AIDS Research and Therapy最新文献

We report on the successful management of severe immune reconstitution inflammatory syndrome (IRIS) in a 28-year-old Indonesian male with advanced HIV/AIDS, complicated by disseminated histoplasmosis. This case highlights the clinical challenges and innovative approaches in treating severe IRIS, where conventional management strategies proved inadequate. The patient presented with progressive clinical deterioration briefly after initiation of antiretroviral therapy (ART). Disseminated histoplasmosis was suspected based on clinical and radiographic findings and later confirmed as the underlying infectious trigger of IRIS, guiding targeted therapeutic strategies. Clinical management involved the novel use of a Janus kinase (JAK) inhibitor and a cytokine adsorption filter (CytoSorb^®), alongside escalated antifungal and immunosuppressive therapies. This multifaceted approach not only stabilized the patient's condition but also highlighted the importance of considering advanced therapeutic options in severe IRIS cases. The use of JAK inhibition in this context provides new insights into the modulation of immune responses in IRIS, while cytokine adsorption therapy offered a method to control the systemic inflammatory response that characterizes this condition. This case underscores the critical need for awareness of uncommon pathogens like Histoplasma in IRIS and illustrates the potential for integrating novel therapeutic modalities to improve outcomes in these complex scenarios. Our experience suggests that early consideration of advanced immunomodulatory therapies should be considered in severe IRIS cases refractory to standard treatments.

Background: We sought to understand the results of using different estimating equations (with and without a "race" category) and the addition of cystatin C as a biomarker on Chronic Kidney Disease (CKD) stage estimates among persons with HIV (PWH), for whom CKD is an important comorbidity.

Methods: Biomarkers were measured in this cross-sectional single site U.S. clinic-based study from 2014 to 2016. Other laboratory and clinical data were abstracted from the electronic health record based on the last recorded value proximal to the study visit. Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) glomerular filtration estimating equations with and without cystatin C were applied to categorize CKD stage, and staging agreement was assessed using the difference of proportions test. Multivariable regression analyses evaluated factors associated with CKD stage, and the Breslow-Day test evaluated whether race served as an effect modifier.

Results: Among 306 PWH, the median age was 48.2 years, 86 (28%) were female, 185 (61%) were Black, 91 (30%) Caucasian, 13 (4%) Latinx, and 46 (15%) had hepatitis C virus (HCV) co-infection. The median CD4 + T-lymphocyte count was 659/mm³, 299 (98%) were on ART, and 228 (75%) had HIV VL < 20 c/mL. Using the 2009 and 2012 CKD-EPI equations (including race), more individuals were categorized as having normal kidney function (Stage 1) with inclusion of cystatin C than creatinine alone (73% vs. 55%, p < 0.00001); fewer individuals were classified in CKD stages III-V using both cystatin C and creatinine than creatinine alone, though this did not meet statistical significance (8% vs. 12%, p = 0.14). Using 2021 equations (excluding race) a larger proportion were classified as normal kidney function with inclusion of cystatin C than creatinine alone (74% vs. 49%, p = 0.00001); fewer were categorized as CKD III-V with inclusion of cystatin C than creatinine alone (8% vs. 13%, p = 0.03). Multivariable linear regression identified age (β=-0.75, p < 0.0001) and tobacco use (β=-4.10, p = 0.03) as factors associated with kidney function. Race was not an effect modifier in our analyses based on the Tarone adjusted Breslow-Day test.

Conclusion: Among PWH, cystatin C shifted estimates of kidney function towards normal and resulted in shifts in kidney function categorization much more so than the race effect. As some antiretrovirals raise creatinine without affecting GFR, cystatin C is an important biomarker to confirm diminished kidney function among persons with HIV.

Background: To evaluate the effectiveness of a healthcare-school collaborative intervention model in improving HIV/AIDS-related knowledge and attitudes among high school students.

Methods: A randomized controlled trial was conducted with 444 Grade 10-11 students from a Shanghai high school. Participants were cluster-randomized into two groups: a traditional model group (n = 299, routine health education) and a new model intervention group (n = 145, receiving healthcare-school collaborative interventions, including on-campus clinics, peer education, and digital outreach). Self-administered questionnaires measured outcomes at baseline and after the intervention.

Results: Baseline data revealed high awareness of HIV transmission routes (91.6%) but lower understanding of non-transmission routes (75.88%). Post-intervention, the new model group demonstrated significantly higher knowledge rates than the traditional group in critical areas: recognizing that HIV is not transmitted through dining together (92.91% vs. 85.71%), mosquito bites (90.55% vs. 34.59%), mother-to-child transmission (96.85% vs. 89.85%), and condom effectiveness (85.04% vs. 75.19%) (all P < 0.05). Furthermore, 87.4% of students in the new model group expressed willingness to maintain friendships with peers living with HIV/AIDS, surpassing the traditional group (78.57%, P = 0.035). Knowledge scores were significantly higher in the new model group (9.28 ± 1.27 vs. 8.46 ± 1.27, P < 0.05). Satisfaction surveys showed high approval for the intervention, with 89.76% of participants satisfied with the format and 83.46% perceiving it as useful.

Conclusion: The healthcare-school collaborative model, integrating on-site health services, multimedia education, and behavioral guidance, effectively enhances HIV/AIDS knowledge, reduces stigma, and fosters healthy sexual attitudes among adolescents. This model offers a scalable and effective framework for school-based HIV prevention efforts.

Background: Cardiovascular disease (CVD) is a leading cause of mortality among people living with HIV (PLHIV) in sub-Saharan Africa. Dyslipidemia, a major modifiable CVD risk factor, is poorly characterized in Ghanaian PLHIV, particularly across age groups. This study determined the prevalence and factors associated with dyslipidemia among PLHIV in Ghana's Eastern Region.

Methods: A facility-based cross-sectional study was conducted between February and June 2020 at two hospitals (Atua Government Hospital and St. Martins de Porres Hospital). We enrolled 440 PLHIV aged ≥ 18 years on antiretroviral therapy (ART) for ≥ 6 months, excluding pregnant/lactating individuals and those on special diets. Participants were categorized into three age groups: 18-34, 35-54, and ≥ 55 years. Dyslipidemia was defined per the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria (elevated triglycerides ≥ 150 mg/dL, LDL-C ≥ 130 mg/dL, or HDL-C < 40 mg/dL). Data on sociodemographic, lifestyle, ART history, and body composition were collected using structured questionnaires and physical measurements. Bivariate analyses and binary logistic regression identified determinants (p < 0.05).

Results: The overall prevalence of dyslipidemia was 64.1% (95% CI: 59.5-68.5%). The prevalence was higher among females (64.4%) compared with males (58.2%). Regression analysis identified significant independent predictors: alcohol use (aOR = 2.05, 95% CI:1.20-3.52), physical inactivity (aOR = 1.88, 95% CI:1.12-3.15), higher BMI (aOR = 1.24 per unit increase, 95% CI:1.02-1.50), and muscle mass (aOR = 0.85 per unit increase, 95% CI:0.75-0.97). Unexpectedly, participants who reported never smoking had lower odds of dyslipidemia (aOR = 0.16, 95% CI: 0.06-0.41). No significant associations were found with ART regimen/duration, education, or age.

Conclusion: Dyslipidemia is highly prevalent among Ghanaian PLHIV and is strongly associated with modifiable lifestyle and body composition factors. Integrated interventions targeting alcohol reduction, physical activity promotion, and weight management are urgently needed within routine HIV care. The unexpected association with smoking warrants further investigation.

Background: Dolutegravir (DTG)-based antiretroviral therapy (ART) is a preferred first-line treatment for HIV/AIDS, but concerns about adverse drug events (ADEs) persist. This study aimed to determine the prevalence of ADEs and identify associated independent risk factors among Thai people living with HIV (PLWH) on DTG-based regimens for at least one year.

Methods: This retrospective cohort study examined 1,270 Thai individuals living with HIV receiving a DTG/3TC/TDF regimen for ≥ 1 year at a secondary care hospital between 2021 and 2023. The primary outcome was any ADE (Grade ≥ 1) documented during the first 12 months of DTG therapy. Multivariate logistic regression, adjusted for confounders including sex, was used to identify independent predictors of ADEs.

Results: Among 1,270 participants, 684 (53.86%) experienced at least one ADE. The cohort was predominantly ART-experienced, with a median duration since HIV diagnosis of 6.00 years (IQR 4.00-9.00 years). The most frequent ADEs included a decline in estimated glomerular filtration rate (eGFR) (17.72%), anemia (15.43%), weight gain (9.29%), and nausea (7.80%). Independent risk factors associated with increased ADE odds were: older age (≥ 40 years vs. 18-29 years, global p = 0.040), psychiatric comorbidity (aOR 3.13; 95% CI 1.02-9.56; p = 0.046), history of cryptococcosis (aOR 1.45; 95% CI 1.05-2.13; p = 0.035) ,underweight status (BMI < 18.5 kg/m²) (aOR 2.22; 95% CI 1.50-3.38; p < 0.001), and baseline eGFR < 90 mL/min/1.73m² (aOR 1.45; 95% CI 1.09-1.93; p < 0.011). Conversely, a longer duration on ART prior to DTG initiation (> 15 years) was associated with a 68% reduction in ADE odds (aOR 0.32; 95% CI 0.14-0.75; p = 0.008).

Conclusions: Over half (53.86%) of patients on long-term DTG-based therapy experienced at least one ADE. Risk was significantly elevated in older adults, those with psychiatric illness, previous cryptococcosis, underweight status, or lower baseline eGFR. Healthcare providers should implement proactive monitoring and tailored management strategies for these high-risk patients to optimize ART safety and efficacy outcomes.

Background: Common mental disorders (CMDs) and alcohol use disorder (AUD) are significant barriers to effective antiretroviral therapy (ART) adherence among people living with HIV (PLHIV), especially in sub-Saharan Africa. Suboptimal adherence to ART contributes to increased morbidity and mortality in this population. CMD and AUD frequently co-occur, with alcohol often serving as a maladaptive coping mechanism for psychological distress, thereby compounding the negative impact on treatment outcomes. Understanding the mediating role of AUD in the relationship between CMD and ART adherence is essential for designing targeted interventions aimed at improving HIV treatment success.

Methods: A hospital-based cross-sectional analytical study was conducted between August and October 2023 in Moshi Municipality, Kilimanjaro. A multistage systematic sampling technique was used to recruit participants. Data were collected using structured sociodemographic and interviewer-administered, validated assessment tools. Statistical analyses included one-way ANOVA for continuous variables, chi-square tests for categorical variables, and logistic regression to estimate odds ratios (ORs) with 95% confidence intervals. Mediation analysis was conducted using R version 4.4.2, with significance set at p < 0.05.

Results: The study involved 532 participants, with an average age of 46.6 ± 13.3 years; 71.4% were female. The prevalence of depression, anxiety, and ART non-adherence was 14.8%, 12.4%, and 10.7%, respectively. Among men, depression and anxiety were both significantly associated with ART non-adherence in model1 and 2 respectively (depression OR = 5.38, 95% CI: 1.80-16.08; OR = 5.10, 95% CI: 1.55-16.82. Anxiety OR = 5.12, 95% CI: 1.63-16.12; OR = 5.30, 95% CI: 1.48-18.92). Among women, only depression significantly increased ART non-adherence in all models, respectively (OR = 2.50, 95% CI: 1.16-5.36; OR = 2.51, 95% CI: 1.13-5.59; OR = 3.26, 95% CI: 1.34-7.95). Alcohol use disorder significantly mediated the relationship between depression and ART non-adherence more substantially than alcohol use alone, with mediation effects up to 45.5%.

Conclusion: Depression is significantly associated with ART non-adherence in both genders, and AUD is a key mediator, especially among male participants. These data support the integration of mental health and substance use care into HIV services, with attention to gender-specific risk factors.

Background: Community-based enhanced adherence counseling (CEAC) is person-centered intervention provided to PLHIV on ART and with unsuppressed viral load (VL) in community settings. This study assessed the effectiveness of CEAC in achieving viral load suppression (VLS) and explored key predictors to inform scalable strategies in resource-limited settings.

Methods: A quantitative, retrospective follow-up study was conducted between October 2022 and October 2024 on 2839 PLHIVs enrolled to CEAC service. Study participants were HIV-infected individuals who were on ART for at least six months and had unsuppressed VL. Frontline community health workers provided them with three-to-six monthly sessions of counseling to address underlying barriers to treatment adherence. Client-level data were collected using CommCare mobile app and analyzed in SPSS.

Results: A total of 2839 PLHIV were enrolled in CEAC, of which 2365 (83.3%; 95% CI: 82.0-84.5%) clients achieved VLS after receiving three-to-six months of CEAC. Major significant predictors of VLS included age 1-14 years [AOR (95% CI) = 2.08 (1.25-3.41)], having a baseline VL of < 10,000 copies/mL [AOR (95% CI) = 1.75 (1.41-2.17)], and enrolled to other community-based case management services [AOR (95% CI) = 5.77 (4.33-7.71)]. Moreover, PLHIV with adherence related challenges resolved had higher odds of VLS [AOR = 1.86; 95%CI: 1.48 - 2.34].

Conclusion: CEAC service demonstrated encouraging results in supporting VLS among PLHIVs on ART with unsuppressed VL count. Community-based interventions showed potential in addressing individual barriers that were challenging to health facility to improve VLS. We recommend continuing efforts to scale up and integrate CEAC with ongoing health facility EAC services to synergistically improve VLS and accelerate epidemic control.

Background: People living with Human immunodeficiency virus (HIV; PLHIV) have high rates of post-traumatic stress disorder (PTSD), which contributes to poor health outcomes. Avoidant behavior, a hallmark feature and overlapping symptom of PTSD and HIV stigma, may undermine antiretroviral therapy (ART) adherence. Few studies have evaluated PTSD treatment effects on HIV outcomes. Cognitive Processing Therapy (CPT), an evidence-based PTSD treatment, can be adapted to address internalized stigma and adherence by reducing avoidance. In alignment with the U = U (Undetectable = Untransmissible) campaign, this pilot randomized controlled trial (RCT) tested feasibility of integrating CPT with an adherence intervention (Life-steps; CPT-L) in a Ryan White clinic.

Methods: Forty-one adults with HIV, PTSD, and suboptimal HIV care (e.g., missed appointments, detectable viral load) were recruited from a South Carolina Ryan White clinic. Participants were randomized 1:1 to CPT-L (n = 20) or Life-steps only (n = 21). Outcomes included PTSD symptoms, HIV stigma, quality of life, viral load, and appointment engagement, assessed at baseline, post-intervention, and 3-month follow-up. Analyses used linear regression/ANOVA, with viral load detection examined via Fisher's exact test.

Results: CPT-L participants showed significantly greater reductions in PTSD symptoms (Δ = 11.55, SE = 4.32, p = .01) and HIV stigma (Δ = 22.63, SE = 7.33, p = .006) compared with Life-steps only. Preliminary trends also indicated improved HIV care indicators, including appointment attendance, ART adherence, and viral suppression.

Conclusions: Integrating CPT with adherence counseling reduced PTSD symptoms and HIV stigma, and showed potential to improve HIV outcomes. This innovative approach may advance U = U goals by increasing viral suppression among PLHIV with PTSD.

Women of reproductive age (WRA) face the greatest burden of the HIV/AIDS epidemic in low- and middle-income countries, including Tanzania. Comprehensive HIV/AIDS knowledge is vital for effective prevention. Using the 2022 Tanzania Demographic and Health Survey and Malaria Indicator Survey we found that only 15.9% of WRA possessed comprehensive HIV/AIDS knowledge. Higher knowledge was associated with marital status, education, literacy, employment, wealth index, using internet, sexually transmitted infections awareness. However, increase in age associated with lower odds. These findings highlight the critical need for targeted intervention emphasizing digital platforms and continued education to enhance knowledge among WRA in Tanzania.

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.