AIDS Research and Therapy最新文献

Introduction: Abortion is a critical reproductive health issue among young women living with HIV (YWLHIV). Despite the widespread use of the antiretroviral therapy (ART) for women of reproductive age, its impact on abortion prevalence remains unclear. We set out to determine the prevalence of abortion among the YWLHIV receiving TLD-based ART regimen in northern Uganda and its association with the ART regimen and duration alongside other key socio-demographic, reproductive health, lifestyle and facility access- related factors.

Methods: A cross-sectional study of YWLHIV who reported at least one pregnancy in northern Uganda. Using an interviewer-administered questionnaire, participants were asked about their abortion history, ART regimen and duration, contraceptive use, parity, male partner's HIV status, and access to community-based family planning resources. Descriptive statistics for abortion prevalence, Chi-square test, Fisher's Exact test, bivariate and multivariate Poisson regression analyses for the associations between these variables and the occurrence of abortion were used. The 5% significance level and 95% confidence intervals were considered.

Results: We analyzed data of 268 YWLHIV who reported conceiving at least one pregnancy. The abortion prevalence was 20.9% (95% Confidence Interval (CI) of 16.2% - 26.1%). No significant association was found between the abortion experience and ART regimens nor duration. The significant predictors for abortion included awareness of public health facilities that provide family planning services, parity, sero-concordant HIV-positive partnerships, and modern contraceptive use.

Conclusion: This study found a substantial abortion prevalence of 20.9% among the YWLHIV in northern Uganda. There was no significant association between the occurrence of abortion and ART regimens nor duration. Key predictors of abortion included awareness of public health facilities that provide family planning services, parity, use of contraceptive methods and the male partner's HIV positive status. To reduce abortion, creation of awareness of public health facilities that provide family planning services, contraceptive use, and couple-focused HIV testing and status disclosure are recommended.

Introduction: Antiretroviral therapy (ART) reduces morbidity and mortality due to human immunodeficiency virus (HIV) infection. In 2019, Tanzania adopted Dolutegravir (DTG) as a first-, second-line, and third-line treatment for children and adolescents living with HIV (CALHIV). Viral load suppression (VLS) is desirable in the prevention of HIV transmission thus achieving the third '95' target. DTG treatment has highly potent antiviral activity, a high genetic barrier to resistance, and a high safety profile. We aimed to determine VLS and associated factors among CALHIV on DTG-based ART in Tanzania.

Methods: We conducted a retrospective cohort analysis among CALHIV who were on a DTG-based regimen in Tanzania between 2019 and 2021. We extracted demographic and clinical characteristics from the care and treatment clinic database. A multilevel mixed effects Poisson regression model was used to determine factors associated with VLS at < 1000 copies/ml among CALHIV on a DTG-based regimen.

Results: A total of 63,453 CALHIV on a DTG-based regimen were analysed. The proportion of viral suppression was 91.64%. Overall, 66.19% of previously unsuppressed individuals became suppressed, and 88.45% of previously suppressed remained suppressed. Factors leading to higher chances of viral suppression were aged 15-19 years (aRR: 1.02; 95%CI: 1.017-1.03), those in WHO stage I (aRR: 1.03; 95%CI: 1.01-1.04), those in WHO stage II (aRR: 1.02; 95%CI: 1.00-1.04), and those who ever received a multi-month prescription on ART (aRR: 1.25; 95% CI: 1.23-1.28), while those aged 10-14 years (aRR: 0.98; 95%CI: 0.97-0.99), previously unsuppressed prior to starting DTG (aRR: 0.92; 95%CI: 0.91-0.93), duration on ART more than 24 months (aRR: 0.96; 95%CI: 0.94-0.97), not retained in care (aRR: 0.83; 95% CI: 0.77-0.89), severe malnutrition (aRR:0.77; 95%CI: 0.69-0.94) and coastal zone (aRR: 0.98; 95% CI: 0.96-0.99) were less likely to achieve VLS.

Conclusions: This study showed DTG-based regimens have a good response for both naïve, previously unsuppressed, and suppressed Children and Adolescents Living with HIV (CALHIV) with significant improvement in viral suppression. Improving retention in care and malnutrition might improve VLS and achieve the third '95'.

Background: To inform strategies aimed at reducing Metabolic Syndrome (MetS) among People Living with HIV (PLWH), it is important to understand the contribution of pre-Antiretroviral Therapy (ART) health. We estimated the prevalence and factors associated with MetS among ART naïve PLWH.

Methods: A multi-centre cross-sectional study was conducted among adult ART naïve PLWH. MetS was defined as presence of any three sub-components; central obesity, raised blood pressure, impaired fasting glucose, reduced high-density lipoprotein cholesterol and raised triglycerides. Modified World Health Organization (WHO) Steps questionnaire was used to collect information on demographics, behavioral, and physical measurements. Fasting blood samples were taken for blood sugar, high density lipoprotein cholesterol (HDLc) and triglyceride measurements. MetS prevalence was estimated and logistic regression used to determine associated factors. Adjusted odds ratios (aOR) and 95% confidence intervals (95%CI) were reported.

Results: Of 347 ART naïve PLWH with median age 38 years (IQR:19-67), MetS prevalence was at 15.3% (95% CI: 11.7-19.5). Abnormal HDLc was the most prevalent MetS sub-component 64.8% (95% CI: 59.6-69.9). Each year increase in age of participants increased odds of Mets by 4% (aOR = 1.04, 95% CI: 1.01-1.07). Being overweight/obese increased the odds of having MetS by 3.2 times compared to being of healthy weight (aOR = 3.2, 95% CI: 1.6-6.3).

Conclusion: We found that about one in seven ART Naïve PLWH in Accra, Ghana, met the diagnostic criteria for MetS. The contributory factors were consistent with known risk factors for cardiometabolic illnesses. We recommend routine screening of PLWH for MetS sub-components.

Introduction: Advances in HIV/AIDS treatment have transformed HIV into a manageable chronic condition. However, cardiovascular disease (CVD) and other non-communicable diseases are increasingly emerging among people living with HIV (PLHIV), especially in developing countries. This study assessed the prevalence and determinants of CVD risk among PLHIV in Nigeria.

Methods: A cross-sectional study was conducted from February to May 2024 across ten Nigerian health facilities, involving 1,000 PLHIV on antiretroviral therapy (ART). Data on socio-demographic characteristics, lifestyle behaviors, family history of CVD, and HIV-related clinical factors were collected through structured questionnaires and medical records. Chi-square tests and logistic regression analyses were conducted using SPSS v24, with significance set at p < 0.05.

Results: Participants had a median age of 48 years (IQR: 41-56), and 60.7% were female. Hypertension (26.2%), overweight (27.9%), high-risk waist-hip ratio (39.6%), and obesity (19.6%) were common. Overall, 61.1% were at risk for CVD. Significant predictors of higher CVD risk included urban residence (aOR: 1.48; 95% CI: 1.13-1.94), smoking (aOR: 2.16; 95% CI: 1.26-3.68), family history of hypertension (aOR: 1.7; 95% CI: 1.2-2.4), being on ART for ≥ 10 years (aOR: 1.5; 95% CI: 1.1-2.01), and infrequent consumption of high-fat, sugar, and salt (HFSS) foods (aOR: 1.4; 95% CI: 1.1-1.9). Conversely, being retired or a student was associated with lower risk.

Conclusion: CVD risk is prevalent among PLHIV in Nigeria and is linked to demographic, clinical, and lifestyle factors. Targeted, integrated interventions, and client-centered care strategies are required to reduce CVD burden among PLHIV.

Background: Long-acting injectable (LAI)-PrEP provides better protection against HIV compared to oral PrEP, which requires taking a daily pill. Our study aimed to assess knowledge about oral and LAI-PrEP and identify factors associated with willingness to use LAI-PrEP among key populations (KPs) in Uganda.

Methods: We conducted a cross-sectional study at the Most at Risk Populations Initiative (MARPI) clinic between November and December 2021. Participants were recruited through convenience sampling and interviewed using a structured questionnaire by trained interviewers. Participants were categorised into three groups based on their oral PrEP use: those who had not yet initiated PrEP, those who had discontinued oral PrEP, and those currently on oral PrEP. Modified Poisson regression analysis was performed to determine factors associated with the participants' willingness to use LAI-PrEP. Data was analysed using STATA 14 software.

Results: Of the 234 participants, 135 (57.7%) were female, 82.5% knew about LAI-PrEP, and 65.8% were willing to use it. The mean age was 28.7 years (standard deviation [SD] 5.8). Willingness to use LAI-PrEP was less likely among divorced, widowed, or separated individuals than singles (i.e., people with no prior marital experience and neither in a romantic relationship) (adjusted prevalence ratio [aPR] 0.65, 95% CI: 0.43-0.98). Relative to current oral PrEP users, willingness to use LAI-PrEP was similar among those who discontinued oral PrEP (aPR 1.39, 95% CI: 0.92-2.11) and those who had not yet initiated PrEP but were at risk for HIV (aPR 1.26, 95% CI: 0.83-1.89).

Conclusions: This cross-sectional analysis of diverse members of KPs in Uganda revealed that the willingness to use LAI-PrEP was lower among individuals who were divorced, separated, or widowed compared to those who were single. Future studies should investigate effective methods for promoting the uptake of long-acting PrEP formulations among populations at high risk of HIV acquisition.

Background: Syphilis poses a significant threat to global health, particularly in high-risk populations and resource-limited settings. Despite progress in HIV screening, syphilis testing often lags, exacerbating disparities in healthcare delivery. This study evaluated the clinical performance of the iStatis Syphilis Antibody (Ab) Test in South African point-of-care environments.

Methods: A prospective cross-sectional study was conducted with 1,500 enrolled participants across three urban South African sites. The clinical performance of the iStatis Syphilis Antibody (Ab) Test was evaluated using three sample types: capillary blood, EDTA venous whole blood, and plasma. Diagnostic sensitivity and specificity were assessed.

Results: The iStatis test demonstrated excellent diagnostic performance, with sensitivities of 96.40% (capillary blood), 98.80% (venous whole blood), and 99.00% (plasma), and a specificity of 100% across all sample types. A high prevalence of syphilis (33%) was identified. Notably, 90.51% of positive cases were female, and 75.7% of these women were pregnant, highlighting a vulnerable population. The study also revealed a high reinfection rate, suggesting that syphilis can recur relatively quickly post-treatment, underscoring the ongoing transmission challenge.

Conclusion: The iStatis Syphilis Antibody Test is a highly accurate and versatile tool that detects syphilis at different stages using various sample types, making it ideal for use in settings without full laboratory access. The study highlights its potential to improve early diagnosis and control of syphilis, especially in light of high reinfection rates in South Africa. Further research is needed to assess its use in rural areas, long-term performance, and cost-effectiveness to support wider adoption.

Objective: To analyze factors associated with the discontinuation of pre-exposure prophylaxis (PrEP) for HIV among users in Brazil.

Methods: An analytical case-control study was conducted using retrospective data (2018-2020) from PrEP users monitored by Brazil's Unified Health System (SUS) via the Medicines Logistics Control System (SICLOM). Cases (interrupted PrEP, n = 629) were matched 1:10 by sex at birth and age to controls (maintained PrEP, n = 6290). Logistic regression identified factors associated with discontinuation.

Results: Factors significantly associated with PrEP discontinuation included previous anal lesions (adjusted Odds Ratio: 1.92; 95% Confidence Interval [CI]: 1.06-3.28; p = 0.022), active infections within the first 30 days of PrEP (aOR: 1.51; 95% CI 1.07-2.07; p = 0.014), and frequent medication forgetfulness (aOR: 1.48; 95% CI 1.19-1.84; p < 0.001). Not experiencing adverse effects during the first month was protective (aOR: 0.73; 95% CI 0.61-0.87; p < 0.001). The median time until discontinuation was 8 months.

Conclusion: Early clinical experiences and adherence behaviors are critical for PrEP continuation. Enhanced support and monitoring, particularly in the first 30 days post-initiation, are pivotal to improve PrEP persistence in Brazil.

Postpartum adiposity is associated with long-term risk of cardiovascular disease (CVD), which may be influenced by HIV infection. We investigated cross-sectional correlations between postpartum adiposity measures, and circulating proteins linked to CVD in women living with and without HIV. Irrespective of HIV status, adiposity was positively correlated with fatty acid binding protein 4, leptin and galectin 9; and negatively correlated with insulin-like growth factor binding protein 2 and V-set immunoglobulin domain containing 2. The link between adiposity and CVD-linked circulating proteins underscores the role of protein markers in understanding the cardiometabolic health of postpartum women living with and without HIV. Clinical trial number: Not applicable.

Background: The introduction of HIV self-testing (HIVST) kits has revolutionized HIV prevention by offering a confidential and accessible option, particularly for vulnerable groups. Despite this, uptake varies widely due to multiple influencing factors. In Tanzania, where HIV prevalence among women remains high, the determinants of HIVST use are not well understood. This study addresses this gap by analyzing the 2022 Tanzania Demographic and Health Survey (TDHS), aiming to identify key predictors of HIVST uptake among women of reproductive age.

Methods: This study conducted a cross-sectional analysis using 2022 TDHS data. Data management and analysis were performed using Stata 18. Given the survey's complex design, a multilevel mixed-effect logistic regression model was used to identify predictors of HIVST kit use, with results presented as adjusted odds ratios (AORs) and 95% confidence intervals (CIs). Statistical significance was set at p < 0.05.

Results: The prevalence of HIVST kit usage among women of reproductive age in Tanzania was 3.2% (95% CI: 2.8-3.7%). Individual-level factors associated with a higher likelihood of HIVST kit use included age, 25-34 (AOR = 1.93, 95%CI: 1.43-2.60) and 35-49 (AOR = 1.60, 95%CI:1.43-2.26), secondary/higher education (AOR = 2.77, 95%CI: 1.57-4.85), belonging to the rich wealth quintile (AOR = 2.69, 95%CI: 1.52-4.77), internet use (AOR = 3.04, 95%CI: 2.04-4.52), awareness of sexually transmitted infections (STIs) (AOR = 2.03, 95%CI: 1.21-3.42), and one or higher number of sexual partners. At the community level, geographical zone was associated with increased odds of use, while living in a high poverty level community (AOR = 0.52, 95%CI: 0.30-0.89) was associated with a lower likelihood of HIVST kit use.

Conclusion: This study highlights a low uptake of HIVST kits among reproductive-aged women in Tanzania, driven by both individual and community factors. Higher education and STI awareness significantly increase HIVST use, indicating the need for education and targeted health communication. Additionally, community poverty underscores the importance of economic empowerment and resource support to improve access. Addressing these factors can help tailor interventions to boost HIVST uptake and reduce HIV transmission in Tanzania.

HIV drug resistance (HIVDR) was retrospectively characterized among 20 children and adolescents with HIV with virologic failure on non-nucleoside reverse transcriptase inhibitor (NNRTI)-based therapy, and virologic response in those switched to dolutegravir (DTG)-based therapy described. All participants had at least one NNRTI resistance mutation, most commonly K103N (N = 12) and 15 (75%) had nucleoside reverse transcriptase inhibitor (NRTI) resistance mutations, most commonly M184I/V (N = 15). Five (45%) of 11 participants who were switched to DTG-based regimens for a median of 50 months had HIV suppression. Further studies to understand the role of pre-existing HIVDR in the failure of DTG-based regimens are needed.