Southern African journal of HIV medicine最新文献

Background: Extrapulmonary tuberculosis (EPTB) is common among people living with HIV (PLWH). Abdominal ultrasound is an accessible investigation, frequently employed to support the diagnosis of EPTB, but may lead to misdiagnoses of diseases with overlapping clinical features, such as lymphoma.

Objectives: To describe the abdominal ultrasound features and confirmed diagnoses of patients referred to a biopsy clinic with unexplained lymphadenopathy.

Method: This was a retrospective descriptive study of patients attending the peripheral lymph node biopsy clinic at Groote Schuur Hospital between 2017 and 2020, who had abdominal ultrasound examinations while being investigated for unexplained lymphadenopathy. Ultrasound features were compared to the final diagnosis made on the lymph node biopsy.

Results: Thirty-four patients were included, most of whom were PLWH (59%). Approximately one-third had a confirmed diagnosis of lymphoma (29%) and approximately one-third had a confirmed diagnosis of tuberculosis (32%). Splenic hypoechoic lesions were more common in patients with lymphoma (64%) than in patients with tuberculosis (46%) and malignancy (17%). Ascites was equally distributed between patients with tuberculosis (36%) and lymphoma (36%). The ultrasound report and confirmed diagnoses agreed in 40% of patients with tuberculosis. Additionally, 36% of patients with confirmed lymphoma were suspected to have tuberculosis based on the abdominal ultrasound.

Conclusion: Abdominal ultrasound abnormalities such as splenic hypoechoic lesions, lymphadenopathy, and ascites/pleural effusion have a differential diagnosis including both tuberculosis and lymphoma, and should be investigated accordingly.

Background: CYP2B6 slow metabolisers have higher efavirenz concentrations, which are further increased by isoniazid inhibiting efavirenz's accessory metabolic pathway.

Objectives: We investigated the association between CYP2B6 genotype and toxicity in people living with HIV (PLWH) on isoniazid and efavirenz.

Method: We enrolled participants from the efavirenz arm of the ADVANCE trial (reference no.: NCT03122262), who received isoniazid and consented to genotyping. We compared efavirenz concentrations on and off isoniazid, stratified by CYP2B6 genotype. We explored associations between the CYP2B6 genotype and efavirenz concentrations on isoniazid; and changes over 24 weeks in lipids, alanine aminotransferase (ALT), fasting plasma glucose (FPG), sleep quality, and Modified Mini Screen (MMS) scores.

Results: A total of 168 participants, median age 31 years, 57% female, had classifiable CYP2B6 genotypes. Efavirenz concentrations on isoniazid were higher (pseudo-median difference 0.49 µg/mL (95% confidence interval [CI] [0.19-0.91]) and associated with increases in total and high-density lipoprotein (HDL)-cholesterol. CYP2B6 slow metabolisers had higher efavirenz concentrations on isoniazid than extensive metabolisers (β = 1.66 [95% CI 0.98-2.34]). CYP2B6 slow metabolisers had greater increases in total (β = 0.44 mmol/L [95% CI 0.01-0.86]) and HDL-cholesterol (β = 0.39 mmol/L [95% CI 0.21-0.57]) than extensive metabolisers. There were no associations between efavirenz concentrations or CYP2B6 genotype, and change in ALT, FPG, low-density lipoprotein (LDL)-cholesterol, triglycerides, sleep quality, or MMS scores.

Conclusion: CYP2B6 slow metabolisers on isoniazid and efavirenz had greater efavirenz concentrations and increases in total and HDL-cholesterol. We found no association between CYP2B6 genotype or efavirenz concentrations and sleep or psychiatric symptoms.

Background: Testing for HIV using rapid test devices assists in determining HIV status and ascertains if treatment is required. Rapid HIV quality assurance (QA) training is conducted to ensure accuracy of test results in non-laboratory settings.

Objectives: This study aimed to determine the factors associated with the accuracy of rapid HIV testing among primary healthcare (PHC) workers who received HIV testing QA training in the Eastern Cape, South Africa.

Method: A cross-sectional analytical study design was used to purposively recruit 167 PHC workers with prior training on HIV testing QA. Data were collected in 2022 using a self-administered questionnaire. STATA version 17.0 was used for data analysis.

Results: Tester accuracy measured by a proficiency testing (PT) score of greater than 80% was achieved among 64.7% of the testers. Comprehensive HIV QA training was significantly associated with a PT score of greater than 80% (P = 0.001). On multivariable analyses, a PT score of greater than 80% was less likely with rural facilities (adjusted odd ratios [aOR] = 0.56, 95% confidence interval [CI]: 0.36-0.92, P = 0.020), Grade 12 education (aOR = 0.40, 95% CI: 0.19-0.85, P = 0.017), mentorship (aOR = 0.55, 95% CI: 0.35-0.85, P = 0.008), and attitudes towards inaccurate HIV results (aOR = 0.13, 95% CI: 0.02-0.82, P = 0.03); while implementation of QA processes (aOR = 3.94, 95% CI: 1.22-12.74, P = 0.022) and elements of QA in the HIV Testing Services register (aOR = 4.93, 95% CI: 1.45-16.74, P = 0.011) were associated with a PT score of greater than 80%.

Conclusion: Exposure to comprehensive rapid HIV QA training were associated with higher tester accuracy. A framework for QA training is required for standardisation of training in the country.

Background: Ensuring uninterrupted HIV treatment for female sex workers (FSWs), who face a disproportionately high HIV burden, is crucial for curbing HIV transmission and disease. Structural, social, and legal barriers impede their access to HIV services. The differentiated service delivery (DSD) model, designed to tailor and decentralise HIV services, aims to overcome these barriers. However, the impact of the DSD model for HIV treatment uptake among FSWs in sub-Saharan Africa (SSA) is not well documented.

Objectives: To assess the implementation of the DSD model in improving HIV treatment outcomes among FSWs in SSA.

Method: A systematic review literature was conducted to include available records from January 2019 to March 2024, using electronic databases such as EBSCOhost, Science Direct, SCOPUS, PubMed Central, and others. Ten studies met the eligibility criteria for inclusion for the review. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was registered with the International Prospective Register of Systematic Reviews (ID: CRD42023440551).

Results: The uptake of HIV treatment services varied depending on whether the DSD model was facility-based, community-based, or a combination of both. Community-based models were generally preferred and led to better treatment outcomes due to their comprehensive health services.

Conclusion: To improve HIV treatment outcomes for FSWs in SSA, it is essential to strengthen DSD model implementation, access, and utilisation, particularly at the community level.

Background: HIV and hepatitis B virus (HBV) coinfection impacts negatively on the prognosis for people living with HIV (PLHIV). HBV is relatively neglected compared to HIV in the South African setting, with limited coinfection seroprevalence data from the Free State.

Objectives: This study aimed to determine the seroprevalence of current and previous HBV in PLHIV in the Free State, South Africa.

Method: In this descriptive cross-sectional study, 1007 residual HIV viral load (VL) samples were selected and screened for markers of current HBV infection (hepatitis B surface antigen [HBsAg]) and previous exposure to HBV (total antibodies to hepatitis B core antigen [HBcTA]) between 01 February 2022 and 31 March 2022. Seroprevalence was assessed for municipal health districts, age, sex, and HIV VL categories.

Results: HBsAg seroprevalence was 6.26% and HBcTA seroprevalence was 36.05%. HBsAg seroprevalence was significantly higher in men at 8.12% as compared to women at 4.38% (P = 0.014). HBcTA seropositivity was also higher in men than in women, at 42.97% for men and 29.08% for women (P < 0.0001). Peak HBsAg and HBcTA positivity was observed among the 40-59-year age group in both men and women. No significant difference was found in HBV seroprevalence and exposure between districts or HIV VL categories.

Conclusion: These findings demonstrate that PLHIV in the Free State, South Africa, fall under the intermediate HBV prevalence category. HBV infection remains a public health concern and emphasis should be placed on identifying and addressing programmatic gaps regarding diagnosis and management.

Background: The success of HIV treatment hinges on consistent adherence to antiretroviral therapy (ART).

Objectives: To conduct a longitudinal pilot study to assess the feasibility, acceptability and effectiveness of a mobile app to improve ART adherence.

Method: This study included adults living with HIV and using ART, who were allocated into two groups according to their willingness to use the app: users of the mobile application for ART management (Mobile) and non-users (Control). The application was developed by the researchers, and uses an alarm system to record ART use. Adherence was also assessed using the 'Cuestionario para la Evaluación de la Adhesión al Tratamiento Antiretroviral' (CEAT-VIH) and the Multi-Method Tool questionnaire. Another questionnaire was administered to application users to assess acceptability. After 90 days, all the questionnaires were reapplied.

Results: A significant difference in adherence was observed between the Mobile and Control groups (P = 0.04), but there was no significant difference in time (P = 0.2) or interaction (P = 0.5).

Conclusion: The application was not effective in improving ART adherence and showed low viability, but was considered acceptable among the participants.

Background: Kidney disease is a growing non-AIDS-related comorbidity among people living with HIV (PLWH). Tenofovir disoproxil fumarate (TDF) can result in proximal tubulopathy and acute tubular injury, whereas atazanavir/ritonavir (ATV/r) can cause interstitial nephritis and renal stones, both of which can lead to chronic kidney disease.

Objectives: To examine the relationship between second-line combination antiretroviral therapy (ART) and the risk of kidney disease and morphological changes among PLWH in Dar es Salaam, Tanzania.

Method: A cross-sectional study of adult PLWH receiving TDF-based second-line ART. Socio-demographic and clinical data were gathered, and laboratory tests were conducted to determine the estimated glomerular filtration rate (eGFR). Ultrasonography was performed to visualise the kidneys.

Results: A total of 323 patients were enrolled (67.8% women), with a median age of 44 (interquartile range [IQR]: 39-51) years. Patients were on second-line ART for a median of 49 [IQR: 25-73] months, and 60% received ATV/r. Low eGFR (< 90 mL/min per 1.73 m²) was found in 22% of patients, proportionately higher among patients on ATV/r compared to those on a lopinavir/ritonavir (LPV/r) (P < 0.05). Nearly one-third (32.2%) of patients had a triad of renal calcinosis, renal calculi, and nephritis on ultrasonography. Patients using ATV/r had significantly smaller kidney volumes and greater proportions of renal calculi and nephritis compared to those on LPV/r (P < 0.05).

Conclusion: Adults on second-line ART containing TDF were found to have a high prevalence of renal kidney disease in the Tanzanian context. Predictors of kidney disease were older age, proteinuria, and ATV/r-based regimen as compared to LPV/r.

Background: Rare cases of HIV cure exist. Clinical trials of HIV cure are also underway. However, little is documented about how potential cures are perceived by African people living with HIV, although they are key stakeholders.

Objectives: We explored knowledge, beliefs, and experiences about HIV cure in Soweto, South Africa.

Method: We conducted qualitative research with five stratified focus groups (N = 49). Consenting adults living with HIV were eligible. Facilitators asked participants about their knowledge of HIV cure, experience of purported cures, and beliefs about cure possibilities. Transcripts from audio recordings were thematically analysed.

Results: Participants had knowledge of the concept of cure as eradication, not remission. Three main themes emerged about possible HIV cures. Firstly, hope and scepticism: people feared unequal access to technologies. Secondly, cultural and conventional approaches: there were beliefs in traditional healers, scepticism towards culturally purported cures (e.g. imbiza herbal tonic), and a desire for medical cures to obviate pill burdens. Thirdly, anticipated socio-behavioural effects: beliefs existed that cures might improve happiness, reduce emotional burdens of disclosure, facilitate HIV-free generations, increase risk behaviours, and reduce health checks, but not change societal attitudes to HIV.

Conclusion: In Soweto, South Africa, people living with HIV hope for medical technologies - such as cure and long-acting treatments - to relieve the biopsychosocial burdens of chronic treatment. Despite treatment knowledge, some people try culturally purported cures for HIV. In HIV cure trials, consent language should avoid 'cure' when remission is meant. Care should address pill burden, and counselling should address sex, substances, exercise, and nutrition.

Background: In South Africa, men are less likely than women to use HIV-testing services (HTS). They are also unlikely to start and adhere to antiretroviral therapy until the virus has progressed to advanced AIDS stages.

Objectives: To explore young men's barriers to and facilitators of accessing and utilising HTS at the rural Driefontein and peri-urban Steadville Township in Ladysmith, KwaZulu-Natal (KZN) province, and to develop a comprehensive framework of care for young men to encourage and support them to utilise HTS at primary healthcare facilities.

Method: This exploratory-descriptive qualitative study entailed using semi-structured interviews conducted via WhatsApp and landline audio calls with 17 young men between 18 years and 30 years of age in Steadville and Driefontein communities in KZN in September 2021. Participants were purposively and conveniently sampled, and the data were analysed thematically.

Results: All participants were unmarried isiZulu African men experienced with HTS in the last 4 years. Fear of an HIV-positive test result, limited HTS knowledge, and stigma around HIV and AIDS were challenges linked to HTS utilisation. Unsafe sexual encounters, voluntary medical male circumcision, early virus-detection, having a significant other living with HIV, and HIV-status curiosity encouraged young men to utilise HTS.

Conclusion: Various barriers and facilitators to HTS utilisation, are key for consideration when deriving contextual interventions acceptable to young men as efforts to raise awareness and attract and retain men in care.