Use Of Antiretroviral Therapy Research Articles

Correlated depressive symptoms within seroconcordant, expectant partners living with HIV in Zambézia Province, Mozambique: a cross-sectional study.

Approximately 15% of people with HIV in sub-Saharan Africa have comorbid depression, which impacts treatment outcomes. We describe predictors of baseline depressive symptoms in 1079 female and 1079 male participants in a cluster-randomized trial in Zambézia Province, Mozambique from November 2017 to December 2020. We modeled each partners' depressive symptoms (Patient Health Questionnaire-9 [PHQ-9]) using proportional odds models adjusted for enrollment date, age, body mass index [BMI], partner's PHQ-9 score, district, relationship status, education, occupation, WHO HIV clinical stage, and antiretroviral therapy use history. A post hoc analysis assessed covariate-adjusted rank correlation between partner depressive symptoms. Females were younger than males (median 23 vs. 28 years) and more likely to report no education (20.7% vs. 7.9%). Approximately 10% screened positive for depression (PHQ-9 score ≥ 10). Partner depressive symptoms were predictive of higher participant PHQ-9 scores. A male partner PHQ-9 score of 10 (versus 5) increased the odds that the female partner would have a higher PHQ-9 score (adjusted odds ratio: 7.25, 95% Confidence Interval [CI]: 5.43-9.67). Partner PHQ-9 scores were highly correlated after covariate adjustment (Spearman's rho 0.65, 95% CI 0.57-0.72). Interventions aimed to reduce depressive symptoms and improve HIV-related outcomes during pregnancy should address both partners' depressive symptoms.

Kaposi Sarcoma: A Forgotten Complication in Well-Controlled HIV

Kaposi sarcoma (KS), often described as one of the AIDS-defining illnesses, has decreased in prevalence with the widespread use of antiretroviral therapy (ART). This case series includes an atypical presentation of KS in 2 patients with well-controlled HIV and a brief review of the literature on KS. Both patients had multiple cutaneous discolored plaques and ulceration with pathology confirmation of KS. They had normal CD4 counts and undetectable HIV and human herpesvirus-8 viral loads at the time of diagnosis. Therefore, patients with HIV with new skin lesions should be screened for KS regardless of the CD4 count or adherence to ART.

Diffuse Large B-Cell Lymphoma in the Public-Sector of Johannesburg, South Africa, in the Era of Widescale Antiretroviral Therapy Use.

Diffuse large B-cell lymphoma (DLBCL) is a high-grade non-Hodgkin lymphoma with increased incidence among people living with HIV-infection (PLWH). Although its frequency is reportedly attenuated by antiretroviral therapy (ART), we have previously shown a similar rate of DLBCL in the post-ART era (2017) in Johannesburg, South Africa compared with that observed when ART had only limited availability in the South Africa state-sector (2007). Here, we present a more detailed analysis of DLBCL in the pre-and post-ART eras in Johannesburg. All cases of DLBCL diagnosed in the state-sector hospitals of Johannesburg in 2007 and 2017 were extracted from the laboratory information system, and factors of interest compared. Most (>85%) were observed among PLWH at both time-points; ART-coverage was significantly higher in 2017 compared with 2007, but with failed immunological recovery in 50% of cases. The immunohistochemically-defined cell of origin differed according to HIV-status; the germinal center (GC) and non-GC subtypes predominating in the PLWH and the HIV-negative group, respectively. MYC-gene rearrangement was more common than is reported elsewhere (22.1%), whereas BCL6 and BCL2 gene rearrangements were less so (14.6% and 0%, respectively). Slight improvement in survival was noted in the post-ART era, but remained poor, with bone marrow involvement and albumin levels ≤30 g/L independently associated with mortality. Although the frequency of DLBCL in Johannesburg has not dropped significantly in the post-ART era, a slight improvement in survival is observed. However, outcomes remain poor, indicating a need for further improvements in care.

PCR253 Establishing Content Validity of Three New Patient Reported Outcome (PRO) Measures for Use in HIV Long-Acting Oral Antiretroviral Therapy (LA-OART) Clinical Trials

Long-acting oral antiretroviral therapy (LA-OART) is in development for people living with HIV (PLWH). This study aimed to demonstrate content validity of patient reported outcome (PRO) measures for use within LA-OART clinical trials. Previously, a targeted literature review and concept elicitation interviews with clinicians and PLWH were conducted to develop conceptual models (CMs) capturing PLWH experiences of OART, adherence facilitators and barriers, and perspectives on a hypothetical switch to LA-OART.

Impact of Alcohol on Bone Health in People Living With HIV: Integrating Clinical Data From Serum Bone Markers With Morphometric Analysis in a Non-Human Primate Model.

People living with HIV (PLWH) represent a vulnerable population to adverse musculoskeletal outcomes due to HIV infection, antiretroviral therapy (ART), and at-risk alcohol use. Developing measures to prevent skeletal degeneration in this group requires a grasp of the relationship between alcohol use and low bone mass in both the PLWH population and its constituents as defined by sex, age, and race. We examined the association of alcohol use with serum biochemical markers of bone health in a diverse cohort of PLWH enrolled in the New Orleans Alcohol Use in HIV (NOAH) study. To explore the effects of alcohol on bone in the context of HIV and ART and the role of estrogen, we conducted a parallel, translational study using simian immunodeficiency virus (SIV)+/ART+ female rhesus macaques divided into four groups: vehicle (Veh)/Sham; chronic binge alcohol (CBA)/Sham; Veh/ovariectomy (OVX); and CBA/OVX. Clinical data showed that both osteocalcin (Ocn) and procollagen type I N-propeptide (PINP) levels were inversely associated with multiple measures of alcohol consumption. Age (>50 years) significantly increased susceptibility to alcohol-associated suppression of bone formation in both female and male PLWH, with postmenopausal status appearing as an additional risk factor in females. Serum sclerostin (Scl) levels correlated positively with measures of alcohol use and negatively with Ocn. Micro-CT analysis of the macaque tibias revealed that although both CBA and OVX independently decreased trabecular number and bone mineral density, only OVX decreased trabecular bone volume fraction and impacted cortical geometry. The clinical data implicate circulating Scl in the pathogenesis of alcohol-induced osteopenia and suggest that bone morphology can be significantly altered in the absence of net change in osteoblast function as measured by serum markers. Inclusion of sophisticated tools to evaluate skeletal strength in clinical populations will be essential to understand the impact of alcohol-induced changes in bone microarchitecture. © 2022 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

Middle Ear Pathologies Persist in Adults Living With HIV Despite the Use of Antiretroviral Therapy

Middle Ear Pathologies Persist in Adults Living With HIV Despite the Use of Antiretroviral Therapy

HIV protease inhibitor attenuated astrocyte autophagy involvement in inflammation via p38 MAPK pathway

HIV-associated neurocognitive disorder (HAND) is prevalent in people living with HIV, despite the use of antiretroviral therapy (ART). Although several risk factors have been proposed to be related to HAND, substantial effort has been made to explore the neurotoxic effects of ART on HAND. HIV protease inhibitor (PI), an essential component of ART, has neurotoxicity in vivo and in vitro, which can contribute to the development of HAND. However, the pathogenesis of PI-associated neurotoxicity remains unclear. Here, we explored whether PI treatment is a potential pathogenic factor for HAND and elucidated its potential mechanisms. In our study, U87 cells were exposed to PIs, including lopinavir (LPV), ritonavir (RTV), darunavir, indinavir, and saquinavir at different concentrations, we found that LPV, LPV/RTV, and saquinavir attenuated autophagy in U87 cells, the results of Western blot showed that the expression of p62 dramatically was elevated and the level of LC3II/LC3I was decreased. Moreover, comparative transcriptomics revealed the involvement of the inflammatory response in the physiological activities of U87 cells exposed to LPV, with differential genes significantly enriched in the p38 MAPK signaling pathway. In the following study, we verified the results from RNA-sequence using the liquid chip technique, qRT-PCR, Elisa, and western blots, which suggested that LPV induced inflammatory response and the p38 MAPK pathway was involved in this process. Collectively, we demonstrated that PIs attenuated the involvement of astrocyte autophagy in inflammation via the p38 MAPK pathway, providing new insights into the mechanism of HAND.

Key data from AIDS 2022.

We report on the highlights ofthe 24th International AIDS Conference, held in Montreal in 2022. We address three main themes: human immunodeficiency virus (HIV) targets and cascades, HIV and sexually transmitted infection prophylaxis, and HIV treatment, including the use of antiretroviral therapy in pregnancy.

Abstract 13277: Hiv and Race Are Independently Associated With Endothelial Dysfunction

Objective: Assessing the vascular function in HIV + compared to HIV - with assessment of body composition, inflammation, and gut integrity markers. Introduction: HIV and ART are associated with an increased risk of CVD. Thus, the need for a non-invasive test to detect increased risk or early signs of CVD. Hypothesis: HIV and non-white race are independently associated with vascular dysfunction. High viral load, BMI, and inflammation damage endothelial function. Methods: We included participants ≥18 years, with peripheral arterial tonometry testing (EndoPAT2000) between 2014-2022. HIV + had a stable ART regimen, and a VL ≤400 c/mL. We measured the vessel’s adaptability with Reactive Hyperemia Index (RHI) (normal>1.67) and elasticity with Augmentation Index (AI) (normal<-10). We assessed markers of systemic inflammation, immune activation, and gut integrity. We used linear mixed models to estimate endothelial dysfunction with a significant p-value<0.05. Results: Overall, 511 participants (296 HIV+ and 215 HIV-) were included. The estimated RHI among HIV+ was 13% lower (p=0.01) compared to HIV-. In Non-White, the estimated RHI was 9% lower (p=0.001) than in White. Every 1% increase in BMI we would expect RHI to increase 0.17% (p=0.01). At the time of EndoPAT, the estimated RHI was 8% lower (p=0.04) among PI antiretroviral therapy use compared to HIV+ who were taking NRTI or NNRTIs. The estimated odds of having endothelial dysfunction (RHI ≤ 1.67) is 1.56 times greater (95% CI: 1.05, 2.31) in Non-White compared to White, independent of HIV status [OR=1.4 (95% CI: 0.94, 2.13)]. There was not enough evidence to suggest that inflammation, gut, or monocyte markers, current or nadir CD4, duration of HIV, or current treatment with NRTI or NNRTIs at the time of EndoPat was associated with endothelial dysfunction. Conclusions: HIV and non-white race are independently associated with endothelial dysfunction. PI use was associated with vascular dysfunction in all racial groups.

Substance Use and Adherence to Antiretroviral Therapy among People Living with HIV in the United States.

People with HIV (PWH) report substance use at higher rates than HIV-uninfected individuals. The potential negative impact of single and polysubstance use on HIV treatment among diverse samples of PWH is underexplored. PWH were recruited from the Center for Positive Living at the Montefiore Medical Center (Bronx, NY, USA) from May 2017-April 2018 and completed a cross-sectional survey with measures of substance use, antiretroviral therapy (ART) use, and ART adherence. The overall sample included 237 PWH (54.1% Black, 42.2% female, median age 53 years). Approximately half of the sample reported any current substance use with 23.1% reporting single substance use and 21.4% reporting polysubstance use. Polysubstance use was more prevalent among those with current cigarette smoking relative to those with no current smoking and among females relative to males. Alcohol and cannabis were the most commonly reported polysubstance combination; however, a sizeable proportion of PWH reported other two, three, and four-substance groupings. Single and polysubstance use were associated with lower ART adherence. A thorough understanding of substance use patterns and related adherence challenges may aid with targeted public health interventions to improve HIV care cascade goals, including the integration of substance use prevention into HIV treatment and care settings.

RF12 | PSUN104 Visceral adiposity index as a measure of cardiometabolic disease in persons living with HIV

Abstract Well-treated persons living with HIV (PLWH) are predisposed to fat redistribution/visceral adiposity, potentially due to anti-retroviral therapy (ART) use and/or the virus itself, and demonstrate a 2-fold higher risk of cardiovascular disease (CVD) compared to those without HIV. Visceral adipose tissue (VAT) is a metabolically unfavorable ectopic fat depot, which is highly inflamed and dysfunctional. Fat redistribution leading to VAT accumulation is related to increased CVD risk. Current gold standard measures of VAT are obtained using CT and MRI, but are not used clinically. The visceral adiposity index (VAI) is a simple tool combining biochemical measures with anthropometrics that can be easily evaluated by the clinician. VAI may be a surrogate measure of VAT and indeed has been shown to relate to insulin resistance, type 2 diabetes mellitus, metabolic syndrome and CVD among the general population. In this study, we evaluated VAI in PLWH and its relation to VAT, anthropometric measures and other cardiometabolic parameters. 45 PLWH on stable ART with no known CVD were recruited as part of a clinical trial to evaluate CVD indices and were included if they were virologically controlled (HIV viral load <200 copies/mL) and demonstrated increased abdominal VAT (VAT area>110cm2) on CT. For purposes of this study, baseline fasting biochemical, radiologic and anthropometric data were used. VAI was calculated using the standard sex-specific formulas which incorporate waist circumference (WC), BMI, triglycerides and HDL. Presence of coronary plaque was assessed using coronary CT angiography or coronary PET scans. Linear regression was performed to assess relationships with VAI. Non-normally distributed variables were log-transformed for analyses. Participants were predominantly male (73%), Caucasian (53%), and non-Hispanic (84%) with mean age 55 ± 7 years. Participants had a long duration of HIV and ART use (20 ± 8 and 15 [12,19] years, respectively). The majority of PLWH were obese (BMI 31.9 ± 5.8 kg/m2) with VAT 189 [127,267]cm2 and VAI 4.9 [2.8,7.3]. VAI correlated strongly with VAT (r=0.59, P<0.0001), anthropometric measures (BMI r=0.36, P=0.02; WC r=0.43, P=0.004; WHR r=0.33, P=0.03) and ALT (r=0.32, P=0.03), and did not relate to HIV-specific parameters and other metabolic parameters (blood pressure, HbA1c). Participants with coronary plaque tended to have a higher VAI compared to those without coronary plaque (log VAI 0.7 ± 0.3 vs. 0.5 ± 0.3, P=0.056). These data show VAI, an easily obtained measure, is strongly correlated with abdominal VAT area measured by CT and may be a useful biomarker for visceral adiposity in HIV. Furthermore, VAI may be related to ALT and coronary plaque, which could help identify those PLWH at risk for fatty liver disease (another ectopic fat depot) and heart disease, respectively. Further studies are needed to assess the utility of VAI in evaluating metabolic disease in HIV. Presentation: Saturday, June 11, 2022 1:24 p.m. - 1:29 p.m., Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

Factors Correlated with Body Image Dissatisfaction in Children and Adolescents Diagnosed with HIV: A Cross-Sectional Study.

(1) Background: The adverse effects of continuous use of antiretroviral therapy can generate dissatisfaction with body image in children and adolescents diagnosed with Human Immunodeficiency Virus infection (HIV) infection. The aim of this study was to verify the prevalence and factors associated with body image dissatisfaction (BI) in children and adolescents diagnosed with HIV infection; (2) This is a cross-sectional study with 60 children and adolescents (32 females; 28 males) aged 8-15 years diagnosed with HIV, carried out in Florianópolis, Brazil. Information on BI was collected through a silhouette scale, as well as sociodemographic information, biological maturation, lifestyle, self-esteem, adherence to antiretroviral treatment and aspects of HIV infection; (3) Results: The results indicated that 53.13% of female patients and 53.57% of male patients were dissatisfied with their BI. Lower subscapular skinfold and higher calf skinfold values were associated with BI dissatisfaction in females. Pre-pubertal maturation stage, higher economic level, lower concentrations of CD4+ lymphocytes, lower viral load, lower level of physical activity and longer time in front of the computer and/or video game were associated with BI dissatisfaction in males; (4) Conclusions: BI dissatisfaction was observed in more than half of patients and morphological, economic, behavioral and HIV infection aspects were associated with BI dissatisfaction.

Sexual behaviours of HIV sero-discordant couples in the context of art: a systematic review of studies from Sub-Saharan Africa

The impact of the use of antiretroviral therapy (ART) on the sexual behaviours of serodiscordant couples (SDC) is not well documented. This systematic review attempts to examine the strength of evidence from primary studies on the impact of ART on the sexual behaviours of serodiscordant couples in SSA. In this study, 16 studies that fit the inclusion criteria were identified. Nine were cohort studies, six cross-sectional and one randomised controlled trial. Risky sexual behaviours generally declined on several indicators used to assess them. Five within individual studies reported a decrease in unprotected sex from baseline to follow-up, while of the four that said consistent condom use, they observed a significant increase in condom use from baseline to follow-up. For the between-individual studies, one study posited that ART is significantly associated with inconsistent condom use, whereas reporting multiple and concurrent partners and self-reported symptoms of sexually transmitted infections (STIs) were associated with not being on ART. Overall, there was evidence of lower-risk sexual behaviours with ART among SDC in sub-Saharan Africa. However, this relationship was not established to be causal. Further research is required to fully explore and validate the impact of ART on the sexual practices of these couples. Behavioural programmes should be strengthened and targeted towards couple-based counselling and testing with disclosure of status and continue encouraging consistent condom use among steady couples.

Human Immunodeficiency Virus Infection-Associated Cardiomyopathy and Heart Failure.

The landscape of human immunodeficiency virus (HIV) epidemiology and treatment is ever-changing, with the widespread and evolving use of antiretroviral therapy (ART). With timely ART, people living with HIV (PLWH) are nearing the life expectancies and the functionality of the general population; nevertheless, the effects of HIV and ART on cardiovascular health remain under investigation. The pathophysiology of HIV-related cardiomyopathy and heart failure (HF) have historically been attributed to systemic inflammation and changes in cardiometabolic function and cardiovascular architecture. Importantly, newer evidence suggests that ART also plays a role in modulating the process of HIV-related cardiomyopathy and HF. In the short term, newer highly active ART (HAART) seems to have cardioprotective effects; however, emerging data on the long-term cardiovascular outcomes of certain HAART medications, i.e., protease inhibitors, raise concerns about the potential adverse effects of these drugs in the clinical course of HIV-related HF. As such, the traditional phenotypes of dilated cardiomyopathy and left ventricular systolic failure that are associated with HIV-related heart disease are incrementally being replaced with increasing rates of diastolic dysfunction and ischemic heart disease. Moreover, recent studies have found important links between HIV-related HF and other clinical and biochemical entities, including depression, which further complicate cardiac care for PLWH. Considering these trends in the era of ART, the traditional paradigms of HIV-related cardiomyopathy and HF are being called into question, as is the therapeutic role of interventions such as ventricular assist devices and heart transplantation. In all, the mechanisms of HIV-related myocardial damage and the optimal approaches to the prevention and the treatment of cardiomyopathy and HF in PLWH remain under investigation.

TWO CASE REPORT OF PARVOVIRUS B19 INFECTION IN HIV-INFECTED PATIENTS: DIFFERENT CLINICAL PRESENTATIONS FOLLOWING ACUTE AND PERSISTENT B19V INFECTION

Parvovirus B19 (B19V) infection could cause clinical manifestations depending on the host‘s immunologic and hematologic status. In immunocompetents individuals, clinical manifestations range from asymptomatic, or flu-like symptoms in childhood including a viral exanthem (fifth disease) to a fatal hydrops fetalis in pregnant women. B19V infect red blood cell (RBC) precursors and in immunocompromised hosts, such as HIV-infected patients, it could be manifested as pure red cell aplasia and chronic anemia. B19V may cause transient aplastic crisis (TAC) in patients with increased RBC destruction, including hereditary spherocytosis (HS). To report cases of B19V infection in HIV-positive adults in follow-up at Instituto Nacional de Infectologia Evandro Chagas. Case 1: A 27-year-old black male with HIV since childhood on irregular use of antiretroviral therapy (ART) complained of vertigo, headache, vomiting, fever. In April 2021 he had Hb 1,7 g/dL, Ht 6.5%, reticulocytes 0%, HIV viral load 40,305 cps/mL and CD4 + count 6 cells/μL. Up to October 2021 he required multiple RBC transfusions. Myelogram showed giants proerythroblasts with nuclear inclusions, B19V real time polymerase chain reaction (qPCR) detected 4.3 × 10 10 IU/mL, and B19V anti-IgM was negative. He received intravenous immunoglobulin (IVIG) and stabilized RBC counts. Nine months after treatment, he remained asymptomatic but had 11 cells/ μL CD4+ count and 27,642 HIV cps/mL due to poor adherence to ART. B19V was still detectable in qPCR (1.8 × 10 6 IU/mL), but he did not receive any additional treatment because blood counts were normal. Case 2: A 61-year-old white male with HIV since 2009 on regular use of ART, undetectable HIV viral load, but historically low CD4 + count, presented four weeks of lethargy, and an acute incident of dizziness, diarrhea, and syncope. He exhibited pancytopenia (Hb 5.6 g/dL, Ht 15.2%, WBC 1.48 × 10 9 /L, and platelets 41,000 per mm 3 ), non-immune hemolytic anemic features, jaundice, and palpable spleen. Reticulocyte counts were unavailable. He received transfusions of RBC, the HIV viral load at admission was undetectable, and CD4 + count 127 cells/ μL. The myelogram presented giant proerythroblasts with nuclear inclusions, and bone marrow had 95% cellularity and mild erythroid hyperplasia. B19V anti-IgM was indeterminate, while B19V qPCR detected 8.9 × 10 3 IU/mL, in August 2021. The patient received IVIG and nine months later, showed resolution of pancytopenia, but maintained elevated indirect bilirubin, indicative of chronic hemolysis. B19-DNA was no longer detected by qPCR, hematoscopy showed spherocytes, and the osmotic fragility test suggested RBC membranopathy, revealing an undiagnosed HS. Anemia is a common finding in the HIV setting, is often multifactorial, and represents a significant risk factor for mortality in AIDS. Our study highlights the importance of B19V infection be considered as a part of the differential diagnosis of anemia in this group. Clinicians should search for typical bone marrow and virologic findings. Identification of B19V DNA by qPCR was essential herein because of low sensitivity of serologic tests. Our findings showed that adherence to ART and the status of immunosuppression were crucial to the parvovirus clearance after IVIG. These cases highlight the challenging management of refractory parvovirus disease in immunosuppressed patient.

S3421 HIV/AIDS, and MAC vs COVID Diarrhea

Introduction: During the COVID pandemic, it was difficult to differentiate COVID diarrhea vs other causes, especially in the HIV/AIDS population. HIV infected patients are at high risk for GI infections. Biopsy of the small intestine identifies etiologies which help to differentiate infection, inflammatory, and neoplastic GI disease. Case Description/Methods: A 39-year-old male presented with two months of epigastric abdominal pain, severe diarrhea, and dehydration during the COVID pandemic in 2020. Past medical history of AIDS wasting syndrome. The patient was severely hypotensive. Exam was notable for mild epigastric tenderness,and hepatomegaly. Complete blood count (CBC) revealed a Hemoglobin (Hg) of 4.3 g. COVID 19 was positive. Gastrointestinal panel PCR was negative. CD4 count 1, HIV RNA viral load 48,700. MRI of the abdomen and pelvis showed diffuse bowel wall thickening in the small intestines. On hospital day 2, Esophagogastroduodenoscopy (EGD) and Colonoscopy were performed for anemia and diarrhea, which revealed abnormal variegated mucosa in the duodenum. Colonoscopy showed a normal mucosal appearance. The pathology report of the duodenum revealed macrophages in the lamina propria, which stained positive for Acid Fast Bacilli. Duodenal biopsy showed markedly expanded lamina propria with numerous histiocytes having finely granular chromatin pattern (Panel 1 and 2). The patient was diagnosed with Mycobacterium avium-intracellulare enteritis. Discussion: This 39-year-old male presented with chronic diarrhea without fever or respiratory symptoms. The most pertinent question for the health care team was whether COVID 19 caused the diarrhea.. Endoscopy with biopsy of the small intestine was essential for an accurate diagnosis. MAC infection in HIV has been dramatically declining since the widespread use of antiretroviral therapy and prophylaxis against MAC infection compared to the 1990s (from 65.3/1000 in 1992 to 2/1000 in 2015) (1). It is important to differentiate MAC from other diseases with a macrophage infiltration or inclusions: including Whipple’s, histoplasmosis, and macroglobulinemia. Patients with MAC enteritis present with fever, and watery diarrhea with diffuse small bowel malabsorption which mimics Whipple’s disease. However, the key to differentiate these two entities is doing a duodenal biopsy showing foamy macrophages with PAS-positive acid-fast bacilli (2).Figure 1.: Histology finding.

Physician perspectives on benefits in patient care from UNC-Project Malawi

Background: The growth of academic medical centres associated with international programmes has raised questions about the benefits and harms of medical experiences abroad for medical trainees and patients. Few studies explore the potential benefits to the institution or country that send these individuals. Objective: This pilot qualitative study explores the benefits medical professionals perceive they bring back to the USA from their global health experiences abroad. Methods: Medical staff who participated in University of North Carolina (UNC)–Project Malawi and who could meet for an in-person interview from October 2016 – March 2017 were recruited. Interviews were guided by an a priori semi-structured questionnaire. Each interview was transcribed and analysed by three reviewers. Results: A total of 8 out of 13 (62%) eligible potential respondents were interviewed. Participants perceived UNC-Project Malawi to benefit themselves, partnership institutions, and patients in Malawi, North Carolina, and throughout the world. After returning to UNC, participants recalled specific instances of increased diagnostic confidence (2/8) influenced by their experiences abroad. In addition, by partnering in research, participants felt that certain concepts were advanced including the syndromic management of symptomatic patients with sexually transmitted infections (1/8), the use of antiretroviral therapy to treat and prevent HIV transmission (2/8), and malaria vaccine development (1/8). Conclusion: Participants perceived that their global health experience either influenced their thought processes concerning the medical management of patients in the USA or resulted in a better understanding of research relevant to the global standard of care for specific diseases. International academic medical centre partnerships can offer rich settings for career skills development and a unique platform for collaborating on the management of clinical diseases that affect patients globally. These benefits can be maximised by establishing bi-directional curriculum goals and defining shared research agendas.

Factors associated with antiretroviral therapy use among pregnant women in rural and urban settings in Southern Province, Zambia: 2016-2019.

To assess antiretroviral therapy (ART) coverage among pregnant women living with HIV and compare the characteristics of women who received and did not receive ART during pregnancy in Zambia. A cross-sectional study was conducted at urban and rural health facilities in Southern Province, Zambia, from 2016 to 2019. Pregnant women living with HIV delivering at study sites were enrolled and administered a questionnaire, and the results of infant diagnostic testing for HIV at birth was documented. About 1184 mother/infant pairs were enrolled. ART coverage was 93.7%. Most women who did not receive ART during pregnancy reported HIV diagnosis at delivery (18.0%) or during pregnancy (57.7%). The primary reported reason for not receiving ART was not wanting to take the drugs. Women who did not receive ART during pregnancy were significantly younger, less likely to have disclosed their HIV-infection status to others, and less likely to have received antenatal care than women who received ART. ART use correlated with higher levels of education in urban but not rural sites. Overall, 1.0% of infants were infected with HIV at birth, including 0.8% of infants born to women who received ART and 4.1% of infants born to women who did not. Most women received ART according to guidelines, resulting in low perinatal transmission rates of HIV to infants. Efforts to increase ART coverage and prevent vertical transmission should focus on identifying incident HIV infections during pregnancy and strengthening counselling for newly diagnosed pregnant women.

Clinical and programmatic outcomes of HIV-exposed infants enrolled in care at geographically diverse clinics, 1997-2021: A cohort study.

BackgroundAlthough 1·3 million women with HIV give birth annually, care and outcomes for HIV-exposed infants remain incompletely understood. We analyzed programmatic and health indicators in a large, multidecade global dataset of linked mother–infant records from clinics and programs associated with the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium.Methods and findingsHIV-exposed infants were eligible for this retrospective cohort analysis if enrolled at <18 months at 198 clinics in 10 countries across 5 IeDEA regions: East Africa (EA), Central Africa (CA), West Africa (WA), Southern Africa (SA), and the Caribbean, Central, and South America network (CCASAnet). We estimated cumulative incidences of DNA PCR testing, loss to follow-up (LTFU), HIV diagnosis, and death through 24 months of age using proportional subdistribution hazard models accounting for competing risks. Competing risks were transfer, care withdrawal, and confirmation of negative HIV status, along with LTFU and death, when not the outcome of interest. In CA and EA, we quantified associations between maternal/infant characteristics and each outcome. A total of 82,067 infants (47,300 EA, 10,699 CA, 6,503 WA, 15,770 SA, 1,795 CCASAnet) born from 1997 to 2021 were included. Maternal antiretroviral therapy (ART) use during pregnancy ranged from 65·6% (CCASAnet) to 89·5% (EA), with improvements in all regions over time. Twenty-four-month cumulative incidences varied widely across regions, ranging from 12·3% (95% confidence limit [CL], 11·2%,13·5%) in WA to 94·8% (95% CL, 94·6%,95·1%) in EA for DNA PCR testing; 56·2% (95% CL, 55·2%,57·1%) in EA to 98·5% (95% CL, 98·3%,98·7%) in WA for LTFU; 1·9% (95% CL, 1·6%,2·3%) in WA to 10·3% (95% CL, 9·7%,10·9%) in EA for HIV diagnosis; and 0·5% (95% CL, 0·2%,1·0%) in CCASAnet to 4·7% (95% CL, 4·4%,5·0%) in EA for death. Although infant retention did not improve, HIV diagnosis and death decreased over time, and in EA, the cumulative incidence of HIV diagnosis decreased substantially, declining to 2·9% (95% CL, 1·5%,5·4%) in 2020. Maternal ART was associated with decreased infant mortality (subdistribution hazard ratio [sdHR], 0·65; 95% CL, 0·47,0·91 in EA, and sdHR, 0·51; 95% CL, 0·36,0·74 in CA) and HIV diagnosis (sdHR, 0·40; 95% CL, 0·31,0·50 in EA, and sdHR, 0·41; 95% CL, 0·31,0·54 in CA). Study limitations include potential misclassification of outcomes in real-world service delivery data and possible nonrepresentativeness of IeDEA sites and the population of HIV-exposed infants they serve.ConclusionsWhile there was marked regional and temporal heterogeneity in clinical and programmatic outcomes, infant LTFU was high across all regions and time periods. Further efforts are needed to keep HIV-exposed infants in care to receive essential services to reduce HIV infection and mortality.

Antiretroviral Therapy for HIV Infection Induced-Neuropathic Pain, A Narrative Review.

Human immunodeficiency virus (HIV) causes acquired immunodeficiency syndrome (AIDS). AIDS is a human disease in which there is a systematic failure of the immune system, thereby leading to severe opportunistic infections. HIV is treated with antiretroviral therapy (ART), which helps in preventing the virus from replicating in the body. ART also enables the immune system to repair itself and restrict further injury. Nevertheless, the long-term use of ART leads to multiple neurological complications (e.g.neuropathic pain). Neuropathic pain (NP) arises if the nervous system is damaged or not working correctly. NP is is characterized by pain in both hands and feet and can hinder the quality of life (QOL) as it is always linked to impaired cognition, anxiety, depression, loss of function, among others. To provide an overview of the clinical issues regarding the toxicity implications arising from the long-tern use of antiretroviral therapy (ART). In this paper, we ascertained and summarized studies on manifestations of ART-induced neuropathic pain (ART-NP)-using the relevant and up-to-date facts from Google Scholar, and PubMed, among others. While ART assists in suppressing HIV and may help to lessen neurocognitive impairments, long-term use incurs toxicity to the central nervous system (CNS). Consequently, future studies must explore the effects of ART on adaptations in distinct regions of the CNS as well as the pathophysiological feature of ART-induced NP.