact the psychological well-being of people with HIV.

Background: In India, despite significant advancements in Antiretroviral Therapy (ART), stigma and discrimination remain major barriers for people living with HIV (PLHIV), often hindering ART adherence and compromising treatment outcomes. This study aimed to assess the determinants and contributing factors of HIV-related stigma among PLHIV in Mizoram, a northeastern state with one of the highest HIV prevalence rates in the country.

Methods: A cross-sectional study was conducted among 300 PLHIV attending the ART Center, in Aizawl, Mizoram. Descriptive statistics, Chi-square tests, and binary logistic regression were used to assess factors associated with stigma and treatment adherence.

Results: A total of 300 PLHIV were enrolled in the study, comprising 176 (58.7%) males and 124 (41.3%) females. In the internalized stigma domain, males experienced significantly higher stigma compared to females (aOR = 2.394, CI = 1.294-4.426, p = 0.005). In the felt-normative stigma domain, participants aged 41-50 years reported higher stigma levels compared to aged 51 years and above (aOR = 0.329, CI = 0.110-0.985, p = 0.047). Regarding medication adherence, 208 (69.3%) participants demonstrated optimal adherence to ART, while 92 (30.7%) had sub-optimal adherence.

Conclusion: Most PLHIV in our study reported low to moderate stigma across domains. To reduce HIV related stigma among PLHIV, one should prioritize patient centric counselling, educational interventions in the form of mass communication, printed media etc., to ensure their psychological well-being and to create educational awareness involving the community and healthcare professionals to promote more positive thoughts on HIV which will reduce HIV related stigma in the society.