Southern African journal of HIV medicine最新文献

Background: HIV-related stigma and discrimination are significant barriers to public health interventions, particularly among youth. In Malaysia, discriminatory attitudes towards people living with HIV (PLHIV) hinder efforts to achieve the National Strategic Plan for Ending AIDS by 2030. Stigma deters individuals from HIV testing, disclosure, treatment-seeking, and antiretroviral therapy adherence, undermining the cascade of care needed to reach the Joint United Nations Programme on HIV/AIDS (UNAIDS) 95-95-95 goals.

Objectives: This study aimed to identify risk factors for HIV-related discriminatory attitudes among pre-university students.

Method: A cross-sectional study was conducted at a public foundation centre in Selangor. A total of 329 pre-university students were recruited via simple random sampling. The study included active students who could read and write in Malay. Data were collected using a self-administered questionnaire. Descriptive and multivariate logistic regression analyses were conducted using SPSS version 29.0.

Results: Among the 329 participants, 224 (68.1%) met the criteria for discriminatory attitudes based on global HIV stigma indicators, which assess attitudes towards interacting with PLHIV in everyday settings. Multivariate analysis identified two significant risk factors: (1) female gender (adjusted odds ratio [aOR] = 1.776, 95% confidence interval [CI] = 1.064-2.964, P = 0.028) and (2) inadequate HIV knowledge (aOR = 4.546, 95% CI = 2.715-7.610, P = 0.001).

Conclusion: This study revealed a high prevalence of discriminatory attitudes among pre-university students. Female gender and inadequate HIV knowledge were significant predictors. These findings support the development of targeted interventions to reduce HIV stigma and strengthen national prevention and treatment efforts.

Background: Paediatric HIV remains a major public health challenge. Little is known about the HIV knowledge, perceptions, and behaviours of healthcare professionals caring for these children.

Objectives: To assess the level of knowledge, attitudes and practices (KAP) of healthcare workers (HCW) caring for children with HIV in a tertiary hospital setting.

Method: A cross-sectional study was conducted at Pelonomi Tertiary Hospital between July 2022 and September 2022. Healthcare workers, selected through purposive sampling, completed an anonymous self-administered KAP questionnaire on paediatric HIV.

Results: There were 94 participants in this study; 62 were nurses and 32 were medical doctors. Less than half of the HCWs (44.7%) had adequate knowledge. Doctors (87.5%) were more knowledgeable than nurses (22.6%). Areas in which there was a significant difference in knowledge (P < 0.05) were in breastfeeding, vertical transmission prevention, management of HIV and tuberculosis co-infection, the use of the polymerase chain reaction test, and first-line treatment regimens. The attitudes of the majority of HCWs were favourable and optimistic. Regarding practices, more nurses (60.7%) wore gloves than doctors (37.5%). The majority of HCWs (85.7%) disposed of sharps appropriately.

Conclusion: Despite the low levels of knowledge among study participants, particularly among the nursing group, favourable attitudes suggested that HCWs were willing to increase their levels of knowledge. Healthcare workers can be empowered in a supportive workplace by being offered interactive training sessions based on established guidelines.

Background: Dolutegravir- has superior viral suppression compared to efavirenz-based antiretroviral therapy (ART). However, there are limited programmatic data on suppression in rural areas of South Africa.

Objectives: We aimed to compare 6- and 12-month viral suppression of dolutegravir and efavirenz regimens and determine factors available in TIER.Net (the national electronic database for HIV and tuberculosis care) associated with suppression.

Method: We conducted a retrospective cohort study using Mopani District programme data from TIER.Net. Clients aged ≥ 15 years initiated on tenofovir-lamivudine-dolutegravir (TLD) or tenofovir-emtricitabine-efavirenz (TEE) between 01 October 2021 and 31 March 2023, with ≥ 150 days in care, were included. We analysed 6- and 12-month suppression proportions and factors associated with suppression using logistic regression.

Results: A total of 472 clients on TEE and 944 on TLD were included. Six-month viral loads were available for 47.7% (225/472) of TEE and 57.4% (542/944) of TLD clients. Six-month suppression (< 50 copies/mL) was 65.5% (355/542) for TLD and 53.8% (121/225) for TEE (P = 0.002). TLD was associated with increased odds of suppression at 6 months (adjusted odds ratio [aOR] 1.6; 95% CI: 1.1-2.2). At 12 months, viral loads were available for 60.7% (573/944) of TLD and 56.1% (265/472) of TEE clients. Twelve-month suppression (< 50 copies/mL) was 70.0% (401/573) for TLD and 68.3% (181/265) for TEE with no statistically significant differences between TEE and TLD clients. Low-level viraemia (50 copies/mL - 999 copies/mL) at 12 months was 25.0% for TLD and 20.8% for TEE.

Conclusion: TLD showed improved suppression compared to TEE at 6 but not 12 months. The high proportion of clients with low-level viraemia is concerning. All clients, regardless of regimen, need evaluation for adherence support.

Background: Evaluating long-term efficacy, safety and pharmacokinetics of long-acting cabotegravir + rilpivirine (CAB+RPV LA) in sub-Saharan African populations is important because of the region's unique demographics and antiretroviral therapy resistance patterns.

Objectives: To describe the 96-week efficacy, safety and pharmacokinetics of CAB+RPV LA in South African participants from the pooled FLAIR and ATLAS-2M Phase 3/3b randomised studies.

Method: Primary endpoint: proportion of participants with plasma HIV-1 RNA levels ≥ 50 copies/mL at Week 96. Secondary endpoints: proportion of participants with plasma HIV-1 RNA levels < 50 copies/mL, confirmed virological failure (CVF; two consecutive plasma HIV-1 RNA ≥ 200 copies/mL), adverse events and pharmacokinetics.

Results: Sixty-six participants were included, (CAB+RPV LA, n = 49; current oral antiretroviral regimen [CAR], n = 17). Forty-five (92%) on CAB+RPV LA and 15 (88%) on CAR maintained HIV-1 RNA levels < 50 copies/mL. At Week 96, two participants, one in each arm, had CVF. Ninety per cent on CAB+RPV LA and 76% on CAR of participants experienced an adverse event; six (12%) of which were drug-related (CAB+RPV LA: n = 6). Injection-site reactions were common (78% [Grade 1: 80%; Grade 2: 20%]). CAB and RPV trough plasma concentrations remained above respective in vitro protein-adjusted 90% inhibitory concentrations following all doses.

Conclusion: This subgroup analysis of South African participants demonstrated durable efficacy, acceptable safety profile and pharmacokinetics of injectable CAB+RPV LA up to 96 weeks, consistent with long-term data from other regions and studies.

Background: Accurate non-sputum-based tuberculosis (TB) diagnostics are urgently needed to improve diagnostic yield and patient outcomes.

Objectives: To compare the diagnostic accuracy and diagnostic yield of Urine Xpert Ultra (Urine-XPU) and Urine Determine^TM TB Lipoarabinomannan (LAM) antigen test (AlereLAM) against both a microbiological and composite reference standard (MRS and CRS) in a rural, routine care setting in South Africa.

Method: Adults (≥ 18 years) with HIV had sputum, urine and blood collected for comprehensive TB testing shortly after admission. Additionally, focused assessment with sonography for HIV-associated TB (FASH) was performed. The MRS was defined by Xpert Ultra or culture-based tests for Mycobacterium tuberculosis. The CRS incorporated these mycobacterial tests, FASH findings, and clinical response to empiric TB treatment. Follow-up was conducted at 3 months.

Results: A total of 206 participants were enrolled, with a median age of 39 years and 63% were female. Using the MRS the sensitivity of AlereLAM was 45.2% (95% confidence interval [CI]: 31.2-60.1) and Urine-XPU, 59.5% (95%CI: 44.5-73.0); and the specificity of AlereLAM was 93.6% (95%CI: 88.2-96.6) and Urine-XPU 95.0% (95%CI: 90.0% - 97.6%). Urine-XPU and AlereLAM performed better than sputum Xpert Ultra (Sputum-XPU) in patients with more severe illness. Additionally, Urine-XPU showed potential for accurately detecting rifampicin resistance.

Conclusion: Urine-XPU and AlereLAM demonstrated comparable diagnostic accuracy for TB in hospitalised adults with HIV. Integrating Urine-XPU alongside AlereLAM and Sputum-XPU may improve timely and accurate diagnosis of TB and rifampicin resistance. Further research is required to optimise the diagnosis-to-treatment pathway.

[This corrects the article DOI: 10.4102/sajhivmed.v26i1.1679.].

Background: Mortality among people living with HIV (PLWH) in developing settings remains elevated, despite high coverage with antiretroviral therapy (ART), with 70% - 80% being virally suppressed (VS).

Objectives: This study aimed to determine cause-specific mortality in PLWH in South Africa.

Method: An autopsy study with detailed medical record review was undertaken in PLWH dying in hospital. Minimally invasive autopsies were performed on 38 VS and 21 unsuppressed PLWH (≥ 18 years) dying in hospital between May 2018 and April 2022. We assessed clinical and histological findings to determine underlying, contributing, and immediate causes of death (CODs).

Results: Median CD4 counts were 180 and 42 cells/mm³ in patients with and without VS respectively. Leading immediate CODs in both VS and unsuppressed PLWH were respiratory failure, sepsis, and septic shock; leading contributing CODs in decreasing order of frequency in both groups were acute kidney injury (AKI), bacterial pneumonia, immunological failure, gastroenteritis and current tuberculosis. Leading underlying CODs in both groups were hypertension, current tuberculosis, malignancies, and chronic obstructive pulmonary disease. VS was associated with lower risk of septic shock and AKI.

Conclusion: VS on ART appeared to reduce risk of death from specific pathologies. However, infections, multi-organ failure, non-AIDS-defining malignancies, and metabolic diseases remain important CODs. Incomplete immune reconstitution appears to be a key contributor to premature death.

Background: Viral suppression (VS) rates in children on antiretroviral therapy (ART) are lower than in adults. We described the effect of enhanced adherence counselling (EAC) on VS among children with high HIV viral load accessing dolutegravir (DTG)-based ART in a programme setting in Malawi.

Objectives: This study evaluated the proportion of children with high viral load on DTG-based ART who re-suppressed following EAC and factors associated with VS post-EAC.

Method: We included all patients aged < 15 years with a high viral load result (> 1000 copies/mL) after taking DTG-based ART for at least 6 months between January 2022 and March 2023, covering 104 healthcare facilities in Malawi. Descriptive statistics summarised the distribution of demographic and clinical characteristics. Multivariable logistic regression determined the factors associated with VS following EAC.

Results: Overall, 1475 participants were enrolled; 884 (59.9%) were aged 10-14 years. A total of 1448 (98.2%) were enrolled in EAC, of whom 787 (54.3%), 308 (21.3%), and 353 (24.4%) completed three, two, and one session(s), respectively. Follow-up HIV viral load results were available for 1091 (74%) participants enrolled in EAC, and 782 (71.7%) achieved VS. Patients from urban areas were less likely to achieve VS post-EAC than those from rural areas (adjusted odds ratio [aOR]: 0.58, 95% confidence interval [CI]: 0.42-0.80).

Conclusion: Nearly three-quarters of children with high viral load on DTG-based regimens achieved VS following EAC. Further research on the other contributors of virologic failure among children in Malawi is required.

Background: Dolutegravir in second-line antiretroviral therapy (ART) is more effective with recycled tenofovir than switching to zidovudine. However, dolutegravir resistance is more frequent in second-line compared to first-line ART.

Objectives: We report long-term virologic outcomes from a clinical trial.

Method: AntiRetroviral Therapy In Second-line: investigating Tenofovir-lamivudine-dolutegravir (ARTIST) was a randomised, double-blind, phase II clinical trial. Eligible participants had two consecutive HIV-1 RNA ≥ 1000 copies/mL on first-line ART, mostly tenofovir-emtricitabine-efavirenz. Participants were switched to tenofovir-lamivudine-dolutegravir (TLD) with lead-in 50 mg dolutegravir twice daily in stage one (n = 62), and randomised to TLD with additional lead-in 50 mg dolutegravir or placebo for the first 14 days in stage two (n = 130). We present results up to 158 weeks, combining stages one and two.

Results: We enrolled 192 participants: 127/176 (72%) had resistance (Stanford score ≥ 15) to both tenofovir and lamivudine. At week 48, 151/186 (81%; 95% confidence interval [CI] 75%, 87%) had HIV-1 RNA < 50 copies/mL. Of 127 participants with follow-up through week 158, 78% (95% CI 70%, 85%) maintained HIV-1 RNA < 50 copies/mL, 11% had HIV-1 RNA 50-999 copies/mL, and 11% had HIV-1 RNA ≥ 1000 copies/mL. Twenty-nine participants met criteria for resistance testing: one developed intermediate-level dolutegravir resistance (G118R mutation) at week 96, and one had high-level dolutegravir resistance (E138K, G118R, G163R, T66A mutations) detected at week 146.

Conclusion: Among adults switching to TLD with detectable HIV-1 RNA and substantial tenofovir and lamivudine resistance, a high proportion maintained virologic suppression up to 158 weeks. Emergent dolutegravir resistance occurred in ~1% of participants after 2-3 years on second-line TLD.