AIDS Research and Therapy最新文献

Background: HIV testing services are crucial in preventing the spread of the virus and providing care for those infected. Despite the decline in the number of newly infected people, HIV/AIDS remains a major public health problem in Africa. Being aware of one's HIV status is linked to reduced risk and changes in behavior. Individuals who are newly diagnosed with HIV can quickly be linked to antiretroviral therapy (ART), as well as care and support service.

Methods: Data from the recent Demographic and Health Surveys were used for analysis. The study used a total of 82,361 young women. The determinants of non-testing were examined using a multilevel mixed-effects logistic regression model. Significant factors associated with HIV non-testing were declared significant at p-values < 0.05. The adjusted odds ratio and confidence interval were used to interpret the results. A model with the lowest deviance and highest logliklihood ratio was selected as the best-fit model.

Results: HIV non-testing prevalence among women in 12 Sub-Saharan Africa was 53.96% (95% CI: 53.61%, 54.30%). Women age (AOR = 1.88, 95% CI: 1.02, 1.38), educational level (AOR = 0.711, 95% CI: 0.673,0.751), marital status (AOR = 1.61, 95% CI: 1.5,1.74), media exposure (AOR = 1.08, 95% CI: 1.04,1.12), wealth index (AOR = 0.86, 95% CI: 0.82, 0.899), visited health facility (AOR = 0.41, 95% CI: 0.396, 0.424), Age at first sexual intercourse (AOR = 1.12, 95% CI: 1.001,1.25), risky sexual behavior (AOR = 1.34, 95% CI: 1.26,1.42), knowledge (AOR = 0.71, 95% CI: 0.684, 0.731), residence (AOR = 0.567, 95% CI: 0.542,0.592), distance from the health facility (AOR = 0.927, 95% CI: 0.893, 0.962), had higher odds of HIV non testing prevalence.

Conclusion: According to this study, the prevalence of HIV non-testing among young women in Sub-Saharan Africa is alarmingly high at 53.96%. This prevalence is determined by risky sexual activities, age, marital status and other factors. Targeted awareness campaigns, especially for those in disadvantaged circumstances, should be put into place to address this problem. Testing is promoted by stepping up community outreach and using media campaigns. Furthermore, expanding access to medical facilities and offering counseling services will motivate more young women to be checked, which will ultimately improve the region's health results. To achieve this, interventions such as mobile testing units, youth-friendly clinics, and school-based awareness campaigns should be prioritized to ensure effective engagement and support for young women.

Introduction: Viral load suppression is essential for reducing human immunodeficiency virus (HIV) related morbidity and mortality. To eliminate the HIV epidemic and enhance adherence to antiretroviral therapy (ART) globally, the Joint United Nations Program on HIV/AIDS and the World Health Organization (WHO) recommend enhanced adherence counseling (EAC) for individuals with a viral load above 1000 copies/ml. EAC helps identify and address adherence barriers, assisting patients in recognizing challenges and developing an effective plan to achieve viral load suppression. It also enables early detection of ART failure, ensuring a timely and appropriate switch to second-line medications.

Method: We conducted a systematic review and meta-analysis by performing comprehensive literature search in PubMed, Google Scholar, Hinari-Research4life, and Since Direct to identify relevant articles. Data were extracted via an Excel spreadsheet (version 5.1) and then imported into STATA (version 17.1) for analysis. A random-effects model was applied to the pooled effect of the outcomes, with a 95% confidence interval, which was visualized using a forest plot. Heterogeneity was assessed via I² statistics, and publication bias was examined through a funnel plot and Egger's test (p < 0.05) to determine statistical significance.

Results: This systematic review and meta-analysis included eleven primary studies with a total of 4488 participants. The pooled rate of viral load suppression after enhance adherence counseling among HIV patients on ART was 63% [95%CI: ( 55-71)], with significant heterogeneity (I²-100, p = 0.00). The funnel plot showed asymmetry, and Egger's test result of 0.8104 indicated no publication bias. A leave-one-out analysis revealed that all studies fell within the 95% CI of the pooled rate, suggesting that no single study significantly influenced the overall estimate. In the subgroup analysis the viral load suppression rate was 61% [95% CI: (55-66)] in Ethiopia, and 69% [95%CI: ( 49-90)] in Uganda and it ranged from 63% across all age groups to70% in adult HIV patients.

Conclusion: The rate of viral load suppression following enhanced adherence counseling among HIV patients on antiretroviral therapy(ART) in East Africa was 63%.This value is significantly below the 95% target set by the WHO and UNAIDS under the 95-95-95 framework, emphasizing a substantial gap in achieving the desired outcome of viral load suppression in this region.

Background: This study aimed to assess the PrEP utilization and associated factors among sexually active adolescents and young adults in Soroti city.

Method: A cross-sectional design was employed. Descriptive analysis assessed the level of PrEP utilization while multivariate logistic regression assessed associated factors.

Results: Of the 421 participants, 61(14%) reported having used PrEP. Factors associated with PrEP utilization included: gender (P-value=0.03), HIV risk awareness (P-value=0.002), stigma (P-value<0.001), and social support (P-value<0.001).

Conclusion: PrEP utilization among adolescents and young adults in Soroti City is limited. There is need to address the gender and social inequities in accessing and utilizing PrEP for HIV prevention.

Background: Antiretroviral therapy (ART) has dramatically reduced HIV-related morbidity and mortality worldwide, but adherence remains a critical challenge, particularly in Sub-Saharan Africa. In Somalia, where HIV prevalence is low but health systems are fragile, little is known about the lived experiences of people living with HIV (PLHIV) regarding ART adherence.

Methods: A qualitative study was conducted at ART clinic In Mogadishu Somalia between March-August 2024. A total of 22 adult PLHIV and 12 healthcare providers (8 ART nurses and 4 case managers) participated. Purposive sampling was used to recruit participants; Data were collected through 30 in-depth interviews and 4 focus group discussions using semi-structured guides. Interviews were audio-recorded, transcribed, translated, and thematically analyzed using NVivo software, with emerging themes classified into barriers and facilitators of adherence.

Results: Barriers to adherence included stigma and discrimination, religious and cultural beliefs (such as reliance on prayer or holy water), economic hardship (transport costs, food insecurity), health system challenges (stock-outs, long waiting times, confidentiality concerns), and psychological factors (depression, denial). Facilitators included strong family and social support, religious coping that motivated adherence, positive patient-provider relationships, peer support networks, and personal motivation and resilience, particularly among patients committed to living for their children. Illustrative quotes highlighted the daily struggles and strategies patients employed to remain in care.

Conclusion: ART adherence in Somalia is shaped by complex interactions between socio-cultural, economic, psychological, and health system factors. Interventions that reduce stigma, integrate mental health services, strengthen health systems, provide economic and food support, and leverage religious and peer networks are essential. Collaborating with traditional and religious leaders may further improve acceptance and sustainability of ART programs.

Background: In Ethiopia, where vertical transmission (VT) of HIV remains high, this study investigates the impact of maternal virological failure (VF) on VT outcomes.

Methods: A retrospective cohort of 541 HIV-positive pregnant women from three high-prevalence hospitals was analyzed using bivariable and multivariable logistic regression.

Results: Multivariable logistic regression revealed that maternal VF was strongly associated with VT of HIV. Mothers with VF were nearly ten times more likely to transmit HIV to their infants compared to those with viral suppression (AOR = 9.96; 95% CI 3.19-31.11; p < 0.001). Additional independent predictors of VT included ART initiation during pregnancy (AOR = 3.54; 95% CI 1.48-8.48; p = 0.005), baseline CD4 count ≤ 350 cells/mm3 (AOR = 5.66; 95% CI 2.67-12.00; p < 0.001), poor ART adherence (AOR = 8.09; 95% CI 3.09-21.24; p < 0.001), and absence of infant nevirapine prophylaxis (AOR = 6.54; 95% CI 2.42-17.69; p < 0.001).

Conclusion: Maternal VF was strongly associated with increased risk of VT. These findings highlight the importance of early initiation of ART, consistent viral suppression, adherence support, and routine viral load monitoring as key strategies to reduce VT, particularly in high-burden settings. Strengthening these interventions may help target the small subset of mothers at highest risk and improve overall prevention outcomes.

Bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) is indicated for people with HIV who are virologically suppressed, including those with M184V/I. Data on B/F/TAF effectiveness during viremia with M184V/I are limited. This observational study retrospectively collected clinical/demographic data from adults with viremia and M184V/I receiving B/F/TAF or alternate antiretroviral therapy (ART). Virologic suppression at 3 and ≥ 6 months was evaluated. For participants with data, 5/5 (100%) and 7/8 (88%) on B/F/TAF and 4/6 (67%) and 7/10 (70%) on alternate ART achieved virologic suppression at 3 and ≥ 6 months, respectively. Virologic suppression was achieved in most people with HIV who were viremic with M184V/I on B/F/TAF, as with alternate ART.

Objective: To systematically evaluate the attrition rate of PWH undergoing ART and its influencing factors.

Methods: We systematically searched Embase, PubMed, Web of Science, The Cochrane Library, VIP, WanFang, CNKI, and the Chinese Biomedical Literature Database for studies on the attrition rate and/or influencing factors of ART in PWH. The search period covered from database inception to January 2025. Two researchers independently screened the literature, extracted data, and appraised the quality of the included studies. Data analyses were performed using RevMan 5.3 and Stata 16.0 software.

Results: A total of 19 studies were ultimately included, of which 11 were cohort studies, 4 were case-control studies, and 4 were cross-sectional studies. The meta-analysis showed that the attrition rate among PWH receiving ART was 4.0 per 100 person-years (95% CI: 2.0-5.0 per 100 person-years). Factors identified as influencing attrition among PWH included age(OR = 1.51, 95%CI:1.46,1.64), male gender(OR = 1.30, 95%CI:1.17,1.44), unmarried or living alone(OR = 1.43, 95%CI:1.30,1.59), alcohol consumption(OR = 8.48, 95%CI:1.33,53.74), infection via intravenous drug use(OR = 2.15, 95%CI:1.89,2.46), initial treatment regimen including protease inhibitors (PI) (OR = 1.58, 95%CI:1.34,1.86), baseline CD4⁺ T lymphocyte count > 350/µL(OR = 1.84, 95%CI:1.11,3.05), adverse drug reactions(OR = 1.71, 95%CI:1.26,2.34), inconvenient access to medication(OR = 5.38, 95%CI:1.79,16.18), low family support(OR = 4.81, 95%CI:1.86,12.44), passive acceptance of treatment(OR = 16.04, 95%CI:1.72,149.42), interval from diagnosis to ART initiation > 1 year(OR = 1.20, 95%CI:1.10,1.53), and ART initiation year in 2016 or later(OR = 1.57, 95%CI:1.28,1.93). (P < 0.05). For some factors(alcohol consumption, inconvenient access to medication, low family support, passive acceptance of treatment), the small number of included studies and/or substantial heterogeneity limits the certainty of the evidence and the stability of the findings; therefore, they should be interpreted with caution.

Conclusion: Our meta-analysis indicates that ART attrition among PWH in China is relatively high and influenced by multiple factors. Accelerating ART initiation, optimizing medication access and adverse-event management, and strengthening social and family support may reduce attrition and improve treatment outcomes. Trial registration This study has been registered in PROSPERO under the registration number CRD420251023033.

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.