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Mantina, N. M., Nakayima Miiro, F., Smith, J., McClelland, D. J., Magrath, P. A., Madhivanan, P.
BMJ Open, 10.12.2023
Tilføjet 10.12.2023
IntroductionHuman papillomavirus (HPV) is the causative agent of nearly all cervical cancers. Despite the proven safety and efficacy of HPV vaccines in preventing HPV-related cancers, the global vaccine coverage rate is estimated to only be 15%. HPV vaccine coverage rates are more actively tracked and reported for adolescents 17 years and younger but there is still a critical window of opportunity to intervene and promote HPV vaccination among young adults aged 18–26 years who are still eligible to be vaccinated. This protocol for a qualitative evidence synthesis aims to review perspectives of HPV vaccination among young adults (18–26 years) and identify facilitators and barriers that influence HPV vaccination uptake and decision-making. Methods and analysisSeven databases will be searched from 1 January 2006 to the date of final search. For inclusion, studies must report HPV vaccination perspectives of young adults aged 18–26 years and use qualitative study methods or analysis techniques. Studies will be screened in a two-stage process guided by the eligibility criteria. Final included studies will be evaluated for methodological strengths and limitations using the Critical Appraisal Skills Programme quality assessment tool for qualitative studies. After data extraction, framework analysis will be used to analyse the data applying the socioecological model. Finally, the Grading of Recommendations Assessment, Development and Evaluation - Confidence in the Evidence from Reviews of Qualitative research will be applied to evaluate the confidence in synthesised qualitative findings. The methodology of this review follows the Cochrane Handbook guidelines on qualitative evidence syntheses. Ethics and disseminationFormal ethical approval is not required for this study. Findings will be disseminated through peer-reviewed publications, conference presentations and professional networks. PROSPERO registration numberCRD42023417052.
Læs mere Tjek på PubMedValliappan Muthu, Ritesh Agarwal, Shivaprakash Mandya Rudramurthy, Deepak Thangaraju, Manoj Radhakishan Shevkani, Atul K. Patel, Prakash Srinivas Shastri, Ashwini Tayade, Sudhir Bhandari, Vishwanath Gella, Jayanthi Savio, Surabhi Madan, Vinaykumar Hallur, Venkata Nagarjuna Maturu, Arjun Srinivasan, Nandini Sethuraman, Raminder Pal Singh Sibia, Sanjay Pujari, Ravindra Mehta, Tanu Singhal, Puneet Saxena, Varsha Gupta, Vasant Nagvekar, Parikshit Prayag, Dharmesh Patel, Immaculata Xess, Pratik Savaj, Inderpaul Singh Sehgal, Naresh Panda, Gayathri Devi Rajagopal, Riya Sandeep Parwani, Kamlesh Patel, Anuradha Deshmukh, Aruna Vyas, Raghava Rao Gandra, Srinivas Kishore Sistla, Priyadarshini A. Padaki, Dharshni Ramar, Saurav Sarkar, Bharani Rachagulla, Pattabhiraman Vallandaramam, Krishna Prabha Premachandran, Sunil Pawar, Piyush Gugale, Pradeep Hosamani, Sunil Narayan Dutt, Satish Nair, Hariprasad Kalpakkam, Sanjiv Badhwar, Kiran Kumar Kompella, Nidhi Singla, Milind Navlakhe, Amrita Prayag, Gagandeep Singh, Poorvesh Dhakecha, Arunaloke Chakrabarti
Clinical Microbiology and Infection, 9.12.2023
Tilføjet 9.12.2023
To compare COVID-19-associated pulmonary mucormycosis (CAPM) with COVID-19-associated rhino-orbital mucormycosis (CAROM), ascertain factors associated with CAPM among patients with COVID-19, and identify factors associated with 12-week mortality in CAPM.
Læs mere Tjek på PubMedAbdela, A. A., Yifter, H., Reja, A., Shewaamare, A., Ofotokun, I., Degu, W. A.
BMJ Open, 9.12.2023
Tilføjet 9.12.2023
ObjectivesHIV-induced chronic inflammation, immune activation and combination antiretroviral therapy (cART) are linked with adverse metabolic changes known to cause cardiovascular adversities. This study evaluates the prevalence of lipodystrophy, and metabolic syndrome (MetS), and analyses risk factors in HIV-infected Ethiopians taking cART. MethodsA multicentre cross-sectional study was conducted at tertiary-level hospitals. Eligible participants attending the HIV clinics were enrolled. Sociodemographic, anthropometric, clinical, HIV treatment variables, lipid profile, fasting blood glucose level, risk factors and components of MetS, also lipodystrophy, were studied. Data were analysed by SPSS statistical package V.25 with descriptive and analytical statistics. For multivariable analysis of risk factors, a logistic regression model was used. Results were presented in frequency and percentages, mean±SD, or median+IQR. Statistical significance was taken as p45 years (aHR 1.8, 95% CI 1.2 to 2.4), female sex (aHR 1.8, 95% CI 1.1 to 2.8), body mass index (BMI)>25 kg/m2 (aHR 2.7, 95% CI 1.8 to 4.1), efavirenz-based cART (aHR 2.8, 95% CI 1.6 to 4.8) and lopinavir/ritonavir-based cART (aHR 3.7, 95% CI 1.0 to 13.3). The prevalence of lipodystrophy was 23.6%. Prior exposure to a stavudine-containing regimen was independently associated with lipodystrophy (aHR 3.1, 95% CI 1.6 to 6.1). ConclusionOur study revealed 38% of the participants had MetS indicating considerable cardiovascular disease (CVD) risks. Independent risk factors for MetS were BMI≥25 kg/m2, efavirenz and lopinavir/ritonavir-based cART, female sex and age ≥45 years. In addition to prevention, CVD risk stratification and management will reduce morbidity and mortality in people with HIV infection.
Læs mere Tjek på PubMedBMC Infectious Diseases, 9.12.2023
Tilføjet 9.12.2023
Abstract Background HIV has become a manageable chronic condition due to the success and scale-up of antiretroviral therapy (ART). Globally, South Africa has the highest number of people living with HIV (PLHIV) and research evidence indicates that countries with the highest burden of PLHIV have a substantial burden of obesity, hypertension (HPT) and type 2 diabetes (T2D). We sought to summarize the burden of these three common NCDs among PLHIV in South Africa. Methods In this systematic review, multiple databases were searched for articles reporting on the prevalence of obesity, HPT, and T2D among PLHIV in South Africa published since journal inception until March 2022. A meta-analysis was conducted using random-effects models to obtain pooled prevalence estimates of the three NCDs. Heterogeneity was assessed using X2 test on Cochran’s Q statistic. Results We included 32 studies, with 19, 22 and 18 studies reporting the prevalence of obesity, HPT, and T2D among PLHIV, respectively. The overall prevalence of obesity, HPT, and T2D was 23.2% [95% CI 17.6; 29.9], 25.5% [95% CI 15.6; 38.7], and 6.1% [95% CI 3.8; 9.7] respectively. The prevalence of obesity was significantly higher among women (P = 0.034) compared to men, however the prevalence of HPT and T2D did not differ by sex. The prevalence of each of the three NCDs did not differ significantly between rural, urban, and peri-urban areas. The prevalence of obesity and T2D was higher in studies conducted between 2013 and 2022 compared to studies conducted between 2000 and 2012, while the prevalence of HPT was higher between 2000 and 2012 compared to between 2013 and 2022. Conclusions These findings suggest that South Africa is experiencing a syndemic of NCDs among people PLHIV highlighting the need to increase cost-effective interventions and management strategies that involve integrated HIV and NCD care in the South African setting.
Læs mere Tjek på PubMedNicolas Margot, Vidula Naik, Anurag Nekkalapudi, Archana Boopathy, Brie Falkard, Christian Callebaut
Journal of Medical Virology, 9.12.2023
Tilføjet 9.12.2023
Infection, 9.12.2023
Tilføjet 9.12.2023
Moore, Amelia E.B.; Burns, James E.; Sally, Deirdre; Milinkovic, Ana; Krokos, Georgios; John, Joemon; Rookyard, Christopher; Borca, Alessandro; Pool, Erica R.M.; Tostevin, Anna; Harman, Alyss; Dulnoan, Dwight S.; Siddique, Musib; Gilson, Richard; Arenas-Pinto, Alejandro; Cook, Gary J.R.; Saunders, John; Dunn, David; Blake, Glen M.; Pett, Sarah L.
AIDS, 9.12.2023
Tilføjet 9.12.2023
Objective: Bone loss in people with HIV (PWH) is poorly understood. Switching tenofovir disoproxil fumarate (TDF) to tenofovir alafenamide (TAF) has yielded bone mineral density (BMD) increases. PETRAM (NCT#:03405012) investigated whether BMD and bone turnover changes correlate. Design: Open-label, randomized controlled trial. Setting: Single-site, outpatient, secondary care. Participants: Nonosteoporotic, virologically suppressed, cis-male PWH taking TDF/emtricitabine (FTC)/rilpivirine (RPV) for more than 24 weeks. Intervention: Continuing TDF/FTC/RPV versus switching to TAF/FTC/RPV (1 : 1 randomization). Main outcome measures: :[18F]NaF-PET/CT for bone turnover (standardized uptake values, SUVmean) and dual-energy x-ray absorptiometry for lumbar spine and total hip BMD. Results: Thirty-two men, median age 51 years, 76% white, median duration TDF/FTC/RPV 49 months, were randomized between 31 August 2018 and 09 March 2020. Sixteen TAF:11 TDF were analyzed. Baseline-final scan range was 23–103 (median 55) weeks. LS-SUVmean decreased for both groups (TAF -7.9% [95% confidence interval -14.4, -1.5], TDF -5.3% [-12.1,1.5], P = 0.57). TH-SUVmean showed minimal changes (TAF +0.3% [-12.2,12.8], TDF +2.9% [-11.1,16.9], P = 0.77). LS-BMD changes were slightly more favorable with TAF but failed to reach significance (TAF +1.7% [0.3,3.1], TDF -0.3 [-1.8,1.2], P = 0.06). Bone turnover markers decreased more with TAF ([CTX -35.3% [-45.7, -24.9], P1NP -17.6% [-26.2, -8.5]) than TDF (-11.6% [-28.8, +5.6] and -6.9% [-19.2, +5.4] respectively); statistical significance was only observed for CTX (P = 0.02, P1NP, P = 0.17). Conclusion: Contrary to our hypothesis, lumbar spine and total hip regional bone formation (SUVmean) and BMD did not differ postswitch to TAF. However, improved LS-BMD and CTX echo other TAF-switch studies. The lack of difference in SUVmean may be due to inadequate power. Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.
Læs mere Tjek på PubMedZhou, Jie; Yang, Yuecong; Xie, Zhiman; Lu, Dongjia; Huang, Jinping; Lan, Liuyang; Guo, Baodong; Yang, Xiping; Wang, Qing; Li, Zhuoxin; Zhang, Yu; Yang, Xing; Ai, Sufang; Liu, Ningmei; Liang, Hao; Ye, Li; Huang, Jiegang
AIDS, 9.12.2023
Tilføjet 9.12.2023
Objective: Identifying the gut microbiota associated with host immunity in the AIDS stage. Design: We performed a cross-sectional study. Methods: We recruited people living with HIV (PLWH) in the AIDS or non-AIDS stage and evaluated their gut microbiota and metabolites by using 16S ribosomal RNA (rRNA) sequencing and liquid chromatography–mass spectrometry (LC-MS). Machine learning (ML) models were used to analyze the correlations between key bacteria and CD4+ T cell count, CD4+ T cell activation, bacterial translocation, gut metabolites, and KEGG functional pathways. Results: We recruited 114 PLWH in the AIDS stage and 203 PLWH in the non-AIDS stage. The α-diversity of gut microbiota was downregulated in the AIDS stage (P
Læs mere Tjek på PubMedMoore, David J.; Sun-Suslow, Ni; Nichol, Ariadne A.; Paolillo, Emily W.; Saloner, Rowan; Letendre, Scott L.; Iudicello, Jennifer; Morgan, Erin E.
AIDS, 9.12.2023
Tilføjet 9.12.2023
Objective: Frailty measures vary widely and the optimal measure for predicting HIV-associated neurocognitive disorders (HAND) is unclear. Design: A study was conducted to examine the clinical utility of three widely used frailty measures in identifying HIV-associated neurocognitive disorders. Methods: The study involved 284 people with HIV (PWH) at least 50 years enrolled at UC San Diego\'s HIV Neurobehavioral Research Program. Frailty measurements included the Fried Phenotype, the Rockwood Frailty Index, and the Veterans Aging Cohort Study (VACS) Index. HAND was diagnosed according to Frascati criteria. ANOVAs examined differences in frailty severity across HAND conditions. ROC analyses evaluated sensitivity and specificity of each measure to detect symptomatic HAND [mild neurocognitive disorder (MND) and HIV-associated dementia (HAD)] from no HAND. Results: Across all frailty measures, frailty was found to be higher in HAD compared with no HAND. For Fried and Rockwood (not VACS), frailty was significantly more severe in MND vs. no HAND and in HAD vs. ANI (asymptomatic neurocognitive impairment). For discriminating symptomatic HAND from no HAND, Fried was 37% sensitive and 92% specific, Rockwood was 85% sensitive and 43% specific, and VACS was 58% sensitive and 65% specific. Conclusion: These findings demonstrate that Fried and Rockwood outperform VACS in predicting HAND. However, ROC analyses suggest none of the indices had adequate predictive validity in detecting HAND. The results indicate that the combined use of the Rockwood and Fried indices may be an appropriate alternative. Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
Læs mere Tjek på PubMedMichael, Henry Ukachukwu; Brouillette, Marie-Josée; Tamblyn, Robyn; Fellows, Lesley K.; Mayo, Nancy E.
AIDS, 9.12.2023
Tilføjet 9.12.2023
Objective: This study aimed to estimate the strength of the association between anticholinergic/sedative burden and concurrent physical frailty in people aging with HIV. Design: This cross-sectional analysis examined baseline data from 824 adults with a mean age of 53 enrolled in the Positive Brain Health Now study. Methods: Anticholinergic medications were identified using four methods: Anticholinergic Cognitive Burden (ACB) scale, Anticholinergic Risk Scale (ARS), Anticholinergic Drug Scale (ADS), and the anticholinergic list of the Anticholinergic and Sedative Burden Catalog (ACSBC). Sedatives were identified using the Sedative Load Model (SLM) and the sedative list of the ACSBC. Physical frailty was assessed using a modified Fried Frailty Phenotype based on self-report items. Multivariable logistic regression models, adjusted for sociodemographic factors, lifestyle considerations, HIV-related variables, comorbidities, and co-medication use, were used to estimate odds ratios (ORs). Results: Anticholinergic burden demonstrated associations with frailty across various methods: total anticholinergic burden (OR range: 1.22–1.32; 95% CI range: 1.03–1.66), sedative burden (OR range: 1.18–1.24; 95% CI range: 1.02–1.45), high anticholinergic burden (OR range: 2.12–2.74; 95% CI range: 1.03–6.19), and high sedative burden (OR range: 1.94–2.18; 95% CI: 1.01–4.34). Conclusion: The anticholinergic and sedative burdens may represent modifiable risk factors for frailty in people aging with HIV. Future studies should evaluate the effects of reducing anticholinergic and sedative burdens on frailty outcomes and explore the prognostic value of diverse scoring methods. Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
Læs mere Tjek på PubMedJacobson, Jeffrey M.; Felber, Barbara K.; Chen, Huichao; Pavlakis, George N.; Mullins, James I.; de Rosa, Stephen C.; Kuritzkes, Daniel R.; Tomaras, Georgia D.; Kinslow, Jennifer; Bao, Yajing; Olefsky, Maxine; Rosati, Margherita; Bear, Jenifer; Hannaman, Drew; Laird, Gregory M.; Cyktor, Joshua C.; Heath, Sonya L.; Collier, Ann C.; Koletar, Susan L.; Taiwo, Babafemi O.; Tebas, Pablo; Wohl, David A.; belanzauran-Zamudio, Pablo F.; Mcelrath, M. Juliana; Landay, Alan L.
AIDS, 9.12.2023
Tilføjet 9.12.2023
Objective: The primary objective of the study was to assess the immunogenicity of an HIV-1 Gag conserved element DNA vaccine (p24CE DNA) in people with HIV (PWH) receiving suppressive antiretroviral therapy (ART). Design: AIDS Clinical Trials Group A5369 was a phase I/IIa, randomized, double-blind, placebo-controlled study of PWH receiving ART with plasma HIV-1 RNA less than 50 copies/ml, current CD4+ T-cell counts greater than 500 cells/μl, and nadir CD4+ T-cell counts greater than 350 cells/μl. Methods: The study enrolled 45 participants randomized 2 : 1 : 1 to receive p24CE DNA vaccine at weeks 0 and 4, followed by p24CE DNA admixed with full-length p55Gag DNA vaccine at weeks 12 and 24 (arm A); full-length p55Gag DNA vaccine at weeks 0, 4, 12, and 24 (arm B); or placebo at weeks 0, 4, 12, and 24 (arm c). The active and placebo vaccines were administered by intramuscular electroporation. Results: There was a modest, but significantly greater increase in the number of conserved elements recognized by CD4+ and/or CD8+ T cells in arm A compared with arm C (P = 0.014). The percentage of participants with an increased number of conserved elements recognized by T cells was also highest in arm A (8/18, 44.4%) vs. arm C (0/10, 0.0%) (P = 0.025). There were no significant differences between treatment groups in the change in magnitude of responses to total conserved elements. Conclusion: A DNA-delivered HIV-1 Gag conserved element vaccine boosted by a combination of this vaccine with a full-length p55Gag DNA vaccine induced a new conserved element-directed cellular immune response in approximately half the treated PWH on ART. Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
Læs mere Tjek på PubMedBMC Infectious Diseases, 8.12.2023
Tilføjet 8.12.2023
Abstract Background HIV has become a manageable chronic condition due to the success and scale-up of antiretroviral therapy (ART). Globally, South Africa has the highest number of people living with HIV (PLHIV) and research evidence indicates that countries with the highest burden of PLHIV have a substantial burden of obesity, hypertension (HPT) and type 2 diabetes (T2D). We sought to summarize the burden of these three common NCDs among PLHIV in South Africa. Methods In this systematic review, multiple databases were searched for articles reporting on the prevalence of obesity, HPT, and T2D among PLHIV in South Africa published since journal inception until March 2022. A meta-analysis was conducted using random-effects models to obtain pooled prevalence estimates of the three NCDs. Heterogeneity was assessed using X2 test on Cochran’s Q statistic. Results We included 32 studies, with 19, 22 and 18 studies reporting the prevalence of obesity, HPT, and T2D among PLHIV, respectively. The overall prevalence of obesity, HPT, and T2D was 23.2% [95% CI 17.6; 29.9], 25.5% [95% CI 15.6; 38.7], and 6.1% [95% CI 3.8; 9.7] respectively. The prevalence of obesity was significantly higher among women (P = 0.034) compared to men, however the prevalence of HPT and T2D did not differ by sex. The prevalence of each of the three NCDs did not differ significantly between rural, urban, and peri-urban areas. The prevalence of obesity and T2D was higher in studies conducted between 2013 and 2022 compared to studies conducted between 2000 and 2012, while the prevalence of HPT was higher between 2000 and 2012 compared to between 2013 and 2022. Conclusions These findings suggest that South Africa is experiencing a syndemic of NCDs among people PLHIV highlighting the need to increase cost-effective interventions and management strategies that involve integrated HIV and NCD care in the South African setting.
Læs mere Tjek på PubMedTobias Kasper, Gavin Yamey, Sinead Dwyer, Kaci Kennedy McDade, Jon Lidén, Cora Lüdemann, Mohamed Mustafa Diab, Osondu Ogbuoji, Prashant Poodla, Christina Schrade, Andrea Thoumi, Armand Zimmerman, Yibeltal Assefa, Luke N Allen, Paulin Basinga, Patricia J Garcia, Debra Jackson, Henry Mwanyika, Rachel Nugent, Anthony Ofosu, Salman Rawaf, K Srinath Reddy, Dykki Settle, Beth Tritter, Christoph Benn
Lancet, 8.12.2023
Tilføjet 8.12.2023
Global campaigns to control HIV, tuberculosis, malaria, and vaccine-preventable illnesses showed that large-scale impact can be achieved by using additional international financing to support selected, evidence-based, high-impact investment areas and to catalyse domestic resource mobilisation. Building on this paradigm, we make the case for targeting additional international funding for selected high-impact investments in primary health care. We have identified and costed a set of concrete, evidence-based investments that donors could support, which would be expected to have major impacts at an affordable cost.
Læs mere Tjek på PubMedNambusi Kyegombe, Gbolahan Ajibola, Maureen Sakoi-Mosetlhi, Tsholofelo Rebatenne, Motswedi Anderson, Simani Gaseitsiwe, Joseph Makhema, Una Ngwenya, Sikhulile Moyo, Odile Sauzet, Lucy Mupfumi
PLoS One Infectious Diseases, 8.12.2023
Tilføjet 8.12.2023
by Nambusi Kyegombe, Gbolahan Ajibola, Maureen Sakoi-Mosetlhi, Tsholofelo Rebatenne, Motswedi Anderson, Simani Gaseitsiwe, Joseph Makhema, Una Ngwenya, Sikhulile Moyo, Odile Sauzet, Lucy Mupfumi
Læs mere Tjek på PubMedMalaria Journal, 8.12.2023
Tilføjet 8.12.2023
Abstract Background The use of primaquine for mass drug administration (MDA) is being considered as a key strategy for malaria elimination. In addition to being the only drug active against the dormant and relapsing forms of Plasmodium vivax, primaquine is the sole potent drug against mature/infectious Plasmodium falciparum gametocytes. It may prevent onward transmission and help contain the spread of artemisinin resistance. However, higher dose of primaquine is associated with the risk of acute haemolytic anaemia in individuals with a deficiency in glucose-6-phosphate dehydrogenase. In many P. falciparum endemic areas there is paucity of information about the distribution of individuals at risk of primaquine-induced haemolysis at higher dose 45 mg of primaquine. Methods A retrospective cross-sectional study was carried out using archived samples to establish the prevalence of G6PD deficiency in a malaria hotspot area in Misungwi district, located in Mwanza region, Tanzania. Blood samples collected from individuals recruited between August and November 2010 were genotyped for G6PD deficiency and submicroscopic parasites carriage using polymerase chain reaction. Results A total of 263 individuals aged between 0 and 87 were recruited. The overall prevalence of the X-linked G6PD A− mutation was 83.7% (220/263) wild type, 8% (21/263) heterozygous and 8.4% (22/263) homozygous or hemizygous. Although, assessment of the enzymatic activity to assign the phenotypes according to severity and clinical manifestation as per WHO was not carried out, the overall genotype and allele frequency for the G6PD deficiency was 16.4% and 13. 2%, respectively. There was no statistically significant difference in among the different G6PD genotypes (p > 0.05). Out of 248 samples analysed for submicroscopic parasites carriage, 58.1% (144/248) were P. falciparum positive by PCR. G6PD heterozygous deficiency were associated with carriage of submicroscopic P. falciparum (p = 0.029). Conclusions This study showed that 16.4% of the population in this part of North-western Tanzania carry the G6PD A− mutation, within the range of 15–32% seen in other parts of Africa. G6PD gene mutation is widespread and heterogeneous across the study area where primaquine would be valuable for malaria control and elimination. The maps and population estimates presented here reflect potential risk of higher dose of primaquine being associated with the risk of acute haemolytic anaemia (AHA) in individuals with a deficiency in glucose-6-phosphate dehydrogenase and call further research on mapping of G6PD deficiency in Tanzania. Therefore, screening and education programmes for G6PD deficiency is warranted in a programme of malaria elimination using a higher primaquine dose.
Læs mere Tjek på PubMedRosen, Joseph G.; Knox, Justin R.; Rucinski, Katherine B.; Mcingana, Mfezi; Mulumba, Ntambue; Comins, Carly A.; Shipp, Lillian; Makama, Siyanda; Beckham, S. Wilson; Hausler, Harry; Baral, Stefan D.; Schwartz, Sheree R.
Journal of Acquired Immune Deficiency Syndromes, 8.12.2023
Tilføjet 8.12.2023
Background: Given intersecting social and structural factors, female sex workers (FSW) exhibit elevated risk of HIV and substance use. However, there is limited study of how distinct substance use typologies influence HIV treatment outcomes among FSW. Setting: A cross-sectional survey with objective viral load assessments of 1,391 FSW enrolled into a treatment optimization-focused trial in Durban, South Africa (2018-2020). Methods: We used latent class analysis to uncover discrete patterns in past-month self-reported use of the following substances: heavy alcohol use, cannabis, cocaine, crack, ecstasy, methamphetamine, heroin, and whoonga. We used Wald tests to identify multilevel predictors of latent class membership and multivariable mixture modeling to quantify associations of substance use classes with HIV viremia (>50 RNA copies/mL). Results: Substance use (87%) and HIV viremia (62%) were highly prevalent. LCA uncovered three polysubstance use profiles: Heavy Alcohol Use Only (∼54%); Cannabis, Heavy Alcohol, & Crack Use (∼28%); and Whoonga & Crack Use (∼18%). Whoonga & Crack Use was associated with social and structural adversities, including homelessness, outdoor/public sex work, HIV stigma, and violence. Relative to Heavy Alcohol Use Only, HIV viremia was significantly higher in the Whoonga & Crack Use class (adjusted odds ratio [adjOR] 1.97, 95% confidence interval [95%CI] 1.13-3.43) but not in the Cannabis, Heavy Alcohol, & Crack Use class (adjOR 1.17, 95%CI 0.74-1.86). Conclusion: HIV viremia differed significantly across identified polysubstance use profiles among South African FSW. Integrating drug treatment and harm reduction services into HIV treatment programs is key to improving virologic outcomes in marginalized communities. Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
Læs mere Tjek på PubMedBearden, David R.; Mwanza-Kabaghe, Sylvia; Bositis, Christopher M.; Dallah, Ifunanya; Johnson, Brent A.; Siddiqi, Omar K.; Elafros, Melissa A.; Gelbard, Harris A.; Okulicz, Jason F.; Kalungwana, Lisa; Musonda, Nkhoma; Theodore, William H.; Mwenechanya, Musaku; Mathews, Manoj; Sikazwe, Izukanji T.; Birbeck, Gretchen L.
Journal of Acquired Immune Deficiency Syndromes, 8.12.2023
Tilføjet 8.12.2023
Background: Seizures are relatively common among children with HIV in low-and middle-income countries, and are associated with significant morbidity and mortality. Early treatment with antiretroviral therapy may reduce this risk by decreasing rates of central nervous system infections and HIV encephalopathy. Methods: We conducted a prospective, unmatched case-control study. We enrolled children with new-onset seizure from University Teaching Hospital in Lusaka, Zambia as well as two regional hospitals in rural Zambia. Controls were children with HIV and no history of seizures. Recruitment took place from 2016-2019. Early treatment was defined as initiation of ART prior to 12 months of age, at a CD4 percentage greater than 15% in children ages 12 months to 60 months, or a CD4 count greater than 350 cell/mm3 for children 60 months or older. Logistic regression models were used to evaluate the association between potential risk factors and seizures. Results: We identified 73 children with new-onset seizure and compared them to 254 control children with HIV but no seizures. Early treatment with antiretroviral therapy was associated with a significant reduction in the odds of seizures (OR 0.04, 95% CI 0.02—0.09; p
Læs mere Tjek på PubMedNGUMBAU, Nancy M.; NEARY, Jillian; WAGNER, Anjuli D; ABUNA, Felix; OCHIENG, Ben; DETTINGER, Julia C; GÓMEZ, Laurén; MARWA, Mary M.; WATOYI, Salphine; NZOVE, Emmaculate; PINTYE, Jillian; BAETEN, Jared M.; KINUTHIA, John; JOHN-STEWART, Grace
Journal of Acquired Immune Deficiency Syndromes, 8.12.2023
Tilføjet 8.12.2023
Background: Oral PrEP and male partner HIV self-testing (HIVST) is being scaled up within antenatal clinics (ANC). Few data are available on how co-distribution influences acceptance of both interventions. Methods: We utilized data from the PrIMA (NCT03070600) trial in Kenya. Women included in this analysis were determined to be at high risk of HIV and offered oral PrEP and partner HIVST. Characteristics were compared between women who chose: 1) PrEP and HIVST, 2) HIVST-alone, 3) PrEP-alone, or 4) declined both (reference), excluding women who had partners known to be living with HIV. Results: Among 911 women, median age was 24 years, 87.3% were married, 43.9% perceived themselves to be at high risk of HIV and 13.0% had history of intimate partner violence (IPV). Overall, 68.9% accepted HIVST and 18.4% accepted PrEP with 54.7% accepting HIVST-alone, 4.2% PrEP-alone and 14.3% both HIVST and PrEP. Of women accepting HIVST, partner HIV testing increased from 20% to 82% and awareness of partner HIV status increased from 4.7% to 82.0% between pregnancy and 9-months postpartum (p
Læs mere Tjek på PubMedFeelemyer, Jonathan; Bershteyn, Anna; Scheidell, Joy D.; Brewer, Russell; Dyer, Typhanye V; Cleland, Charles M; Hucks-Ortiz, Christopher; Justice, Amy; Mayer, Ken; Grawert, Ames; Kaufman, Jay S.; Braithwaite, Scott; Khan, Maria R
Journal of Acquired Immune Deficiency Syndromes, 8.12.2023
Tilføjet 8.12.2023
Background Background Given the disproportionate rates of incarceration and lower life expectancy (LE) among Black sexual minority men (BSMM) and Black transgender women (BTW) with HIV, we modeled the impact of decarceration and screening for psychiatric conditions and substance use on LE of US BSMM/BTW with HIV. Methods We augmented a microsimulation model previously validated to predict LE and leading causes of death in the US with estimates from the HPTN 061 cohort and the Veteran’s Aging Cohort Studies. We estimated independent associations among psychiatric and substance use disorders, to simulate the influence of treatment of one condition on improvement on others. We used this augmented simulation to estimate LE for BSMM/BTW with HIV with a history of incarceration under alternative policies of decarceration (i.e., reducing the fraction exposed to incarceration), screening for psychiatric conditions and substance use, or both. Results Baseline LE was 61.3 years. Reducing incarceration by 25%, 33%, 50%, and 100% increased LE by 0.29 years, 0.31 years, 0.53 years, and 1.08 years, respectively, versus no reductions in incarceration. When reducing incarceration by 33% and implementing screening for alcohol, tobacco, substance use, and depression, in which a positive screen triggers diagnostic assessment for all psychiatric and substance use conditions and linkage to treatment, LE increased by 1.52 years compared to no screening or decarceration. Discussion LE among BSMM/BTW with HIV is short compared with other people with HIV. Reducing incarceration and improving screening and treatment of psychiatric conditions and substance use could substantially increase LE in this population. Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
Læs mere Tjek på PubMedBrooks, Hannah L.; Graves, Erin; De Schacht, Caroline; Emílio, Almiro; Matino, Ariano; Aboobacar, Arifo; Audet, Carolyn M.
Journal of Acquired Immune Deficiency Syndromes, 8.12.2023
Tilføjet 8.12.2023
Sandhya Hora, Prabhjyoti Pahwa, Hamda Siddiqui, Anoushka Saxena, Minal Kashyap, Jayesh K. Sevak, Ravinder Singh, Maryam Javed, Pushpa Yadav, Pratibha Kale, Gayatri Ramakrishna, Meenu Bajpai, Asmita Rathore, Jaswinder S. Maras, Shakun Tyagi, Shiv K. Sarin, Nirupama Trehanpati
Journal of Medical Virology, 7.12.2023
Tilføjet 7.12.2023
American Journal of Tropical Medicine and Hygiene, 7.12.2023
Tilføjet 7.12.2023
Journal Name: The American Journal of Tropical Medicine and Hygiene Volume: 109 Issue: 6 Pages: 1266-1269
Læs mere Tjek på PubMedBMC Infectious Diseases, 7.12.2023
Tilføjet 7.12.2023
Abstract Background Human mpox has increasingly been reported worldwide since May 2022, with higher incidence in men who have sex with men (MSM) and persons living with HIV (PLHIV) with presentation typical for generalized macules and papules. Case presentation We are describing a case of human mpox, which presented as widespread, atypical round verrucous lesions that went undiagnosed in the community for six months and was treated with antibacterials and antifungals given the similarity to skin manifestations associated with endemic mycoses. Conclusions Suspicion for human mpox should be high in young MSM and PLHIV who present with rash and mpox should be ruled out earlier.
Læs mere Tjek på PubMedInfection, 6.12.2023
Tilføjet 6.12.2023
Infection, 6.12.2023
Tilføjet 6.12.2023
Frances Jenkins, Thomas Le, Rima Farhat, Angie Pinto, Azim Anzari, David Bonsall, Tanya Golubchik, Rory Bowden, Frederick J. Lee, Sebastiaan J. van Hal
Journal of Medical Virology, 6.12.2023
Tilføjet 6.12.2023
Soeurette Policar, Alana Sharp, Joanne Isidor Hyppolite, Gérald Marie Alfred, Eva Steide, Leïnadine Lucien, Naiké Ledan, Matthew Kavanagh
PLoS One Infectious Diseases, 5.12.2023
Tilføjet 5.12.2023
by Soeurette Policar, Alana Sharp, Joanne Isidor Hyppolite, Gérald Marie Alfred, Eva Steide, Leïnadine Lucien, Naiké Ledan, Matthew Kavanagh Background Failure to retain people living with HIV (PLHIV) in care remains a significant barrier to achieving epidemic control in Haiti, with as many as 30% lost from care within one year of starting treatment. Community-led monitoring (CLM) is an emerging approach of improving healthcare and accountability to service users, through a cycle of monitoring and advocacy. In 2020, a CLM program was launched in Haiti to identify barriers to retention and advocating for better health services. Methods Data from the community-led monitoring program in Haiti were analyzed, from a sample of 65 healthcare facilities in the Nord, Artibonite, and Ouest departments collected from April 2021 to February 2022. Qualitative data from six community-based focus groups and 45 semi-structured individual interviews were analyzed. Results Confidentiality and stigmatization emerged as barriers to care, particularly due to the separation of PLHIV from other patients in view of community members. To avoid identification, patients described traveling long distances, with the reimbursement of transportation costs described as being insufficient or unavailable. Costs of non-HIV clinical services were a frequent concern and respondents described a need for clinics to provide food during all patient visits. Stock-outs were a regular challenge; by contrast, treatment literacy did not emerge as a major barrier to retention. Conclusions These findings represent the first instance, to our knowledge, of original data from a community-led monitoring program being published in any country. These findings suggest that improving treatment retention for PLHIV is dependent on improving the acceptability and affordability of healthcare services. Ensuring confidentiality is critical, particularly where stigma is high. Retention could be improved by systematically strengthening patient confidentiality protections throughout the healthcare system, providing patients with sufficient travel compensation and other incentives, and delivering wraparound services provided for free. Addressing these challenges will require ongoing advocacy for community-developed recommendations and solutions.
Læs mere Tjek på PubMedBMC Infectious Diseases, 5.12.2023
Tilføjet 5.12.2023
Abstract Background Human mpox has increasingly been reported worldwide since May 2022, with higher incidence in men who have sex with men (MSM) and persons living with HIV (PLHIV) with presentation typical for generalized macules and papules. Case presentation We are describing a case of human mpox, which presented as widespread, atypical round verrucous lesions that went undiagnosed in the community for six months and was treated with antibacterials and antifungals given the similarity to skin manifestations associated with endemic mycoses. Conclusions Suspicion for human mpox should be high in young MSM and PLHIV who present with rash and mpox should be ruled out earlier.
Læs mere Tjek på PubMedGeorgia Bisbas
Lancet Infectious Diseases, 5.12.2023
Tilføjet 5.12.2023
“History has the power to shape not only what we remember, but what we forget.” In the final paragraph of the introduction to In Her Hands, Women\'s Fight Against AIDS in the United States, historian Emma Day perfectly sums up the message behind her book. Day seeks to readdress the narrative around women\'s fight against HIV/AIDS and the political systems that overlooked, mistreated, and maligned them during the 1980s epidemic of the disease. It is her intention to ensure that we remember the struggles that women faced with accuracy and in their entirety, as no one subgroup of sufferers should take precedence in the history books when we recall the scale and severity of this disease.
Læs mere Tjek på PubMedJournal of Infectious Diseases, 4.12.2023
Tilføjet 4.12.2023
AbstractBackgroundImmune dysregulation in people with HIV-1 (PWH) persists despite potent antiretroviral therapy (ART) and, consequently, PWH tend to have lower immune responses to licensed vaccines. However, limited information is available about the impact of mRNA vaccines in PWH. This study details the immunologic responses to SARS-CoV-2 mRNA vaccines in PWH and their impact on HIV-1.MethodsWe quantified anti-S IgG binding and neutralization of three SARS-CoV-2 variants of concern and complement activation in blood from virally suppressed men with HIV-1 (MWH) and men without HIV-1 (MWOH), and the characteristics that may impact the vaccine immune responses. We also studied antibody levels against HIV-1 proteins and HIV-1 plasma RNA.ResultsMWH had lower anti-S IgG binding and neutralizing antibodies against the three variants compared to MWOH. MWH also produced anti-S1 antibodies with a ten-fold greater ability to activate complement and exhibited higher C3a blood levels than MWOH. MWH had decreased residual HIV-1 plasma viremia and anti-Nef IgG approximately 100 days after immunization.ConclusionsMWH respond to SARS-CoV-2 mRNA vaccines with lower antibody titers and with greater activation of complement, while exhibiting a decrease in HIV-1 viremia and anti-Nef antibodies. These results suggest an important role of complement activation mediating protection in MWH.
Læs mere Tjek på PubMedJournal of Infectious Diseases, 4.12.2023
Tilføjet 4.12.2023
AbstractBackgroundChronic inflammation persists in some people living with HIV (PLWH) during antiretroviral therapy and is associated with premature aging. The gp120 subunit of HIV-1 envelope sheds and can be detected in plasma, showing immunomodulatory properties even in the absence of detectable viremia. We evaluated whether plasmatic soluble gp120 (sgp120) and a family of gp120-specific anti-cluster A antibodies, linked to CD4 depletion in vitro, contribute to chronic inflammation, immune dysfunction, and sub-clinical cardiovascular disease in participants of the Canadian HIV and Aging cohort (CHACS) with undetectable viremia.MethodsCross-sectional assessment of sgp120 and anti-cluster A antibodies was performed in 386 individuals from CHACS. Their association with pro-inflammatory cytokines and subclinical coronary artery disease was assessed using linear regression models.ResultsHigh levels of sgp120 and anti-cluster A antibodies inversely correlated with CD4 count and CD4:CD8 ratio. The presence of sgp120 was associated with increased levels of IL-6. In participants with detectable atherosclerotic plaque and detectable sgp120, anti-cluster A antibodies and their combination with sgp120 levels correlated positively with the total volume of atherosclerotic plaques.Conclusionssgp120 may act as a pan toxin causing immune dysfunction and sustained inflammation in a subset of PLWH, contributing to the development of premature comorbidities.
Læs mere Tjek på PubMedMS Kapembwa, PA Batman, SC Fleming, GE Griffin
International Journal of Infectious Diseases, 4.12.2023
Tilføjet 4.12.2023
The emergence of the human immunodeficiency virus (HIV) epidemic in Africa was first reported among patients originating from Central Africa presenting with severe wasting symptoms resembling marasmus in 1983. The illness was associated commonly with chronic, and often life-threatening diarrhoea [1]. There was no evidence of an underlying immunosuppressive disease, no history of blood-product transfusion, homosexuality, or intravenous-drug abuse and the disease appeared to affect females as frequently as males.
Læs mere Tjek på PubMedBMC Infectious Diseases, 3.12.2023
Tilføjet 3.12.2023
Abstract We present a rare case of pathology-proven CMV pneumonitis in a patient with HIV infection after presenting with cough and fever. This presentation was complicated by recurrence of symptoms after treatment in the setting of continued uncontrolled HIV infection. This case raised the importance of further discussion regarding best treatment guidelines for CMV pneumonitis for patients with HIV.
Læs mere Tjek på PubMedBMC Infectious Diseases, 3.12.2023
Tilføjet 3.12.2023
Abstract Objective Droplet digital PCR (ddPCR) is a novel assay to detect pneumocystis jjrovecii (Pj) which has been defined to be more sensitive than qPCR in recent studies. We aimed to explore whether clinical features of pneumocystis pneumonia (PCP) were associated with ddPCR copy numbers of Pj. Methods A total of 48 PCP patients were retrospectively included. Pj detection was implemented by ddPCR assay within 4 h. Bronchoalveolar fluid (BALF) samples were collected from 48 patients with molecular diagnosis as PCP via metagenomic next generation sequencing (mNGS) or quantitative PCR detection. Univariate and multivariate logistic regression were performed to screen out possible indicators for the severity of PCP. The patients were divided into two groups according to ddPCR copy numbers, and their clinical features were further analyzed. Results Pj loading was a pro rata increase with serum (1,3)-beta-D glucan, D-dimmer, neutrophil percentage, procalcitonin and BALF polymorphonuclear leucocyte percentage, while negative correlation with albumin, PaO2/FiO2, BALF cell count, and BALF lymphocyte percentage. D-dimmer and ddPCR copy number of Pj were independent indicators for moderate/severe PCP patients with PaO2/FiO2 lower than 300. We made a ROC analysis of ddPCR copy number of Pj for PaO2/FiO2 index and grouped the patients according to the cut-off value (2.75). The high copy numbers group was characterized by higher level of inflammatory markers. Compared to low copy number group, there was lower level of the total cell count while higher level of polymorphonuclear leucocyte percentage in BALF in the high copy numbers group. Different from patients with high copy numbers, those with high copy numbers had a tendency to develop more severe complications and required advanced respiratory support. Conclusion The scenarios of patients infected with high ddPCR copy numbers of Pj showed more adverse clinical conditions. Pj loading could reflect the severity of PCP to some extent.
Læs mere Tjek på PubMedBushra Sabri, Chakra Budhathoki, Allison M. McFall, Shruti H. Mehta, David D. Celentano, Sunil S. Solomon, Aylur K. Srikrishnan, Santhanam Anand, Canjeevaram K. Vasudevan, Gregory M. Lucas
PLoS One Infectious Diseases, 2.12.2023
Tilføjet 2.12.2023
by Bushra Sabri, Chakra Budhathoki, Allison M. McFall, Shruti H. Mehta, David D. Celentano, Sunil S. Solomon, Aylur K. Srikrishnan, Santhanam Anand, Canjeevaram K. Vasudevan, Gregory M. Lucas Lifetime exposures to violence among men who have sex with men (MSM) are associated with multiple psychosocial health risks and can affect engagement and outcomes of HIV treatment. This study a) explored relationships between levels of exposures to violence and HIV care continuum outcomes among MSM living with HIV in India, and b) identified psychosocial correlates of HIV care continuum outcomes among MSM living with HIV and those with lifetime cumulative exposures to violence (CVE). CVE referred to exposures to violence in both childhood and adulthood. This cross-sectional analysis used survey data collected between August 2016 and May 2017 from 1763 men who have sex with men living with HIV across 10 cities in India, using respondent-driven sampling. We found that higher levels of violence exposure were significantly associated with lower awareness of HIV positive status, and lower likelihood of initiating antiretroviral therapy. Compared with MSM living with HIV that had no CVE, those with CVE were more likely to report perpetration of interpersonal violence, alcohol misuse, depressive symptoms, and HIV transmission risk behaviors and to have two to four co-occurring psychosocial problems. In multivariable analysis with the subset of MSM with CVE, psychosocial correlates significantly associated with at least one HIV care continuum outcome were HIV transmission risk behaviors, perpetration of interpersonal violence, depression, and alcohol misuse. The findings highlight the need for integrating care for lifetime violence exposures and associated behavioral problems in HIV care settings for men who have sex with men living with HIV in India.
Læs mere Tjek på PubMedEndalamaw, A., Gilks, C. F., Ambaw, F., Assefa, Y.
BMJ Open, 2.12.2023
Tilføjet 2.12.2023
IntroductionThe public’s accepting attitude toward people living with HIV is crucial in reducing HIV-related stigma and discrimination, increasing people’s access to HIV service. This study examines the inequalities in accepting attitudes toward people living with HIV in Ethiopia from 2005 to 2016. MethodsThis cross-sectional study was based on the 2005, 2011 and 2016 Ethiopian Demographic Health Surveys. A total of 17 075, 28 478 and 25 542 adults were included in the 2005, 2011 and 2016 surveys, respectively. Socioeconomic inequality was investigated using the concentration curve and Erreygers’ concentration index (ECI), which is scaled from –1 (pro-poor) to +1 (pro-rich). The ECI was decomposed to identify the contributors to socioeconomic inequality using generalised linear regression with the logit link function. ResultsAccepting attitude toward people living with HIV was 17.9% (95% CI: 16.6%, 19.3%) in 2005, which increased to 33.5% (95% CI: 31.8%, 35.3%) in 2011 and 39.6% (95% CI: 37.6%, 41.9%) in 2016. ECI was 0.342 (p
Læs mere Tjek på PubMedEndalamaw, A., Gilks, C. F., Ambaw, F., Assefa, Y.
BMJ Open, 2.12.2023
Tilføjet 2.12.2023
IntroductionThe public’s accepting attitude toward people living with HIV is crucial in reducing HIV-related stigma and discrimination, increasing people’s access to HIV service. This study examines the inequalities in accepting attitudes toward people living with HIV in Ethiopia from 2005 to 2016. MethodsThis cross-sectional study was based on the 2005, 2011 and 2016 Ethiopian Demographic Health Surveys. A total of 17 075, 28 478 and 25 542 adults were included in the 2005, 2011 and 2016 surveys, respectively. Socioeconomic inequality was investigated using the concentration curve and Erreygers’ concentration index (ECI), which is scaled from –1 (pro-poor) to +1 (pro-rich). The ECI was decomposed to identify the contributors to socioeconomic inequality using generalised linear regression with the logit link function. ResultsAccepting attitude toward people living with HIV was 17.9% (95% CI: 16.6%, 19.3%) in 2005, which increased to 33.5% (95% CI: 31.8%, 35.3%) in 2011 and 39.6% (95% CI: 37.6%, 41.9%) in 2016. ECI was 0.342 (p
Læs mere Tjek på PubMedJustman, Jessica; Wright, Connor; El-Sadr, Wafaa M.
AIDS, 2.12.2023
Tilføjet 2.12.2023
Tincati, Camilla; Bono, Valeria; Cannizzo, Elvira Stefania; Tosi, Delfina; Savi, Federica; Falcinella, Camilla; Casabianca, Anna; Orlandi, Chiara; Luigiano, Carmelo; Augello, Matteo; Rusconi, Stefano; Muscatello, Antonio; Bandera, Alessandra; Calcagno, Andrea; Gori, Andrea; Nozza, Silvia; Marchetti, Giulia
AIDS, 2.12.2023
Tilføjet 2.12.2023
Introduction: Impairment of the gastrointestinal (GI) barrier leads to microbial translocation and peripheral immune activation which are linked to disease progression. Data in the setting of primary HIV/SIV infection suggest that gut barrier damage is one of the first events of the pathogenic cascade, preceding mucosal immune dysfunction and microbial translocation. We assessed gut structure and immunity as well as microbial translocation in acutely- and chronically-infected, combination cART-naïve individuals. Methods: Fifteen people with Primary HIV infection (P-HIV) and 13 with Chronic HIV infection (C-HIV) c-ART naïve participants were cross-sectionally studied. Gut biopsies were analyzed in terms of gut reservoirs (total, integrated and unintegrated HIV DNA); tight junction proteins (E-cadherin, Zonula Occludens-1), CD4 expression, neutrophil myeloperoxidase (histochemical staining); collagen deposition (Masson staining). Flow cytometry was used to assess γδ T-cell frequency (CD3+panγδ+Vδ1+/Vδ2+). In plasma we measured microbial translocation (LPS, sCD14, EndoCAb) and gut barrier function (I-FABP) markers (ELISA). Results: P-HIV displayed significantly higher tissue HIV DNA, yet neutrophil infiltration and collagen deposition in the gut were similar in the two groups. In contrast, microbial translocation markers were significantly lower in P-HIV compared to C-HIV. A trend to higher mucosal E-cadherin, and gut γδ T-cells was also observed in P-HIV. Conclusions: Early HIV infection features higher HIV DNA in the gut, yet comparable mucosal alterations to those observed in chronic infection. In contrast, microbial translocation is contained in primary HIV infection, likely due to a partial preservation of E-cadherin and mucosal immune subsets, namely γδ T-cells. Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
Læs mere Tjek på PubMedCherkos, Ashenafi S.; Cranmer, Lisa M.; Njuguna, Irene; LaCourse, Sylvia M.; Mugo, Cyrus; Moraa, Hellen; Maleche-Obimbo, Elizabeth; Enquobahrie, Daniel A.; Richardson, Barbra A.; Wamalwa, Dalton; John-Stewart, Grace
AIDS, 2.12.2023
Tilføjet 2.12.2023
Objective: Evaluate effects of TB-HIV co-treatment on clinical and growth outcomes in children with HIV (CHIV). Design: Longitudinal study among Kenyan hospitalized ART-naive CHIV in the PUSH trial (NCT02063880). Methods: CHIV started ART within 2 weeks of enrollment; Anti-TB therapy was initiated based on clinical and TB diagnostics. Children were followed for 6 months with serial viral load, CD4%, and growth assessments (weight-for-age [WAZ], height-for-age [HAZ], and weight-for-height [WHZ]). TB-ART treated and ART-only groups were compared at 6-months post-ART for undetectable viral load [VL] (
Læs mere Tjek på PubMedMa, Hongfei; Liang, Wei; Han, Aojing; Zhang, Qian; Gong, Shun; Bai, Yang; Gao, Daiming; Xiang, Hao; Wang, Xia
AIDS, 2.12.2023
Tilføjet 2.12.2023
Objective: We aimed to explore the effect of particulate matter (PM) exposure on renal function in people living with HIV/AIDS (PWHA). Methods: A total of 37,739 repeated measurements were conducted on eGFR levels, serum creatinine (Scr), and the triglyceride-glucose (TyG) index in 6,958 PWHAs. The relationship between 1–28 day moving averages of PM concentrations with Scr and eGFR was assessed using linear mixed-effects models. Modified Poisson regression models were employed to assess the associations of cumulative PM exposure with the incidence of chronic kidney disease (CKD). Mediation analyses were used to examine the role of TyG index. Results: Short-term exposure to PM was related to reduced renal function. The strongest associations between exposure to PM1, PM2.5, and PM10 and percent changes in eGFR were observed at 7-day moving average exposure windows, with a respective decrease of 0.697% (−1.008%, −0.386%), 0.429% (−0.637%, −0.220%), and 0.373% (−0.581%, −0.164%) per IQR increment. Long-term exposure to PM1, PM2.5, and PM10 was positively linked with the incidence of CKD, with each IQR increment corresponding to fully adjusted RRs (95% CIs) of 1.631 (1.446, 1.839), 1.599 (1.431, 1.787), and 1.903 (1.665, 2.175), respectively. TyG index mediated 8.87%, 8.88%, and 7.58% of the relationship between cumulative exposure to PM1, PM2.5, and PM10 and increased risk of CKD, respectively. Conclusion: Exposure to PM among PWHAs is linked to reduced renal function, potentially contributing to increased CKD incidence, where the TyG index might serve as a partial mediator. Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
Læs mere Tjek på PubMedJohnson, Leigh F.; Myer, Landon; Jamieson, Lise; Meyer-Rath, Gesine; Delany-Moretlwe, Sinead; Davey, Dvora Joseph
AIDS, 2.12.2023
Tilføjet 2.12.2023
Background: Pregnant and breastfeeding women (PBW) in sub-Saharan Africa have high HIV incidence rates and associated risk of vertical transmission to their infants. Oral pre-exposure prophylaxis (PrEP) and injectable PrEP (long-acting cabotegravir, or CAB-LA) can potentially reduce this HIV transmission, but population-level impacts are uncertain. Methods: We extended a previously-developed model of HIV and PrEP in South Africa to allow for variable PrEP duration and preference in PBW. We considered three potential scenarios for PrEP provision to PBW: oral PrEP only, CAB-LA only and allowing oral/CAB-LA choice, with uptake and retention assumptions informed by South African data, each compared to a ‘base’ scenario without PrEP for PBW. Results: Without PrEP for PBW, the model estimates 1.31 million new infections will occur between 2025 and 2035 in South African adults and children, including 100,000 in PBW, 16,800 in infants at/before birth, and 35,200 in children through breastmilk. In the oral PrEP only scenario, these numbers would reduce by 1.2% (95% CI: 0.7–1.7%), 8.6% (4.8–12.9%), 4.0% (2.1–5.8%) and 5.3% (3.0–8.2%) respectively. In the CAB-LA only scenario, the corresponding reductions would be 6.1% (2.9–9.6%), 41.2% (19.8–65.0%), 12.6% (6.0–19.4%) and 29.5% (13.9–46.8%) respectively, and in the oral/CAB-LA choice scenario, similar reductions would be achieved (5.6% [3.4–8.0%], 39.0% [23.4–55.9%], 12.4% [7.4–16.8%] and 27.6% [16.5–39.9%] respectively). Conclusion: CAB-LA has the potential to be substantially more effective than oral PrEP in preventing HIV acquisition in PBW and vertical transmission, and can also modestly reduce HIV incidence at a population level. Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
Læs mere Tjek på PubMedHolden, Clare J.; Lampe, Fiona C.; Burns, Fiona M.; Chaloner, Clinton; Johnson, Margaret; Kinloch-De Loes, Sabine; Smith, Colette J.
AIDS, 2.12.2023
Tilføjet 2.12.2023
Objective: To investigate the association of age at anti-retroviral therapy (ART) initiation with CD4:CD8 T cell ratio in virally suppressed people with HIV on long-term ART, and to characterize potential CD4:CD8 ratio recovery in this population by age. Design: A longitudinal study of people attending an HIV clinic at the Royal Free Hospital NHS Trust, London, who initiated ART between 2001 and 2015, and achieved and maintained HIV-1 viral suppression (VL
Læs mere Tjek på PubMedTruong, Hong-Ha M.; Heylen, Elsa; Kadede, Kevin; Amboka, Sayo; Otieno, Beatrice; Odhiambo, Hanningtone; Odeny, Damaris; Hewa, Marion; Opiyo, Maurice; Opondo, Fidel; Ogolla, David; Guzé, Mary A.; Miller, Lara E.; Bukusi, Elizabeth A.; Cohen, Craig R.; the Maneno Yetu Study Team
Journal of Acquired Immune Deficiency Syndromes, 30.11.2023
Tilføjet 30.11.2023
Riebensahm, Carlotta; Berzigotti, Annalisa; Surial, Bernard; Haerry, David; Günthard, Huldrych F.; Tarr, Philip E.; Furrer, Hansjakob; Rauch, Andri; Wandeler, Gilles; Swiss HIV Cohort Study
Journal of Acquired Immune Deficiency Syndromes, 30.11.2023
Tilføjet 30.11.2023
Abstract: Background: Physical activity (PA) regulates intrahepatic storage of fat and reduces the risk of liver steatosis. Given our limited understanding of the pathogenesis of metabolic complications in people with HIV (PWH), it remains unclear if evidence from the general population can be extrapolated to PWH. We investigated the association between PA and liver steatosis in a single site of the Swiss HIV Cohort Study (SHCS). Methods: We screened consecutive SHCS participants using vibration controlled transient elastography and defined liver steatosis as CAP ≥248dB/m. PA was measured using the International Physical Activity Questionnaire. We evaluated the association of three different measures of PA with liver steatosis in separate multivariable logistic regression models. Results: Of 466 participants, 127 (27.3%) were female, median age was 52 years (interquartile range 43-59) and 244 (52.4%) were overweight (BMI ≥25 kg/m2). Liver steatosis was present in 235 (50.4%) individuals. In multivariable analysis, PA below the recommendations of the European Association for the Study of the Liver was associated with steatosis (adjusted odds ratio (aOR), 2.34; 95% confidence interval (CI), 1.44-3.85). Using alternative scales of PA, including metabolic equivalents task (MET) minutes (min) per week (aOR 0.76, 95% CI 0.60-0.94) and sitting hours per day (aOR, 1.16; 1.07-1.26), yielded comparable results and associations were similar when we restricted analyses to lean (BMI
Læs mere Tjek på PubMedCrane, Heidi M; Nance, Robin M; Ruderman, Stephanie A; Haidar, Lara; Tenforde, Mark W; Heckbert, Susan R; Budoff, Matthew J; Hahn, Andrew W; Drumright, Lydia N.; Ma, Jimmy; Mixson, L. S.; Lober, William B; Barnes, Gregory S; McReynolds, Justin; Attia, Engi F; Peter, Inga; Moges, Tesfaye; Bamford, Laura; Cachay, Edward; Mathews, William C; Christopolous, Katerina; Hunt, Peter W; Napravnik, Sonia; Keruly, Jeanne; Moore, Richard D; Burkholder, Greer; Willig, Amanda L; Lindstrom, Sara; Whitney, Bridget M; Saag, Michael S; Kitahata, Mari M; Crothers, Kristina A; Delaney, Joseph AC
Journal of Acquired Immune Deficiency Syndromes, 30.11.2023
Tilføjet 30.11.2023
Abstract: BACKGROUND: People with HIV (PWH) are at increased risk for venous thromboembolism (VTE). We conducted this study to characterize VTE including provoking factors among PWH in the current treatment era. METHODS: We included PWH with VTE between 2010-2020 at six sites in the CFAR Network of Integrated Clinical Systems (CNICS) cohort. We ascertained for possible VTE using diagnosis, VTE-related imaging, and VTE-related procedure codes, followed by centralized adjudication of primary data by expert physician reviewers. We evaluated sensitivity and positive predictive value of VTE ascertainment approaches. VTEs were classified by type and anatomic location. Reviewers identified provoking factors such as hospitalizations, infections, and other potential predisposing factors such as smoking. RESULTS: We identified 557 PWH with adjudicated VTE: 239 (43%) had pulmonary embolism (PE) with or without deep venous thrombosis (DVT), and 318 (57%) had DVT alone. Ascertainment with clinical diagnoses alone missed 6% of VTEs identified with multiple ascertainment approaches. DVTs not associated with intravenous lines were most often in the proximal lower extremities. Among PWH with VTE, common provoking factors included recent hospitalization (n=134, 42%), infection (n=133, 42%), and immobilization/bed rest (n=78, 25%). Only 57 (10%) PWH had no provoking factor identified. Smoking (46%), HIV viremia (27%) and injection drug use (22%) were also common. CONCLUSION: We conducted a robust adjudication process that demonstrated the benefits of multiple ascertainment approaches followed by adjudication. Provoked VTEs were more common than unprovoked events. Non-traditional and modifiable potential predisposing factors such as viremia and smoking were common. Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
Læs mere Tjek på PubMedViguerie, Alex; Song, Ruiguang; Bosh, Karin; Lyles, Cynthia M.; Farnham, Paul G.
Journal of Acquired Immune Deficiency Syndromes, 30.11.2023
Tilføjet 30.11.2023
Background: Whether the COVID-19 pandemic has had a disproportionate impact on mortality among persons with diagnosed HIV (PWDH) in United States is unclear. Through our macro-scale analysis, we seek to better understand how the COVID-19 pandemic affected mortality among PWDH. Methods: We obtained mortality and population data for the years 2018-2020 from the National HIV Surveillance System (NHSS) for the U.S. PWDH population, and from publicly available data for the general population. We computed mortality rates and excess mortality for both the general and PWDH populations. Stratifications by age, race/ethnicity, and sex were considered. For each group, we determined whether the 2020 mortality rates and mortality risk ratio showed a statistically significant change from 2018-2019. Results. Approximately 1550 excess deaths occurred among PWDH in 2020, with Black, Hispanic/Latino and PWDH 55 and older comprising the majority of excess deaths. Mortality rates increased in 2020 from 2018-2019 across the general population in all groups. Among PWDH, mortality rates either increased, or showed no statistically significant change. These increases were similar to, or smaller than, those observed in the general population, resulting in a 7.7% decrease in the mortality risk ratio between PWDH and the general population. Conclusions: While mortality rates among PWDH increased in 2020 relative to 2018-2019, the increases were smaller, or of similar magnitude, to those observed in the general population. We thus do not find evidence of elevated mortality risk from the COVID-19 pandemic among PWDH. These findings held across subpopulations stratified by age, sex, and racial/ethnic group. Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
Læs mere Tjek på PubMedArnold, Elizabeth Mayfield; Kamal, Susan; Rotheram-Borus, Mary Jane; Bridges, S. Kate; Gertsch, William; Norwood, Peter; Swendeman, Dallas; the ATN CARES Team
Journal of Acquired Immune Deficiency Syndromes, 30.11.2023
Tilføjet 30.11.2023
Background: Youth living with HIV (YLH) have an increased risk for psychosocial stressors that can impact their antiretroviral (ARV) adherence. We examined factors associated with self-reported ARV adherence among YLH ages 12-24 years old. Setting: YLH (N=147) were recruited in Los Angeles, California, and New Orleans, Louisiana from 2017-2020. Methods: YLH whose self-reported recent (30 days) ARV adherence was “excellent” or “very good” were compared to non-adherent YLH on sociodemographic, clinical, and psychosocial factors using both univariate and multivariate analyses. Results: Participants were predominantly male (88%), and 81% identified as gay, bisexual, transgender, queer, or other. The mean duration on ARV was 27 months (range: 0-237 months). Most YLH (71.2%) self-reported being adherent, and 79% of those who self-reported adherence were also virally suppressed (
Læs mere Tjek på PubMedMi, Tianyue; Zhang, Jiajia; Yang, Xueying; Chen, Shujie; Weissman, Sharon; Olatosi, Bankole; Li, Xiaoming
Journal of Acquired Immune Deficiency Syndromes, 30.11.2023
Tilføjet 30.11.2023
Background: Risk factors for suicidality among people with HIV (PWH) may evolve over their disease course, particularly as they develop comorbidities such as mental health disorders over time. Setting: This study compared the leading risk factors of suicide ideation/attempt among PWH in South Carolina across different combination antiretroviral therapy (cART) eras. Methods: A statewide cohort of PWH who were diagnosed between 2005 and 2016, with a follow-up record until 2020, was involved in the study. A Cox proportional hazards model was employed to examine the association of suicide ideation/attempt and predictors including demographics, HIV-related characteristics, and mental health conditions. Results: Among 8,567 PWH, the incidence of suicide ideation/attempt increased from 537.7 per 100,000 person-years (95% Confidence Interval [CI] 460.2-615.1) in the early cART cohort (2005-2008) to 782.5 (95% CI 697.6-867.4) in the late cART cohort (2009-2016). Leading risk factors of suicide ideation/attempt changed across cART cohort. In the early cART cohort, PWH with suicide ideation/attempt were more likely to be White and diagnosed with bipolar disorder (Ps
Læs mere Tjek på PubMedDickey, Brittney L.; Yanik, Elizabeth L.; Thompson, Zachary; Burkholder, Greer; Kitahata, Mari M.; Moore, Richard D.; Jacobson, Jeff; Mathews, W. Christopher; Christopoulos, Katerina A.; Fleming, Julia; Napravnik, Sonia; Achenbach, Chad; Coghill, Anna E.
Journal of Acquired Immune Deficiency Syndromes, 30.11.2023
Tilføjet 30.11.2023
Background PWH are experiencing an increased prevalence of non-AIDS defining cancers (NADCs). Our study investigated the association of immunosuppression and HIV control with NADCs among PWH on antiretroviral therapy (ART) in the US. Methods Among patients across 8 clinical cohorts on ART between 1996-2016 we assessed immune function and HIV control utilizing six metrics of CD4 count or HIV-RNA viral load (VL): (1) CD4 or VL at ART initiation; (2) change in CD4 or VL following ART initiation; and (3) proportion of follow-up time at CD4>500 cells/ul or VL
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