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47 ud af 47 tidsskrifter valgt, søgeord (hiv) valgt, emner højest 180 dage gamle, sorteret efter nyeste først.
712 emner vises.
Arish Mudra Rakshasa-Loots, Shalena Naidoo, Thandi Hamana, Busiswa Fanqa, Kaylee S. van Wyhe, Filicity Lindani, Andre J. W. van der Kouwe, Richard Glashoff, Sharon Kruger, Frances Robertson, Simon R. Cox, Ernesta M. Meintjes, Barbara Laughton
PLoS One Infectious Diseases, 23.02.2024
Tilføjet 23.02.2024
by Arish Mudra Rakshasa-Loots, Shalena Naidoo, Thandi Hamana, Busiswa Fanqa, Kaylee S. van Wyhe, Filicity Lindani, Andre J. W. van der Kouwe, Richard Glashoff, Sharon Kruger, Frances Robertson, Simon R. Cox, Ernesta M. Meintjes, Barbara Laughton People living with HIV are at three times greater risk for depressive symptoms. Inflammation is a notable predictor of depression, and people with HIV exhibit chronic inflammation despite antiretroviral therapy. We hypothesised that inflammatory biomarkers may mediate the association between HIV status and depressive symptoms. Participants (N = 60, 53% girls, median [interquartile range (IQR)] age 15.5 [15.0, 16.0] years, 70% living with HIV, of whom 90.5% were virally-suppressed) completed the nine-item Patient Health Questionnaire (PHQ-9). We measured choline and myo-inositol in basal ganglia, midfrontal gray matter, and peritrigonal white matter using magnetic resonance spectroscopy, and 16 inflammatory proteins in blood serum using ELISA and Luminex™ multiplex immunoassays. Using structural equation mediation modelling, we calculated standardised indirect effect estimates with 95% confidence intervals. Median [IQR] total PHQ-9 score was 3 [0, 7]. HIV status was significantly associated with total PHQ-9 score (B = 3.32, p = 0.022). Participants with HIV showed a higher choline-to-creatine ratio in the basal ganglia than those without HIV (β = 0.86, pFDR = 0.035). In blood serum, participants with HIV showed higher monocyte chemoattractant protein-1 (MCP-1, β = 0.59, pFDR = 0.040), higher chitinase-3 like-1 (YKL-40, β = 0.73, pFDR = 0.032), and lower interleukin-1beta (IL-1β, β = -0.67, pFDR = 0.047) than those without HIV. There were no significant associations of any biomarkers with total PHQ-9 score. None of the indirect effects were significant, mediating
Læs mere Tjek på PubMedFredrik Nyman
PLoS One Infectious Diseases, 23.02.2024
Tilføjet 23.02.2024
by Fredrik Nyman The human immunodeficiency virus (HIV) emerged as an endemic health crisis in the United States during the early 1980s. Initially labelled a “gay disease” due to its prevalence among gay men, the spread of HIV led to widespread fear and moral panic, as there was limited medical knowledge on preventing its transmission. While HIV is often associated with Sub-Saharan Africa, this article focuses on Sweden, a pioneering nation that became the first to achieve the remarkable Joint UNAIDS/WHO 90-90-90 continuum in addressing the epidemic. However, despite this significant milestone, the punitive legislation and attitudes prevalent in Sweden have had a counterproductive effect on curbing the virus’s spread. Drawing upon a comprehensive triangulation of various data and sources on the evolution of public policy in Sweden, this article argues for the urgent need to reduce stigma surrounding HIV and AIDS. By undertaking further measures to combat stigmatisation, we not only have the potential to prevent the spread of HIV but also significantly enhance the quality of life for individuals living with the virus. An essential step in this journey is to eliminate the legally-enforced mandatory disclosure of one’s HIV status, which would mark a tremendous victory for all those affected. With limited evidence to support the effectiveness of criminalisation and penal laws, no longer being viewed as criminals for non-disclosure would be a monumental achievement, positively transforming the lives of people living with HIV and fostering a more inclusive and supportive society.
Læs mere Tjek på PubMedGriesel, Rulan; Banda, Clifford G; Zhao, Ying; Omar, Zaayid; Wiesner, Lubbe; Meintjes, Graeme; Sinxadi, Phumla; Maartens, Gary
Journal of Acquired Immune Deficiency Syndromes, 23.02.2024
Tilføjet 23.02.2024
Background Dolutegravir exposure is reduced after switching from efavirenz, which could select for dolutegravir resistance if switching occurs during virologic failure. Methods We measured serial dolutegravir trough concentrations after switching from efavirenz in a clinical trial, which randomised some participants to a supplemental dolutegravir dose or placebo for the first 14 days. Changes in dolutegravir trough concentrations between days 3, 7, 14 and 28 were evaluated. The primary outcome was the geometric mean ratio (GMR) of dolutegravir trough concentrations on day 7 versus day 28. Results Twenty-four participants received double-dose dolutegravir (50 mg twice daily) and 11 standard-dose for the first 14 days. Baseline characteristics were: 77% female, median age 36 years, CD4 cell count 254 cells/mm3, and HIV-1 RNA 4.0 log10 copies/mL. The GMR (90% CI) of dolutegravir trough concentrations on day 7 versus day 28 were: 0.637 (0.485 to 0.837) in the standard-dose group and 1.654 (1.404 to 1.948) in the double-dose group. There was a prolonged induction effect at day 28 in participants with efavirenz slow metaboliser genotypes. One participant in the double-dose group had a dolutegravir trough concentration below the protein-binding adjusted concentration needed to inhibit 90% of HIV-1 (PA-IC90) at day 3. Conclusions No participants on standard-dose dolutegravir had dolutegravir trough concentrations below the PA-IC90. Slow efavirenz metaboliser genotypes had higher baseline efavirenz concentrations and more pronounced and longer period of induction post-switch. These findings suggest that a 14-day lead-in supplemental dolutegravir dose may not be necessary when switching from a failing efavirenz-based first-line regimen. Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.
Læs mere Tjek på PubMedStoner, Marie C.D.; Smith, Louis; Ming, Kristin; Mancuso, Noah; Patani, Henna; Sukhija-Cohen, Adam; Granados, Yancy; Wagner, Danielle; Johnson, Mallory O.; Napierala, Sue; Neilands, Torsten B.; Saberi, Parya
Journal of Acquired Immune Deficiency Syndromes, 23.02.2024
Tilføjet 23.02.2024
Background: Despite improvements in antiretroviral therapy (ART) availability, suboptimal adherence is common among youth with HIV (YWH) and can increase drug resistance and poor clinical outcomes. Our study examined an innovative mobile app-based intervention that used automated directly observed therapy (aDOT) using artificial intelligence, along with conditional economic incentives (CEIs) to improve ART adherence and enhance viral suppression among YWH. Setting: We conducted a pilot study of the aDOT-CEI intervention, informed by the operant framework of Key Principles in Contingency Management Implementation, to improve ART adherence among YWH (18–29) in California and Florida who had an unsuppressed HIV viral load. Methods: We recruited 28 virally unsuppressed YWH from AIDS Healthcare Foundation (AHF) clinics, who used the aDOT platform for 3 months. Study outcomes included feasibility and acceptability, self-reported ART adherence, and HIV viral load. Results: Participants reported high satisfaction with the app (91%), and 82% said that it helped them take their medication. Comfort with the security and privacy of the app was moderate (55%), and 59% indicated the incentives helped improve daily adherence. Conclusion: Acceptability and feasibility of the aDOT-CEI intervention were high with potential to improve viral suppression, although some a priori metrics were not met. Pilot results suggest refinements which may improve intervention outcomes, including increased incentive amounts, provision of additional information, and reassurance about app privacy and security. Additional research is recommended to test the efficacy of the aDOT-CEI intervention to improve viral suppression in a larger sample. Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.
Læs mere Tjek på PubMedBMC Infectious Diseases, 22.02.2024
Tilføjet 22.02.2024
Abstract Background Diabetes mellitus (DM) has a direct impact on the clinical manifestation and prognosis of active tuberculosis disease (TB) and is known to increase the chance of developing the condition. We sought to determine the prevalence of DM in adult Ugandan patients with recently diagnosed TB and the associated sociodemographic, anthropometric, and metabolic characteristics of TB-DM comorbidity. Methods In this cross-sectional study conducted at the adult TB treatment centres of three tertiary healthcare facilities in Uganda, we screened adult participants with recently diagnosed TB (diagnosed in
Læs mere Tjek på PubMedBMC Infectious Diseases, 22.02.2024
Tilføjet 22.02.2024
Abstract Background Hospital admission outcomes for people living with HIV (PLHIV) in resource-limited settings are understudied. We describe in-hospital mortality and associated clinical-demographic factors among PLHIV admitted at a tertiary-level public hospital in Uganda. Methods We performed a cross-sectional analysis of routinely collected data for PLHIV admitted at Kiruddu National Referral Hospital between March 2020 and March 2023. We estimated the proportion of PLHIV who had died during hospitalization and performed logistic regression modelling to identify predictors of mortality. Results Of the 5,827 hospitalized PLHIV, the median age was 39 years (interquartile range [IQR] 31–49) and 3,293 (56.51%) were female. The median CD4 + cell count was 109 cells/µL (IQR 25–343). At admission, 3,710 (63.67%) were active on antiretroviral therapy (ART); 1,144 (19.63%) had interrupted ART > 3 months and 973 (16.70%) were ART naïve. In-hospital mortality was 26% (1,524) with a median time-to-death of 3 days (IQR 1–7). Factors associated with mortality (with adjusted odds ratios) included ART interruption, 1.33, 95% confidence intervals (CI) 1.13–1.57, p 0.001; CD4 + counts ≤ 200 cells/µL 1.59, 95%CI 1.33–1.91, p
Læs mere Tjek på PubMedBMC Infectious Diseases, 22.02.2024
Tilføjet 22.02.2024
BMC Infectious Diseases, 22.02.2024
Tilføjet 22.02.2024
Abstract Background Tuberculosis (TB) is a major cause of mortality worldwide. Children and people living with HIV (PLHIV) have an increased risk of mortality, particularly in the absence of rapid diagnosis. The main challenges of diagnosing TB in these populations are due to the unspecific and paucibacillary disease presentation and the difficulty of obtaining respiratory samples. Thus, novel diagnostic strategies, based on non-respiratory specimens could improve clinical decision making and TB outcomes in high burden TB settings. We propose a multi-country, prospective diagnostic evaluation study with a nested longitudinal cohort evaluation to assess the performance of a new stool-based qPCR, developed by researchers at Baylor College of Medicine (Houston, Texas, USA) for TB bacteriological confirmation with promising results in pilot studies. Methods The study will take place in high TB/HIV burden countries (Mozambique, Eswatini and Uganda) where we will enroll, over a period of 30 months, 650 PLHIV (> 15) and 1295 children under 8 years of age (irrespective of HIV status) presenting pressumptive TB. At baseline, all participants will provide clinical history, complete a physical assessment, and undergo thoracic chest X-ray imaging. To obtain bacteriological confirmation, participants will provide respiratory samples (1 for adults, 2 in children) and 1 stool sample for Xpert Ultra MTB/RIF (Cepheid, Sunnyvale, CA, USA). Mycobacterium tuberculosis (M.tb) liquid culture will only be performed in respiratory samples and lateral flow lipoarabinomannan (LF-LAM) in urine following WHO recommendations. Participants will complete 2 months follow-up if they are not diagnosed with TB, and 6 months if they are. For analytical purposes, the participants in the pediatric cohort will be classified into “confirmed tuberculosis”, “unconfirmed tuberculosis” and “unlikely tuberculosis”. Participants of the adult cohort will be classified as “bacteriologically confirmed TB”, “clinically diagnosed TB” or “not TB”. We will assess accuracy of the novel qPCR test compared to bacteriological confirmation and Tb diagnosis irrespective of laboratory results. Longitudinal qPCR results will be analyzed to assess its use as treatment response monitoring. Discussion The proposed stool-based qPCR is an innovation because both the strategy of using a non-sputum based sample and a technique specially designed to detect M.tb DNA in stool. Protocol registration details ClinicalTrials.gov Identifier: NCT05047315.
Læs mere Tjek på PubMedBMC Infectious Diseases, 22.02.2024
Tilføjet 22.02.2024
Abstract Introduction The frequency of mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) in Latin America has decreased considerably. However, new infections continue to be recorded, and the pediatric population remains one of the most vulnerable groups in this region. The main objective of the study was to describe the clinical, epidemiological and psychosocial characteristics of new diagnoses of HIV MTCT in 2018 in the PLANTAIDS network (Paediatric Network for Prevention, Early Detection and Treatment of HIV in Children) during the 3 years following diagnosis. Methodology Retrospective, multicenter, descriptive study based on a 3-year follow-up of patients diagnosed with HIV infection due to MTCT in 2018 in 10 hospitals in 8 Latin American countries (Costa Rica, Ecuador, Mexico, Honduras, El Salvador, Panama, Guatemala and Venezuela). The hospitals belonged to the PLANTAIDS network, which is included in CYTED (Ibero-American Programme of Science and Technology for Development). Results The study population comprised 72 pediatric patients (38.9% male). The median age at diagnosis was 2.4 years (IQR: 0.8–5.4). There were 35 cases of opportunistic infections corresponding to 25 patients (34.7%), with tuberculosis being the most common. Adequate childhood vaccination coverage was achieved in 80.5%. There were 3 cases of acute SARS-CoV-2 infection, and these were asymptomatic or mildly symptomatic. According to the Centers for Disease Control and Prevention (CDC) classification, the most frequent clinical-immunological stage at all check-ups was C1. Three patients died from opportunistic infections and/or advanced HIV infection. Conclusions It is important to diagnose HIV infection early in pediatrics, since early initiation of ART is associated with a decrease in mortality. Despite this, HIV infection has a poor prognosis in children, necessitating adequate follow-up to ensure adherence to health care and ART, although it can sometimes prove difficult in children.
Læs mere Tjek på PubMedKarol Serwin, Kaja Scheibe, Anna Urbańska, Bogusz Aksak‐Wąs, Malwina Karasińska‐Cieślak, Piotr Ząbek, Ewa Siwak, Iwona Cielniak, Elżbieta Jabłonowska, Kamila Wójcik‐Cichy, Paweł Jakubowski, Monika Bociąga‐Jasik, Adam Witor, Aleksandra Szymczak, Bartosz Szetela, Miłosz Parczewski
Journal of Medical Virology, 22.02.2024
Tilføjet 22.02.2024
Malaria Journal, 22.02.2024
Tilføjet 22.02.2024
Abstract Background Although Ethiopia has made a remarkable progress towards malaria prevention and control, malaria remains one of the most devastating parasitic diseases affecting humans. However, the distribution and transmission of malaria varies across the country. The study aimed to describe 5 years of malaria distribution and magnitude within the West Wallaga Zone and its respective woredas. Methods A retrospective cross-sectional study design was conducted from April 10, 2019 to May 2019. Surveillance data collected weekly for a 5-year (2014–2018) from health facilities and private clinics that were archived in zonal PHEM database were reviewed. The checklist contained variety of variables was developed to collect data. Descriptive analysis was conducted to determine the proportion of Plasmodium species, positivity rate, mortality and fatality rate, time trend, and admission status; and presented by text, tables and figures. Results Of the total of 588,119 suspected malaria cases, 78,658 (43/1000 populations) were positive with average positivity rate of 13.4%. Among confirmed cases, 59,794 (75%) of cases were attributed to Plasmodium falciparum, 16,518 (20%) were Plasmodium vivax, and 2,360 (5%) were mixed infections. The maximum (145,091) and minimum (74,420) transmissions were reported in 2014 and 2018, respectively. There was seasonal variation in transmission; spring (from May to July) and also autumn seasons (from October to November) were found as malaria transmission peaks. Although incidence rate declined throughout the study period, the average annual incidence rate was 14.38 per 1000 populations. The average case fatality rate of 5 consecutive years was 12/78,658 (15/100,000) population. Conclusion Although the malaria prevalence was decreased, the mortality due to malaria was increased in the 5-year study period, and malaria is still among the major public health problems. The dominant species of malaria parasites were P. falciparum and P. vivax. Attention is needed in scaling-up vector control tools in high malaria transmission periods.
Læs mere Tjek på PubMedInfection, 22.02.2024
Tilføjet 22.02.2024
Abstract Purpose This study examined the characteristics, incidence and prognostic factors of the first AIDS-defining condition developed after more than one year of continuous antiretroviral therapy (ART) among people living with HIV (PLHIV). Methods We used data from two multicentre observational cohorts of PLHIV in Germany between 1999 and 2018. Our outcome was the first AIDS-defining event that occurred during follow-up after more than one year of continuous ART. Descriptive analyses at ART initiation, at the time of the AIDS event and of the most frequently observed types of AIDS-defining illnesses were performed. We calculated the incidence rate (IR) per 1000 person-years (PY) and used a bootstrap stepwise selection procedure to identify predictors of the outcome. Results A total of 12,466 PLHIV were included in the analyses. 378 developed the outcome, constituting an overall IR of 5.6 (95% CI 5.1–6.2) AIDS events per 1000 PY. The majority of PLHIV was virally suppressed at the time of the event. Oesophageal candidiasis and wasting syndrome were the most frequently diagnosed AIDS-defining illnesses. We found a low CD4 count at ART initiation, a previous AIDS-defining condition and transmission through intravenous drug use to be meaningful prognostic factors of the outcome. Conclusion The overall rate of AIDS-defining events among PLHIV under long-term ART was low, highlighting the importance of continuous treatment. PLHIV who started ART with indicators of impaired immune functioning were more susceptible to disease progression, suggesting that the public health response should continue to focus on early and sustained treatment for all PLHIV.
Læs mere Tjek på PubMedAndrew MulatoEric LansdonRon AoyamaJohannes VoigtMichael LeeAlbert LiclicanGary LeeEric SingerBrian StaffordRuoyu GongBernard MurrayJulie ChanJohnny LeeYili XuShekeba AhmadyarAna GonzalezAesop ChoGeorge J. StepanUli SchmitzBrian SchultzBruno MarchandBoris BrumshteinRuth WangHelen YuTomas CihlarLianhong XuStephen R. Yant1Department of Virology, Gilead Sciences, Foster City, California, USA2Department of Structural Biology and Chemistry, Gilead Sciences, Foster City, California, USA3Department of Drug Metabolism, Gilead Sciences, Foster City, California, USA4Department of Discovery Sciences and Technology, Gilead Sciences, Foster City, California, USA5Department of Medicinal Chemistry, Gilead Sciences, Foster City, California, USA, Miguel Angel Martinez
Antimicrobial Agents And Chemotherapy, 22.02.2024
Tilføjet 22.02.2024
BMC Infectious Diseases, 22.02.2024
Tilføjet 22.02.2024
BMC Infectious Diseases, 22.02.2024
Tilføjet 22.02.2024
Abstract Background Tuberculosis (TB) is a major cause of mortality worldwide. Children and people living with HIV (PLHIV) have an increased risk of mortality, particularly in the absence of rapid diagnosis. The main challenges of diagnosing TB in these populations are due to the unspecific and paucibacillary disease presentation and the difficulty of obtaining respiratory samples. Thus, novel diagnostic strategies, based on non-respiratory specimens could improve clinical decision making and TB outcomes in high burden TB settings. We propose a multi-country, prospective diagnostic evaluation study with a nested longitudinal cohort evaluation to assess the performance of a new stool-based qPCR, developed by researchers at Baylor College of Medicine (Houston, Texas, USA) for TB bacteriological confirmation with promising results in pilot studies. Methods The study will take place in high TB/HIV burden countries (Mozambique, Eswatini and Uganda) where we will enroll, over a period of 30 months, 650 PLHIV (> 15) and 1295 children under 8 years of age (irrespective of HIV status) presenting pressumptive TB. At baseline, all participants will provide clinical history, complete a physical assessment, and undergo thoracic chest X-ray imaging. To obtain bacteriological confirmation, participants will provide respiratory samples (1 for adults, 2 in children) and 1 stool sample for Xpert Ultra MTB/RIF (Cepheid, Sunnyvale, CA, USA). Mycobacterium tuberculosis (M.tb) liquid culture will only be performed in respiratory samples and lateral flow lipoarabinomannan (LF-LAM) in urine following WHO recommendations. Participants will complete 2 months follow-up if they are not diagnosed with TB, and 6 months if they are. For analytical purposes, the participants in the pediatric cohort will be classified into “confirmed tuberculosis”, “unconfirmed tuberculosis” and “unlikely tuberculosis”. Participants of the adult cohort will be classified as “bacteriologically confirmed TB”, “clinically diagnosed TB” or “not TB”. We will assess accuracy of the novel qPCR test compared to bacteriological confirmation and Tb diagnosis irrespective of laboratory results. Longitudinal qPCR results will be analyzed to assess its use as treatment response monitoring. Discussion The proposed stool-based qPCR is an innovation because both the strategy of using a non-sputum based sample and a technique specially designed to detect M.tb DNA in stool. Protocol registration details ClinicalTrials.gov Identifier: NCT05047315.
Læs mere Tjek på PubMedJournal of the American Medical Association, 21.02.2024
Tilføjet 21.02.2024
Even small increases in out-of-pocket costs for preexposure prophylaxis (PrEP), a medication that can prevent people from being infected with HIV, could result in patients not filling their prescriptions, a recent study in Health Affairs projected.
Læs mere Tjek på PubMedManon Vautrin, Fabienne Tombette, Vinca Icard, Marie Leoz, Mary-Anne Trabaud, Antoine Ouziel, Luc Panetta, Véronique Lemée, Jean Christophe Plantier, Alice Moisan
Clinical Microbiology and Infection, 21.02.2024
Tilføjet 21.02.2024
As described for many years, HIV-1 are divided into four groups: HIV-1/M (comprising several subtypes and recombinant forms), HIV-1/O (with two subgroups, H and T), HIV-1/N and HIV-1/P. Despite the strong genetic divergence between HIV-1/M and HIV-1/O, 19 HIV-1/MO unique recombinant forms (URF_MO) have been described in 23 patients, in Cameroun and France, since 1999. The conditions of their emergence remain unclear and various contexts have been described, including the in vivo emergence of an HIV-1/MO in an HIV-1/M+O dually infected patient [1] or the direct transmission of an HIV-1/MO, within a Cameroonian couple [2].
Læs mere Tjek på PubMedBMC Infectious Diseases, 21.02.2024
Tilføjet 21.02.2024
Abstract Introduction The frequency of mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) in Latin America has decreased considerably. However, new infections continue to be recorded, and the pediatric population remains one of the most vulnerable groups in this region. The main objective of the study was to describe the clinical, epidemiological and psychosocial characteristics of new diagnoses of HIV MTCT in 2018 in the PLANTAIDS network (Paediatric Network for Prevention, Early Detection and Treatment of HIV in Children) during the 3 years following diagnosis. Methodology Retrospective, multicenter, descriptive study based on a 3-year follow-up of patients diagnosed with HIV infection due to MTCT in 2018 in 10 hospitals in 8 Latin American countries (Costa Rica, Ecuador, Mexico, Honduras, El Salvador, Panama, Guatemala and Venezuela). The hospitals belonged to the PLANTAIDS network, which is included in CYTED (Ibero-American Programme of Science and Technology for Development). Results The study population comprised 72 pediatric patients (38.9% male). The median age at diagnosis was 2.4 years (IQR: 0.8–5.4). There were 35 cases of opportunistic infections corresponding to 25 patients (34.7%), with tuberculosis being the most common. Adequate childhood vaccination coverage was achieved in 80.5%. There were 3 cases of acute SARS-CoV-2 infection, and these were asymptomatic or mildly symptomatic. According to the Centers for Disease Control and Prevention (CDC) classification, the most frequent clinical-immunological stage at all check-ups was C1. Three patients died from opportunistic infections and/or advanced HIV infection. Conclusions It is important to diagnose HIV infection early in pediatrics, since early initiation of ART is associated with a decrease in mortality. Despite this, HIV infection has a poor prognosis in children, necessitating adequate follow-up to ensure adherence to health care and ART, although it can sometimes prove difficult in children.
Læs mere Tjek på PubMedNolwenn Conan, Erica Simons, Menard L. Chihana, Liesbet Ohler, Ellie FordKamara, Mduduzi Mbatha, Gilles vanCutsem, Helena Huerga
PLoS One Infectious Diseases, 20.02.2024
Tilføjet 20.02.2024
by Nolwenn Conan, Erica Simons, Menard L. Chihana, Liesbet Ohler, Ellie FordKamara, Mduduzi Mbatha, Gilles vanCutsem, Helena Huerga
Læs mere Tjek på PubMedBMC Infectious Diseases, 20.02.2024
Tilføjet 20.02.2024
Abstract Background Oral candidiasis is a common opportunistic infection in patients with human immunodeficiency virus (HIV). In addition, most of these patients suffer from vitamin D deficiency. This study aimed to investigate the association between vitamin D levels and oral candidiasis in patients with HIV infection. Methods This case‒control study was conducted on HIV-infected patients. Cases were patients with oral candidiasis diagnosed based on physical examinations. Controls were age- and sex-matched individuals without oral candidiasis. The levels of 25-OH vitamin D and other laboratory markers (CD4 count and viral load) were compared between the case and control groups. Results A total of 104 cases and 102 controls were included in the study. The cases had significantly lower 25-OH vitamin D3 levels (MD = 33.86 ng/mL, 95% CI= (31.85, 35.87), P
Læs mere Tjek på PubMedBMC Infectious Diseases, 20.02.2024
Tilføjet 20.02.2024
Abstract Objective This study aimed to assess weight gain associated with treatment switching to INSTI-based regimens in people living with HIV (PLWH) and to determine whether it is accompanied by worsening features of hypertension, dyslipidemia, or hyperglycemia. Methods In this two-center retrospective observational study, we assessed weight gain and metabolic features in PLWH who switched to an INSTI-based regimen (study group) as compared to patients who remained on a non-INSTI regimen (control group) over a 24-month follow-up period. Results One-hundred seventy-four PLWH were included in the study group, and 175 were included in the control group. The study group gained 2.51 kg ± 0.31 (mean ± standard deviation) over the 2 years of follow-up, while the control group gained 1.1 ± 0.31 kg over the same time course (p
Læs mere Tjek på PubMedBMC Infectious Diseases, 17.02.2024
Tilføjet 17.02.2024
BMC Infectious Diseases, 17.02.2024
Tilføjet 17.02.2024
Abstract Background The World Health Organization endorsed Truenat MTB rapid molecular assay in 2020 and recommended additional in-country evaluation studies before uptake. We evaluated the accuracy and operational feasibility of Truenat MTB assay (Truenat) in comparison with GeneXpert Ultra and culture. Methods In a cross-sectional study of 250 presumptive TB patients, participants were requested to provide a sputum sample on the day of their visit to the clinic. The sputum sample was homogenized and a portion was tested using GeneXpert Ultra as per the routine standard procedure and the other portion was tested using Truenat assay at the clinic laboratory. The second sample portion was processed for Concentrated Fluorescent smear Microscopy (CFM), LJ, and MGIT cultures. Truenat sensitivity and specificity were compared to GeneXpert Ultra and culture. Test performance characteristics and operational feasibility assessment data through interview of the study laboratory staff were also collected and summarized as proportions and percentages. Results Of the 250 participants recruited in the study, the sensitivity and specificity of Truenat was n/N (%, 95%CI); 66/82 (80.5, 70.2–88.4) and 156/159 (98.1, 94.5–99.6) when compared with Ultra, 50/64 (89.3, 66.0-87.4) and 166/180 (92.2, 87.2–95.6) when compared with LJ, 58/71 (81.7,70.7–89.8) and 131/138 (94.9, 89.8–97.9) when compared to MGIT culture and 59/73 (80.8, 69.9–89.1) and 159/169 (94.1,89.3–97.1) when compared to LJ and/or MGIT culture. The sensitivity of Truenat was lower, 14/23 (60.9, 40.6–82.8) among smear-negative compared to 45/50 (90.0, 78.1–96.6) among smear-positive participants but not different by HIV status. There were no special training needs especially among laboratory personnel with previous GeneXpert /molecular test experience, 19/242 (7.8%) error/invalid, and 12 (17,4%) uninterpretable/indeterminate results mainly for rifampicin resistance determination. However, there were 3 (3.5%) of GeneXpert Ultra indeterminate results. Conclusion Among presumptive TB patients in Uganda, the Truenat assay has high sensitivity and specificity. The Truenat assay has acceptable operational feasibility attributes when compared with the GeneXpert Assay.
Læs mere Tjek på PubMedXia Zhong, Dan Yuan, Shuang feng Fan, Yang Liu, Ling Su, Shi Jiao He, Shu Liang, Yi Yang
PLoS One Infectious Diseases, 17.02.2024
Tilføjet 17.02.2024
by Xia Zhong, Dan Yuan, Shuang feng Fan, Yang Liu, Ling Su, Shi Jiao He, Shu Liang, Yi Yang Background Few studies on molecular epidemiology have studied people with newly diagnosed HIV infection and ART Failure Patients at the same time in rural China. With more serious HIV epidemic than in other provinces in China, Sichuan is an area suitable for this study. Objective To analyze the characteristics of HIV-1 molecular networks and factors related to network entry among newly diagnosed HIV infection and ART Failure Patients in three county-level cities (A, B, C) in Sichuan Province, to provide scientific basis for accurate prevention and control. Methods Nested PCR amplification method was used to amplify HIV-1 pol gene region of 530 blood samples, Sequencer 4.9 was used to edit, clean and splice the gene sequence, Bioedit correction, Fastree 2.1.8 and Figtree 1.4.2 to construct evolutionary tree and determine genotype. HyPhy2.2.4 and Cytoscape 3.6.1 software were used to construct molecular network. Logistic regression analysis was applied. Results 523(98.68%) pol sequences were obtained, and a total of 518 valid sequences with basic information came into the final analyses. A total of 6 genotypes were detected, namely CRF01_AE (320,61.78%), CRF07_BC (149,28.76%), B (30,5.79%), CRF08_BC (11, 2.12%), CRF55_01B (6, 1.16%) and C (2, 0.39%). 186 of 518(35.91%) sequences entered the network at a genetic distance of 0.8%, forming 42 propagation clusters. “High-risk transmitters”(connected with two and more) accounted for 21.62%. Logistic regression showed that≥50 years old (OR = 2.474) were more risky than 18–49 years old, CRF07_BC sub-type (OR = 0.174) were less risky than CRF01_AE sub-type, B sub-type (OR = 6.698) is higher risky than CRF01_AE sub-type, and District B (OR = 0.077) less risky than that of A city. Conclusion The sources of HIV infection in rural Sichuan are diversified and complicated. The prevention and control of HIV infection in Sichuan Province should focus on strengthening the long-term dynamic detection of elderly population, B strain sub-type, and in City A.
Læs mere Tjek på PubMedHyle, Emily P.; Wattananimitgul, Nattanicha; Mukerji, Shibani S.; Foote, Julia H.A.; Reddy, Krishna P.; Thielking, Acadia; Yu, Liyang; Viswanathan, Anand; Rubin, Leah H.; Shebl, Fatma M.; Althoff, Keri N.; Freedberg, Kenneth A.
AIDS, 16.02.2024
Tilføjet 16.02.2024
Objective: Almost 400 000 people with HIV (PWH) in the United States are over age 55 years and at risk for age-associated dementias (AAD), including Alzheimer\'s disease and vascular contributions to cognitive impairment and dementia (VCID). We projected the cumulative incidence and mortality associated with AAD among PWH at least 60 years in the United States compared with the general population. Design/methods: Integrating the CEPAC and AgeD-Pol models, we simulated two cohorts of male and female individuals at least 60 years old: PWH, and general US population. We estimated AAD incidence and AAD-associated mortality rates. Projected outcomes included AAD cumulative incidence, life expectancy, and quality-adjusted life-years (QALYs). We performed sensitivity and scenario analyses on AAD-specific (e.g. incidence) and HIV-specific (e.g. disengagement from HIV care) parameters, as well as premature aging among PWH. Results: We projected that 22.1%/16.3% of 60-year-old male individuals/female individuals with HIV would develop AAD by 80 years compared with 15.9%/13.3% of male individuals/female individuals in the general population. Accounting for age-associated and dementia-associated quality of life, 60-year-old PWH would have a lower life expectancy (QALYs): 17.4 years (14.1 QALYs) and 16.8 years (13.4 QALYs) for male and female individuals, respectively, compared with the general population [men, 21.7 years (18.4 QALYs); women, 24.7 years (20.2 QALYs)]. AAD cumulative incidence was most sensitive to non-HIV-related mortality, engagement in HIV care, and AAD incidence rates. Conclusion: Projected estimates of AAD-associated morbidity, mortality, and quality of life can inform decision-makers and health systems planning as the population of PWH ages. Improved AAD prevention, treatment, and supportive care planning are critical for people aging with HIV. Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.
Læs mere Tjek på PubMedShalekoff, Sharon; Da Costa Dias, Bianca; Loubser, Shayne; Strehlau, Renate; Kuhn, Louise; Tiemessen, Caroline T.
AIDS, 16.02.2024
Tilføjet 16.02.2024
Objective: CCR5-tropic viruses are preferentially transmitted during perinatal HIV-1 infection. CCR5 density on CD4+ T cells likely impacts susceptibility to HIV-1 infection. Design: Fifty-two mother–infant dyads were enrolled. All mothers were living with HIV-1, 27 of the infants acquired HIV-1 in utero and 25 infants remained uninfected. Methods: CCR5 density, together with frequencies of CD4+ and CD8+ T cells expressing immune activation (CCR5, ICOS and HLA-DR) and immune checkpoint (TIGIT and PD-1) markers, were measured in whole blood from the dyads close to delivery. Results: Compared with mothers who did not transmit, mothers who transmitted HIV-1 had less exposure to ART during pregnancy (P = 0.015) and higher plasma viral load close to delivery (P = 0.0005). These mothers, additionally, had higher CCR5 density on CD4+ and CD8+ T cells and higher frequencies of CCR5, ICOS and TIGIT-expressing CD8+ T cells. Similarly, compared with infants without HIV-1, infants with HIV-1 had higher CCR5 density on CD4+ and CD8+ T cells and higher frequencies of CCR5, TIGIT, and PD-1-expressing CD4+ and CD8+ T cells as well as higher frequencies of HLA-DR-expressing CD8+ T cells. CCR5 density on maternal CD4+ T cells remained significantly associated with transmission after adjusting for maternal viral load and CD4+ T cell counts. Mother–infant dyads with shared high CCR5 density phenotypes had the highest risk of transmission/acquisition of infection compared with dyads with shared low-CCR5 density phenotypes. Conclusion: This study provides strong evidence of a protective role for a combined mother–infant low CD4+ T-cell CCR5 density phenotype in in-utero transmission/acquisition of HIV-1. Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.
Læs mere Tjek på PubMedPatel, Deesha; Beer, Linda; Yuan, Xin; Tie, Yunfeng; Baugher, Amy R.; Jeffries, William L. IV; Dailey, Andre; Henny, Kirk D.; for the Medical Monitoring Project
AIDS, 16.02.2024
Tilføjet 16.02.2024
Objective: To identify factors – including social determinants of health (SDOH) – that explain racial/ethnic disparities in antiretroviral therapy (ART) adherence and sustained viral suppression (SVS) among U.S. men who have sex with men (MSM) with HIV. Design : We used weighted data from 2017 to 2021 cycles of the Medical Monitoring Project. Methods: Among MSM taking ART, we calculated prevalence differences (PDs) with 95% confidence intervals (CIs) of ART adherence (100% ART adherence, past 30 days) and SVS (all viral loads in past 12 months
Læs mere Tjek på PubMedCooley, Sarah A.; Petersen, Kalen J.; Tice, Caitlin; Langford, Dianne; Burdo, Tricia H.; Roman, June; Ances, Beau M.
AIDS, 16.02.2024
Tilføjet 16.02.2024
Objective: Neurofilament light chain protein (NfL) is a marker of neuronal injury and neurodegeneration. Typically assessed in cerebrospinal fluid, recent advances have allowed this biomarker to be more easily measured in plasma. This study assesses plasma NfL in people with HIV (PWH) compared to people without HIV (PWoH), and its relationship with cognitive impairment, cardiovascular risk, and a neuroimaging metric of brain aging (brain-age gap). Design: 104 PWH (HIV RNA
Læs mere Tjek på PubMedMohammad Pritom, Gazi Sakir; Yang, Xueying; Gao, Haoyuan; Chen, Shujie; Zhang, Jiajia; Olatosi, Bankole; Li, Xiaoming
AIDS, 16.02.2024
Tilføjet 16.02.2024
Background and objective: The risk factors of diabetes mellitus (DM) in people with HIV (PWH) may be dynamic in a life course manner. This study aimed to describe incidence of DM and investigate the trajectory of changes in risk factor associated with DM incidence over around 15 years among a statewide cohort of PWH in South Carolina (SC). Design: This is a population-based cohort study. Methods: Data were retrieved from the integrated statewide electronic health records between 2006 and 2020 in SC. Separate subgroup analysis was conducted according to the patients’ different follow up duration (i.e., 5, 10, and 15 years) to observe the evolving risk factors of DM development, using multivariable logistic regressions. Results: The DM incidence among a total of 9115 PWH was 8.9 per 1000 person-years. In the overall model, being >60 years old, hypertension, and obesity were positively associated with DM while alcohol consumption, years of HIV diagnosis and high percentage days of viral suppression were negatively associated with the outcome. In the subgroup analyses, similar risk factors were observed. The odds of DM increased in a graded fashion with age. Hypertension was positively associated with DM in all groups and retention to care was negatively associated with the outcome in groups 1 and 3. Conclusion: This large-scale population-based study has revealed a relatively lower incidence of DM among PWH than some other US States. The evolving risk factors over time underline the need for maintaining retention to care to prevent the occurrence of DM. Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.
Læs mere Tjek på PubMedAsnake Simieneh, Surafel Gashaneh, Rahel Dereje
PLoS One Infectious Diseases, 16.02.2024
Tilføjet 16.02.2024
by Asnake Simieneh, Surafel Gashaneh, Rahel Dereje Background Public health problems related to tuberculosis (TB) remain substantial globally, particularly in resource-limited countries. Determining TB treatment outcomes and identifying contributing factors are the basic components of the TB control strategy. In Ethiopia, different studies have been done on treatment outcomes and multiple associated factors, and there is also a little information on the effect of nutritional status on TB treatment outcomes. So there is a need for comprehensive research that examines the combined effects of multiple factors along with nutritional status. Methods A five-year institution-based retrospective cross-sectional study was conducted at Mizan Tepi University Teaching Hospital, South West Ethiopia. This study included all tuberculosis patients who were documented in the TB registration and had known treatment outcomes at the treatment facility between January 1, 2016, and December 31, 2020. Data was collected through a pretested structured data extraction checklist. Data were entered into Epidata version 3.1 and analyzed through SPSS version 22. Multiple logistic regression was employed to assess the association between dependent and independent variables. A p-value of less than 0.05 was considered statistically significant. Result Of the total 625 TB patients, 283 (45.3%), 175 (28%), and 167 (26.7%) had smear-positive, extra-pulmonary, and smear-negative tuberculosis, respectively. The majority of study participants had normal weight (62.2%), were in the age group of 15–44 (67.4%), were new cases (73.8%), and were from urban areas (69.4%). About 32.2% of cases were HIV-positive. The overall unsuccessful treatment rate was 25%. From the total unsuccessful treatment rates, the highest proportion was a death rate of 90 (14.4%), followed by a treatment failure of 56 (9%). Being female (AOR = 1.7, 95% CI: 1.2–2.5), HIV positive (AOR = 2.7, 95% CI: 1.9–4.1), undernutrition (BMI
Læs mere Tjek på PubMedJournal of Infectious Diseases, 16.02.2024
Tilføjet 16.02.2024
Abstract Background The relationship between accelerated epigenetic aging and musculoskeletal outcomes in women with HIV (WWH) has not been studied.Methods We measured DNA methylation age using the Infinium MethylationEPIC BeadChip in a cohort from the Women\'s Interagency HIV Study (n = 190) with measures of bone mineral density (BMD) and physical function. We estimated 6 biomarkers of epigenetic aging—epigenetic age acceleration (EAA), extrinsic EAA, intrinsic EAA, GrimAge, PhenoAge, and DNA methylation–estimated telomere length—and evaluated associations of epigenetic aging measures with BMD and physical function. We also performed epigenome-wide association studies to examine associations of DNA methylation signatures with BMD and physical function.Results This study included 118 WWH (mean age, 49.7 years; 69% Black) and 72 without HIV (mean age, 48.9 years; 69% Black). WWH had higher EAA (mean ± SD, 1.44 ± 5.36 vs −1.88 ± 5.07; P < .001) and lower DNA methylation–estimated telomere length (7.13 ± 0.31 vs 7.34 ± 0.23, P < .001) than women without HIV. There were no significant associations between accelerated epigenetic aging and BMD. Rather, measures of accelerated epigenetic aging were associated with lower physical function.Conclusions Accelerated epigenetic aging was observed in WWH as compared with women without HIV and was associated with lower physical function in both groups.
Læs mere Tjek på PubMedBMC Infectious Diseases, 16.02.2024
Tilføjet 16.02.2024
Janet D. Siliciano, and Robert F. Siliciano
Science, 15.02.2024
Tilføjet 15.02.2024
Jana K. Dickter, Ahmed Aribi, Angelo A. Cardoso, Sara Gianella, Ketevan Gendzekhadze, Shirley Li, Ye Feng, Antoine Chaillon, Gregory M. Laird, Diana L. Browning, Justine A. Ross, Deepa D. Nanayakkara, Alfredo Puing, Rodica Stan, Lily L. Lai, Sue Chang, Trilokesh D. Kadambi, Sandra Thomas, Monzr M. Al Malki, Ryo Nakamura, Joseph Alvarnas, Randy A. Taplitz, Sanjeet S. Dadwal, Stephen J. Forman, John A. Zaia
New England Journal of Medicine, 15.02.2024
Tilføjet 15.02.2024
New England Journal of Medicine, Volume 390, Issue 7, Page 669-671, February 2024.
Læs mere Tjek på PubMedRichterman, Aaron; Sinha, Pranay; Ivers, Louise C; Gross, Robert; Rantleru, Tumelo; Tamuhla, Neo; Bisson, Gregory P.
Journal of Acquired Immune Deficiency Syndromes, 15.02.2024
Tilføjet 15.02.2024
Background Food insecurity and undernutrition are related but distinct concepts contributing to poor HIV and tuberculosis outcomes. Pathways linking them with immunologic profile, which may relate to clinical outcomes, remain understudied. Methods We analyzed data from a cohort study of 165 ART-naïve adults with advanced HIV and newly diagnosed tuberculosis in Botswana from 2009-2013. 29 plasma biomarkers were measured pre-ART and four weeks post-ART initiation. We used principal components analysis (PCA) and multivariable linear regression models to assess relationships between immunological profiles and food insecurity (based on the Household Food Insecurity Access Scale), undernutrition (Body Mass Index < 18.5 kg/m2), and clinical outcomes. Results PCA identified 5 principal components (PCs) with eigenvalues >1. After adjustment, food insecurity was associated with PC3 pre-ART (0.19 per increased category of severity, 95% CI 0.02 to 0.36) and post-ART (0.24, 95% CI 0.07 to 0.41). PC3 was driven by higher levels of IFN-α, IFN-γ, IL-12p40, VEGF, IL-1α, and IL-8, and decreased concentrations of IL-3. Undernutrition was associated with PC5 post-ART (0.49, 95% CI 0.16 to 0.82). PC5 was driven by higher levels of IL-8, MIP-1α, IL-6, and IL-10, and decreased concentrations in IP-10 and IFN-α. Post-ART PC3 (4.3 percentage point increased risk per increased score of 1, 95% CI 0.3 to 8.9) and post-ART PC5 (4.8, 95% CI 0.6 to 8.9) were associated with death in adjusted models. Discussion We identified two distinct immunologic profiles associated with food insecurity, undernutrition, and clinical outcomes in patients with advanced HIV and TB. Different pathophysiologic processes may link food insecurity and undernutrition with poor outcomes in this vulnerable patient population. Future studies should assess the impact of improving food access and intake on immune function and clinical outcomes. Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.
Læs mere Tjek på PubMedWeld, Ethel D.; Ogasawara, Ken; Fuchs, Edward J.; Louissaint, Nicolette; Caffo, Brian; Hendrix, Craig W.
Journal of Acquired Immune Deficiency Syndromes, 15.02.2024
Tilføjet 15.02.2024
Background. Anal sex remains the greatest HIV transmission risk for men who have sex with men and carries substantial population attributable risk among women. Despite a growing array of HIV pre-exposure prophylaxis (PrEP) options, rectal microbicides remain desirable as on demand, non-systemic PrEP. Rectal microbicide product development for PrEP requires understanding the spatiotemporal distribution of HIV infectious elements in the rectosigmoid to optimize formulation development. Setting. Outpatient setting with healthy research participants. Methods. Six healthy men underwent simulated receptive anal sex with an artificial phallus fitted with a triple lumen catheter in the urethral position. To simulate ejaculation of HIV-infected semen, autologous seminal plasma laden with autologous blood lymphocytes from apheresis labeled with 111Indium-oxine (cell-associated) and 99mTechnetium-sulfur colloid (cell-free) as HIV surrogates were injected into the rectal lumen through the phallic urethra. Spatiotemporal distribution of each radioisotope was assessed using SPECT/CT over eight hours. Analysis of radiolabel distribution used a flexible principal curve algorithm to quantitatively estimate rectal lumen distribution. Results. Cell-free and cell-associated HIV surrogates distributed to a maximal distance of 15 and 16 cm, respectively, from the anorectal junction (∼19 and ∼20 cm from the anal verge), with a maximal signal intensity located 6 and 7 cm, respectively. There were no significant differences in any distribution parameters between cell-free and cell-associated HIV surrogate. Conclusions. Cell-free and cell-associated HIV surrogate distribution in the rectosigmoid can be quantified with spatiotemporal pharmacokinetic methods. These results describe the ideal luminal target distribution to guide rectal microbicide development. Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.
Læs mere Tjek på PubMedWandika, Brenda; Nyapara, Florence; Aballa, Calvince; Richardson, Barbra A.; Wamalwa, Dalton; John-Stewart, Grace; Inwani, Irene; Njuguna, Irene
Journal of Acquired Immune Deficiency Syndromes, 15.02.2024
Tilføjet 15.02.2024
Introduction Adolescents living with HIV (ALH) have poorer adherence to antiretroviral therapy (ART) than adults. Many ALH in sub-Saharan Africa (SSA) are enrolled in boarding schools where stigma is pervasive and may impact adherence. Methods We collected sociodemographic data, school information, medical history, and viral load (VL) data from ALH age 14-19 in 25 HIV clinics in 3 counties in Kenya. Using generalized estimating equations, we compared ART adherence in ALH attending day and boarding schools. Results Of 880 ALH, 798 (91%) were enrolled in school, of whom 189 (24%) were in boarding schools. Of those in school, median age was 16 (IQR: 15, 18), 55% were female, 78% had a parent as a primary caregiver, and 74% were on DTG-based ART. Median age at ART initiation was 6 years (IQR 3, 10). Overall, 227 (29%) ALH self-reported missing ART when school was in session (40% in boarding and 25% in day school). After adjusting for sociodemographic and HIV care characteristics, ALH in boarding schools were significantly more likely to self-report missing ART than those in day schools (adjusted Prevalence Ratio (aPR): 1.47, 95% CI 1.18, 1.83, p=0.001). Among 194 ALH, only 60% had undetectable (
Læs mere Tjek på PubMedDe Wit, Stéphane; Bonnet, Fabrice; Osiyemi, Olayemi; Bisshop, Fiona; Olalla, Julian; Routy, Jean-Pierre; Wyen, Christoph; Moodley, Riya; Pappa, Keith; Wang, Ruolan; Oyee, James; Saggu, Parminder; Letang, Emilio; Wynne, Brian; Jones, Bryn; Smith, Kimberly Y.; Ait-Khaled, Mounir
Journal of Acquired Immune Deficiency Syndromes, 15.02.2024
Tilføjet 15.02.2024
Background: Switching to the 2-drug regimen dolutegravir/lamivudine demonstrated durable non-inferior efficacy vs continuing 3- or 4-drug tenofovir alafenamide–based regimens for maintaining virologic suppression in people with HIV-1 through Week 144 in TANGO. Setting: 134 centers, 10 countries. Methods: Adults with HIV-1 RNA 6 months and no history of virologic failure were randomized to switch from stable tenofovir alafenamide–based regimens to dolutegravir/lamivudine on Day 1 (early-switch group) for 196 weeks. Those randomized to continue tenofovir alafenamide–based regimens on Day 1 who maintained virologic suppression at Week 144 switched to dolutegravir/lamivudine at Week 148 (late-switch group). Efficacy, safety, and tolerability (including weight and biomarker changes) of dolutegravir/lamivudine in early-switch and late-switch groups were assessed through Week 196. Results: Overall, 369 participants switched to dolutegravir/lamivudine on Day 1 (early-switch) and 298 switched at Week 148 (late-switch). In the early-switch group, 83% (306/369) maintained virologic suppression through Year 4, and 3% (11/369) reported new adverse events between Weeks 144 and 196. The late-switch group at Week 196 and early-switch group at Week 48 had comparable proportions with virologic suppression (93% each) and similar safety profiles. No late-switch participants and 1 early-switch participant met confirmed virologic withdrawal criteria through Week 196, with no resistance-associated mutations observed. Treatment continued to be well tolerated long-term. Conclusion: Switching from tenofovir alafenamide–based regimens to dolutegravir/lamivudine showed durable efficacy, high barrier to resistance, and good tolerability through 4 years. These results support dolutegravir/lamivudine as a robust treatment for maintaining virologic suppression. Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.
Læs mere Tjek på PubMedMehtani, Nicky J.; Strough, Alix; Strieff, Sarah; Zevin, Barry; Eveland, Joanna; Riley, Elise D.; Gandhi, Monica
Journal of Acquired Immune Deficiency Syndromes, 15.02.2024
Tilføjet 15.02.2024
Background: Long-acting (LA) antiretrovirals may provide meaningful benefit to people who use drugs and people experiencing homelessness (PEH) who face disproportionate structural and psychosocial barriers in adhering to daily oral HIV antiretroviral therapy (ART) or pre-exposure prophylaxis (PrEP), but their use in these populations has not been studied. Setting: The Maria X. Martinez Health Resource Center is a low-barrier (e.g., no appointment) community-based clinic serving San Francisco PEH. Methods: A multidisciplinary care model with robust monitoring and outreach support was developed to provide LA-ART and LA-PrEP to eligible patients experiencing difficulties adhering to oral antiretrovirals. Feasibility was assessed by evaluating rates of HIV viremia and on-time injections among patients receiving LA antiretrovirals over the first 24 months of program implementation. Results: Between November 2021 and November 2023, 33 patients initiated LA-ART or LA-PrEP (median age, 37 years; 27% transgender/non-binary; 73% non-White; 27% street homeless; 52% sheltered homeless; 30% with opioid use disorder; 82% with methamphetamine use disorder). Among 18 patients with HIV, 14 initiated LA-ART injections with detectable viremia (median CD4 count, 340 cells/mm3; mean log10 viral load, 3.53; standard deviation [SD], 1.62), eight had never previously been virally suppressed, and all but one achieved or maintained virologic suppression (mean, 9.67 months; SD, 8.30). Among 15 LA-PrEP patients, all remained HIV-negative (mean, 4.73 months; SD, 2.89). Of 224 injections administered total, 8% were delayed >7 days. Discussion: The implementation of LA antiretrovirals is feasible in low-barrier, highly supportive clinical settings serving vulnerable PEH. Expansion of such programs will be critical to Ending the HIV Epidemic. Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.
Læs mere Tjek på PubMedÖzkaya, Hacer Deniz; Elazab, Khaled; Turan, Bülent; Nazlı, Arzu; Öztürk, Barçın; Pullukçu, Hüsnü; Gökengin, Deniz
Journal of Acquired Immune Deficiency Syndromes, 15.02.2024
Tilføjet 15.02.2024
Background: Late diagnosis of HIV infection is a major global problem. In Turkiye, only 41% - 50% of people living with HIV (PLWH) are diagnosed, suggesting that many opportunities for HIV testing might be missed. Setting: The aim of this study is to determine the missed testing opportunities for HIV in healthcare settings in Turkiye and the predictors for missed opportunities (MOs). Methods: The study included patients with a new HIV diagnosis, presenting to care between January 2018 and December 2020. They were given a verbal questionnaire face to face, by a telephone call or an online meeting for visits to a healthcare setting within the year prior to their diagnosis. Electronic medical records were also examined. Results: The sample included 198 patients with at least one visit to any healthcare setting, with a total of 1677 visits. Patients had an indication for HIV testing in 51.3% (861/1677) of the visits; an HIV test was not offered in 77.9% (671/861) and was considered a MO. The highest number of MOs was in emergency departments (EDs) (59.8%) (180/301).The most common reason for visiting was constitutional symptoms and indicator conditions (ICs) (55.4%) (929/1677). University graduates and those with a CD4+T cell count
Læs mere Tjek på PubMedSkye OPSTEEN; Tim FRAM; Jacob K. FILES; Emily B. LEVITAN; Paul GOEPFERT; Nathaniel ERDMANN
Journal of Acquired Immune Deficiency Syndromes, 15.02.2024
Tilføjet 15.02.2024
There is mounting evidence that HIV infection is a risk factor for severe presentations of COVID-19. We hypothesized that the persistent immune activation associated with chronic HIV infection contributes to worsened outcomes during acute COVID-19. The goals of this study were to provide an in-depth analysis of immune response to acute COVID-19 and investigate relationships between immune responses and clinical outcomes in an unvaccinated, sex and race-matched cohort of people with HIV (PWH, n=20) and people without HIV (PWOH, n=41). There is mounting evidence that HIV infection is a risk factor for severe presentations of COVID-19. We hypothesized that the persistent immune activation associated with chronic HIV infection contributes to worsened outcomes during acute COVID-19. The goals of this study were to provide an in-depth analysis of immune response to acute COVID-19 and investigate relationships between immune responses and clinical outcomes in an unvaccinated, sex and race-matched cohort of people with HIV (PWH, n=20) and people without HIV (PWOH, n=41). We performed flow cytometric analyses on peripheral blood mononuclear cells from PWH and PWOH experiencing acute COVID-19 (≤ 21 days post-symptom onset). PWH were younger (median 52 vs 65 years) and had milder COVID-19 (40% vs 88% hospitalized) compared to PWOH. Flow cytometry panels included surface markers for immune cell populations, activation and exhaustion surface markers (with and without SARS-CoV-2-specific antigen stimulation), and intracellular cytokine staining. We observed that PWH had increased expression of activation (e.g., CD137, OX40) and exhaustion (e.g., PD1, TIGIT) markers as compared to PWOH during acute COVID-19. When analyzing the impact of COVID-19 severity, we found that hospitalized PWH had lower non-classical (CD16+) monocyte frequencies, decreased expression of TIM3 on CD4+ T cells, and increased expression of PDL1 and CD69 on CD8+ T cells. Our findings demonstrate that PWH have increased immune activation and exhaustion as compared to a cohort of predominately older, hospitalized PWOH and raises questions on how chronic immune activation impacts acute disease and the development of post-acute sequelae. Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.
Læs mere Tjek på PubMedMachavariani, Eteri; Miceli, Janet; Altice, Frederick L.; Fanfair, Robyn Neblett; Speers, Suzanne; Nichols, Lisa; Jenkins, Heidi; Villanueva, Merceditas
Journal of Acquired Immune Deficiency Syndromes, 15.02.2024
Tilføjet 15.02.2024
Background: Re-engaging people with HIV (PWH) who are newly out-of-care remains challenging. Data-to-care (D2C) is a potential strategy to re-engage such individuals. Methods: A prospective randomized controlled trial compared a D2C strategy using a disease intervention specialist (DIS) vs standard-of-care (SOC) where 23 HIV clinics in 3 counties in Connecticut could re-engage clients using existing methods. Using a data reconciliation process to confirm being newly out-of-care, 655 participants were randomized to DIS (N=333) or SOC (N=322). HIV care continuum outcomes included re-engagement at 90 days, retention in care and viral suppression (VS) by 12 months. Multivariable regression models were used to assess factors predictive of attaining HIV care continuum outcomes. Results: Participants randomized to DIS were more likely to be re-engaged at 90 days (aOR=1.42, p=0.045). Independent predictors of re-engagement at 90 days were: age>40 years (aOR=1.84, p=0.012) and peri-natal HIV risk category (aOR=3.19, p=0.030). Predictors of retention at 12 months included: re-engagement at 90 days (aOR=10.31, p
Læs mere Tjek på PubMedReis, Karl; Wolf, Allison; Perumal, Rubeshan; Seepamore, Boitumelo; Guzman, Kevin; Ross, Jesse; Cheung, Ken; Amico, K. Rivet; Brust, James C.M.; Padayatchi, Nesri; Friedland, Gerald; Naidoo, Kogieleum; Daftary, Amrita; Zelnick, Jennifer; O’Donnell, Max
Journal of Acquired Immune Deficiency Syndromes, 15.02.2024
Tilføjet 15.02.2024
Introduction For people living with HIV/AIDS, care is commonly delivered through Differentiated Service Delivery (DSD). Although people with multidrug-resistant tuberculosis (MDR-TB) and HIV/AIDS experience severe treatment associated challenges, there is no DSD model to support their treatment. In this study, we defined patterns of medication adherence and characterized longitudinal barriers to inform development of an MDR-TB/HIV DSD framework. Methods Adults with MDR-TB and HIV initiating bedaquiline (BDQ) and receiving antiretroviral therapy (ART) in KwaZulu-Natal, South Africa, were enrolled and followed through the end of MDR-TB treatment. Electronic dose monitoring devices (EDM) measured BDQ and ART adherence. Longitudinal focus groups were conducted and transcripts analyzed thematically to describe discrete treatment stage-specific and cross-cutting treatment challenges. Results 283 participants were enrolled and followed through treatment completion (median 17.8 months [IQR 16.5–20.2]). Thirteen focus groups were conducted. Most participants (82.7%, 234/283) maintained high adherence (mean BDQ adherence 95.3%; mean ART adherence 85.5%), but an adherence-challenged subpopulation with
Læs mere Tjek på PubMedMishra, Shivangi; Gala, Jinay; Chacko, Jose
Critical Care Medicine, 15.02.2024
Tilføjet 15.02.2024
Objectives: Critically ill patients with tuberculosis carry high mortality. Identification of factors associated with mortality in critically ill tuberculosis patients may enable focused treatment. Data Sources: An extensive literature search of PubMed (MEDLINE), Embase, the Cochrane Library, and Google Scholar was performed using Medical Subject Headings terms “tuberculosis,” “critical care,” “critical care outcome,” and “ICU.” We aimed to identify factors affecting mortality in critically ill tuberculosis patients. Study Selection: All the studies comparing factors affecting mortality between survivors and nonsurvivors in critically ill tuberculosis patients were included. The database search yielded a total of 3017 records, of which 17 studies were included in the meta-analysis. Data Extraction: Data were collected including the name of the author, year and country of publication, duration of the study, number of patients studied, type of tuberculosis, patient demography, smoking history, laboratory parameters, comorbidities, the requirement for mechanical ventilation, duration of ventilation, ICU and hospital length of stay (LOS), type of lung involvement, complications, and outcomes. Data Synthesis: The major factors that contributed to mortality in critically ill tuberculosis patients were age, platelet count, albumin, C-reactive protein (CRP), the requirement and duration of invasive mechanical ventilation, Pao2/Fio2 ratio, presence of acute respiratory distress syndrome, shock, hospital-acquired infections, renal replacement therapy, and ICU and hospital LOS. Conclusions: Patient age, platelet count, albumin and CRP levels, the requirement and duration of invasive mechanical ventilation, Pao2/Fio2 ratio, hospital-acquired infections, renal replacement therapy, and ICU LOS were variables associated with mortality.
Læs mere Tjek på PubMedJournal of Infectious Diseases, 15.02.2024
Tilføjet 15.02.2024
Abstract As use of HIV integrase strand transfer inhibitors (INSTI) increases and formulations are being developed for maintenance therapies and chemoprophylaxis, assessing virus suppression under INSTI-based regimens in prevention-relevant biologic compartments, such as the male genital tract, is timely. We used cell-source marker virion immunocapture to examine amplification of particle RNA then assessed the phylogenetic relatedness of seminal and blood viral sequences from men with HIV who were prescribed INSTI-based regimens. Seminal plasma immunocaptures yielded amplifiable virion RNA from 13/24 (54%) men, and the sequences were primarily associated with markers indicative of macrophage and resident dendritic cell sources. Genetic distances were greatest (>2%) between seminal virions and circulating proviruses, pointing to ongoing low-level expression from tissue-resident cells. While the low levels in semen predict an improbable likelihood of transmission, viruses with large genetic distances are expressed under potent INSTI therapy and have implications for determining epidemiologic linkages if adherence is suboptimal.
Læs mere Tjek på PubMedJournal of Infectious Diseases, 15.02.2024
Tilføjet 15.02.2024
Abstract Background The histone deacetylase inhibitor vorinostat (VOR) can reverse human immunodeficiency virus type 1 (HIV-1) latency in vivo and allow T cells to clear infected cells in vitro. HIV-specific T cells (HXTCs) can be expanded ex vivo and have been safely administered to people with HIV (PWH) on antiretroviral therapy.Methods Six PWH received infusions of 2 × 107 HXTCs/m² with VOR 400 mg, and 3 PWH received infusions of 10 × 107 HXTCs/m² with VOR. The frequency of persistent HIV by multiple assays including quantitative viral outgrowth assay (QVOA) of resting CD4+ T cells was measured before and after study therapy.Results VOR and HXTCs were safe, and biomarkers of serial VOR effect were detected, but enhanced antiviral activity in circulating cells was not evident. After 2 × 107 HXTCs/m² with VOR, 1 of 6 PWH exhibited a decrease in QVOA, and all 3 PWH exhibited such declines after 10 × 107 HXTCs/m² and VOR. However, most declines did not exceed the 6-fold threshold needed to definitively attribute decline to the study intervention.Conclusions These modest effects provide support for the strategy of HIV latency reversal and reservoir clearance, but more effective interventions are needed to yield the profound depletion of persistent HIV likely to yield clinical benefit.Clinical Trials Registration. NCT03212989.
Læs mere Tjek på PubMedEdward Muteesasira, Davis Akampumuza, Dismus Abaho, Lillian Nuwasasira, Edward Kumakech
PLoS One Infectious Diseases, 14.02.2024
Tilføjet 14.02.2024
by Edward Muteesasira, Davis Akampumuza, Dismus Abaho, Lillian Nuwasasira, Edward Kumakech Background Intimate partner violence (IPV) disproportionately affects married women living with HIV (MWLHIV), resulting in undesirable human rights, socio-economic, mental, maternal, and child health consequences. Community Support systems against Violence (CoSaV) are widely available and promising public and voluntary resources for the prevention and mitigation of IPV but are poorly investigated. We set out to identify the predictors for the utilization of the CoSaV among the MWLHIV. Methods This was a quantitative cross-sectional study conducted among 424 consecutively sampled MWLHIV attending the Antiretroviral Therapy (ART) clinic at Kabale Regional Referral Hospital in southwestern Uganda in April 2021. Using an interviewer-administered questionnaire, data were collected on the participant’s socio-demographic characteristics, exposure to IPV, awareness about the CoSaV, perceptions about the quality, accessibility and challenges in accessing the CoSaV and the utilization. Modified Poisson regression model was used to identify the predictors for the utilization of CoSaV using the Statistical Package for Social Sciences (SPSS) version 23.0. Results The mean age of the 424 participants in the study was 39.5 ± 10.2 years. More than half of the participants 51.9% (220/424) reported exposure to any IPV. Utilization of any CoSaV was found to be above average at 58.3% among the participants. The formal support (police, local government leaders, health workers and counselors) were more frequently utilized compared to the informal support (family, relatives and friends). Utilization of any CoSaV was higher among the women who were aware of the CoSaV and also those who were exposed to violence. Accessibility was identified as an independent predictor for utilization of any CoSaV. Conclusions Intimate partner violence (IPV) was prevalent among MWLHIV in southwestern Uganda. However, the utilization of any CoSaV was suboptimal. The formal CoSaV were more frequently utilized than the informal support systems. Accessibility was an independent predictor for utilization of any CoSaV. There is need to improve access in order to increase the utilization of the CoSaV and contribute to the attainment of sustainable development goal 5.2.1 and end violence against women.
Læs mere Tjek på PubMedSohini Paul, Anupam Sharma, Radhika Dayal, Mahika Mehta, Sudeshna Maitra, Kuhika Seth, Monal Nagrath, Sowmya Ramesh, Niranjan Saggurti
PLoS One Infectious Diseases, 14.02.2024
Tilføjet 14.02.2024
by Sohini Paul, Anupam Sharma, Radhika Dayal, Mahika Mehta, Sudeshna Maitra, Kuhika Seth, Monal Nagrath, Sowmya Ramesh, Niranjan Saggurti Limited evidence is available on the vulnerability of Adolescent Girls and Young Women (AGYW) to sexual risk behaviour and STI/HIV. Though there are almost no statistics available on vulnerability, related literature suggests that AGYW have low awareness about sexual risk behaviour/ transmission and the prevalence of STI/HIV, making them vulnerable. We conducted a rapid review of peer-reviewed studies addressing transmission network, prevalence, incidence awareness, common determinants of sexual risk behaviour/STI/HIV, health-seeking behaviour and existing interventions addressing the situation among AGYW (age 15–24) to inform the evidence gap in this crucial area of research. We registered the study in PROSPERO (CRD42023403713). We developed detailed inclusion/exclusion criteria, searched JSTOR, PubMed, Google Scholar, Science Direct and Population Council Knowledge Commons databases and followed the guidance from Cochrane Rapid Review to develop the rapid review. We also searched the bibliography of the included studies. We included the English language peer-reviewed quantitative, qualitative, mixed method studies published from Jan 1 2000 to Mar 31 2023. Six reviewers extracted data, and the seventh reviewer independently assessed the quality. Ninety-six studies met the inclusion criteria. We used descriptive statistics and narrative synthesis methods for data analysis. We also conducted a Risk of Bias Assessment (RoB) to check the quality of the included studies. Inadequate literature was found on the transmission network. Prevalence and awareness of STI/HIV are low among AGYW. However, Female Sex Workers, sex-trafficked women or drug users in this age group suffer more. Age, education, income, relationship dynamics with spouses/partners, multiple partners, and substance use are crucial in determining STI/HIV. Traditional sources of health seeking are more popular than formal sources because of social stigma. Mass media campaigns, community mobilization programs, and life skills training programs increase awareness about HIV, condom use and self-efficacy. The inclusion of only English language studies and not conducting meta-analysis because of high heterogeneity are some of the limitations of the study.
Læs mere Tjek på PubMedNguyen, N. T., Nguyen, T., Vu, G. V., Truong, N., Pham, Y., Guevara Alvarez, G., Armstrong-Hough, M., Shelley, D.
BMJ Open, 14.02.2024
Tilføjet 14.02.2024
ObjectivesTo assess the prevalence of depressive symptoms and associated factors among people living with HIV (PLWH) who were current cigarette smokers and receiving treatment at HIV outpatient clinics (OPCs) in Vietnam. DesignA cross-sectional survey of smokers living with HIV. SettingThe study was carried out in 13 HIV OPCs located in Ha Noi, Vietnam. ParticipantsThe study included 527 PLWH aged 18 and above who were smokers and were receiving treatment at HIV OPCs. Outcome measuresThe study used the Centre for Epidemiology Scale for Depression to assess depressive symptoms. The associations between depressive symptoms, tobacco dependence and other characteristics were explored using bivariate and Poisson regression analyses. ResultsThe prevalence of depressive symptoms among smokers living with HIV was 38.3%. HIV-positive smokers who were female (prevalence ratio, PR 1.51, 95% CI 1.02 to 2.22), unmarried (PR 2.06, 95% CI 1.54 to 2.76), had a higher level of tobacco dependence (PR 1.06, 95% CI 1.01 to 1.11) and reported their health as fair or poor (PR 1.66, 95% CI 1.22 to 2.26) were more likely to have depression symptoms compared with HIV-positive smokers who were male, married, had a lower level of tobacco dependence and self-reported their health as good, very good or excellent. ConclusionThe prevalence of depressive symptoms among smokers receiving HIV care at HIV OPCs was high. Both depression and tobacco use screening and treatment should be included as part of ongoing care treatment plans at HIV OPCs.
Læs mere Tjek på PubMedJournal of the American Medical Association, 14.02.2024
Tilføjet 14.02.2024
A man with HIV had syncopal episodes and hypoxemia after recent exposure to SARS-CoV-2; computed tomography revealed diffuse bilateral pulmonary micronodular opacities, a 2.2-cm nodule in the lingula, and mediastinal and hilar lymphadenopathy. What is the diagnosis and what would you do next?
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