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Introduction: The use of anti-retroviral therapy (ART) has made HIV a manageable condition, but there are risks associated with medications like reverse transcriptase inhibitors (RTIs) and integrase strand transfer inhibitors (INSTIs), such as liver and renal toxicity. It is essential to understand these risks for effective treatment and case management. Investigating liver toxicity related to RTIs and INSTIs in Nigeria is crucial for optimizing HIV treatment. This study aimed to assess the impact of tenofovir lamivudine dolutegravir (TLD) on the liver function of HIV patients at Nigerian Navy Hospital (NNH)-Warri. Methods: The liver function of 170 participants was assessed, with 120 on ART and the remainder being HIV-negative attendees at NNH-Warri. The study used a cross-sectional design and selected participants through random sampling. We collected data using a semi-structured questionnaire. Blood samples were taken through venipuncture and stored at – 20 °C before analysis. Ethical approval was obtained, and data analysis was conducted using SPSS Statistical Software Version 23, with significance set at p < 0.05. Results: The study found significant differences in AST, TP, Alb, and GST levels between HIV-positive subjects receiving TLD and HIV-negative individuals. HIV-positive subjects had lower AST and Alb levels but higher TP and GST levels. Further analysis revealed correlations between age, gender, and liver enzymes, highlighting the complex relationship between HIV, liver function, and treatment outcomes. Conclusion: The study suggests that decreased AST levels may have a protective effect, while ALT activity had minimal impact. Changes in TP, Alb, and GSTs emphasize the importance of monitoring hepatic synthetic function and detoxification pathways in HIV patients taking TLD. [ABSTRACT FROM AUTHOR]

Background: Human Immunodeficiency Virus (HIV) and type 2 diabetes (T2D) are amongst the leading causes of death in South Africa. The preferred first-line anti-retroviral treatment contains dolutegravir (DTG), shown to increase body weight, may compound the already high rates of obesity and associated risk for T2D. South Africa has widespread food insecurity, making traditional dietary strategies difficult to implement. Time-restricted eating (TRE) may be an appropriate intervention in resource-limited communities. Methods: This article outlines the development and feasibility testing of a TRE intervention to inform the design of a TRE randomised controlled trial in women (20–45 years old) living with overweight/obesity and HIV, receiving DTG-based treatment from a resource-limited community in Cape Town, South Africa. Factors influencing TRE adoption were identified using the Capability, Opportunity, Motivation – Behaviour model and the Theoretical Domains Framework, combining in-depth interviews (IDIs) and focus group discussions. Participants from the IDIs went on to participate in a single arm 4-week TRE pilot trial where feasibility was explored in terms of reach, acceptability, applicability, and implementation integrity. An iterative, thematic analysis approach was employed to analyse the qualitative data. Results: Participants included 33 isiXhosa-speaking women (mean age 37.1 years, mean BMI 35.9 kg/m2). Thematic analysis identified psychological capability (knowledge of fasting), social influences (cultural preferences, family support), and reflective motivation (awareness of weight, health impact, motivation for TRE) as key factors influencing adoption of TRE for weight management. In a 4-week TRE pilot trial (n = 12), retention was 100%. Positive outcomes perceived included improved energy, appetite control and weight loss. TRE was perceived as acceptable, easy, and enjoyable. Family support facilitated adherence, while habitual and social eating and drinking practices were barriers. Compliance was high, aided by self-selected eating times, reminders, and weekly calls. Recommendations included the incorporation of dietary education sessions and text messages to provide additional support and reminders. Conclusions: This study indicates that TRE is a feasible weight management strategy in women living with overweight/obesity and HIV, receiving DTG-based treatment in a resource-limited community. These findings will ensure that the forthcoming TRE randomised controlled trial is adapted and optimised to the local South African context. [ABSTRACT FROM AUTHOR]

Long Acting Injectable (LAI) therapy to treat HIV is an alternative to daily oral medications. The success of early roll-out of LAI to eligible patients requires a better understanding of patients' awareness and interest in this novel therapy. We administered an electronic survey to patients attending an urban HIV clinic in the US South. Eligible participants were 18 + years old with a most recent HIV-1 viral load < 200 copies/ml, without any evidence of genotypic resistance to LAI components or chronic hepatitis B. Survey recipients were asked about current treatment, engagement in care, and knowledge of LAI. Between January-April 2023, 480 patients were screened; 319 were eligible, and 155 (49%) completed the survey. The majority (119, 77%) were aware of, and 87 (56%) were interested in LAI. In regression analysis, only age was associated with interest in LAI (OR 0.95, 95% CI 0.92,0.99). Among proposed benefits of injectables, ease of travel without pills, lack of daily pill-taking, and fewer medication interactions were most appealing. Among proposed concerns with injectables, higher cost and insurance coverage of the new medicine were most worrisome. A large majority of people with HIV (PWH) are aware of the newest treatment available, and just over half of our sample expressed interest in LAI. Older age was associated with lower interest in LAI. LAI is appealing for its convenience, privacy, and avoidance of drug interactions, while the increased costs associated with LAI need to be addressed. [ABSTRACT FROM AUTHOR]

Background: Among people living with HIV(PHIV) with unsuppressed viral load after six or more months of anti-retroviral therapy (ART), three intensive adherence counseling sessions (IAC) sessions are recommended. However, there is limited information about IAC completion rates. We investigated the factors associated with IAC completion among PLHIV with an unsuppressed viral load on first and second-line ART in mid-western Uganda. Methods: In this retrospective review of medical records, we abstracted routine HIV data between January 2018 and September 2019 at the Fort Portal Regional Hospital. IAC completion was the primary outcome measured as the receipt of ≥ 3 consecutive good ART adherence scores of ≥ 95.0% during the IAC sessions, spaced one month apart within three months. The modified Poisson regression analysis with robust standard errors was used to determine factors associated with the outcome, reported as risk ratio (RR) and 95% confidence interval (CI). Results: We studied 420 participants of whom 204 (48.6%) were aged 20–39 years (mean age, 33.6 ± 13.3 years) and 243 (57.9%) were female. 282 (67.1%) participants completed their IAC sessions. Secondary or higher levels of education (Adjusted RR (aRR) 0.79, 95% CI 0.64–0.98), no follow-up for IAC (aRR 0.76, 95% CI 0.67–0.87), malnutrition (aRR 0.65, 95% CI 0.43–0.99) were associated with a lower likelihood of IAC completion while being in a separated/widowed or divorced relationship (aRR 1.23, 95% CI 1.01–1.49) was associated with a higher likelihood of IAC completion. Conclusions: We found a low IAC completion rate compared to the desired target of 100%. Nutritional support for malnourished PLHIV receiving IAC, follow-ups, and targeted health education on the importance of IAC are needed to improve the IAC completion rate. [ABSTRACT FROM AUTHOR]

HIV is recognised as a multifaceted chronic disease, bearing psychosocial consequences that potentially impact on the personal and social well-being of those living with it. Adolescents and youth bear a significant proportion of the burden of the HIV epidemic but they have low rates of disclosure of their HIV status. This study aims to determine the views of adolescents living with perinatally acquired HIV on HIV status disclosure among 361 adolescents aged 15–19 in Eswatini. A cross-sectional study was conducted on adolescents who already knew their status, and data were collected using a structured questionnaire. A majority of the participants, 55% (n = 200), were females, and 44% (n = 160) were males. A low number of adolescents (22%) had disclosed their HIV status to anyone. Adolescents who found it difficult to understand disclosure themselves had low levels of onward disclosure (27%) compared to adolescents who better understood the disclosure event. Our results revealed that adolescents' prevalence of HIV status disclosure was low. This raises concerns as some of the adolescents were in relationships with partners who were not aware of their status. However, older adolescents displayed some level of disclosure self-efficacy in that a higher proportion of them disclosed better than younger adolescents. [ABSTRACT FROM AUTHOR]

Abstract Introduction The use of anti-retroviral therapy (ART) has made HIV a manageable condition, but there are risks associated with medications like reverse transcriptase inhibitors (RTIs) and integrase strand transfer inhibitors (INSTIs), such as liver and renal toxicity. It is essential to understand these risks for effective treatment and case management. Investigating liver toxicity related to RTIs and INSTIs in Nigeria is crucial for optimizing HIV treatment. This study aimed to assess the impact of tenofovir lamivudine dolutegravir (TLD) on the liver function of HIV patients at Nigerian Navy Hospital (NNH)-Warri. Methods The liver function of 170 participants was assessed, with 120 on ART and the remainder being HIV-negative attendees at NNH-Warri. The study used a cross-sectional design and selected participants through random sampling. We collected data using a semi-structured questionnaire. Blood samples were taken through venipuncture and stored at – 20 °C before analysis. Ethical approval was obtained, and data analysis was conducted using SPSS Statistical Software Version 23, with significance set at p

Abstract Background Human Immunodeficiency Virus (HIV) and type 2 diabetes (T2D) are amongst the leading causes of death in South Africa. The preferred first-line anti-retroviral treatment contains dolutegravir (DTG), shown to increase body weight, may compound the already high rates of obesity and associated risk for T2D. South Africa has widespread food insecurity, making traditional dietary strategies difficult to implement. Time-restricted eating (TRE) may be an appropriate intervention in resource-limited communities. Methods This article outlines the development and feasibility testing of a TRE intervention to inform the design of a TRE randomised controlled trial in women (20–45 years old) living with overweight/obesity and HIV, receiving DTG-based treatment from a resource-limited community in Cape Town, South Africa. Factors influencing TRE adoption were identified using the Capability, Opportunity, Motivation – Behaviour model and the Theoretical Domains Framework, combining in-depth interviews (IDIs) and focus group discussions. Participants from the IDIs went on to participate in a single arm 4-week TRE pilot trial where feasibility was explored in terms of reach, acceptability, applicability, and implementation integrity. An iterative, thematic analysis approach was employed to analyse the qualitative data. Results Participants included 33 isiXhosa-speaking women (mean age 37.1 years, mean BMI 35.9 kg/m2). Thematic analysis identified psychological capability (knowledge of fasting), social influences (cultural preferences, family support), and reflective motivation (awareness of weight, health impact, motivation for TRE) as key factors influencing adoption of TRE for weight management. In a 4-week TRE pilot trial (n = 12), retention was 100%. Positive outcomes perceived included improved energy, appetite control and weight loss. TRE was perceived as acceptable, easy, and enjoyable. Family support facilitated adherence, while habitual and social eating and drinking practices were barriers. Compliance was high, aided by self-selected eating times, reminders, and weekly calls. Recommendations included the incorporation of dietary education sessions and text messages to provide additional support and reminders. Conclusions This study indicates that TRE is a feasible weight management strategy in women living with overweight/obesity and HIV, receiving DTG-based treatment in a resource-limited community. These findings will ensure that the forthcoming TRE randomised controlled trial is adapted and optimised to the local South African context.

Abstract Background Among people living with HIV(PHIV) with unsuppressed viral load after six or more months of anti-retroviral therapy (ART), three intensive adherence counseling sessions (IAC) sessions are recommended. However, there is limited information about IAC completion rates. We investigated the factors associated with IAC completion among PLHIV with an unsuppressed viral load on first and second-line ART in mid-western Uganda. Methods In this retrospective review of medical records, we abstracted routine HIV data between January 2018 and September 2019 at the Fort Portal Regional Hospital. IAC completion was the primary outcome measured as the receipt of ≥ 3 consecutive good ART adherence scores of ≥ 95.0% during the IAC sessions, spaced one month apart within three months. The modified Poisson regression analysis with robust standard errors was used to determine factors associated with the outcome, reported as risk ratio (RR) and 95% confidence interval (CI). Results We studied 420 participants of whom 204 (48.6%) were aged 20–39 years (mean age, 33.6 ± 13.3 years) and 243 (57.9%) were female. 282 (67.1%) participants completed their IAC sessions. Secondary or higher levels of education (Adjusted RR (aRR) 0.79, 95% CI 0.64–0.98), no follow-up for IAC (aRR 0.76, 95% CI 0.67–0.87), malnutrition (aRR 0.65, 95% CI 0.43–0.99) were associated with a lower likelihood of IAC completion while being in a separated/widowed or divorced relationship (aRR 1.23, 95% CI 1.01–1.49) was associated with a higher likelihood of IAC completion. Conclusions We found a low IAC completion rate compared to the desired target of 100%. Nutritional support for malnourished PLHIV receiving IAC, follow-ups, and targeted health education on the importance of IAC are needed to improve the IAC completion rate.

Objective：To investigate the current situation and characteristics of human immunodeficiency virus（HIV）/hepatitis B virus（HBV）co⁃infection among HIV⁃infected individuals, as well as to analyze the effectiveness of anti⁃retroviral therapy（ART）and its influencing factors for HIV/HBV co⁃infected patients. Methods：The study selected newly diagnosed HIV patients in Nantong City from January, 2016, to December, 2021, as the research subjects. Based on the results of hepatitis B surface antigen（HBsAg）testing, the patients were categorized into two groups：an HIV mono⁃infection group（1 830 cases）and an HIV/HBV co⁃infection group （135 cases）. The study compared the HIV infection characteristics of the two groups before ART, analyzed the virological suppression and CD4+ T lymphocyte count changes after ART therapy, and evaluated the improvement of immune function and its influencing factors. Results：HIV/HBV co⁃infection led to more severe immune impairment of the patients before ART than those in the HIV mono⁃ infection group. After receiving ART, both the HIV mono ⁃ infection group and the HIV/HBV co ⁃ infection group showed a gradual increase in CD4+ T count, and the virological suppression rate was over 90% in both groups after two years of ART. Univariate and multivariate logistic regression analyses showed that the increasing age at ART initiation, initial CD4+ T count < 200 cells/μL, and initial HIV RNA ≥4.5［lg（copies/mL）］were risk factors for immune reconstitution. There was also an increasing trend in the rate of favorable immune reconstitution with a prolonged treatment time. Co ⁃ infection with HBV exacerbated immune impairment in HIV ⁃ infected individuals before ART, which may affect immune reconstitution. Conclusion：HBV infection can worsen immune damage in HIV⁃infected individuals. The current ART strategy for HIV/HBV co⁃infection effectively suppresses dual infection and benefits immune reconstitution in HIV/HBV co ⁃ infection. However, there are insufficiencies in ART and efficacy monitoring in patient management, highlighting the need for further standardization of clinical diagnosis and treatment activities. [ABSTRACT FROM AUTHOR]

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Human Immunodeficiency Virus (HIV) infection is among the most challenging issues in the healthcare system, presenting significant financial and hygiene problems with a wide range of clinical manifestations. Despite the hopeful outcomes of Antiretroviral Therapies (ARTs), the current strategies for the treatment of patients with HIV infection have not shown clinical significance for all subjects, which is mainly due to the complexity of the disease. Therefore, the need for collaborative and interdisciplinary research focused on deciphering the multifaceted cellular, and molecular immunopathogenesis of HIV remains essential in the development of innovative and more efficacious therapeutic approaches. T-regulatory (Treg) cells function as suppressors of effector T-cell responses contributing to the inhibition of autoimmune disorders and the limitation of chronic inflammatory diseases. Notably, these cells can play substantial roles in regulating immune responses, immunopathogenesis, viral persistence and disease progression, and affect therapeutic responses in HIV patients. In this review, we aim elucidating the role of T-regulatory cells (Tregs) in the immunopathogenesis of HIV, including immunological fatigue and seroconversion. In particular, the focus of the current study is exploration of novel immunotherapeutic approaches to target HIV or related co-infections.

Background: HIV infection is a serious lifelong health risk, leading to increased illness and death. In children, adhering to antiretroviral therapy (ART) is crucial to reduce these harmful effects. Yet, due to the challenges of pediatric patients and the social issues related to HIV, sticking to ART can be difficult in this group. Aims and Objectives: The study was conducted to evaluate the adherence of pediatric patients to their daily ART dosages. We also tried to understand the causes that led to the failure to follow the scheduled dosages and evaluate how these factors affected our study population. Materials and Methods: We examined the adherence to ART in 49 patients, aged 2–15, who had been on ART for at least 12 months. They visited the ART center at Medical College and Hospital, Kolkata, between August 01 and September 30, 2022. Ethical clearance was granted by the Institution’s Ethics Committee. The participants were chosen through systematic random sampling. We collected data through interviews and chart reviews and analyzed it using SPSS version 19. Results: Out of the 49 participants, 34 (69.38%) adhered to ART in the preceding month. For the non-adherent patients (n=15), the main reasons included conflicting ART dosage timing with school hours and children falling asleep at dosing time. Most (53.1%) were in the 5–10 age groups, with 93.88% in WHO Stage 1 of the disease and 6.12% in Stage II. In 77.6% of cases, mothers were the primary caregivers, and 79.6% of caregivers were HIV positive. Many children (71.43%) were unaware of their disease. Out of the 31 children whose disease status was known to others, grandparents of 23 and siblings of 12 were aware. Six of these children faced stigma from relatives and neighbors. ART adherence was significantly associated (P

Abstract Nearly half of the deaths among hospitalized human immuno deficiency virus-infected patients in the highly active antiretroviral therapy era have been attributed to liver disease. This may range from an asymptomatic mild increase of liver enzymes to cirrhosis and liver failure. Different works of literature elucidated both retroviral infection and the adverse effects of highly active antiretroviral therapy as a cause of hepatotoxicity. Individual adaptations to medications and environmental exposures, shaped by cultural norms and genetic predispositions, could potentially modulate the risk and progression of liver disease in this population. Therefore, this study aims to assess the predictors of severe hepatotoxicity in retroviral-infected adults receiving highly active antiretroviral therapy regimens within the Ilubabor Zone, Southwest Ethiopia. A facility-based cross-sectional study was conducted among adult retroviral-infected patients in five selected anti-retro virus therapy clinics from May1 to July 30/2022. A systematic sampling technique was used to select 457 study participants and Binary logistic regression statistical data analysis was used, P value

Background: HIV infection is a serious lifelong health risk, leading to increased illness and death. In children, adhering to antiretroviral therapy (ART) is crucial to reduce these harmful effects. Yet, due to the challenges of pediatric patients and the social issues related to HIV, sticking to ART can be difficult in this group. Aims and Objectives: The study was conducted to evaluate the adherence of pediatric patients to their daily ART dosages. We also tried to understand the causes that led to the failure to follow the scheduled dosages and evaluate how these factors affected our study population. Materials and Methods: We examined the adherence to ART in 49 patients, aged 2-15, who had been on ART for at least 12 months. They visited the ART center at Medical College and Hospital, Kolkata, between August 01 and September 30, 2022. Ethical clearance was granted by the Institution's Ethics Committee. The participants were chosen through systematic random sampling. We collected data through interviews and chart reviews and analyzed it using SPSS version 19. Results: Out of the 49 participants, 34 (69.38%) adhered to ART in the preceding month. For the non-adherent patients (n=15), the main reasons included conflicting ART dosage timing with school hours and children falling asleep at dosing time. Most (53.1%) were in the 5-10 age groups, with 93.88% in WHO Stage 1 of the disease and 6.12% in Stage II. In 77.6% of cases, mothers were the primary caregivers, and 79.6% of caregivers were HIV positive. Many children (71.43%) were unaware of their disease. Out of the 31 children whose disease status was known to others, grandparents of 23 and siblings of 12 were aware. Six of these children faced stigma from relatives and neighbors. ART adherence was significantly associated (P<0.05) with the caregiver's occupation (P=0.006), the child's age when starting ART (P=0.001), parents' AIDS-related deaths (P=0.003), and travel time to the ART center from home (P<0.02). Conclusion: Although most children adhered to their ART regimen, there is room for improvement. Caregivers, especially for younger children, play a crucial role. Empathetic education for caregivers and children, tailored to their age, along with regular adherence checks, can enhance medication adherence significantly. [ABSTRACT FROM AUTHOR]

Nearly half of the deaths among hospitalized human immuno deficiency virus-infected patients in the highly active antiretroviral therapy era have been attributed to liver disease. This may range from an asymptomatic mild increase of liver enzymes to cirrhosis and liver failure. Different works of literature elucidated both retroviral infection and the adverse effects of highly active antiretroviral therapy as a cause of hepatotoxicity. Individual adaptations to medications and environmental exposures, shaped by cultural norms and genetic predispositions, could potentially modulate the risk and progression of liver disease in this population. Therefore, this study aims to assess the predictors of severe hepatotoxicity in retroviral-infected adults receiving highly active antiretroviral therapy regimens within the Ilubabor Zone, Southwest Ethiopia. A facility-based cross-sectional study was conducted among adult retroviral-infected patients in five selected anti-retro virus therapy clinics from May1 to July 30/2022. A systematic sampling technique was used to select 457 study participants and Binary logistic regression statistical data analysis was used, P value < 0.05 was considered statistically significant. The prevalence of severe hepatotoxicity was 21.44% in the study population. CD+4 count < 200 cells/mm3 (AOR = 2.19, 95% CI 1.04–5.22, P = 0.01), human immunodeficiency virus co-infection with tuberculosis (AOR = 2.82, 95% CI 1.01–8.29, P = 0.03) and human immuno deficiency virus co-infection with hepatitis-B/hepatitis C virus (AOR = 5.02, 95% CI 1.82–16.41) were predictors of severe hepatotoxicity. The magnitude of severe hepatotoxicity was high among adult retroviral-infected patients on highly active anti-retroviral drug regimens. Co-infection of human immuno deficiency virus with hepatitis B virus or hepatitis C virus, tuberculosis and CD4+T-cell count below 200 cells/mm3 were predictors of severe hepatotoxicity. Therefore, HIV patients on highly active antiretroviral therapy require close attention and regular monitoring of their liver function. [ABSTRACT FROM AUTHOR]

Objectives: People living with HIV may find personalized access to accurate information on antiretroviral therapy (ART) challenging given the stigma and costs potentially associated with attending physical consultations. Artificial intelligence (AI) chatbots such as ChatGPT may help to lower barriers to accessing information addressing concerns around ART initiation. However, the safety and accuracy of the information provided remains to be studied. Methods: We instructed ChatGPT to answer questions that people living with HIV frequently ask about ART, covering i) knowledge of and access to ART; ii) ART initiation, side effects, and adherence, and iii) general sexual health practices while receiving ART. We checked the accuracy of the advice against international HIV clinical practice guidelines. Results: ChatGPT answered all questions accurately and comprehensively. It recognized potentially life‐threatening scenarios such as abacavir hypersensitivity reaction and gave appropriate advice. However, in certain contexts, such as specific geographic locations or for pregnant individuals, the advice lacked specificity to an individual's unique circumstances and may be inadequate. Nevertheless, ChatGPT consistently re‐directed the individual to seek help from a healthcare professional to obtain targeted advice. Conclusions: ChatGPT may act as a useful adjunct in the process of ART counselling for people living with HIV. Improving access to information on and knowledge about ART may improve access and adherence to ART and outcomes for people living with HIV overall. [ABSTRACT FROM AUTHOR]

Human immunodeficiency virus (HIV) is a virus that causes defects in the human immune system. HIV can abnormally activate immune cells, greatly reduce CD4 +T lymphocytes in the intestine, weaken the defense against pathogenic bacteria, make intestinal immune dysfunction, imbalance of intestinal flora, and cause other system abnormalities. In clinical practice, anti retroviral therapy (ART) is accompanied by diarrhea, nausea, allergy and other adverse reactions. In recent years, studies have found that the combination of probiotics and ART treatment can regulate intestinal flora, inhibit bacterial translocation, and reduce the inflammatory coefficient of HIV infected people. This article mainly summarizes the efficacy and mechanism of adjuvant treatment of HIV patients by supplementing a variety of probiotics after the intestinal microecological changes caused by HIV. It shows that dietary adjuvant treatment of HIV infection with probiotics has a positive effect and is an economic and feasible treatment method. [ABSTRACT FROM AUTHOR]

Human immunodeficiency virus(HIV) is transmitted sexually, through blood transfusions, sharing intravenous needles, and from the mother to a child during the birth process and breastfeeding. Most of the patients diagnosed with HIV develop AIDS within ten years if left untreated. HIV infected patients have a higher risk of complications than those who are not having the disease. Surgical site infections and pneumonia are the most common short term postoperative complications in patients suffering from this disease. The use of antiretroviral therapy against HIV infection can result in an increased risk of cardiovascular disease by changing the profile of lipids and platelet aggregation. HIV associated thrombocytopenia can also cause bleeding. Here we present a case of a 47 year old patient who was operated for oral cancer and developed postoperative bleeding as a complication apart from postoperative infection. There was no thrombocytopenia in our patient, but anemia occurred due to blood loss. There was also substantial increase in TLC count when he developed infection. [ABSTRACT FROM AUTHOR]

Background: Although people living with HIV (PLWH) now have a longer life expectancy due to antiretroviral therapy, several factors impact their health-related quality of life (HRQoL). Understanding the dimensions and determinants of HRQoL among PLWH is crucial to developing solutions to improve their overall wellbeing. Aim: This research aimed to explore the HRQoL and its associated factors among PLWH in Lagos, Nigeria. Setting: Seven HIV testing and treatment centres in Lagos. Methods: A cross-sectional survey was conducted with 385 participants. Socio-demographic and HRQoL data were obtained using questionnaires and the Medical Outcomes Study HIV Health Survey (MOS-HIV). Logistic regression models were used to identify variables that were associated with quality of life. Results: The physical health summary and mental health summary scores measured by the MOS-HIV were 54.2 ± 5.3 and 56.3 ± 6.7, respectively. Being married, having higher levels of education, shorter duration of HIV and higher income levels were significantly associated with better HRQoL. The duration of HIV was found to have an inversely proportional influence on the quality of life of PLWH, both in physical health (χ2 = 9.477, p = 0.009) and mental health (χ2 = 11.88, p = 0.004) dimensions. Conclusion: The HRQoL of PLWH in Lagos, Nigeria was relatively low. Education, duration of HIV, marital status and income level are predictors of HRQoL. Contribution: This study is valuable for healthcare professionals and policymakers, providing them with essential information to tailor interventions and allocate resources effectively to improve the overall wellbeing of PLWH in Nigeria.

Background: Anti-retroviral therapy is associated with myriads of side-effects. Central nervous system related side effects are troublesome and mostly self limiting. Working knowledge of these side effects can improve the prescription habits of physicians. The study aimed pattern of central system related adverse drug reactions (ADRs) due to anti-retroviral therapy in HIV infected patients in tertiary care hospitals in North India. Materials and methods: A prospective observational study was conducted and all HIV positive patients, previously registered and new; attending OPD who encountered ADRs were enrolled in our study irrespective of their age and sex. Data was collected using ADR reporting form issued by Indian Pharmacopoeia Commission. Causality assessment was done by using Naranjo’s Probability Scale. Modified Hartwig severity scale was used to evaluate severity, WHO criteria for seriousness and guidelines of council for international organizations of medical sciences to decide the predictability of ADRs. Results: A total of 250 patients encountered various types of ADRs during the study period. Total number of ADRs recorded was 452. Out of total ADRs (n=452) recorded, 20.35% (n=92) were central system related ADRs. Most common central nervous system related ADR was dizziness. Most central nervous system related ADRs were of moderate type and possible in nature on causality assessment. Conclusion: Relatively overweight, older age and baseline CD4 absolute count below 250 cells/mm3, were predictors for central nervous system related side effects due to anti-retroviral therapy in HIV patients. We suggest that more stringent evaluation and monitoring should be carefully done in all HIV/AIDS patients who will receive and on efavirenz based anti-retroviral therapy, especially if they have the above predictors.

Background: Women living with HIV are a minority population with unique care needs. Rates of unintended pregnancy are higher among women living with HIV versus HIV negative women. However, uptake of contraception among women living with HIV including long-acting-reversible contraceptives (LARCs) remains low. This quality improvement project aimed to identify gaps in reproductive healthcare for women living with HIV attending Melbourne Sexual Health Centre (MSHC). Methods: We performed a retrospective review of women living with HIV attending MSHC for HIV care February 2019–February 2020. Women aged over 45 years were excluded. Primary outcomes included proportion using contraception, methods used and whether a sexual or reproductive health history had been taken in the past year. Results: A total of 100 women were included, predominantly born overseas (Asia, 38%; sub-Saharan Africa, 34%). Of these, 5% were pregnant, 16% were trying to conceive and 1% were undergoing elective oocyte preservation. Of the remaining 74 women, 48.6% were using any form of contraception, including 17.6% women using less-effective methods (withdrawal and condoms), 6.8% using the combined oral contraceptive pill, 18.9% using LARCs and 5.4% using permanent methods. Sexual activity status was documented for 61% women, 1% declined to answer and not documented for 38% women. Conclusions: Rate of contraceptive use in this study was lower than previously reported among women living with HIV in Australia; however, our findings suggest contraceptive methods may be changing in light of undetectable equals untransmittable and increased fertility desires. Discussions regarding sexual activity and reproductive health were limited. Mechanisms to increase clinician–patient discourse regarding these important issues should be explored. Women living with HIV are a minority in Australia. They present unique healthcare challenges, particularly relating to sexual and reproductive health. Evidence shows higher rates of unplanned pregnancy and lower rates of long-acting-reversible contraception use among women living with HIV. We highlight gaps in care at an Australian metropolitan centre and suggest contraceptive options used by women living with HIV may be changing in the era of modern HIV treatment. We suggest changes in care provision to meet demand, including use of 'women-centred' models of care. [ABSTRACT FROM AUTHOR]

Background: India has 2.1 million people living with HIV/AIDS (PLHIV). The objective of this study was to ascertain the extent of anti‑retroviral therapy (ART) adherence and reasons for nonadherence among PLHIV in India. Methods: We conducted a systematic review and meta‑analysis using the following criteria: (1) Observational or experimental studies conducted in India and (2) English language studies. Published during January 2012–June 2018 with data collection during the same period (3). 95% ART adherence rate (primary outcome). We reviewed bibliographic databases (PubMed, Scopus) and extracted relevant data. The forest plot was used to display the meta‑analysis results. Analyses were performed in Stata 14 using the “Metaprop_one” function. Results: A total of 511 records were identified after removing duplicates, 59 full‑texts were screened of which 15 studies were included in the meta‑analysis. Only one study was conducted in rural India, with <95% adherence reported by all its participants. The PLHIV reported several reasons for their ART nonadherence including forgetfulness (8/15), running out of pills (3/15), distance from the health center and associated travel (2/15), alcohol abuse (3/15), concealment of HIV status from family (2/15, felt stigma (2/15), depressive symptoms (2/15), and fear of side‑effects (2/15). The overall pooled estimate of ART adherence was 54.1% (95% confidence interval [CI] 27%–81%), while among facility‑based studies, the ≥95% adherence rate was significant higher. 62% (95% CI 46%–0.78%). Conclusions: Despite the universal provision of free of cost ART to all PLHIV in government health facilities in India, suboptimal adherence to treatment persists in nearly half of these patients. [ABSTRACT FROM AUTHOR]

Context: Combating human immunodeficiency virus/acquired immunodeficiency syndrome epidemic has been possible due to advances in prevention strategies and Antiretroviral therapy (ART). Optimal adherence to ART is a major factor in achieving the desired immunological, virological, and patient well‑being outcomes. Several socio‑demographic, patient, treatment, and health‑care system‑related factors influence nonadherent behavior to ART. Aims: This study was planned to assess (1) ART adherence level, (2) factors and reasons associated with nonadherence, and (3) impact of suboptimal adherence on treatment outcomes. Settings and Design: This was a cross‑sectional analytical study of 300 patients in a tertiary care hospital in Puducherry, India. Methods: Random sampling was used to collect data from patient treatment cards and a predesigned structured questionnaire. The pill count method was used to calculate adherence level. Statistical Analysis Used: Nonadherence was chosen as a dependent variable and factors affecting adherence were chosen as independent variables. Test for significance was carried out by Chi‑square test and Fisher’s exact test. Results: Optimal adherence was seen in 68.3%. Factors significantly associated with nonadherence were lower education level, high prior CD4 count, irregular follow‑up, missing doses in the past, and being late for pharmacy pill refills. Adherence was positively associated with mean increase in CD4 count over 6 months. Conclusions: In our study, the adherence rate is suboptimal which can lead to failure of ART. Nonadherence was associated with a decrease in CD4 count overtime. Most of the factors significantly affecting ART adherence were patient behavior related. These factors can be used for target intervention during reinforcement adherence counseling. [ABSTRACT FROM AUTHOR]

Introduction: Understanding the pathophysiology of HIV infection has been crucial to the design of effective anti-viral strategies. HIV infection is declining worldwide due to early diagnosis and the effective long-term use of anti-retroviral therapy. New infections decreased from 3.3 million in 2002–2.3 million in 2012. However, in the Middle East and North Africa (MENA), an estimated 83,000 individuals still acquired the virus, with 37,000 morbidities reported. The first incidence of acquired immunodeficiency syndrome (AIDS) from the Kingdom of Saudi Arabia (KSA) was reported in 1984. By the end of 2013, around 1509 patients had been diagnosed with HIV infection. HIV surveillance has improved in KSA with advances in medical care, counseling, family planning, diagnostic evaluation, and anti-retroviral therapy, but challenges remain. Patients receiving anti-retroviral therapy still show significant morbidity and mortality. Further targeted treatment regimens and preventive strategies are required to control HIV infection in KSA. Progress towards meeting the 90–90–90 goals for HIV in the MENA has also not been systematically monitored. Method: In this review, we examine current screening programs, therapeutic modalities, the emergence of drug resistance, and future perspectives for HIV-associated health care in KSA. Conclusion: The aim is to offer insight for healthcare policymakers to comply with the UNAIDS 2020 vision program and help establish the prevailing paradigms in the HIV community for an AIDS-free generation and the 90–90–90 goals for diagnosis.

Tagese Yakob Barata,1 Girumneh Abiso,2 Eskinder Israel,3 Simegn Molla,4 Eskinder Wolka4 1Department of Public Health Emergency, Institute of Bele Awassaa Health Office, Wolaita, Ethiopia; 2Department of Infection Prevention and Health Promotion, Institute of Sodo Town Health Office, Wolaita, Ethiopia; 3Department of Reproductive Health, Institute of Public Health, Wolaita Sodo University, Wolaita, Ethiopia; 4Department of Epidemiology and Biostatistics, Institute of Public Health, Wolaita Sodo University, Wolaita, EthiopiaCorrespondence: Tagese Yakob Barata, Email yitagesuj@gmail.comBackground: Although the goal of ART is to have better health, extend the life of the HIV-infected patient, and decrease HIV-related death, there is a continuation of HIV-related mortality with the use of ART. This study aimed to assess the incidence of mortality and its predictors among adult HIV/AIDS patients who were on ART follow-up at Wolaita Sodo Comprehensive specialized hospital in southern Ethiopia.Methods: A retrospective follow-up study was conducted from May 1 to June 30, 2021 among adult HIV/AIDS patients with a total of 441 adult HIV/AIDS patients in this hospital included. Kaplan–Meier failure curve and Log rank test were fitted, and Cox-proportional hazards model was also used to identify the predictors of mortality. Both crude and adjusted hazard ratios (AHR) with their 95% confidence interval (CI) were calculated to show the strength of association. The proportional assumption was conducted by using a global test based on the Schoenfeld residuals.Results: Incidence of the mortality rate was 5.61 (95% CI, 4.2– 7.3) per 100 person-years observation. In the multivariable analysis, HIV/AIDS patients were widowed (aHR; 10.9 (95% CI, 3.13– 37.99), poorly drug-adhered (aHR; 5.6 (95% CI, 2.4– 13.2) and fair adhered (aHR; 3.53 (95% CI, 1.58– 7.87), WHO clinical stage IV (aHR; 5.91, (95% CI, 1.41– 24.71), history of substance use (aHR; 2.02 (95% CI, 1.01– 4.06) and history of IV drug use (aHR; 2.26 (95% CI, 1.10– 4.74) independently predicted the mortality of patients.Conclusion: In this study, incidence of mortality was relatively high. The rate of mortality may be minimized by paying particular attention to individuals with widowing, substance use at the baseline, advanced clinical stage IV, history of IV drug use at the baseline, and those with adherence problems.Keywords: mortality, anti-retroviral therapy, HIV/AIDS, Wolaita Sodo town

Nigus Kabtu Belete, Darik Temesgen Assefa, Tesfaye Feleke Gadore, Manaye Yihune Teshale, Eshetu Zerihun Tariku School of Public Health, College of Medicine and Health Science, Arba Minch University, Arba Minch, EthiopiaCorrespondence: Nigus Kabtu Belete, Tel +251914552360, Email nigushabtu2014@gmail.comIntroduction: Overweight/obesity is an emerging public health problem in low income countries. Currently sub-Saharan African countries are facing a double burden of malnutrition. Evidence has shown that overweight/obesity is becoming a problem for people living with HIV. But little is known in our setting. Thus, this study is designed to assess the association between overweight/obesity and ART drug regimen among adult HIV patients in Gamo zone public health facilities southern Ethiopia.Objective: To assess the association between overweight/obesity and ART drug regimen among adult HIV patients in Gamo zone public health facilities southern Ethiopia.Methods: Institution-based cross-sectional study was conducted from April 10 to May 10, 2022, among systematically selected adult HIV patients. The data were collected by using a structured interviewer-administered questionnaire, patient record review, and physical measurements. Multivariate logistic regression model was used to assess the association between dependent and independent variables. A p-value < 0.05 with its 95% CI was considered as a statistically significant and interpreted accordingly.Results: The magnitude of overweight/obesity were 13.5% (95% CI:(10.4– 17.2)). Being male (2.484(1.308, 4.716)), duration on ART (took for ≥ 5 years) ((2.249(1.218, 4.152)), and ART drug regime (3.789(1.965, 7.304)) were significantly associated with overweight/obesity.Conclusion: Overweight/obesity is significantly associated to ART drug regimen type among adult HIV patients. Furthermore, sex and duration on ART drug were found significantly associated with overweight/obesity of adult HIV patients.Keywords: obesity, overweight, HIV, anti-retroviral therapy, drug, Gamo zone, Ethiopia

ObjectiveThis study aimed to study the relationship between auto-antibodies against apolipoprotein A1 (anti-apoA1 IgG), human immunodeficiency virus (HIV) infection, anti-retroviral therapy (ART), and the tryptophan pathways in HIV-related cardiovascular disease.DesignThis case–control study conducted in South Africa consisted of control volunteers (n = 50), people living with HIV (PLWH) on ART (n = 50), and untreated PLWH (n = 44). Cardiovascular risk scores were determined, vascular measures were performed, and an extensive biochemical characterisation (routine, metabolomic, and inflammatory systemic profiles) was performed.MethodsAnti-apoA1 IgG levels were assessed by an in-house ELISA. Inflammatory biomarkers were measured with the Meso Scale Discovery® platform, and kynurenine pathway metabolites were assessed using targeted metabolomic profiling conducted by liquid chromatography-multiple reaction monitoring/mass spectrometry (LC-MRM/MS).ResultsCardiovascular risk scores and vascular measures exhibited similarities across the three groups, while important differences were observed in systemic inflammatory and tryptophan pathways. Anti-apoA1 IgG seropositivity rates were 15%, 40%, and 70% in control volunteers, PLWH ART-treated, and PLWH ART-naïve, respectively. Circulating anti-apoA1 IgG levels were significantly negatively associated with CD4+ cell counts and positively associated with viremia and pro-inflammatory biomarkers (IFNγ, TNFα, MIPα, ICAM-1, VCAM-1). While circulating anti-apoA1 IgG levels were associated with increased levels of kynurenine in both control volunteers and PLWH, the kynurenine/tryptophan ratio was significantly increased in PLWH ART-treated.ConclusionHIV infection increases the humoral response against apoA1, which is associated with established HIV severity criteria and kynurenine pathway activation.

Stigma toward People Living with Human Immunodeficiency Virus (PLHIV) remains a public health concern in Ghana and beyond. Whereas several studies have associated Anti-Retroviral Therapy (ART) services with stigma, the specific forms, and key drivers of stigma towards ART clients in poverty-stricken settings have not been exhaustively explored. Based on a case study of ART clients in the Upper East Region, this study explores the specific forms and the main drivers of stigma towards ART clients. We employed a qualitative research approach in the collection and analysis of the data. Purposive sampling was used to select the ART facilities and staff, and a convenient sampling procedure was employed to select the ART clients to participate in semi-structured key informant interviews. Barriers such as lack of knowledge, cultural norms, and a weak enabling environment were found to drive ‘public stigma’ and ‘self-stigma’ towards ART clients in the region. The former manifests in gossip, finger-pointing, insults, mockery, avoidance, and refusal of employment; while self-stigma was shown in a ‘feeling of guilt’, ‘self-isolation’, ‘excessive thinking’, ‘fear of insults’, and ‘fear of death’. These may lead to adverse health outcomes and loss of livelihoods. Therefore, we advocate the immediate and strict implementation of existing policies and legislation that aim to eliminate HIV-induced stigma in communities. Within this implementation framework, the Ghana Health Service, the Ghana AIDS Commission, the Christian Health Association of Ghana, and Non-Governmental Organizations (NGOs) in health are entreated to employ culturally appropriate education to increase awareness of the effectiveness of ART and promote the adoption of accepting attitudes towards ART clients in communities. We also recommend the conduct of a large-scale mixed methods research to identify specific forms of stigma encountered by ART clients in the country to inform the (re)design and implementation of ART anti-stigma policies and programmes.

HIV/AIDS prevalence in Botswana is amongst the highest in the world and remains a significant public health problem. however, the introduction of anti-retroviral therapy (ART) lead to a significant reduction in morbidity and mortality. Decentralization of anti-retroviral therapy has improved access to treatment for people living with HIV. Treatment outcomes for patient initiated on treatment at different levels of care is unknown and this study seeks to compare treatment outcomes of patients enrolled on ART at different levels of the health care. This is a retrospective crosssectional study that included review of data from January 2017 to December 2018. The study was conducted in 2 health districts in the country. Nine hundred and sixty (960) patient's record were included in analysis. More than half (63%) of patients were enrolled at primary care level while 37% were at tertiary level. Sixty one percent (n = 587) were female while 39% (n = 373) were males. There were no statistically significant differences in viral load suppression after 12 months of treatment between patients enrolled at tertiary level and primary care level, x2 = 0.75, p value = 0.56. Time to initiation was longer at tertiary (median = 126) compared to primary are level (median = 18), p < 0.001. We reccommend further decentralization of ART services to lower levels of the health care system to initiate PLWHIV early on treatment and improve their health outcomes and reduce transmission through treatment by prevention. [ABSTRACT FROM AUTHOR]

Background: People living with HIV (PLWH) might be at risk of more severe COVID-19. Although anti-retroviral therapy (ART) may have theoretical activity against COVID-19, which can protect PLWH from COVID-19. Therefore, this study aims to assess the negative consequences of the COVID-19 lockdown on HIV care and antiretroviral therapy (ART) adherence. Methods: This cross-sectional study included HIV+ patients in Jeddah aged =18 years old who had clinic visits during the lockdown period (April-August 2020) and were on ART for = 2 years; newly diagnosed patients were excluded. Data were collected by a tele-questionnaire and electronic medical records system. Results: A total of 85 participants were recruited. The results showed that 58.82% of participants reported no change in their ART adherence during the lockdown, whereas 37.65% increased and 3.53% had decreased compliance. About 63.53% of participants could come to the clinic, yet 36.47% were disturbed. Approximately 10.59% couldn't reach healthcare providers, and nearly 89.41% could disclose their healthcare providers during the lockdown. Thus, 95.29% disagreed that the lockdown affected their HIV care in general. Though, 34.11% did not have ART refills for some period during the pandemic, with median days of 13 [IQR: 5-30]. Clinically, no significant change was observed in lab results before and after the lockdown. Conclusion: The results showed a minimum negative impact on HIV care during the COVID-19 lockdown; this might be due to the enhanced policies applied by the hospital. However, additional research is necessary to raise the standard of healthcare in Saudi Arabia. [ABSTRACT FROM AUTHOR]

Understanding the pathophysiology of HIV infection has been crucial to the design of effective anti-viral strategies. HIV infection is declining worldwide due to early diagnosis and the effective long-term use of anti-retroviral therapy. New infections decreased from 3.3 million in 2002–2.3 million in 2012. However, in the Middle East and North Africa (MENA), an estimated 83,000 individuals still acquired the virus, with 37,000 morbidities reported. The first incidence of acquired immunodeficiency syndrome (AIDS) from the Kingdom of Saudi Arabia (KSA) was reported in 1984. By the end of 2013, around 1509 patients had been diagnosed with HIV infection. HIV surveillance has improved in KSA with advances in medical care, counseling, family planning, diagnostic evaluation, and anti-retroviral therapy, but challenges remain. Patients receiving anti-retroviral therapy still show significant morbidity and mortality. Further targeted treatment regimens and preventive strategies are required to control HIV infection in KSA. Progress towards meeting the 90–90–90 goals for HIV in the MENA has also not been systematically monitored. In this review, we examine current screening programs, therapeutic modalities, the emergence of drug resistance, and future perspectives for HIV-associated health care in KSA. The aim is to offer insight for healthcare policymakers to comply with the UNAIDS 2020 vision program and help establish the prevailing paradigms in the HIV community for an AIDS-free generation and the 90–90–90 goals for diagnosis. [ABSTRACT FROM AUTHOR]

Eshetu Erjino, Ermias Abera, Lire Lemma Tirore Department of Public Health, College of Medicine and Health Sciences, Wachemo University, Hossana, Sothern EthiopiaCorrespondence: Lire Lemma Tirore, Email ganetlemma@gmail.comBackground: Unsuppressed viral load count in patients on anti-retroviral therapy is linked to poorer survival and increased transmission of the virus. Despite efforts made in Ethiopia, the viral load suppression rate is still low.Objective: To estimate time to viral load suppression and predictors of viral load suppression among adults on anti-retroviral therapy in Nigist Elen Mohamed Memorial Comprehensive Specialized Hospital, 2022.Materials and Methods: A retrospective follow-up study was conducted among 297 adults on anti-retroviral therapy from January 1, 2016, to December 31, 2021. A simple random sampling technique was used to select study participants. The data were analyzed using STATA 14. Cox regression model was used. The adjusted hazard ratio with 95% CI was estimated.Results: A total of 296 records of patients on anti-retroviral therapy were included in this study. The incidence of viral load suppression was 9.68 per 100-person months. The median time for viral load suppression was 9 months. Patients with baseline CD4 ≥ 200 cell/mm3 (AHR: 1.87; 95% CI = 1.34, 2.63), who had no opportunistic infections (AHR = 1.84; 95% CI = 1.34, 2.52), who were on WHO clinical stage-I or II (AHR = 2.12; 95% CI = 1.18, 3.79) and who have taken tuberculosis preventive therapy (AHR = 2.24; 95% CI = 1.66, 3.02) had higher hazards of viral load suppression.Conclusion: The median time for viral load suppression was 9 months. Patients who had no opportunistic infection, with higher CD4 count, on WHO clinical stage-I or II, who have taken tuberculosis preventive therapy had higher hazards of viral load suppression. Careful monitoring and counseling of patients with CD4 levels lower than 200 cells/mm3 are necessary. Careful monitoring and counseling of patients in advanced WHO clinical stages, with lower CD4 count levels and with opportunistic infections is crucial. Strengthening the provision of tuberculosis preventive therapy is warranted.Keywords: anti-retroviral therapy, viral load suppression, predictor

Abstract Purpose This review aimed to determine what methods are used to assess nutritional status, the levels of nutritional status, determinants of undernutrition, and nutritional interventions employed for adolescents with HIV on Anti-Retroviral Therapy follow-up in Low- and Middle-Income countries. Methods Established methods were used to systematically identify and retrieve studies published in five databases between January 2000 to May 2021, and citation searching. Quality was appraised and findings were synthesized using narrative analysis and meta-analysis. Result Body Mass Index is the major indicator of nutritional status. The pooled prevalence of stunting, wasting, and overweight were 28.0%, 17.0%, and 5.0%, respectively. Adolescent males are 1.85 and 2.55 times more likely than adolescent females to suffer from both stunting and wasting at AOR = 1.85 (95%:1.47, 2.31) and AOR = 2.55 (95%: 1.88, 3.48), respectively. Similarly, adolescents with a history of opportunistic infections were 2.97 times more likely to be stunted than uninfected adolescents, AOR = 2.97 (95%:1.73, 5.12). One single intervention study found significant improvements in anthropometric status after nutritional supplementation. Conclusion and recommendation The few studies that have been conducted on nutritional status in adolescents living with HIV in low- and middle-income countries indicate that stunting and wasting are common in this population. Avoiding opportunistic infections is an important protective factor but the review highlighted the generally inadequate and fragmented nature of nutritional screening and support programs. Development of comprehensive and integrated systems for nutritional assessment and intervention services during ART follow-up should be prioritized to improve adolescent clinical outcomes and survival.

Abstract Background Supporting people living with HIV using anti-retroviral therapy (ART) is important due to the requirement for strict medication adherence. To date, no data from longitudinal studies evaluating adherence by treatment-naïve people living with HIV are currently available. We investigated the adherence of treatment-naïve people living with HIV over time and examined the relationships among decisional conflicts, adherence, and health-related quality of life (HRQL). Methods The survey items included adherence (visual analogue scale [VAS]), decisional conflict (decisional conflict scale [DCS]), and HRQL (Medical Outcomes Study HIV Health Survey [MOS-HIV]). The DCS and MOS-HIV scores and the VAS and MOS scores were collected electronically at the ART initiation time point and at 4-, 24-, and 48-week post-treatment time points. Results A total of 215 participants were enrolled. The mean DCS score was 27.3 (SD, 0.9); 23.3% of participants were in the high-score and 36.7% in the low-score groups. The mean adherence rates at 4, 24, and 48 weeks were 99.2% (standard error [SE], 0.2), 98.4% (SE, 0.4), and 96.0% (SE, 1.2), respectively. The least-square means of the MOS-HIV for the DCS (high vs. low scores) were 64.4 vs. 69.2 for general health perceptions and 57.7 vs. 64.0 for HRQL, respectively. Conclusion Adherence among treatment-naïve people living with HIV was maintained at a higher level, and HRQL tended to improve with ART. People with high levels of decisional conflict tended to have lower HRQL scores. Support for people living with HIV during ART initiation may be related to HRQL.

Association between protease inhibitors (PI) and Type II diabetes mellitus (T2DM) in human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) patients is largely debated. This study examined the odds of developing T2DM among HIV/AIDS Medicare beneficiaries treated with PI and possible racial disparities in the odds. We performed a nested casecontrol study of Medicare database 2013–2017. We included HIV/AIDS positive beneficiaries who were enrolled continuously in Medicare Part A/B with no previous history of T2DM. PI-users were matched to non-PI users and non-anti-retroviral therapies (ART) users using a1:1 greedy propensity score (PS) matching. Multivariablee logistic regressions were performed to assess the odds of developing T2DM. The analysis included 2,353 HIV/AIDS beneficiaries. Matched samples were generated for PI vs. non-PI groups (n = 484) and PI vs. non-ART groups (n = 490). Compared to the non-PI group, the odds of developing T2DM were higher in PI-users (AOR: 1.76; 95% CI: 1.17–2.64), in Caucasian PI-users (AOR: 1.81; 95% CI: 1.02–3.22) and in African-American PI-users (AOR: 1.86; 95% CI: 1.03–3.36). Compared to the non-ART group, the odds of developing T2DM were higher in PI-users (AOR: 1.87; 95% CI: 1.25–2.81), in Caucasian PI-users (AOR: 1.96; 95% CI: 1.14–3.39) and in African-American PI-users (AOR: 2.05; 95% CI: 1.03–4.09). The use of PI is associated with higher odds of T2DM; odds were higher among African-Americans than Caucasians. [ABSTRACT FROM AUTHOR]

Background: The effect of alcohol consumption and human immunodeficiency virus (HIV) disease prognosis has been examined in several studies with inconsistent findings. We sought to determine the effect of alcohol consumption on HIV disease prognosis by examining CD4+ T cell count/µL (CD4+ count) and HIV RNA concentration [HIV viral load (VL)] independent of anti-retroviral therapy (ART). Methods: A secondary analysis was performed on a cross-sectional survey data of 1120 participants between 2018 and 2020. Questionnaires were used to obtain the participants' history of alcohol consumption. Blood samples were assayed for CD4+ T cell count/µL (CD4+ count) and HIV RNA concentration (HIV viral load). The history of alcohol consumption was categorized into non-alcohol consumers, non-heavy alcohol consumers, and heavy-alcohol consumers. Age, cigarette smoking, gender, and ART use were considered potential confounders. Participants were categorized into two cohorts for the analysis and a multivariate logistic regression was used to establish relationships among virally unsuppressed participants who were ART-experienced and ART-naïve. Results: A total of 1120 participants were considered for analysis. The majority were females (65.9%) between 15-39 years (72.4%). The majority were non-smokers and non-alcohol consumers (88% and 79%, respectively). ART-experienced females had an increased risk of having a higher VL (VL > 1000). This finding was statistically significant [RR, 0.425, 95% CI, (0.192-0.944), p-value, 0.036]. However, ART-experienced participants aged above 64 years had an increased risk of having a lower VL (VL < 1000 copies/mL) and a lower risk of having a higher VL (VL > 1000). However, ART-naïve participants aged between 40-64 years had a significantly lower risk of having higher CD4 count (CD4+ > 500 cells) and an increased risk of having a lower CD4 count [OR, 0.566 95% CI, (0.386-0.829), p-value, 0.004]. History of alcohol consumption did not have a significant effect on CD4+ cell count and VL in neither the ART-experienced nor the naïve cohort. Conclusions: Female middle-aged people living with HIV (PLWH) are more likely to have a poorer HIV disease state, independent of alcohol consumption. Alcohol consumption may not have a direct effect on CD4+ cell count and VL in either ART-naïve or experienced patients. [ABSTRACT FROM AUTHOR]

Human immunodeficiency virus-associated salivary gland disease is a complication seen in patients infected with the human immunodeficiency virus (HIV), with the commonest manifestation being the benign lymphoepithelial cyst (BLEC). The purpose of this study was to systematically review the effects of antiretroviral therapy (ART) in Human Immune Virus-infected patients with confirmed benign lymphoepithelial cysts of the parotid gland. The review was conducted between August 2020 and December 2021 using the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. Patients infected with a diagnosis of BLEC of parotid gland based were included. Studies from all countries were included with no age, language, and time restrictions. We used Microsoft Excel to create a data extraction form piloted before the official start. Inter-rater agreement was calculated for most of the data collection. The risk of bias was assessed using a Cochrane tool. After reviewing 512 records, 42 met the study criteria with a total of 785 patients. The median sample size of all eligible studies was 10 ranging from 2 to 60. The pooled mean age was 29 years ± 24.2. Studies primarily assessed the effect of ART on BLECs. Patients examined in the studies ranged from children to the elderly. Studies from South Africa had a higher proportion of women while American studies had a higher proportion of men. There is evidence that ARVs are effective in treating BLEC and may be used as first-line therapy for HIV infected patients. [ABSTRACT FROM AUTHOR]

The prevalence of age-related comorbidities is increased in people living with HIV, even in those well-controlled on combination antiretroviral therapy (ART). Persistent immune activation and inflammation may play pivotal roles in the pathogenesis; however, the burden of morbidities in the older HIV infected population may be exacerbated and driven by distinct mechanisms. In a cross sectional study of 45 HIV-infected participants 60 years or older, we examined the relationships between 14 immunomodulatory and inflammatory factors and the Veterans Aging Cohort Study (VACS) Index, a metric of multimorbidity and mortality comprised of age, CD4 count, hemoglobin, Fibrosis-4 [FIB-4], and estimated glomerular filtration rate [eGFR], by linear regression analysis. All participants were virally suppressed (

Abstract Background Uganda’s current guidelines recommend immediate initiation of Anti-Retroviral Therapy (ART) for persons living with HIV in order to reduce HIV/AIDS related morbidity and mortality. However, not all eligible PLHIV initiate ART within the recommended time following HIV diagnosis. We assessed the prevalence and factors associated with delayed ART initiation among PLHIV referred for ART initiation, five years since rolling out the test and treat guidelines. Methods In this cross-sectional study, we enrolled adult patients referred to Mulago Immune Suppressive Syndrome (Mulago ISS) clinic for ART initiation from January 2017 to May 2021. We collected data on socio-demographics, HIV diagnosis and referral circumstances, and time to ART initiation using a questionnaire. The outcome of interest was proportion of patients that delayed ART, defined as spending more than 30 days from HIV diagnosis to ART initiation. We performed multivariable logistic regression and identified significant factors. Results A total of 312 patients were enrolled of which 62.2% were female. The median (inter-quartile range [IQR]) age and baseline CD4 count of the patients were 35 (28–42) years and 315 (118.8–580.5) cells/μL respectively. Forty-eight (15.4%) patients delayed ART initiation and had a median (IQR) time to ART of 92 (49.0–273.5) days. The factors associated with delayed ART initiation were; 1) having had the HIV diagnosis made from a private health facility versus public, (adjusted odds ratio [aOR] = 2.4 (95% confidence interval [CI] 1.1–5.5); 2) initial denial of positive HIV test results, aOR = 5.4 (95% CI: 2.0–15.0); and, 3) having not received a follow up phone call from the place of HIV diagnosis, aOR = 2.8 (95% CI: 1.2–6.8). Conclusion There was significant delay of ART initiation among referred PLHIV within 5 years after the rollout of test and treat guidelines in Uganda. Health system challenges in the continuity of HIV care services negatively affects timely ART initiation among referred PLHIV in Uganda.

Abstract Background Acquired immune deficiency syndrome is an infectious disease caused by the human immunodeficiency virus (HIV) that primarily targets an individual's immune system. In Ethiopia, nearly 24% of HIV-related deaths occur in children under the age of five. However, studies regarding the survival time of HIV-positive under-five children after anti-retroviral therapy initiation are limited with poor evidence of predictors of death. Objective To assess survival time and predictors of death among HIV infected under-five children after initiation of anti-retroviral therapy in West Amhara Referral Hospitals, Northwest Ethiopia, 2021. Methods A multicenter institution-based retrospective follow-up study was conducted among 432 HIV-positive under-five children on anti-retroviral therapy selected by simple random sampling from January 2010 to December 2019. A standardized data extraction tool was employed, which was adapted from anti-retroviral therapy entry and follow-up forms. The event of interest for this study is death, whereas the absence of experience of death is censored. Data were entered into Epi-Data version 3.1 and exported to STATA version 14. The Kaplan–Meier curve was used to estimate the survival probability. The Cox regression model was used to identify independent predictors of death. Results Among the 415 records included in the final analysis, 25 (6.02%) of the individuals were died. The incidence rate of death was found to be 2.87 per 1000 child-months (95%CI: 1.94–4.25). The cumulative survival probabilities of children after 6, 12, 24, and 36 months were 0.97, 0.95, 0.92, and 0.85 respectively. HIV-infected under-five children who lived in rural areas (AHR 3.32:-95% CI 1.17–9.39), with poor adherence to anti-retroviral therapy (AHR = 3.36; CI: 1.06, 10.69), without Isoniazide prophylaxis (AHR = 3.15; CI: 1.11, 8.94) and with anemia (AHR: 3.05, 95% CI: 1.16, 8.03) were at higher risk of death. Conclusion and recommendation Death of HIV-infected under-five children on anti-retroviral therapy is high within the first one year after enrolment. Living in rural area, had poor adherence, lacked Isoniazide prophylaxis, and anemia were predictors of death. Therefore, clinicians shall emphasize for those specific risk factors of death and take action accordingly.

Abenezer Abraham Anito,1,&ast; Tsegaye Lolaso Lenjebo,2,&ast; Eskinder Woticha,2 Fithamlak Solomon3 1Ohio State University Global One Health Initiative, Addis Ababa, Ethiopia; 2School of Public Health, Wolaita Sodo University, Wolaita Sodo, Ethiopia; 3School of Medical Laboratory, Wolaita Sodo University, Wolaita Sodo, Ethiopia&ast;These authors contributed equally to this workCorrespondence: Abenezer Abraham Anito, Tel +251-94-142-0184 ; +251-90-201-3026, Email howmarad@gmail.comBackground: A majority of clients on first-line antiretroviral therapy with an initial high viral load will resuppress following an adherence intervention. Some sociodemographic and clinical characteristics were found to affect resuppression. Few reports on the outcome of the intervention and its associated factors in our country, with inconsistent results and some missed clinical factors of potential association, have compelled this study. The study aimed to assess the proportion of viral load suppression and associated factors among clients on antiretroviral therapy in public hospitals of Hawassa City Administration, Ethiopia.Methods: An institution-based cross-sectional study with retrospective document review was conducted among 342 participants on antiretroviral therapy enrolled for counseling since its start in November 2016. Data were captured using a pretested and structured checklist from all client charts with complete data, entered into EpiData 3.1.0 and exported to SPSS 27 for analysis. The proportion of viral load suppression was determined. Bivariate and multivariate logistic regressions were performed to identify associated factors. Statistical significance was determined at a 95% CI and P< 0.05.Results: The proportion of viral load suppression was found to be 40.9% (35.7%– 46.5%). Nevirapine-based antiretroviral treatment regimens (AOR 0.125, 95% CI 0.034– 0.464), malnutrition (AOR 0.565, 95% CI 0.329– 0.971), poor adherence (AOR 0.504, 95% CI 0.287– 0.886), lower CD4 count (AOR 0.149, 95% CI 0.071, 0.314), and fewer counseling sessions (AOR 0.330, 95% CI 0.149– 0.729) were significantly associated with viral load suppression.Conclusion: The proportion of viral load suppression is lower than that recommended by the World Health Organization. Nevirapine-based regimens, poor nutritional status, poor adherence, lower CD4 count, and fewer counseling sessions risk a lower proportion of viral load suppression. This calls for the need to devise strategies to address these factors and to revisit program implementation.Keywords: viral load suppression, antiretroviral therapy, enhanced adherence counseling, Hawassa, Ethiopia

Background: HIV testing services (HTS) are a component of HIV prevention and care programs in developed countries and have proven to be a cost-effective way of monitoring the disease, reducing risky behaviours and leading patients to other services. Objective: To determine the prevalence and risky behavioural factors associated with HIV among the attendees of HIV testing services in a part of Ogun state, Nigeria. Methods: This was a descriptive cross-sectional study of HTS clients in health facilities within Ogun State, Nigeria. A multi-stage sampling technique was used for data collection using a pretested, close-ended, interviewer-administered questionnaire. Results: A total of 800 respondents with a mean age of 32.57±10.39 years were surveyed. The prevalence of HIV was 1.6%. The majority (93.6%) of the respondents were sexually experienced. The percentage tested previously among study participants was 5.0%. This significantly comprised those below the age of 18 years (X2 = 22.01, p = 0.0001) and female respondents (Χ2 = 4.84, p = 0.028). Only 21 (2.6%) have had unprotected sex with a casual partner. Significantly more of the female respondent had been involved in this risky sexual behaviour (X2 = 4.52, p = 0.034). Only 7 (0.9%) had sex with multiple sexual partners in the last three months, and 17 (2.1%) were positive for symptomatic STI screening. Conclusion: The prevalence of HIV was low to be 1.6%, and the percentage tested previously was 5.0%. The practice of free HIV screening should be maintained to encourage more people to undergo the test.

Reservoirs of HIV remain a major obstacle to the complete eradication of virus despite regular anti‐retroviral therapy (ART). Memory stem cells (Tscm), one of the major reservoirs, are relatively less studied owing to their presence in lower numbers and inaccessible anatomical locations. We have evaluated the molecular characteristics of Tscms in patients with ART interruption (n = 15) versus patients on uninterrupted ART (n = 12) using flow cytometry. RNA sequencing was done in the sorted Tscms to study the differential gene expression. Patients with ART interruption had significantly lower baseline CD4+T‐cell counts and high viral loads as compared to patients on ART. The former group had significantly higher frequency of CD4+ and CD8+Tscms with a higher expression of PD‐1 on CD8+Tscms. The transcriptome profile of Tscm was significantly different among the patient groups. The main pathways were cellular and metabolic pathways, cellular development pathways, cell differentiation and negative regulation of cellular migratory pathways. An increased yet dysfunctional CD8+ memory stem cells describe HIV‐1‐infected patients with break‐in ART and a distinct transcriptional signature of CD4+ Tscm as compared to those of patients on ART. A more detailed understanding of the biology and dynamics of Tscm in future studies is warranted. Strategies to improve the functionality of the CD8+ Tscm will help these patients to tackle the outburst of viral replication that occurs after the cessation of therapy. [ABSTRACT FROM AUTHOR]

Objective To explore the effects of antiretroviral therapies with TDF or TAF and without TDF and TAF on CK -MB and CK in HIV/AIDS patients. Methods A retrospective analysis was conducted on newly treated HIV/AIDS patients from June 2020 to December 2020 in the outpatient department of Changsha First Hospital. The general data of 365 HIV/AIDS patients were analyzed. Levels of CK-MB and CK at baseline and weeks 12, 24, and 48 were collected respectively, so were the baseline and 48-week electrocardiogram and color Doppler echocardiography. Results Among 365 HIV/AIDS patients, 326 were male and 39 were female. The aver- age age was (32.56 ± 10.20) years. CK-MB was different in different treatment periods (F = 26.58, P < 0.05) . There was interaction between different antiviral treatment periods and antiviral regimens (F = 95.57, P < 0.05). There was a difference in CK-MB among different antiviral regimens (F = 174.98, P < 0.05), in which the CK-MB in the TDF-containing group became higher and higher as the prolonged treatments. There was no difference in CK among different treatment periods (F = 3.14, P = 0.07). There was no interaction between different antiviral regimens and antiviral regimens (F = 1.81, P = 0.16). However, there were differences in CK among different antiviral regimens (F = 4.47, P = 0.01). There was no statistical difference in the incidence of ECG abnormalities at baseline and week 48 among different ART protocols (χ² = 0.58, P = 0.75; χ² = =3.14, P = 0.21). There was no statistical difference in the incidence of cardiac color ultrasound abnormalities at baseline and week 48 between different ART protocols (χ² = 1.32, P = 0.52; χ² = 0.58, P = 0.75). Conclusions Different anti-virus therapies have impacts on CK -MB and CK in HIV/AIDS patients, especially the TDF-containing therapy shows a greater impact, but it has no significant impact on ECG and cardiac color ultrasound. [ABSTRACT FROM AUTHOR]

Purpose: This review aimed to determine what methods are used to assess nutritional status, the levels of nutritional status, determinants of undernutrition, and nutritional interventions employed for adolescents with HIV on Anti-Retroviral Therapy follow-up in Low- and Middle-Income countries. Methods: Established methods were used to systematically identify and retrieve studies published in five databases between January 2000 to May 2021, and citation searching. Quality was appraised and findings were synthesized using narrative analysis and meta-analysis. Result: Body Mass Index is the major indicator of nutritional status. The pooled prevalence of stunting, wasting, and overweight were 28.0%, 17.0%, and 5.0%, respectively. Adolescent males are 1.85 and 2.55 times more likely than adolescent females to suffer from both stunting and wasting at AOR = 1.85 (95%:1.47, 2.31) and AOR = 2.55 (95%: 1.88, 3.48), respectively. Similarly, adolescents with a history of opportunistic infections were 2.97 times more likely to be stunted than uninfected adolescents, AOR = 2.97 (95%:1.73, 5.12). One single intervention study found significant improvements in anthropometric status after nutritional supplementation. Conclusion and recommendation: The few studies that have been conducted on nutritional status in adolescents living with HIV in low- and middle-income countries indicate that stunting and wasting are common in this population. Avoiding opportunistic infections is an important protective factor but the review highlighted the generally inadequate and fragmented nature of nutritional screening and support programs. Development of comprehensive and integrated systems for nutritional assessment and intervention services during ART follow-up should be prioritized to improve adolescent clinical outcomes and survival. [ABSTRACT FROM AUTHOR]