HIV-infected People Research Articles

Current state of care for cancer patients with HIV in Russia: Data from an oncologist survey

Background. HIV infection and its consequences remain one of the dramatic problems of our time. Currently, for people receiving antiretroviral therapy, non-AIDS-related diseases are becoming relevant, among which malignant tumors are steadily coming to the fore. International data show that HIV-infected patients with cancer are significantly less likely to receive full anti-tumor treatment than patients without HIV. Aim. To obtain objective data on the incidence, clinical course, and effectiveness of the most common therapies for patients with malignancies and HIV in real-world practice in Russia. Materials and methods. The study was supported by the All-Russian National Union "Association of Oncologists of Russia." The questionnaire was sent to 1000 oncologists in all regions of the Russian Federation, of which 366 (36%) participated in the anonymous survey. The study did not imply any material award for the respondents. The questionnaire was developed with the direct collaboration of leading oncology experts in malignancies in HIV patients. It included questions about the frequency of follow-up of oncological patients with HIV, awareness of oncologists about the features of the malignancies in HIV patients, and treatment and supportive therapy of cancer patients with HIV infection. The key points of the analysis were the frequency and conditions of the standard anti-tumor treatment program for patients with cancer and HIV. Results. Lack of knowledge among oncologists, low oncological alertness among infectious disease doctors, and lack of specific guidelines for the management of this complex cohort of patients are the main reasons why patients with cancer and HIV fail to receive standard treatment for cancer in Russia. Conclusion. The urgency of the issue of treatment of patients with cancer and HIV warranted the study. This is due to the global trend of an increase in malignancies in HIV-infected people. Conducting educational activities, valid population studies, and creating a national register of these patients will form the basis for developing special clinical guidelines approved by the Ministry of Health of Russia.

PECULIARITIES OF FATAL CASES IN HIV-INFECTED PATIENTS WITH CENTRAL NERVOUS SYSTEM LESIONS IN TUBERCULOSIS INPATIENT SETTINGS FOR 2014-2023

Aim of the work is to study the peculiarities of fatal cases of CNS lesions in patients with tuberculosis against the background of HIV infection.Materials and methods. A retrospective analysis of 68 medical histories of tuberculosis patients with HIV infection who died in the CNE "Zaporizhia Regional Phthisiopulmonology Clinical Treatment and Diagnostic Center" for the years 2014-2023 was carried out. An analysis of the anamnesis, clinical and radiological data, laboratory indicators, final clinical and pathological diagnoses was carried out.Results. The mortality rate among HIV-infected people in TB hospitals has a steady downward trend. In 2014-2023, 1234 patients with HIV infection were treated at the CNE "Zaporizhia Regional Phthisiopulmonology Clinical Treatment and Diagnostic Center", 214 (17.3%) died. In 2014, 33 (24.6%) out of 134 HIV-positive patients died, and in 2023, 3 (6.8%) out of 44 HIV-positive patients died. Central nervous system (CNS) lesions among the dead were noted in 68 (31.8%) patients. The study of medical records found that among those who died with CNS lesions, men prevailed - 55 (80.9%), women - 13 (19.1%), young patients - 53 (77.9%), and 15 (22.1%) patients over 45 years of age. In the structure of central nervous system lesions in patients with active tuberculosis, tuberculous meningoencephalitis prevails in fatal cases - 35 (51.5%), a significant share of cryptococcal meningoencephalitis - 18 (26.5%) and progressive multifocal leukoencephalopathy - 9 (13.2%). The main reason that leads to fatal consequences is the late diagnosis of HIV infection - in 26 (38.2%) the number of CD4<50 cl./μl, 36 (52.9%) patients did not receive antiretroviral therapy (ART), 18 (26 .5%) of patients had been taking ART for a year. Improvement of tuberculosis microbiological diagnosis due to the introduction of the Xpert MTB/RIF® (Ultra) test at all levels of the laboratory network, the introduction of a mandatory test for cryptococci, free CT, MRI examination for the diagnosis in HIV-infected patients, improvement of drug-resistant tuberculosis treatment regimens contributed to the reduction of mortality in case of HIV and tuberculosis combination, which was 24.6% in 2014, and 6.8% in 2023.Conclusions. Diagnosis and treatment of CNS diseases in patients with active tuberculosis against the background of HIV infection requires a comprehensive approach: early diagnosis of HIV infection, tuberculosis and lesions of the CNS, improvement of treatment.

A young male patient with cardiomyopathy associated with human immunodeficiency virus infection in the era of highly active antiretroviral therapy

Background: Cardiomyopathy in young people, especially those associated with HIV infection, has been reduced since the era of Highly Active Antiretroviral Therapy (HAART). In the era of post-HAART, manifestations of human immunodeficiency virus (HIV)-associated cardiomyopathy with impaired left ventricular (LV) systolic function are approximately about 1-3% of HIV-infected people. In this case, we presented how to diagnose and appropriately manage such a patient. Case Illustration: A 27-year-old male patient who works as a health worker came to the emergency room with complaints of shortness of breath; it worsened in the last 2 weeks. He got vital signs: blood pressure 97/60 mmHg, heart rate 118 bpm, respiratory rate 23 tpm, and oxygen saturation 99 % with oxygen supplementation of 8 lpm. Risk factors in patients such as smoking, family history, hypertension, diabetes mellitus, and dyslipidemia were denied. He was diagnosed with HIV on (antiretroviral therapy) ART 3 years ago with risk factors for free sex without protection. The last CD4 value was 796 cells/ul (normal value 637 – 1485). The echocardiography showed all chamber dilatation, global hypokinetic, and a significant decrease in LV systolic function (LVEF 16%). Laboratory examination showed an increase of N-terminal prohormone of brain natriuretic peptide (NT-proBNP) into 6824 pg/mL (normal value <85.8). It was then treated by optimizing HF therapy continue HIV therapy. Conclusion: In HIV patients who have fallen into heart failure, a proper diagnosis using relevant tools could be a reference for clinicians to make the right decision. Prompt treatment combination of optimal HF therapy and HIV therapy are becoming the keys to the treatment. Keyword: antiretroviral, cardiomyopathy, heart failure, human immunodeficiency virus

Risk groups of HIV infection among the population of the Omsk region

The peculiarities of the course of the epidemic process of HIV infection, including the formation of certain risk groups by gender, age and social status, are relevant, as they allow the development of specific preventive measures. The aim is to identify risk groups for HIV infection among the population of the Omsk region in 1996–2023. Data from the main statistical reporting forms, the Federal Register of Persons Infected with the Human Immunodeficiency Virus, and the results of epidemiological investigations were used for the analysis. The analysis made it possible to establish the main trends in the development of the epidemic process of HIV infection in the Omsk region. The general trend of decreasing morbidity has been revealed, which coincides with that in the Russian Federation, primarily due to the large volume of preventive measures carried out. Changes in the characteristics of the risk groups of infection have been established — the contingents of injecting drug users and men who have sex with men, prevailing at an early stage of the epidemic, have been replaced by persons who became sexually infected from individuals of the opposite sex. At the same time, the proportion of infected women approached that of men. This entailed the risk of perinatal transmission of HIV infection. The introduction of mandatory screening for HIV infection markers in pregnant women and the implementation of antiretroviral prophylaxis has reduced the number of cases of perinatal infection of newborns to a minimum. An increase in the share of the rural population in the total structure of newly diagnosed people with HIV infection may indicate both lower awareness of this problem and shortcomings in the provision of medical care, its lower accessibility compared to the urban population. The prevalence in the structure of HIV-infected people who are not engaged in work indicates that the most socially unprotected contingents are involved in the epidemic process, as a rule, they are not ready to take care of their own health and the health of others, often leading an antisocial lifestyle. Thus, HIV infection in the Omsk region remains one of the priority epidemiological problems requiring the formation of an integrated approach to its solution. The conducted research made it possible to identify the main risk groups for HIV infection, in relation to which targeted preventive strategies should be applied.

The effect of sodium deoxyribonucleate with iron complex on the expression of surface markers of MT-4 cells infected with human immunodeficiency virus type 1 (HIV-1) (Retroviridae: Primate lentivirus group)

The persistence of immune dysfunction during therapy has serious consequences for the health of HIV-infected people. Therefore, an important direction is the search for drugs that can reduce the inflammatory potential of the immune system and serve as an additional component of antiviral therapy. Aim ‒ to study the effect of the immunomodulatory drug Sodium deoxyribonucleate with iron complex (DNA-Na-Fe) on the expression of activation markers in MT-4 cells infected with HIV-1. Expression levels of CD4, CD28, CD38, CD62L and HLA-DR proteins on the plasma membrane were measured in cells. To assess viral activity, the p24 protein was quantified by ELISA. The two cell variants with different replicative activity were analyzed. Control cells, cells with DNA-Na-Fe, infected cells and infected cells with DNA-Na-Fe were tested. Based on the results obtained, it can be concluded that antiviral activity of the drug in MT-4 cells infected with HIV-1 is associated with immunomodulatory activity that enhances the expression of membrane proteins CD4, CD28, CD38 and CD62L. Diversity in the effect of DNA-Na-Fe on the studied surface proteins expression in two cell lines indicates that they depend on the characteristics of the combined molecular biological processes occurring in cells. And the increased effects observed in a system with changes in replicative activity assumes its active participation in virus replication at the stages of virus penetration and budding. Studies have shown that DNA-Na-Fe has antiviral and immunomodulatory activity.

Respiratory Syncytial Virus among People Living with HIV: Is There a Case for Rolling Out Prophylaxis? A Viewpoint Based on a Systematic Review.

Respiratory Syncytial Virus (RSV) is responsible for a considerable burden of respiratory disease among children and older adults. Several prophylactic strategies have recently been introduced. We review the available evidence on the interplay between RSV infection and HIV, looking at the specific role of RSV prophylactic strategies in individuals affected by or exposed to HIV. We conducted a systematic review on the association between HIV infection and RSV incidence and severity. We searched in PubMed/MEDLINE for clinical epidemiological studies covering outcomes such as RSV-associated illness, severity, and mortality in individuals affected by or exposed to HIV. A total of 36 studies met the inclusion criteria and were included, the majority conducted in sub-Saharan Africa. There was no compelling evidence suggesting a higher incidence of RSV illness among HIV-infected people. A higher risk of severe disease was consistent among both HIV-positive and HIV-exposed but uninfected (HEU) children. Case fatality rates were also higher for these groups. Evidence on a differing risk among adults was scarce. HIV-positive pregnant women should be given priority for recently approved RSV vaccination, for protection of their newborns. HIV-infected and HEU infants should be considered risk groups for nirsevimab prophylaxis in their first year of life and possibly beyond.

A Novel Electrochemical Method to Detect HIV in Saliva

Human Immunodeficiency Virus (HIV) is a global epidemic that causes acquired immunodeficiency syndrome (AIDS) with time. Approximately 14% (one in seven) of HIV-infected people do not know their HIV status till 2022 [1]. These people have a higher chance of spreading HIV without knowing its consequences. So, there is an unmet need for more HIV testing techniques to isolate and identify all HIV-infected people as soon as after their infection. Till now, there are no available techniques to detect HIV in saliva due to HIV’s low concentrations and the inhibition properties of saliva. We developed a nickel-based electrochemical method to detect HIV in saliva for the first time. This method does not require any biorecognition element for the detection, thus making it label-free. The difference in current responses during the chronoamperometry helps to distinguish HIV from saliva. It happens due to the blocking of the formation of NiOOH in the presence of HIV on the nickel surface. This method has high sensitivity and exhibits a linear current trend with increasing concentrations of HIV culture fluid. Also, it has a lower detection limit of around 50 copies/mL and a high selectivity of HIV over Epstein-Barr Virus (EBV), which is the most common co-infection for HIV patients. Also, the most common route to transmit EBV is through saliva. So, this novel method will create a new opportunity for the commercialization of non-invasive HIV testing techniques that minimize the spreading rate of HIV by fastening HIV testing.[1] “Global HIV & AIDS statistics — Fact sheet.” Accessed: Nov. 26, 2023. [Online]. Available: https://www.unaids.org/en/resources/fact-sheet

HIV Sero-Prevalence among Tuberculosis Patients in Bangladesh: a nationwide cross-sectional study

Introduction Bangladesh is committed to achieving the SDG target of ending the tuberculosis epidemic and achieving UHC by 2030. To inform policy and program decision-making, this nationwide sero-survey of HIV among tuberculosis patients was conducted. Methods The cross-sectional survey utilized a two-stage probability proportional to size (PPS) systematic random sampling technique for selected TB reporting centers (TRCs) from June 2020 to December 2021. The estimated 12,065 diagnosed tuberculosis patients, according to the NTP diagnostic algorithm, irrespective of age and sex, were included. The required information was collected through face-to-face interviews and record reviews using a pre-tested electronic TAB-based semi-structured questionnaire. With all aseptic precautions for all respondents who gave consent, 5 ml. venous blood was collected for the standard confirmatory test by 4th generation ELISA method for detection of antibody of HIV1/2/P24 antigen. Results Out of 12,065 TB patients surveyed, most of them were from the Dhaka division (25%), urban (76%), 55 years and above (28%), male (56%), married (82%), illiterate (36%) and living in a nuclear family (70%). A total of 12 (0.1%) HIV-positive cases were found among TB patients across the country, and the majority (33%) of them belonged to the age group of 35 to 44 years, male (58%), lower educational group (67%), urban resident (67%), and from nuclear family (77%). The HIV-positive patients found more among pulmonary TB patients (83%) who were detected bacteriologically positive (58%) but smear and gene expert negative (75%). Among them, none was found to have progressed to drug-resistant TB. Conclusion HIV affects the immune system, and TB is one of the leading causes of death in HIV-infected people. Although the rate is low, there is a need for continued efforts to prevent and treat TB in Bangladesh, particularly among older age groups, urban residents, and those with co-morbidities such as diabetes.

HIV-related cognitive disorders in children in Kinshasa (Democratic Republic of Congo)

ObjectivesHIV-infected individuals are at increased risk of neurocognitive disorders compared with the general population. Studies suggest that, despite the combination of antiretroviral drugs, HIV infection causes immune activation leading to significant neural damage; however, there is little data on HIV-infected young people in our country.MethodologyThis is a comparative cross-sectional study conducted between November 2020 and March 2021 on two hundred and sixteen children aged 6–15 years, including 106 HIV-positive children and 108 healthy children. Cognitive performance was assessed using the Differential Ability Scale Second Edition (DAS-II).ResultsHIV-infected children showed lower cognitive scores than control children in the subtest group of verbal ability (82.1% vs. 43.5%); non-verbal ability (84.9% vs. 45.4%); spatial ability (79.2% vs. 21.3%) and generall conceptual ability (GCA) (88.7% vs. 43.5%). The children in the control group had significantly higher ability scores in the diagnostic tests and in school achievement, and the difference was statistically significant.ConclusionCognitive impairment remains a significant complication in HIV-positive children, as suggested by low cognitive scores in more than half of our participants. This is an unresolved issue with implications for survival, quality of life and daily functioning in these children. It is important that clinicians are able to identify and manage these cognitive deficits.

Factors associated with human papillomavirus infections among women living with HIV in public health facilities in Western Oromia, Ethiopia

BackgroundHuman Papillomavirus infection (HPV) is among the most common sexually transmitted infections with the highest incidence and prevalence worldwide. HPV has been established as the main cause of cervical cancer and remains a public health problem globally. In Western Oromia, Ethiopia cervical screening remains a major issue because of limited resources, and shortage of HPV testing technology. As a result, the prevalence of HPV and associated factors remain unknown among HIV-positive women. This study aimed to assess the prevalence of HPV and associated factors among women living with HIV attending Antiretroviral Therapy (ART) services in public health facilities of East Wollega and West Showa Zones, Ethiopia, 2022.MethodUsing a cross-sectional study design, a total of 415 women ≥ 18 years old were enrolled using systematic random sampling from five public health facilities. Cervical specimens were collected by a trained nurse from April 01 2022, to May 30, 2022, and tested at Nekemte Public Health Research and Referral Molecular Biology, a certified/accredited laboratory for HPV-DNA Polymerase Chain Reaction by expertise using Abbott m2000rt-PCR assays. Finally, Epi data version 4.6 was used for data entry and SPSS version 24.0 were used for data cleaning and analysis, and frequencies and prevalence of HPV were computed. Variables were identified using the multivariable model and statistically significant associations of variables were determined based on the adjusted odds ratio (AOR) with its 95% CI and P-value < 0.05 to determine the strength of association.ResultThe prevalence of HPV was 30.4% [95% CI: 26.0, 34.9]. Of HPV-infected women, 11.9% were positive for HPV-16, 9.5% for HPV-18, and 65.9% were positive for other hr-HPV . The odds of HPV infection among women aged beyond 48 years are 2.85 times the odds of HPV among people who were aged 18–27(AOR = 2.85, 95% CI: 1.16, 5.58). The odds of HPV infection among women who had three or more sexual partners is 4.12 times the odds of HPV infection among women with a single sexual partner(AOR = 4.12, 95% CI: 2.34–8.62). The odds of HPV infection among women who didn’t use condom during sexual intercourse are 4.73 times the odds of HPV among women who used condom during sexual intercourse. (AOR = 4.73, 95% CI: 1.98–9.33). The odds of HPV infection among women who had history of is 4.52 times the odds of HPV infection among women with no history of abortion. [AOR = 4.52, 95% CI: 2.04, 6.89] The odds of HPV infection among women with history of Sexually Transmitted Infection (STI) 3.62 times the odds of HPV among women with no history of STI (AOR = 3.62, 95%CI: 1.75, 5.83). The odd of HPV among women with abnormal vaginal discharge is 3.31 times the odds of the disease among women with normal vaginal discharge [AOR = 3.31, 95% CI: 2.87,7.35).Conclusion and recommendationThe prevalence of HPV infection among HIV-infected women was high in the study area. Given the above-associated factors, we recommend that the stakeholders integrate HPV prevention strategies into HIV /AIDS services. Furthermore, the study has provided essential information about the HIV link with hr-HPV infections, which may explain the high prevalence among HIV-infected women. This can contribute to policy development and planning of prevention strategies incorporating HPV infection prevention especially among youth and HIV-infected people.

COVID-19 Vaccine Risk Perception and Associated Vaccine Hesitancy Among HIV-Infected People at Parirenyatwa Centre of Excellence

&amp;lt;i&amp;gt;Background:&amp;lt;/i&amp;gt; The impact of COVID-19 on people living with HIV (PLWH) is particularly concerning due to their existing health vulnerabilities. The low uptake of the COVID-19 vaccine and the failure to achieve herd immunity highlight the need to address vaccine hesitancy, especially in developing countries battling multiple infectious diseases. &amp;lt;i&amp;gt;Objective:&amp;lt;/i&amp;gt; This study aimed to determine the relationship between COVID-19 vaccine risk perception and vaccine hesitancy among PLWH. &amp;lt;i&amp;gt;Materials and Methods:&amp;lt;/i&amp;gt; An analytical cross-sectional design was used, involving 348 participants from Parirenyatwa Centre of Excellence, recruited via systematic random sampling. Data collection, following ethical approval, was conducted using a self-administered questionnaire. The data were categorized into structure, process, and outcome, and analyzed with SPSS version 22. &amp;lt;i&amp;gt;Results:&amp;lt;/i&amp;gt; The study found that 79.9% of PLWH perceived a risk in taking the COVID-19 vaccine. About 55% had moderate knowledge of COVID-19, and 48.4% of those vaccinated had completed the vaccine course, with 43.2% receiving two doses and 7.2% only one dose. Motivations for vaccination included accessing services, travel compliance, work allowances, and entry permissions. Vaccine hesitancy was evident in 56% of participants, who were also unlikely to recommend vaccination to others. A positive correlation (r=0.159, p&amp;lt;0.03) was observed between vaccine risk perception and hesitancy. Barriers included fear of long waits, vaccine safety concerns, and insufficient information. &amp;lt;i&amp;gt;Conclusions:&amp;lt;/i&amp;gt; The study demonstrated a significant positive correlation between vaccine risk perception and hesitancy among PLWH. It underscores the necessity of tailored vaccination messages addressing the specific concerns of PLWH and the need for increased governmental investment in awareness campaigns to achieve 75% herd immunity.

Prevalence and epidemiological characteristics of major chronic diseases in people living with HIV in Taizhou, Zhejiang Province, 1998-2022

Objective: To understand the prevalence of major chronic diseases of diabetes, cardiovascular disease and malignant tumor in people living with HIV in Taizhou. Methods: The data were collected from China Information System for Disease Control and Prevention and Taizhou Chronic Disease Information Management System. A total of 5 126 people living HIV under follow-up in Taizhou from 1998 to 2022 were included in the analysis. Software SAS 9.4 was used for χ2 test, trend analysis and logistic regression analysis. Results: In the 5 126 people living with HIV, the reported prevalence rates of diabetes,cardiovascular disease and malignant tumor were 10.28% (527/5 126),3.98% (204/5 126) and 6.01% (308/5 126), respectively. 37.00% (195/527) and 48.58% (256/527), 40.20% (82/204) and 48.53% (99/204), 37.66% (116/308) and 48.38% (149/308) were diagnosed as diabetes, cardiovascular disease and malignant tumor before and after confirmation of HIV infection. From 2013 to 2022, the proportion of HIV infected people diagnosed with diabetes, cardiovascular disease and malignant tumor after confirmation increased (trend χ2=79.98,P<0.001; trend χ2=17.44,P<0.001; trend χ2=32.06,P<0.001). Based on the analysis on the factors for complicated chronic diseases in people living with HIV, it was found that women under 60 years old (aOR=0.66, 95%CI: 0.50-0.86) and those with access to antiviral treatment for >5 years before 2016 (aOR=0.54,95%CI:0.37-0.78) were less likely to develop complicated chronic diseases, and those under 60 years old with initial CD4+T lymphocytes counts <200 cells/µl (aOR=1.32, 95%CI: 1.02-1.70), those aged 40-49 and 50-59 years (aOR=2.88, 95%CI:2.20-3.79; aOR=5.43, 95%CI: 4.10-7.21) as well as those without a record of treatment medication use after 2016 (aOR=1.95,95%CI:1.20-3.16) were more likely to develop complicated chronic diseases. The probability of developing complicated chronic diseases might increase with age in people living with HIV. Conclusions: From 1998 to 2022, there was a certain proportion of complicated chronic diseases among HIV infected individuals in Taizhou, and the proportion of diagnosed cases increased after HIV infection was confirmed. It is necessary to conduct early chronic disease screening, behavior intervention and standardized management in people living with HIV.

The prevalence of hepatitis B virus infection among HIV-infected patients in the Ningxia Hui Autonomous Region, China, November 2002 to July 2023

We tested HIV-infected people with HBV serological markers of Ningxia. Of 1008 HIV-positive individuals, 70 (6.9 %) tested positive for HBsAg, 570 (56.5 %) tested positive for anti-HBs, and 483 (47.9 %) tested positive for anti-HBc. Of 70 HBV-positive individuals, 13 (18.5 %) tested positive for HBeAg, 31 (44.3 %) tested positive for anti-HBe, 3 (4.2 %) exhibited acute infection.

Association between kidney dysfunction and electrolytes imbalance among HIV patients attending Muhororo District Hospital

Background: Kidney diseases has been recognized as one of the challenging complications in HIV infected people. Hyponatremia and hyperkalemia are the most disturbed electrolytes associated with an increased risk of death both in hospitalized and in ambulatory HIV patients. Aim: The study aimed to assess the association between renal dysfunction and serum electrolytes disorders among HIV infected patients. Method: It was a retrospective study conducted at Muhororo district hospital from May up to July 2023. HIV infected patients were enrolled in the study and their serum creatinine, sodium, potassium and chloride were tested and the results analyzed by using SPSS version 22. A P-value less than 0.05 was considered statistically significance. Result: Among 115 HIV infected patients, 67.8% were females and 32.1% were males. The Mean serum creatinine was elevated among HIV infected patients [1.01(mg/dl) ±0.27, 0.99(mg/dl) ±0.26], and 40.8% had hyponatremia, 8% had hypernatremia, 6% had hypokalemia 7.8% had hyperkalemia 17.3% had hypochloremia and 20% had hyperchloremia Mean serum sodium was slightly decreased [134.1(mmol/l) ±11.8], there was no change in mean of both serum K+ and CL_ [4.4 (mmol/l) SD±1 / 100.7(mmol/l) with SD±14.2 for serum Cl-]. Serum creatinine was significantly associated with Na+ and K+ [P=0.04, r=-0.19/ p=0.01, r= 0.22] however the correlation between Cl- and Serum creatinine was not statistically significant [P=0.3, r=-0.08]. Conclusion: The study found elevated serum creatinine and, the weak correlation between creatinine and electrolytes in HIV infected patients on ART. The present findings need to be confirmed with further studies with large sample size. HIV infected patients should change life style that predispose their health to the development of kidney diseases they must also stick on healthcare provider’s counselling. Keywords: HIV, Kidney Dysfunction, Serum electrolytes.

Predictors of HIV Viral Load Suppression After Enhanced Adherence Counseling, Nekemte, Ethiopia

BackgroundEnhanced adherence counseling refers to the counseling intervention for Human Immunodeficiency Virus (HIV) patients with an elevated viral load result, a viral load of > 1000 copies/ml, on a routine or need-based viral load test. The Federal Ministry of Health, Ethiopia, has launched routine viral load testing and enhanced adherence counseling since 2016 for high-viral load people living with HIV, which is applicable throughout the country for all health facilities providing HIV care and treatment. Our study aimed to assess viral load suppression after enhanced adherence counseling and its predictors among high viral load people living with HIV who were on antiretroviral therapy.MethodWe conducted a health facility-based retrospective follow-up study among 352 HIV-infected high-viral load people enrolled in enhanced adherence counseling from July 2018 to June 2021 in Nekemte town public health facilities. Cox proportional hazard analysis was used to identify independent predictors.ResultsThe overall 65.1% of 352 persons on antiretroviral treatment achieved HIV viral load suppression after enhanced adherence counseling, (15.01 per 100 person months (95% CI13.02-16.99)). The median time to viral load suppression was 5 months. Age ≥ 15 years (AHR = 1.99, 95% CI: 1.11–3.57), no history of opportunistic infection (AHR = 2.01, 95% CI: 1.18–3.41), and not using substances (AHR = 2.48, 95% CI: 1.19–5.14) were more likely to have viral load suppressed, while having an initial viral load count greater than 50,000 RNA copies/ml (AHR = 0.56, 95% CI: 0.37–0.85) were less likely to have viral load suppressed after enhanced adherence counseling.ConclusionAge, history of opportunistic infections, substance use, and an initial viral load count > 50,000 RNA copies/mL were significant predictors of viral load suppression. Enrolling all high-viral-load patients in enhanced adherence counseling is recommended for viral load suppression.

Multifocal superficial thrombophlebitis of the extremities in HIV infection

Long-term observations indicate an increased risk of developing venous thromboembolic conditions in people with the human immunodeficiency virus, their tendency to relapse or a widespread nature. In addition, the incidence of thrombosis increases several times in HIV-infected people compared to the average rates characteristic of people of the same age. A clinical case of multiple bilateral lesions of the subcutaneous veins of the upper and lower extremities in a young patient with HIV infection is presented. Ineffective outpatient treatment and ascending superficial thrombophlebitis of the lower extremities required emergency hospitalization and surgical treatment of the patient to prevent thromboembolic complications. In the postoperative period, in order to prevent the progression of the thrombotic process, as well as to relieve the symptoms of an acute inflammatory reaction of the venous wall and paravasal tissues, a complex application of compression therapy, modern oral anticoagulant drugs, phlebotropic drugs with proven efficacy was carried out. The postoperative period proceeded without complications. In the next few days, the patient’s condition improved, there was a clear regression of thrombotic limb damage. Conclusion: In case of multiple thrombotic lesions of the subcutaneous veins of the upper and lower extremities on the background of HIV infection, the combination of timely surgical intervention with systemic anticoagulant therapy and phlebotropic agents of general and topical use has significant effectiveness in the medical rehabilitation of the patient.

A Retrospective Medical Record Review on the Outcome of Enhanced Adherence Counseling among Unsuppressed HIV Clients in Benue State, Nigeria

Background: According to the WHO estimation, up to 70 % of patients with an initial high viral load will achieve viral load suppression following an adherence intervention. In Benue State, very limited studies have been done that show viral load suppression following enhanced adherence counselling (EAC). This study assesses viral suppression after enhanced adherence counselling and its predictors among unsuppressed HIV seropositive people in the State, the time to commence EAC after the unsuppressed VL result, and to estimate the time to repeat the viral load test after EAC. Methods: This was a retrospective review of electronic medical records of all HIV-infected people with a viral load greater than 1000 copies/ml after six months on HAART as of December 2022, in Benue State. Patients with VL ≥ 1000 copies/ml were expected to receive EAC and have a repeat VL after three months of good adherence. Six months following the documented unsuppressed result, we determined: the viral load suppression rate after EAC, the time to commencement of EAC, the time to repeat the viral load test after EAC, and the predictors of viral load suppression among clients with unsuppressed viral load. Result: Of the 234,185 People Living with HIV (PLHIV) on ART between December 2022 and July 2023, up to 210, 514 (89.9%) did viral load testing and 9194 (3.9%) had VL &gt;1000 copies/ml. Of these 9,194 unsuppressed PLHIV, EAC uptake was 90.3% (n=8,307), EAC completion rate was 62.5% (n=5,220), and viral suppression rate following EAC was 93.8% (4897/5220). PLHIV who have been on treatment for less than five years were more likely to achieve viral load suppression. Conclusion: The study demonstrated a post-EAC viral load re-suppression rate of 93.8%, indicating significant effectiveness. Nonetheless, notable deficiencies were observed in both EAC enrollment and completion. It is imperative to identify and address the underlying reasons for these gaps to fully optimize the benefits of Enhanced Adherence Counseling (EAC).

The feasibility of pathogenetic therapy for chronic viral hepatitis C in adult HIV-infected patients

In the third decade of the XXI century, HIV infection and viral hepatitis C remain urgent problems of modern medicine. Only in the Russian Federation in 2023, more than 1.6 million HIV-infected people and about 2 million patients with chronic viral hepatitis C are registered. Patients with a combined course of these diseases are of particular concern. However, insufficient coverage of etiotropic therapy for patients with chronic viral hepatitis C due to its high cost leaves pathogenetic therapy as the only available method of treatment for many of them. Material and Methods. Clinical data of patients hospitalized in the day hospital of the state budgetary health care institution "Samara Regional Clinical Center for AIDS Prevention and Control" were used. Physical, virological, immunological, biochemical and general clinical methods, elastometry of liver tissue were used for examination of hospitalized patients. Statistical processing of the results was performed using the application program "Statgrarhics Plus for Windows". Pathogenetic therapy was carried out in a two-week course in accordance with the "Recommendations for the diagnosis and treatment of adult patients with hepatitis C" (2013) and included (along with protective regime and therapeutic nutrition) the use of detoxification and metabolic therapy. Antiretroviral therapy with 3–4 drugs was carried out in 68% of the patients. Results. It was shown that the prescribed course of pathogenetic therapy of chronic viral hepatitis C did not have the expected effectiveness in the majority of patients referred for treatment according to the dynamics of changes in the values of "liver tests", despite the fact that the "right subcostal syndrome" was eliminated in 75.7% of persons with stage 3 and 66.7% with stages 4A and 4B of HIV infection. Statistical studies of the relationship (linear, rank and canonical) did not reveal its presence between the results of the conducted treatment and the complex of initial clinical and clinicallaboratory data obtained during hospitalization of the examined persons. Discussion. The presence of cytolysis syndrome and "right subcostal syndrome" is not a valid criterion for referral to a two-week course of pathogenetic therapy of chronic viral hepatitis C in order to obtain a positive result in the majority of patients with stages 3, 4A and 4B of HIV infection. Other baseline data (virologic and immunologic indices, degree of liver tissue fibrosis, indices of general and biochemical blood analysis) had no reliable correlation with the results of treatment, which did not allow their use for predicting the effectiveness of the prescribed treatment. Antiretroviral therapy was not associated with the results of pathogenetic therapy of chronic viral hepatitis C according to the indicators of cytolysis syndrome and "right subcostal syndrome", despite the fact that most of the prescribed drugs had a hepatotoxic effect.

Outcome of Darunavir-Cobicistat-Based Regimens in HIV-Infected People Who Have Experienced Virological Failure.

To evaluate the virological outcome of darunavir-cobicistat (DRVc)-based regimens in adults living with HIV who had experienced virological failure (VF) on any previous drug combination. This was a retrospective cohort study (CSLHIV Cohort) of adults living with HIV who started a DRVc-based regimen with HIV-RNA >50 copies/mL after VF on any previous drug combination. Data on demographics, antiretroviral treatment since HIV diagnosis, and immunological and metabolic parameters from baseline (start of DRVc) to 48 weeks were analyzed in order to assess the cumulative proportion of those who achieved virological success (VS), defined as at least one instance of HIV-RNA <50 copies/mL within 12 months from baseline. Follow-up lasted from the start of the DRVc-based regimen (baseline) to the first instance of HIV-RNA <50 copies/mL, last available visit, or lossto follow-up or death, whichever occurred first. Univariate and multivariate Cox proportional-hazard regression models were used to identify baseline factors associated with VS. A total of 176 individuals were included, and 120 (68.2%) achieved <50 HIV-RNA copies/mL within 12 months since baseline. On multivariate analysis, baseline HDL cholesterol was independently associated with the occurrence of VS (adjusted HR 1.021, 95% CI 1.004-1.038; p=0.014). Among the 120 subjects with VS, 27 (22.5%) had had VF during a median follow-up of 20.8 months since the first undetectable HIV-RNA. Resistance testing after VF was available in two cases, which harboured the HIV variant-bearing protease inhibitor-resistance mutations D30N, I50V, and N88D. During a median follow-up of 38.4 months, 65 of 176 (36.9%) individuals discontinued DRVc for any reason (37 of 120, 30.8%) and achieved VS vs. 28 of 56 (50%) without VS (p=0.019). Time to discontinuation was longer in people with VS (41.5 vs. 23.0 months, p=0.0007). No statistically significant changes were observed in immunological or lipid profiles during follow-up. Most individuals in this study achieved VS within 12 months from the beginning of a DRVc-based regimen; therefore, this treatment represent a viable option for people who have experienced VF on other regimens.

Kaposi Sarkomu Nedeniyle Hematoloji Kliniğinde Yatan HIV (+) Hastanın Orem’in Öz Bakım Eksikliği Kuramına Göre Hemşirelik Yönetimi: Olgu Sunumu

The World Health Organization reported that 38.4 million people were living with HIV in 2021 and 650 thousand people lost their lives due to HIV and viruses. Kaposi's sarcoma is still one of the most common cancers in HIV-infected people. Individuals living with this disease also have many biological, psychological and social needs. The aim of this article is to determine the needs of a young patient with Kaposi's sarcoma who has just been diagnosed with HIV (+) according to Orem Self-Care Deficit Nursing Theory, to perform nursing care and to guide nurses working in the field. Data were collected by face-to-face interviews in the hematology clinic, care was planned, applied and evaluated according to the model. As a result of the theoretical evaluation of the case, the nursing diagnoses of "impaired gas exchange, activity intolerance, excess fluid volume, anxiety, deterioration in body image, lack of knowledge, risk of infection, and deterioration of the oral mucous membrane" were determined. Orem Self-Care Deficit Nursing Theory is a useful model for determining the needs of HIV-positive patients and in the implementation of nursing interventions.