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Background: To date there remains much ambiguity in the literature regarding the immunological interplay between SARS‐CoV‐2 and HIV and the true risk posed to coinfected individuals. There has been little conclusive data regarding the use of CD4 cell count and HIV viral load stratification as predictors of COVID‐19 severity in this cohort. Methods: We performed a retrospective, observational cohort study on people living with HIV (PLWH) who contracted COVID‐19 in central and eastern Europe. We enrolled 536 patients from 16 countries using an online survey. We evaluated patient demographics, HIV characteristics and COVID‐19 presentation and outcomes. Statistical analysis was performed using SPSS 20.1. Results: The majority of the study cohort were male (76.4%) and 152 (28.3%) had a significant medical comorbidity. Median CD4 cell count at COVID‐19 diagnosis was 605 cells/μL [interquartile range (IQR) 409–824]. The majority of patients on antiretroviral therapy (ART) were virally suppressed (92%). In univariate analysis, CD4 cell count <350 cells/μL was associated with higher rates of hospitalization (p < 0.0001) and respiratory failure (p < 0.0001). Univariate and multivariate analyses found that an undetectable HIV VL was associated with a lower rate of hospitalization (p < 0.0001), respiratory failure (p < 0.0001), ICU admission or death (p < 0.0001), and with a higher chance of full recovery (p < 0.0001). Conclusion: We can conclude that detectable HIV viral load was an independent risk factor for severe COVID‐19 illness and can be used as a prognostic indicator in this cohort. [ABSTRACT FROM AUTHOR]

Abstract Background HIV/AIDS is the most known powerful risk factor for morbidity and mortality in the world. The greatest biological markers in HIV patients are CD4 cell count and hemoglobin level, as they are independent predictors of survival of HIV patients. The objective of this study was to investigate the common socio-demographic, clinical, and behavioral Predictor’s affecting the CD4 cell count, and hemoglobin level with survival time to default from ART treatment among HIV positive adults under ART treatment at university of Gondar comprehensive and specialized hospital, North-west Ethiopia. Method This study was conducted at University of Gondar comprehensive specialized hospital by using a retrospective cohort follow up study design. The source of data in this study was secondary data obtained from patients chart. Bayesian joint models were employed to get wide-ranging information about HIV/AIDS progression. Result From a total of 403 HIV positive adults, about 44.2% were defaulted from therapy and the rest were actively followed ART treatment. The estimate of the association parameter for the current true value of CD4 cell count ( $${\alpha }_{1}$$ α 1 ), and hemoglobin level ( $${\alpha }_{2}$$ α 2 ), trend of CD4 cell count ( $${\alpha }_{2}$$ α 2 ) and hemoglobin level ( $${b}_{2}$$ b 2 ) is positive. Positive values indicating that the higher CD4 cell count and hemoglobin level is related with the higher time of defaulting from ART. Predictor’s hematocrit, weight, platelet cell count, lymphocyte count, sex, adherence, and WHO clinical stage were joint determinate risk factors affecting CD4 cell count, hemoglobin level and time to default at 5% level of significance. Conclusion Current study results revealed that hematocrit, weight, BMI, platelet cell count, lymphocyte count, sex (female), and good treatment adherence were significantly associated with higher CD4 cell count, hemoglobin level and time to default while having advanced WHO clinical stage-IV had significantly decreased CD4 cell, hemoglobin level, and time to default from treatment. Patients with HIV should be given special attention based on these important factors to improve their health and prolong their lives.

Abstract Introduction AIDS continues to be a serious global public health issue. It targets CD4 cells and immunological cells, which are in charge of the body's resistance against pathogenic pathogens. In situations with limited resources, CD4 cell measurement is essential for assessing treatment responses and clinical judgments in HIV-infected children receiving Anti-Retroviral Therapy (ART). The volatility of CD4 cells during ART follow-up is still largely uncharacterized, and there are few new datasets on CD4 cell changes over time. Therefore, the purpose of this analysis was to identify the factors that were predictive of CD4 cell count changes over time in children who started ART at Mekelle General Hospital in northern Ethiopia. Methods A retrospective follow-up study was done. 437 patients in Mekelle general hospital, northern Ethiopia, from 2014–2016 were involved. All patients who have started anti-retrieval treatment (ART) and measured their CD4 cell count at least twice, including the baseline and those who initiated ART treatment, were included in the study population. An exploratory data analysis and linear mixed model analysis were used to explore the predictors of CD4 cell count change in patients and consider variability within and between patients. Results This study found the correlation variation explained in cells accounted for between patients was 61.3%, and the remaining 38.7% variation existed within. This indicates that there is a substantial change in random slope and intercept between and within patients. WHO clinical stage IV (β = -1.30, 95% CI: -2.37, -0.23), co-infection HIV/TB (β = -1.78, 95% CI: -2.58, -0.98), children aged 2–5 (β = -0.43; 95% CI: -0.82, -0.04), and 6–14 years (β = -1.02; 95% CI: -1.47, -0.56), non-opportunistic infection (β = 1.33, 95% CI: 0.51, 2.14), and bedridden functional status (β = -1.74, 95% CI: -2.81, -0.68) were predictors of cell changes over time. Conclusions This study found that patients receiving ART experienced a significant change in CD4 cells over time. Because 61.3% of the variation in CD4 cells explained between patients and the remaining 38.7% within patients, such nested data structures are often strong correlation evidence. Co-infection of HIV/TB, functional status, age category of children, WHO clinical stage, and opportunistic infections are potential predictors of CD4 cells count change. Hence, special guidance and attention is also required, especially for those patients who have an opportunistic infections, higher WHO clinical stages, co-infections with HIV and TB, and bedridden functional status.

This study compared the effects of 12 weeks of aerobic training against baseline data of People Living with Human Immunodeficiency Virus (PLWH) Cluster of Differentiation 4 (CD4) cell count, and Health-Related Quality of life (HRQoL) (Physical-health Component Summary (PCS) and Mental-health Component Summary (MCS)). A within-subject quasi-experimental multimethod design was used. There was purposive sampling of participants on Highly Active Antiretroviral Therapy (HAART) under Botswana Network of People Living with HIV/AIDS (BONEPWA). The 28 participants (23 females and 5 males) who met the inclusion criteria were of age 18 to 45. After 6 weeks, one female dropped out of the study. Participants were subjected to 12 weeks of aerobic training, three times a week for 60 minutes per session. The significant differences between CD4 cell count and the HRQoL variables at baseline and week 12 of the participants were compared using the paired t-test. All analysis was done using Statistical Package for the Social Sciences (SPSS) version 24.0 software. The alpha value was set at p<0.05 level of significance. The mean age and standard deviation of participants was 37.7 (± 6.84) years. Statistically significant (p< 0.05) improvements were found in MCS measures after intervention. There were no statistically significant (p>0.05) improvements in CD4 count and PCS measures after intervention. PLWH can be advised to engage in regular aerobic training 3 times a week for 60 minutes especially when on HAART. The research is relatively preliminary; therefore, there could be some replication of the study by other researchers. [ABSTRACT FROM AUTHOR]

Introduction: AIDS continues to be a serious global public health issue. It targets CD4 cells and immunological cells, which are in charge of the body's resistance against pathogenic pathogens. In situations with limited resources, CD4 cell measurement is essential for assessing treatment responses and clinical judgments in HIV-infected children receiving Anti-Retroviral Therapy (ART). The volatility of CD4 cells during ART follow-up is still largely uncharacterized, and there are few new datasets on CD4 cell changes over time. Therefore, the purpose of this analysis was to identify the factors that were predictive of CD4 cell count changes over time in children who started ART at Mekelle General Hospital in northern Ethiopia. Methods: A retrospective follow-up study was done. 437 patients in Mekelle general hospital, northern Ethiopia, from 2014–2016 were involved. All patients who have started anti-retrieval treatment (ART) and measured their CD4 cell count at least twice, including the baseline and those who initiated ART treatment, were included in the study population. An exploratory data analysis and linear mixed model analysis were used to explore the predictors of CD4 cell count change in patients and consider variability within and between patients. Results: This study found the correlation variation explained in cells accounted for between patients was 61.3%, and the remaining 38.7% variation existed within. This indicates that there is a substantial change in random slope and intercept between and within patients. WHO clinical stage IV (β = -1.30, 95% CI: -2.37, -0.23), co-infection HIV/TB (β = -1.78, 95% CI: -2.58, -0.98), children aged 2–5 (β = -0.43; 95% CI: -0.82, -0.04), and 6–14 years (β = -1.02; 95% CI: -1.47, -0.56), non-opportunistic infection (β = 1.33, 95% CI: 0.51, 2.14), and bedridden functional status (β = -1.74, 95% CI: -2.81, -0.68) were predictors of cell changes over time. Conclusions: This study found that patients receiving ART experienced a significant change in CD4 cells over time. Because 61.3% of the variation in CD4 cells explained between patients and the remaining 38.7% within patients, such nested data structures are often strong correlation evidence. Co-infection of HIV/TB, functional status, age category of children, WHO clinical stage, and opportunistic infections are potential predictors of CD4 cells count change. Hence, special guidance and attention is also required, especially for those patients who have an opportunistic infections, higher WHO clinical stages, co-infections with HIV and TB, and bedridden functional status. [ABSTRACT FROM AUTHOR]

Background: HIV/AIDS is the most known powerful risk factor for morbidity and mortality in the world. The greatest biological markers in HIV patients are CD4 cell count and hemoglobin level, as they are independent predictors of survival of HIV patients. The objective of this study was to investigate the common socio-demographic, clinical, and behavioral Predictor's affecting the CD4 cell count, and hemoglobin level with survival time to default from ART treatment among HIV positive adults under ART treatment at university of Gondar comprehensive and specialized hospital, North-west Ethiopia. Method: This study was conducted at University of Gondar comprehensive specialized hospital by using a retrospective cohort follow up study design. The source of data in this study was secondary data obtained from patients chart. Bayesian joint models were employed to get wide-ranging information about HIV/AIDS progression. Result: From a total of 403 HIV positive adults, about 44.2% were defaulted from therapy and the rest were actively followed ART treatment. The estimate of the association parameter for the current true value of CD4 cell count ( α 1 ), and hemoglobin level ( α 2 ), trend of CD4 cell count ( α 2 ) and hemoglobin level ( b 2 ) is positive. Positive values indicating that the higher CD4 cell count and hemoglobin level is related with the higher time of defaulting from ART. Predictor's hematocrit, weight, platelet cell count, lymphocyte count, sex, adherence, and WHO clinical stage were joint determinate risk factors affecting CD4 cell count, hemoglobin level and time to default at 5% level of significance. Conclusion: Current study results revealed that hematocrit, weight, BMI, platelet cell count, lymphocyte count, sex (female), and good treatment adherence were significantly associated with higher CD4 cell count, hemoglobin level and time to default while having advanced WHO clinical stage-IV had significantly decreased CD4 cell, hemoglobin level, and time to default from treatment. Patients with HIV should be given special attention based on these important factors to improve their health and prolong their lives. [ABSTRACT FROM AUTHOR]

Background: With the advent of antiretroviral therapy (ART), most children living with HIV in sub-Saharan Africa (SSA) are growing toward adolescence, with scarcity of evidence on the size of viral reservoirs to enhance paediatric cure research strategies. This study aims to compare HIV-1 proviral DNA levels according to virological response among adolescents living with perinatally acquired HIV-1 (ALPHIV) and identify associated-factors in the Cameroonian context. Methods: In this observational cohort study, HIV-1 RNA viremia and CD4+ T-cell count were assessed through RT-PCR and flow cytometry respectively at three time-points over 18 months of observation. At the third time-point, 80 randomly-selected participants were classified as with viremia (≥50 HIV-1 copies/mL; n = 40) or without viremia (

Background People living with HIV have higher sudden cardiac death (SCD) rates compared with the general population. Whether HIV infection is an independent SCD risk factor is unclear. Methods and Results This study evaluated participants from the Veterans Aging Cohort Study, an observational, longitudinal cohort of veterans with and without HIV infection matched 1:2 on age, sex, race/ethnicity, and clinical site. Baseline for this study was a participant's first clinical visit on or after April 1, 2003. Participants were followed through December 31, 2014. Using Cox proportional hazards regression, we assessed whether HIV infection, CD4 cell counts, and/or HIV viral load were associated with World Health Organization (WHO)-defined SCD risk. Among 144 336 participants (30% people living with HIV), the mean (SD) baseline age was 50.0 years (10.6 years), 97% were men, and 47% were of Black race. During follow-up (median, 9.0 years), 3035 SCDs occurred. HIV infection was associated with increased SCD risk (hazard ratio [HR], 1.14; 95% CI, 1.04-1.25), adjusting for possible confounders. In analyses with time-varying CD4 and HIV viral load, people living with HIV with CD4 counts 500 copies/mL (HR, 1.70; 95% CI, 1.46-1.98) had increased SCD risk versus veterans without HIV. In contrast, people living with HIV who had CD4 cell counts >500 cells/mm3 (HR, 1.03; 95% CI, 0.90-1.18) or HIV viral load

Awoke Seyoum Tegegne Department of Statistics, Bahir Dar University, Bahir Dar, EthiopiaCorrespondence: Awoke Seyoum Tegegne, Email bisrategebrail@yahoo.comBackground: The availability of medication related to HIV treatment in the world is one of the substantial improvements for reaching USAID’s 90-90 targets. Among the 90% of patients who have awareness about their disease, 90% are accessing their treatment and patients who received appropriate treatment have a suppressed viral load and improved CD4 cell count. Therefore, the main objective of the current study was to investigate the quality of life and associated factors of people living with HIV receiving first-line regimens at public hospitals in the Amhara region, Ethiopia.Methods: A retrospective cohort study was conducted on 700 adult HIV-infected patients under treatment with first-line regimens, who were followed-up in 17 public hospitals in the Amhara region. A multivariate linear regression analysis was used for the current study.Results: Of the 700 patients included in the current analyses, 59.5% (n=358) reported no impairment in self-care, while 63.1% (n=380) were extremely anxious/depressed. The overall expected EQ-5D utility score and visual analog scale (EQ-VAS) scores were 0.388 0.41 and 66.20 17.22 respectively. The current study indicated that the covariates sex, age of patient, level of education, appointment frequency, disclosure status of the disease, and substance use significantly affected the quality of life of people living with HIV and under treatment with first-line regimens. Hence, higher CD4 cell count and less detectable viral load lead to good quality of life of people living with HIV.Conclusion: This study indicates that certain covariates have been identified as statistically significant predictors of the study variable “quality of life” of HIV-positive people. The findings obtained in the current investigation can help policy-makers to revise the current directives. The result obtained in this study can also help health staff to conduct health-related education during the treatment of HIV patients.Keywords: quality of life, viral load, CD4 cell count, first-line regimes, HIV/AIDS, opportunistic infections

CD4 cell count at entry into human immunodeficiency virus (HIV) care is a useful indicator of success of multiple steps in HIV public health programming. We demonstrate that CD4 cell count at care initiation was stable in St Louis between 2017 and 2019 but declined in 2020. Missouri efforts in the Ending the HIV Epidemic plan should focus on rapidly identifying individuals with undiagnosed HIV infection. [ABSTRACT FROM AUTHOR]

Introduction: Depression is up to five times more prevalent in people living with HIV (PLWHIV). There are neurohormonal, virological and psychosocial factors involved and it is associated with antiretroviral treatment non-adherence, decreased life expectancy, faster progression to AIDS and premature death. Studies support that with lower CD4 levels, and the higher viral load (VL), depression increases. Objective: To establish whether there is a correlation and association between the VL and CD4 count with depression and its symptoms in PLWHIV. Method: Under follow-up in the Infectious Disease outpatient clinic a survey of sociodemographic variables, and a Beck's Depression Inventory (BDI) was applied to the study subjects, whose results were analyzed using Rho Spearman (rs) and Chi Squared test (X2) with VL and CD4 levels. Results: 137 individuals were included, from 18-73 years, which 97 (70.8%) were male assigned at birth. The prevalence of depression reported, was 25.5%. A positive correlation was found between VL and BDI score, and a negative correlation between BDI score and CD4. In addition, correlation was found between VL, and depressive symptoms such as guilt, discouragement and self-image perception. These symptoms were strongly associated with death wishes, previous suicide attempts, and treatment non-dherence. Conclusion: VL may have implication in depression and its symptoms in this population, so their control is extremely important to prevent depressive episodes and suicidal behavior and prolong treatment adherence.

Introduction: Data regarding the immunogenicity of a quadrivalent inactivated influenza vaccine (IIV4) among persons with HIV with different levels of CD4 cell count are limited. Here, we report the immunogenicity of IIV4 in persons with HIV with different CD4 cell count levels by determining seroprotection (SP) and seroconversion rate after vaccination. Method: Persons with HIV were prospectively recruited to receive IIV4 (season 2021) between November 2021 and January 2022. Hemagglutination inhibition titers were assessed before and at 28 days after vaccination and classified as SP or seroconversion with comparison of characteristic between CD4 cell count >350 cells/mm3 group and CD4 cell count ≤350 cells/mm3. Result: A total of 70 persons with HIV received the IIV4. The mean (SD) age was 48 (9) years, and 64% were men. Most of them (74%) were maintained on a nonnucleoside reverse transcriptase inhibitor–based regimen with an undetectable HIV viral load (100%). There was a significantly greater proportion of persons with HIV who achieved SP against A/Hong Kong/2571/2019-like virus (H3N2) variant in those with CD4 cell count >350 cells/mm3 compared with those with CD4 cell count ≤350 cells/mm3 (98.3% vs. 72.3%), relative risk 1.35 (95% confidence interval: 1.13 to 1.61, P = 0.011). Furthermore, the participants with CD4 cell count >350 cells/mm3 were significantly more likely to achieve SP against B/Phuket/287/2013 strain (98.3% vs. 72.3%, relative risk 1.35; 95% confidence interval: 1.13 to 1.61, P = 0.011). Conclusion: Persons with HIV with greater CD4 cell count could achieve a higher chance of SP against B/Phuket/287/2013 and A/Hong Kong/2571/2019-like virus (H3N2) strains after IIV4 vaccination. Therefore, new strategies should be investigated and offered to those with low CD4 cell counts. [ABSTRACT FROM AUTHOR]

Recovery of CD4-positive T lymphocyte count after initiation of antiretroviral therapy (ART) has been thoroughly examined among people with human immunodeficiency virus infection. However, immunological response after restart of ART following care interruption is less well studied. We compared CD4 cell-count trends before disengagement from care and after ART reinitiation. Data were obtained from the East Africa International Epidemiology Databases to Evaluate AIDS (IeDEA) Collaboration (2001–2011; n  = 62,534). CD4 cell-count trends before disengagement, during disengagement, and after ART reinitiation were simultaneously estimated through a linear mixed model with 2 subject-specific knots placed at the times of disengagement and treatment reinitiation. We also estimated CD4 trends conditional on the baseline CD4 value. A total of 10,961 patients returned to care after disengagement from care, with the median gap in care being 2.7 (interquartile range, 2.1–5.4) months. Our model showed that CD4 cell-count increases after ART reinitiation were much slower than those before disengagement. Assuming that disengagement from care occurred 12 months after ART initiation and a 3-month treatment gap, CD4 counts measured at 3 years since ART initiation would be lower by 36.5 cells/μL than those obtained under no disengagement. Given that poorer CD4 restoration is associated with increased mortality/morbidity, specific interventions targeted at better retention in care are urgently required. [ABSTRACT FROM AUTHOR]

Objective To determine the frequency and spectrum of cutaneous manifestations in patients with AIDS and their relationship to CD4 counts. Methods 300 HIV seropositive patients who visited the Dermatology outpatient department and HIV clinic of Services Hospital, Lahore over a period of 1year (June 2017-May 2018) were included in this cross sectional study. Out of 300 patients, 290 were on ART. Thorough cutaneous examination was performed after informed consent. CD4 counts (cells/mm3) of the patients noted from medical record. All the mucocutaneous conditions of the patients were noted and categorized as infectious, noninfectious dermatoses and drug reactions. Clinical and immunological staging method developed by World Health Organization (WHO) was used to classify patients into different stages. Data analysis was carried out using SPSS V.22. Results Among the 300 HIV-positive individuals, a gender ratio of 3:1 was observed with 228 (76.0%) men and 72 (24%) women. Patients' average age was 33.67±10.84 years. Heterosexual route of transmission was the commonest route 96 (32%), followed by blood transfusion 84 (28%), surgical procedure 72 (24%), intravenous drug abuse 44 (14.7%) and sharing of common needle or injection 20 (6.7%). The mean duration of HIV was 1.49±0.77 years. There were more dermatoses per subject as the CD4 count dropped. Immunological deterioration lead to increase in the number of patients having dermatoses; 8% patients with CD4 count of >500 compared to 77.3% patients with CD4 count of 200-350. Dermatophytosis was the most common infection, 60 patients with a mean CD4 count of 165.6±10.2 followed by candidiasis, 40 patients with CD4 count of 220 ±179.1. Xerosis was the most common non-infectious disorder. Conclusion Mucocutaneous manifestations develop during the course of HIV infection. Dermatophytosis and candidiasis exhibit a significant reciprocal relationship with CD4 cell count, and because of this they can be utilised as an indirect evidence of severe immunosuppression to initiate highly active anti-retroviral therapy in the absence of access to resources for CD4 cell count. [ABSTRACT FROM AUTHOR]

Few data are available on the impact of COVID-19 vaccination on CD4 counts and HIV-RNA in persons living with HIV (PLWH). We present the data of 235 PLWH who were vaccinated with BNT162b2 in March 2021–February 2022 at the "Cotugno" hospital in Naples. PLWH treated at the "Cotugno" hospital, who were vaccinated at the hospital vaccination center, without prior COVID-19 and for whom immunological/virological data were available in the last 12 months and in the 6 months after vaccination were included. Antispike Ab were available for 187 and 64 PLWH after the second and third doses: PLWH with antispikes >33 binding antibodies units (BAU)/mL increased from 91% to 98%. Antinucleocapsid Ab performed in 147 and 56 patients identified 19 (13%) asymptomatic/paucisymptomatic COVID-19 infections after the second dose and an additional 15 (27%) after the third dose. Immunological/virological data were collected before vaccination (T0), after the second dose (T1), and after the third dose (T2). The absolute number of CD4 increased after the third dose (median 663, 657, and 707 at T0, T1, and T2; p < 0.000 T0 vs. T2). The proportion of patients with HIV-RNA <50 copies/mL increases significantly after the second dose (73%; 85.7%; 87.7%; p < 0.000 T0 vs. T2). The presence of COVID-19 asymptomatic/paucisymptomatic infections (demonstrated by the presence of antinucleocapsid Ab) significantly increases SARS-CoV-2 antispike Ab after second dose, but not after third dose. Asymptomatic/paucisymptomatic COVID-19 infections do not have influence on CD4 cell number and HIV-RNA level. Similarly, the presence of not-controlled HIV-RNA (HIV-RNA >50 copies/mL) does not influence antispike Ab response. According to our data, the response to SARS-CoV2 vaccination is effective in people living with HIV. Vaccination against COVID-19 appears to positively affect immunological and virological levels in people living with HIV. [ABSTRACT FROM AUTHOR]

Objectives: Our objective was to compare the immunological responses to commonly used antiretroviral therapy (ART) regimens among people with advanced HIV in the USA and to assess virological outcomes and regimen persistence. Methods: This study included ART‐naïve adults with advanced HIV infection (CD4 cell count <200 cells/μL) initiating ART with bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF), boosted darunavir (bDRV), dolutegravir (DTG), or elvitegravir (EVG/c)‐containing regimens between 1 January 2018 and 31 December 2020 in the Observational Pharmaco‐Epidemiology Research and Analysis (OPERA) cohort. Cox proportional hazards models and linear mixed models with random intercept were fit with inverse probability of treatment weighting. Results: Overall, 1349 people with advanced HIV (816 B/F/TAF, 253 DTG, 146 EVG/c, 134 bDRV) were followed for a median of 22 months. Compared with B/F/TAF, a lower likelihood of achieving a CD4 cell count ≥200 cells/μL was observed with bDRV (hazard ratio [HR] 0.76; 95% confidence interval [CI] 0.60–0.96), DTG (HR 0.82; 95% CI 0.69–0.98), and EVG/c (HR 0.73; 95% CI 0.57–0.93). All groups had a similar pattern of CD4:CD8 ratio changes: a rapid increase in the first 6 months (ranging from +0.15 to +0.16 units), followed by a slower increase thereafter. Only 40 individuals (4%) achieved CD4:CD8 ratio normalization (≥1). B/F/TAF was associated with a faster time to virological suppression (viral load <200 copies/mL) and a slower time to discontinuation compared with other regimens. Conclusions: Among people with advanced HIV infection, B/F/TAF initiation was associated with faster CD4 cell count recovery and favourable virological outcomes compared with bDRV‐, DTG‐, and EVG/c‐based regimens, although no difference was observed in CD4:CD8 ratio changes over time across regimens. [ABSTRACT FROM AUTHOR]

BackgroundPatterns of antiretroviral therapy (ART) use and immunologic correlates vary globally, and contemporary trends are not well described.MethodsThe REPRIEVE trial (Randomized Trial to Prevent Vascular Events in HIV) enrolled persons with human immunodeficiency virus (HIV) who were aged 40-75 years, receiving ART, and had low-to-moderate cardiovascular disease risk. ART use was summarized within Global Burden of Disease (GBD) super-regions, with adjusted linear and logistic regression analyses examining associations with immune parameters and key demographics.ResultsA total of 7770 participants were enrolled, with a median age of 50 years (interquartile range, 45-55 years); 31% were female, 43% were black or African American, 15% were Asian, 56% had a body mass index >25 (calculated as weight in kilograms divided by height in meters squared), and 49% were current or former smokers. The median CD4 T-cell count was 620/µL (interquartile range, 447-826/ µ L), and the median duration of prior ART use, 9.5 years (5.3-14.8) years. The most common ART regimens were nucleoside/nucleotide reverse-transcriptase inhibitor (NRTI) plus nonnucleoside reverse-transcriptase inhibitor (43%), NRTI plus integrase strand transfer inhibitor (25%), and NRTI plus protease inhibitor (19%). Entry ART varied by GBD region, with shifts during the trial enrollment period. In adjusted analyses, entry CD4 cell count and CD4/CD8 ratio were associated with GBD region, sex, entry regimen, duration of ART, and nadir CD4 cell count; CD4 and CD8 cell counts were also associated with body mass index and smoking status.ConclusionsThere were substantial variations in ART use by geographic region and over time, likely reflecting the local availability of specific medications, changes in treatment guidelines and provider/patient preferences. The analyses of CD4 cell counts and CD4/CD8 ratios may provide valuable insights regarding immune correlates and outcomes in people living with HIV.Clinical trials registrationNCT02344290.

Objective: To subdivide the antiretroviral therapy (ART) human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) patients by modeling the CD4 cell count variable, with an aim to reduce the medical burden from lifelong ART. Materials and Methods: The data of outpatients at the research unit between August 2009 and December 2020 were exported and mined. A recency-frequency (RF) model was established for data subdivision, and data of non-churn ART patients were preserved. Common factor analysis (CFA) was conducted on the three indicators of the baseline/mean/last CD4 cell counts to obtain critical variables; then, k-means modeling was used to subdivide ART patients and their medical burden was analyzed. Results: A total of 12,106 samples of non-churn ART patients were preserved by RF modeling. The baseline/mean/last CD4 cell counts served as important variables employed for modeling. The patients were divided into 15 types, including two types with poor compliance and poor immune reconstitution, two types with good compliance but poor immune reconstitution, four types with poor compliance but good immune reconstitution, and seven types with good compliance and good immune reconstitution. The frequency of visits was 5.25–9.95 visits/person/year, and the percentage of examination fees was 44.24%–59.05%, with a medical burden of 4114.24–12,676.66 yuan/person/year, of which 42.62%–70.09% was reduced. Conclusion: The CD4 cell count is not only an important indicator for judging post-ART immune recovery, but also a major modeling variable in subdividing ART patients with varying medical burdens. Poor compliance and poor immune reconstitution lead to excessive visits and frequent examinations, which were the leading causes of the heavy medical burden of ART.

Abstract Background Research on the immune response to inactivated COVID-19 vaccination among people living with HIV (PLWH) is limited, especially among those with low CD4+ T lymphocyte (CD4 cell) count. This prospective cohort study aimed to assess the humoral immune response to inactivated COVID-19 vaccination among PLWH compared to HIV negative controls (HNCs) and to determine the impact of CD4 cell count on vaccine response among PLWH. Methods The neutralizing antibodies (nAbs) and the specific IgM and IgG-binding antibody responses to the inactivated COVID-19 vaccine at the third month after the second dose of inactivated COVID-19 vaccination were measured among 138 PLWH and 35 HNCs. Multivariable logistic regression and multiple linear regression models were conducted to identify factors associated with the seroconversion rate of antibodies and the magnitude of anti-SARS-CoV-2 antibody titers, respectively. Results At the end of the third month after two doses of vaccination, the seroconversion rates of IgG were comparable between PLWH (44.9%; 95% CI 36.5–53.3%) and HNCs (60.0%; 95% CI 42.9–77.1%), respectively. The median titers and seroconversion rate of nAbs among PLWH were 0.57 (IQR: 0.30–1.11) log10 BAU/mL and 29.0% (95% CI 21.3–36.8%), respectively, both lower than those in HNCs (P 0.05). Multivariable regression analyses showed that CD4 cell count

Type II diabetes mellitus (DM) and hypertension (HTN) diseases are part of the world’s challenges in achieving sustainable development goals. Cases of type II diabetes mellitus and hypertension diseases in low and middle-income countries are becoming a concern. Type II diabetes mellitus is an inflammatory disease. When there is inflammation the immune system is triggered and haemoglobin level is affected. While there have been numerous strategies to address the issue, these efforts have not been sufficient to guarantee a reduction in disease severity. This was an experimental study conducted in Kakamega County, Kenya. It employed a randomized control trial approach, with two groups: treatment and control. Systematic random sampling was used in identifying participants and simple randomization was used to allocate the respondent to the intervention groups. Sample sizes of 34 (treatment group) and 30 (control group) were used to produce quantitative data. This study evaluated the effect of COVI-soup on haemoglobin (Hb) and cluster of differentiation 4 (CD4) cell count of patients living with both type II diabetes mellitus and hypertension. The treatment group received COVI-soup (a soup composed of butternut squash, ginger, garlic, sunflower pepper, chia seeds and turmeric) while the control group was on a rice soup. Statistical Packages for Social Science (SPSS) version 20 was used in the data analysis. A paired student t-test was used to determine the effect of COVI-soup on Hb and CD4 cell count. There was a positive effect in CD4 cell count in the treatment group (P =0.001) whereas there was no significant effect in the control group (P =0.267). The mean change in CD4 cell count in the treatment group was 97 cells/ul and in the control 75 cells/ul. There was a positive effect (increase) on hemoglobin levels in the treatment group (p=0.0001) whereas there was no significant effect in the control group (p =0.126). The hemoglobin mean change in the treatment group was 3.9 g/dl and in the control 0.5 g/dl. Therefore, COVI-soup had a positive effect on hemoglobin and CD4 cell count levels among patients with both hypertension and type II diabetes mellitus. [ABSTRACT FROM AUTHOR]

Objective: To subdivide the antiretroviral therapy (ART) human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) patients by modeling the CD4 cell count variable, with an aim to reduce the medical burden from lifelong ART. Materials and Methods: The data of outpatients at the research unit between August 2009 and December 2020 were exported and mined. A recency-frequency (RF) model was established for data subdivision, and data of non-churn ART patients were preserved. Common factor analysis (CFA) was conducted on the three indicators of the baseline/mean/last CD4 cell counts to obtain critical variables; then, k-means modeling was used to subdivide ART patients and their medical burden was analyzed. Results: A total of 12,106 samples of non-churn ART patients were preserved by RF modeling. The baseline/mean/last CD4 cell counts served as important variables employed for modeling. The patients were divided into 15 types, including two types with poor compliance and poor immune reconstitution, two types with good compliance but poor immune reconstitution, four types with poor compliance but good immune reconstitution, and seven types with good compliance and good immune reconstitution. The frequency of visits was 5.25–9.95 visits/person/year, and the percentage of examination fees was 44.24%–59.05%, with a medical burden of 4114.24–12,676.66 yuan/person/year, of which 42.62%–70.09% was reduced. Conclusion: The CD4 cell count is not only an important indicator for judging post-ART immune recovery, but also a major modeling variable in subdividing ART patients with varying medical burdens. Poor compliance and poor immune reconstitution lead to excessive visits and frequent examinations, which were the leading causes of the heavy medical burden of ART. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Over the last 15 years, there has been a decline in Human Immunodeficiency Virus (HIV) infection and HIV/AIDS mortality in West and Central Africa, due to the success of antiretroviral medication. However, as HIV patients live longer, the risk of metabolic diseases mediated by adverse drug effects increases. This can be mitigated by ensuring a correct diet routine. This study assessed the effects of nutritional status on the immune recovery of HIV/AIDS patients in the Southwest Region of Cameroon. The main aim of this study is to assess the influence of the nutritional status of patients on Highly Active Antiretroviral Therapy (HAART) on their immune recovery. SUBJECTS AND METHODS: Sociodemographic and socioeconomic information were collected using questionnaires, and anthropometric measurements were made to obtain information for calculating Body Mass Index (BMI). Whole anticoagulated blood was obtained to measure CD4 cell count, haemoglobin concentration, and HIV Viral Load (VL). Statistical analysis was performed using SPSS 22, and significant levels were set at 0.05. Chi-square was used to compare proportions. Univariate and multivariate analyses were used to look for the association between variables. RESULTS: The majority or patients (47.2%, 238/610) had a normal BMI, while 39 (6.5%), 173 (28.9%), and 104 (17.4%) showed undernutrition, overweight, and obesity, respectively. Consumption of vegetables was associated with CD4 count status (χ2 = 10.034; p = 0.007) and lowered viral load. Smoking increased the risk of having a viral load higher than 75 HIV RNA copies/ml by 18 times (CI 1.86-180.32, p = 0.013). CONCLUSIONS: About half of the people living with HIV/AIDS (PLWHA) under HAART in this study were either obese or under-nourished based on anthropometric indicators. Nevertheless, consuming fruits and vegetables and non-consumption of alcohol were important factors that promoted immune recovery in this population.

BackgroundWhy some persons living with human immunodeficiency virus (HIV) (PLWH) progress quickly and others remain "healthy" for a decade or more without treatment remains a fundamental question of HIV pathology. We aimed to assess the epidemiological characteristics of HIV long-term nonprogressors (LTNPs) based on a cohort of PLWH in China observed between 1989 and 2016.MethodsWe conducted a nationwide, retrospective cohort study among Chinese PLWH with HIV diagnosed before 1 January 2008. Records were extracted from China's national HIV/AIDS database on 30 June 2016. LTNPs were defined as those with AIDS-free, antiretroviral therapy-naive survival, with CD4 cell counts consistently ≥500/μL for ≥8 years after diagnosis. Prevalence was calculated, characteristics were described, and determinants were assessed by means of logistic regression. Potential sources of bias were also investigated.ResultsOur cohort included 89 201 participants, of whom 1749 (2.0%) were categorized as LTNPs. The injection drug use (IDU) route of infection was reported by 70.7% of LTNPs, compared with only 37.1% of non-LTNPs. The odds of LTNP status were greater among those infected via IDU (adjusted odds ratio [95% confidence interval], 2.28 [1.94-2.68]) and with HIV diagnosed in settings with large populations of persons who inject drugs (1.75 [1.51-2.02] for detention centers, 1.61 [1.39-1.87] for Yunnan, 1.94 [1.62-2.31] for Guangdong, and 2.90 [2.09-4.02] for Xinjiang).ConclusionsOverrepresentation of the IDU route of infection among LTNPs is a surprising finding worthy of further study, and this newly defined cohort may be particularly well suited to exploration of the molecular biological mechanisms underlying HIV long-term nonprogression.

Background: Research on the immune response to inactivated COVID-19 vaccination among people living with HIV (PLWH) is limited, especially among those with low CD4+ T lymphocyte (CD4 cell) count. This prospective cohort study aimed to assess the humoral immune response to inactivated COVID-19 vaccination among PLWH compared to HIV negative controls (HNCs) and to determine the impact of CD4 cell count on vaccine response among PLWH. Methods: The neutralizing antibodies (nAbs) and the specific IgM and IgG-binding antibody responses to the inactivated COVID-19 vaccine at the third month after the second dose of inactivated COVID-19 vaccination were measured among 138 PLWH and 35 HNCs. Multivariable logistic regression and multiple linear regression models were conducted to identify factors associated with the seroconversion rate of antibodies and the magnitude of anti-SARS-CoV-2 antibody titers, respectively. Results: At the end of the third month after two doses of vaccination, the seroconversion rates of IgG were comparable between PLWH (44.9%; 95% CI 36.5–53.3%) and HNCs (60.0%; 95% CI 42.9–77.1%), respectively. The median titers and seroconversion rate of nAbs among PLWH were 0.57 (IQR: 0.30–1.11) log10 BAU/mL and 29.0% (95% CI 21.3–36.8%), respectively, both lower than those in HNCs (P < 0.05). After adjusting for age, sex, comorbidities, and CD4 cell count, the titers and seroconversion rate of nAbs were comparable between PLWH and HNCs (P > 0.05). Multivariable regression analyses showed that CD4 cell count < 200/μL was independently associated with lower titers and seroconversion rate of nAbs among PLWH (P < 0.05). A positive correlation was observed between the CD4 cell count and nAbs titers in PLWH (Spearman's ρ = 0.25, P = 0.0034). Conclusion: Our study concluded that the immune response to inactivated COVID-19 vaccination among PLWH was independently associated with CD4 cell count, PLWH with lower CD4 cell count showed a weaker humoral immune response, especially those with CD4 cell count < 200/μL. This finding suggests that expanding COVID-19 vaccination coverage among PLWH is impendency. In addition, aggressive ART should be carried out for PLWH, especially for those with low CD4 cell count, to improve the immune response to vaccines. [ABSTRACT FROM AUTHOR]

Aims: This study investigated the synergistic and independent effects of adherence to antiretroviral therapy (ART) and viral load on quality of life (QoL) among people with HIV/AIDS. Methods: This was a cross-sectional study of 129 patients with HIV/AIDS. The WHOQOL-BREF and the Morisky Medication Adherence Scale were used to measure QoL and adherence respectively. Information on viral load and CD4 cell count was obtained from patients' records and verified by a physician. An additive interaction method was used to estimate the synergistic effect of the linear regression. Findings: Patients who were adhering to ART and had an undetectable viral load had significantly higher scores on four domains of QoL − environment, physical health, social relationships and psychological − than those who were non-adherent. Moreover, ART adherence and undetectable viral load had a positive synergistic effect on QoL after controlling for covariate variables. Conclusion: Participants were more likely to have a good QoL if they had both undetectable viral loads and good ART adherence. [ABSTRACT FROM AUTHOR]

Awoke Seyoum Tegegne,1 Mitiku Wale Muluneh,2 Setegn Bayabil Agegn,2 Hailegebrael Birhan Biresaw2 1Department of Statistics, Bahir Dar University, Bahir Dar, Ethiopia; 2Department of Statistics, Debre Tabor University, Debre Tabor, EthiopiaCorrespondence: Mitiku Wale Muluneh, Tel + 251-923-23-27-68, Email mitikuwale@gmail.comBackground: Medication adherence plays a significant in the success of combination antiretroviral therapy (cART). Therefore, the current investigation was conducted with the objective of comparing adherence and CD4 cell count with respect to virologic failure among HIV-infected adults under cART.Methods: A retrospective study design was conducted on 792 randomly selected HIV-infected adult patients who initiated first-line cART enrolled in the first 10 months of 2012 and followed up to August 2018 by using a simple random sampling technique based on their identification number.Results: The main outcome for the current investigation was the virologic failure which was decreased with successive visits. The area under the receiver operating characteristic curve for adherence and CD4 cell count change were 0.68 and 0.63 with χ2 = 21.2; p-value < 0.001 for the 12-month assessment. Similarly, these areas for the 36th and 60th month assessments were 0.71 and 0.66, with χ2 = 23.2; p-value < 0.001, and 0.73 and 0.71 with χ2 = 24.3; p-value < 0.001 for adherence and CD4 cell count, respectively.Conclusion: Pill count adherence was more accurate compared to CD4 cell count change for assessing virologic responses. Therefore, because of its easy access, simple use, cost-effectiveness, and accuracy, the adherence to cART was in favor of CD4 cell count change for monitoring the healthcare quality of HIV-infected patients.Keywords: adherence to cART, CD4 cell count, viral load, HIV, virologic failure, Ethiopia

Abstract Background Fever of unknown origin (FUO) is a challenge for clinicians treating patients with HIV/AIDS. CD4 counts can be helpful in the diagnosis and treatment. This study aimed to determine several common etiologies of FUO stratified by CD4 count levels in HIV/AIDS patients. Methods A cross-sectional retrospective and prospective study was conducted in 195 HIV/AIDS patients with FUO admitted to the National Hospital for Tropical Diseases from January 2016 to June 2019. Clinical parameters, immune status, and etiologies for each patient were recorded. Odds ratios were calculated to compare the distributions of common etiologies in groups with two different CD4 count levels:

Unstable housing, including homelessness, is a public policy concern for all populations, and more critically for people with a serious health condition such as HIV. We measure the effect of unstable housing on HIV treatment biomarkers: viral suppression (viral load 350 cells per μl). We use panel data (1995-2015) from 3082 participants of the Women's Interagency HIV Study (WIHS) sites in Bronx and Brooklyn (NY), Chicago (IL), Los Angeles and San Francisco (CA), and Washington (DC). The instrumental variable (IV) measures allocations for the Housing Opportunities for People with AIDS (HOPWA) per person newly infected with HIV, and it represents actual availability of housing assistance for HIV-positive persons at the metropolitan area level. Using an extended probit model with the IV, we find that unstable housing reduces the likelihood of viral suppression by 51 percentage points, and decreases the probability of having adequate CD4 cell count by 53 percentage points. The endogeneity-corrected results are larger than naïve probits, which show decreases of 8.1 and 7.8 percentage points, respectively. The hypothesized pathways for the effect are: decreased use of mental healthcare/counseling, any healthcare, and less continuity of care. Increasing efforts to improve housing assistance, including HOPWA, and other interventions to make housing more affordable for low-income populations, and HIV-positive populations in particular, may be warranted not only for the benefits of stable housing, but also to improve HIV-related biomarkers.

Background: Tuberculosis is one of the most lethal communicable diseases in the world. In tuberculosis patients, HIV speeds up the course of the infection from latent to active illness. This study aimed to identify joint clinical and socio demographic determinant factors of CD4+ cell count and body weight in HIV/TB co-infected adult patients. Methods: From January 2013 to December 2019, 374 HIV/TB co-infected individuals were treated and had follow-ups. This study used descriptive data analysis, a linear mixed effects model for longitudinal data, and joint modeling of the two longitudinal outcome variables. Results: In this study, 51.1% of the 374 HIV-TB co-infected patients were women, 47.1% were rural dwellers, and 71.9% developed extra pulmonary TB. Females made up 54.3% of all patients who died. To detect the presence of correlation among repeated measured data, the AR (1) structure was chosen. The joint model was more appropriate for analysing and interpreting current data. Conclusions: Baseline age, follow-up time, baseline weight, place of residence, adherence level, educational background, functional status, WHO clinical stage, smoking status and type of TB developed were identified as significant joint factors in CD4 cell count and weight of HIV/TB co-infected patients from potential joint predictor variables. Therefore, the concerned bodies, specifically the FMOH and regional health staffs, should enhance public awareness about the factors that lead to a drop in CD4 count and weight gain, as well as an increased risk of death from HIV/TB co-infection. Furthermore, special attention should be paid to women and patients with poor adherence. Medication and treatment must be affordable and accessible to all co-infected patients in order to maximize their CD4 count and proportional body weight to their height, and to lengthen the lives of individuals who are co-infected.

Background: Hypertension is a major healthcare problem in Nigeria with a probable prevalence of 36.6%. Human immunodeficiency virus (HIV) infection is a global healthcare problem. The factors which influence hypertension in HIV subjects have not been completely identified. The study aimed to determine the prevalence of hypertension and the factors which might influence hypertension in HAART-naive HIV subjects. Methodology: This was a cross-sectional study involving 393 treatment-naive HIV subjects and 136 age and sex-matched HIV seronegative controls. Anthropometric and demographic data were obtained, blood pressure measurements and other relevant investigations were performed. Hypertension was defined here as systolic blood pressure (SBP) > 140mmHg and diastolic blood pressure (DBP) > 90mmHg. Hypertension was compared between the HIV subjects and the non-HIV control. The association of the variables with hypertension in HIV subjects were determined. Results: The mean age of the HIV subjects was 39±11 years. Females were 282(72.0%) and males 110(28.0%). The prevalence of hypertension was 23.7% in HIV subjects and 31.6% in the non-HIV control. The prevalence of hypertension was 17.2% in HIV subjects with high density lipoprotein cholesterol (HDL) <1.0mg/dl and this was significantly lower than the prevalence of hypertension of 27.1% in those whose serum HDL was > 1.0mg/dl. There was no significant association between hypertension and 24-hour urine osmolality (24HUOsm) (p=0.094), body mass index (BMI) (p=0.572), 24hour urine protein (24HUP) (p=0.606), serum total cholesterol (p=0.628), serum low density lipoprotein cholesterol (LDL) (p=0.116), triglyceride (TG) (p=0.925), Systolic blood pressure had a significant correlation with serum HDL, (r=0.114, p=0.024). Similarly, CD4 cell count correlated significantly with DBP (r=0.123, p=0.012. Serum HDL (p=0.0.024) and CD4 cell count (p=0.012) predicted hypertension in HIV subjects. Conclusion: The prevalence of hypertension of 23.7% in HIV subjects was high in this study. Low CD4 cell count and low serum HDL were predictors of hypertension in HIV subjects. [ABSTRACT FROM AUTHOR]

Purpose: WHO recommends dolutegravir (DTG) based regimens as first-line treatment for HIV-1 infection. However, few studies have been conducted in Indian population. Hence, our study evaluated the safety, tolerability, and efficacy of DTG 50 mg with Tenofovir and Lamivudine (300/300mg) fixed dose combination in treatment naïve adult Indian patients. Methods: This was an open label, multicenter, prospective, interventional, phase IV study conducted across 14 sites between February 2019 and July 2020. 24 weeks was the treatment duration for each subject. The primary end point was to assess the incidence of adverse events (AEs) and secondary end points were to assess the proportion of patients achieving plasma HIV-1 RNA levels < 50 copies/mL at week 24 and change in CD4+ cell count from the baseline. Safety analysis was conducted using Safety Analysis Set and efficacy analysis was carried out using Full Analysis Set and Per protocol set. Results: A total of 288 patients were screened; 250 were enrolled; and 229 completed the study. 389 AEs were reported from 58% of patients. Of these, 61 were related to study treatment. One event of decreased creatinine clearance led to study discontinuation. One serious event of pyrexia was reported, which was unrelated to the study drug. The most common AEs were headache (18%), pyrexia (14%), vomiting (6.4%) and upper respiratory tract infections (6%). No deaths were reported. At week 24, 86.8% of the patients achieved plasma HIV-1 RNA levels < 50 copies/mL and the mean CD4 cell count increased from 350.2 (SD, 239.73) at baseline to 494.6 (SD, 261.40) with an average increase of 143.2 (SD, 226.14) cells. Conclusion: This study demonstrated the safety and efficacy of DTG based regimen in treatment naïve HIV-1 patients in Indian population and support use of DTG as first-line treatment regimen. [ABSTRACT FROM AUTHOR]

Abstract Introduction CD4 count is an important predictor of disease progression, opportunities infection, deaths, and to understand the time interval between initial HIV infection to the first diagnosis. However, baseline CD4 count and the time period between initial infection and the diagnosis amongst PLHIV in Bhutan never been evaluated. Methods This is a retrospective study of the diagnosed PLHIV from the existing data system from January 10 to 30, 2021. Out of 512 reported HIV cases, 488 of those who were more than or equal to 18 years old and had their CD4 count testing within 6 months before initiating ART were considered for analysis. Descriptive statistical analysis was used to analyze the characteristics of the study population and relationship were established using the χ 2 Test. We have sought ethics approval and waiver for informed consent as it is the retrospective study of the client's record. The client's confidentiality was ensured by removing all the identifiers. Results The mean CD4 was 345 cells/ml for males and females. Twenty‐five percent of the clients had CD4 counts below 200, 30%, between 200 and 349, 25% between 350 and 499, and 20% above 500 cells/ml. A larger number of males showed a CD4 count below 200 cells/ml while more females showed a CD4 count more than 500 cells/ml. The mean time interval between initial infection to the first diagnosis was 4 years in males and females. However, about one‐fourth were found to have been infected between 5 and 8 years before diagnosis and less than 10% were diagnosed within less than 1 year of infection. Conclusions The study revealed a late diagnosis of HIV infection in Bhutan thereby risking the transmission to the community and risk of severe disease and mortality. The upscaling of voluntary counseling and testing, medical screening, and alternative methods like community‐based testing including HIV Self Testing for early detection needs to be implemented in the country.

Abstract Background HIV is an infectious disease affecting 36.7 million people worldwide. In recent times, Antiretroviral Therapy (ART) has become accessible to the majority of People Living with HIV (PLHIV) and this has transformed the course of infection to one that is chronic, characterized by fewer diseases pathognomonic of AIDS. In view of this, there is a pressing need for better markers, apart from the routine HIV indicators, to detect comorbidities such as Neurocognitive Impairment (NCI). The aim of this study was to find out the association between Veterans Aging Cohort Study (VACS) index and Neurocognitive function in HIV positive patients. Methods In our study, we included 97 HIV positive patients and their Neurocognitive function was assessed using a combination of Montreal Cognitive Assessment and Grooved Pegboard Test, while VACS index was calculated using the most recent laboratory values. Binomial Logistics Regression analyses, adjusting for potential confounding variables, was performed to determine the association between VACS score and Neurocognitive Impairment. Results We found that a higher VACS Index was associated with global and domain-wise Neurocognitive impairment (p

Introduction: Cryptosporidiosis is a protozoal infection caused by Cryptosporidium species which manifest with chronic diarrhoea among HIV/AIDS patients resulting in high morbidity and mortality among this group. The aim of this study was to correlate the occurrence with CD4 cell count among HIV seropositive patients presenting with diarrhoea at the Ahmadu Bello University Teaching Hospital Zaria. Methodology: This was a cross-sectional comparative study among 183 HIV seropositive patients attending the HIV treatment clinic of Ahmadu Bello University Teaching Hospital, Zaria and 183 seronegative controls. Stool samples were collected from each participant and processed using formol ether concentration method and the supernatant from the concentration was used for ELISA (Prospect Oxoid UK) to detect Cryptosporidium antigen. The blood samples from participants at the general out-patient department were subjected for HIV screening using Determine while the blood samples from participants at the HIV treatment clinic were analysed using Partec CyFlow® CD4 easy kit for CD4 cell quantification. Results: A total of 366 diarrhoeal stool samples were collected from HIV seropositive and HIV seronegative patients, 9 (4.9%) were positive for Cryptosporidium antigen by ELISA. In HIV seronegative patients, only 1 (0.55%) Cryptosporidium oocyst was positive. Five (55.6%) of the HIV seropositive patients with cryptosporidiosis had CD4+ count less than 200cells/ml and 4 (44.4%) had a CD4+ count between 200-349, there was a significant association between the CD4 cell count and occurrence of Cryptosporidiosis. (OR = 5.55, p = 0.007). Conclusion: Cryptosporidiosis was found to be prevalent among HIV patients with low CD4 cell counts. [ABSTRACT FROM AUTHOR]

Background: The computed tomography (CT) features of acquired immune deficiency syndrome (AIDS)-associated pulmonary cryptococcosis (PC) are correlated with the viral load of human immunodeficiency virus (HIV). An increase in CD4-positive T lymphocyte (CD4) cell count in peripheral blood after a highly active antiretroviral therapy (HAART) can reflect the morphological changes of lung lesions. Objectives: This study aimed to evaluate the correlation between CT features and HIV viral load and to determine a cut-off value for CD4 cell count increment to investigate the prognosis of PC. It also aimed to examine the morphology of PC lesions and their prognosis following HAART. Methods: Sixty-two patients with AIDS-associated PC, confirmed by pathology or follow-up, were enrolled in this study. The CT findings were recorded and classified as nodular, cavitary, and consolidation groups and their subtypes. Forty HIV patients who had undergone HAART were screened in this study, and the outcomes of lung lesions were recorded in a follow-up of 3 - 6 months. The participants were divided into improvement and progression groups. The correlation analysis and the receiver operator characteristic (ROC) curve analysis were used to examine the correlation between CT morphology and HIV viral load and to determine the cut-off value for CD4 cell count increment. The intraclass correlation coefficient (ICC) for inter-observer agreement was also calculated. Results: In the nodular group, patients with miliary nodules had the highest HIV viral load in peripheral blood (miliary nodules vs. solitary nodules, P = 0.009; miliary nodules vs. multiple nodules; P = 0.024). In the cavitary group, thick-walled cavity lesions had a higher HIV viral load than thin-walled cavity lesions (thin-walled vs. thick-walled cavity lesions, P = 0.036). Changes in the morphology of lesions, indicating the progression or improvement of PC, had a positive correlation with the CD4 cell count increment (F = 4.260, P = 0.045). The cut-off value for CD4 cell count increment to differentiate the two outcomes (progression and improvement) was 44/µL. The area under the curve (AUC) was 0.851, and sensitivity, specificity, and accuracy were estimated at 0.815, 0.714, and 0.764, respectively. Conclusion: In AIDS-associated PC, different types of lesions were related to the HIV viral load, and CD4 cell count increment following HAART was associated with the morphological changes of lesions. This finding can be helpful for clinicians and radiologists to make an accurate diagnosis and evaluate the treatment outcomes, as well as disease progression. [ABSTRACT FROM AUTHOR]

Background: Historically, antiretroviral therapy (ART) initiation was based on CD4 criteria, but this has been replaced with 'Test and Start' wherein all people living with HIV are offered ART. We describe the baseline immunologic status among children relative to evolving ART policies in Mozambique. Methods: This retrospective evaluation was performed using routinely collected data. Children living with HIV (CL aged 5-14 years) with CD4 data in the period of 2012-2018 were included. ART initiation "policy periods" corresponded to implementation of evolving guidelines: in period 1 (2012-2016), ART was recommended for CD4 <350 cells/mm3; during period 2 (2016-2017), the CD4 threshold increased to <500 cells/mm3; Test and Start was implemented in period 3 (2017-2018). We described temporal trends in the proportion of children with severe immunodeficiency (CD4 <200 cells/mm3) at enrollment and at ART initiation. Multivariable regression models were used to estimate associations with severe immunodeficiency. Results: The cohort included 1815 children with CD4 data at enrollment and 1922 at ART initiation. The proportion of children with severe immunodeficiency decreased over time: 20% at enrollment into care in period 1 vs. 16% in period 3 (P = 0.113) and 21% at ART initiation in period 1 vs. 15% in period 3 (P = 0.004). Children initiating ART in period 3 had lower odds of severe immunodeficiency at ART initiation compared with those in period 1 [adjusted odds ratio (aOR) = 0.67; 95% CI: 0.51 to 0.88]. Older age was associated with severe immunodeficiency at enrollment (aOR = 1.13; 95% CI: 1.06 to 1.20) and at ART initiation (aOR = 1.14; 95% CI: 1.08 to 1.21). Conclusions: The proportion of children with severe immunodeficiency at ART initiation decreased alongside more inclusive ART initiation guidelines. Earlier treatment of children living with HIV is imperative. [ABSTRACT FROM AUTHOR]

Panitha Jindahra,1 Angsana Phuphuakrat,2 Thanapol Tangjaisanong,3 Sukanya Siriyotha,4 Tanyatuth Padungkiatsagul,5 Kavin Vanikieti,5 Pisit Preechawat,5 Anuchit Poonyathalang,5 Somnuek Sungkanuparph,6 Teeratorn Pulkes,1 Supoch Tunlayadechanont1 1Division of Neurology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand; 2Division of Infectious Diseases, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand; 3Department of Medicine, Bangkhunthian Geriatric Hospital, Bangkok, 10150, Thailand; 4Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand; 5Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand; 6Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan 10540, ThailandCorrespondence: Panitha JindahraDivision of Neurology, Department of Medicine, Faculty of Medicine Ramathbodi Hospital, Mahidol University, Bangkok, ThailandTel/Fax +66 2201 1386Email panitha.jin@mahidol.ac.thIntroduction: Acute optic neuritis (ON) has been increasingly reported in patients infected with human immunodeficiency virus (HIV). We aimed to describe clinical characteristics of HIV-infected patients with ON.Materials and Methods: This observational retrospective study was performed from January 2008 to January 2016 in a university hospital in Bangkok, Thailand. Demographic data and clinical manifestations were retrospectively reviewed.Results: We included 10 HIV-infected patients and divided them into two groups: infectious and non-infectious ON. There were six patients in the infectious ON group (five males, mean age 33.6 years, median CD4 cell counts during ON episodes 36.5 cells/μL, high viral loads, median initial visual acuity [VA] 1.7, median VA difference [initial VA – follow-up VA] 0). Four patients developed cryptococcal meningitis and 2 developed neuro-syphilis. They were treated with amphotericin B plus fluconazole and penicillin G sodium, respectively. There were four patients in the non-infectious ON group (two males, mean age 44.3 years, median CD4 cell count during acute ON 157.5 cells/μL, undetectable viral loads, median initial VA 1.3, and median VA difference 1.2). They were given corticosteroid treatments. There were no statistically significant differences between the two groups with respect to age, sex, and initial VA. There were statistically significant differences in median VA difference and median CD4 cell counts between the two groups (p=0.02 and 0.03, respectively). There was a significant correlation between CD4 counts and duration in three non-infectious ON patients treated with antiretroviral therapy (ART, p< 0.001).Discussion: Patients with infectious ON had low initial CD4 counts and high viral loads. Patients with non-infectious ON had increasing CD4 cell counts and undetectable HIV viral load following ART. The findings are highly suggestive of immune reconstitution inflammatory syndrome. The CD4 cell counts and viral loads may help to identify the type of acute ON in HIV-infected patients and establish proper therapies.Keywords: optic neuritis, human immunodeficiency virus, acquired immune deficiency syndrome, CD4 cell count, immune reconstitution inflammatory syndrome

ObjectiveTo illustrate an approach to compare CD4 cell count and HIV-RNA monitoring strategies in HIV-positive individuals on antiretroviral therapy (ART).DesignProspective studies of HIV-positive individuals in Europe and the USA in the HIV-CAUSAL Collaboration and The Center for AIDS Research Network of Integrated Clinical Systems.MethodsAntiretroviral-naive individuals who initiated ART and became virologically suppressed within 12 months were followed from the date of suppression. We compared 3 CD4 cell count and HIV-RNA monitoring strategies: once every (1) 3 ± 1 months, (2) 6 ± 1 months, and (3) 9-12 ± 1 months. We used inverse-probability weighted models to compare these strategies with respect to clinical, immunologic, and virologic outcomes.ResultsIn 39,029 eligible individuals, there were 265 deaths and 690 AIDS-defining illnesses or deaths. Compared with the 3-month strategy, the mortality hazard ratios (95% CIs) were 0.86 (0.42 to 1.78) for the 6 months and 0.82 (0.46 to 1.47) for the 9-12 month strategy. The respective 18-month risk ratios (95% CIs) of virologic failure (RNA >200) were 0.74 (0.46 to 1.19) and 2.35 (1.56 to 3.54) and 18-month mean CD4 differences (95% CIs) were -5.3 (-18.6 to 7.9) and -31.7 (-52.0 to -11.3). The estimates for the 2-year risk of AIDS-defining illness or death were similar across strategies.ConclusionsOur findings suggest that monitoring frequency of virologically suppressed individuals can be decreased from every 3 months to every 6, 9, or 12 months with respect to clinical outcomes. Because effects of different monitoring strategies could take years to materialize, longer follow-up is needed to fully evaluate this question.

ObjectiveTo illustrate an approach to compare CD4 cell count and HIV-RNA monitoring strategies in HIV-positive individuals on antiretroviral therapy (ART).DesignProspective studies of HIV-positive individuals in Europe and the USA in the HIV-CAUSAL Collaboration and The Center for AIDS Research Network of Integrated Clinical Systems.MethodsAntiretroviral-naive individuals who initiated ART and became virologically suppressed within 12 months were followed from the date of suppression. We compared 3 CD4 cell count and HIV-RNA monitoring strategies: once every (1) 3 ± 1 months, (2) 6 ± 1 months, and (3) 9-12 ± 1 months. We used inverse-probability weighted models to compare these strategies with respect to clinical, immunologic, and virologic outcomes.ResultsIn 39,029 eligible individuals, there were 265 deaths and 690 AIDS-defining illnesses or deaths. Compared with the 3-month strategy, the mortality hazard ratios (95% CIs) were 0.86 (0.42 to 1.78) for the 6 months and 0.82 (0.46 to 1.47) for the 9-12 month strategy. The respective 18-month risk ratios (95% CIs) of virologic failure (RNA >200) were 0.74 (0.46 to 1.19) and 2.35 (1.56 to 3.54) and 18-month mean CD4 differences (95% CIs) were -5.3 (-18.6 to 7.9) and -31.7 (-52.0 to -11.3). The estimates for the 2-year risk of AIDS-defining illness or death were similar across strategies.ConclusionsOur findings suggest that monitoring frequency of virologically suppressed individuals can be decreased from every 3 months to every 6, 9, or 12 months with respect to clinical outcomes. Because effects of different monitoring strategies could take years to materialize, longer follow-up is needed to fully evaluate this question.

Background: Fever of unknown origin (FUO) is a challenge for clinicians treating patients with HIV/AIDS. CD4 counts can be helpful in the diagnosis and treatment. This study aimed to determine several common etiologies of FUO stratified by CD4 count levels in HIV/AIDS patients.Methods: A cross-sectional retrospective and prospective study was conducted in 195 HIV/AIDS patients with FUO admitted to the National Hospital for Tropical Diseases from January 2016 to June 2019. Clinical parameters, immune status, and etiologies for each patient were recorded. Odds ratios were calculated to compare the distributions of common etiologies in groups with two different CD4 count levels: < 50 cells/mm3 and ≥ 50 cells/mm3.Results: The proportions of opportunistic infections and noninfectious etiologies were 93.3% and 3.6%, respectively. Tuberculosis was the most common opportunistic infection (46.7%), followed by talaromycosis (29.2%) and Pneumocystis jiroveci (PCP) infection (20.5%). Tuberculosis was predominant in all CD4 level groups. Most patients with talaromycosis had CD4 counts below 50 cells/mm3. In total, 53.8% of the patients were infected by one pathogen. The risks of tuberculosis and talaromycosis in FUO-HIV patients were high when their CD4 counts were below 50 cells/mm3.Conclusions: Opportunistic infections, especially tuberculosis, are still the leading cause of FUO in HIV/AIDS patients. Tuberculosis and Talaromyces marneffei (TM) infection should be considered in patients with CD4 cell counts < 50 cells/mm3. This study implies that guidelines for appropriate testing to identify the etiology of FUO in HIV/AIDS patient based on the CD4 cell count should be developed, thereby reducing resource waste. [ABSTRACT FROM AUTHOR]

We identify the determinants of the change in CD4 cell count and survival time of children living with HIV taking antiretroviral therapy. In a retrospective study, a cohort of 201 children living with HIV/AIDS aged less than 15 years were followed from October 2013 to March 2017. Separate linear effect models were done for the longitudinal outcome of CD4 cell count. The Cox PH model was conducted for the time-to-event outcome. Joint modeling was performed both for the longitudinal and survival outcomes, results were compared with the separate analysis. However, with the specific interest in identifying the determinants and characterizing the relationship between longitudinal CD4 cell count and time-to-event outcomes, the study focused on joint modeling. The finding from the joint model indicated that the estimated association parameter was −0.10, this shows lower values of CD4 cells associated with higher death. Seemingly; observation time, age, WHO clinical stages, history of Tuberculosis (assuming that Tuberculosis is active), and functional status were determinants for the mean change in the square root of CD4 cell count. Furthermore, WHO clinical stages, functional status, history of TB, and Body Mass Index have a significant negative impact on the survival probabilities of children living with HIV. [ABSTRACT FROM AUTHOR]

Introduction: CD4 count is an important predictor of disease progression, opportunities infection, deaths, and to understand the time interval between initial HIV infection to the first diagnosis. However, baseline CD4 count and the time period between initial infection and the diagnosis amongst PLHIV in Bhutan never been evaluated. Methods: This is a retrospective study of the diagnosed PLHIV from the existing data system from January 10 to 30, 2021. Out of 512 reported HIV cases, 488 of those who were more than or equal to 18 years old and had their CD4 count testing within 6 months before initiating ART were considered for analysis. Descriptive statistical analysis was used to analyze the characteristics of the study population and relationship were established using the χ2 Test. We have sought ethics approval and waiver for informed consent as it is the retrospective study of the client's record. The client's confidentiality was ensured by removing all the identifiers. Results: The mean CD4 was 345 cells/ml for males and females. Twenty‐five percent of the clients had CD4 counts below 200, 30%, between 200 and 349, 25% between 350 and 499, and 20% above 500 cells/ml. A larger number of males showed a CD4 count below 200 cells/ml while more females showed a CD4 count more than 500 cells/ml. The mean time interval between initial infection to the first diagnosis was 4 years in males and females. However, about one‐fourth were found to have been infected between 5 and 8 years before diagnosis and less than 10% were diagnosed within less than 1 year of infection. Conclusions: The study revealed a late diagnosis of HIV infection in Bhutan thereby risking the transmission to the community and risk of severe disease and mortality. The upscaling of voluntary counseling and testing, medical screening, and alternative methods like community‐based testing including HIV Self Testing for early detection needs to be implemented in the country. [ABSTRACT FROM AUTHOR]

Background: HIV is an infectious disease affecting 36.7 million people worldwide. In recent times, Antiretroviral Therapy (ART) has become accessible to the majority of People Living with HIV (PLHIV) and this has transformed the course of infection to one that is chronic, characterized by fewer diseases pathognomonic of AIDS. In view of this, there is a pressing need for better markers, apart from the routine HIV indicators, to detect comorbidities such as Neurocognitive Impairment (NCI). The aim of this study was to find out the association between Veterans Aging Cohort Study (VACS) index and Neurocognitive function in HIV positive patients. Methods: In our study, we included 97 HIV positive patients and their Neurocognitive function was assessed using a combination of Montreal Cognitive Assessment and Grooved Pegboard Test, while VACS index was calculated using the most recent laboratory values. Binomial Logistics Regression analyses, adjusting for potential confounding variables, was performed to determine the association between VACS score and Neurocognitive Impairment. Results: We found that a higher VACS Index was associated with global and domain-wise Neurocognitive impairment (p < 0.01), specifically in the domains of attention (p < 0.01) and fine motor skills (p = 0.01). Our study also showed that among all the VACS components, older age (p = 0.02) and lower hemoglobin (p < 0.01) values were associated with global NCI. After plotting an ROC curve, a VACS cut-off score of 11.00 was identified as it had good sensitivity (87.0%) and specificity (71.4%) in identifying Global NCI. Conclusion: Our findings extend prior research on the use of VACS Index to predict global and domain-wise NCI in HIV-positive patients. However, further research with more comprehensive neurocognitive testing is required in our setting before VACS Index can be used as a tool to screen for neurocognitive dysfunction among PLHIV. [ABSTRACT FROM AUTHOR]

Objectives: Despite better access to antiretroviral therapy (ART) over recent years, HIV remains a major global cause of mortality. The present study aimed to identify predictors of in‐hospital mortality among HIV‐positive patients presenting to an emergency department (ED). Methods: In this cross‐sectional study, HIV‐positive patients presenting to the Charlotte Maxeke Johannesburg Academic Hospital adult ED between 07 July 2017 and 18 October 2018 were prospectively enrolled. Data were compared between participants who survived to hospital discharge and those who died. The data were further subjected to univariate and multivariate logistic regression analyses to determine variables that were associated with in‐hospital mortality. Results: Of a total of 1224 participants, the in‐hospital mortality was 13.6% (n = 166). On multivariate analysis, respiratory rate > 20 breaths/min [odds ratio (OR) = 1.90, P = 0.012], creatinine > 120 μmol/L (OR = 1.97, P = 0.006), oxygen saturation < 90% (OR = 2.09, P = 0.011), white cell count < 4.0 × 109/L (OR = 2.09, P = 0.008), ART non‐adherence or not yet on ART (OR = 2.39, P = 0.012), Glasgow Coma Scale < 15 (OR = 2.53, P = 0.000), albumin < 35 g/L (OR = 2.61, P = 0.002), lactate > 2 mmol/L (OR = 4.83, P = 0.000) and cryptococcal meningitis (OR = 6.78, P = 0.000) were significantly associated with in‐hospital mortality. Conclusions: Routine clinical and laboratory parameters are useful predictors of in‐hospital mortality in HIV‐positive patients presenting to the ED with an acute illness. These parameters may be of value in guiding clinical decision‐making, directing the appropriate use of resources and influencing patient disposition, and may also be useful in developing an outcome prediction tool. [ABSTRACT FROM AUTHOR]

Background We analyzed associations between immunodeficiency and cancer incidence in a nationwide cohort of people living with human immunodeficiency virus (HIV; PLWH) in South Africa. Methods We used data from the South African HIV Cancer Match Study built on HIV-related laboratory measurements from the National Health Laboratory Services and cancer records from the National Cancer Registry. We evaluated associations between time-updated CD4 cell count and cancer incidence rates using Cox proportional hazards models. We reported adjusted hazard ratios (aHRs) over a grid of CD4 values and estimated the aHR per 100 CD4 cells/µL decrease. Results Of 3 532 266 PLWH, 15 078 developed cancer. The most common cancers were cervical cancer (4150 cases), Kaposi sarcoma (2262 cases), and non-Hodgkin lymphoma (1060 cases). The association between lower CD4 cell count and higher cancer incidence rates was strongest for conjunctival cancer (aHR per 100 CD4 cells/µL decrease: 1.46; 95% confidence interval [CI], 1.38–1.54), Kaposi sarcoma (aHR, 1.23; 95% CI, 1.20–1.26), and non-Hodgkin lymphoma (aHR, 1.18; 95% CI, 1.14–1.22). Among infection-unrelated cancers, lower CD4 cell counts were associated with higher incidence rates of esophageal cancer (aHR, 1.06; 95% CI, 1.00–1.11) but not breast, lung, or prostate cancer. Conclusions Lower CD4 cell counts were associated with an increased risk of developing various infection-related cancers among PLWH. Reducing HIV-induced immunodeficiency may be a potent cancer-prevention strategy among PLWH in sub-Saharan Africa, a region heavily burdened by cancers attributable to infections. [ABSTRACT FROM AUTHOR]

Background People living with HIV have higher sudden cardiac death (SCD) rates compared with the general population. Whether HIV infection is an independent SCD risk factor is unclear. Methods and Results This study evaluated participants from the Veterans Aging Cohort Study, an observational, longitudinal cohort of veterans with and without HIV infection matched 1:2 on age, sex, race/ethnicity, and clinical site. Baseline for this study was a participant's first clinical visit on or after April 1, 2003. Participants were followed through December 31, 2014. Using Cox proportional hazards regression, we assessed whether HIV infection, CD4 cell counts, and/or HIV viral load were associated with World Health Organization (WHO)–defined SCD risk. Among 144 336 participants (30% people living with HIV), the mean (SD) baseline age was 50.0 years (10.6 years), 97% were men, and 47% were of Black race. During follow‐up (median, 9.0 years), 3035 SCDs occurred. HIV infection was associated with increased SCD risk (hazard ratio [HR], 1.14; 95% CI, 1.04–1.25), adjusting for possible confounders. In analyses with time‐varying CD4 and HIV viral load, people living with HIV with CD4 counts 500 copies/mL (HR, 1.70; 95% CI, 1.46–1.98) had increased SCD risk versus veterans without HIV. In contrast, people living with HIV who had CD4 cell counts >500 cells/mm3 (HR, 1.03; 95% CI, 0.90–1.18) or HIV viral load

Abstract Background CD4 cell count has been identified to be an essential component in monitoring HIV treatment outcome. However, CD4 cell count monitoring sometimes fails to predict virological failure resulting in unnecessary switch of treatment lines which causes drug resistance and limitations of treatment options. This study assesses the use of both viral load (HIV RNA) and CD4 cell count in the monitoring of HIV/AIDS progression. Methods Time-homogeneous Markov models were fitted, one on CD4 cell count monitoring and the other on HIV RNA monitoring. Effects of covariates; gender, age, CD4 baseline, HIV RNA baseline and adherence to treatment were assessed for each of the fitted models. Assessment of the fitted models was done using prevalence plots and the likelihood ratio tests. The analysis was done using the “msm” package in R. Results Results from the analysis show that viral load monitoring predicts deaths of HIV/AIDS patients better than CD4 cell count monitoring. Assessment of the fitted models shows that viral load monitoring is a better predictor of HIV/AIDS progression than CD4 cell count. Conclusion From this study one can conclude that although patients take more time to achieve a normal CD4 cell count and less time to achieve an undetectable viral load, once the CD4 cell count is normal, mortality risks are reduced. Therefore, both viral load monitoring and CD4 count monitoring can be used to provide useful information which can be used to improve life expectance of patients living with HIV. However, viral load monitoring is a better predictor of HIV/AIDS progression than CD4 cell count and hence viral load is deemed superior.

Background: Despite improved availability and better access to antiretroviral therapy (ART), approximately 36% of human immunodeficiency virus (HIV)-positive South Africans are still not virally suppressed. Objective: The aim of this study was to describe the patterns of presentation of HIV-positive patients to a major central hospital emergency department (ED). Methods: In this prospectively designed study, consecutive HIV-positive patients presenting to the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) adult ED were enrolled between 07 July 2017 and 18 October 2018. Results: A total of 1224 participants were enrolled. Human immunodeficiency virus was newly diagnosed in 212 (17.3%) patients, 761 (75.2%) were on ART, 245 (32.2%) reported ART non-adherence, 276 (22.5%) had bacterial pneumonia, 244 (19.9%) had tuberculosis (TB), 86 (7.0%) had gastroenteritis, 205 (16.7%) required intensive care unit admission, 381 (31.1%) were admitted for ≥ 7 days and 166 (13.6%) died. With regard to laboratory parameters, CD4 cell count was 100 cell/mm3 in 527 (47.6%) patients, the viral load (VL) was 1000 copies/mL in 619 (59.0%), haemoglobin was 11 g/dL in 636 (56.3%), creatinine was 120 µmol/L in 294 (29.3%), lactate was 2 mmol/L in 470 (42.0%) and albumin was 35 g/L in 633 (60.8%). Conclusion: Human immunodeficiency virus-positive patients presenting to the CMJAH ED demonstrated a high prevalence of opportunistic infections, required a prolonged hospital stay and had high mortality rates. There is a need to improve the quality of ART services and accessibility to care.

Background: With the advent of antiretroviral therapy (ART), most children living with HIV in sub-Saharan Africa (SSA) are growing toward adolescence, with scarcity of evidence on the size of viral reservoirs to enhance paediatric cure research strategies. This study aims to compare HIV-1 proviral DNA levels according to virological response among adolescents living with perinatally acquired HIV-1 (ALPHIV) and identify associated-factors in the Cameroonian context., Methods: In this observational cohort study, HIV-1 RNA viremia and CD4 + T-cell count were assessed through RT-PCR and flow cytometry respectively at three time-points over 18 months of observation. At the third time-point, 80 randomly-selected participants were classified as with viremia (≥50 HIV-1 copies/mL; n = 40) or without viremia (<50 HIV-1 copies/mL; n = 40); immune-competent (≥500 CD4 + T cells/mm 3 ) or immunocompromised (<500 CD4 + T cells/mm 3 ). Among these participants, total HIV-1 DNA load was quantified through droplet digital PCR using Bio-Rad QX200., Results: Of the 80 randomly-selected adolescents, median [IQR] age was 15 (13-17) years, 56.2% were female, duration on ART was 9.3 [5.4-12.2] years. Among the 40 viremic ones (median viremia 7312 [283-71482]) HIV-1 copies/ml, 75.0% (30/40) were in virological failure (≥1000 HIV-1 copies/ml), while median of CD4 T cells were 494 [360-793] cell/mm 3 with 48.8% (39/80) immunocompromised. No significant variation in HIV-1 RNA viremia and CD4 T cell count was observed between the three time-points, and 13.7% (11/80) adolescents remained aviremic and immune-competent throughout (stable adolescents). A positive and moderate correlation (r = 0.59; p < 0.001) was found between HIV-1 DNA levels and HIV- 1 RNA viremia. Regarding the CD4 T cell count, a negative and weak correlation (r = -0.28; p = 0.014) was found with HIV-1 DNA loads only among adolescents with viremia. Starting ART within the first year of life, ART for over 9 years and aviremia appear as predictors of low HIV-1 DNA loads., Conclusion: Among ALPHIV, high HIV-1 RNA indicates an elevated viral reservoir size, representing a drawback to cure research. Interestingly, early ART initiation and longer ARTduration lead to sustained viral control and limited HIV-1 reservoir size. As limited size of viral reservoir appears consistent with viral control and immune competence, adolescents with sustained viral control (about 14% of this target population) would be candidates for analytical ART interruptions toward establishing paediatric post-treatment controllers in SSA., Competing Interests: The authors declared there are no conflicts of interest., (© 2024 The Authors.)

Abstract Introduction The way syphilis affects the immunologic and virologic parameters of a human immunodeficiency virus (HIV) infection remains controversial. The aim of this study was to investigate the impact of syphilis infection on lymphocyte and lymphocyte subset counts as well as viral load in HIV-infected patients. Methods All HIV-infected patients attending the outpatient clinic for infectious diseases of Hannover Medical University Hospital diagnosed with syphilis between 2009 and 2016 were retrospectively evaluated for changes in total lymphocyte, B cell, CD3+ T cell, CD4+ and CD8+ T cell counts as well as in HIV viral load. These parameters were assessed at three different time points, i.e., 3–6 months before, at diagnosis and 3–6 months after treatment of syphilis. Results Eighty-four HIV-infected patients, all with early syphilis, were identified. The vast majority were men who have sex with men (MSM), and 80% were receiving antiretroviral therapy (ART). Syphilis was associated with a significant reduction in the total lymphocyte count and counts of all studied lymphocyte subsets, including CD4+ T cells, whose percentage among lymphocytes did not change. No significant changes in HIV viral load were observed at any of the studied time points. Further, antibiotic treatment of syphilis restored lymphocyte counts back to pretreatment levels. Conclusion Syphilis induces a relative non-CD4+ T cell-specific lymphopenia in HIV-infected patients. Our data suggest that serologic testing for syphilis should be considered in HIV-infected MSM in case of an otherwise unexplained drop in total lymphocyte count.