AIDS Stage Research Articles

Influence of the Type of Antiretroviral Treatment on the Time to Reach High Pharmacotherapy Complexity in People Living With HIV.

The introduction of antiretroviral therapy (ARV) has significantly improved the survival of people living with HIV (PLWH), increasing the proportion of individuals over 50 years old. This aging trend poses challenges, such as the development of age-related comorbidities and a higher prevalence of polypharmacy. The pharmacotherapeutic complexity, assessed using the Medication Regimen Complexity Index (MRCI), is crucial for identifying and optimizing treatment, especially in elderly and polymedicated patients. The main objective was to assess the association between different ARV regimens and the time required to reach a high level of pharmacotherapeutic complexity in PLWH. A single-center observational analytical research study was conducted, including adult PLWH on active ARV from January 2010 to December 2021 with follow-up until December 2023. An analysis of the time to reach MRCI ≥11.25 was performed, followed by a Cox regression model to determine the influence of ARV on high MRCI. A total of 789 PLWH were included, median age of 52 years (interquartile range: 45-58). Overall, 195 patients had an MRCI value ≥11.25 with a mean time to reach it of 181.86 months (95% confidence interval [CI]: 176.24 to 187.49). Significant differences were observed in sex, advanced age, AIDS stage, presence of comorbidities, polypharmacy, and ARV-related variables. A multivariate Cox proportional hazards model showed an association between integrase inhibitor (INSTI)-containing regimens (hazard ratio [HR]: 1.83; 95% CI: 1.08 to 3.10) and non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimens (HR: 0.72; 95% CI: 0.52 to 0.98) with the time to reach high MRCI. In summary, NNRTI-based regimens were associated with a lower likelihood of developing high MRCI compared to INSTI-based regimens, which was associated with a higher likelihood. These conclusions are based on a profile of PLWH that included advanced age and a high prevalence of comorbidities and polypharmacy. Identifying high MRCI may help us implement pharmacotherapeutic optimization strategies to improve health outcomes.

Multilocular subcutaneous bacillary angiomatosis as a primary manifestation of AIDS

AbstractA 34‐year‐old male patient presented with a clinical picture of multilocular subcutaneous skin nodules in addition to marked lymphadenopathy and general physical deterioration. A comprehensive diagnostic workup including serology, skin biopsy and imaging studies led to the initial diagnosis of human immunodeficiency virus (HIV) infection in AIDS stage with rare multilocular subcutaneous bacillary angiomatosis (BA) caused by Bartonella henselae. BA describes a process of neovascularisation of the skin or of internal organs (particularly the liver and spleen) and was first described in HIV‐positive patients by Stoler et al. in 1983. Both cutaneous and systemic symptoms are variable. There is no standardized treatment. The patient was started on antibiotic therapy with doxycycline, which was subsequently augmented with rifampicin. As the patient's general condition deteriorated and lymphocytopenia aggravated, he was transferred to an internal medicine ward for further treatment and subsequently commenced on antiretroviral therapy. This case corroborates numerous aspects of the cases described in the literature yet differs from them in that subcutaneous lesions are uncommon, particularly when infected with Bartonella henselae, illustrating the clinical spectrum of BA. Furthermore, it emphasises the significance of prompt and thorough diagnosis encompassing HIV serology in instances of skin lesions, accompanied by systemic signs and evidence of immunosuppression.

Progressive Multifocal Leukoencephalitis of the Immunocompromised Subject: A Case Report from Zinder National Hospital

Progressive multifocal leukoencephalitis (PML) is a rare opportunistic infection of HIV-infected individuals. It is a viral infection caused by the John Cunningham (JC) virus, which occurs during the AIDS stage. An elderly patient immunosuppressed by HIV for more than 5 years presented to the HNZ SMIT with headache, vomiting, visual disturbances, speech disorders and numbness of the limbs, all of which had been evolving in a febrile context for more than seven months. Neurological examination revealed left hemiparesis, frontal syndrome, temporal syndrome and homolateral hemianopia. Cerebral computed tomography revealed multiple lesions of leukoencephalitis. PCR revealed JC virus. The patient was put on corticosteroids, rehydration and nursing care. The course was marked by a progressive deterioration in the patient's neurological condition, culminating in death. We report the clinical, biological and CT features of this progressive multifocal leukoencephalitis.

Crosstalk between human immunodeficiency virus infection and salivary bacterial function in men who have sex with men.

Engaging in anal sexual intercourse markedly increases the risk of developing HIV among men who have sex with men (MSM); oral sexual activities tend to uniquely introduce gut-derived microbes to salivary microbiota, which, combined with an individual's positive HIV status, may greatly perturb oral microecology. However, till date, only a few published studies have addressed this aspect. Based on 16S rRNA sequencing data of bacterial taxa, MicroPITA picks representative samples for metagenomic analysis, effectively revealing how the development and progression of the HIV disease influences oral microbiota in MSM. Therefore, we collected samples from 11 HIV-negative and 44 HIV-positive MSM subjects (stage 0 was defined by HIV RNA positivity, but negative or indeterminate antibody status; stages 1, 2, and 3 were defined by CD4+ T lymphocyte counts ≥ 500, 200-499, and ≤ 200 or opportunistic infection) and selected 25 representative saliva samples (5 cases/stage) using MicroPITA. Metagenomic sequencing analysis were performed to explore whether positive HIV status changes salivary bacterial KEGG function and metabolic pathway in MSM. The core functions of oral microbiota were maintained across each of the five groups, including metabolism, genetic and environmental information processing. All HIV-positive groups displayed KEGG functions of abnormal proliferation, most prominently at stage 0, and others related to metabolism. Clustering relationship analysis tentatively identified functional relationships between groups, with bacterial function being more similar between stage 0-control groups and stage 1-2 groups, whereas the stage 3 group exhibited large functional changes. Although we identified most metabolic pathways as being common to all five groups, several unique pathways formed clusters for certain groups; the stage 0 group had several, while the stage 2 and 3 groups had few, such clusters. The abundance of K03046 was positively correlated with CD4 counts. As HIV progresses, salivary bacterial function and metabolic pathways in MSM progressively changes, which may be related to HIV promoting abnormal energy metabolism and exacerbate pathogen virulence. Further, infection and drug resistance of acute stage and immune cell destruction of AIDS stage were abnormally increased, predicting an increased risk for MSM individuals to develop systemic and oral diseases.

Impact of Dolutegravir-based Regimen on Tolerance and Virologic Suppression, Compared to Non-dolutegravir Regimen among PLHIV in Southern Senegal

Background: In 2020, Senegal began a transition to a Dolutgravir-based treatment as a first-line regimen in all new ART initiators in accordance with WHO recommendations. Aims: To determine the virological suppression and the tolerance on patients under a dolutegravir-based regimen by comparison with patients on a regimen without dolutegravir after at least 6 months of treatment. Materials and Methods: A cross-sectional study based on retrospective data (from January 2nd, 2017 to June 30th; 2022) involving 469 patients, 219 people were initiated with Dolutegravir regimen ART between Jan 2nd, 2020, and June 30th, 2022, and 250 patients treated using the old protocol (non-dolutegravir regimen). Patients who had received both the old protocol then switched to a DTG based regimen were excluded from the study. A single questionnaire was used to collect data. Sociodemographic, clinical and virological parameters and the last control of the virological load were analyzed with Stata 16 software. Descriptive statistics and univaried analysis were also carried-out. Results: In the dolutegravir regimen ART group, 161 (73, 52%) of 219 were women and 58 (26.48) were men. The median participant age was 43·0 years (IQR 33·0–53·0) and the median time on ART was 28·0 months (23·0–36·0). The dolutegravir-based regimen combined tenofovir, lamivudine and dolutegravir. 15 (6, 85 %) were receiving tuberculosis treatment at the time of ART initiation. The proportion of patients screened at an advanced clinical stage of AIDS (WHO stage 3 or 4) were 63, 47%. People initiated on dolutegravir were more likely to be retained in care at 12 months (100% vs. 95.20%; p=0.075) and having viral suppression (96.80%vs. 96.40% ; p=0,810) compared with those initiated on non-dolutegravir-based regimens but the difference was not statistically significant. Fewer patients presented side effects due to triple therapy in the dolutegravir-based regimen group compared to the non-dolutegravir group (2.74% vs. 3.20%; p=0.77). In the dolutegravir based regimen the side effects were mainly vomiting, insomnia, and dizziness. The mean gain weight was 6,7± 8,2 kilograms. For the non-dolutegravir regimen group, 195 (78.00%) were women. The median participants age was 43·0 years (IQR 34·0–53·0) and the median time on ART was 55·0 years (48·0–65·0) months. 18 (7, 20%) were receiving tuberculosis treatment at time of ART initiation. The therapeutic protocol combined TDF, lamivudine, Efavirenz in 225 cases (90%). A percentage of 59.20% patients were screened at an advanced clinical stage of AIDS (WHO Stage 3 and 4). In this group the side effects were mainly nausea and insomnia and the mean gain weight was 7,2 ± 6,2 kilograms. Conclusion: The results of our study show a high rate of viral suppression, and good tolerance of the dolutegravir-based regimen in a decentralized setting.

Sociodemographic and clinical characteristics of patients with HIV treated in a hospital in the Colombian Orinoco region 2018-2023

Introduction: The human immunodeficiency virus is a worldwide public health problem, with an average number of infected people between 33.1 and 45.7 million and the death of an average of 630 000 people per year. According to the WHO, only 54% of people infected with HIV know they are infected. Methods: Observational, descriptive, retrospective, retrospective, cross-sectional study of patients who consulted a hospital in the Colombian Orinoquía and who underwent confirmation of HIV diagnosis in the period from 2018 to 2023. Results: 337 patients were obtained, 72.70% male and 23.30% female; the mean age was 34.89 years (SD ± 12.63); 94.07% came from urban areas and 5.93% from rural areas; 56.08% were in the HIV stage and 43.92% in the AIDS stage; according to the mechanisms of transmission, heterosexual 70.92%, homosexual 13.06%, bisexual 9.50%, and maternal infant 6. 53%; the most frequent opportunistic diseases and/or coinfections were cerebral toxoplasmosis (24.32%), esophageal candidiasis (20.27%), pneumonitis pneumonia (17.57%), pulmonary tuberculosis 13.51%, 89.06% of patients started antiretroviral therapy during hospital stay, mortality reported in this cohort of patients diagnosed in the period from 2018 to 2023 was 8.01%. Conclusions: It is important to strengthen actions to improve access to health services for patients living with HIV, avoid prolonged stays in hospital care centers, and prevent severe opportunistic infections that require prolonged treatments leading to drug interactions and affecting adherence to treatments.

Immuno-Diagnostic Interest in Monitoring CD16+CD56+ (Natural Killer) Cells and CD19+CD45+ (B Lymphocytes) in Individuals Newly Diagnosed with HIV in a Tertiary Care Center.

Monitoring multiple cellular markers of immune cells may provide a more accurate evaluation of the immune status of people living with human immunodeficiency virus (PLHIV). This study assessed the value of CD16+CD56+ cells (NK cells) and CD19+ lymphocytes (B cells) phenotyping in indicating viral load, AIDS status, and treatment efficacy. A retrospective, laboratory-based study was conducted at the Diagnostic immunology division of a referral tertiary hospital. It involved 82 newly diagnosed HIV patients treated between 2009-2016. We explored three objectives: (1) the paired change in CD16+CD56+ and CD19+CD45+ cells counts and percentages from baseline to 2-to-6 months after treatment; (2) the association of these phenotypes with 5 gradual categories of viral load; and (3) the accuracy of CD16+CD56+ and CD19+CD45+ cells counts in indicating AIDS stage defined as CD4+ < 200 cells/mm3. The second and third objectives were tested using a pooled analysis (N = 300-373). The median CD19+CD45+ and CD16+CD56+ counts increased by 1.9-fold and 1.3-fold after treatment respectively (p < 0.001). A negative correlation of viral load with both CD16+CD56+ (ρ = -0.29, p < 0.001) and CD19+CD45+ (ρ = -0.34, p < 0.001) counts was observed. CD16+CD56+ count < 73 cells/mm3 and CD19+CD45+ count < 166.5 were indicative for AIDS with 95.5% and 63.6% sensitivity respectively. Findings advocate for the usefulness of CD16+CD56+ and CD19+CD45+ phenotyping in characterizing the severity of HIV infection and its impact on both the humoral and cellular immunity, as well as monitoring the effectiveness of treatment.

Relationship Between Multimorbidity, Nutritional Status and Duration of ARV Treatment to Major Signs of HIV at RSUD Dr. Soetomo Surabaya

People living with HIV/AIDS (PLWHA) can have better health outcomes with early identification of the AIDS phase. In the first three years, PLWHA may progress to the AIDS stage. This cross-sectional study aimed to determine the relationship between multimorbidity, nutritional status and duration of Antiretroviral (ARV) treatment on major signs of PLWHA. This study was conducted in the Intermediate and Infectious Disease Treatment Unit (UPIPI) at regional public hospital (RSUD) Dr. Soetomo Surabaya from January to February 2023. As many as 52 PLWHA who started HIV treatment at RSUD Dr. Soetomo in 2020 to 2021 were sampled in this study, which was obtained from medical records. The dependent variable in this study was the major sign of HIV. Independent variables in this study were multimorbidity, nutritional status, and the duration of ARV treatment. This study found that 76.9% of PLWHA experienced major signs. Multimorbidity and duration of ARV treatment did not have an association with major signs of HIV (&lt;em&gt;p&lt;/em&gt;-value &amp;gt; 0.05). Nutritional status has a significant association with major clinical symptoms of HIV (&lt;em&gt;p&lt;/em&gt;-value &amp;lt; 0.05). PLWHA with underweight had higher odds of having a major sign (&lt;em&gt;p&lt;/em&gt;-value = 0.017; PR = 1.507; 95% CI 1.131-2.008) than PLWHA with normal nutritional status. Thereby, it is hoped that the hospital will be assisted in determining health promotion needs such as screening and evaluation of nutritional status to monitor the nutritional status of patients, which will improve their health outcomes.

Dysbiosis of gut microbiota and metabolites during AIDS: implications for CD4 + T cell reduction and immune activation.

Identifying the gut microbiota associated with host immunity in the AIDS stage. We performed a cross-sectional study. We recruited people with HIV (PWH) in the AIDS or non-AIDS stage and evaluated their gut microbiota and metabolites by using 16S ribosomal RNA (rRNA) sequencing and liquid chromatography-mass spectrometry (LC-MS). Machine learning models were used to analyze the correlations between key bacteria and CD4 + T cell count, CD4 + T cell activation, bacterial translocation, gut metabolites, and KEGG functional pathways. We recruited 114 PWH in the AIDS stage and 203 PWH in the non-AIDS stage. The α-diversity of gut microbiota was downregulated in the AIDS stage ( P < 0.05). Several machine learning models could be used to identify key gut microbiota associated with AIDS, including the logistic regression model with area under the curve (AUC), sensitivity, specificity, and Brier scores of 0.854, 0.813, 0.813, and 0.160, respectively. The decreased key bacteria ASV1 ( Bacteroides sp.), ASV8 ( Fusobacterium sp.), ASV30 ( Roseburia sp.), ASV37 ( Bacteroides sp.), and ASV41 ( Lactobacillus sp.) in the AIDS stage were positively correlated with the CD4 + T cell count, the EndoCAb IgM level, 4-hydroxyphenylpyruvic acid abundance, and the predicted cell growth pathway, and negatively correlated with the CD3 + CD4 + CD38 + HLA-DR + T cell count and the sCD14 level. Machine learning has the potential to recognize key gut microbiota related to AIDS. The key five bacteria in the AIDS stage and their metabolites might be related to CD4 + T cell reduction and immune activation.

Literature Review: pola makan dan kualitas diet pada remaja dan dewasa dengan HIV/AIDS

Background: Human Immunodeficiency Virus (HIV) infection remains an unresolved health problem in Brazil. Diet plays an important role in the immune system of HIV/AIDS patients because adequate amounts of macronutrients and micronutrients are important. Food quality has also been used as a proxy for predicting the risk of death and chronic diseases. Measuring diet quality is an indicator that can describe a person's dietary practices in accordance with the dietary recommendations set out to be able to live healthily.Objective: This study aimed to analyze the dietary patterns and diet quality of adolescents and adults with HIV/AIDS.Methods: This study was a systematic literature review. The protocol used in the systematic literature review of this study used the PRISMA method. The SLR protocol and evaluation were performed using the PRISMA method to select research articles that had been found. The PRISMA method collects articles from PubMed, Google Scholar, Research Gate, SINTA, Garuda, and Scopus databases. The search terms used were Indonesian and English. The search terms used in Indonesian were "Diet and HIV/AIDS" OR "Diet Quality and HIV/AIDS". The search terms in English were "dietary habit and HIV/AIDS" OR "diet quality and HIV/AIDS". The articles collected were published between 2014 and 2022.Results: According to the findings of a systematic literature review, consumption patterns that do not meet the needs of HIV infection will lead to chronic malnutrition and AIDS, resulting in a drastic decrease in resistance to other infections. Diet plays an important role in the immune system of HIV/AIDS patients, because adequate intake of macro-and micronutrients is essential for normal functioning. Diet quality is influenced by the diversity of food ingredients and food security, which remains low. Diet quality in HIV/AIDS patients affects their body weight, mental health status, physical health status, CD4 count, and other health problems.Conclusion: Dietary habits do not meet intake requirements due to HIV infection, which causes chronic malnutrition and, at the AIDS stage, results in a drastic decrease in resistance to other infections. Diet quality in HIV/AIDS patients affects their body weight, mental health status, physical health status, CD4 count, and other health problems.

Preventive Measures on Sexual Freedom in The Maesan Wetan Area In Islam and Health Sciences

&#x0D; Abstract. The problem experienced by society in general is sexual freedom which is practiced by most teenagers and parents on average. Free sex or sexual freedom is carried out by force and there is consensual consent for men and women. They are free to do so even though there is already a statutory law that regulates the prohibition of sexual harassment. This service is carried out in the Maesan Wetan area and aims to anticipate sexual freedom in society. The method of this dedication is a qualitative method and lectures with three stages, namely: the first stage, presentation of free sex material in hadith and medical science. The second stage, the question and answer method. The third stage is evaluation. The results of this service are: First, the public's knowledge of the dangers of free sex increases. Second, the strategy is to stay away from it and overcome it by providing educational aspects for their children to stay away from free sex. Third, the community has the ability to know the bad consequences arising from free sex, namely HIV-AIDS which causes the perpetrators to develop the disease. There is no medicine for this disease that can cure it and only relies on drugs that can reduce and reduce the number of HIV viruses, namely Antiretrovirals (ARVs) so that they do not enter the AIDS stage. In addition, ARVs function to prevent opportunistic infections that can attack the human immune system.

Cultural and religious barriers in the Middle East leading to delayed management of acute HIV case resulting in irreversible blindness: a case report.

A 26-year-old male who resides in a country in the Middle East visited the local general hospital emergency department on 17 July 2018. He presented with symptoms of persistent upper respiratory tract infection, dysphagia, and generalized fatigue. Denied any previous history of sexual contact, smoking, drinking, or using illicit drugs. This patient repeatedly attended the emergency department seeking medical attention and was treated for viral and bacterial upper respiratory tract symptoms by conservative and antibiotic therapy, yielded in short term relief but recurrence and worsening symptoms, especially dysphagia symptoms. On examination, the patient looked unwell, cachectic, and frail with normal vital signs and no positive findings on chest and abdominal examination; however, Ear Nose and Throat and oral examination revealed extensive oropharyngeal candidiasis. That is when he was suspected of having an immunodeficiency syndrome of some sort, and based on those serious findings, he was advised hospital admission for further investigations, diagnosis and management. The patient refused hospital admission against medical advice despite all the potential risks explained clearly, as he had a pre-planned family reunion holiday to Turkey, which was again strongly advised against as likely he will deteriorate while on holiday, but he went on with his plan, accordingly, oropharyngeal candidiasis was successfully treated with oral antifungal tablets, pending further investigations and definitive management. Then in 24 July 2018, he travelled to Turkey, where he developed symptoms of shortness of breath and dry a cough then he became systemically unwell and was admitted to a local hospital in Turkey where he was diagnosed with a lower respiratory tract infection and treated with intravenous antibiotics for 7 days; then on 6 August 2018, he flew back on an emergency flight to his home country, where he was admitted to the acute medical admission unit and arranged to have patient laboratory investigations. The results revealed positive HIV infection with a plasma HIV viral load was greater than 3000000 copies/ml, and advanced immunosuppression with CD3+/CD4+ T-lymphocyte was 40 cells/mm3. The social aspect of this case was apparent from denying sexual contact. The patient did not have any history of surgical operations, no family history of HIV infection, no previous blood transfusion, or use of contaminated syringes. By exclusion sexual mode of transmission is the only possible way of contracting HIV infection in this case, considering the fact that he was outside his country as single man for few years while studying. In the Middle East countries, due to religious and cultural reservations coupled with HIV diagnosis stigma, the diagnosis of the serious sexually transmitted infections such as HIV is usually delayed, as a result these patients will go on and develop late-stage disease and irreversible complications when diagnosed, entering the AIDS stage with rapid progression of irreversible complications like Cytomegalovirus, Ear Nose and Throat retinitis and blindness before they start definitive treatment. The oropharyngeal candidiasis and repeated upper and lower respiratory tract infections that are non-responding to therapy are usually red flag signs of immunosuppression, which warrants high clinical vigilance from the clinician side to take a detailed sexual history and rule out acute HIV infection by testing for it at early stages, in patients with high clinical suspicion , in addition to the other possible causes of immunosuppression. Therefore, assuring confidentiality, taking a careful sexual history and gathering data in an acceptable way for these patients and considering a holistic approach yield a better management outcome.

Antiretroviral medication adherence for people with HIV/AIDS.

People with HIV/AIDS require treatment with antiretrovirals (ARV) to reduce the amount of HIV virus in the body so it does not enter the AIDS stage, while people with AIDS require ARV treatment to prevent opportunistic infections with various complications. This study aimed to determine the ARV medication adherence of people living with HIV/AIDS (PLWHA), get information on the facts that influence PLWHA's use of ARV, analyze factors that influence PLWHA's use of ARV, and get information about treatment management for PLWHA. This study is a systematic review. Research information was obtained using the Google Scholar facility and an index of journal publications. Factors related to ARV adherence in PLWHA include family support, level of knowledge, peer group support, side effects of medicine, motivation, behavioral skills, psychology of PLWHA patients, boredom, stigma, health care facilities, therapy guidelines, characteristics of comorbidities, perception, gender, health insurance, self-efficacy, social isolation, age, education level, income, duration of ARV treatment, support from health workers, spiritual motivation, and use of health services for the last three years. Adherence and family support play important roles in healing PLWHA. PLWHA must adhere to treatment with antiretrovirals. Family support plays an important role in healing PLWHA. It is suggested to the families of PLWHA that they give motivation and comply with the advice of health workers.

Quantitative Assessment of a Dual Epidemic Caused by Tuberculosis and HIV in the Philippines.

Tuberculosis (TB) and human immunodeficiency virus (HIV) are the two major public health emergencies in the Philippines. The country is ranked fourth worldwide in TB incidence cases despite national efforts and initiatives to mitigate the disease. Concurrently, the Philippines has the fastest-growing HIV epidemic in Asia and the Pacific region. The TB-HIV dual epidemic forms a lethal combination enhancing each other's progress, driving the deterioration of immune responses. In order to understand and describe the transmission dynamics and epidemiological patterns of the co-infection, a compartmental model for TB-HIV is developed. A class of people living with HIV (PLHIV) who did not know their HIV status is incorporated into the model. These unaware PLHIV who do not seek medical treatment are potential sources of new HIV infections that could significantly influence the disease transmission dynamics. Sensitivity analysis using the partial rank correlation coefficient is performed to assess model parameters that are influential to the output of interests. The model is calibrated using available Philippine data on TB, HIV, and TB-HIV. Parameters that are identified include TB and HIV transmission rates, progression rates from exposed to active TB, and from TB-latent with HIV to active infectious TB with HIV in the AIDS stage. Uncertainty analysis is performed to identify the degree of accuracy of the estimates. Simulations predict an alarming increase of 180% and 194% in new HIV and TB-HIV infections in 2025, respectively, relative to 2019 data. These projections underscore an ongoing health crisis in the Philippines that calls for a combined and collective effort by the government and the public to take action against the lethal combination of TB and HIV.

Virological Outcomes Among Pregnant Women Receiving Antiretroviral Treatment in the Amhara Region, North West Ethiopia.

Globally, approximately 35 million people are infected with HIV infection. Sub-Saharan countries contributed 71% of global burden. Women are the most affected groups accounting for 51% of global infection and 90% of HIV infections in children (<15 years) are a result of mother to child transmission. In the absence of any intervention, mother-to-child transmission has been estimated to 30-40% that could occur at various periods like during pregnancy, delivery, and post-partum, via breastfeeding. For future generations to be born HIV-free, evidences on the level of viremia and contributing factors in pregnant mothers is important. The objective of this study is to determine the magnitude of viral non-suppression rate among pregnant women and identify the risk factors associated with viral non-suppression. A cross-sectional study was conducted from July 01, 2021 to June 30, 2022, in pregnant women who are on antiretroviral treatment and attending HIV viral load testing in Amhara region viral load testing sites, North West Ethiopia. Socio-demographic, clinical, and HIV-1 RNA viral load data were collected from the excel database. The data were analyzed in SPSS 23.0 statistical software. Overall viral non-suppression rate was 9.1%. In other words, the viral suppression rate was 90.9%. Pregnant women being at AIDS stages III and IV and with fair treatment adherence and suspected testers were statistically associated with increased viral non-suppression rate. Relatively low viral non-suppression rate among pregnant mothers that had almost met the third 90 of UNAIDS target. But, still, some mothers received a non-suppressed viral replication specifically the odds of having a non-suppressed viral load was higher in pregnant women with poor treatment adherence and WHO Stage III and IV and suspected testers.

Fatal Case of a Cerebral and Pulmonary Aspergillosis in an HIV-Infected Patient

Introduction: Cerebral aspergillosis is a rare and very severe pathology, usually affecting immunocompromised patients, for whom early antifungal treatment is necessary. Because of the clinical and microbiological diagnostic difficulty, brain imaging is crucial for the positive and differential diagnosis. However, the scannographic and MRI appearance is not very specific, as aspergillosis lesions classically present as multiple rounded images, with or without a hemorrhagic component, with or without annular enhancement after contrast injection. Diffusion imaging may present a more specific aspect and help in early diagnosis. Case Report: The patient was 48 years old and had been followed for 4 months for positive HIV infection at the AIDS stage. She presented with a sudden onset of HTIC syndrome (headache, vomiting and confusion) in a febrile context.On admission, the clinical examination found a stable patient on the HD and respiratory plan, BMI: 16 kg/m2, polypneic at 28cpm, febrile at 39°the other constants are normal (FC: 90 b/mn, BP: 11/8 cmHg, FR: 28 c/mn. The somatic examination was without particularities. The biological workup showed white blood cells at 14900 (PNN: 13800) and CD4 lymphocytes at 45/mm.The evolution was marked by the occurrence of acute respiratory distress 3 days later with an elevated D-Dimer level of 740 µg/L. A thoracic angioscan was performed to rule out pulmonary embolism. Aspergillosis serology was performed: positive. The diagnosis of cerebral aspergillosis by dissemination from the pulmonary focus was retained. The patient died within 24 hours. Conclusion: Morphological imaging of cerebral aspergillosis lesions is not very specific. Knowledge of their appearance on diffusion imaging (global restriction of water diffusion or heterogeneous "target" appearance) can provide valuable assistance in the positive and differential diagnosis of aspergillosis.

Effectiveness of personalized tobacco cessation intervention package among patients with schizophrenia and related psychotic disorders - A two-group experimental study.

Persons with schizophrenia and related psychotic disorders (PwS) smoke more, and have twice the rate of mortality, with 10-25 years lower life expectancy than the general population. Evidence-based tobacco cessation interventions would help in quitting. To evaluate the effectiveness of a personalized tobacco cessation intervention package for patients attending the outpatient psychiatry department. The study adopted a two-group experimental design in PwS, using a simple randomization method. Eligible participants were randomly allocated to either the intervention group (n=85) receiving the intervention package or the control group (n=85) receiving brief advice to stop tobacco. The study outcomes were measured at baseline, 1, 3, and 6 months. SPSS 23 was used for data analysis. Intention-to-treat analysis was used to manage missing data. The p-value of <0.05 is considered statistically significant. At 6 months, there was a significant difference (p<0.001) in 7 days point-prevalence abstinence (28 % vs 10.8 %), reduction of tobacco by at least 50 % (62.4 % vs 40.9 %) with an attrition rate of 15.3 % vs 30.5 % in intervention and control group respectively. Reduction in nicotine dependence and tobacco craving, an increase in motivation level, quit attempts and clinical improvement favored the intervention group. 16.5 % of participants expressed interest in pharmacotherapy for tobacco cessation, 3.5 % were referred to a specialized tobacco cessation center, two control group participants were hospitalized for drug default, and withdrawal symptoms reported were mild. Implementing a tobacco cessation intervention based on the stage of motivation aids in abstinence and reduction of tobacco use in PwS.

Predict the Effects of Dolutegravir (DTG) Plus Lamivudine (3TC) on Immunological Responses in People Living with HIV (PLWHIV).

Immune recovery in people living with HIV (PLWHIV) is a residual aspect of antiretroviral treatment (ART) in most patients, but in a non-negligible proportion of them, the CD4+ lymphocytes count, or CD4/CD8 ratio remains suboptimal. We performed a model of the immune response after 24 weeks of switching to a 2DR with DTG plus 3TC in a retrospective multicenter cohort of undetectable and experienced patients using significant predictor variables associated with the parameters or situations defined as success and failure. Clinical variables studied were CD4+ and CD8+ lymphocyte count, percentage of CD4, and CD4/CD8 ratio. These parameters were assessed at baseline and 24 weeks after the switch. Based on the evolution of each variable, four categories of immune response and four categories of non-immune response were defined. Immune response was defined as CD4+ count > 500 cells/mm3, %CD4 > 30%, CD8+ count < 1000 cells/mm3 and CD4/CD8 ratio ≥ 0.9. Non-response is just the opposite. In our different models of immunological response, the presence of stage of AIDS (p = 0.035, p = 0.065) and current age over 50 years (p = 0.045) are postulated as statistically significative limiting factors in achieving an improvement in CD4, %CD4, CD8, and CD4/CD8 ratio. Late HIV diagnosis (p = 0.156), without statistical significance, enhanced late the previous variables. In contrast, conditions where patients start with CD4 > 500 cells/mm3 (p = 0.054); CD4 > 30% (p = 0.054, p = 0.084); CD8 < 1000 cells/mm3 (p = 0.018), and CD4/CD8 ≥ 0.9 (p = 0.013, p = 0.09) are detected as stimulating or conducive to DTG plus 3TC treatment success. These models represent a proof of concept that could become a valuable tool for clinicians to predict the effects of DTG plus 3TC on immunological responses prior to the switch in undetectable pre-treated PLWHIV with immune dysfunction. The main predictors for immunological failure were late HIV diagnosis, stage of AIDS, and current age over 50 years. In contrast, starting with a normalized immune status was detected as stimulating or conducive to DTG plus 3TC treatment success.

MATHEMATICAL ANALYSIS OF TRANSMISSION DYNAMICS OF HIV/ AIDS IN RISK STRUCTURED POPULATION

A model for assessing the impact of key population at risk in spreading HIV/ AIDS is designed. The model is shown to have a globally asymptotically stable (GAS) disease-free equilibrium whenever the associated reproduction number is less than unity. It has a unique GAS endemic equilibrium whenever reproduction number exceeds unity, if there is no back and forth movement in susceptible classes. It is shown that if infected individuals with high risk abandon their risky behavioral practices, then the disease burden will reduce. Furthermore, if infected individuals with low risk do not adopt risky behaviors then the transmission of the disease will decrease. Partial Rank Correlation Coefficient (PRCC) indices are assessed using all the infection-related classes and basic reproduction number of the model. Uncertainty and sensitivity analysis results show that controlling the effective contact rate, disease-induced death rate in AIDS stage with low and high risk classes will help controlling the transmission of the disease.

ТРУДНОСТИ ДИАГНОСТИКИ НЕКРОТИЧЕСКИХ ИНФЕКЦИЙ МЯГКИХ ТКАНЕЙ У ПАЦИЕНТОВ С ВИЧ-ИНФЕКЦИЕЙ

The article presents a case of diagnosing and treatment of a patient with necrotizing soft tissue infection of the right upper limb with immunodeficiency on HIV infection that progressed to AIDS stage. No typical clinical and laboratory indicators in patients with compromised immunity being found at the consultation may result in late diagnosis and delayed proper treatment, as well as in rapidly progressing soft tissue necrosis. All of this substantiates the severity of such patients’ condition and their high mortality rate. Medical officers should be aware of these features in order to attentively provide medical care to patients suffering from soft tissue infections that require surgical interventions.