Acquired Immunodeficiency Syndrome Research Articles

Insights into gastrointestinal manifestation of human immunodeficiency virus: A narrative review

Human immunodeficiency virus (HIV) modifies CD4-positive cells, resulting in immunodeficiency and a wide range of gastrointestinal (GI) manifestations. The burden of HIV-related GI illnesses has significantly evolved with the widespread use of antiretroviral therapy (ART). While ART has effectively reduced the occurrence of opportunistic infections, it has led to an increase in therapy-related GI illnesses. Common esophageal conditions in HIV patients include gastroesophageal reflux disease, idiopathic esophageal ulcers, herpes simplex virus, cytomegalovirus (CMV), and candidal esophagitis. Kaposi’s sarcoma, a hallmark of acquired immunodeficiency syndrome, may affect the entire GI system. Gastritis and peptic ulcer disease are also frequently seen in patients with HIV. Diarrhea, often linked to both opportunistic infections and ART, requires careful evaluation. Bloody diarrhea, often a sign of colitis caused by bacterial infections such as Shigella or Clostridium difficile, is prevalent. Small bowel lymphoma, although rare, is increasing in prevalence. Anorectal disorders, including proctitis, fissures, and anal squamous cell carcinoma, are particularly relevant in homosexual men, underlining the importance of timely diagnosis. This review comprehensively explores the epidemiology, pathogenesis, and treatment considerations for the various GI disorders associated with HIV, highlighting the importance of accurate diagnosis and effective treatment to improve outcomes for HIV-infected patients.

Tumour necrosis factor-α induces macromolecule translocation in HIV-derived duodenal organoids

BackgroundDisease progression from human immunodeficiency virus (HIV) infection to acquired immunodeficiency syndrome (AIDS) is marked by chronic immune activation, partly due to increased translocation of gut-derived microbial antigens. Elevated mucosal tumour necrosis factor-α (TNF-α) and resulting epithelial cell apoptosis may be the etiology. However, studies using carcinoma cell lines have failed to find a causal link, possibly due to cellular abnormalities related to the malignant transformation of these immortal cell lines.MethodsWe established intestinal organoid monolayers from healthy controls and HIV-infected adults and characterized their growth dynamics and cellular composition. We then examined the effects of HIV-associated cytokines on transepithelial resistance (TER), apoptosis and macromolecule translocation.ResultsOrganoid monolayers from HIV-infected patients grew similarly to healthy controls, forming confluent monolayers within one to two weeks containing enterocytes, Paneth, goblet and stem cells. IFN-γ synergized with TNF-α, allowing TNF-α to cause caspase-mediated apoptosis and TER reduction within 5 ± 3 hours, reflecting patient sample heterogeneity. This led to paracellular passage of 4 kDa Dextran and transcytosis of 44 kDa horse radish peroxidase, both of which could be blocked by pan-caspase inhibitor, Q-VD-Oph.ConclusionOur study confirms that intestinal organoid monolayers from biopsies of HIV-infected individuals can be used to study apoptosis-related epithelial barrier dysfunction and macromolecular translocation. We provide direct evidence that TNF-α-induced apoptosis triggered two pathways of macromolecular translocation: paracellular passage via apoptotic leaks and transcytosis. Therapies targeting apoptosis may be useful in preventing disease progression from HIV to AIDS.

HIV infections and AIDS in Poland in 2022.

In 2022 due to increase in the number of migrants from Ukraina changes in HIV epidemiological situation in Poland was noticed e.g., double number of new infections, increase among women and children. The aim of the study was to assess the epidemiological situation of newly diagnosed HIV infections, AIDS cases and death among AIDS cases in Poland in 2022 in comparison to the changes in preceding years. Analysis of the epidemiological situation was based on reports of newly detected HIV and AIDS cases received from doctors and laboratories and the results of the annual survey of HIV testing conducted among the laboratories throughout the country. A dataset on clients from anonymous Voluntary Testing and Counselling (VCT) network was also used. They are coordinated by the National AIDS Center, which anonymously collects epidemiological and behaviour data on people who come for testing. In 2022 there were 2 604 HIV cases newly diagnosed in Poland (diagnosis rate 6.88 per 100,000), including 753 among non-Polish citizens. The number of newly detected HIV infections increased by 78.2% compared to the previous year and was higher by 97.7% compared to the median in 2016-2020 years. The number of non-Polish citizens increased by 219,1%. The total number of AIDS cases was 137 (incidence 0.36 per 100,000). The HIV infection was most often detected in the age group 30-39 (36.6%) and among men (67.2%). Among cases with known transmission route, 42.9% concerned among men who had sexual contact with men and 41.9% by heterosexual contacts. The percentage of AIDS cases diagnosed at the same time with HIV diagnosis increased by more than 6 percent points in comparison to 2021. In 2022 the number of newly detected HIV infections increased significantly in Poland compared to the previous year, probably due to HIV infection registered among Ukrainian migrants.

Successfully salvaging a HIV-positive patient with mixed CIDP and meningoencephalitis: a case report

We describe an acquired immunodeficiency syndrome (AIDS) patient who first exhibited chronic inflammatory demyelinating polyneuropathy (CIDP) and subsequently developed meningoencephalitis due to ganciclovir (GCV)-resistant cytomegalovirus (CMV) infection. The patient first presented with peripheral nervous system (PNS) symptoms, followed by central nervous system (CNS) symptoms. Based on auxiliary examinations, including cerebrospinal fluid (CSF) tests, electromyography (EMG), brain magnetic resonance imaging (MRI) and GCV drug resistance tests, the patient was diagnosed with CIDP and meningoencephalitis due to CSF GCV-resistant CMV. After the combined application of intravenous immunoglobulin treatment, corticosteroid treatment, antiretroviral therapy (ART), and adjusted anti-CMV treatment, the patient achieved persistent relief. This case underscores the importance of considering CMV as a common etiology of neurological disorders in AIDS patients. It also highlights the necessity of prompt drug resistance testing when anti-CMV therapy yields suboptimal responses.

Co-infection of intestinal protozoa and intestinal parasites with Helicobacter pylori among HIV AIDS patients at Jimma Medical Center, Ethiopia.

Co-infection of intestinal protozoa and intestinal parasites with Helicobacter pylori among HIV AIDS patients at Jimma Medical Center, Ethiopia.

Identification of a novel small-molecule inhibitor of the HIV-1 reverse transcriptase activity with a non-nucleoside mode of action

BackgroundHuman immunodeficiency virus-1 (HIV-1) is the causative agent of acquired immunodeficiency syndrome, which is a major global health problem. Although combination antiretroviral therapy (cART) successfully expands the lifespan of HIV-1-infected patients, long-term cART often increases drug resistance and adverse effects. Therefore, efforts are ongoing to develop novel anti-HIV-1 drugs.MethodsThe anti-HIV-1 activities of compounds were investigated using TZM-bl reporter cell line, A3.01 T cell line, and peripheral blood mononuclear cells infected with several HIV-1 strains, including wild type and drug-resistance associated mutants. Next-generation sequencing analysis and in silico molecular docking studies were employed to determine the mode of action of the compound.ResultsWe identified a small-molecule inhibitor consisting of a thiadiazole core appended to two pyrazoles (BPPT), which exerted a highly potent inhibitory effect on HIV-1 infectivity, with a half-maximal effective concentration (EC50) of 60 nM, without causing cytotoxicity. In experiments with various HIV-1 strains and cell types, the potency of BPPT was found to be comparable to that of commercial antiretroviral agents (azidothymidine, nevirapine, and others). Further analysis of the mode of action demonstrated that BPPT is a novel type of HIV-1 non-nucleoside reverse transcriptase inhibitor (NNRTI). Analysis of viruses harboring drug-resistance-associated mutations showed that BPPT was potent against G190A (C or S) mutations in reverse transcriptase (RTase), exhibiting high-level resistance to other NNRTIs. Next-generation sequencing analysis of long-term treatment with BPPT displayed an RTase mutation profile different from that in the case of established NNRTIs. Given these data, in silico molecular docking studies demonstrated the molecular mechanism underlying the BPPT-mediated inhibition of RTase.ConclusionOur data suggest that BPPT is a novel small-molecule inhibitor of HIV-1 RTase and could serve as a promising chemical scaffold to complement or replace conventional treatments, particularly for overcoming resistance associated with the G190 mutation.

Repurposing Efavirenz, the HIV Antiretroviral Drug for Chikungunya Virus Infection.

Chikungunya virus (CHIKV) has frequently recurred in recent decades, causing outbreaks worldwide in tropical and subtropical regions. The re-emergence of CHIKV poses a substantial risk to human health, as no efficacious drugs are currently available to curb new outbreaks. Here, the anti-CHIKV activity of efavirenz was investigated by in vitro cell culture-based antiviral assays in different relevant cell lines. Efavirenz is a non-nucleoside reverse transcriptase inhibitor (NNRTI) used for the treatment of acquired immunodeficiency syndrome (AIDS), and it has good oral bioavailability, long half-life, and affordable low cost. This study demonstrated dose-dependent robust anti-CHIKV activity of efavirenz at low micromolar concentration in two different cell lines with 50% effective concentration (EC50) of 1.1 to 1.3 μM. Interestingly, efavirenz also inhibited the replication of Sindbis virus (SINV) at a low micromolar range indicating potential broad anti-alphavirus activity. Time of addition assay, direct transfection of virus replicon RNA, and minus-sense-specific reverse transcription polymerase chain reaction (RT-PCR) elucidated that efavirenz hinders the viral replication at an early stage after the virus entry by inhibiting the viral RNA synthesis. Further, the binding affinity of efavirenz toward purified capsid protein (CP) was observed, suggesting that CP could be one of the antiviral targets for efavirenz in addition to viral or host proteins involved in viral RNA replication. Finally, the in vivo efficacy of efavirenz was assessed in a murine model and a decrease in CHIKV viral load was observed. In summary, the present study underscores the potential of repurposing efavirenz for antiviral therapy against CHIKV to curb future viral outbreaks.

Development and validation of a nomogram for predicting the incidence of infectious events in patients with idiopathic inflammatory myopathies.

Infection is a leading cause of mortality in idiopathic inflammatory myopathies (IIMs). This study aimed to develop a nomogram for predicting severe infection risk in IIM patients. Patients with IIMs admitted to Zhongshan Hospital, Fudan University, from January 2015 to January 2022 were enrolled. They were randomly divided into derivation (70%) and validation (30%) sets. Univariate and multivariate Cox regression identified independent risk factors for severe infection, and the Akaike information criterion (AIC) was applied for model selection. A nomogram was constructed to predict severe infection risks at 6 months, 1 year, and 3 years. Predictive accuracy and discriminative ability were evaluated using the concordance index (C-index), calibration curves, and the area under the receiver operating characteristic curve (AUC). Decision curve analysis (DCA) assessed clinical utility. Kaplan-Meier (K-M) curves were used to analyze survival differences between high- and low-risk groups stratified by nomogram scores. Among 263 IIM patients, 81 experienced 106 severe infection events, with lower respiratory tract infections being the most common (47.2%). Independent risk factors included age at onset (HR 1.024, 95% CI 1.002-1.046, p=0.036), lactate dehydrogenase (HR 1.002, 95% CI 0.999-1.005, p=0.078), HRCT score (HR 1.004, 95% CI 1.001-1.006, p=0.002), and lymphocyte count (HR 0.48, 95% CI 0.23-0.99, p=0.048). The nomogram demonstrated strong predictive performance, with AUCs of 0.84, 0.83, and 0.78 for 6 months, 1 year, and 3 years in the derivation set, and 0.91, 0.77, and 0.64 in the validation set. Calibration curves showed good agreement between predicted and observed risks, while DCA demonstrated significant net benefit over individual predictors. Kaplan-Meier curves revealed significant differences in the cumulative risk of severe infection between high- and low-risk groups. Further validation in DM and ASS subgroups demonstrated that the nomogram effectively predicted severe infections, with AUCs of 0.86, 0.81, and 0.73 for DM and 0.86, 0.83, and 0.74 for ASS at 6 months, 1 year, and 3 years, respectively. We have developed a new nomogram to predict severe infection risk in IIM patients at 6 months, 1 year, and 3 years. This model aids clinicians and patients in formulating treatment and follow-up strategies.

A combined model based on lung CT imaging and clinical characteristics for the diagnosis of AIDS with infection of Talaromyces marneffei

ObjectiveTo construct a combined model based on the CT and clinical characteristics of acquired immune deficiency syndrome (AIDS) with infection of Talaromyces marneffei (TM) and evaluate the diagnostic efficacy of the combined model.MethodsA retrospective analysis was conducted on 225 patients with AIDS patients with pulmonary infection admitted to the Shanghai Public Health Clinical Center from February 2012 to October 2022. Based on the final microbiological test results, they were divided into a group infected with TM and a group not infected with TM. Univariate and multivariate analyses were conducted on the lung CT imaging and clinical characteristics of these 225 patients. A nomogram was used to construct a combined model, and a calibration plot was drawn to test the diagnostic efficacy of the combined model.ResultsMultivariate logistic regression analysis showed that fever, rash, elevated PLT, elevated Hb, CD4+T lymphocyte count < 50/ul, and lung CT histology features including diffuse punctate and nodular shadows, mass-like consolidation, consolidation shadows, single or multiple lung abscesses or cyst shadows, and pleural effusion were independent risk factors for the diagnosis of AIDS with TM infection (P < 0.05). The construction of a joint model using nomogram and calibration plot showed that the constructed joint model had a high degree of fit.ConclusionThe combined model constructed in this study has certain clinical value for evaluating whether AIDS co-infection is caused by TM.Clinical trialNot applicable.

Association of Hearing Loss With HIV in Children.

The study aimed to assess the incidence of hearing loss (HL) in children with human immunodeficiency virus (HIV) using pure-tone audiometry and to find the association of HL with the duration of the disease and severity of HIV infection. A cross-sectional study was done on 60 children in the age group of five to 18 years who presented to the anti-retroviral therapy (ART) clinic for follow-up. All children were confirmed cases of HIV by reverse transcription polymerase chain reaction (RT-PCR). For the study, all HIV-positive children were screened for any HL. Pure-tone audiometry was used for determining the hearing test. The degree and type of HL were assessed. The laterality of HL was assessed. The association of HL with the CD4 count and viral load was assessed. Mann-Whitney test, Fisher's exact test, and independent t-test were used for statistical analysis with a p-value < 0.05 being considered statistically significant. HL was present in 10 (16.67%) cases, and all of them had conductive HL. Six cases had unilateral HL, while four cases had bilateral HL. In the majority (seven (70.00%)) of patients, the degree of HL was mild, followed by moderate HL (two (20.00%)) and minimal in only one (10.00%) patient. Compared to the HL- group, the HL+ group had significantly lower mean CD4 counts (483 ± 247.17 vs. 690.32 ± 301.09, p-value = 0.046) and significantly higher median viral load (2036.5 vs. 0, p < 0.0001). A significantly strong positive correlation was seen between the severity of HL with the viral load (r = 0.749, p = 0.018), and a significantly very strong negative correlation was seen between the severity of HL with CD4 counts (r = -0.809, p = 0.008). An incidence rate of 16.67% HL was found among children with HIV. HL was predominantly mild in nature, and all cases had conductive HL. HL holds a direct correlation with increasing severity of HIV disease and subsequent falling of CD4 counts.Based on the results, it is recommended that all HIV-positive children must undergo routine audiology screening to determine the HL and provide them with audiological aid.

Comparison of CURB-65 and qSOFA Combined with Serum Markers and HRCT in Predicting Mortality in AIDS with Pneumocystis jirovecii Pneumonia.

To evaluate and compare the clinical predictive value of the CURB-65 and qSOFA scores, combined with serum markers and HRCT scores, in assessing mortality risk in Acquired Immunodeficiency Syndrome (AIDS) patients with Pneumocystis jirovecii pneumonia (PJP). Descriptive analytical study. Place and Duration of the Study: Department of Respiratory and Critical Care Medicine, Beijing Youan Hospital, Capital Medical University, Beijing, China, from January to December 2022. Patients with AIDS and PJP were divided into two groups based on prognosis: Non-survivors (n = 35) and survivors (n = 85). Clinical data such as WBC count, CRP, PCT, CD4+ T lymphocyte count, and so on were collected. CURB-65, qSOFA, and HRCT scores were calculated. Independent risk factors for mortality were identified using logistic regression analysis, and their clinical predictive value was assessed using the area under the ROC curve (AUC). The non-survivors group had longer mechanical ventilation duration, higher rate of tracheal intubation, WBC count, CRP, PCT, CURB-65 score, qSOFA score, and HRCT score, but lower CD4+ T lymphocyte count than the survivors group (p <0.05). Univariate and multivariate logistic regression identified WBC count 1.15 × 109/L, CURB-65 score (14), qSOFA score (11.02), and HRCT score (1.37) as independent risk factors for mortality in AIDS patients with PJP (p <0.05). ROC analysis showed that CURB-65 had better predictive value than qSOFA for individual indicators (p <0.001), and CURB-65 + HRCT + WBC outperformed qSOFA+ HRCT + WBC for combined indicators (p <0.001). The combination of the CURB-65 score, HRCT score, and WBC count may effectively assess disease severity and mortality risk in AIDS patients with PJP. Acquired immunodeficiency syndrome, Pneumocystis jirovecii pneumonia, CURB-65 score and qSOFA score, Serum markers, HRCT score, Mortality prediction.

Designing a multi-epitope vaccine targeting the HIV-1 subtype CRF01_AE in Indonesia.

Designing a multi-epitope vaccine targeting the HIV-1 subtype CRF01_AE in Indonesia.

Nurses’ knowledge and attitudes regarding HIV/AIDS in Erbil City: a cross-sectional study

Introduction: Lack of knowledge about the spread of human immunodeficiency virus (HIV) is the primary reason behind the discriminatory attitudes of nurses towards people living with HIV and acquired immunodeficiency syndrome (AIDS). Therefore, this study aimed to investigate nurses’ knowledge and attitudes towards HIV/AIDS. Methodology: This descriptive cross-sectional study involved 188 nurses working in two major public hospitals in Erbil city. The study participants were selected using a census method. The questionnaires were designed to specifically evaluate the nurses’ knowledge and attitudes towards HIV/AIDS. The data were analyzed using IBM SPSS version 26. Results: The mean score of knowledge about HIV/AIDS was 65.60 ± 9.79, which was at a moderate level. The mean score of attitudes toward HIV/AIDS was 36.64 ± 10.34, which was at a poor level. There was a low negative correlation between knowledge and attitude towards HIV/AIDS (p = 0.009). Married individuals and Muslims had higher knowledge, while participants aged over 30 years had a more positive attitude. Single individuals, urban residents, and Christians had more positive attitudes compared to their counterparts. Conclusions: Lack of knowledge of HIV/AIDS and its transmission can impede the care process, while a positive attitude towards patients with AIDS is essential for providing compassionate care. Therefore, it is crucial to explore effective strategies that can enhance healthcare providers’ knowledge and attitudes towards patients with AIDS. This approach can improve the quality of care provided to this vulnerable population.

Cardiovascular Manifestations of People Living with HIV/AIDS: A Report from a Tertiary Care Hospital

Abstract- BACKGROUND : To study the profile and characteristics of cardiovascular abnormalities among PLWHA (patients living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) at a tertiary care hospital in India. The association of cardiovascular abnormalities with the CD4 count and disease stages, according to the World Health Organization (WHO) classification, was also analyzed. METHODS : A total of 200 [diagnosed as per the NACO criteria] were compared with 50 healthy controls. The predominantly young cohort of our study represents the HIV/AIDS population of India patients with HIV/AIDS. All patients underwent blood investigations, chest X-ray, electrocardiography, echocardiography, High sensitive NT pro BNP RESULTS: The mean age of the patients was 38.66 ± 9.22 years, with a male-to-female ratio of 3.25:1. Echocardiographic abnormalities were found in 52% of the patients and 12% of the controls, with the most common abnormality being left ventricular diastolic dysfunction. Echocardiographic abnormalities were markedly more common in patients with a CD4 count of &lt;200/mL The advanced stage of the disease, according to the WHO classification, was also associated with an increased incidence of echocardiographic abnormalities. CONCLUSION : Cardiovascular abnormalities in the form of electrocardiogram and ECHO findings were present in 54.5% and 52% of patients, respectively. Echocardiographic findings showed significant correlation with CD4 count and WHO disease stage.

The Association Between Syphilis Infection and HIV Acquisition and HIV Disease Progression in Sub-Saharan Africa

Syphilis and other sexually transmitted infections (STIs) are highly prevalent in most regions experiencing severe human immunodeficiency virus (HIV) epidemics. In sub-Saharan Africa, the region most heavily affected by HIV, the prevalence of syphilis among people living with HIV (PLWH) is notably high. This region accounts for 40% of global STIs and 70% of HIV cases. Despite the high prevalence of syphilis and other STIs among PLWH in the region, there are limited studies on the interplay between the two infections from the region. Most studies on the association between syphilis and HIV transmission/progression from the region are limited to specific groups of people, such as female sex workers or pregnant women. In this manuscript, we evaluated the association between the two infections using population-based surveys conducted in the region. Statistical methods (such as logistic regression models and propensity score matching) were employed to assess the interplay between the two infections. Our findings indicated that syphilis infection was associated with higher odds of HIV acquisition. Moreover, co-infection with syphilis was associated with higher odds of HIV disease progression among antiretroviral therapy (ART)-treated PLWH, though the association did not reach statistical significance. Our findings suggest that the recognition and treatment of syphilis to reduce the risk of HIV acquisition/progression should be a public health priority in sub-Saharan Africa, where ART may not be readily available.

Establishment and evaluation of a predictive model for immune reconstitution in people living with HIV after antiretroviral therapy

BackgroundAchieving complete immune reconstitution (CIR) in people living with human immunodeficiency virus (PLWH) following antiretroviral therapy (ART) is essential for preventing acquired immunodeficiency syndrome (AIDS) progression and improving survival. However, there is a paucity of robust prediction models for determining the likelihood of CIR in PLWH after ART. We aimed to develop and validate a CIR prediction model utilizing baseline data.MethodsBaseline data including demographic information, immunological profiles, and routine laboratory test results, were collected from PLWH in Yunnan, China. Baseline referred to the first recorded results after HIV diagnosis but before initiating ART, and these initial measurements served as the baseline data for analysis. The participants were divided into training and validation sets (7:3 ratio). To construct the model and accompanying nomogram, univariable and multivariable Cox regression analyses were performed. The model was evaluated using the C-index, time-dependent receiver operating characteristic (ROC) curves, calibration curves, and clinical decision curves to assess discrimination, calibration, and clinical applicability.ResultsFive thousand four hundred eight PLWH were included, with a CIR of 38.52%. Cox regression analysis revealed various independent factors associated with CIR, including infection route, baseline CD4+T cell count, baseline CD4/CD8 ratio, interval from HIV diagnosis to ART initiation, and the level of PLT, Glu, Crea, HGB, ALT. A nomogram was formulated to predict the probability of achieving CIR at years 4, 5, and 6. The model demonstrated good performance, as evidenced by an AUC of 0.8 for both sets. Calibration curve analysis demonstrated a high level of agreement, and decision curve analysis revealed a significant positive yield.ConclusionsThis study successfully developed a prediction model with robust performance. This model has considerable potential to aid clinicians in tailoring treatment strategies, which could enhance outcomes and quality of life for PLWH.

Community health workers' knowledge of Ubuntu informed care in tuberculosis, HIV, and AIDS in Gauteng province.

Community health workers (CHWs) work with community members who experience various health problems. They assist community members to lead a healthy life and achieve an acceptable health status. To achieve this, there is a need for CHWs to apply Ubuntu philosophy when providing care related tuberculosis (TB), Human Immunodeficiency Virus (HIV), and acquired immunodeficiency syndrome (AIDS). The aim of this study was to assess CHW's knowledge of Ubuntu-informed Care in tuberculosis, HIV, and AIDS Services in Gauteng province, South Africa. A total of 380 CHWs were recruited from a district in Gauteng province to participate in a training on the management of TB, HIV and AIDS. A questionnaire with 40 multiple choice questions was administered to the CHWs before the training. SPSS version 28 was used to analyse the data. The scores ranged from 9 to 33 out of 40 (M = 21.6, s.d. = 4.2). Out of the 380 participants, 274 (72.1%) passed the pretest while 106 participants (27.9%) failed. The highest mean scores were achieved by female participants (M = 21.6, s.d. = 4.3), participants aged 21-30 years (M = 21.8, s.d. = 4.1) and participants with additional course qualification after Grade 12 (M = 23.5, s.d. = 3.4). The findings highlight the need for targeted training interventions to improve the knowledge of CHWs on TB, HIV and AIDS.Contribution:This study adds to the literature on the need for inclusion of Ubuntu when caring for people living with HIV and TB.

Cross-cultural adaptation and validation of the 9-item Indonesian HIV/AIDS Stigma Scale (InHASS-9) for the general population

Stigma against people living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) (PLWHA) poses significant health threats and contributes to the uncontrolled transmission of HIV. Although tools for measuring stigma against PLWHA have been validated in Indonesia, a previous study was geographically limited and conducted with small sample sizes. The aim of this study was to perform cross-cultural adaptation and validate the psychometric properties of the 9-item Indonesian HIV/AIDS Stigma Scale (InHASS-9) in the Indonesian general population. Utilizing a cross-sectional design, the study recruited 1,302 participants from six major islands in Indonesia. The validity of the instrument was determined using recognized group validity and construct validity, while internal consistency was evaluated using Cronbach's alpha. During the adaptation phase, nine simple items were finalized for inclusion in the scale. The findings revealed that the InHASS-9 instrument exhibited strong internal consistency, with Cronbach's alpha coefficient of 0.83, indicating high reliability. In conclusion, the InHASS-9 instrument is a valid and reliable tool for assessing the extent of social stigma associated with PLWHA in Indonesia.

Autoimmune Hepatitis-Like Liver Injury after COVID-19 Vaccination; Review of Molecular Underpinnings and Clinicopathologic Picture

Mass vaccination against COVID-19 infection has been able to substantially alleviate the consequent mor-talities and the spread of the disease. The paced design and administration of novel mRNA-based vaccinespaved the way for the production against cancers and acquired immunodeficiency syndrome. Various sideeffects, lethal in some instances, are described for COVID-19 vaccines, including the instigation of inci-dence or relapse of autoimmune disorders, including autoimmune hepatitis (AIH). Molecular mimicry withthe spike protein S1 and cross-reactions, adjuvants-induced autoimmune/autoinflammatory syndrome,epitope spreading, and bystander activation are among the molecular mechanisms that are hypothesized tomediate vaccine-induced autoimmunity. Pathological and serologic evaluations of patients with liver injuryfollowing COVID-19 vaccination have displayed that most cases can be categorized as probable or definitefor the diagnosis of AIH. AIH and AIH-like liver injuries following COVID-19 vaccination are generallymanageable with the administration of corticosteroids and other immunosuppressive therapies if required.Data on the safety of subsequent vaccination is scarce; however, vaccination during maintenance therapywith steroids seems safe. More importantly, the recognition of asymptomatic cases with altered liver ami-notransferase levels necessitates the design of prospective cohorts to assess the long-term consequences ofsub-clinical liver dysfunction induced by COVID-19 vaccines.

Construction and validation of a nomogram to predict 1-year mortality risk in patients with HIV/AIDS undergoing maintenance hemodialysis

This single-center retrospective study aimed to explore the 1-year mortality risk factors in 166 patients with human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) undergoing maintenance hemodialysis (MH) between 6 June 2017 and 6 June 2023, and construct a 1-year mortality prediction model. The patients were classified into survival and mortality groups based on the 1-year follow-up results, and into training and validation sets at a ratio of 1:1 (53 mortalities and 53 survivors in the training set and 48 mortalities and 58 survivors in the validation set). Stepwise logistic regression was used to construct a 1-year mortality prediction model and to visualize it as a nomogram. Receiver operating characteristic (ROC) analysis, calibration curves, and decision curves were used for nomogram evaluation in the training set and validation in the validation set. Age (≥52 years) (OR (95% CI): 2.05 (3.191–18.892), p < .001), neutrophil to albumin ratio (NAR) (≥0.135) (OR (95% CI): 4.753 (2.011–11.234), p < .001), and HIV-RNA (≥24,650) (OR (95% CI): 13.786 (5.493–34.598), p < .001), represents three of five independent risk factors of 1-year mortality in HIV/AIDS undergoing MH. The AUC of the nomogram for the training and validation sets were 0.908 (95% CI: 0.853–0.963) and 0.939 (95% CI: 0.896–0.983), respectively. The 1-year mortality prediction showed good separation capacity, calibration capacity, and clinical net benefit, which may benefit the management of patients with HIV/AIDS undergoing MH.