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For people who are in danger of getting infected by the Human Immunodeficiency Virus (HIV) and for those who have already been diagnosed with HIV, the antiretroviral pharmaceutical treatment constitutes a prevention measure, but also a necessary treatment for a long and healthy life. Pre-exposure prophylaxis (PrEP) is a modern prevention measure against the HIV spread and has been implemented in many countries since 2016. Recently, in the autumn of 2022, PrEP was legislated as a prevention measure in Greece, too. After a temporary worsening of the HIV epidemiological status in Greece, with a major increase of HIV infections in 2011 and 2012, in the following years, until 2021, the epidemiological data showed a significant decreasing trend. Hopefully, further improvement of the HIV epidemiological status could lead to the achievement of the goals of UNAIDS 95-95-95 in the year 2030. Nevertheless, there still remain a lot of barriers, such as the lack of information, deterring those who are in danger of HIV infection or live with HIV from taking the available prevention measures, including PrEP. To overcome these barriers, actions have to be taken, such as campaigns to enhance the awareness of people who face the danger of HIV infection. [ABSTRACT FROM AUTHOR]

People living with HIV-HCV co-infection comprise a target group for HCV-micro-elimination. We conducted an HCV cascade of care (CoC) for HIV-HCV co-infected individuals living in Greece and investigated factors associated with different HCV-CoC stages. We analyzed data from 1213 participants from the Athens Multicenter AIDS Cohort Study. A seven-stage CoC, overall and by subgroup (people who inject drugs (PWID), men having sex with men (MSM), men having sex with women (MSW), and migrants], was constructed, spanning from HCV diagnosis to sustained virologic response (SVR). Logistic/Cox regression models were employed to identify factors associated with passing through each CoC step. Among 1213 anti-HCV-positive individuals, 9.2% died before direct-acting antiviral (DAA) availability. PWID exhibited higher mortality rates than MSM. Of 1101 survivors, 72.2% remained in care and underwent HCV-RNA testing. Migrants and PWID showed the lowest retention rates. HCV-RNA was available for 79.2% of those in care, with 77.8% diagnosed with chronic HCV. Subsequently, 71% initiated DAAs, with individuals with very low CD4 counts (<100 cells/μL) exhibiting lower odds of DAA initiation. SVR testing was available for 203 individuals, with 85.7% achieving SVR. The SVR rates did not differ across risk groups. In 2023, significant gaps and between-group differences persisted in HCV-CoC among HIV-HCV co-infected individuals in Greece. [ABSTRACT FROM AUTHOR]

People who inject drugs (PWID) have an increased risk of HIV infection partly due to injection behaviors often related to opioid use. Medications for opioid use disorder (MOUD) have been shown to reduce HIV infection risk, possibly by reducing injection risk behaviors. MOUD may benefit individuals who do not receive it themselves but are connected through social, sexual, or drug use networks with individuals who are treated. This is known as spillover. Valid estimation of spillover in network studies requires considering the network's community structure. Communities are groups of densely connected individuals with sparse connections to other groups. We analyzed a network of 277 PWID and their contacts from the Transmission Reduction Intervention Project. We assessed the effect of MOUD on reductions in injection risk behaviors and the possible benefit for network contacts of participants treated with MOUD. We identified communities using modularity-based methods and employed inverse probability weighting with community-level propensity scores to adjust for measured confounding. We found that MOUD may have beneficial spillover effects on reducing injection risk behaviors. The magnitudes of estimated effects were sensitive to the community detection method. Careful consideration should be paid to the significance of community structure in network studies evaluating spillover. [ABSTRACT FROM AUTHOR]

Background: This study seeks to understand the empirical nature of macro-financial factors associated with the worsening of HIV infections and the risks that need to be carefully monitored for a sustainable improvement in HIV outcomes as developing countries seek to achieve the United Nations 95-95-95 targets. Methods: The author used a panel VAR model to study the long-term endogenous relationships between percentage changes in the annual spot price of the most traded commodities, GDP per capita, health spending, and the HIV infection rate of developing countries. Results: The author discovered that shocks of global commodity prices negatively impact GDP per capita, real government health spending, and real private health spending. These shocks have adverse spillover effects characterized by worsening HIV infections. The reactions from price shocks suggest that GDP per capita contract immediately when a commodity price shock hits developing economies. Real government health spending and real private health spending also contract instantly. HIV infections begin worsening three years after the shock in the energy and precious metal blocks of countries. HIV infections also begin to worsen two years after shocks in the agricultural block of counties. These impacts are statistically significant and can potentially reverse the positive HIV infection gains achieved in the previous years. Emergency funds, insurance schemes, and international aid for HIV need to discharge more funds to counter these shocks. Conclusions: There is a significant risk of reversing HIV infection outcomes arising from commodity price shocks. Funding agencies must protect HIV prevention services from global macro-economic shocks as countries move closer to the United Nations 95-95-95 targets. [ABSTRACT FROM AUTHOR]

Background: Variation in host immune responses to SARS-CoV-2 is regulated by multiple genes involved in innate viral response and cytokine storm emergence like IL-10 and TNFa gene polymorphisms. We hypothesize that IL-10; -592 C > A and − 1082 A > G and TNFa-308 G > A are associated with the risk of SARS-COV2 infections and clinical outcome. Methods: Genotyping, laboratory and radiological investigations were done to 110 COVID-19 patients and 110 healthy subjects, in Ismailia, Egypt. Results: A significant association between the − 592 A allele, A containing genotypes under all models (p < 0.0001), and TNFa A allele with risk to infection was observed but not with the G allele of the − 1082. The − 592 /-1082 CG and the − 592 /-1082/ -308 CGG haplotypes showed higher odds in COVID-19 patients. Severe lung affection was negatively associated with − 592, while positive association was observed with − 1082. Higher D-dimer levels were strongly associated with the − 1082 GG genotype. Survival outcomes were strongly associated with the GA genotype of TNFa. -308 as well as AGG and AAA haplotypes. Conclusion: IL-10 and TNFa polymorphisms should be considered for clinical and epidemiological evaluation of COVID-19 patients. [ABSTRACT FROM AUTHOR]

Background: Tele-harm reduction (THR) is a telehealth-enhanced, peer-led, harm reduction intervention delivered within a trusted syringe services program (SSP) venue. The primary goal of THR is to facilitate linkage to care and rapid, enduring virologic suppression among people who inject drugs (PWID) with HIV. An SSP in Miami, Florida, developed THR to circumvent pervasive stigma within the traditional healthcare system. Methods: During intervention development, we conducted in-depth interviews with PWID with HIV (n = 25) to identify barriers and facilitators to care via THR. We employed a general inductive approach to transcripts guided by iterative readings of the raw data to derive the concepts, themes, and interpretations of the THR intervention. Results: Of the 25 PWID interviewed, 15 were in HIV care and adherent to medication; 4 were in HIV care but non-adherent; and 6 were not in care. Themes that emerged from the qualitative analysis included the trust and confidence PWID have with SSP clinicians as opposed to professionals within the traditional healthcare system. Several barriers to treatment were reported among PWID, including perceived and actual discrimination by friends and family, negative internalized behaviors, denial of HIV status, and fear of engaging in care. Facilitators to HIV care included empathy and respect by SSP staff, flexibility of telehealth location, and an overall destigmatizing approach. Conclusion: PWID identified barriers and facilitators to receipt of HIV care through the THR intervention. Interviews helped inform THR intervention development, centered on PWID in the destigmatizing environment of an SSP. [ABSTRACT FROM AUTHOR]