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The role of CREB and MAPK signaling pathways in ATLL patients. CREB 和 MAPK 信号通路在 ATLL 患者中的作用。
IF 2.1 4区 医学 Q3 INFECTIOUS DISEASES Pub Date : 2024-11-11 DOI: 10.1186/s12981-024-00664-x
Mohammad Mehdi Akbarin, Seyed Abdolrahim Rezaee, Zahra Farjami, Hossein Rahimi, Houshang Rafatpanah

Background: HTLV-1 is a worldwide distribution retrovirus with 10-20 million infected individuals. ATLL is an Adult T-cell leukaemia lymphoma caused by aggressive T-cell proliferation that is infected by HTLV-1 and is associated with an inferior prognosis. The exact molecular pathogenesis has yet to be fully understood. CREB, a transcription factor, acts as a molecular switch that controls the expression of numerous genes in response to various extracellular signals. Its activation is primarily mediated through phosphorylation by multiple kinases, including MAPKs. MAPKs, a family of serine/threonine kinases, serve as crucial mediators of intracellular signaling cascades.

Method and material: This study investigated, 38 HTLV-I-infected individuals, including 18 HTLV-1 asymptomatic carriers (ACs) and 20 ATLL subjects. mRNA was extracted and converted to cDNA from Peripheral blood mononuclear cells (PBMCs), and then the expression of TAX, HBZ, CREB, and MAPK was analyzed by TaqMan qPCR. The genomic HTLV-1 Proviral loads were examined among the study group.

Results: The data analysis showed a significant difference in the mean of CREB expression amongst study groups (ATLL and carriers, (p = 0.002). There is no statistical difference between the MAPK gene expression (p = 0.35). HBZ, TAX, and HTLV-1 proviral load weree significantly higher in ATLL subjects compared to  ACs  (p = 0.002, 0.000, and 0.000), respectively. Moreover, our results, demonstrated a direct positive correlation among HBZ, CREB, and TAX gene expression in ATLL patients (p = 0.001), whilst between the  ACs, TAX gene expression had a positive significant correlation with HBZ and HTLV-1 proviral load (p = 0.007 and p = 0.004, respectively).

Conclusion: The present study demonstrated that CREB gene expression was higher in the ATLL group than ACs, while there was no difference for MAPK. Therefore, this pathway may not strongly involve in the activation of CREB. The CREB may be a prognostic factor for the development of HTLV-I-associated diseases and can be used as a monitoring marker for the efficiency of the therapeutic regime and prognosis.

背景:HTLV-1 是一种分布于全球的逆转录病毒,感染者达 1,000 万至 2,000 万。ATLL 是一种成人 T 细胞白血病淋巴瘤,由 HTLV-1 感染的侵袭性 T 细胞增殖引起,预后较差。确切的分子发病机制尚未完全清楚。CREB 是一种转录因子,作为一种分子开关,可控制许多基因的表达,以响应各种细胞外信号。它的激活主要是通过多种激酶(包括 MAPKs)的磷酸化介导的。MAPKs 是丝氨酸/苏氨酸激酶家族的一种,是细胞内信号级联的关键介质:从外周血单核细胞(PBMCs)中提取 mRNA 并转化为 cDNA,然后用 TaqMan qPCR 分析 TAX、HBZ、CREB 和 MAPK 的表达。研究组还检测了基因组 HTLV-1 病毒载量:数据分析显示,各研究组(ATLL 和携带者)的 CREB 平均表达量存在明显差异(P = 0.002)。MAPK 基因的表达没有统计学差异(p = 0.35)。与 ACs 相比,ATLL 受试者的 HBZ、TAX 和 HTLV-1 病毒载量明显更高(p = 0.002、0.000 和 0.000)。此外,我们的研究结果表明,在 ATLL 患者中,HBZ、CREB 和 TAX 基因表达呈直接正相关(p = 0.001),而在 ACs 中,TAX 基因表达与 HBZ 和 HTLV-1 病毒载量呈显著正相关(分别为 p = 0.007 和 p = 0.004):本研究表明,ATLL 组的 CREB 基因表达高于 AC 组,而 MAPK 基因表达则无差异。因此,该通路可能并未强烈参与 CREB 的激活。CREB可能是HTLV-I相关疾病发展的预后因素,可作为治疗方案效率和预后的监测指标。
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引用次数: 0
AIDS mortality in Brazil, 2012-2022: a time series study. 2012-2022 年巴西艾滋病死亡率:时间序列研究。
IF 2.1 4区 医学 Q3 INFECTIOUS DISEASES Pub Date : 2024-11-05 DOI: 10.1186/s12981-024-00669-6
Lucas de Souza Luna, Rafael Pedro de Souza Nascimento, Paula Esbaltar de Oliveira, Adeilton Gonçalves da Silva Junior, Márcio Bezerra-Santos, Rodrigo José Videres Cordeiro de Brito, Rodrigo Feliciano do Carmo, Carlos Dornels Freire de Souza

Background: Human immunodeficiency virus (HIV) infection is a health problem in Brazil and worldwide. Without treatment, the infection can progress to Acquired Immunodeficiency Syndrome (AIDS), with a high mortality potential. The objective of this study was to analyze the time trend of AIDS mortality in Brazil, macro-regions, federal units and their respective capitals, from 2012 to 2022.

Methods: This is a time-series study of all AIDS deaths in Brazil from 2012 to 2022. The study included the annual number of deaths and the crude and standardized mortality rates. The Joinpoint regression model was used for the time analysis of the standardized rates. Annual percentage change (APC) and average annual percentage change (AAPC) were calculated. A 95% confidence interval (CI) and a 5% significance level were used.

Results: During the period analyzed, 128,678 AIDS deaths were recorded in Brazil, with a crude mortality rate of 6.3/100,000 and a standardized mortality rate of 5.3/100,000. From 2012 to 2020, three regions showed a declining trend in AIDS mortality: Central-West (AAPC - 2.3%; 95%CI -4.3 to -0.21; p = 0.03), Southeast (AAPC - 5.6%; 95%CI -6.8 to -4.0; p < 0.001), and South (AAPC - 4.4%; 95%CI -5.27 to -3.6; p < 0.001). There was also a downward trend in 10 states and 10 capitals. There was an increase in the number of deaths from 2020 onwards in the North, Northeast and Southeast regions compared to 2019.

Conclusion: There was a downward trend in AIDS mortality from 2012 to 2020 and an upward trend from 2020 to 2022. The regional differences observed could reflect the social disparities that exist in Brazil. In addition, the Covid-19 pandemic has had an impact on the process of dealing with HIV in Brazil.

背景:人类免疫缺陷病毒(HIV)感染是巴西乃至全世界的一个健康问题。如果不进行治疗,感染者会发展为获得性免疫缺陷综合症(艾滋病),死亡率极高。本研究旨在分析 2012 年至 2022 年巴西宏观地区、联邦单位及其各自首府艾滋病死亡率的时间趋势:这是一项对 2012 年至 2022 年巴西所有艾滋病死亡病例进行的时间序列研究。研究内容包括每年的死亡人数、粗死亡率和标准化死亡率。在对标准化死亡率进行时间分析时使用了连接点回归模型。计算了年度百分比变化(APC)和平均年度百分比变化(AAPC)。采用 95% 的置信区间 (CI) 和 5% 的显著性水平:在分析期间,巴西共记录了 128,678 例艾滋病死亡病例,粗死亡率为 6.3/100,000,标准化死亡率为 5.3/100,000。从 2012 年到 2020 年,三个地区的艾滋病死亡率呈下降趋势:中西部(AAPC - 2.3%;95%CI -4.3 to -0.21;P = 0.03)、东南部(AAPC - 5.6%;95%CI -6.8 to -4.0;P 结论:从 2012 年到 2020 年,艾滋病死亡率呈下降趋势:2012 年至 2020 年艾滋病死亡率呈下降趋势,2020 年至 2022 年呈上升趋势。观察到的地区差异可能反映了巴西存在的社会差异。此外,"Covid-19 "大流行也对巴西应对艾滋病毒的进程产生了影响。
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引用次数: 0
Brief communication: The cohort of women prescribed HIV PrEP at the Veterans Health Administration. 简讯:退伍军人健康管理局开具艾滋病毒 PrEP 处方的妇女队列。
IF 2.1 4区 医学 Q3 INFECTIOUS DISEASES Pub Date : 2024-11-01 DOI: 10.1186/s12981-024-00670-z
Shimrit Keddem, Kaitlyn Broderick, Puja Van Epps, Christopher B Roberts, Sumedha Chhatre, Lauren A Beste

The goal of this study was to describe the cohort of women prescribed PrEP at the Veterans Health Administration. We used a cross-sectional study of electronic health record data. We used descriptive statistics and calculated estimated average percent change by year of prescription. A total of 417 women were prescribed PrEP over the study period. The most substantial change over time in PrEP prescribing occurred among women aged 18-24, in Other race group, and in the Western US. Though PrEP prescribing increased since its approval, more research is needed to identify barriers and expand PrEP access for women Veterans.

本研究的目的是描述退伍军人健康管理局开具 PrEP 处方的女性群体。我们对电子健康记录数据进行了横断面研究。我们使用了描述性统计方法,并计算了按处方年份估算的平均百分比变化。在研究期间,共有 417 名女性被处方 PrEP。随着时间的推移,PrEP 处方量变化最大的是 18-24 岁的女性、其他种族群体和美国西部地区。尽管自 PrEP 获批以来,处方量有所增加,但仍需开展更多的研究,以找出障碍并扩大女性退伍军人获得 PrEP 的机会。
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引用次数: 0
Association between differentiated HIV care delivery model and low-level viremia among people living with HIV in Rwanda. 卢旺达艾滋病毒感染者中差异化艾滋病毒护理服务模式与低水平病毒血症之间的关系。
IF 2.1 4区 医学 Q3 INFECTIOUS DISEASES Pub Date : 2024-11-01 DOI: 10.1186/s12981-024-00650-3
Jackson Sebeza, Mariam S Mbwana, Habib O Ramadhani, Zuhura M Ally, Taylor Lascko, Peter Memiah, Simeon Tuyishime, Galican Rwibasira

Background: Low-level viremia (LLV) (HIV-RNA 51-999 copies/mL) is associated with increased risk of non viral load suppression (HIV-RNA ≥ 1000 copies/mL). We assessed the association between differentiated service delivery model (DSDM) and LLV among people living with HIV (PLHIV) in Rwanda.

Methods: We conducted a retrospective cohort analysis using routinely collected data of adults living with HIV from 28-healthcare facilities in Rwanda before and after the introduction of DSDM. Under DSDM, PLHIV initiated treatment within seven days of HIV diagnosis and medication pick-up up to six months for those with sustained viral load suppression suppression. Proportions of LLV at 6,12 and 18 months were quantified. Multivariable log binomial regression models were used to assess the effect of DSDM on LLV. To handle missing data, multiple imputations was performed.

Results: Of 976 people living with HIV, 645(66.0%) were female and 463(47.4%) initiated treatment during DSDM. The median age was 37 (interquartile range: 32-43) years. LLV was 7.4%, 6.6% and 5.4%, at 6,12 and 18 months, respectively. Compared to those who initiated treatment before DSDM, starting treatment during DSDM increased six-month LLV [adjusted risk ratio (aRR) = 2.8: 95%CI (1.15-6.91)] but not at 12 [aRR = 2.3: 95%CI (0.93-5.75)] and 18 months [aRR = 0.3: 95%CI (0.09-1.20)]. Using imputed datasets, the association between DSDM and LLV persisted.

Conclusions: DSDM was associated with increased risk of LLV at 6-months. possibly due to the minimal amount of time PLHIV had in pondering and accepting the HIV diagnosis. Continued support is needed among people receiving early antiretroviral therapy initiation to prevent development of LLV.

背景:低水平病毒血症(LLV)(HIV-RNA 51-999 copies/mL)与非病毒载量抑制(HIV-RNA ≥ 1000 copies/mL)的风险增加有关。我们评估了卢旺达艾滋病毒感染者(PLHIV)中差异化服务提供模式(DSDM)与 LLV 之间的关联:我们利用从卢旺达 28 家医疗机构定期收集到的成年 HIV 感染者数据,对引入 DSDM 前后的情况进行了回顾性队列分析。根据 DSDM,艾滋病毒感染者在确诊艾滋病毒后七天内开始接受治疗,病毒载量持续抑制的感染者可在六个月内取药。对 6、12 和 18 个月的 LLV 比例进行了量化。多变量对数二项式回归模型用于评估 DSDM 对 LLV 的影响。为处理缺失数据,进行了多重推定:在976名艾滋病病毒感染者中,645人(66.0%)为女性,463人(47.4%)在DSDM期间开始接受治疗。中位年龄为 37 岁(四分位数间距:32-43)。在6、12和18个月时,LLV分别为7.4%、6.6%和5.4%。与在 DSDM 之前开始治疗的患者相比,在 DSDM 期间开始治疗会增加 6 个月的 LLV [调整风险比 (aRR) = 2.8:95%CI (1.15-6.91)],但不会增加 12 个月 [aRR = 2.3:95%CI (0.93-5.75)] 和 18 个月 [aRR = 0.3:95%CI (0.09-1.20)]。使用估算数据集后,DSDM 和 LLV 之间的关联依然存在:结论:DSDM 与 6 个月后 LLV 风险的增加有关,这可能是由于 PLHIV 在思考和接受 HIV 诊断方面的时间极短。需要继续支持早期开始接受抗逆转录病毒治疗的人群,以防止 LLV 的发展。
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引用次数: 0
Brief communication: comorbidities and aging in people living with HIV. 简讯:艾滋病毒感染者的合并症和老龄化。
IF 2.1 4区 医学 Q3 INFECTIOUS DISEASES Pub Date : 2024-10-26 DOI: 10.1186/s12981-024-00667-8
Laura Beatriz de Camargo Vicioli, E Lenice do Rosário de Souza

The main objective of the study was to assess the occurrence of non-aids-related comorbidities typical of aging in people living with HIV diagnosis 20 years ago or more and under treatment with antiretroviral drugs for a long time. The associations between the same age group in people living with HIV with reported ART use 20 + years and people living with HIV with reported ART use between two and five years in relation to the risk of comorbidities studied, there was a predominance of metabolic alterations in the 50-60 and 60 + age groups (p < 0.003). The conclusion was that exists a higher risk of comorbidities associated with people living with HIV for more than 20 years, but the length of treatment did not necessarily influence this risk.

这项研究的主要目的是评估 20 年前或更早诊断出艾滋病毒并长期接受抗逆转录病毒药物治疗的艾滋病毒感染者出现与艾滋病无关的典型老龄化合并症的情况。在报告使用抗逆转录病毒疗法 20 年以上的艾滋病病毒感染者和报告使用抗逆转录病毒疗法 2 至 5 年的艾滋病病毒感染者中,同一年龄组的合并症风险与所研究的合并症风险之间存在关联,50-60 岁和 60 岁以上年龄组的合并症以代谢改变为主(p<0.05)。
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引用次数: 0
Virologically suppressed switch to Dolutegravir/Lamivudine 2-Drug regimen versus switch to commonly prescribed 3-Drug regimens in the United States. 在美国,病毒被抑制后改用多鲁曲韦/拉米夫定两药方案与改用常用的三药方案。
IF 2.1 4区 医学 Q3 INFECTIOUS DISEASES Pub Date : 2024-10-26 DOI: 10.1186/s12981-024-00668-7
Gerald Pierone, Jennifer S Fusco, Laurence Brunet, Vani Vannappagari, Supriya Sarkar, Cassidy E Henegar, Jean van Wyk, Michael B Wohlfeiler, Anthony Mills, Gregory P Fusco

Background: Two-drug regimens (2DRs) have been introduced in recent years to potentially reduce antiretroviral therapy (ART) toxicities and drug-drug interactions while demonstrating comparable efficacy to three-drug regimens (3DRs) for people with HIV (PWH). The objective of this study was to compare the real-world effectiveness and durability of a single-tablet 2DR of dolutegravir/lamivudine (DTG/3TC) with that of commonly prescribed 3DRs in ART-experienced, virologically suppressed PWH during the first 24 months of DTG/3TC availability in the United States.

Methods: Virologically suppressed (viral load [VL] < 200 copies/mL) adult PWH initiating DTG/3TC 2DR, bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF), or a DTG-based 3DR between 01MAY2019 and 31OCT2020 were identified in the OPERA® cohort and followed through 30APR2021. Univariate Poisson regression (incidence rates) and marginal structural Cox proportional hazards models with inverse probability of treatment weights (hazard ratios) were used to quantify relationships between regimen type and confirmed virologic failure (2 consecutive VLs ≥ 200 copies/mL) or regimen discontinuation. Reasons for discontinuation were examined.

Results: A total of 8,037 ART-experienced, virologically suppressed PWH met the inclusion criteria and switched to DTG/3TC (n = 1,450), BIC/FTC/TAF (n = 5,691), or a DTG-based 3DR (n = 896). Incidence rates of confirmed virologic failure were low for all groups, at 0.66 (DTG/3TC), 0.84 (BIC/FTC/TAF), and 1.78 (DTG 3DR) per 100 person-years (py). Compared to DTG/3TC, only the DTG 3DRs were associated with a statistically significant increased hazard of confirmed virologic failure (hazard ratio: 5.21, 95% confidence interval: 1.85, 14.67). Discontinuation rates per 100 py were highest in the DTG 3DR group (24.90), followed by the DTG/3TC group (17.69) and the BIC/FTC/TAF group (8.30). Regardless of regimen, discontinuations were infrequently attributed to effectiveness (VL ≥ 200 copies/mL; 4%) or tolerability (adverse diagnoses, side effects, or lab abnormalities; 6%).

Conclusions: Among virologically suppressed PWH initiating a new regimen, few individuals experienced virologic failure in real-world clinical care. While rates of regimen discontinuation were high, most discontinuations could not be attributed to a lack of virologic control or poor tolerability. These findings suggest that DTG/3TC is an effective option for ART-experienced, virologically suppressed PWH.

背景:双药治疗方案(2DR)是近年来推出的一种治疗方案,它可以减少抗逆转录病毒疗法(ART)的毒性和药物相互作用,同时对艾滋病病毒感染者(PWH)具有与三药治疗方案(3DR)相当的疗效。本研究的目的是比较多罗替拉韦/拉米夫定(DTG/3TC)单片剂 2DR 与常用的 3DR 在美国 DTG/3TC 上市后 24 个月内对有抗逆转录病毒治疗经验、病毒学抑制的感染者的实际疗效和持久性:病毒载量[VL] ®队列,并随访至 2021 年 4 月 30 日。采用单变量泊松回归(发病率)和边际结构 Cox 比例危险模型(治疗加权的逆概率)(危险比)来量化治疗方案类型与确诊病毒学失败(连续 2 次 VL≥ 200 copies/mL)或治疗方案终止之间的关系。对停药原因进行了研究:共有8037名有抗逆转录病毒治疗经验、病毒学抑制的PWH符合纳入标准,并改用DTG/3TC(1450人)、BIC/FTC/TAF(5691人)或基于DTG的3DR(896人)。所有组别的确诊病毒学失败发生率都很低,分别为每 100 人年 0.66 例(DTG/3TC)、0.84 例(BIC/FTC/TAF)和 1.78 例(DTG 3DR)。与 DTG/3TC 相比,只有 DTG 3DR 与确诊病毒学失败的风险显著增加有关(风险比:5.21,95% 置信区间:1.85, 14.67)。每 100 个 py 中,DTG 3DR 组的停药率最高(24.90),其次是 DTG/3TC 组(17.69)和 BIC/FTC/TAF 组(8.30)。无论采用哪种治疗方案,因疗效(VL ≥ 200 copies/mL;4%)或耐受性(不良诊断、副作用或实验室异常;6%)而停药的情况并不常见:结论:在接受新治疗方案的病毒学抑制的艾滋病患者中,很少有人在实际临床治疗中出现病毒学失败。虽然治疗方案的停药率很高,但大多数停药并不能归因于缺乏病毒学控制或耐受性差。这些研究结果表明,DTG/3TC 是有抗逆转录病毒治疗经验、病毒学抑制的 PWH 的有效选择。
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引用次数: 0
Brief communication: Effect of mobile health intervention on medication time adherence among people living with HIV/AIDS receiving care at selected hospitals in Owerri, Imo State Nigeria. 简讯:移动医疗干预对尼日利亚伊莫州奥韦里选定医院接受治疗的艾滋病毒/艾滋病感染者按时服药的影响。
IF 2.1 4区 医学 Q3 INFECTIOUS DISEASES Pub Date : 2024-10-24 DOI: 10.1186/s12981-024-00653-0
Chinelo Judith Ezelote, Eunice Anyalewechi Nwoke, Sally Nkechinyere Ibe, Blessed Okwuchi Nworuh, Gregory Ndubeze Iwuoha, Chimezie Christain Iwuala, Obinna Godwin Udujih, Joy Nkechi Osuoji, Alain Simon Inah, Alexis Ebikonbowei Okaba, Eleanor Asuzu

Aim: This study aimed to assess the impact of Mobile health (M-health) on medication time adherence among people living with HIV/AIDS (PLWHA).

Methods: The study included all PLWHA who were receiving care at the Federal University Teaching Hospital Owerri (FUTH) and Imo State Specialist Hospital (ISSH) Umugumma during the study duration. The test group (FUTH) received a 2-way text message sent three times a week and a once-a-week phone call, while the control group (ISSH) received only the standard care.

Findings: The result shows that the adherence was higher among PLWHA in the test group compared to those in the control group (P = 0.000, χ2 = 168.62, 95% confidence interval (CI): 7.22 to 16.19).

Conclusion: M-health intervention significantly improved the medication time adherence among the participants in the test group compared to those in the control group.

目的:本研究旨在评估移动医疗(M-health)对艾滋病毒/艾滋病感染者(PLWHA)坚持服药时间的影响:研究对象包括研究期间在联邦大学奥韦里教学医院(FUTH)和伊莫州专科医院(ISSH)Umugumma 接受治疗的所有艾滋病毒/艾滋病感染者。试验组(FUTH)每周收到三次双向短信,每周接到一次电话,而对照组(ISSH)只接受标准护理:结果显示,与对照组相比,测试组 PLWHA 的依从性更高(P = 0.000,χ2 = 168.62,95% 置信区间(CI):7.22 至 16.19):与对照组相比,M-health 干预明显改善了测试组参与者的服药时间依从性。
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引用次数: 0
Brief communication: The extent and determinants of viral suppression among patients on protease inhibitor-based Anti-retro-viral therapy undergoing intensive adherence counselling in a public HIV care center in Uganda. 简讯:乌干达一家公立艾滋病护理中心接受强化依从性咨询的蛋白酶抑制剂类抗逆转录病毒疗法患者的病毒抑制程度和决定因素。
IF 2.1 4区 医学 Q3 INFECTIOUS DISEASES Pub Date : 2024-10-24 DOI: 10.1186/s12981-024-00661-0
Zubair Lukyamuzi, Hood Ibanda, Joseph Ggita, Denis Mawanda, Brenda M Gati, Rita Nakalega, Ronald Kiguba

Background: Protease inhibitor (PI)-based Antiretroviral Therapy (ART) regimens are key drugs in HIV management, especially when used as second line drugs. However, some PI-based ART have high adherence demands or tolerable adverse effects which may affect adherence and subsequently viral suppression. We assessed the extent of viral suppression, its determinants, and the experiences of clients on PI-based ART undergoing intensive adherence counselling (IAC) in a public HIV clinic.

Methods: Mixed methods sequential explanatory study involving a quantitative retrospective chart review for clients on PI-based ART who had received IAC from Dec 2016 to May 2023 and qualitative interviews for clients on PI-based ART who had received IAC in the past six months at an urban public HIV clinic in Uganda.

Results: In this study, a total of 189 client charts were included. The median number of IAC sessions received was three (interquartile range, IQR, of 3 to 4) with median time of receiving IAC of three ( IQR, of 2 to 4). One half (51%, 95/186) of the clients had achieved viral suppression and the odds of suppression increased by 30% for every additional month on IAC. Respondents perceived the effectiveness of PI-based ART and IAC in achieving and supporting viral suppression, respectively.

Conclusion: Despite the perceived effectiveness of PI-based ART and IAC, suboptimal levels of viral suppression were observed among clients on PI-based ART who had received IAC. Therefore, it is important to provide IAC for optimal duration as it increases the chances of viral suppression. Further investigation of the barriers of viral suppression for clients on PI-based ART undergoing IAC is needed.

背景:以蛋白酶抑制剂(PI)为基础的抗逆转录病毒疗法(ART)是治疗艾滋病的关键药物,尤其是作为二线药物使用时。然而,一些以蛋白酶抑制剂为基础的抗逆转录病毒疗法对患者的依从性要求较高,或存在可耐受的不良反应,这可能会影响患者的依从性,进而影响病毒抑制效果。我们评估了病毒抑制的程度、其决定因素以及在一家公立艾滋病诊所接受强化依从性咨询(IAC)的 PI 抗逆转录病毒疗法患者的经历:混合方法序列解释性研究,包括对 2016 年 12 月至 2023 年 5 月期间接受过强化依从性咨询的 PI 抗逆转录病毒疗法患者进行定量回顾性病历审查,以及对乌干达一家城市公立 HIV 诊所在过去六个月中接受过强化依从性咨询的 PI 抗逆转录病毒疗法患者进行定性访谈:本研究共纳入 189 份客户病历。接受 IAC 治疗次数的中位数为 3 次(四分位数间距为 3-4 次),接受 IAC 治疗时间的中位数为 3 天(四分位数间距为 2-4 天)。一半(51%,95/186)的受访者实现了病毒抑制,接受 IAC 治疗每增加一个月,病毒抑制的几率就增加 30%。受访者认为基于 PI 的抗逆转录病毒疗法和 IAC 在实现和支持病毒抑制方面分别有效:尽管基于 PI 的抗逆转录病毒疗法和 IAC 被认为是有效的,但在接受了 IAC 的基于 PI 的抗逆转录病毒疗法的患者中,病毒抑制水平仍未达到最佳。因此,提供最佳持续时间的 IAC 非常重要,因为它能增加病毒抑制的机会。需要进一步调查接受 IAC 的 PI 抗逆转录病毒疗法患者的病毒抑制障碍。
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引用次数: 0
Mucosal leishmaniasis of the lips and cheeks: a first concomitant presentation of visceral and mucosal leishmaniasis in a patient living with HIV/AIDS in Monastir, Tunisia. 嘴唇和脸颊粘膜利什曼病:突尼斯莫纳斯提尔一名艾滋病毒/艾滋病感染者首次同时患上内脏和粘膜利什曼病。
IF 2.1 4区 医学 Q3 INFECTIOUS DISEASES Pub Date : 2024-10-23 DOI: 10.1186/s12981-024-00660-1
Latifa Berrezouga, Ikbel Kooli, Sameh Belgacem, Wafa Marrakchi, Seifeddine Ben Hamouda, Adnene Toumi, Hamouda Babba, Abdelfattah Zakhama, Mohamed Chakroun

Background: Visceral Leishmaniasis (VL) is the most severe and fatal disease if left untreated. In people living with HIV/AIDS (PLHA), VL is considered an emerging opportunistic infection. The aim of this manuscript was to report a first case in Tunisia of a concomitant presentation of visceral and oral leishmaniasis in a patient LHA. A systematic review of the literature was performed according to PRISMA guidelines, as well.

Case presentation: The patient, a 43-year-old heterosexual man, treated for HIV/AIDS was referred for macrocheilitis of the upper and lower lips. A noticeable nodular and painless swelling extending to the cheeks' mucosa was noted. The patient's poor oral hygiene was evident due to the presence of multiple dental caries. Histological analysis of the biopsied lower lip sample revealed the presence of numerous Leishmania amastigotes. The diagnosis of VL was clinically confirmed by the presence of a mild splenomegaly and pancytopenia and biologically by the identification of the parasite using PCR Lei and the species L. infantum involved using RFLP-PCR and culture. The treatment consisted of an intravenous administration of liposomal Amphotericin B (Ambisome®, 40 mg/kg/weight) for a period of 6 weeks. A favorable outcome was noted after one year with the resolution of clinical symptoms and a negative Leishmania blood PCR test. After 2 years, the patient remained asymptomatic but showed a positive Leishmania blood PCR test. Dolutegravir® was introduced in the patient's ART regimen.

Conclusions: To the best of our knowledge, this is the first case report in Tunisia of atypical VL diagnosed through an uncommon oral location in an HIV/AIDS co-infected patient . Since VL is a severe and potentially fatal disease, it is essential for dentists to perform a thorough clinical examination and adopt a multidisciplinary approach in order to ensure an early diagnosis and an effective treatment outcome.

背景:如果不及时治疗,内脏利什曼病(VL)是最严重、最致命的疾病。在艾滋病毒/艾滋病感染者(PLHA)中,VL 被认为是一种新出现的机会性感染。本手稿旨在报告突尼斯首例同时患有内脏利什曼病和口腔利什曼病的 LHA 患者。此外,还根据 PRISMA 指南对文献进行了系统性回顾:患者是一名 43 岁的异性恋男子,曾接受过艾滋病毒/艾滋病治疗,因上下唇大疤痕炎而转诊。患者出现明显的结节性无痛肿胀,并延伸至脸颊粘膜。由于存在多处龋齿,患者的口腔卫生状况很差。对下唇活检样本进行的组织学分析显示,存在大量利什曼原虫。轻度脾肿大和全血细胞减少在临床上证实了 VL 的诊断,利用 PCR Lei 对寄生虫进行了生物鉴定,并利用 RFLP-PCR 和培养鉴定了所涉及的幼年利什曼原虫。治疗包括静脉注射两性霉素 B 脂质体(Ambisome®,40 毫克/千克/体重),为期 6 周。一年后,患者临床症状消失,利什曼原虫血液 PCR 检测呈阴性,治疗效果良好。两年后,患者仍无症状,但利什曼原虫血液 PCR 检测呈阳性。在患者的抗逆转录病毒疗法中加入了多罗替韦®:据我们所知,这是突尼斯首例通过不常见的口腔部位诊断出非典型 VL 的病例报告。由于 VL 是一种严重且可能致命的疾病,牙科医生必须进行全面的临床检查,并采用多学科方法,以确保早期诊断和有效治疗。
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引用次数: 0
Brief communication: coagulation profiles of HIV positive patients on antiretroviral therapy (ART) at the Mampong Municipal Hospital, Ashanti-Region, Ghana: a case control study. 简讯:加纳阿散蒂地区曼蓬市立医院接受抗逆转录病毒疗法(ART)的艾滋病毒阳性患者的凝血状况:病例对照研究。
IF 2.1 4区 医学 Q3 INFECTIOUS DISEASES Pub Date : 2024-10-22 DOI: 10.1186/s12981-024-00665-w
Freddie Boateng Opoku, Akua Koaso Yalley, Nicholas Israel Nii-Trebi, Ekoutiame Ahlin, Abena Asefuaba Yalley, Ransford Kyeremeh

This study aimed to ascertain how the current two ART regimens used in Ghana affected HIV patients' coagulation profiles. A case-control study was conducted on 102 HIV positive patients at the Mampong Municipal Hospital. Coagulation parameters measured showed APTT was normal in majority of ART-experienced participants but prolonged in majority of ART-naïve participants. The mean platelet count was significantly higher in ART-experienced participants. No significant differences were found between the coagulation profiles of ART-experienced patients on two different drug regimens. In conclusion, current ART can enhance the coagulation profiles in HIV-infected patients, by improving platelet count and APTT.

本研究旨在确定加纳目前使用的两种抗逆转录病毒疗法如何影响艾滋病患者的凝血功能。研究对曼彭市医院的 102 名艾滋病毒阳性患者进行了病例对照研究。测量的凝血参数显示,大多数接受过抗逆转录病毒疗法的患者的 APTT 正常,但大多数接受过抗逆转录病毒疗法的患者的 APTT 延长。抗逆转录病毒疗法有经验者的平均血小板计数明显较高。接受两种不同药物治疗的有抗逆转录病毒疗法经验的患者的凝血状况无明显差异。总之,目前的抗逆转录病毒疗法可以通过改善血小板计数和 APTT 来改善 HIV 感染者的凝血功能。
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引用次数: 0
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AIDS Research and Therapy
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