AIDS Research and Therapy最新文献

Background: Primary drug resistance (PDR) is an important cause of antiretroviral therapy (ART) failure. However, the prevalence and characteristics of PDR in Ganzhou remain unclear.

Methods: From July 2018 to August 2021, treatment-naïve, newly diagnosed HIV-infected individuals in Ganzhou, China were recruited. Blood samples were collected, and the HIV pol gene was amplified by nested PCR followed by Sanger sequencing. Sequence editing and assembly were performed using DNASTAR Lasergene software, and subsequent analysis for resistance mutations and drug susceptibility profiling was conducted using the Stanford University HIV Drug Resistance Database.

Results: Among 108 successfully amplified samples, seven exhibited low-, intermediate-, or high-level resistance mutations, resulting in a PDR prevalence of 6.5%. Among them, the mutation rate of non-nucleoside reverse transcriptase inhibitors (NNRTIs) was 4.6%, and the drug resistance mutation rates of nucleoside reverse transcriptase inhibitors and integrase strand transfer inhibitors (INSTIs) were both 0.9%. No protease inhibitor resistance was detected. Nine drug resistance mutations were detected, among which six were related to NNRTIs, one was related to nucleoside reverse transcriptase inhibitors, and two were related to INSTIs. The K103N and Y181C mutations conferred intermediate-to-high resistance to NNRTIs, while A98G and V179E caused low-to-intermediate resistance to NNRTIs, and the remaining mutations led to low drug resistance to the respective drugs.

Conclusions: Compared to other regions in China, Ganzhou exhibits a relatively low PDR among newly diagnosed HIV-infected individuals. However, the emergence of INSTI-resistant strains underscores the need for enhanced resistance surveillance to prevent the spread of drug-resistant strains caused by ART failure.

People living with HIV (PLHIV) are at increased risk of COVID-19 related morbidity and mortality. We describe the effect of a 'One-Stop-Shop' intervention on COVID-19 vaccine uptake among PLHIV in Nairobi and Kajiado Counties, Kenya. All PLHIV in selected HIV clinics in Nairobi and Kajiado were included. They received the COVID-19 vaccine alongside other PLHIV services within the HIV clinics. Descriptive statistics, Pearson's chi-square test and two sample proportion tests were performed. COVID-19 vaccine uptake among PLHIV in both counties increased post-intervention. Nairobi County had 61% COVID-19 vaccine uptake post intervention compared to 38% pre intervention while Kajiado County had 72% uptake, up from 49% pre intervention. Females had the highest post intervention uptake in both counties at 52% (Nairobi) and 54% (Kajiado). In conclusion, COVID-19 vaccine uptake among PLHIV increased after implementation of the One-Stop-Shop intervention.

Background: People with HIV (PWH) are at risk of co-infections, such as latent tuberculosis (LTBI), hepatitis B (HBV), hepatitis C (HCV), and syphilis; hence, routine screening is critical. However, evaluation of routine screening is not being fully implemented in Ghana. This study assessed the prevalence of these co-infections among PWH in Accra, Ghana.

Methods: The HIV Cure Research Infrastructure Study (H-CRIS) followed 390 PWH from three HIV treatment centres in Accra. A cross-sectional study was conducted within this cohort, and participants were screened for LTBI, hepatitis B, hepatitis C, and syphilis using standardized assays. LTBI was detected using the QuantiFERON-TB Gold Plus assay. Syphilis testing included treponemal and non-treponemal assays. HBV and HCV were tested using rapid test kits. Data was collected on demographics, viral load, CD4 count, ART regimen, and therapy duration. Descriptive statistics used frequency and proportion, while inferential analysis employed chi-square tests, t-tests, and odds ratios (OR) to assess associations.

Results: Among 390 participants, median age: 45 years (IQR: 39-52 years), 69% (269/390) were virologically suppressed, and 80% (312/390) had CD4 counts above 350 cells/µL. The prevalence of co-infections was 12% (48/390) for HBV, 10.8% (42/390) for LTBI, 12.5% (40/320) for syphilis, and 1% (4/390) for HCV, with 2% (8/390) having more than two co-infections. LTBI was associated with age (> 60 years; OR = 3.5) and years of HIV diagnosis (> 10 years; OR = 2.2).

Conclusion: The significant burden of co-infections among PWH in Ghana highlights the urgent need to integrate routine screening into HIV care.

Background: Human immunodeficiency virus self-testing (HIVST) using oral fluid is the best way to receive preventive and treatment services, which helps lower morbidity and mortality related to the problem.

Purpose: To assess the acceptance and associated factors of human immunodeficiency virus self-testing using oral fluid among targeted adult clients at public health facilities in Sheger City, Ethiopia in 2023.

Patients and methods: An institution-based cross-sectional study was conducted from July 1 to 30, 2023 among clients visiting health facilities for Voluntary counseling and testing (VCT), Provider-initiated counseling and testing (PICT), and Prevention of mother-to-child transmission (PMTCT) services. A total of 317 study participants were selected using a systematic random sampling method. A structured questionnaire was used to collect data from the clients through interviews. Clients were asked to use HIVST using oral fluid when they came for HIV testing at the VCT, PICT, and PMTCT services, and those responded 'yes' to the question "will you accept HIVST using oral fluid today?", were considered as acceptors. Data were analyzed using bivariate and multivariable binary logistic regression. Variables with a p-value of < 0.25 in bivariate analysis, were candidates for multivariable analysis. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) were calculated to identify the presence and strength of association.

Results: In total, 314 study participants were involved making a response rate of 99.1%. The overall acceptance of human immunodeficiency virus self-testing (HIVST) among targeted adult clients attending public health facilities in the study area was 169 (53.8%) (95%CI: 48.1%, 59.2%). Being married (AOR = 3.97; 95%CI: 1.74, 9.05), having fear of being stigmatized (AOR = 3.75; 95%CI: 1.64, 8.61), obtaining counseling during HIV testing (AOR = 3.33; 95%CI: 1.28, 8.64) and not sure about confidential information related to HIV testing (AOR = 2.49; 95%CI: 1.13, 5.46) were factors that were significantly associated with acceptance of HIVST using oral fluid.

Conclusion: This study found that acceptance of HIVST among targeted adults in public health facilities was consistent with global findings. Factors such as being married, fear of stigma, receiving counseling, and concerns about confidentiality were significantly associated with HIVST acceptance. Addressing these factors can help increase HIVST acceptance.

Background: The delivery of HIV prevention services (e.g., HIV testing, pre-exposure prophylaxis (PrEP) initiation and refills, and STI testing) in community pharmacies could address clinic barriers faced by pregnant women such as extended travel and wait times. We conducted a qualitative study in Western Kenya to select and prioritize attributes and levels for a discrete choice experiment (DCE) to design pharmacy-based HIV prevention services for pregnant women.

Methods: We began by identifying a comprehensive list of attributes and levels relevant to women considering HIV prevention during pregnancy. This list was informed by recommended HIV prevention interventions for pregnant women, our objective to design services for pharmacy settings, and attributes identified in the literature as important for other populations when choosing HIV and pharmacy-based services. From March to November 2022, we recruited participants using stratified purposeful sampling and collected qualitative data through seven focus group discussions with women, four with health providers, and eight individual interviews with technical experts. Interviews were audio-recorded, translated, transcribed, and summarized in debrief reports. We conducted debriefing meetings and analyzed these reports to identify and refine the essential attributes that would influence decisions to access HIV prevention services from a pharmacy during pregnancy.

Results: We initially identified twelve potential attributes that were evaluated during the focus groups. Five attributes were eliminated based on ranking exercises with women and health providers. Additional attributes suggested during the focus groups were ranked low by participants or not mentioned frequently enough and, therefore, not included. We finalized and refined levels for each attribute using insights from the literature, participant feedback, and design considerations. The study identified seven attributes: service location, type of HIV test, STI testing availability, partner HIV testing availability, PrEP availability, service access methods (e.g., appointment versus walk-ins), and service fee.

Conclusions: This study was the first step in data collection toward defining attributes and levels for a DCE survey and successfully identified seven preliminary attributes and levels. Pre-testing and pilot testing activities further explored the feasibility and understanding of the attributes and levels.

Background: Differentiated service delivery (DSD) models in resource-limited settings reduce strain on health services and improve clinical outcomes such as retention and viral suppression, but little is known about the impact of HIV DSD models on quality of life (QoL), which is essential for optimizing person-centered care. This study assessed the impact of DSD models on Quality of life, loss to follow-up (LTFU), and mortality among persons living with HIV (PLHIV) on Antiretroviral therapy (ART) over time at a large urban HIV clinic in Uganda.

Methods: Records of 1,000 PLHIV enrolled in a 10-year cohort at the Infectious Diseases Institute (IDI) clinic in Kampala, Uganda were retrospectively analyzed. QoL was assessed using an adapted Medical Outcomes Study (MOS-HIV) tool. QoL scores, sustained annual viral suppression (< 200 copies/mL), all-cause mortality and LTFU (≥ 3 months of missed visits) were compared for PLHIV in three DSD models for ≥ 6 consecutive months-fast-track drug refill (FTDR), facility-based groups (FBG), and composite model combining these two-versus facility-based individual management (FBIM) or the standard of care (SOC). Inverse probability treatment weighting was applied for covariate comparability while robustness of results was checked using G-computation. Sustained viral suppression was compared using odds ratios; all-cause mortality and LTFU were compared using hazard ratios from the Cox proportional hazard regression model.

Results: Of the 1,000 PLHIV, 980 had ≥ 1 follow-up and were included in the analysis. Median age was 45 years (IQR: 40-51), 62% were female, and 95% had a suppressed viral load at baseline. Baseline QoL was 90.1% in any DSD model vs. 89.2% in SOC. After eight years of follow-up, weighted mean QoL was higher in participants enrolled in DSD models than the SOC (90.4% vs. 89.1%; weighted mean ratio 3.66, 95% CI 2.10-6.37, p-value < 0.001); there were no statistical differences across DSD models. Participants in DSD models were more likely to have sustained viral suppression (weighted odds ratio 1.69, 95% CI 1.24-2.31), lower mortality (weighted hazard ratio 0.08, 95% CI 0.03-0.20) and lower LTFU rates (weighted hazard ratio 0.08, 95% CI 0.02-0.31).

Conclusion: DSD models were associated with modestly higher quality of life, better viral suppression, and lower mortality and LTFU compared to the standard of care. These findings support the broader adoption of DSD models in delivering ART across HIV programs to enhance the QoL and clinical outcomes among PLHIV.

Background: Achieving and maintaining viral suppression and optimal adherence to antiretroviral therapy are crucial for improving health outcomes in general population of people living with HIV. This study aimed to evaluate the effects of monetary incentives on these key treatment goals.

Methods: We conducted a systematic review and meta-analysis, searching the Cochrane Library, Medline, EMBASE, CINAHL, Web of Science, and Scopus databases from inception to March 2025. We included randomized controlled trials comparing monetary incentives with routine care in people living with HIV. The primary outcomes were viral suppression and adherence to antiretroviral therapy. Random-effects meta-analyses were used to calculate pooled odds ratios with 95% confidence intervals. This study was registered with PROSPERO (registration number CRD42024524374).

Results: Thirteen randomized controlled trials were included. Compared with routine care, monetary incentives significantly improved viral suppression (OR = 1.39,95%CI: 1.11, 1.74); p = 0.004; I²=42%), adherence to antiretroviral therapy (OR = 1.62,95%CI: 1.13,2.31; p = 0.008; I²=30%) and retention in care (OR = 1.27, 95% CI: 1.02-1.57; p = 0.03; I²=9%). The difference in CD4 + T-cell counts between groups did not reach statistical significance (SMD = -38.90, 95% CI: -77.35 to -0.45; p = 0.05), with low heterogeneity (I² = 28%).

Conclusion: Monetary incentives effectively improve viral suppression and adherence to antiretroviral therapy among people living with HIV. Integrating monetary incentives into HIV care models could be a promising strategy to optimize treatment outcomes. Further research is needed to assess the long-term sustainability and cost-effectiveness of such interventions.

Background: The option B⁺ prevention of mother to child transmission of human immunodeficiency virus is the lifelong provision of antiretroviral therapy for all human immunodeficiency virus positive pregnant and breastfeeding women regardless of immune status. In Ethiopia, the overall mother-to-child transmission rate of human immunodeficiency virus was 15.9%. This study assessed determinants of human immunodeficiency virus infection among infants born to human immunodeficiency virus positive women on option B + prevention of mother to child transmission of human immunodeficiency virus in Tigray, north Ethiopia.

Methods: Unmatched case-control study was conducted in Tigray region from October 2023 to April 2024. A total of 43 cases and 129 controls were selected using simple random sampling technique. Multivariable logistic regression analysis was fitted to identify the factors associated with mother to child transmission of human immunodeficiency virus at P < 0.05. Multicolinearity was checked among predictor variables using Variance Inflation Factor and Tolerance test. Furthermore, the goodness of fit of the logistic model was tested using Hosmer-Lemshow test.

Results: This study showed that rural residence (Adjusted Odds ratio: 33.3, 95% CI: 1.02-87.05), World Health Organization disease stage III (Adjusted Odds ratio: 57.4, CI: 9.25- 297.54) and IV (Adjusted Odds ratio: 78.9, CI: 12.64-345.62) during initiation of antiretroviral therapy and a child with mouth ulcer during exclusive breastfeeding (Adjusted Odds ratio: 65, IC: 6.39-456.23) were the factors significantly associated with mother to child transmission of human immunodeficiency virus. Besides, mothers' educational status (Adjusted Odds ratio: 0.2, CI: 0.04, 0.35), late time of antiretroviral therapy initiation after human immunodeficiency virus diagnosis (Adjusted Odds ratio: 0.14, CI: 0.02-0.18) and absence of human immunodeficiency virus exposed infant follow up visit (Adjusted Odds ratio: 0.04, IC: 0.005-0.09) had significant association with the mother to child transmission of human immunodeficiency virus.

Conclusion: The determinant factors significantly associated with mother to child transmission of human immunodeficiency virus were identified. Health care providers should strengthen option B + prevention mother to child transmission of human immunodeficiency virus services to reduce the mother to child transmission of human immunodeficiency virus.

Background: The HIV/AIDS pandemic remains a public health concern. Studies on host genetic polymorphisms that confer resistance to HIV-1 infection or delay HIV disease progression are scarce in African countries. Herein, we investigate the proportion of the mutated phenotype of the AIDS-related polymorphisms CCR5-Delta32, CCR2-64I, and SDF1-3'A in HIV-infected and uninfected individuals in Luanda, the capital of Angola, a sub-Saharan African country.

Methods: This was a cross-sectional study conducted with 284 individuals, of whom 159 were HIV-negative and 125 were HIV-positive. The CCR5-Delta32, CCR2-64I, and SDF1-3'A genotypes were detected by conventional PCR and visualised on 2% agarose gel. A Chi-square test determined the frequency of each genetic variant and was deemed significant when p < 0.05.

Results: The frequency of CCR5-Delta32, CCR2-64I, and SDF1-3 A was 0% (0/272), 60.2% (154/256), and 42.5% (114/268), respectively. CCR2-64I and SDF1-3 A polymorphisms were statistically related to HIV infection (p < 0.001). Statistically significant was observed between ABO blood groups (p = 0.006) and HIV-1 subtype (p = 0.015) with CCR2-64I. Also, the age group (p = 0.024) and RH blood group (p = 0.018) were statistically related to the distribution of SDF1-3 A polymorphism.

Conclusions: We found no CCR5-Delta32 allele, while CCR2-64I and SDF1-3'A were found and presented a relationship with HIV infection, age, ABO/RH blood group, and HIV-1 subtypes. The observed associations of CCR2-64I and SDF1-3'A with HIV underscore the urgent need for further multidisciplinary research, with potential implications for targeted prevention and public health strategies. Therefore, studies investigating biological and non-biological factors related to susceptibility to HIV infection and AIDS progression or death should be conducted in Angola.