HIV-infected Population Research Articles

Anemia in Human Immunodeficiency Virus Infection: Exploring the Interplay Between Antiretroviral Therapy, Opportunistic Infections, Iron Status, and Anemia

Background:Anemia is a prevalent hematological complication among individuals with Human Immunodeficiency Virus (HIV), contributing significantly to increased morbidity and mortality. This study investigates the intricate relationships between antiretroviral therapy (ART), opportunistic infections (OIs), iron metabolism, and anemia in HIV-positive patients in Indonesia. Objective:To elucidate the multifactorial associations among ART regimens, opportunistic infections, iron biochemical parameters, and anemia development in individuals living with HIV. Method:A cross-sectional epidemiological study was conducted at Sulianti Saroso Infectious Disease Hospital, Indonesia, from July to November 2023. The study involved 300 adult HIV-positive patients undergoing ART, with exclusion criteria encompassing pregnant or postpartum individuals, those with recent blood transfusions, and patients with chronic kidney diseases. Data collection included anemia status, ART regimen details, history of opportunistic infections, and iron metabolic profiles (serum iron, total iron-binding capacity [TIBC], and ferritin levels). These were obtained through systematic medical record reviews and laboratory diagnostics. Descriptive statistics, bivariate, and multivariate analyses were employed to explore predictive factors for anemia. Results:The study identified an anemia prevalence of 24.3%, with significantly higher rates among female patients (p = 0.004) and older age groups (p = 0.031). Multivariate regression analysis highlighted critical predictors of anemia: second-line ART (adjusted odds ratio [AOR]: 2.536, p = 0.028), serum iron concentrations (AOR: 0.984, p < 0.001), ferritin levels (AOR: 1.002, p = 0.023), and absolute lymphocyte count (AOR: 0.516, p = 0.003). Conclusion:The findings emphasize the necessity of longitudinal monitoring of hematologic and biochemical parameters to enhance anemia management in HIV-infected populations. The complex interplay between ART regimens, immune status, and iron metabolism underscores the importance of tailored, patient-centered clinical interventions. Keywords:anemia; HIV; antiretroviral therapy; opportunistic infections; iron metabolism

Non-AIDS defining cancers in HIV-infected individuals: a concise review

Non-acquired immunodeficiency syndrome (AIDS)-defining cancers (NADCs) present a growing concern in human immunodeficiency virus (HIV)-infected individuals, impacting morbidity and mortality rates. This paper synthesizes current epidemiological data and explores the multifaceted relationship between HIV infection and NADC risk. Epidemiological studies indicate a shifting landscape of cancer incidence among HIV-infected populations, with a notable rise in NADCs over recent decades. Factors such as prolonged life expectancy due to effective antiretroviral therapy (ART) and aging of the HIV-infected population contribute to this trend. Despite the overall decline in AIDS-defining cancers, NADCs have emerged as a significant cause of morbidity and mortality in HIV-infected individuals. Immunodeficiency, chronic inflammation, and oncogenic viral co-infections, such as human papillomavirus and hepatitis C virus, compound the risk of developing NADCs. Diagnostic challenges persist, with delayed detection and suboptimal management contributing to poor outcomes. Treatment modalities for NADCs in HIV-infected individuals require careful consideration, balancing cancer-directed therapy with potential interactions with ART and immune reconstitution. Prevention strategies, including cancer screening and lifestyle modifications, are crucial in mitigating the burden of NADCs in this population. As the landscape of HIV care continues to evolve, understanding the epidemiology and clinical characteristics of NADCs is imperative for optimizing clinical management and improving outcomes in HIV-infected individuals.

HIV-1 Infection Trends in Lower Silesia (2010-2020): A Comparative Analysis of Women and Men and the Urgent Need for Enhanced Screening.

Human Immunodeficiency Virus (HIV) remains a major global health issue. In Poland, men represent 79% of the HIV-infected population, but the proportion of women diagnosed has been increasing. This study examines the clinical condition of newly diagnosed HIV-1 patients in Lower Silesia at three key points: 2010, 2016, and 2020, to understand infection dynamics and improve regional screening and prevention efforts. The objective of the study is to compare the clinical condition of newly diagnosed women and men with HIV-1 in Lower Silesia at three time points in order to identify trends and differences that can inform targeted public health strategies. A retrospective analysis of medical records from the HIV clinic in Wroclaw was conducted for the years mentioned. The dataset included demographic information, transmission routes, clinical status, and co-infections. The study included 202 patients, of whom 27 were women. Heterosexual transmission was the primary route among women (2010/2016/2020 - 44.44%/57.14%/90.91%), while men predominantly acquired HIV-1 through homosexual contact (2010/2016/2020 - 52.94%/80.82%/75%). A significant decrease in infections from intravenous drug use was observed among men (Chi2 = 24.85, df = 2,p < 0.001). Women consistently had lower CD4+ T cell counts, with a median (Q1, Q3) of 250 (108-288), significantly lower than men's 431 (280-550) (Mann-Whitney U-test: z = 4.23, p < 0.001). Women were also more frequently diagnosed as late presenters (OR: 6.07, 95% CI (2.34-15.82)). This study identifies significant gender disparities in HIV-1 diagnosis in Lower Silesia, with women being six times more likely to be diagnosed as late presenters. This highlights the necessity for enhanced and targeted public health interventions, particularly within the context of antenatal care.

Incidence and persistence of asymptomatic Leishmania infection among HIV-infected patients in Trang province, Southern Thailand: A cohort study.

Leishmaniasis poses a significant health burden, particularly among immunocompromised patients. In Thailand, Leishmania infection caused by Leishmania martiniquensis and Leishmania orientalis lacks information about the incidence and risk factors among HIV-infected populations. This longitudinal cohort study aimed to investigate the incidence and persistence of Leishmania infection among HIV-infected individuals in an affected area, Trang Province, Southern Thailand. The study also identified risk factors associated with the incidence of Leishmania infection. The study enrolled 373 participants in the HIV clinic, Trang Hospital, who initially tested negative for Leishmania infection during 2015-2016, and 133 individuals initially tested positive for Leishmania infection. Thus, follow-up visits of 506 participants occurred during 2018-2019. Direct Agglutination Test (DAT) and nested PCR (nPCR) identified incidents and persistent cases of Leishmania infection. Cox proportional-hazards regression analyses were performed to assess risk factors for the incidence of Leishmania infection. Among the initially negative group, 12 incident cases comprised one L. orientalis infection and 11 seropositive cases using DAT, resulting in a cumulative incidence of 3.2% and an incidence density of 10.38 per 1000 person-years. Increasing age was a significant predictor of the incidence of Leishmania infection. Five persistent cases comprised one Leishmania donovani complex and four seropositive cases using DAT in the initially positive group, with a cumulative persistence rate of 3.7% and a persistence density of 12.85 per 1000 person-years. All patients were asymptomatic. This study sheds light on the incidence and persistence of Leishmania infection among HIV-infected individuals in Trang Province, Southern Thailand, underscoring the importance of continued monitoring and tailored interventions to mitigate the impact of this co-infection.

7172 Osteoporosis Associated with Antiretroviral Therapy - Case report

Abstract Disclosure: C.E. Guillen Lopez: None. L.A. Sanchez Ato: None. A. Patel: None. A. Molkina: None. T. Ayub: None. L. Robles: None. A. Arce Gastelum: None. Osteoporosis presents a substantial public health challenge, contributing significantly to morbidity and mortality through fractures. While postmenopausal osteoporosis is common, secondary osteoporosis affects a significant number of patients, including over 30% of postmenopausal and 50-80% of men. People living with HIV (PLWH) experience age-related medical comorbidities earlier and more extensively than those without HIV. The compromised bone health in PLWH is attributed to factors associated with the virus, antiretroviral therapy (ART) side effects, and health disparities such as inadequate nutrition, low body weight, hypogonadism, vitamin D deficiency, and increased recreational substance use. More recently, it has become apparent that vertebral fractures are more common in PLWH, with a prevalence of 11.1% and a 2.30-fold more significant risk than the general population. Low bone mass density (BMD) is twice as common in PLWH, increasing to 3 times as common in PLWH on ART. ART initiation leads to transient bone loss with nucleotide reverse transcriptase inhibitors such as tenofovir disoproxil fumarate (TDF) and protease inhibitors, causing higher BMD loss. In contrast, integrase and specific reverse-transcriptase inhibitors have minimal adverse effects on BMD. The newer formulation, tenofovir alafenamide (TAF), is believed to have a more favorable impact on bone health than TDF. The repercussions of diminished bone health, particularly osteoporotic fractures, have significant medical and economic implications. They are leading to early mortality, disability, and a loss of independence. The HIV Medicine Association (HIVMA) and Infectious Diseases Society of America (IDSA) recommend BMD screening for all HIV-infected patients at 50 years. 58-year-old male PLWH reveals a history of osteoporosis with multiple spinal (L1, L4-5, S1) and bilateral wrist fractures on TDF for 15 years. The patient has been treated with bisphosphonates. Alendronate was initially prescribed, but due to acid reflux side effects, zoledronic acid was a better option. Despite various ART regimens, Dolutegravir/Lamivudine was started four years ago without further fractures. Recent bone density assessments showed improvement in the lumbar spine, returning to a normal range with a T-score of 0.6. However, the left femoral neck remains at -2.5, and the right femoral neck is at -2.2, showing minimal change. To enhance BMD in PLWH on ART, transitioning to alternatives with lower bone loss associations and using bisphosphonates as tolerated are suggested. As the HIV-infected population ages, proactive screening for low BMD is vital to manage evolving health needs and prevent bone-related complications. A holistic approach includes evaluation for secondary etiologies of osteoporosis, medical treatment, and vitamin D and calcium supplementation. Presentation: 6/3/2024

Assessing the Importance of Theory-Based Correlates of Future HIV Vaccine Intentions Among Black Men Who Have Sex With Men.

In the United States, Black men who have sex with men (BMSM) represent the most vulnerable population for HIV infection. A potential vaccine could ultimately be the most effective HIV prevention strategy. Understanding the factors that may adversely affect HIV vaccine acceptance among BMSM is critical. We conducted two online surveys with BMSM; one recruited 432 respondents, and another recruited 204. Respondents completed a demographic assessment and questions derived from health behavior change theories and the relevant empirical literature. The two surveys yielded similar results. The findings indicate that vaccine uptake self-efficacy, perceived likelihood of important others receiving the vaccine, and susceptibility to HIV were related to intentions to receive a future HIV vaccine. Other potentially important variables include perceived HIV stigma, response efficacy, how much one conceals one's sexual orientation, and perceived HIV discrimination. Future research and health communication campaigns should consider these factors in potential HIV vaccine programs.

Comparison of short- and long-term humoral immune responses to pneumococcal polysaccharide and glycoconjugate vaccines in an HIV-infected population

Immunisation is recommended internationally to protect against pneumococcal infections in HIV-infected adults. However, vaccination schedule designs are mostly based on studies of initial rather than long-term antibody responses. This UK observational study investigated the short- and long-term antibody responses to polysaccharide and glycoconjugate pneumococcal vaccines in an adult HIV-infected cohort. We studied a subgroup of 152 of 839 participants from the AIR (Assessment of Immune Responses to Routine Immunisations in HIV-infected Adults, ISRCTN95588307) studythat had received pneumococcal vaccinationsand had blood samples collected pre- and post-vaccination, as well as at least annually for four subsequent calendar years. Patients received either Pneumovax-23 (PPV, N=89) or Prevenar-13 (PCV, N=63) as their primary vaccine, with immunity assessed by measuring IgG antibody concentrations for 12 pneumococcal polysaccharide serotypes (PnPS). The primary outcome was achieving IgG antibody concentrations above the recommended World Health Organisation (WHO) threshold of 0.35µg/mL for at least 8/12 of the PnPS assessed (WHO≥8/12PnPS). Patients who did not achieve WHO≥8/12PnPS after the primary vaccination were offered further vaccination with PCV; booster vaccinations with PCV were additionally offered to those where antibody levels subsequently fell below the WHO≥8/12PnPS threshold. Patients receiving PCV as their primary pneumococcal vaccine were significantly more likely to achieve WHO≥8/12PnPS after a single vaccine dose than those receiving PPV (54% vs. 33%, p=0.012). This difference persisted following booster vaccination with PCV, with cumulative rates of WHO≥8/12PnPS in those receiving PCV vs. PPV as the primary vaccine of 88% vs. 67% and 100% vs. 85% after receiving up to one and two booster vaccinations, respectively. Where WHO≥8/12PnPS was achieved, this persisted significantly longer in those receiving PCV as their primary vaccine compared to PPV (median: 23.5 vs. 11.1 months; p=0.010). Immunisation with PCV resulted in quantitatively greater antibody responses than immunisation with PPV in a cohort of HIV-infected UK adults. Individuals receiving PCV as their primary vaccine required fewer total pneumococcal vaccine doses to achieve WHO≥8/12PnPS and experienced greater duration of time above this threshold than those with PPV as the primary vaccine. However, the median longevity of both vaccine responses was relatively short, which supports the use of ongoing booster doses using high-valency glycoconjugate vaccines to sustain WHO≥8/12PnPS threshold antibody levels.

PREVALENCE OF HEPATITIS B VIRUS INFECTION AMONG HIV PATIENTS INBENUE SOUTH SENATORIAL DISTRICT, NIGERIA

Hepatitis B infection seriously threatens global public health, especially in developing nations. Despite severalefforts on ascertaining the true prevalence of HBV, it tenaciously varies across different locations and subpopulations, particularly among those at risk of infection such as the HIV-infected population. This study aimed atdetermining the sero-prevalence of HIV-HBV co-infection in Benue South Senatorial District, Nigeria. This crosssectional study was conducted in four anti-retroviral therapy (ART) specialized clinics between May 1, andSeptember 2023 using pretested questionnaires, after obtained ethical approval and informed consent.Bloodsamples of participants were screened using HBsAg testing kitsand the results were interpreted according to themanufacturer’s instructions. The screening for HIV-HBV co-infection showed a sero-prevalence of 25/457 (5.47%).The distribution based on clinic location was 12(48%) GH Otukpo, 8(32%) GH Oju, 2(8%) GH Ugbokpo and3(12%) SMH Okpoga. The distribution also revealed that most cases were in the age group 40-49 and the femalegender.The prevalence showed that only 3/25 (12.0%) reported a history of sexually transmitted diseases other thanHIV while 2/25 (8.0%) had a history of multiple sex partners. Most co-infected cases 23/25(92.0%) had no historyof same-sex relationships and 23/25(92.0%) had recent history of unprotected sex. In Nigeria, hepatitis B infectionremains a significant public health problem. Notable preventive strategies include abstinence from sex, avoidanceof multiple sex partners, strict adherence to safe sex, and avoiding contact with infected body fluids. Otherstrategies such as averting mother-to-infant hepatitis B transmission, scale-up of screening programs and extensivevaccination programs are eminently recommended in the course of HBV control.

Nutritional assessment in the HIV-infected older population receiving antiretroviral therapy.

Malnutrition is a pronounced public health issue which often seems underestimated in the older people living with HIV (PLWH) virus infection. PLWH are highly vulnerable to nutritional problems resulting from agingrelated deterioration, disease itself, and adverse effects of antiretroviral therapy (ART). The comprehensive nutritional assessments are necessary to perform routinely in this population to monitor and provide appropriate interventions to reduce comorbid conditions. In this review, we focus on the untoward impacts of malnutrition and nutritional assessments on the morbidity and mortality in the older PLWH. Some predictive factors of nutritional status in this group of patients are discussed. We propose the important components for nutrition assessment tool for older PLWH on ART. Highlighted issue is the need for developing uniform standardized tools for the early diagnosis of malnutrition in this population. Applications of the nutritional assessments, proper nutritional interventions, and regular monitoring of nutritional status in older PLWH liv-ing in every clinical setting may help the patients get better well-being.

Leishmania Infection among HIV-Infected Patients in a Southern Province of Thailand: A Cross-Sectional Study.

Leishmaniasis, a neglected tropical disease, imposes a notable health burden, especially on immunocompromised individuals such as HIV patients. Recognizing its prevalence and risk factors in specific populations is vital for effective prevention. This study in Satun Province, southern Thailand, aimed to ascertain leishmaniasis prevalence and identify associated risks among HIV-infected patients. A cross-sectional study was conducted among 650 HIV-infected individuals at a tertiary care hospital. Data on demographic characteristics, clinical parameters, and potential risk factors were collected. Individual plasma, buffy coat, and saliva samples were collected. Leishmania infection was determined using the direct agglutination test and nested polymerase chain reaction (nPCR) of nPCR-buffy coat and nPCR-saliva. The association between risk factors and Leishmania infection was assessed with logistic regression analysis. The prevalence of Leishmania infection was 8.61% (56/650). Species was identified among 20 HIV-infected patients as follows: Leishmania orientalis (N = 14), Leishmania martiniquensis (N = 4), and Leishmania donovani complex (N = 2). The factors associated with Leishmania infection included age (adjusted odds ratio [OR] = 1.03), intravenous drug use (adjusted OR = 2.39), CD4 cell count <500 cells/mm3 (adjusted OR = 2.40), and a viral load ≥50 copies/mL (adjusted OR = 5.16). The prevalence of Leishmania infection among HIV-infected patients in Satun Province was considerable. These findings underscore the need for integrated care and targeted interventions to address this infection and improve public health outcomes. Further research and collaborative efforts are warranted to develop effective prevention and control strategies for Leishmania infection in the HIV-infected Thai population.

One-month daily and three-month weekly rifapentine plus isoniazid are comparable in completion rate and safety for latent tuberculosis infection in non-HIV Population: a randomized controlled trial

ObjectivesThe weekly rifapentine plus isoniazid for 3 months (3HP) improves completion rate of latent tuberculosis infection treatment, but flu-like symptoms are common. The novel 1HP regimen, involving daily rifapentine plus isoniazid for 28 days, has demonstrated low toxicity in HIV-infected populations. We aimed to investigate whether 1HP has a lower incidence rate of systemic drug reaction (SDR) compared with 3HP during treatment in non-HIV populations. MethodsThis randomized, multicentre trial compared the completion rate and risks of SDRs of 1HP and 3HP in aged ≥13 years non-HIV subjects with latent tuberculosis infection between September 2019 and September 2023 (ClinicalTrials.gov: NCT04094012). We also investigated associations between SDRs and plasma levels of drugs and their metabolites. ResultsA total of 251 and 239 individuals were randomly assigned to 1HP and 3HP groups, respectively, with completion rates of 82.9% (208/251) and 84.5% (202/239), respectively. Among them, 12.7% (32/251) and 10.9% (26/239) of 1HP and 3HP groups experienced SDRs, respectively (p 0.522), predominantly urticaria in 1HP group (59.4% [19/32]) and flu-like syndrome in 3HP group (80.8% [21/26]). Among participants experiencing SDRs, 43.8% (14/32) and 34.6% (9/26) in 1HP and 3HP groups, respectively, completed treatment (p 0.470). Cutaneous reactions were more common in 1HP than 3HP group (32.7% [82/251] vs. 13.0% [31/239], p < 0.001). In 1HP group, urticaria was associated with a higher plasma desacetyl-rifapentine level (ug/mL) at both 2 (median [interquartile range]: 36.06 [17.46–50.79] vs. 22.94 [14.67–31.65], p 0.018) and 6 hours (26.13 [15.80–53.06] vs. 29.83 [18.13–34.01], p 0.047) after dosing. DiscussionIn non-HIV population, the incidence rate of SDR under 1HP is not lower than 3HP. Notably, urticaria, rather than flu-like syndrome, was the predominant SDR associated 1HP. The findings of this study underscore the feasibility of 1HP regimen in non-HIV populations with a high-completion rate exceeding 80%.

OPTIMAL CONTROL ANALYSIS OF HIV/AIDS DISEASE SPREAD MODEL IN INDONESIA

The Human Immunodeficiency Virus (HIV) is a contagious virus that weakens the immune system of infected individuals, making them more susceptible to various diseases. These individuals are referred to as those exposed to the AIDS disease, which unfortunately, cannot be cured. To effectively manage AIDS, prevention is crucial in slowing down the spread and growth of the HIV virus. Mathematical modeling can play a significant role in the optimal control of AIDS. In this study, the , , , , model with three different optimal controls were employed. Optimal control involves public health education campaigns, screening, and treatment. The goal is to minimize the number of individuals infected with HIV/AIDS using Pontryagin's Maximum Principle. This principle considers various factors, such as population class coefficients, cost weights, and control variables to determine the most effective approach. The simulation results indicate that counseling control in the exposed population class ( ) yields better outcomes compared to counseling control in the susceptible class and treatment control in the HIV-infected population class. This implies that focusing on educating and counseling individuals who are exposed to HIV can be more efficient in AIDS control than targeting those already infected or at risk. By applying these optimal control strategies, it may be possible to mitigate the impact of HIV/AIDS and improve public health outcomes.

The temporal relationship between body composition and cardiometabolic profiles in an HIV-infected (on antiretroviral therapy) versus HIV-free Western Cape study population.

Cardiovascular risk is a health concern in people living with HIV/AIDS (PLWH). This longitudinal study (baseline vs 36 months) aimed to investigate the relationship between body composition and markers of cardiovascular risk in a South African study population [HIV free, n = 22 vs HIV positive on antiretroviral therapy (HIV+ART), n = 73)]. Health questionnaires, anthropometric measurements, biochemical analyses and flow-mediated dilation were performed. Linear mixed-model statistical analyses were applied. The HIV+ART vs the HIV-free groups were independently associated with body mass index (BMI) [-4.92 (-7.99 to -1.84), p = 0.002] and waist circumference [-10.5 (-17.2 to -3.77), p = 0.003]. ART duration was associated with BMI [2.60 (0.57-4.62), p = 0.013], waist circumference [3.83 (0.03-7.63), p = 0.048] and high-density lipoprotein cholesterol [20.18 (2.37-41.09), p = 0.025]. The data showed that intricate relationships existed in this study population between HIV, ART, body composition and cardiometabolic variables. There is a need for more research investigating cardiovascular risk in PLWH, particularly in the context of changes in body composition measures.

IJCM_288A: Factors responsible for death among HIV infected patients registered in ART Centre Jabalpur, Madhya Pradesh.

Background: Factors responsible for death in HIV infected population are necessary to devise disease specific preventive interventions at both state and national level HIV programs. This study examines the factors responsible for death among HIV-infected individuals registered in Anti-Retro-viral Therapy (ART) center Jabalpur, Madhya Pradesh. Objectives: 1. To understand the trends of HIV deaths in last 6 years in Jabalpur District. 2. To understands the factors responsible for deaths among registered HIV positive patients in ART Centre of Jabalpur District. Methodology: A retrospective chart review of factors responsible for death was undertaken among HIV-infected patients who were treated between January 2016 and December 2021 at ART Center Jabalpur. Results: Among total of 83 sample cases registered from January 2016 to December 2021, 86.7% of those who died were males. Mean duration of survival after initiation of treatment is 17 months. 49.4% of the cases falls under the age group of 31-45 years. 75.9% of the cases contracted the virus through sexual mode of transmission. 56.6% of the cases had opportunistic infections. Tuberculosis is (32.5%) is the leading opportunistic infections and 28.9% of cases had CD4 count in the range of 50-199 cells/mm. Conclusion: Tuberculosis has remained the leading factor responsible for deaths among the HIV patients on ART. Deaths were significantly associated with patient’s CD4 count at the time of diagnosis and the presence of opportunistic infections during treatment.

EHealth-Enhanced Peer Navigation for Substance Use Treatment and HIV Prevention Service Linkage for Young Adults Surveilled by the Criminal Legal System: Protocol for a Pilot Randomized Trial Study.

In the United States, the proportion of criminal legal-involved (CLI) adults with a substance use disorder reaches 72%, and ~150,000 persons with HIV pass through a carceral setting annually, which represents 16% of the HIV-infected population nationally. Despite the high need for substance use treatment and HIV prevention services, few carceral settings successfully link CLI individuals to treatment upon release. Young adults represent 41.9% of the adults incarcerated in the United States and have the highest HIV incidence rates nationally. Peer patient navigation has successfully increased community-based care linkage for people living with HIV leaving jail; yet, peer-led navigation for HIV prevention among HIV-negative CLI populations is undeveloped and untested. eHealth approaches to substance use and HIV prevention services hold promise because they improve access to effective intervention services, particularly for younger people. This paper describes a protocol for a pilot randomized controlled trial that aims to improve linkage to substance use treatment and HIV prevention services using peer navigation and a codeveloped eHealth technology adjunct. The three aims of this study are to (1) adapt an existing evidence-based navigator model and incorporate codeveloped eHealth technology to refer and link young adults (18 to 29 years) surveilled by the criminal legal system to substance use and pre-exposure prophylaxis (PrEP) services; (2) refine and test the intervention with criminal legal-involved young adults (CLI-YAs); and (3) assess the feasibility, acceptability, and impact of the intervention. Data to inform the intervention will be collected via system partner interviews (n=4) and focus groups with CLI-YAs (n=24). Next, an open trial (n=10) will be conducted. The intervention will be refined via interviews with participants and facilitators, and a randomized pilot trial (n=75) will be conducted to assess the feasibility, acceptability, and preliminary impact of the eHealth-enhanced navigation on substance use and PrEP services linkage. Exit interviews conducted with a subsample of intervention participants (n=10), the navigator (n=1), and system partners (n=4) will assess intervention acceptability and suggestions for improvement. A community of practice, a group of system partners with an interest in working toward solutions to common problems, will inform each phase of the study. The project is currently ongoing. The project was funded in September 2022. Internal review board approval was received on March 21, 2022. The first results from early study aims are expected to be published in 2025. This study provides an opportunity to reduce HIV acquisition and improve access to substance use treatment in a systemically marginalized group: young CLI-YAs. The results will contribute to the development and testing of a future multilevel randomized controlled trial. DERR1-10.2196/54815.

Vaccination impact on impending HIV-COVID-19 dual epidemic with autogenous behavior modification: Hill-type functional response and premeditated optimization technique.

An HIV-COVID-19 co-infection dynamics is modeled mathematically assimilating the vaccination mechanism that incorporates endogenous modification of human practices generated by the COVID-19 prevalence, absorbing the relevance of the treatment mechanism in suppressing the co-infection burden. Envisaging a COVID-19 situation, the HIV-subsystem is analyzed by introducing COVID-19 vaccination for the HIV-infected population as a prevention, and the "vaccination influenced basic reproduction number" of HIV is derived. The mono-infection systems experience forward bifurcation that evidences the persistence of diseases above unit epidemic thresholds. Delicate simulation methodologies are employed to explore the impacts of baseline vaccination, prevalence-dependent spontaneous behavioral change that induces supplementary vaccination, and medication on the dual epidemic. Captivatingly, a paradox is revealed showing that people start to get vaccinated at an additional rate with the increased COVID-19 prevalence, which ultimately diminishes the dual epidemic load. It suggests increasing the baseline vaccination rate and the potency of propagated awareness. Co-infection treatment needs to be emphasized parallelly with single infection medication under dual epidemic situations. Further, an optimization technique is introduced to the co-infection model integrating vaccination and treatment control mechanisms, which approves the strategy combining vaccination with awareness and medication as the ideal one for epidemic and economic gain. Conclusively, it is manifested that waiting frivolously for any anticipated outbreak, depending on autogenous behavior modification generated by the increased COVID-19 prevalence, instead of elevating vaccination campaigns and the efficacy of awareness beforehand, may cause devastation to the population under future co-epidemic conditions.

Pneumocystis jirovecii infection prophylaxis in non-HIV infected individuals: Risk assessment and modalitiesw

Pneumocystis jirovecii (PJ), an opportunistic fungus, can have major consequences in terms of morbidity and mortality. These infections occur mainly in immunocompromised patients and are known for their pulmonary tropism (Pneumocystis pneumonia, PCP). While prevention modalities have been studied in HIV-infected populations, evidence is scarce in non-HIV patients. The decision to prescribe prophylaxis for PJ requires assessment of the clinical context, as well as existing risk factors that may predispose an individual to develop PCP. Few indicators exist that are sufficiently sensitive and specific to predict the occurrence of PCP. The decision to use prophylaxis must be made on a case-by-case basis.

Carbapenem Resistance among HIV-Infected Patients: A Scoping Review

Background: Antibiotic resistance is an escalating global health concern, with carbapenems, potent last-line antibiotics, facing increasing resistance and potentially dire consequences. This scoping review sought to consolidate data on carbapenem resistance in human immunodeficiency virus (HIV)-infected patient cohorts as the intricate relationship between HIV and antibiotic resistance remains inadequately understood. Methods: We employed a scoping review methodology and conducted a comprehensive search across Google Scholar, Scopus, Cochrane, and PubMed, utilizing specific search terms related to carbapenem resistance and HIV. We extracted and analyzed data, encompassing study design, geographic location, number of HIV-infected participants, CD4 cell counts, specimen types, cultured organisms, carbapenem susceptibility, and comparisons between HIV-infected and uninfected cohorts. Results: This review encompassed 15 studies, involving 2365 HIV-infected participants, primarily employing cross-sectional designs, with nine studies conducted in African countries. The most frequently analyzed specimens included urine, stool, and sputum, with Escherichia coli emerging as the most frequently cultured organism. Commonly used carbapenem drugs included imipenem, meropenem, and ertapenem, with varying susceptibility patterns. Imipenem and meropenem exhibited sensitivities exceeding 80%, except for one study with Pseudomonas aeruginosa, which demonstrated 73% sensitivity. Ertapenem displayed fluctuating sensitivities ranging from 58% to 100% for different bacterial organisms. Only one study reported the colonization of carbapenem-resistant Enterobacterales (CRE) in HIV-infected patients, with HIV status not significantly influencing CRE carriage. When comparing HIV-infected and uninfected cohorts, four studies found no substantial impact of HIV status on carbapenem resistance. Conclusion: In the context of the HIV burden and opportunistic infections, carbapenem resistance demonstrated relatively consistent patterns across most studies comparing HIV-infected and uninfected cohorts. However, the presence of CRE among HIV-infected individuals raises concerns regarding nosocomial infections. The limited reporting of CD4 counts in the included studies necessitates further exploration of potential associations with immune status. E. coli, frequently cultured in these studies, exhibited varying resistance patterns, and the impact of HIV on these patterns remains uncertain. Carbapenem susceptibility displayed variability among different organisms, underscoring the nuanced nature of resistance. As such, this scoping review serves as a foundation for comprehending carbapenem resistance in HIV-infected populations but underscores the necessity for more comprehensive research in this field.

Persistent Immune Activation and Chronic Inflammation: Unraveling Their Impact on Anemia in HIV Infection

Persistent immune activation and chronic inflammation represent pivotal facets of Human Immunodeficiency Virus (HIV) infection, profoundly influencing disease progression and complications. This abstract synthesizes current knowledge to unravel the intricate interplay between persistent immune activation, chronic inflammation, and their consequential impact on the development and exacerbation of anemia among individuals living with HIV. Persistent immune activation and chronic inflammation are recognized hallmarks of HIV infection, contributing significantly to disease pathogenesis and complications. This paper aims to elucidate their intricate roles in perturbing erythropoiesis, leading to anemia, thus highlighting the pathophysiological mechanisms and clinical implications within the context of HIV. Anemia, emerging as a consequence of persistent immune activation and chronic inflammation in HIV, bears significant clinical implications. Its association with disease progression, treatment responses, and prognostic implications underscores its criticality in the comprehensive care of HIV-infected populations. Persistent immune activation and chronic inflammation intricately contribute to the pathogenesis of anemia in HIV infection. Understanding their multifaceted roles in disrupting erythropoiesis holds promise for developing targeted interventions and refining management strategies to alleviate anemia burden among individuals living with HIV. Keywords: Immune Activation, Chronic Inflammation, Anemia, HIV

Fracture Risk with Modified FRAX in Men Living with HIV

Background: Aging of the HIV-infected population and prolonged use of ARTs, produced metabolic alterations, including increased fracture risk. FRAX is a validated, computer-based clinical fracture risk calculator which estimates 10-year risk of major fracture, and hip fracture. However may underestimate risk in HIV-infected individuals. Several experts recommend considering HIV a cause of secondary osteoporosis.Methodology: Were included 52 men living with HIV, classified as high, moderate and low risk using ABRASSO graphic tool.Results: High risk prevalence found for major fracture and hip fracture were both 2 (4.2 %) using FRAX; while 10 (20.8 %) and 14 (29.2 %) using modified FRAX, respectively. Considering bone densitometry, 5 (12.8 %) were high risk for hip fracture and was noticed an increase in high risk major fracture from 4.2 % with FRAX to 5.1 % with FRAX considering bone densitometry. As for the low risk, 19 (39.6 %) for major fracture and 23 (47.9 %) for hip fracture with FRAX. While low risk modified FRAX were 0 (0 %) for major fracture and 8 (16.7 %) for hip fracture. It was also evidenced an association of high risk for major fracture and hip fracture with modified FRAX using Fisher's exact test [p=0.0273 (bilateral)].Conclusion: It was concluded is recommended using modified FRAX for people living with HIV for better control and therapeutic decision-making about osteometabolic alterations provocated for the virus and ARTs.