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BACKGROUND: HIV notification and testing integrated into partner service (PS) practices among HIV-positive individuals have been proven to be an efficient approach for case finding, although it remains a weak link in China. Although nonmarital sexual activities accounted for a large proportion of newly diagnosed HIV-positive cases in China, little is known about PS uptake and associated factors within nonmarital partnerships. OBJECTIVE: This study aimed to describe HIV PS utilization and its associated factors among HIV-positive individuals with nonmarital sexual partners. METHODS: We recruited newly diagnosed HIV-positive individuals who had nonmarital sexual partners in 2022 in Zhejiang Province and offered them PS. We described the PS uptake cascade within sexual partner categories and analyzed the associated factors with 3 primary outcomes from the participants' perspective: nonmarital partner enumeration, HIV testing, and HIV positivity. RESULTS: In this study, 3509 HIV-positive individuals were recruited as participants, and they enumerated 2507 nonmarital sex partners (2507/14,556, 17.2% of all nonmarital sex partners) with contact information. Among these, 43.1% (1090/2507) underwent an HIV test, with an HIV-positive rate of 28.3% (309/1090). Heterosexual commercial partners were the least likely of being enumerated (441/4292, 10.3%) and had the highest HIV-positive rate (40/107, 37.4%). At the participant level, 48.1% (1688/3509) of the participants enumerated at least one nonmarital sex partner with contact information, 52.7% (890/1688) had a sex partner tested for HIV, and 31% (276/890) had at least one nonmarital sex partner who tested positive. Multivariate analysis indicated that gender and transmission route were associated with both nonmarital sex partner enumeration and HIV testing. Age and occupation were associated with nonmarital sex partner enumeration and HIV positivity. Compared with participants who had no regular nonmarital sex partner, those who had a regular nonmarital sex partner were more likely to enumerate nonmarital sex partners (adjusted odds ratio [aOR] 3.017, 95% CI 2.560-3.554), have them get tested for HIV (aOR 1.725, 95% CI 1.403-2.122), and have an HIV-positive nonmarital sex partner (aOR 1.962, 95% CI 1.454-2.647). CONCLUSIONS: The percentage of partner enumeration was low, and HIV testing rate was moderate among nonmarital partnerships of HIV-positive individuals. More efforts should be made to improve PS practices among HIV-positive individuals and address the gap in partner enumeration, especially for heterosexual commercial nonmarital partnerships. Additionally, enhancing PS operational skills among health care personnel could increase the overall efficiency of PS uptake in China.
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Trazado de Contacto , Infecciones por VIH , Parejas Sexuales , Humanos , China/epidemiología , Masculino , Estudios Transversales , Femenino , Adulto , Trazado de Contacto/métodos , Trazado de Contacto/estadística & datos numéricos , Persona de Mediana Edad , Infecciones por VIH/epidemiología , Infecciones por VIH/diagnóstico , Adolescente , Adulto Joven , Prueba de VIH/estadística & datos numéricos , Prueba de VIH/métodos , Encuestas y Cuestionarios , Síndrome de Inmunodeficiencia Adquirida/epidemiologíaRESUMEN
BACKGROUND: HIV/AIDS has emerged as a nationwide epidemic and has taken the forefront position as the primary infectious killer of adults in China. The control and prevention of the disease have been hampered by a weak link in the form of heterosexual transmission. However, conventional intervention measures have demonstrated suboptimal efficacy in reducing the incidence of new HIV infections. In light of the current epidemiological characteristics, we have developed and executed an innovative intervention model known as the Joint Prevention and Control Mechanism of the 'CDC-Public Security Bureau-NGO'. The purpose of this research is to assess the impact of this model on the AIDS awareness, HIV infection rates, sexual behavior, and associated factors among female sex workers and elderly clients. Through the provision of robust evidence of the efficacy of this innovative model, we seek to advocate for its implementation in future interventions. METHODS: The research design of this study incorporates both a serial cross-sectional study and time-series analysis from 2014 to 2021, including a 4-year traditional intervention (2014-2017) and the 4-year 'CDC-Public Security Bureau-NGO' innovative intervention (2018-2021), was conducted to evaluate the effects of the new intervention. The GM(1, 1) model was performed to predict the proportion of HIV infection without implementing the innovative intervention in 2018-2021; P and C values were used to evaluate the performance of the model. Mann-Kendall test and descriptive methods were used to analyzed the trend of traditional and innovative interventions models on HIV positive detection rate in FSWs and elderly clients. RESULTS: The condom usage rates during the last commercial sexual encounter for FSWs and elderly clients improved from 74.9% and 9.1%, respectively, to 96.9% and 28.1%. (P < 0.05), newly reported cases of HIV have decreased by 15.56% yearly and the HIV positive detection rate among middle-aged and elderly people has dropped by 14.47%. The innovative intervention model has significantly reduced the HIV infection rates. CONCLUSIONS: The 'CDC-Public Security Bureau-NGO' innovative intervention has achieved beneficial effects on HIV/AIDS prevention and control and provides a good reference for Guangxi, China.
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Infecciones por VIH , Humanos , China/epidemiología , Femenino , Adulto , Estudios Transversales , Estados Unidos/epidemiología , Infecciones por VIH/prevención & control , Infecciones por VIH/epidemiología , Persona de Mediana Edad , Centers for Disease Control and Prevention, U.S. , Síndrome de Inmunodeficiencia Adquirida/prevención & control , Síndrome de Inmunodeficiencia Adquirida/epidemiología , Trabajadores Sexuales/estadística & datos numéricos , Anciano , Adulto Joven , Conducta Sexual/estadística & datos numéricos , Masculino , Conocimientos, Actitudes y Práctica en SaludRESUMEN
BACKGROUND: Population ageing and access to antiretroviral therapy have resulted in an increase in the proportion of older people living with human immunodeficiency virus (HIV). However, scant knowledge is available to inform the design of educational programmes to target these persons in low- and middle-income countries. AIM: This study aimed to examine how persons aged ≥ 50 years view their risk of contracting HIV, and the extent to which they are supported in preventing infection and are impacted by the HIV or acquired immune deficiency syndrome (AIDS) epidemic. SETTING: Rural sites in the Western Cape Province of South Africa. METHODS: This study followed a qualitative design. Two focus group discussions with persons aged ≥ 50 years and interviews with two key informants were conducted at seniors' centres. Discussions were digitally audio recorded and the recordings were transcribed, and data were thematically analysed. RESULTS: Overall, awareness of the risk of older persons contracting HIV infection in this population was poor. Stigmatisation of the disease in the community and at health care facilities affected individuals' willingness to be tested for the virus and/or to disclose their status, if positive. Participants viewed HIV and AIDS education programmes as focussed on the youth and educational sessions for large groups were not helpful in stemming the epidemic. CONCLUSION: Dissemination of information on older persons' vulnerability to the disease, and education on HIV and AIDS tailored for and targeted at this age group have been relatively neglected.Contribution: Educational programmes on HIV, as well as productive channels and platforms to target older populations, particularly those with a low health literacy level are required.
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Síndrome de Inmunodeficiencia Adquirida , Grupos Focales , Infecciones por VIH , Conocimientos, Actitudes y Práctica en Salud , Investigación Cualitativa , Humanos , Sudáfrica , Masculino , Femenino , Infecciones por VIH/prevención & control , Persona de Mediana Edad , Anciano , Síndrome de Inmunodeficiencia Adquirida/prevención & control , Población Rural , Estigma SocialRESUMEN
BACKGROUND: This study examines global trends in acquired immune deficiency syndrome (AIDS) incidence, mortality, and disability-adjusted life years (DALYs) from 1990 to 2019, focusing on regional disparities in AIDS incidence, mortality, and DALYs across various levels of socio-demographic index (SDI). It also investigates variations in AIDS incidence, mortality, and DALYs across different age groups, and projects specific trends for the next 25 years. METHODS: Comprehensive data on AIDS from 1990 to 2019 in 204 countries and territories was obtained from a GBD study. This included information on AIDS incidence, mortality, DALYs, and age-standardized rates (ASRs). Projections for AIDS incidence and mortality over the next 25 years were generated using the Bayesian age-period-cohort model. RESULTS: From 1990 to 2019, the global incidence of HIV cases increased from 1,989,282 to 2,057,710, while the age-standardized incidence rate (ASIR) decreased from 37.59 to 25.24 with an estimated annual percentage change (EAPC) of -2.38. The ASIR exhibited an upward trend in high SDI and high-middle SDI regions, a stable trend in middle SDI regions, and a downward trend in low-middle SDI and low SDI regions. In regions with higher SDI, the ASIR was higher in males than in females, while the opposite was observed in lower SDI regions. Throughout 1990 to 2019, the age-standardized death rate (ASDR) and age-standardized DALY rate remained stable, with EAPCs of 0.24 and 0.08 respectively. Countries with the highest HIV burden affecting women and children under five years of age are primarily situated in lower SDI regions, particularly in sub-Saharan Africa. Projections indicate a significant continued decline in the age-standardized incidence and mortality rates of AIDS over the next 25 years, for both overall and by gender. CONCLUSIONS: The global ASIR decreased from 1990 to 2019. Higher incidence and death rates were observed in the lower SDI region, indicating a greater susceptibility to AIDS among women and < 15 years old. This underscores the urgent need for increased resources to combat AIDS in this region, with focused attention on protecting women and < 15 years old as priority groups. The AIDS epidemic remained severe in sub-Saharan Africa. Projections for the next 25 years indicate a substantial and ongoing decline in both age-standardized incidence and mortality rates.
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Síndrome de Inmunodeficiencia Adquirida , Años de Vida Ajustados por Discapacidad , Carga Global de Enfermedades , Humanos , Síndrome de Inmunodeficiencia Adquirida/epidemiología , Síndrome de Inmunodeficiencia Adquirida/mortalidad , Carga Global de Enfermedades/tendencias , Masculino , Femenino , Incidencia , Adulto , Persona de Mediana Edad , Adulto Joven , Adolescente , Años de Vida Ajustados por Discapacidad/tendencias , Salud Global/estadística & datos numéricos , Preescolar , Predicción , Niño , Lactante , Anciano , Teorema de BayesRESUMEN
Ensuring good quality of life (QoL) among persons with diagnosed HIV (PWH) is a priority of the National HIV/AIDS Strategy (NHAS), which established 2025 goals for improving QoL. Goals are monitored through five indicators: self-rated health, unmet needs for mental health services, unemployment, hunger or food insecurity, and unstable housing or homelessness. Among the growing population of PWH aged ≥50 years, progress toward these goals has not been assessed. Data collected during the 2017-2022 cycles of the Medical Monitoring Project, an annual complex sample survey of U.S. adults with diagnosed HIV, assessed progress toward NHAS 2025 QoL goals among PWH aged ≥50 years, overall and by age group. The recent estimated annual percentage change from baseline (2017 or 2018) to 2022 was calculated for each indicator. Among PWH aged ≥50 years, the 2025 goal of 95% PWH with good or better self-rated health is 46.2% higher than the 2022 estimate. The 2025 goals of a 50% reduction in the other indicators range from 26.3% to 56.3% lower than the 2022 estimates. Decreasing hunger or food insecurity by 50% among PWH aged ≥65 was the only goal met by 2022. If recent trends continue, other NHAS QoL 2025 goals are unlikely to be met. Multisectoral strategies to improve access to housing, employment, food, and mental health will be needed to meet NHAS 2025 goals for QoL among older PWH.
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Objetivos , Infecciones por VIH , Calidad de Vida , Humanos , Persona de Mediana Edad , Estados Unidos/epidemiología , Infecciones por VIH/diagnóstico , Infecciones por VIH/epidemiología , Anciano , Masculino , Femenino , Síndrome de Inmunodeficiencia Adquirida/epidemiología , Inseguridad AlimentariaRESUMEN
Histoplasmosis is caused by the fungus Histoplasma capsulatum and is often fatal for individuals with acquired immunodeficiency syndrome (AIDS). Delayed diagnosis is a major factor in worsening coinfection, as it can be mistaken for other diseases. Thus, rapid identification of Histoplasma in immunocompromised patients is essential. Molecular techniques, particularly polymerase chain reaction (PCR), were used in this study to identify H. capsulatum in patients coinfected with histoplasmosis and AIDS. Blood samples from 14 individuals with AIDS and disseminated histoplasmosis were collected and analyzed. The PCR method successfully amplified the fungal region in whole blood samples, while PCR-RFLP analysis confirmed a consistent profile in the samples. Genetic sequencing further confirmed the fungal species. Compared to clinical tests such as fungal culture and urinary antigen detection, molecular analysis proved faster, more sensitive, and cost-effective. These molecular markers can potentially be incorporated into routine diagnostics in the future. Further studies are needed to expand and enhance this diagnostic approach, particularly in patients with nonprogressive clinical forms of histoplasmosis.
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Infecciones Oportunistas Relacionadas con el SIDA , Histoplasma , Histoplasmosis , Reacción en Cadena de la Polimerasa , Humanos , Histoplasmosis/diagnóstico , Histoplasmosis/microbiología , Histoplasma/genética , Histoplasma/aislamiento & purificación , Infecciones Oportunistas Relacionadas con el SIDA/microbiología , Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Masculino , Femenino , ADN de Hongos/análisis , ADN de Hongos/genética , ADN de Hongos/sangre , Adulto , Polimorfismo de Longitud del Fragmento de Restricción , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Síndrome de Inmunodeficiencia Adquirida/microbiología , Persona de Mediana EdadRESUMEN
BACKGROUND: Transgender women (TGWs) constitute one of the key populations for HIV prevention and control and constitute a high-risk group due to a lack of health services. The aim of this study was to investigate knowledge, attitudes and practices (KAPs) related to HIV and knowledge access and needs amongst transgender women in Chongqing, China. METHODS: A cross-sectional study was conducted from October 2022 to March 2023. A total of 128 self-identified TGWs were recruited in Chongqing, China, via snowball sampling, and a KAP-related questionnaire was completed via Questionnaire Star. RESULTS: For the 128 TGWs surveyed effectively, the total knowledge of AIDS-related knowledge was 82.03%, with significant differences in age, education level, marital status, occupation and average monthly income (p < 0.05). Significant differences were obtained in terms of personal attitudes toward AIDS and place of domicile and literacy (p < 0.05) and subjective norms in terms of literacy (p < 0.05). No significant difference was observed between the groups in terms of HIV-related practices. The corresponding values were assigned to knowledge, attitudes or practices. The total scores of the three aspects were 6.77 ± 1.47 (95% confidence interval [CI]: 3.89-9.65) (range: 0-8), 14.22 ± 2.37 (95% CI: 9.57-18.87) (range: 0-18) and 6.66 ± 1.79 (95% CI: 3.16-10.17) (range: 0-9), respectively. The main approaches for TGWs to acquire AIDS knowledge are 'Internet/smartphone' (81.68%), 'TV/radio' (49.62%) and 'special education on AIDS prevention in schools' (48.09%). TGW is more inclined to accept promotional activities such as 'WeChat push' (58.02%), 'peer education' (44.27%) and 'mobile app management' (37.40%). AIDS knowledge indicates that TGW needs to strengthen publicity, including 'transmission routes' (71.76%), 'voluntary counselling and testing knowledge' (67.94%) and 'virus-related knowledge' (64.89%). CONCLUSIONS: First, the knowledge rate of AIDS amongst TGWs in Chongqing, China, still has room for improvement, and there is a gap between knowledge and behavior. Second, TGWs are tolerant of AIDS and people living with AIDS and have a strong awareness of AIDS prevention. Third, the health department should attach importance to the group of TGW over 35 years old, low-income, and low-educated, and promote social organizations and network platforms to further strengthen the health education and publicity of AIDS from the perspectives of knowledge acquisition and needs.
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Síndrome de Inmunodeficiencia Adquirida , Conocimientos, Actitudes y Práctica en Salud , Personas Transgénero , Humanos , Estudios Transversales , China/epidemiología , Femenino , Adulto , Personas Transgénero/psicología , Personas Transgénero/estadística & datos numéricos , Síndrome de Inmunodeficiencia Adquirida/prevención & control , Síndrome de Inmunodeficiencia Adquirida/psicología , Encuestas y Cuestionarios , Adulto Joven , Masculino , Persona de Mediana Edad , AdolescenteRESUMEN
Objective: To analyse the factors related to the use of provider-initiated test and counselling services for inmates at high risk of HIV /AIDS. METHODS: This descriptive cross-sectional study was conducted at the Polyclinic of Class IIA Abepura Correctional Institution, Papua Province, Indonesia, from November to December 2020, and involved 140 inmates, of age 18 years or older selected by simple random sampling technique, at high risk of HIV after obtaining informed consent. All had been tested for HIV status were fluent in Indonesian and willing to participate in the study. The use of provider-initiated testing and counselling services was recorded in 112 (80%) cases. Data were collected using a structured questionnaire exploring aspects related to testing and counselling. Data were analysed using SPSS v.21. RESULTS: The association between use of provider-initiated testing and counselling services and acceptance of HIV/AIDSrelated stigma and discrimination was significant (odds ratio=20.781; p<0.001). The association between use of provider-initiated testing and counselling services was also significant with belief in its usefulness (odds ratio=12.372; p<0.001), family and institutional support (odds ratio = 9.993; p<0.001), need for services (odds ratio = 6.587; p<0.001), and knowledge of services (odds ratio = 6.130; p<0.001). Conclusion: It is essential to build a cross-programme collaboration between health workers and security officers in the form of regular counselling to reduce the stigma and discrimination among inmates.
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Consejo , Infecciones por VIH , Aceptación de la Atención de Salud , Humanos , Consejo/métodos , Consejo/estadística & datos numéricos , Masculino , Infecciones por VIH/diagnóstico , Adulto , Estudios Transversales , Indonesia , Femenino , Aceptación de la Atención de Salud/estadística & datos numéricos , Adulto Joven , Estigma Social , Prueba de VIH/métodos , Prueba de VIH/estadística & datos numéricos , Prisioneros/estadística & datos numéricos , Prisioneros/psicología , Persona de Mediana Edad , Encuestas y Cuestionarios , Síndrome de Inmunodeficiencia Adquirida/diagnósticoRESUMEN
BACKGROUND: The provision of professional counseling services for persons living with human immunodeficiency virus (PLHIV) is crucial in the prevention and treatment continuum of the disease. However, for counselors of people infected with the human immunodeficiency virus (HIV) leading to acquired immune deficiency syndrome (AIDS) to give their best, their motivations to become counselors and the challenges they face in their line of duty need to be contextually understood and addressed. We ascertained the roles, motivations, and experiences of HIV/AIDS counselors in the Volta Region of Ghana to inform HIV/AIDS counseling decision-making in the region and the country. METHODS: A phenomenological study conducted among sixteen (16) HIV/AIDS counselors from five HIV/AIDS sentinel sites in the Volta region of Ghana, recruited through a purposive sampling approach and interviewed to ascertain their HIV/AIDS counseling-related experiences. The data were thematically analyzed using the Atlas. ti software, and sub-themes supported with verbatim quotes. RESULTS: Five motives for becoming an HIV/AIDS counselor were found. These include being randomly assigned to the unit, developing interest in the job, because of the status of a relative, witnessing bad attitudes of healthcare providers, and seeing HIV- clients lacking knowledge of the condition. The study found that these counselors performed six core roles: providing nutritional counseling, educating clients on HIV, treatment, and medication provision, conducting testing and comprehensive counseling of clients, providing social support to clients, and offering financial support to clients. The experiences these counselors had were boosting clients' health status, counseling clients back to a normal mental state, cooperation from clients, participants gaining knowledge on HIV through counseling, counseling clients to accept their status, and when a client delivered an HIV-negative baby. Their negative experiences included clients denying their HIV status, clients defaulting on their treatment, uncooperative clients, death of clients due to fear of breach of confidentiality, self-stigmatization among clients, and the myths some people hold towards HIV/AIDS. CONCLUSION: By organizing capacity-building training programs for HIV/AIDS counselors in the Volta region and addressing the negative experiences they encounter, they could be empowered to provide effective counseling, curative, and social services to people living with HIV in the region, leading to improved health outcomes.
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Consejo , Consejeros , Infecciones por VIH , Motivación , Humanos , Ghana , Infecciones por VIH/psicología , Infecciones por VIH/terapia , Masculino , Consejeros/psicología , Femenino , Adulto , Persona de Mediana Edad , Síndrome de Inmunodeficiencia Adquirida/psicología , Síndrome de Inmunodeficiencia Adquirida/terapia , Investigación CualitativaRESUMEN
Adenosine is a neuro- and immunomodulator that functions via G protein-coupled cell surface receptors. Several microbes, including viruses, use the adenosine signaling pathway to escape from host defense systems. Since the recent research developments in its role in health and disease, adenosine and its signaling pathway have attracted attention for targeting to treat many diseases. The therapeutic role of adenosine has been extensively studied for neurological, cardiovascular, and inflammatory disorders and bacterial pathophysiology, but published data on the role of adenosine in viral infections are lacking. Therefore, the purpose of this review article was to explain in detail the therapeutic role of adenosine signaling against viral infections, particularly COVID-19 and HIV. Several therapeutic approaches targeting A2AR-mediated pathways are in development and have shown encouraging results in decreasing the intensity of inflammatory reaction. The hypoxia-adenosinergic mechanism provides protection from inflammation-mediated tissue injury during COVID-19. A2AR expression increased remarkably in CD39 + and CD8 + T cells harvested from HIV patients in comparison to healthy subjects. A combined in vitro treatment performed by blocking PD-1 and CD39/adenosine signaling produced a synergistic outcome in restoring the CD8 + T cells funstion in HIV patients. We suggest that A2AR is an ideal target for pharmacological interventions against viral infections because it reduces inflammation, prevents disease progression, and ultimately improves patient survival.
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Síndrome de Inmunodeficiencia Adquirida , Adenosina , COVID-19 , Evasión Inmune , Receptor de Adenosina A2A , SARS-CoV-2 , Transducción de Señal , Humanos , COVID-19/inmunología , COVID-19/virología , Receptor de Adenosina A2A/metabolismo , SARS-CoV-2/inmunología , SARS-CoV-2/fisiología , SARS-CoV-2/patogenicidad , Adenosina/metabolismo , Síndrome de Inmunodeficiencia Adquirida/inmunología , Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Tratamiento Farmacológico de COVID-19 , Linfocitos T CD8-positivos/inmunología , Linfocitos T CD8-positivos/metabolismo , Apirasa/metabolismo , Apirasa/inmunologíaRESUMEN
INTRODUCTION: The present study investigated the impact of immune recovery and the duration of antifungal adherence in the consolidation phase of disseminated histoplasmosis (DH) in acquired immune deficiency syndrome (AIDS) patients living in a hyperendemic area in northeastern Brazil. MATERIAL AND METHODS: Sixty-nine patients with DH/AIDS, admitted to the São José Hospital between 2010 and 2015, who continued histoplasmosis consolidation therapy at the outpatient clinic were studied. The follow-up duration was at least 24 months. RESULTS: Sixty-eight patients used itraconazole 200-400 mg/day or amphotericin B deoxycholate weekly during the consolidation phase, and six patients relapsed during follow-up. The overall median duration of consolidation antifungal use was 250 days [IQR 101 - 372]. Antifungal withdrawal by medical decision occurred in 41 patients (70.7 %) after a median of 293 days [IQR 128 - 372] of use; 16 patients discontinued by their own decision, with a median of 106 days [IQR 37 - 244] of therapy; three patients had no information available, and nine continued on AF therapy. The median CD4+ T-cell count in the group without relapse was 248 cells/µL [IQR 115-355] within 6 months after admission; conversely, in the relapse group, the median cell count remained below 100 cells/µL. Irregular adherence to highly active antiretroviral therapy (HAART) was the leading risk factor associated with relapse and death (p< 0.01). DISCUSSION: The regular use of HAART, combined with immune recovery, proved to be highly effective in preventing relapses in DH/AIDS patients, suggesting that long-term antifungal therapy may not be necessary.
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Infecciones Oportunistas Relacionadas con el SIDA , Síndrome de Inmunodeficiencia Adquirida , Anfotericina B , Antifúngicos , Ácido Desoxicólico , Histoplasmosis , Humanos , Histoplasmosis/tratamiento farmacológico , Histoplasmosis/inmunología , Masculino , Femenino , Antifúngicos/uso terapéutico , Antifúngicos/administración & dosificación , Adulto , Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Síndrome de Inmunodeficiencia Adquirida/inmunología , Persona de Mediana Edad , Ácido Desoxicólico/uso terapéutico , Ácido Desoxicólico/administración & dosificación , Anfotericina B/uso terapéutico , Anfotericina B/administración & dosificación , Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Infecciones Oportunistas Relacionadas con el SIDA/inmunología , Infecciones Oportunistas Relacionadas con el SIDA/microbiología , Recuento de Linfocito CD4 , Brasil/epidemiología , Itraconazol/uso terapéutico , Itraconazol/administración & dosificación , Reconstitución Inmune , Combinación de Medicamentos , Quimioterapia de Consolidación , Estudios Retrospectivos , Cumplimiento de la Medicación/estadística & datos numéricos , Recurrencia , Duración de la Terapia , Resultado del Tratamiento , Estudios de Seguimiento , Terapia Antirretroviral Altamente ActivaRESUMEN
Neurocognitive disorders are mental health conditions that are caused by medical illnesses and can lead to several acquired cognitive deficits, which represent a decline from a previously attained level of functioning. The principal domains of cognitive functions include complex attention, executive function, learning and memory, language, perceptual-motor function, and social cognition. Studies have shown that people living with human immunodeficiency virus (HIV) are at a heightened risk of experiencing cognitive challenges across multiple domains. Given that, a substantial number of people live in Amhara region, assessing cognitive domains to estimate the current magnitude and factors associated with neurocognitive disorders among HIV/AIDS patients is crucial. An institutional-based cross-sectional study was conducted among 569 participants adults living with HIV attending the city's selected health facilities from March 20 to April 30, 2023. A multistage sampling technique was used. The International HIV Dementia Scale (IHDS) was used to measure the outcome of interest. The data were collected using a structured questionnaire and document review. The data were analyzed using STATA version 14. Multiple binary logistic regressions were used as the final model. A total of 501 individuals, with a response rate of 88.04% participated in the study. The overall proportion of HIV patients with neurocognitive impairment was 54.7% (95% CI 50.62-58.77). Factors associated with the neurocognitive impairment were: being widowed AOR = 3.05 (95% CI 1.47-6.31), divorced AOR = 1.95 (1.16-3.28), rural residence AOR = 2.28 (95% CI 1.02-5.09), CD4 count below 500 cells/dl AOR = 1.61 (95% CI 1.03-2.50), history of opportunistic infection AOR = 2.21 (95% CI 1.42-3.41), being in first-line drug regimen AOR = 2.92 (95% CI 1.22-7.00), being in a first-line regimen with Efavirenz AOR = 4.36 (95% CI 1.07-17.73), and impairment in daily living AOR = 2.64 (95% CI 1.39-4.99). In this study, the proportion of neurocognitive impairment was greater than that in most previous studies conducted in Ethiopia. The factors associated with the disorder were: being widowed or divorced, living in a rural area, having low CD4, having a history of opportunistic infection, receiving a first-line drug regimen, receiving efavirenz-containing drugs, and having impaired daily living. Hence, routine neuropsychological screenings should be integrated into comprehensive ART care by the regional health bureau and implemented by hospitals and health centers.
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Infecciones por VIH , Trastornos Neurocognitivos , Humanos , Masculino , Femenino , Etiopía/epidemiología , Adulto , Estudios Transversales , Persona de Mediana Edad , Trastornos Neurocognitivos/epidemiología , Trastornos Neurocognitivos/etiología , Infecciones por VIH/epidemiología , Infecciones por VIH/complicaciones , Infecciones por VIH/psicología , Infecciones por VIH/tratamiento farmacológico , Factores de Riesgo , Adulto Joven , Síndrome de Inmunodeficiencia Adquirida/epidemiología , Síndrome de Inmunodeficiencia Adquirida/psicología , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Complejo SIDA Demencia/epidemiología , AdolescenteRESUMEN
This study investigated the association between serum albumin concentration and 12-weeks mortality of HIV/AIDS with late diagnosis in China. This retrospective cohort study included, 1079 inpatients diagnosis with late HIV/AIDS between January 2018 and December 2021. Disease progression was estimated based on the 12-weeks mortality rate. Cox proportional hazards regression models were used to evaluate the relationship between serum albumin levels and disease progression. The effects of serum albumin levels on mortality was estimated via Kaplan-Meier curves. The mortality risk decreased by 7% with every 1 g/L increase in serum albumin after adjustment ([HR] = 0.93, 95% CI: 0.88-0.97). Compared with that of the low (< 28 g/L) serum albumin group, the middle (28-34 g/L) group's mortality risk decreased by 70% (HR = 0.30, 95% CI: 0.15-0.59), and that of the high (≥ 34 g/L) group decreased by 40% (HR = 0.6, 95% CI: 0.29-1.23) after adjustment. Our findings suggest a positive correlation between the increase in serum albumin levels upon admission and a decrease in mortality at 12 weeks post-discharge among patients with late AIDS/HIV diagnosis. Further research is needed to characterize the role of serum albumin in 12-weeks mortality prevention in patients with a late diagnosis.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida , Albúmina Sérica , Humanos , Masculino , Femenino , Estudios Retrospectivos , Persona de Mediana Edad , Adulto , Albúmina Sérica/análisis , Síndrome de Inmunodeficiencia Adquirida/mortalidad , Síndrome de Inmunodeficiencia Adquirida/sangre , Síndrome de Inmunodeficiencia Adquirida/diagnóstico , Infecciones por VIH/mortalidad , Infecciones por VIH/sangre , Infecciones por VIH/diagnóstico , China/epidemiología , Modelos de Riesgos Proporcionales , Progresión de la Enfermedad , Diagnóstico Tardío , Estimación de Kaplan-MeierRESUMEN
INTRODUCTION: The global HIV/AIDS initiative in Africa aims for eradication by 2030 and treatment for 95% of HIV-positive adults by 2025. Adult People living with HIV (PLWHs) face health complications, including metabolic syndrome (MS), which heightens the risk of non-communicable diseases (NCDs) and cardiovascular problems. WHO and UNAIDS advocate for the integration of NCDs into primary healthcare, yet addressing MS remains a significant challenge in Africa. The WHO's Global Action Plan aims to reduce chronic diseases by managing risk factors and promoting healthy lifestyles within this population. However, effectively promoting healthy lifestyles necessitates an understanding of the sociocultural contexts that influence behaviors related to MS. Therefore, this study investigates how sociocultural contexts influences on knowledge, attitudes, and practices of PLWHs in Ethiopia regarding MS prevention and associated lifestyle risks, utilizing the PEN-3 model as a sociocultural framework. METHODS: The study utilized a deductive descriptive phenomenological approach, involving 32 voluntarily selected PLWHs who sought routine care at public health institutions from December 29, 2017, to January 22, 2018. Data collection was facilitated by experienced research and task teams using standardized guidelines for focus group discussions and in-depth interviews tailored to the research context. The collected text and survey data were managed with Atlas.ti and SPSS software and analyzed through thematic content analysis. Results were reported in accordance with the consolidated criteria for reporting qualitative research (COREQ) checklist. RESULTS: A study of 32 HIV-positive adults found that knowledge, attitudes, and health-related behaviors were key factors in their health. Participants learned about metabolic syndrome (MS) risks through mass media, peer discussions, and family education. However, there was a lack of awareness about the impact of HIV medications on MS and limited understanding of lifestyle factors for disease prevention. Attitudes reflect complex challenges for PLWHs in perceiving MS and its management. Health-related behaviors varied, with positive practices like fruit and vegetable consumption, regular exercise, and avoidance of harmful substances. Negative practices included sedentary lifestyles, raw meat consumption, alcohol, smoking, and 'Khat' use, which could negatively affect health outcomes. Addressing these culturally preferred behaviors is crucial for improving health among PLWHs. CONCLUSION: The study revealed a notable knowledge gap regarding metabolic syndrome (MS) and its risk factors, leading to inadequate health attitudes and practices. Sociocultural factors-such as beliefs, values, family dynamics, and community support-are crucial in shaping the knowledge, attitudes and practice of PLWHs toward the prevention and management of chronic diseases like MS. The finding suggested that addressing the sociocultural factors affecting HIV-positive individuals' knowledge and practices regarding metabolic syndrome requires a comprehensive, inclusive approach that emphasizes education, community involvement, policy reform, and a focus on reducing stigma.
Asunto(s)
Infecciones por VIH , Conocimientos, Actitudes y Práctica en Salud , Síndrome Metabólico , Humanos , Etiopía , Adulto , Masculino , Síndrome Metabólico/psicología , Femenino , Infecciones por VIH/psicología , Infecciones por VIH/prevención & control , Persona de Mediana Edad , Factores de Riesgo , Síndrome de Inmunodeficiencia Adquirida/psicología , Síndrome de Inmunodeficiencia Adquirida/prevención & control , Adulto JovenRESUMEN
AIDS is a serious disease with impaired immune function caused by human immunodeficiency virus (HIV) infection. The treatment of AIDS has always been the focus of global scientific research, and Tat protein is a key regulatory protein in the process of HIV infection. Its high expression is closely related to virus replication, disease progression, etc. The aim of this study is to explore the molecular mechanism of regulating Tat protein expression by using network pharmacology based traditional Chinese medicine for calming the liver and detoxifying. 129 AIDS patients were enrolled in the study and randomly divided into HAART combined with PGJDP treatment and HAART alone treatment groups. The virological response rate, immunological response status (CD4 + T cell level, CD4/CD8) and incidence of abnormal liver function were observed before and 48 weeks after treatment. Using the TCMSP database to obtain the chemical components and targets of the main traditional Chinese medicine components in PGJDP, clinical results indicate that the combination of HAART and PGJDP treatment can improve the virological response rate (P > 0.05); Increase the number of CD4 + T lymphocytes (P > 0.05); Significantly increased CD4/CD8 ratio (P < 0.01); Simultaneously, it significantly reduced the incidence of liver dysfunction (P < 0.01). After screening and analysis, the Chinese herbal medicine for calming liver and detoxifying has the potential to significantly regulate the expression of Tat protein. These Chinese herbal compounds can reduce the expression of Tat protein by affecting key pathways and regulating the expression of related genes, which has potential therapeutic effects on the treatment of AIDS.