AIDS Research and Therapy最新文献

Background: The COVID-19 pandemic caused significant disruptions to global healthcare systems, including essential services along the HIV care continuum (HCC). While several studies have examined these impacts in specific countries or populations, limited evidence exists on cross-country differences in service disruptions, barriers, and facilitators stratified by national income levels.

Methods: We conducted a mixed-methods systematic review following the Joanna Briggs Institute methodology and PRISMA 2020 guidelines. We searched CINAHL, MEDLINE, Embase, and CAB Direct for quantitative and qualitative studies published between March 2020 and January 2024. Eligible studies assessed the pandemic's impact on one or more stages of the HIV care continuum, including prevention, testing, linkage to care, treatment engagement, antiretroviral therapy (ART) adherence, and viral suppression. Data were extracted, appraised, and synthesized using a convergent integrated approach across low-, middle-, and high-income countries as defined by the World Bank.

Results: A total of 200 studies were included. The most frequently disrupted services were HIV testing, prevention (including pre-exposure prophylaxis [PrEP] use), and medical appointments, particularly in high- and middle-income countries. ART adherence and viral suppression showed greater resilience across all settings. Structural barriers, such as lockdowns, healthcare repurposing, and transportation limitations, were widespread, while digital exclusion, stigma, and socioeconomic inequities disproportionately affected marginalized populations. Key facilitators included telemedicine, multi-month dispensing of ART and PrEP, community-based service delivery, and national-level adaptations. The extent of disruption and success of mitigation strategies varied by income level, reflecting differences in health system preparedness and flexibility.

Conclusions: The COVID-19 pandemic disrupted HIV care globally, with variation across income levels and care continuum stages. Health system resilience, equity in access, and pre-existing adaptive infrastructure significantly shaped outcomes. Findings highlight the need to institutionalize flexible, decentralized, and equity-informed service models to strengthen routine HIV care and pandemic preparedness.

Introduction: While maintaining a relatively low HIV prevalence, Lebanon continues to face significant sociocultural barriers related to HIV. People living with HIV (PLHIV) often experience discrimination, which may impact their quality of life (QoL) and their ability to engage effectively with healthcare providers. This study aimed to evaluate the QoL of PLHIV in Lebanon, examine their experiences with stigma, and assess how their relationships with physicians influence their access to care and information.

Methods: A cross-sectional study was conducted among 91 Lebanese adults living with HIV/AIDS, recruited from the National AIDS Program Center, NGOs, and outpatient clinics. Participants completed a comprehensive questionnaire including the WHOQOL-Brief, the HIV Symptom Index and the HIV Stigma Scale, as well as a demographic section and a section on the relationship with the physician.

Results: Most of the sample was male, unmarried, and asymptomatic. The mean age was 35.5 years (SD = 10.4). The mean WHOQOL-BREF score was 56.32% (SD = 17.2), with the highest score for physical health and the lowest for social relationships. The mean stigma score was 34.21 and the mean HIV symptom index was 1.91. Symptom prevalence and perceived stigma were negative predictors of quality of life, while being employed was a positive predictor of quality of life. The quality of social relationships had a positive impact on stigma. Choosing a physician based on word-of-mouth recommendations had a positive impact on access to health information and services.

Discussion: While clinical management has improved physical health outcomes for PLHIV, psychosocial factors, particularly stigma and lack of social support, continue to hold back overall well-being. Physician-patient trust and employment may enhance access to supportive care environments.

Conclusions: Addressing stigma and strengthening social and healthcare support systems are essential to improving the QoL of PLHIV in Lebanon. Empowering patients to make informed choices about their physicians may play a key role in facilitating better access to care and reducing the burden of stigma.

Venezuela experienced an interruption in antiretroviral therapy (ART) from 2016 to 2018. Although in early 2019, the dolutegravir (DTG) based regimens were implemented for HIV treatment in Venezuela, few studies have evaluated the efficacy of these regimens. This cross-sectional study describes the utilization, switches and efficacy of ART regimens in the main HIV outpatient care in Venezuela in 2024. Data from 1,998 patient records revealed that the dolutegravir/lamivudine/tenofovir (DTG/3TC/TDF) regimen was predominantly used (85.5%). A high viral suppression rate of over 90% was documented for all DTG-based regimens, with no significant difference found between the main regimen (DTG/3TC/TDF) and its alternatives: DTG/emtricitabine/tenofovir alafenamide (TAF), abacavir/3TC + DTG and, DTG/3TC. Overall, almost all switches (97.1%) were made toward DTG/FTC/TAF. Osteoporosis was the main reason for switching treatments (80.1%).

Background: The simultaneous COVID-19 and HIV/AIDS pandemics have created unprecedented challenges, disrupting healthcare for people living with HIV/AIDS (PLWHA) and introducing an additional lethal threat. However, the impact of COVID-19 among PLWHA in Brazil remains unclear. We aimed to investigate the association between HIV infection and COVID-19 mortality in the Brazilian population.

Methods: A multilevel study was conducted using data from the Brazilian Mortality Information System. We examined COVID-19 mortality among individuals with and without mention of HIV on their death certificates from 2020 to 2022. Mixed generalized linear regression models were used, considering the COVID-19 dominant Variant of Concern (VOC) and the vaccine rollout period, adjusted for age group and sex, interaction between HIV and age group, and random effects for federative units.

Results: A total of 4,773,337 deaths were analyzed, including 39,011 among PLWHA. Younger (18-39) and older (80+) PLWHA had higher odds of COVID-19 death, particularly during Delta and Omicron periods. Mortality odds among PLWHA were lower during the vaccination expansion phase but increased during the consolidated phase. Regional disparities were observed, with higher mortality odds in Northern and Northeastern Brazil.

Conclusions: HIV infection was associated with higher COVID-19 mortality in Brazil, particularly in specific age groups and regions. Older adults with HIV had an elevated risk of COVID-19 death across all periods. The vaccine rollout reduced COVID-19 mortality among PLWHA, but the results did not hold over time, as evidenced by the increased odds of death in all age groups following vaccination coverage consolidation in the population.

Background: While Dolutegravir (DTG) containing antiretroviral therapy (ART) has become the preferred regimen for people living with HIV (PLHIV), the pace and equity of its adoption, especially among subgroups with tuberculosis (TB) symptoms and advanced HIV disease (AHD), remain understudied in high-burden settings like rural KwaZulu-Natal (KZN), South Africa. This study describes the transition to DTG and examines the effect of TB and AHD (CD4 count < 200 cells/mm³) on the likelihood of transitioning to DTG in rural KZN, South Africa.

Methods: We conducted a longitudinal cohort analysis using routine HIV program data from 69,916 PLHIV aged ≥ 15 years attending 19 HIV clinics in rural KZN, between 1st October 2019, and December 31st 2023. Kaplan-Meier analysis estimated time to DTG transition, while a multivariate mixed-effect Cox proportional hazards model evaluated factors associated with transitioning to DTG.

Results: Of the 69,916 PLHIV included in the cohort, 49,365 (70.6%) were female, and the median age of the PLHIV was 40 years (IQR: 32-49). By the end of the follow-up period, 70.9% (n = 49,598) of the PLHIV transitioned to DTG in 165,880 person-years. The median time to DTG transition was 14 months among PLHIV without TB symptoms, compared to 22 months among those with TB symptoms. Similarly, PLHIV with CD4 counts ≥ 350 cells/mm³ transitioned at a median of 14 months, while those with CD4 < 200 cells/mm³ transitioned 14 months later. The likelihood of transitioning to DTG was 22% lower among PLHIV with TB symptoms (aHR = 0.78, 95% CI: 0.76, 0.82) compared to their counterparts without TB symptoms, and 43% lower among PLHIV with AHD (aHR = 0.57, 95% CI: 0.54,1.59) compared to their counterparts without AHD.

Conclusion: Our analysis showed that over a quarter of the PLHIV in rural KZN remained on non-DTG-containing regimens by 31st December 2023. PLHIV coinfected with TB and having AHD transitioned at a slower pace than their counterparts.

Background: C-X-C motif chemokine ligand 10 (CXCL10) is implicated in HIV-associated neuroinflammation, yet its association with HIV-associated neurocognitive disorders (HAND) remains unclear. We conducted a meta-analysis to evaluate cerebrospinal fluid (CSF) CXCL10 differences between people living with HIV (PLWH) with and without HAND and to assess the odds of HAND in relation to high versus low CSF CXCL10 levels.

Methods: PubMed, Embase, and Web of Science were systematically searched. Observational studies reporting CSF CXCL10 levels in adult PLWH with and without HAND were included. Standardized mean difference (SMD) and odds ratio (OR) were pooled using random-effects models accounting for the potential influence of heterogeneity.

Results: Eleven studies involving 1,536 PLWH were included. Compared to those without HAND, PLWH with HAND had significantly higher CSF CXCL10 levels (SMD: 0.56, 95% CI: 0.17-0.96; p < 0.001), with high heterogeneity (I² = 86% and τ² = 0.31). The 95% prediction interval (PI: - 0.78 to 1.91) indicated substantial between-study variability. Subgroup analyses showed significantly greater CXCL10 elevation in studies with ≤ 50% ART coverage (SMD: 0.90 vs. 0.17; p = 0.04) and in those evaluating HIV-associated dementia (SMD: 1.45 vs. 0.37; p < 0.001). Meta-regression did not identify any statistically significant moderators, although ART proportion and CD4 + count explained 29.2% and 25.6% of the variance, respectively. No significant association was found between high CSF CXCL10 and HAND (OR: 1.41, 95% CI: 0.90-2.22; p = 0.13).

Conclusion: Elevated CSF CXCL10 may be associated with HAND in PLWH, particularly among ART-naïve individuals and in more severe cognitive impairment. However, substantial heterogeneity and a wide PI suggest that the strength of this association varies across populations. CSF CXCL10 remains a promising but not definitive biomarker for HAND risk stratification.

Introduction: Screening and surveillance of HIV-positive pregnant women remain major public health challenges in the Democratic Republic of the Congo (DRC). This study aimed to describe the epidemiological, clinical, and biological characteristics of HIV-positive pregnant women in South Kivu.

Methods: A retrospective cohort study was conducted at Panzi Hospital from July 2015 to July 2020. Multivariate logistic regression analyses were performed to identify factors associated with HIV status.

Results: Among the 9,143 women enrolled in PMTCT, 6,318 were tested, of whom 256 (4.1%) were HIV-positive, including 112 pregnant women (1.8%). Compared with their HIV-negative counterparts, HIV-positive pregnant women had lower antenatal care attendance compared with HIV-negative counterparts. The main opportunistic infections were candidiasis and genital herpes (2.7% each). Only 58% had available CD4 counts, all above 500 cells/ml. An undetectable viral load (< 30copies/l) was recorded in 60.7% of cases. Liver and renal dysfunctions were observed in 6.2% and 30.3% of patients, respectively, wereas d anemia (< 12 g/dl) affected 61.6%. In multivariable analysis, HIV infection was associated with age < 20 years (aOR = 7.20), primary education (aOR = 5.30), household income of $50-100/month (aOR = 56.4), primiparity (aOR = 10.68), and poverty (aOR = 18). Conversely, multigravidity (aOR = 0.19) and residence in the Ibanda and Kadutu health zones were protective factors CONCLUSION: Epidemiological and biological profiles strongly influence PMTCT outcomes. Strengthening HIV testing, expanding ART access, and routine viral load monitoring particularly among young and primiparous women are essential to improve maternal and neonatal health outcomes in the DRC.

Introduction: Afew studies have assessed the acceptability of mHealth interventions in youth living with HIV, Call For Life -Interactive Voice Response (C4L-IVR) system developed to support patients with HIV and TB in Uganda, specifically to improve treatment adherence and retention in care. This qualitative study examined the acceptability and usage of C4L-IVR, barriers and enablers of adherence and retention in care among youth living with HIV in rural Uganda.

Methods: Nested within a randomised intervention trial (NCT04718974), this qualitative study examined youth 16-24 years old, through focus group discussions and indepth interviews at study end. Induction and deduction analysis was done with support of Nvivo software guided by the information motivation behavioral theory.

Results: Between 9th December 2021 and 28th Apr 2022, 68 participants were recruited, with 38 (56%) females. We conducted 14 interviews 7 focused group discussions (FGD) (02 female only FGD; 5 mixed); and 7 in-depth interviews (IDI) (4 males and 3 females IDI. Seven main themes were identified: information received from the system, motivation from system calls, behavioural skills, barriers to adherence and retention, acceptability of the tool, experiences, and suggestions for improvement. All youth accepted the tool, scoring it highly comfortable on a 5 Likert scale, where 5 was "very comfortable" and 1 "not at all comfortable'.

Conclusion: The high acceptability and usage of C4L system along with impact on behavioral skills, this system had more enablers than barriers to ART adherence and retention in care.

Background: Retention in medical care is essential for people with HIV (PWH) to successfully manage their illness and to reduce HIV transmissions in the United States (U.S.). A major factor that undermines retention in HIV care is co-occurring substance use disorders (SUD). Despite 11-48% of PWH in the U.S. having SUD, few evidence-based retention interventions for this population have been developed. Further, no studies sought guidance from previously out-of-care PWH and substance use histories about what might have helped or hindered their engagement in care when actively using substances. Broaching this topic among people with lived experience could provide novel insights into intervention approaches.

Methods: Participants were recruited from an HIV primary care clinic in the Northeastern United States. This qualitative study conducted individual in-depth interviews with n = 8 PWH and substance use histories focused on their experiences of being out of care and advice they might have to improve retention for PWH and SUD.

Results: Thematic analysis revealed the significance of SUD-related stigma, both as a primary source of stigmatization fears, even when compared to HIV, as well as the enacted stigma associated with SUD in HIV treatment settings. SUD stigma undermined retention in HIV care. Participants highlighted that SUD must be addressed for HIV care engagement to improve.

Conclusions: Findings indicate that novel pathways to address HIV and SUD must be developed. Approaches that reduce stigma risk, such as the "status neutral" approach to care, could support engagement in care for this population.

Background: South Africa continues to face one of the world's highest HIV burdens, with 7.7 million people living with HIV (PLWHIV) in 2023. Despite progress toward UNAIDS 95-95-95 targets, challenges in long-term retention and treatment outcomes persist. This study aimed to evaluate 10-year antiretroviral therapy (ART) outcomes among PLWHIV initiated on treatment in 2013 within Tshwane District, South Africa.

Methods: Retrospective cohort using Tier.Net data from 1,337 adults across 10 randomly selected facilities (clinics and community health centres [CHCs]). Outcomes were retention, loss to follow‑up (LTFU), mortality, viral suppression, and CD4 recovery. We used Kaplan-Meier methods and multivariable models (Cox for LTFU and mortality, logistic for viral suppression, linear for CD4 change). Mortality analyses were limited to participants with complete ascertainment (n = 640).

Results: At 10 years, 47.7% were retained, 30.4% LTFU, 20.1% transferred out, and 3.3% died. Attrition was steepest early and most pronounced among 18-24-year-olds. Advanced WHO stage strongly predicted death (Stage III/IV vs. I/II: aHR 3.06, 95% CI 1.26-7.44), and younger age was protective (≤ 34 vs. > 34 years: aHR 0.28, 95% CI 0.09-0.86). Care at CHCs was associated with lower mortality (aHR 0.33, 95% CI 0.13-0.83) and greater CD4 gains (clinic care: -74.35 cells/µL vs. CHCs; p < 0.001). Female sex was associated with larger CD4 recovery (+ 90.06 cells/µL vs. males; p < 0.001). Only baseline CD4 > 200 cells/µL independently predicted viral suppression (aOR for being suppressed ≈ 1.89, derived from aOR 0.53 for non-suppression; p < 0.001). No baseline covariates were significant predictors of time to LTFU (clinic type borderline: HR 0.80, p = 0.086).

Conclusion: A decade after initiation, fewer than half remained in care. Mortality clustered among older adults and those presenting with advanced disease, while CHC-based care conferred survival and immunologic advantages. Programme priorities should include earlier diagnosis and ART start, youth-friendly retention strategies, and scaling CHC-style differentiated service delivery to improve long-term outcomes.