HIV Duration Research Articles

Assessment of the proportion and the factors associated with partner and family-based index case HIV testing in Woliso Town, Oromia, Ethiopia: a cross-sectional study

ABSTRACT Introduction Around 40% of estimated people with HIV infection remain undiagnosed globally. In Ethiopia, only 72% of people with HIV know their status. This study aims to assess the proportion and the factors associated with partner and family-based index case HIV testing in Woliso Town. Methods A facility-based cross-sectional study was conducted among 346 people currently on ART. Data were entered into Epi Info™ 7.2.3.1 and analyzed using SPSS 21. Significance of odds ratios was determined with 95% CI and p < 0.05. Results Among 345 study participants, 333 (96.5%) with 95% CI (94.5–98.3) index cases have families tested for HIV. The odds of HIV testing were 7.22 times higher among those who disclosed their HIV status (AOR = 7.22 95% CI: 1.45, 35.82) compared to those who did not disclose. Those who stayed <12 months on ARTwere 87% less likely to have tested families (AOR = 0.13 95% CI: 0.03, 0.63) compared to those who stayed ≥12 months on ART. Conclusion Higher proportions of index cases have tested families. Partner and family-based index case HIV testing has association with HIV status disclosure and duration the index cases stayed on ART. The platform of partner and family-based index case HIV testing should be sustained through strengthening disclosure counseling.

Prevalence and Associated Factors of Ocular Manifestations of Acquired Immune Deficiency Syndrome Among Adults at University of Gondar Hospital, North West Ethiopia, 2021.

Acquired immune deficiency syndrome is a disease with common clinical ocular manifestations. Ocular manifestations lead to blindness, which has a common social and economic impact. This study aimed to assess the prevalence and associated factors of ocular manifestations of acquired immune deficiency syndrome among adults at the University of Gondar Hospital, North West Ethiopia, 2021. A cross-sectional study was conducted on 401 patients from June to August 2021. Samples were selected based on a systematic random sampling technique. Data collection was done using structured questionnaires. Data extraction format was used to collect the clinical characteristics of patients including ocular manifestations. Data entry was done by EpiData version 4.6.0.6 and exported to the Statistical Package for the Social Sciences version 26 for data analysis. Associated factors were analyzed by binary logistic regression. P-value <0.05 with a 95% confidence level was used to declare a significant association. A total of 401 patients were involved with a response rate of 91.5%. The overall prevalence of ocular manifestations of acquired immune deficiency syndrome was 28.9%. The common ocular manifestations were seborrheic blepharitis at 16.4% and squamoid conjunctival growth at 4.5%. Age >35 years (AOR=2.52, 95% CI: 1.19, 5.35), Clusters of differentiation 4 count <200 cells/µL (AOR=4.76, 95% CI:2.50, 9.09), World Health Organization stage II (AOR=2.60, 95% CI: 1.23, 5.50), history of eye disease (AOR=3.05, 95% CI: 1.38, 6.72), and duration of Human Immunodeficiency Virus >5 years (AOR=2.79, 95% CI: 1.29, 6.05) were statistically associated with the ocular manifestation of acquired immune deficiency syndrome. In this study, the prevalence of ocular manifestation of acquired immune deficiency syndrome was high. Age, CD4 count, duration of HIV, eye disease history, and WHO clinical staging were the significant factors. Early eye checkups and regular ocular examinations of HIV patients would be helpful.

KARAKTERISTIK ORANG DENGAN HIV/AIDS DI KOTA MANADO

HIV/AIDS continues to be a major global health problem that gradually attacks and weakens the immune system, making it easier for diseases to enter the patient's body. This is called an opportunistic infection which eventually causes death. The age, sex, CD4 count, profession, and other characteristics of people with HIV/AIDS vary. This study aims to identify the characteristics of people with HIV/AIDS in Manado City. The research was conducted using descriptive observational methods at the Batamang Plus Manado Foundation with 1044 data as samples. The variables used were age, sex, risk factors, and duration of HIV. The results found that most people with HIV/AIDS are between 26-35 years old, male, the most dominant risk factor was transmission was MSM/Homo, and the longest duration was 10 years. HIV/AIDS prevention plans and programs must focus on the right target, and educational institutions must provide sex education early to prevent HIV/AIDS transmission.&#x0D; Keywords : Characteristic, HIV, AIDS

Characterization of HIV-Related Stigma in Myanmar.

Characterizing HIV-related stigma and its impacts are important for interventions toward their elimination. A cross-sectional study was conducted in 2016 to evaluate enacted and internalized stigma among adult people living with HIV (PLWH) across four cities in Myanmar using the India Stigma Index questionnaire. Multivariable regression analyses were performed to determine differences in measured enacted and internalized stigma outcomes. Among 1,006 participants, 89% reported any stigma indicator, 47% enacted stigma, and 87% internalized stigma. In regression analysis, city and duration of illness were associated with higher enacted stigma, and younger age was associated with higher internalized stigma. Those with HIV duration > 7.4 years had mean enacted stigma nearly 2 units higher than the overall mean. Internalized stigma increased with duration of illness and leveled off at 5 years. PLWH from smaller cities experienced lower stigma. In Myanmar, nearly 90% of PLWH experience stigma, results that reflect a unique transition point.

A Central Auditory Test reveals differences between drug treatment regimens in adults living with HIV

Objective This exploratory study examined whether central auditory tests show differences between people living with HIV (PLWH) treated with two predominant antiretroviral drug therapy (ART) regimens. Design Cross-sectional. Study Sample 253 PLWH (mean age 39.8 years) from the Shanghai Public Health Clinical Centre, China. Methods The Hearing in Noise Test speech reception threshold (SRT) assessed central auditory function and the Montreal Cognitive Assessment (MoCA) assessed cognition. The relationship between ART regimen and SRT was evaluated with multivariable linear regression incorporating age, HIV duration, and peripheral hearing ability. Multivariable logistic regression was used to ascertain if SRT and ART regimen predicted MoCA impairment. Results The two predominant ART regimens differed by one drug (zidovudine or tenofovir). Participants taking the zidovudine-containing regimen had poorer SRT performance (p=.012) independent of age and hearing thresholds. MoCA scores did not differ between drug regimens, but a negative relationship was found between SRT and MoCA impairment (p=.048). Conclusions ART regimens differed in their association with central auditory test performance likely reflecting neurocognitive changes in PLWH taking the zidovudine-containing regimen. Central auditory test performance also marginally predicted cognitive impairment, supporting further assessment of central auditory tests to detect neurocognitive deficits in PLWH.

Serum Interleukin-6 and Weight Loss in Antiretroviral-naïve and Antiretroviral-treated Patients with HIV/AIDS: Relationships and Predictors.

Cachexia is usually associated with elevated serum interleukin-6 (IL.6) as it stimulates the breakdown of muscle proteins and promotes wasting. A case-control study to evaluate the relationship between weight loss, facial fat loss, and IL-6 in antiretroviral-naïve and treated participants living with HIV/AIDS. IL-6 was assayed by High performance liquid chromatography (HPLC) in 97 in consecutive newly diagnosed antiretroviral-naive (ART-naïve) people living with HIV/AIDS (age ≥18 years); and 118 consecutive, age-matched participants currently on Highly Active Antiretroviral Therapy (HAART), using age as a criterion. In the treated group, 78 (66.7%) subjects were on zidovudine, lamivudine with nevirapine (Z+L+N); 27(23.1%) on tenofovir, lamivudine with emtricitabine (T+L+E); 5(4.3%) on zidovudine, lamivudine with emtricitabine (Z+L+E); 4(3.4%) on zidovudine, lamivudine with tenofovir (Z+L+T); 2(1.7%) on lamivudine, tenofovir with nevirapine (L+T+N); 1(0.9%) on tenofovir, zidovudine, emtricitabine (Z+T+E). A total of 215 participants: 97 ART-naive and 118 HAART-treated, age-matched subjects (40.3±9.6 versus 42.7±10.20years, p=0.08). The mean IL-6 was significantly higher in naïve than treated (0.69±0.04 versus 0.66±0.04 pg/ml, p =0.002). In all, 73 subjects experienced weight loss, 56(76.7%) naive, 17(23.3%) treated, p <0.0001, with significantly higher IL-6 in those with weight loss (0.69±0.05 versus 0.67±0.05pg/ml, p= 0.047). Fifty-eight (27.0%) subjects experienced facial fat loss, 49 (84.5%) naïve, and 9 (15.5%) treated, p <0.0001, with significantly higher IL-6 in those with facial fat loss (0.7 ± 0.05 versus 0.67±0.05pg/ml, p= 0.0001). Negative correlation exists between IL-6 and CD4+ count (r=-0.141, p=0.041). In logistic regression, independent predictors of weight loss include: IL-6 (Adjusted Odds Ratio, aOR 1.3, 95%CI 0·1-2·6, p=0.047); HIV duration (aOR 11.6, p <0.0001); AIDS-defining illness (aOR 3.5, p <0.0001); CD4+ count (aOR 3.2, p=0.004); HAART status (aOR 2.7, p<0.0001). HIV infection is associated with elevation of serum interleukin-6, which likely contributes to weight and facial fat loss among the treatment-naïve participants; while HAART is associated with suppressed IL-6 levels, thereby ameliorating weight and facial fat loss. Inverse relationship exists between serum IL-6 and CD4+ count; serum IL-6 could differentiate between mild- to moderate and severe immunosuppressive states.

Indian patients with human immunodeficiency virus infection have high prevalence but mild severity of non-alcoholic fatty liver disease

Background and aimsAntiretroviral therapy (ART) has substantially decreased AIDS-related mortality. Non-AIDS related diseases like chronic liver disease are becoming more frequent in people living with HIV-AIDS (PLHA). Non-alcoholic fatty live disease (NAFLD) is a common etiology of liver disease in the general population. Our aim was to analyse the prevalence and risk factors of NAFLD in Indian PLHA. MethodsOne hundred consecutive adults (age:36.89 ± 10.4 years, males:65%) with HIV infection were prospectively enrolled. Patients with significant alcohol intake, Hepatitis B or Cco-infection, other liver disease, malignancy or HIV stage IV were excluded. Hepatic steatosis was assessed using hepatobiliary ultrasoundand controlled attenuation parameter (CAP). Fibrosis was assessed non-invasively using FIB-4, NAFLD fibrosis score (NFS) and liver stiffness measurement (LSM). Metabolic and HIV-related risk factors were compared between PLHA with and without NAFLD. ResultsPrevalence of NAFLD using CAP was 60%. Among patients with NAFLD, 27 (45%) were lean. Majority had mild-moderate steatosis. Advanced fibrosis was present in 1 (1.67%) and 4 (6.67%) patients using NFS and LSM and none using FIB-4. PLHA with NAFLD were more likely to be overweight or obese (OR = 4.21,p = 0.002) with a higher proportion of abdominal obesity (OR:25.26,p = 0.001). Other metabolic comorbidities, duration of HIV infection, duration and type of ART, CD4-count or HIV-stagewere not significantly different among PLHA with or without NAFLD. ConclusionPrevalence of NAFLD among Indian PLHA is high although most have mild disease. Almost half of these patients are lean. HIV-related factors do not impact the risk of NAFLD.

HIV and race are independently associated with endothelial dysfunction.

Evaluating the vascular function in HIV-infected compared with HIV uninfected with assessment of body composition, inflammation, and gut integrity markers. A noninvasive test that measures the endothelial function. We included participants at least 18 years old, with peripheral arterial tonometry testing (EndoPAT2000) between 2014 and 2022. Persons with HIV (PWH) had documented infection, a stable ART regimen, and a viral load less than 400 copies/ml. We measured the vessel's function with the reactive hyperemia index (RHI) (normal >1.67) and Augmentation Index. Lower Augmentation Index reflect better arterial elasticity. 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 less than 0.05. Overall, 511 participants (296 HIV-infected; 215 HIV-uninfected controls) were included. Estimated RHI among PWH was 13% lower (P = 0.01) compared with persons without HIV. In nonwhite race, the estimated RHI was 9% lower (P = 0.001) than white race. For 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 protease inhibitor users compared with PWH who were not taking protease inhibitors. The estimated odds of abnormal RHI ≤1.67) is 1.56 times greater [95% confidence interval (CI) 1.05-2.31] in nonwhite race compared with white race, 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+ cell count, or duration of HIV were associated with endothelial dysfunction. HIV, nonwhite race, and protease inhibitor use are independently associated with endothelial dysfunction.

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&gt;1.67) and elasticity with Augmentation Index (AI) (normal&lt;-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&lt;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.

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 &amp;lt;200 copies/mL) and demonstrated increased abdominal VAT (VAT area&amp;gt;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&amp;lt;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.

Frequency of Prediabetes in patients of HIV Infection Presenting at Tertiary Care Hospital

Objective: To find out the frequency of prediabetes in patients of HIV presenting at tertiary care hospital. Study design: Cross sectional study. Place and duration: Department of Medicine, D.G Khan Hospital, D.G Khan. (January 2020 to December 2020) Methodology: Total 187 patients of HIV infection, age 20 years to 60 years both male or female with duration of HIV 10 years were selected and pre-diabetes was studies. Results: Total 187 patients of HIV infection was recruited for this study and prediabetes was assessed. Mean age and mean HIV infection duration was 37.81 ± 12.81 years and 5.31 ± 2.86 years. Prediabetes was noted in 63 (34%) patients. Male patients and female patients were 122 (65.24%) and 65 (34.76%) respectively. Prediabetes was found in 58 (47.54%) males and in 5 (7.69%) females. Prediabetes was significantly (P=0.000) associated with gender. Conclusion: This study showed a higher percentage of prediabetes among HIV infected patients. Most of the cases were belonged to 3rd and 4th decade of life. Males were more victim of HIV infection as compared to females and most of the males were prediabetics. No association of development of prediabetes with duration of HIV infected was noted. Keywords: Prediabetes, HIV infection, diabetes mellitus, IGT

Association between HIV duration and symptom distress among middle-aged and elderly people with HIV-infected in China: a cross-sectional study

BackgroundDebate has persisted regarding whether PLWH with longer HIV durations have lower levels of prevalence and severity of symptoms compared with their newly diagnosed counterparts. Whether and how the HIV duration impact the symptom distress among middle-aged and older PLWH has not been explored clearly.MethodsThe patients with HIV-infected aged more than 40 years old were included from seven designated medical institutions of seven regions in China. Outcome was the score of symptom distress. We used the multiple regression model to calculate adjusted Coefficient of Regression (β) with 95% CI in this study.ResultsAmong 210 participants (mean age 50.8 years; 71.0% male; 68.1% at asymptomatic stage) in the study, the median number of symptoms was 5. Of all symptoms reported, the most distressed symptoms were sleep disturbance (33.33%), followed by memory loss (31.90%), fatigue (26.67%), slow reactions (22.86%), and vision blur (21.90%). All participants were divided into four groups according to HIV duration, and the median of total score of symptom ditress among all participants was 0.1(0.0,0.9). Difference of total scores and clusters’ scores of symptom distress among four HIV duration groups were statistically significant. 51 participants with 6–10 years HIV duration were more likely to be higher level of education, at asymptomatic stage and have higher CD4 + T cell count. After adjustment for gender, age, race, education, marital status, employment, family income, region, stage of disease and CD4 + T cell count, the score of symptom distress among participants with 6–10 years HIV duration had was higher with the extension of HIV duration. Specially in physical symptoms and psychological symptoms,participants with 6–10 years HIV duration reported the persisting worse burdensome.ConclusionsHIV duration with 6–10 yearsmay be a key period that the medical team needs to pay special attention to among middle-aged and elderly PLWH. There is a need to provide medical and psychosocial services targeting middle-aged and elderly PLWH according to their changing symptom distress.Trial registrationClinicaltrials.gov: ChiCTR2100046225. Registered 11 May 2021.

Higher religiosity and spirituality are associated with ethnic group membership among middle-aged and older adults living with HIV

Background: HIV is a chronic illness that impacts the lives of more than 1 million people in the United States. As persons living with HIV (PWH) are living longer, it is important to understand the influence that religiosity/spirituality has among middle-aged and older PWH. Objective: Compare the degree of religiosity/spirituality among middle-aged and older PWH and HIV-negative individuals, and to identify demographic, clinical, and psychosocial factors associated with religiosity/spirituality among PWH. Method: Baseline data on 122 PWH and 92 HIV-negative individuals (ages 36-65 years; 61.1% Non-Hispanic White) from a longitudinal study were analyzed for the current study. Recruitment occurred through HIV treatment clinics and community organizations in San Diego. Participants completed questionnaires on religiosity, spirituality, and psychosocial functioning. Independent samples t-tests, Pearson correlations, and multiple linear regression analyses were conducted to test the study objective. Results: No significant differences in religiosity/spirituality were found between PWH and HIV-negative individuals. Demographic and psychosocial variables were unrelated to religiously/spirituality among HIV-negative individuals. Among PWH, multiple linear regression models indicated higher daily spirituality was significantly associated with racial/ethnic minority membership (Hispanic/Latino, African American/Black, or Other), fewer years of estimated duration of HIV, greater social support, and higher grit. Greater engagement in private religious practices was significantly associated with racial/ethnic minority membership and higher social support. Conclusions: For PWH, being a racial/ethnic minority and having higher social support was associated with greater engagement in religious/spiritual practices. Future longitudinal studies should examine whether religion/spirituality impacts well-being across the lifespan among racial/ethnic minority groups of PWH.

Cardiovascular risk and HIV infection in patients aged 50 years and older at the Ahala District Medical Center

Older people living with HIV (P50+) are living longer and longer and are therefore prone to age-related comorbidities. The objective of this study was to investigate the cardiovascular risk of P50+ followed in an HIV care unit in Cameroon. The proportion of P50+ was 13.9% and 80 were included in the study. The following prevalences of cardiovascular risk factors (CVRF) were found: sedentary lifestyle (77.5%), chronic smoking (5%). Fifteen percent reported having hypertension and 25% of the P50+ had high blood pressure during physical examination. Similarly, 2.5% of the patients reported diabetes and 7.5% of the P50+ had high blood sugar levels. The examinations performed revealed 2.5% of LDL dyslipidemia, 23.1% of glomerular filtration rate abnormalities, 5.7% of left ventricular hypertrophy (LVH), and 22.9% of electrocardiographic signs of myocardial ischemia. The study of the interdependence between CVRF and the characteristics of the population revealed a relationship of dependence between physical activity and age (p=0.002), diabetes and age (p=0.004), diabetes and duration of HIV (p=0.007), LVH and duration of HIV (p=0.001). Cardiovascular risk is high in P50+ which could make them vulnerable to cardiovascular events. It is therefore necessary or even essential that cardiovascular risk assessment be integrated into the continuum of care of PLWH in general and P50+ particularly in HIV care units.

Cryptococcal Antigen Screening and Missed Opportunities for Earlier Diagnosis Among People With HIV and Poor Virologic Control in the Bronx, NY.

Background:There is no established cryptococcal antigen (CrAg) screening guideline for people with HIV who are antiretroviral therapy experienced but have poor virologic control. We assessed factors associated with CrAg screening and describe missed opportunities for earlier testing.Setting:Ambulatory clinics affiliated with Montefiore Medical Center, Bronx, NY.Methods:This was a retrospective chart review of CrAg screening among asymptomatic people with HIV with absolute CD4 counts200 cells/mm3 and HIV viral loads (VLs) > 200 copies/mL receiving HIV care from 2015 to 2020. We used Cox proportional hazards regression to identify predictors of screening, including longitudinal CD4 count and HIV VL as time-varying covariables. Among cases of diagnosed cryptococcosis, we assessed for opportunities for earlier diagnosis.Results:Screening CrAg was performed in 2.9% of 2201 individuals meeting the inclusion criteria. Compared with those not screened, those who were screened had a shorter duration of HIV infection (0.09 vs. 5.1 years; P = 0.001) and lower absolute CD4 counts (12 vs. 24 cells/mm3; P < 0.0001). In a multivariable model stratified by median HIV duration, CD4 < 100 [hazard ratio (HR), 7.07; 95% confidence interval (CI): 2.43 to 20.6], VL > 10,000 (HR, 15.0; 95% CI: 4.16 to 54.0), and a shorter duration of HIV infection (HR, 0.60; 95% CI: 0.42 to 0.86) were associated with screening for those with HIV < 5 years. Among those diagnosed with cryptococcosis (n = 14), 6 individuals had an ambulatory visit in the preceding 6 months but did not undergo screening.Conclusion:CrAg screening was infrequently performed in this at-risk population. Those with a longer duration of HIV infection were less likely to undergo CrAg screening, highlighting potential missed opportunities for earlier diagnosis.

SARS-CoV-2 Specific Immune Response and Inflammatory Profile in Advanced HIV-Infected Persons during a COVID-19 Outbreak.

The main aim of this study was to describe the clinical and immunological outcomes, as well as the inflammatory profile, of patients with advanced HIV in an assisted-living facility in which an outbreak of SARS-CoV-2 occurred. SARS-CoV-2 humoral and specific T-cell response were analyzed in patients with HIV infection and COVID-19; as a secondary objective of the analysis, levels of the inflammatory markers (IL-1β, IL-6, IL-8, and TNFα) were tested in the HIV/COVID-19 group, in HIV-positive patients without COVID-19, and in HIV-negative patients with mild/moderate COVID-19. Antibody kinetics and ability to neutralize SARS-CoV-2 were evaluated by ELISA assay, as well as the inflammatory cytokines; SARS-CoV-2 specific T-cell response was quantified by ELISpot assay. Mann–Whitney or Kruskal–Wallis tests were used for comparisons. Thirty patients were included with the following demographics: age, 57 years old (IQR, 53–62); 76% male; median HIV duration of infection, 18 years (15–29); nadir of CD4, 57/mmc (23–100) current CD4 count, 348/mmc (186–565). Furthermore, 83% had at least one comorbidity. The severity of COVID-19 was mild/moderate, and the overall mortality rate was 10% (3/30). Additionally, 90% of patients showed positive antibody titers and neutralizing activity, with a 100% positive SARS-CoV-2 specific T-cell response over time, suggesting the ability to induce an effective specific immunity. Significantly higher levels of IL-6, IL-8, and TNF-α in COVID-19 without HIV vs. HIV/COVID-19 patients (p < 0.05) were observed. HIV infection did not seem to negatively impact COVID-19-related inflammatory state and immunity. Further data are mandatory to evaluate the persistence of these immunity and its ability to expand after exposure and/or vaccination.

CARDIOVASCULAR RISK AND HIV INFECTION IN PATIENTS AGED 50 YEARS AND OLDER AT THE AHALA DISTRICT MEDICAL CENTER, CAMEROON

Aim and objectives: Older people living with HIV (P50+) are living longer and longer and are therefore prone to age-related comorbidities. The objective of this study was to investigate the cardiovascular risk of P50+ followed in an HIV care unit in Cameroon.&#x0D; Methods: Cardiovascular risk factors (CVRF) were assessed through clinical examination and the following paraclinical exams fasting blood glucose, lipid profile, creatinine level with calculation of glomerular filtration rate according to the Cockcroft and Gault formula and resting electrocardiogram.&#x0D; Results: The proportion of P50+ was 13.9% and 80 patients were included in the study. The following prevalence of CVRF were found sedentary lifestyle (77.5%), chronic smoking (5%). Fifteen percent reported having hypertension and 25% of the P50+ had high blood pressure during physical examination. Similarly, 2.5% of the patients reported diabetes and 7.5% of the P50+ had high blood sugar levels. The examinations performed revealed 2.5% of LDL-cholesterol dyslipidemia, 23.1% of glomerular filtration rate abnormalities, 5.7% of left ventricular hypertrophy (LVH), and 22.9% of electrocardiographic signs of myocardial ischemia. The study of the interdependence between CVRF and the characteristics of the population revealed a relationship of dependence between physical activity and age (p=0.002), diabetes and age (p=0.004), diabetes and duration of HIV (p=0.007), LVH and duration of HIV (p=0.001).&#x0D; Conclusion: Cardiovascular risk is high in P50+ which could make them vulnerable to cardiovascular events. It is therefore necessary or even essential that cardiovascular risk assessment be integrated into the continuum of care of PLWH in general and P50+ particularly in HIV care units.&#x0D; &#x0D; Peer Review History: &#x0D; Received: 29 April 2022; Revised: 8 June; Accepted: 28 June, Available online: 15 July 2022&#x0D; Academic Editor: Dr. A.A. Mgbahurike, University of Port Harcourt, Nigeria, amaka_mgbahurike@yahoo.com&#x0D; UJPR follows the most transparent and toughest ‘Advanced OPEN peer review’ system. The identity of the authors and, reviewers will be known to each other. This transparent process will help to eradicate any possible malicious/purposeful interference by any person (publishing staff, reviewer, editor, author, etc) during peer review. As a result of this unique system, all reviewers will get their due recognition and respect, once their names are published in the papers. We expect that, by publishing peer review reports with published papers, will be helpful to many authors for drafting their article according to the specifications. Auhors will remove any error of their article and they will improve their article(s) according to the previous reports displayed with published article(s). The main purpose of it is ‘to improve the quality of a candidate manuscript’. Our reviewers check the ‘strength and weakness of a manuscript honestly’. There will increase in the perfection, and transparency. &#x0D; Received file: Reviewer's Comments:&#x0D; Average Peer review marks at initial stage: 6.0/10&#x0D; Average Peer review marks at publication stage: 7.0/10&#x0D; Reviewers:&#x0D; Dr. Peter Juma Ochieng, Biotech Research Center (BRC), Obuda University, Hungary, peter26juma@gmail.com&#x0D; Dr. Esther Marguerite Chase DJANGA, Faculty of Medicine and Biomedical Sciences. Department of Public Health. University of Yaoundé I, Cameroon. e.djanga@yahoo.com&#x0D; Similar Articles: &#x0D; SERO-EPIDEMIOLOGICAL STUDY OF HEPATITIS B, C, HIV AND TREPONEMA PALLIDUM AMONG BLOOD DONORS IN HODEIDA CITY- YEMEN

A prospective cohort study of renal function and bone turnover in adults with hepatitis B virus (HBV)-HIV co-infection with high prevalence of tenofovir-based antiretroviral therapy use.

Tenofovir disoproxil fumarate (TDF) is a common component of antiretroviral therapy in hepatitis B virus (HBV)-HIV co-infected adults but few studies have evaluated worsening renal function and bone turnover, known effects of TDF. Adults from eight North American sites were enrolled in this cohort study. Research assessments were conducted at entry and every 24 weeks for ≤192 weeks. Bone markers were tested at baseline, week 96 and week 192 from stored serum. We evaluated changes in markers of renal function and bone turnover over time and potential contributing factors. A total of 115 patients were prospectively followed; median age 49 years, 91% male and 52% non-Hispanic Black. Duration of HIV was 20.5 years. TDF use ranged from 80% to 92% throughout follow-up. Estimated glomerular filtration rate (eGFR) (ml/min/1.73m2 ) decreased from 87.1 to 79.9 over 192 weeks (p < 0.001); however, the prevalence of eGFR <60 ml/min/1.73m2 did not appear to differ over time (always <16%; p=0.43). From baseline to week 192, procollagen type I N-terminal propeptide (P1NP) (146.7 to 130.5ng/ml; p=0.001), osteocalcin (14.4 to 10.2ng/ml; p < 0.001) and C-terminal telopeptides of type I collagen (CTX-1) (373 to 273 pg/ml; p < 0.001) decreased. Younger age, male sex and overweight/obesity versus normal weight predicted a decrease in eGRF. Black race, healthy weight versus underweight, advanced fibrosis, undetectable HBV DNA, and lower parathyroid hormone level predicted worsening bone turnover. In this HBV-HIV cohort with high prevalence of TDF use, several biomarkers of renal function and bone turnover indicated worsening status over approximately 4 years, highlighting the importance of clinical awareness in co-infected adults.

Frequency of Aids Defining Opportunistic Infections in Hospitalized HIV Infected Patients

Background: Human Immunodeficiency virus patients with AIDS defined opportunistic infections with Pneumocystis jiroveci, cryptoccocal, disseminated TB, cytomegalovirus, and cytomegalovirus associated retinitis, and cryptospordiasis.&#x0D; Objective: To determine the frequency of AIDS defining opportunistic infections in hospitalized HIV infected patients.&#x0D; Methodology: This cross sectional study was conducted from 21st October 2018 to 20th April 2019 at Department of Medicine, Civil Hospital, Karachi. Total 154 diagnosed patients of HIV were included. For diagnosis of various AIDS defining illness, clinical, radiological and bacteriological evidence of disseminated tuberculosis chronic cough, and weight loss diagnosed by AFB smear/ gene experts. Pneumocystis jiroveci was diagnosed by bronchoalveolar lavage and CD4 counts. Cryptosporidiosis with watery diarrhea and stool sample microscopy, cerebral toxoplasmosis with headache, hemiparesis, vomiting, diagnosed by serology and cytomegalovirus retinitis with blurred vision diplopia, vision impairment and Cryptococcal meningitis with fever &gt;98.6oF. Headache, stiff neck, photophobia diagnosed by microscopy, culture, or antigen was done. Descriptive statistics were calculated and stratification was done. Post stratification chi square test was applied. P value ≤0.05 was taken as significant.&#x0D; Results: There were 71.4% male and 28.6% female patient. The mean HIV duration was 15.25±5.09 months. The overall mean CD4 count was 174.17±12.85/cumm. 18.8% patient were found with disseminated tuberculosis, 31.2% with pneumocystis pneumonia, 12.3% with cerebral toxoplasmosis, 18.2% with cryptococcal meningitis, 3.9% with cryptospordiasis and 14.9% with cytomegalovirus retinitis.&#x0D; Conclusion: Pneumocystis pneumonia was the most prevalent infection followed by disseminated tuberculosis, cryptococcal meningitis, cytomegalovirus retinitis, cerebral toxoplasmosis, and cryptospordiasis.

Diagnosis of liver fibrosis in ageing patients with HIV at risk for non-alcoholic fatty liver disease in Italy and Canada: assessment of a two-tier pathway.

Since the introduction of effective antiretroviral therapy, liver-related mortality has increased ten-fold in ageing people with HIV. This trend is driven by ageing-related metabolic conditions that cause non-alcoholic fatty liver disease (NAFLD), which affects 35-65% of people with HIV. Clinically significant (stage 2-4) liver fibrosis develops in over 15% of people with HIV who have NAFLD. Strategies are needed to identify people with HIV at risk for significant liver fibrosis and reduce cirrhosis-related complications. Non-invasive tests to diagnose liver fibrosis include ultrasound-based transient elastography and serum biomarkers. Transient elastography is a feasible tool to assess liver fibrosis, but it is not largely accessible in HIV clinics. We aimed to determine whether a two-tier care pathway with assessment of simple serum biomarkers for fibrosis as first tier could reduce the need for the specialist transient elastography test (second tier). Patients were consecutively identified through a clinical programme for liver disease in people with HIV in Canada and Italy. We applied a two-tier care pathway to three prospective cohorts of people with HIV at risk for NAFLD, defined as those with elevated liver transaminases, body mass index (BMI) of 25 or greater, or diabetes. Patients with alcohol abuse or coinfection with hepatitis B or C viruses were excluded. Five simple serum biomarkers of fibrosis, based on liver transaminases, platelets, and BMI (fibrosis-4 index [FIB-4], BARD [BMI, AST to ALT ratio, diabetes] score, NAFLD fibrosis score, AST to ALT ratio, and AST-to-platelet ratio index [APRI]) were applied as a first-tier assessment to exclude significant liver fibrosis. All patients then received transient elastography. We assessed the decrease in referral for transient elastography that would have occurred based on biomarker assessment and discordance between high transient elastography (≥7·1 kPa), indicating significant liver fibrosis, and low serum fibrosis biomarkers (FIB-4 <1·3, BARD score 0-1, NAFLD fibrosis score less than -1·455, AST to ALT ratio <0·8, and APRI <0·5). We also assessed independent factors associated with that discordance by multivariable logistic regression analysis. We included 1202 people with HIV at risk for NAFLD (mean age 51·2 years [SD 10·1], 914 [76%] male and 288 [24%] female, mean HIV duration 16·3 years [SE 9·7], mean BMI 26·5 Kg/m2 [SD 4·5]; prevalence of diabetes 49·5%). 222 (18·5%) of these participants had significant liver fibrosis according to transient elastography. Assessment of simple fibrosis biomarkers would have decreased transient elastography referrals between 22·5% (BARD score) and 82·4% (APRI). Discordance rate ranged from 3·9% (NAFLD fibrosis score) to 11·1% (APRI). After adjustment for age, sex, presence of diabetes, level of HDL cholesterol, and CD4 cell count, BMI (odds ratio 1·12, 95% CI 1·07-1·17) and triglyceride level (1·25, 1·08-1·46) were independent predictors of discordance for low APRI and high transient elastography. Use of a two-tier pathway to identify liver fibrosis in ageing people with HIV at risk for NAFLD could reduce transient elastography examinations by a substantial proportion, reducing costs and helping to optimise use of resources in HIV care. GS is supported by a Senior Salary Award from Fonds de recherche du Québec-Santé (number 296306).