RESUMO
Antiretroviral therapy (ART) has improved the survival of people living with HIV (PLHIV) but this success has been accompanied by an increase in noncommunicable diseases. We conducted a prospective cohort study of 4000 adult PLHIV who were initiating ART in Dar es Salaam, Tanzania, to assess weight gain during the first year of treatment and associated sociodemographic and clinical factors. Anthropometric data were collected at ART initiation and monthly follow-up visits. The mean weight gain during the first year of treatment was 2.6 ± 0.3â kg, and the prevalence of overweight or obesity increased from 26.3% at baseline to 40.7%. Female sex, greater household wealth, lower CD4-T-cell counts, higher WHO HIV disease stage, and pulmonary tuberculosis were associated with a greater increase in body mass index (P < .05). Weight gain following ART initiation was common but was greater among females and PLHIV with advanced HIV or comorbidities.
Assuntos
Infecções por HIV , Aumento de Peso , Humanos , Feminino , Tanzânia/epidemiologia , Masculino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Infecções por HIV/complicações , Adulto , Aumento de Peso/efeitos dos fármacos , Estudos Prospectivos , Pessoa de Meia-Idade , Fármacos Anti-HIV/uso terapêutico , Índice de Massa Corporal , Adulto Jovem , Contagem de Linfócito CD4 , Obesidade/epidemiologia , Obesidade/complicações , População Urbana/estatística & dados numéricos , Antirretrovirais/uso terapêutico , Sobrepeso/epidemiologiaRESUMO
The immunopathogenesis of HIV infection remains poorly understood. Despite the widespread use of effective modern antiretroviral therapy (ART), people living with HIV (PLWH) are known to develop several comorbidities, including type 1 diabetes (T1DM). However, the etiology and critical mechanisms accounting for the onset of T1DM in the preceding context remain unknown. This article proposes to address this topic in order to provide further understanding and future research directions.
Assuntos
Diabetes Mellitus Tipo 1 , Infecções por HIV , Humanos , Diabetes Mellitus Tipo 1/imunologia , Diabetes Mellitus Tipo 1/tratamento farmacológico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/imunologia , Infecções por HIV/complicações , Antirretrovirais/uso terapêutico , HIV-1/imunologia , Fármacos Anti-HIV/uso terapêuticoRESUMO
BACKGROUND: Differentiated service delivery models have been developed to accommodate the rising number of stable antiretroviral therapy clients and to maintain improvements in health outcomes and care retention. Ethiopia adopted the appointment spacing model and has had notable successes in implementing it. However, with the implementation of the six multi-month scripting/appointment spacing model in Ethiopia, little is known about the uptake and its associated factors. Therefore, this study aimed to assess the uptake and associated factors of the six multi-month scripting/appointment spacing differentiated service delivery model of care among stable clients on antiretroviral therapy in Southern Ethiopia. METHODS: A hospital-based cross-sectional study was conducted among 419 stable clients on antiretroviral therapy in southern Ethiopia from June 22 to September 29, 2023. A systematic sampling technique was used to select the study participants. Using a structured questionnaire, socio-demographic, health service delivery, behavioral, and clinical-related data were collected. The collected data were entered into Epi Data version 3.1 and analyzed using Stata version 14. Variables with a P-value <0.05 in the multivariable logistic analysis were considered statistically significant. Multicollinearity and model fitness were checked using the variance inflation factor and the Hosmer and Lemeshow goodness of fit tests, respectively. RESULTS: The uptake of the six multi-month scripting/appointment spacing differentiated service delivery model of care was 63.25% (95% confidence interval (CI): 58.61%, 67.88%). Missed appointment (Adjusted Odds Ratio (AOR): 1.91 (95% CI: 1.13, 3.25)), distance to antiretroviral therapy facility (AOR: 2.90 (95% CI: 1.67, 5.04)), duration on antiretroviral therapy (AOR: 2.21 (95% CI: 1.34, 3.64)), and intermediate social support (AOR: 2.02 (95% CI: 1.29, 3.17)) and strong social support (AOR: 2.71 (95% CI: 1.23, 5.97)) were factors significantly associated with the uptake. CONCLUSION: The uptake of six multi-month scripting/appointment spacing differentiated service delivery models of care was six out of ten clients on antiretroviral therapy. To further improve the uptake, a precise intervention on the identified associated factor is required.
Assuntos
Infecções por HIV , Humanos , Etiópia , Feminino , Masculino , Adulto , Infecções por HIV/tratamento farmacológico , Estudos Transversais , Atenção à Saúde , Pessoa de Meia-Idade , Agendamento de Consultas , Adulto Jovem , Antirretrovirais/uso terapêutico , Adolescente , Inquéritos e Questionários , Fármacos Anti-HIV/uso terapêuticoRESUMO
INTRODUCTION: Courier delivery has become a popular antiretroviral therapy (ART) distribution method in some HIV care settings, yet data on ART courier delivery and how it relates to ART outcomes are scarce. We studied the differences in viral suppression rates between individuals from a South African private sector HIV programme receiving ART by courier delivery and those receiving ART through traditional retail dispensing. METHODS: Individuals aged 15 years or older who were actively enrolled in the Aid for AIDS programme between January 2011 and July 2022 were eligible for the analysis. The outcome of interest was viral suppression defined as a viral load (VL) <400 copies per ml. We calculated adjusted odds ratios (OR) for the association between the ART distribution method and viral suppression, comparing those receiving refills through courier pharmacies versus retail dispensing at the time of the VL testing. We used generalized estimating equations to account for repeated VL testing of the same individual. The models were adjusted for age, sex, calendar year, ART regimen, history of mental illness and medical insurance scheme. We computed adjusted ORs for the calendar periods 2011-2013, 2014-2016, 2017-2019, 2020-2022 and overall. RESULTS: We extracted 442,619 VL measurements from 68,720 eligible individuals, 39,406 (57.3%) were women. The median number of VL measurements per individual was 6 (IQR 3-10). VL suppression was detected in 398,901 (90.1%) tests, and 185,701 (42.0%) of the tests were taken while the individual was receiving ART by courier delivery. Overall, courier delivery was associated with 5% higher odds of viral suppression than retail dispensing (adjusted OR 1.05, 95% CI 1.02-1.08). The strength and direction of this association varied by calendar period, with an adjusted OR of 1.37 (95% CI 1.27-1.48) in 2011-2013 and 1.02 (95% CI 0.97-1.07) in 2020-2022. CONCLUSIONS: Courier delivery of ART is a viable alternative to retail dispensing in the South African private sector, as it was associated with higher viral suppression until 2016 and similar suppression rates in recent years. Further research is needed to investigate the potential benefits and drawbacks of courier delivery of ART in both private and public healthcare settings.
Assuntos
Infecções por HIV , Setor Privado , Humanos , Masculino , África do Sul/epidemiologia , Infecções por HIV/tratamento farmacológico , Feminino , Adulto , Estudos de Coortes , Adulto Jovem , Carga Viral , Pessoa de Meia-Idade , Fármacos Anti-HIV/uso terapêutico , Adolescente , Antirretrovirais/uso terapêuticoRESUMO
BACKGROUND: Loss to follow-up (LTFU) among under-five children from HIV care profoundly affects the treatment outcomes of this vulnerable population. It is a major factor that negatively affects the benefits of antiretroviral therapy (ART). Current information about LTFU among HIV-positive under-five children on ART is essential for effective treatments. To far, nevertheless, limited research has been done in Ethiopia to address this issue. Thus, this study aimed to assess the incidence and predictors of LTFU among HIV-infected under-five children receiving ART in West Amhara Comprehensive Specialized Referral Hospitals. METHODS: A multicenter institution-based retrospective follow-up study was conducted among 435 HIV-infected under-five children on ART selected by simple random sampling from January 1, 2010 to December 31, 2019, and data were collected between December 1, 2021, and January 31, 2022. A standardized data extraction tool adapted from the ART entry and follow-up forms was used. The event of interest for this study was LTFU, whereas the absence of LTFU was censored. Before being transferred to STATA version 14 for analysis, the data were entered into Epi-Data version 3.1. The KaplanâMeier curve was used to estimate an individual's survival-free probability at each specific point in time. The Cox proportional hazards model was used to identify predictors of LTFU. RESULTS: Among the 420 records included in the final analysis, 30 (7.14%) of the individuals were LTFUs. The incidence rate of LTFU was 3.4 per 1000 person-months of observation (95% CI: 2.43-4.87). The survival probabilities of children after 12, 24, 36, and 48 months were 0.97, 0.92, 0.88, and 0.77, respectively. The independent predictors of LTFU were HIV infection in under-five children who lived in rural areas (AHR = 3.64; 95% CI: 1.41, 9.37), poor adherence to ART (AHR = 4.37; 95% CI: 1.59, 12.02), not receiving cotrimoxazole preventive therapy (AHR = 3.75; 95% CI: 1.39, 10.08), not receiving isoniazid prophylaxis (AHR = 3.4; 95% CI: 1.29, 9.01), and having a severe WHO clinical stage (AHR = 5.43; 95% CI: 1.38, 11.43). CONCLUSION AND RECOMMENDATION: The incidence of loss to follow-up was high, especially in the first two years after ART initiation. The risk of LTFU was greater for those who were rural residents, had poor adherence, lacked cotrimoxazole preventive therapy, not given isoniazid prophylaxis, and presented with WHO clinical stages III and IV. Therefore, clinicians should emphasize for cotrimoxazole preventive therapy and isoniazid prophylaxis, for those living in rural areas, who present with poor adherence and WHO clinical stages III and IV.
Assuntos
Infecções por HIV , Perda de Seguimento , Humanos , Etiópia/epidemiologia , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Estudos Retrospectivos , Feminino , Masculino , Incidência , Seguimentos , Pré-Escolar , Lactente , Antirretrovirais/uso terapêutico , Fatores de Risco , Fármacos Anti-HIV/uso terapêuticoRESUMO
BACKGROUND: In many parts of the world, men who have sex with men and transgender individuals face criminalization and discrimination. As a result, they are less likely to seek medical help, despite experiencing higher rates of HIV/AIDS, mental health issues, and other health problems. Reaching key populations (KPs) with essential testing, care, and treatment services can be challenging, as they often have a higher likelihood of contracting and spreading the virus. They have limited access to antiretroviral (ARV) therapy (ART) services, which means that KPs may continue to serve as reservoirs for new HIV infections if they do not receive effective HIV programming. This ongoing issue complicates efforts to control the epidemic. Therefore, modeling a digital health system to track ARV medication access and use is crucial. This paper advocates for the use of digital interventions to manage the health of KPs in underserved regions, using Nigeria as a case study. OBJECTIVE: This study aims to assess digital health interventions for monitoring medication and consultations among transgender people in underserved communities. It also sought to determine whether a system exists that could support ART adherence in Nigeria. Additionally, the study evaluated design strategies to address privacy and confidentiality concerns, aiming to reduce nonadherence to ARV medications among KPs in Nigeria. METHODS: A qualitative approach was adopted for this research, involving a thematic analysis of information collected from interviews with clinicians and other health practitioners who work directly with these communities, as well as from an interactive (virtual) workshop. RESULTS: The findings from the thematic analysis indicate a need to increase attendance at ART therapy sessions through the implementation of an intensive care web app. Unlike previous solutions, this study highlights the importance of incorporating a reminder feature that integrates with an in-app telemedicine consultancy platform. This platform would facilitate discussions about client challenges, such as adverse drug effects, counseling sessions with clinical psychologists, and the impact of identity discrimination on mental health. Other data-driven health needs identified in the study are unique drug request nodes, client-led viral load calculators, remote requests, and drug delivery features within the web app. Participants also emphasized the importance of monitoring medication compliance and incorporating user feedback mechanisms, such as ratings and encouragement symbols (eg, stars, checkmarks), to motivate adherence. CONCLUSIONS: The study concludes that technology-driven solutions could enhance ART adherence and reduce HIV transmission among transgender people. It also recommends that local governments and international organizations collaborate and invest in health management services that prioritize health needs over identity.
Assuntos
Infecções por HIV , Telemedicina , Pessoas Transgênero , Humanos , Pessoas Transgênero/psicologia , Masculino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Feminino , Área Carente de Assistência Médica , Adulto , Antirretrovirais/uso terapêutico , Encaminhamento e Consulta , Adesão à Medicação , Saúde DigitalRESUMO
HIV stigma has a negative influence on antiretroviral therapy (ART) initiation and persistence and viral suppression. Immediate access to ART (RAPID ART) has been shown to accelerate viral suppression (VS) that is sustained up to one year after HIV diagnosis. Little is known about the role of RAPID ART in reducing individual-level stigma. We explored how stigma manifests in RAPID ART encounters and whether RAPID ART interventions influence individual-level HIV stigma during and in the time immediately after the diagnosis experience. We conducted in-depth interviews with 58 RAPID ART patients from three health clinics in San Francisco, CA, and Chicago, IL. Interviews were transcribed, coded, and thematically analyzed. In the results, we discuss three main themes. First, Pre-Diagnosis HIV Beliefs, which included three sub-themes: HIV is "gross" and only happens to other people; HIV (Mis)education; and People are "living long and strong" with HIV. Second, Positive and Reassuring Messages During the RAPID Experience, which included two sub-themes: Correcting Misinformation and Early Interactions with People Living with HIV. Third, The RAPID ART Process Can Disrupt Stigma. RAPID ART encounters served as a potent mechanism to disrupt internalized stigma by providing accurate information and dispelling unhelpful myths through verbal and nonverbal messages. Reducing internalized stigma and misinformation about HIV at this early stage has the potential to reduce the effect of HIV stigma on ART initiation and adherence over time.
Assuntos
Infecções por HIV , Estigma Social , Humanos , Infecções por HIV/psicologia , Infecções por HIV/tratamento farmacológico , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Chicago , São Francisco , Fármacos Anti-HIV/uso terapêutico , Antirretrovirais/uso terapêutico , Adulto JovemRESUMO
SUMMARY: Malignancies in human immunodeficiency virus (HIV) positive individuals have a larger role in morbidity and mortality. Appropriate clinical acumen is required for a clinician to anticipate the occurrence of lymphoma after starting antiretroviral therapy, especially in patients with CD4 <100 cells/mm3. Here is a 30-year-old man with weight loss and appetite, found to be retroviral disease positive status with low CD 4 counts. He was started on antiretroviral treatment, and following that, he developed Hodgkin's lymphoma of mixed cellularity. He is planned for an ABVD regimen and received one cycle of the same without any complications. To our knowledge, we are reporting the first case of an HIV patient with a mixed cellularity form of classical Hodgkin's lymphoma from India.
Assuntos
Infecções por HIV , Doença de Hodgkin , Humanos , Doença de Hodgkin/tratamento farmacológico , Masculino , Adulto , Infecções por HIV/tratamento farmacológico , Índia , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Contagem de Linfócito CD4 , Doxorrubicina/administração & dosagem , Doxorrubicina/efeitos adversos , Bleomicina/efeitos adversos , Bleomicina/administração & dosagem , Dacarbazina/efeitos adversos , Vimblastina/administração & dosagem , Vimblastina/efeitos adversos , Vimblastina/uso terapêutico , Antirretrovirais/uso terapêutico , Antirretrovirais/efeitos adversosRESUMO
BACKGROUND: Malaria and human immunodeficiency virus (HIV) infection coexist in significant numbers in some geographic areas including sub-Sahara Africa (SSA). HIV-infected patients are a World Health Organization (WHO) recognized high risk group for increased malaria morbidity. Majority of HIV-infected patients undertaking treatment in SSA are on WHO recognized first-line combination antiretroviral therapy (cART). Considering the immunity-enhancing capacity of antiretroviral therapies on people living with HIV, this study aimed to explore the association between first-line combination antiretroviral therapy (cART) with malaria parasitaemia and antigenaemia in adult HIV-infected persons and to determine the predictors of malaria antigenaemia in adult persons living with HIV. METHODS: The study was conducted at the AIDS Prevention Initiative in Nigeria (APIN) Centre, Jos University Teaching Hospital, Jos, Plateau State, from August 2018 to February 2019. Epi Info statistical tool was used to determine the sample size and power of the study. The study population consisted of three groups. The first group comprised first-line cART-experienced adult HIV-seropositive subjects, the second group comprised ARV-naïve HIV-seropositive adults and the third group comprised HIV-seronegative adults. For this pilot study, 60 persons were recruited into each group via convenience sampling. Malaria rapid diagnostic test (RDT) was performed according to manufacturer's instruction for all the study participants using SD Bioline Malaria Ag P.f (HRP2/pLDH) (Standard Diagnostics, Hagal-Dong, Korea). All the study participants also had thick and thin blood film malaria microscopy. Data collected was processed and analyzed using the Stata statistical software version 15 (StataCorp, College Station, Texas). Chi square was used to test the association between malaria and first-line cART exposure. Univariate and multivariate analysis were also done to identify factors that were independently associated with malaria antigenaemia. RESULTS: A total of 180 persons participated in the study and involved 60 participants recruited in each of the three study groups. Overall, the predominant study participants were females (56.67%), traders (27.78%), secondary school leavers (43.33%) and urban dwellers (88.89%). Their mean age and standard deviation was 37.07 ± 11.53 years. Using malaria microscopy, the prevalence of malaria parasitaemia in ARV-naïve HIV-infected persons was 5% and 0% in the first-line cART-experienced HIV-infected persons as well as the HIV-negative persons. Malaria RDT result was positive in 7/60 (11.67%) of the first-line cART experienced HIV-infected participants, 6/60 (10%) of the ARV-naïve HIV-infected group and 1/60 (1.67%) of the HIV-negative group. Of the seven positive malaria RDT results in those on first-line cART, five persons were receiving zidovudine/lamivudine/nevirapine (AZT/3TC/NVP) while the remaining two were receiving tenofovir disoproxil fumarate/lamivudine/efavirenz (TDF/3TC/EFV), thus making an antigenaemia proportion of 16.67% and 6.67% respectively. Being an HIV-infected person on first-line cART (OR = 16.20, p = 0.04), having a headache (OR = 6.21, p = 0.03) and non-usage of window nets (OR = 3.74, p = 0.05) were found to be predictors of malaria antigenaemia. CONCLUSION: Malaria parasite burden in HIV-infected persons on first-line cART is lower than that observed in ARV-naïve HIV-infected persons. Our study suggests that TDF/3TC/EFV may be associated with lower malaria antigenaemia when compared with AZT/3TC/NVP and can be considered an alternative first-line antiretroviral regimen in malaria-endemic regions.
Assuntos
Infecções por HIV , Malária , Humanos , Nigéria/epidemiologia , Infecções por HIV/tratamento farmacológico , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Adulto , Feminino , Masculino , Estudos Transversais , Projetos Piloto , Malária/tratamento farmacológico , Malária/epidemiologia , Pessoa de Meia-Idade , Parasitemia/epidemiologia , Parasitemia/tratamento farmacológico , Coinfecção/epidemiologia , Coinfecção/tratamento farmacológico , Antirretrovirais/uso terapêutico , Adulto Jovem , Fármacos Anti-HIV/uso terapêutico , Antígenos de Protozoários/sangueRESUMO
Therapeutic use of HIV-1 broadly neutralizing antibodies (bnAbs), passively administered or induced by therapeutic vaccines, is a focus of advanced treatment strategies under development. To enable monitoring of bnAb activity during concurrent antiretroviral therapy (ART), we developed ART-DEX, an analytic strategy that allows high-throughput detection of pure antibody-based neutralizing activity. ART-DEX combines pH-dependent dissociation of antiretrovirals (ARVs) from plasma proteins and size exclusion to effectively remove ARVs from plasma samples, reducing the confounding effects of ARVs on neutralization assays. For complete details on the use and execution of this protocol, please refer to Schwarzmüller et al.1.
Assuntos
Anticorpos Neutralizantes , Anticorpos Anti-HIV , Infecções por HIV , HIV-1 , Humanos , HIV-1/imunologia , Infecções por HIV/tratamento farmacológico , Infecções por HIV/imunologia , Anticorpos Anti-HIV/imunologia , Anticorpos Anti-HIV/sangue , Anticorpos Neutralizantes/imunologia , Testes de Neutralização/métodos , Fármacos Anti-HIV/uso terapêutico , Antirretrovirais/uso terapêuticoRESUMO
Even during extended periods of effective immunological control, a substantial dynamic of the viral genome can be observed in different cellular compartments in HIV-1 positive individuals, indicating the persistence of active viral reservoirs. To obtain further insights, we studied changes in the proviral as well as in the viral HIV-1 envelope (Env) sequence along with transcriptional, translational and viral outgrowth activity as indicators for viral dynamics and genomic intactness. Our study identified distinct reservoir patterns that either represented highly sequence-diverse HIV-1 populations or only a single / few persisting virus variants. The single dominating variants were more often found in individuals starting ART during early infection phases, indicating that early treatment might limit reservoir diversification. At the same time, more sequence-diverse HIV reservoirs correlated with a poorer immune status, indicated by lower CD4 count, a higher number of regimen changes and more co-morbidities. Furthermore, we noted that in T-cell populations in the peripheral blood, replication-competent HIV-1 is predominantly present in Lymph node homing TN (naïve) and TCM (central memory) T cells. Provirus genomes archived in TTM (transitional memory) and TEM (effector memory) T cells more frequently tended to carry inactivating mutations and, population-wise, possess changes in the genetic diversity. These discriminating properties of the viral reservoir in T-cell subsets may have important implications for new early therapy strategies, underscoring the critical role of early therapy in preserving robust immune surveillance and constraining the viral reservoir.
Assuntos
Infecções por HIV , HIV-1 , HIV-1/genética , HIV-1/imunologia , Humanos , Infecções por HIV/imunologia , Infecções por HIV/virologia , Masculino , Provírus/genética , Subpopulações de Linfócitos T/imunologia , Subpopulações de Linfócitos T/virologia , Adulto , Feminino , Variação Genética , Pessoa de Meia-Idade , Carga Viral , Antirretrovirais/uso terapêutico , Linfócitos T CD4-Positivos/imunologia , Linfócitos T CD4-Positivos/virologiaRESUMO
Despite effective antiretroviral therapy (ART), 15-30% of people with HIV experience poor CD4+ T-cell recovery, termed immunologic non-responders (INR). This study aims to evaluate whether pre-ART plasma levels of interleukin-6 (IL-6), interferon gamma-induced protein-10 (IP-10), macrophage inflammatory protein-1-ß (MIP-1ß), and/or pentraxin-3 (PTX-3) could predict subsequent immunologic recovery. Seventy-four participants were enrolled and classified as INR and immunologic responders (IR) based on CD4+/CD8+ ratio increase over 24 months after starting ART. The results showed no significant differences in cytokine levels between INR and IR. Therefore, IL-6, IP-10, MIP-1ß, and PTX-3 were unsuitable as predictive markers of poor immune recovery.
Assuntos
Biomarcadores , Proteína C-Reativa , Quimiocina CCL4 , Quimiocina CXCL10 , Infecções por HIV , Interleucina-6 , Componente Amiloide P Sérico , Humanos , Infecções por HIV/tratamento farmacológico , Infecções por HIV/imunologia , Infecções por HIV/sangue , Componente Amiloide P Sérico/metabolismo , Masculino , Feminino , Proteína C-Reativa/análise , Proteína C-Reativa/metabolismo , Adulto , Quimiocina CCL4/sangue , Interleucina-6/sangue , Pessoa de Meia-Idade , Biomarcadores/sangue , Quimiocina CXCL10/sangue , Terapia Antirretroviral de Alta Atividade , Resultado do Tratamento , Antirretrovirais/uso terapêutico , Relação CD4-CD8 , Fármacos Anti-HIV/uso terapêuticoRESUMO
BACKGROUND: Human Immune deficiency Virus (HIV) infected children are at higher risk of developing pneumonia. Particularly, in the early phase of HIV infection, the risk of acquiring pneumonia is high, and it remains a major public health problem even after the test and treatment strategy. There is no clear evidence of the overall incidence of pneumonia among HIV-infected children in Amhara region. Aimed to assess the incidence of pneumonia and its predictors among HIV-infected children receiving Antiretroviral therapy in Amhara Region Comprehensive Specialized Hospitals, 2022. METHODS: A multicenter retrospective follow-up study was conducted from June 10, 2014, to February 28, 2022, among 430 HIV-positive children receiving antiretroviral therapy. A simple random sampling technique was used. The data was taken from the national antiretroviral intake and follow-up forms. The data were collected via the KoBo toolbox and analyzed using Stata version 17. The Kaplan-Meier curve and log-rank test were employed. Bivariable and multivariable Cox regression was carried out to identify predictors of pneumonia and a P-value < 0.05 was considered significant in to multivariable analysis. RESULTS: A total of 407 children with a record completeness rate of 94.7% were analyzed in the study. The incidence rate of pneumonia was 4.55 (95% CI; 3.5, 5.92) per 100 person-years observation. The mean survival time was 77.67 months and the total times at risk during follow-up period were yielding 1229.33 person-year observations. Having CD4 cell count below threshold [AHR; 2.71 (95% CI: 1.37, 5.35)], WHO stage III and IV [AHR: 2.17 (95% CI: 1.15, 4.08)], ever had fair and poor treatment adherence [AHR: 2.66 (95% CI: 1.45, 4.89)], and not initiated antiretroviral therapy within seven days [AHR: 2.35 (95% CI: 1.15, 4.78)] were the positive predictors for incidence of Pneumonia. CONCLUSIONS: In this study, the incidence of pneumonia was lower than the previous studies. CD4 cells below the threshold, ever had fair and poor adherence to antiretroviral therapy, WHO stage III and IV, and not initiated antiretroviral therapy within seven days were significant predictors. Therefore,, it is crucial to detect baseline assessment and give attention to those identified predictors promptly, and timely initiation of antiretroviral therapy need special attention.
Assuntos
Infecções por HIV , Pneumonia , Humanos , Estudos Retrospectivos , Masculino , Feminino , Incidência , Seguimentos , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Pneumonia/epidemiologia , Pré-Escolar , Criança , Etiópia/epidemiologia , Lactente , Hospitais Especializados , Fatores de Risco , Antirretrovirais/uso terapêuticoRESUMO
Understanding the interplay between the HIV reservoir and the host immune system may yield insights into HIV persistence during antiretroviral therapy (ART) and inform strategies for a cure. Here, we applied machine learning (ML) approaches to cross-sectional high-parameter HIV reservoir and immunology data in order to characterize host-reservoir associations and generate new hypotheses about HIV reservoir biology. High-dimensional immunophenotyping, quantification of HIV-specific T cell responses, and measurement of genetically intact and total HIV proviral DNA frequencies were performed on peripheral blood samples from 115 people with HIV (PWH) on long-term ART. Analysis demonstrated that both intact and total proviral DNA frequencies were positively correlated with T cell activation and exhaustion. Years of ART and select bifunctional HIV-specific CD4 T cell responses were negatively correlated with the percentage of intact proviruses. A leave-one-covariate-out inference approach identified specific HIV reservoir and clinical-demographic parameters, such as age and biological sex, that were particularly important in predicting immunophenotypes. Overall, immune parameters were more strongly associated with total HIV proviral frequencies than intact proviral frequencies. Uniquely, however, expression of the IL-7 receptor alpha chain (CD127) on CD4 T cells was more strongly correlated with the intact reservoir. Unsupervised dimension reduction analysis identified two main clusters of PWH with distinct immune and reservoir characteristics. Using reservoir correlates identified in these initial analyses, decision tree methods were employed to visualize relationships among multiple immune and clinical-demographic parameters and the HIV reservoir. Finally, using random splits of our data as training-test sets, ML algorithms predicted with approximately 70% accuracy whether a given participant had qualitatively high or low levels of total or intact HIV DNA . The techniques described here may be useful for assessing global patterns within the increasingly high-dimensional data used in HIV reservoir and other studies of complex biology.
Assuntos
DNA Viral , Infecções por HIV , Aprendizado de Máquina , Humanos , Infecções por HIV/tratamento farmacológico , Infecções por HIV/imunologia , Infecções por HIV/virologia , DNA Viral/sangue , Masculino , Feminino , Adulto , HIV-1/genética , HIV-1/imunologia , Estudos Transversais , Provírus/genética , Pessoa de Meia-Idade , Linfócitos T CD4-Positivos/imunologia , Antirretrovirais/uso terapêuticoRESUMO
Human T-lymphotropic virus 1 produces a latent infection and disease with poor prognosis. Although its transmission during solid-organ transplant and development of the disease has been described, it is not clear whether antiretroviral treatment could prevent it. We report the first kidney transplant of a donor with human T-lymphotropic virus positivity to a negative recipient who was under antiretroviral treatment without evidence of transmission. We reviewed the literature, which included reports of 55 solid-organ transplant donors with human T-lymphotropic virus positivity to negative recipients, showing high rates of transmission and disease. The benefits of antiretroviral treatment require evaluation in further studies.
Assuntos
Infecções por HTLV-I , Transplante de Rim , Humanos , Transplante de Rim/efeitos adversos , Resultado do Tratamento , Infecções por HTLV-I/transmissão , Infecções por HTLV-I/diagnóstico , Masculino , Doadores de Tecidos , Vírus Linfotrópico T Tipo 1 Humano/imunologia , Antirretrovirais/uso terapêutico , Fatores de Risco , Pessoa de Meia-Idade , Adulto , Infecção Latente/transmissão , Infecção Latente/diagnóstico , Infecção Latente/virologia , Infecção Latente/imunologia , FemininoRESUMO
INTRODUCTION: Weight gain, together with the onset of overweight and obesity, is a relevant emerging health issue among people living with HIV (PLWH). A large body of literature recognises this issue as a part of the secondary effects of some antiretroviral therapy (ART), but little is known about the role of lifestyle. In order to assess the role of modifiable aspects of lifestyle in addition to ART on the onset of overweight and obesity, we designed a prospective observational study among PLWH. METHODS AND ANALYSIS: This is a prospective observational study among PLWH aged 18-65 years attending the Clinic of Infectious Diseases of Spedali Civili, Brescia, Italy, and on ART for at least 24 months. According to the sample size computation, 175 PLWH will be enrolled. PLWH willing to participate in the study are invited to a scheduled clinical visit to collect anthropometric measures, dietary habits and physical activity levels. During the visit, standardised and validated questionnaires are administered regarding emotional distress, food insecurity, use of food supplements, sleep quality, smoking habit and alcohol consumption/risk of addiction. After the interviews, bioimpedance analysis is performed and blood pressure and heart rate are assessed. After 12 months from baseline, each participant will be asked to participate in a further visit, with the same assessments as at baseline. The primary objective of the study is to assess the role of the modifiable factors of lifestyle in the onset of overweight and/or obesity among on-treatment PLWH experiencing weight gain, focusing on diet and physical activity. ETHICS AND DISSEMINATION: The study research protocol and informed consent procedures were approved by Ethics Committee of Brescia Province (Italy) on 23 May 2023 (NP5892). Informed consent will be obtained from participants. Results will be submitted for publication in international peer-reviewed journals and summaries will be provided annually to the funders.
Assuntos
Infecções por HIV , Estilo de Vida , Aumento de Peso , Humanos , Infecções por HIV/tratamento farmacológico , Infecções por HIV/psicologia , Estudos Prospectivos , Adulto , Pessoa de Meia-Idade , Feminino , Masculino , Adulto Jovem , Idoso , Obesidade/psicologia , Itália , Adolescente , Estudos Observacionais como Assunto , Sobrepeso/epidemiologia , Exercício Físico , Antirretrovirais/uso terapêuticoRESUMO
BACKGROUND: Resistance to antiretrovirals against human immunodeficiency virus (HIV) poses a threat to zero transmission of HIV by 2030. Few studies have been conducted on HIV drug resistance (HIVDR) mutations targeting adolescents. We determined the prevalence, pattern of HIVDR mutations, and factors associated with unsuppressed HIV viral load among adolescents on antiretroviral therapy (ART). METHODS: From March to June 2020, we conducted a cross-sectional study at the Infectious Disease Clinic in Dar es Salaam, Tanzania. HIV-1 viral load was tested using m2000rt Real-Time HIV-1 assay. A sample with a viral load equal or more than 1,000 copies/ml was tested for HIVDR mutations. We determined the factors associated with unsuppressed viral load using logistic regression. A p-value less than 0.05 was considered significant. RESULTS: We enrolled 131 participants with a median age (interquartile range) of 15 (13-18) years. Of all, 24(18.3%) had a viral load above 1000 copies/ml. HIVDR mutations were found in 19/24(68.4%). Mutation to protease inhibitors, nucleotide reverse transcriptase inhibitors, and non-nucleoside reverse transcriptase inhibitors were 1(5.2%), 9(47.4%), and 11(57.9%), respectively. Non-antiretroviral therapy and orphanages were independently associated with unsuppressed viral load. CONCLUSION: The prevalence of HIVDR and unsuppressed HIV viral load among adolescents are relatively high. The use of non-antiretroviral therapy and orphanage influenced the persistence of high viral load. Strategies for surveillance of HIVDR early warning signs should be devised among adolescents.
Assuntos
Farmacorresistência Viral , Infecções por HIV , HIV-1 , Carga Viral , Humanos , Adolescente , Tanzânia/epidemiologia , Infecções por HIV/tratamento farmacológico , Infecções por HIV/virologia , Infecções por HIV/epidemiologia , Estudos Transversais , Masculino , Feminino , Farmacorresistência Viral/genética , Prevalência , HIV-1/efeitos dos fármacos , HIV-1/genética , Mutação , Fármacos Anti-HIV/uso terapêutico , Antirretrovirais/uso terapêuticoRESUMO
Background: Adherence to medications is a crucial factor in achieving the best therapeutic outcomes for patients who have human immunodeficiency virus (HIV). Little is known about the rate and predictors of adherence to antiretroviral therapy (ART) in Egypt. Objectives: To assess the degree of adherence to ART among people living with HIV/AIDS (PLWHA) in Egypt and to explore the predictors of non-adherence. Methods: A cross-sectional study was conducted from January 2021 to December 2021 on 785 PLWHA attending an ART clinic at the main fever hospital in Alexandria, Egypt. Data collection was done using an interviewing questionnaire and pharmacy database records. Multivariate logistic regression analysis was done to identify the predictors of adherence to ART. Results: The overall adherence rate to ART among the study subjects was 66.7%. Female sex (Adjusted Odds Ratio [95% CI]: 1.73 [1.01-2.96]), intravenous drug use (AOR [95% CI]: 2.87 [1.27-6.49]), fair satisfaction with the health service at ART clinics (OR [95% CI]: 1.86 [1.27-2.73]) appeared as independent predictors of poor adherence. Conclusion: The degree of adherence to ART among PLWHA in Egypt is noticeably high, although it was influenced by several patient-, healthcare-, and community-related factors. This work provides an accurate, standardized tool to measure adherence and identify factors that contribute to non-adherence.
Assuntos
Infecções por HIV , Adesão à Medicação , Humanos , Egito , Feminino , Adesão à Medicação/estatística & dados numéricos , Estudos Transversais , Infecções por HIV/tratamento farmacológico , Adulto , Masculino , Pessoa de Meia-Idade , Abuso de Substâncias por Via Intravenosa/epidemiologia , Adulto Jovem , Fármacos Anti-HIV/uso terapêutico , Modelos Logísticos , Fatores Sexuais , Satisfação do Paciente , Adolescente , Antirretrovirais/uso terapêutico , Inquéritos e QuestionáriosRESUMO
Index case Human Immunodeficiency Virus (HIV) testing is a voluntary procedure wherein service providers request index clients to enumerate all sexual partners, including biological children, before proceeding with Human Immunodeficiency Virus (HIV) testing. This approach has demonstrated efficacy as a case-finding strategy aimed at curbing future transmission. Through index testing, we can pinpoint partners and children with undiagnosed infections, thereby facilitating early identification of Human Immunodeficiency Virus (HIV) -positive children who are currently healthy. The study aimed to assess the acceptance of index-case Human Immunodeficiency Virus (HIV) testing and its associated factors among anti-retroviral therapy (ART) patients in public health facilities within the Gedeo zone, southern Ethiopia. The study employed a cross-sectional design with a document review. It involved 396 anti-retroviral therapy (ART) patients and utilized a pretested checklist to extract data from clients' medical records. A simple random sampling technique was used to select anti-retroviral therapy (ART) facilities in the Gedeo zone. Data collection was done from anti-retroviral therapy (ART) patient documents by ODK-Kobo Collect form and data analysis was conducted using statistical package for social science (SPSS) version 25, with bivariate and multivariate analyses performed to identify associations between index case testing and associated factors. A significance level of P ≤ .05 was adopted. The findings were presented in textual format, tables, and graphs, providing a comprehensive overview of the results. The magnitude of the acceptance of the index case testing among anti-retroviral therapy (ART) patients was 240 (60.6% [95% CI: 56%-65%]). Concerning the adherence status of the index case, 156 (39.4%) and 54 (13.6%) had good and poor adherence, respectively. Duration on ART (AOR = 2.30 [95% CI: 1.86, 6.12]), HIV disclosure (AOR = 36.19 [95% CI: 7.26, 180.44]), and good ART adherence status (AOR = 14.52 [95% CI: 2.10, 100.2]) are found to be factors significantly associated with acceptance of index case testing. The study findings indicated that the overall acceptance rate of index case testing was 60%, which falls short of the national benchmark minimum acceptance rate of 95%. Factors significantly linked to the acceptance of index case testing included the duration of ART usage, disclosure of HIV status, and adherence to ART medication. To improve the magnitude of the index case testing, the government and other NGOs working in these areas should work on health education, awareness creation, and improvement of treatment adherence. Ensure the sustainability of ICT services in ART facilities and the provision of quality HIV index case testing services.
Assuntos
Infecções por HIV , Humanos , Etiópia , Estudos Transversais , Infecções por HIV/tratamento farmacológico , Masculino , Feminino , Adulto , Adolescente , Teste de HIV , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Antirretrovirais/uso terapêutico , Adulto Jovem , Pessoa de Meia-Idade , Instalações de SaúdeRESUMO
BACKGROUND: Most new HIV infections are attributed to male-to-male sexual contact in the United States. However, only two-thirds of sexual minority men living with HIV achieve an undetectable viral load (UVL). We tested a web-based antiretroviral therapy adherence intervention called Thrive with Me (TWM) with core features that included medication self-monitoring and feedback, HIV and antiretroviral therapy information, and a peer-to-peer exchange. OBJECTIVE: We assessed the efficacy of TWM on HIV UVL among adult (aged ≥18 years) sexual minority men. Moreover, we assessed the impact of overall engagement and engagement with specific intervention features on HIV UVL. METHODS: In total, 401 sexual minority men (mean age 39.1, SD 10.8 y; 230/384, 59.9% African American) in New York City were recruited between October 2016 and December 2019 and randomized to receive TWM (intervention) or a weekly email newsletter (control) for 5 months. Computerized assessments occurred at baseline and months 5, 11, and 17. The primary outcome was a dichotomous measure of HIV UVL (≤20 copies/µL). Generalized estimating equations with robust SEs were used to assess the effect of the TWM intervention on HIV UVL over the follow-up period in an unadjusted model and a model adjusted for baseline differences and then stratified by baseline recent drug use urinalysis. In secondary analyses, generalized linear models were used to estimate risk differences in the association of overall engagement with TWM (the sum of the number of days participants accessed ≥1 screen of the TWM intervention out of a possible 150 days) and engagement with specific TWM components on HIV UVL throughout the 17-month intervention period. RESULTS: Participant retention was 88.5% (355/401; month 5), 81.8% (328/401; month 11), and 80.3% (322/401; month 17). No consistent differences in HIV UVL were found between those randomized to receive TWM or the control at the 5- (difference-in-differences [DD]=-7.8, 95% CI -21.1 to 5.5), 11- (DD=-13.9, 95% CI -27.7 to 0.04), or 17-month (DD=-8.2, 95% CI -22.0 to 5.7) time points, or when stratified by baseline recent drug use. However, those TWM-assigned participants with high overall levels of engagement (in the upper 25th percentile) were more likely to have an HIV UVL at the end of the 5-month active intervention period compared to those with low engagement (below the 75th percentile; risk difference=17.8, 95% CI 2.5-33.0) or no engagement (risk difference=19.4, 95% CI 3.3-35.5) in the intervention. Moreover, high engagement with the peer-to-peer exchange was associated with HIV UVL over time in unadjusted models. CONCLUSIONS: TWM did not have overall impacts on HIV UVL; however, it may assist some sexual minority men who are highly engaged with this web-based intervention in achieving HIV viral suppression. TRIAL REGISTRATION: ClinicalTrials.gov NCT02704208; https://clinicaltrials.gov/study/NCT02704208.