HIV-infected Adolescents Research Articles

Co-relation between ART (Anti-Retroviral Therapy) Adherence with Nutritional Status and Quality of Life among HIV-Infected Adolescents

Successful treatment for Perinatally Infected Adolescents (PIA) faces physical challenges like the risk of co-morbidity, deferred growth, and development, often resulting in late puberty in girls, and stunting/wasting makes it difficult to reach the transition phase of adulthood. The study aims to identify the correlation between ART adherence with nutritional status and QOL and find the association between adherence scores with selected demographic variables among adolescents. A randomized Controlled Trial design was adopted. Through simple random technique, a total of 388 HIV-infected adolescents were divided into experimental (195) and control (193) groups. The data were collected from four ART clinics in Chennai, India, through standardized ART adherence, QOL, and structured nutritional assessment questionnaires. Motivational counselling was given to the experimental group, and the researcher demonstrated selected asanas. The data were collected from both groups at ‘0’, ‘3’ & 6-month intervals. Descriptive & inferential statistics were used for the analysis of data. Regarding correlation, in the experimental group, baseline assessment showed poor correlation, but in the 3rd & 6th months there was a fair and moderate correlation found and was significant at p=0.05** and P=0.001*** respectively. Whereas in a control group, throughout the assessment period showed that, there was a poor correlation. Regarding association, showed adolescents' age, sex, sex of caregivers, relationship with adolescents, and residence were found significant. Motivational counseling along with asana has a positive correlation to ART adherence to promote the health and well-being of adolescents in the experimental group than in the control group. Keywords: Adherence, Correlation, HIV-infected adolescents, Nutrition, Quality of life.

Dyslipidemia and Nutritional Status of HIV-Infected Children and Adolescents on Antiretroviral Treatment at the Comprehensive Chronic Care and Training Center of Jimma Medical Center.

Highly active antiretroviral treatment is beneficial to suppress human immune virus replication in infected individuals. However, dyslipidemia and other metabolic abnormalities have emerged due to antiretroviral treatment. The prevalence of dyslipidemia in children and adolescents on antiretroviral treatment varies from 20% to 70%. The lack of data on children and adolescents in Ethiopia was the rationale for conducting this study. We aimed to determine prevalence of dyslipidemia and nutritional status in children and adolescents on follow-up at Jimma medical center. A hospital-based cross-sectional study was conducted with 150 children and adolescents on follow-up at Jimma medical center. A systematic sampling technique was employed. An interview was carried out to collect socioeconomic and demographic data and a review of medical records was carried out to collect patients' clinical data. Anthropometric data were computed using the CDC growth chart. About 3-5mL of fasting blood was collected to measure lipid profile. Multivariable logistic regression was performed to find the association between risk factors and lipid profile. The overall prevalence of dyslipidemia in this study was 72%. About 72% and 21.3% of study subjects had low high-density lipoprotein and high triglyceride, respectively. Significant associations were observed between BMI for age ≤5% (AOR: 2.02, 95% CI: 1.14-3.66; P=0.015) and low high-density lipoprotein; greater than 150 months on treatment (AOR: 1.02, 95% CI: 1.00-1.03; P=0.01) and high triglyceride; and BMI for age ≤5% (AOR: 1.86, 95% CI: 1.03-1.37; P=0.04) and high triglyceride. BMI for age <5%, treatment duration of greater than 150 months, and parents' educational level were significantly associated with dyslipidemia, soit is recommended that monitoring of those variables will help to reduce dyslipidemia and its complications in children and adolescents receiving treatment.

Inflammatory profile of vertically HIV-1 infected adolescents receiving ART in Cameroon: a contribution toward optimal pediatric HIV control strategies.

Antiretroviral therapy (ART) has improved the lifespan of people living with HIV. However, their immune system remains in a state of sustained activation/inflammation, which favors viral replication and depletion of helper T-cells with varying profiles according to ART-response. We herein sought to ascertain the inflammatory profile of adolescents living with perinatal HIV-1 infection (ALPHI) receiving ART in an African context. In this cross-sectional and comparative study among ART-experienced ALPHI in Yaoundé-Cameroon, HIV-1 RNA was measured by Abbott Real-time PCR; CD4 cells were enumerated using flow cytometry; serum cytokines were measured by ELISA; HIV-1 proviral DNA was genotyped by Sanger-sequencing; and archived drug resistance mutations (ADRMs) were interpreted using Stanford HIVdb.v9.0.1. Overall, 73 adolescents were enrolled (60 ALPHI and 13 HIV-1 negative peers) aged 15 (13-18) years; 60.00% were female. ART median duration was 92 (46-123) months; median viral load was 3.99 (3.17-4.66) RNA Log10 (copies)/mL and median CD4 count was 326 (201-654) cells/mm3. As compared to HIV-negative adolescents, TNFα was highly expressed among ALPHI (p<0.01). Following a virological response, inflammatory cytokines (IFNγ and IL-12), anti-inflammatory cytokines (IL-4 and IL-10) and inflammation-related cytokines (IL-6 and IL-1β) were highly expressed with viral suppression (VS) vs. virological failure (VF), while the chemokine CCL3 was highly expressed with VF (p<0.01). Regarding the immune response, the inflammatory cytokine TNFα was highly expressed in those that are immunocompetent (CD4≥500 cell/mm3) vs. immunocompromised (CD4<500 cell/mm3), p ≤ 0.01; while chemokine CCL2 was highly expressed in the immunocompromised (p<0.05). In the presence of ADRMs, IL-4 and CCL3 were highly expressed (p=0.027 and p=0.043 respectively). Among ART-experienced ALPHI in Cameroon, the TNFα cytokine was found to be an inflammatory marker of HIV infection; IFNγ, IL-1β, IL-6, and IL-12 are potential immunological markers of VS and targeting these cytokines in addition to antiretroviral drugs may improve management. Moreover, CCL3 and CCL2 are possible predictors of VF and/or being immunocompromised and could serve as surrogates of poor ART response.

Characterizing provider-led adaptations to mobile phone delivery of the Adolescent Transition Package (ATP) in Kenya using the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS): a mixed methods approach

BackgroundThe COVID-19 pandemic resulted in disruptions to routine HIV services for youth living with HIV (YLH), provoking rapid adaptation to mitigate interruptions in care. The Adolescent Transition to Adult Care for HIV-infected adolescents (ATTACH) study (NCT03574129) was a hybrid I cluster randomized trial testing the effectiveness of a healthcare worker (HCW)-delivered disclosure and transition intervention — the Adolescent Transition Package (ATP). During the pandemic, HCWs leveraged phone delivery of the ATP and were supported to make adaptations. We characterized real-time, provider-driven adaptations made to support phone delivery of the ATP.MethodsWe conducted continuous quality improvement (CQI) meetings with HCWs involved in phone delivery of the ATP at 10 intervention sites. CQI meetings used plan-do-study-act (PDSA) cycles and were audio-recorded. Adaptations were coded by two-independent coders using the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS). Adaptation testing outcomes (adopt, retest, or abandon) and provider experience implementing the adaptations were also recorded. We summarized adaptation characteristics, provider experience, and outcomes.ResultsWe identified 72 adaptations, 32 were unique. Overall, adaptations included modification to context (53%, n = 38), content (49%, n = 35), and evaluation processes (13%, n = 9). Context adaptations primarily featured changes to personnel, format, and setting, while content and evaluation adaptations were frequently achieved by simple additions, repetition, and tailoring/refining of the phone delivery strategy. Nine adaptations involved abandoning, then returning to phone delivery. HCWs sought to increase reach, improve fidelity, and intervention fit within their context. Most adaptations (96%, n = 69) were perceived to increase the feasibility of phone delivery when compared to before the changes were introduced, and HCWs felt 83% (n = 60) of adaptations made phone delivery easier. Most adaptations were either incorporated into routine workflows (47%) or tested again (47%).ConclusionAdaptation of phone delivery was a feasible and effective way of addressing challenges with continuity of care for YLH during the COVID-19 pandemic. Adaptations were primarily context adaptions. While FRAME-IS was apt for characterizing adaptations, more use cases are needed to explore the range of its utility.Trial registrationTrial registered on ClinicalTrial.gov as NCT03574129.

High risk of virologic failure among HIV-infected children and adolescents routinely followed-up in Littoral region of Cameroon.

Virological response to antiretroviral therapy (ART) remains a challenge for HIV-infected children and adolescents due to non-optimization of pediatric ART for resource-limited settings. In this study, we aimed to investigate factors associated with virologic failure (VF) in HIV-infected-children and adolescents on ART in Cameroon. A prospective patient-based cohort study was conducted among HIV-infected children (0-9 years) and adolescents (10-19 years) followed-up between November 2018 and October 2019 in 38 healthcare centers located in the Littoral region of Cameroon. The 1st viral load (VL) was assessed after 6 months of ART initiation and the 2nd VL between 3 and 6 six months later in patients with VL ≥1000 copies/ml in accordance with the national algorithm using Abbott Real-Time HIV-1 Viral Load Assay. Multivariate analyses were performed to identify the determinants of higher risk of VF. Of 1,029 HIV-infected children and adolescents (393 children and 636 adolescents), 801 (77.8%) cumulatively presented with VL <1000 copies/mL within 12 months on ART. Adolescents were more likely to have VF than children (24.5% vs 18.3%, OR: 1.39; 95%CI: 1.00-1.93; p = 0.047). Patients followed-up in decentralized care units were significantly more likely to have VF compared to those attending the accredited treatment centers (26.1% vs 16.6%, OR: 1.88, 95%CI: 1.37-2.58; p<0.001). Our findings show a high rate of VL suppression (VLS, 77.8%) among HIV-infected children and adolescents, albeit lower than the established target of 90%. Being adolescent and patients followed in the decentralized care units are high risk factors for VF, thereby necessitating routine therapeutic education of patients and guardians in resource limited countries to improve VLS.

Factors influencing the transition from paediatric to adult HIV care in the Western Cape, South Africa: perspectives of health care providers

Transitioning to adult care for HIV-infected adolescents is a critical process in determining long-term health outcomes. Poor transitioning to adult care can lead to several adverse HIV-related outcomes for adolescents living with HIV, including disruption of care, non-adherence to ART and virological failure. In this qualitative study, we explore the barriers to and facilitators of the transition to adult care among HIV-infected youth from the perspectives of health care workers and allied staff. We enrolled 24 health care workers and allied staff from two infectious diseases clinics in the Western Cape of South Africa. Participants took part in a once-off, semi-structured interview that was conducted face-to-face at the respective clinics. Interviews were audio-recorded and transcribed verbatim for thematic analysis using ATLAS.ti. Two superordinate themes and seven subthemes emerged from the data. We found that barriers to the transition process were related to a lack of preparedness and readiness to transition at both an institutional level and at the level of the caregiver and adolescent. At the institutional level, a lack of a transition policy and limited time and resources available for the transition process were salient barriers. At the caregiver-adolescent level, adolescents’ desire for normality and caregivers’ reluctance to devolve responsibility of care to their children were important barriers to the transition process. Facilitators prepare adolescents and caregivers for transition from an early age. Our findings highlight the importance of considering both adolescent, caregiver and institutional factors when preparing for the transition process. Our findings also show that pressure on the health care system precludes the time required for this process. However, counselling for transition from an early age might be an important way to negate these issues.

“We will tell when we are ready”: perinatally HIV-infected adolescents and self-disclosure of their status in Eswatini

Access to antiretroviral therapy (ART) has promoted a significant decrease in mortality of vertically HIV-infected children. As a result, there has been an increasing growth of this population that reaches adolescence. These adolescents face problems such as self-disclosure and the stigma of the disease. This study aimed to determine the process followed by perinatally HIV-infected adolescents in self-disclosing their HIV status to significant others and the barriers and promoters of perinatally HIV-infected adolescents’ disclosure of their HIV status to others. Data were collected from 15–19-year-old adolescents through 23 in-depth individual interviews and three focus groups. For adolescents, a clear barrier to disclosure was being told when they were younger by a parent to keep their status secret from other people. Lack of trust and fear of breaches of confidentiality which would lead to stigma and discrimination also hindered disclosure. For those adolescents who disclosed, they did so face to face and through short text messages. Adolescents expressed the need to be capacitated to self-disclose and also called for HIV and AIDS education to the general public as a way of fighting stigma and discrimination in their communities and in society. For adolescents to be able to disclose, they have to work through issues of acceptance of their own HIV status first. This study is the first-ever study to document difficulties faced by adolescents in the self-disclosure of their status in Eswatini.

Microalbuminuria in Perinatally HIV-Infected Children and Adolescents in the United States.

The kidney is a common target for human immunodeficiency virus (HIV), making renal disease a common noninfectious complication of HIV. Microalbuminuria is an important marker that can detect early renal damage. Timely detection of microalbuminuria is important to initiate renal management and stop the progression of renal dysfunction in people with HIV. Limited data are available about renal abnormalities in people with perinatal HIV infection. The objective of this study was to determine the prevalence of microalbuminuria in a cohort of perinatally HIV-infected children and young adults receiving combination antiretroviral therapy and investigate correlations between microalbuminuria and clinical and laboratory findings. This was a retrospective study of 71 patients with HIV followed in an urban pediatric HIV clinic in Houston, Texas, between October 2007 and August 2016. Demographic, clinical, and laboratory data were compared between subjects with persistent microalbuminuria (PM) and those without. PM is defined as a microalbumin-to-creatinine ratio ≥30 mg/g on at least 2 occasions separated by at least 1 month. Sixteen of 71 patients (23%) met the definition of PM. In univariate analysis, patients with PM had significantly higher CD8+ T-cell activation and lower CD4+ T-cell nadir. Multivariate analysis demonstrated increased microalbuminuria to be independently associated with older age and CD8+ T-cell activation measured as CD8+HLA-DR+ T-cell percentage. Older age and increased activation of CD8+HLA-DR+ on T cells correlate with presence of microalbuminuria in this cohort of HIV-infected patients.

Treatment factors associated with viral suppression among adolescents on antiretroviral therapy in Kenya

Background: There are approximately 99,159 adolescents living with human immunodeficiency virus in Kenya, with a viral suppression rate of 67%, according to the Joint United Nations Program on HIV/AIDS in 2021 [1] . There are limited studies in Kenya on factors associated with viral load suppression among adolescents. The objectives of this study were to determine the treatment factors associated with viral suppression among adolescents on antiretroviral therapy. Methods: A retrospective cross-sectional analysis of 38,503 HIV-infected adolescents receiving antiretroviral therapy for at least 6 months with a documented viral load result. The data was from routinely collected HIV program data in Kenya that is submitted from comprehensive care centers with electronic medical records to the National Aids and STI Control Program (NASCOP) for the period of January 2018–December 2022. Results: The study population was 38503 HIV-infected adolescents (10–19 years) on antiretroviral therapy. The viral suppression was at 81.2%., higher than the 2021 UNAIDS estimate of 67%. low detectable levels were 88%, low level viremia was 12%, high-risk LLV was 38%, and suspected treatment failure as 62%. Virological suppression with integrase strand transfer inhibitors based regimens – Abacavir and Tenofovir was 81.6% and 86.4%, respectively. The suppression with protease inhibitors based regimens was 70% (highest) and 56.4% (Lowest) Conclusion: The viral suppression among adolescents on antiretroviral therapy was 81.2% lower than the UNAIDS 95/95/95 global target but higher than the 2021 UNAIDS estimate of 67%. There is a need to interrogate the viral suppression in adolescents on protease inhibitors.

Dental caries in HIV-infected children and adolescents: A systematic review with meta-analysis.

This study aimed to evaluate and compare the risk of dental caries in between human immunodeficiency virus (HIV)-infected and uninfected children and adolescents. An electronic search was performed on PubMed/MEDLINE, Web-of-Science, Scopus, LILACS, ProQuest, and ClinicalTrials.gov up to May 2022. The critical appraisal checklist developed by the Joanna Briggs Institute was used to evaluate the quality of the included studies. Meta-analysis was performed using the RevMan 5.4. Sixteen studies were included. A total of 3231 participants were evaluated, including 1701 and 1530 HIV-infected and uninfected children and adolescents, respectively. The meta-analysis revealed a higher risk of dental caries for primary dentitions in HIV-infected children and adolescents by decayed, missing, filled tooth (dmft) (SMD:0.34; p = 0.006) and decayed, missing, filled surface (dmfs) scores (SMD:0.37; p = 0.001). Similar results were observed for permanent dentition, with increased dental caries in HIV-infected children and adolescents with DMFT (SMD:0.32; p = 0.003) and DMFS (SMD:1.78; p < 0.0001) scores. Regarding the quality assessment, most of the included studies were moderate or good quality. However, the certainty of the evidence of the outcomes was very low. This systematic review and meta-analysis showed higher caries severity in permanent and deciduous teeth among HIV-infected children and adolescents.

Perspectives on Self-Disclosure of HIV Status among HIV-Infected Adolescents in Harare, Zimbabwe: A Qualitative Study

AbstractHIV self-disclosure is an important challenge affecting the physical and psychological health of adolescents living with HIV. The study’s aim was to explore the perspectives of HIV-infected adolescents on self-disclosure. Using purposive sampling, 20 adolescents aged 12–19 years were recruited from a HIV care clinic at a tertiary hospital in Harare, Zimbabwe. All were vertically-infected with HIV (HIV transmitted from mother). In depth interviews were conducted to determine participants’ views and experiences of self-disclosure. Interviews were analysed using the framework approach to identify main codes and themes relating to self-disclosure. Adolescents identified stigma and discrimination from peers, as well as lack of HIV knowledge as important barriers to status disclosure. They suggested that community resources such as support groups, media and religion assist them in the disclosure process. HIV status self-disclosure is a challenging task for adolescents, which is affected by individual, interpersonal and social factors. These must be borne in mind to assist with disclosure and facilitate the wellbeing of HIV-positive adolescents.

Physical functioning in adolescents with perinatal HIV

ABSTRACT Perinatal HIV impacts on growth and development in childhood, with physical impairments such as growth limitations, decreased physical activity, reduced exercise tolerance and cardiopulmonary dysfunction continuing into adolescence. There is limited data on other physical functioning domains in perinatally HIV-infected adolescents (PHIVA) thus the aim of this study was to establish the physical sequelae of perinatal HIV in adolescents. This South African cross-sectional study compared PHIVA with HIV-negative adolescents, assessing anthropometry, muscle strength, endurance and motor performance. All ethical considerations were adhered to. The study included 147 PHIVA and 102 HIV-negative adolescents, aged 10–16 years. The majority (87.1%) of PHIVA were virally suppressed however, they still showed significant deficits in height (p < 0.001), weight (p < 0.001) and BMI (p = 0.004). Both groups performed poorly in muscle strength and endurance but did not differ significantly. In motor performance, the PHIVA scored significantly lower for manual dexterity and balance, with significantly more PHIVA with motor difficulty. A regression analysis showed that viral suppression predicted muscle strength (p = 0.032) and age positively predicted endurance (p = 0.044) and negatively predicated aiming and catching (p = 0.009). In conclusion, PHIVA face growth deficits and challenges with motor performance, especially with manual dexterity and balance.

Socio-demographic and HIV-Related Factors Associated with Depression among Retroviral Positive Adolescents in Port Harcourt

Introduction: Depression with HIV constitute a co-morbid condition associated with severe sequalae, which include deliberate self-harm and suicide, even among adolescents. Identifying demographic and HIV-related determinants of depression among adolescents living with HIV is vital for instituting relevant evidence-based interventions for curbing this problem. Thus this aimed to determine the relationship between these factors (socio-demographic and HIV-related factors) and depression among adolescents living with HIV.&#x0D; Methods: A cross-sectional hospital-based study was employed. It involved 140 HIV-infected adolescents, who were selected from the HIV Paediatric clinic of the University of Port Harcourt Teaching Hospital (UPTH) via systematic sampling method. Depression was determined based on the depression component of the depression anxiety stress scale (DASS-21), while social support was assessed using the social support rating scale. Socio-demographic and HIV-related factors comprised independent variables, while dependent variable was depression. Bivariate and multivariate analyses were performed at p&lt;0.05.&#x0D; Results: The mean (±) age of HIV-infected adolescents in the study was 14.05±2.68years. Close to half of the adolescents in the study had been living with HIV from birth (46.4%;n=65). The prevalence of depression was 14.2% (n=20). HIV-infected adolescents aged ≥16 years were four times more likely to experience depression than their younger aged counterparts (AOR: 4.40;95%CI:1.42-13.70). Also, those with higher social support had significantly lower odds of experiencing depression (AOR:0.94;95%CI:0.90-0.99).&#x0D; Conclusion: About 1 in 7 adolescents living with HIV are burdened with depression in the study area. Social support and age of adolescents showed significant relationship with depression in the study. The integration of mental health in Paediatric HIV care could optimize health outcomes.

Subacute myoclonic measles encephalitis - An opportunistic HIV-associated infection.

An unusual cluster of myoclonic epilepsy was observed in a Romanian pediatric HIV cohort concurrent with measles outbreaks. We describe this particular form of subacute measles encephalitis (SME) in a group of HIV-infected children and adolescents with severe immunosuppression. This is a single-center study, starting in 1997 and covering 4 measles outbreaks in Romania. The presumptive diagnosis of subacute myoclonic measles encephalitis (SMME) was based on: (1) epidemiological data, previous measles episode or presumed contact with measles virus (MV), (2) clinical presentation with initial localized myoclonic jerks with rapid extension and subsequent motor deficit with preserved mental status, and (3) neuroimaging studies revealing cortical gray matter lesions. Definitive diagnosis was based on a neuropathological exam and immunohistochemistry of brain tissues, and measles RNA detection in the cerebrospinal fluid (CSF). Thirty-six patients were diagnosed with a particular form of SME during consecutive measles outbreaks in Romania: 1996-1998 (22); 2005-2008 (12); 2010-2011 (1) and 2016-2018 (1). Most children were born in the late 80s and had parenterally acquired HIV infection in early childhood. Before the episode of SMME, 11 patients had confirmed measles, while the rest, without typical rash, had a respiratory tract infection and/or presumed previous measles contact. In all patients, the clinical onset was sudden, with unilateral myoclonus. MRI findings revealed mainly focal cortical gray matter lesions. Neurologic symptoms progressed rapidly to coma and death in most patients. Three patients survived SMME, they had higher CD4 count at onset, slower progression of neurological symptoms, and benefit of immune recovery with cART. Immunocytochemistry studies revealed MV in the brain with a pattern suggesting an ascending viral neural infection. MV was isolated from CSF in 7 out of 8 patients. Sequence analysis of MV RNA from both nasopharyngeal swabs and CSF was available for one patient with similar N-450 strain characteristics. During an outbreak of measles, neurological manifestations, especially myoclonus in immunosuppressed patients, can be related to measles even in the absence of an acute episode. This particular form of subacute myoclonic measles encephalitis is an opportunistic fatal disease. Immune recovery due to effective antiretroviral treatment might increase survival.

Counseling Therapy with Hatha Yoga on Adherence Level, Nutritional Status, and Quality of Life Among HIV-Infected Adolescents: A Randomized Controlled Trial

Introduction: HIV infection and AIDS are associated with numerous challenges, and infected people experience extreme despair, fear, anxiety, and depression. However, counseling therapy and yoga techniques may help ease stress-related illness, produce internal strength through relaxation, and enhance immunity. Objective: This study aimed to evaluate the effectiveness of counseling therapy and Hatha yoga on the adherence level, nutritional status, and quality of life (QOL) of HIV-infected adolescents. Materials and Methods: A randomized controlled trial study was conducted. Through the simple random method, 388 (195 in the experimental and 193 in the control group) HIVinfected adolescents were selected. The data of HIV-infected adolescents and caregivers were collected from four main Antiretroviral Therapy clinics in Chennai, India, through Standardized Antiretroviral Therapy adherence, QOL, and a structured nutritional assessment questionnaire. Motivational counseling was given to the experimental group, and the researcher demonstrated selected asanas. The data were collected from both groups at 0, 3, and 6 months intervals. The descriptive statistics of mean, standard deviation, and inferential statistics of the student independent t test and Chi-square test were used to determine the effectiveness of interventional variables in both groups. Results: The Mean±SD age of the experimental group of adolescents was 13.6±2.2 years, and that of the control group was 13.8±2.4 years. There is an improvement range in the experimental vs the control group for the components of adherence level (13.4% vs 4.9%) and QOL (15.1% vs 0.9%) at a significance of P=0.001 with a 95% confidence interval. Also, the nutritional gain score was significantly increased to 9.3% vs 1.5% (P=0.05). Regarding CD4 (cluster of differentiation 4) count, the baseline mean score was 664.86 vs 669.72, whereas, in the sixth month, it significantly increased to 840.35 vs 703.35 (P=0.001). Conclusion: Motivational counseling and behavior modification of yoga efficiently improved health status and well-being among HIV-infected adolescents in the experimental group compared to the control group.

Long-term evolution in liver disease markers and immune and lipid profiles in vertically HIV/HCV-coinfected youths with sustained viral response after direct-acting antivirals therapy

This study aimed to analyse the long-term effect of direct-acting antivirals (DAAs) in vertically acquired HIV/HCV-coinfected youths. We performed a multicentre, longitudinal and observational study within the Spanish Cohort of HIV-infected children and adolescents and vertically HIV-infected patients transferred to Adult Units (CoRISpe-FARO). We included HIV/HCV-coinfected youths (n = 24) that received DAAs between 2015 and 2017 with successful sustained viral response (SVR) with a subsequent follow-up of at least three years. Long-term evolution in liver disease severity and haematologic markers, lipid and immune profiles after SVR were assessed. Study times were the start date of DAAs treatment (baseline, T0) and 1, 2, 3, 4 and 5 years after SVR (T1, T2, T3, T4 and T5, respectively). We observed global improvements in liver function data that persist over time and a favourable haematologic and immune outcome at the long-term including a constant augment in leucocytes, neutrophils, neutrophils to lymphocytes ratio (NLR) and CD4/CD8 ratio over-time. Regarding the lipid profile, we found a significant increase in total cholesterol T2, total cholesterol/high-density lipoprotein (HDL) ratio at T4, triglycerides at T5, low-density lipoprotein (LDL) over time, and a decrease in HDL in all patients but with marked higher levels in the subgroup receiving anti-HIV Protease Inhibitor (PI)-based regimens. Comparisons of vertically HIV/HCV-coinfected youths after SVR at 3-year follow-up and a control group of vertically HIV-monoinfected youths never infected by HCV showed no significant differences in most variables analysed, suggesting a possible normalization in all parameters.

Viral load suppression in HIV-infected adolescents in cameroon: towards achieving the UNAIDS 95% viral suppression target

BackgroundAchieving the UNAIDS 95% sustained viral suppression (VS) rate requires considerable global efforts, particularly among adolescents living with HIV (ALHIV) who are often associated with high rates of virological failure (VF). In this study, we prospectively assessed the rate of VS, and the factors associated with VF in a cohort of adolescents followed up according to the WHO guidelines in Cameroon.MethodsA cross-sectional study was carried out in 2021 among adolescents (aged 10–19 years) receiving ART in the national program in Cameroon. Socio-demographic and clinical data were collected using patients’ medical files and a brief interview with the participant and/or his guardian. Thereafter, a first viral load test (VL1) was performed using the ABBOTT Platform. For adolescents with VL1 > 1000 copies/ml, adherence-enhancing interventions were routinely performed each month for 3 consecutive months, after which a second viral load (VL2) was measured. Adolescents with VL2 > 1000 copies/ml were considered in VF.ResultsOverall, 280 adolescents were enrolled, of whom 89.3% (250/280) acquired HIV infection via mother-to-child transmission. The median age was 16.0 (IQR: 13.0–18.0) years and the median duration on ART was 9.8 (IQR: 5.1–12.8) years. Females and males were almost equally represented, as 52.1% (146/280) were female, while 47.9% (134/280) were males (p = 0.47). The VS rate was 88.2% (CI: 83.8-91.7%) overall; 89.0% (CI: 82.0-93.1%) and 88.7% (CI: 81.2-93.0%) in females and males, respectively. Being on second or third-line ART, self-declared suboptimal adherence, and a history of past VF were independently associated with VF.ConclusionThe high rate of VS we report in this study is welcome in the era of the 95/95/95 UNAIDS goals, and indicates that improving treatment outcomes in this specific and fragile population that represent adolescents in Sub-Saharan Africa is achievable.Trial registration20/10/2020 NCT04593979 (https://clinicaltrials.gov/ct2/show/NCT04593979).

Disability, fatigue and peripheral neuropathy in adolescents with perinatal HIV infection

ABSTRACT Perinatally HIV-infected adolescents (PHIVA) experience many physical sequelae, but little is known about their levels of disability, fatigue or peripheral neuropathy. This study aimed to determine these sequelae through a cross-sectional analysis in a population of PHIVA and HIV-negative adolescents, based in Johannesburg, South Africa. Outcome measures used were the HIV-related Fatigue Scale, World Health Organization Disability Assessment Schedule 2.0 and the Brief Peripheral Neuropathy Screen, to measure fatigue, level of disability and peripheral neuropathy, respectively. Of the 249 participants assessed, 59% (n = 147) were PHIVA, and the mean age of the participants was 12 years. Clinical data for the PHIVA group showed that the majority (87.1%) were virally suppressed. When compared to the HIV-negative group, PHIVA presented with significantly greater levels of fatigue intensity [1.2(SD±0.5) vs. 1.5(SD±0.9) p = 0.022] and disability [9.2(±6.8) vs. 11.5(±8.9) p = 0.023], with specific limitations in mobility, self-care and participation. No significant differences in peripheral neuropathy were found. In conclusion, PHIVA face challenges with disability and fatigue highlighting the necessity of comprehensive management for this population.

The effectiveness of psychoeducation and problem-solving on depression and treatment adherence in adolescents living with HIV in Botswana: an exploratory clinical trial

BackgroundThis study aimed to explore the effectiveness of psychological interventions (PI): psychoeducation, problem-solving, and rehearsal strategies on depression and adherence in HIV-infected adolescents in Botswana.MethodsFifty adolescents living with HIV were randomized into control (n = 25) and intervention groups (n = 25), the latter being exposed to five weeks of PI sessions. The PHQ-9 and visual analog scale (VAS) were used to measure the outcomes: depression and adherence at pre-intervention, 5- and 24 weeks post-intervention.ResultsThe participants’ mean age (SD) was 17.38 years (1.1), the two groups being similar in socio-demographic variables: gender (χ2 = 2.22; p = 0.135) and age (U = 285, z = − 0.55, p = 0.579). The intervention group scored significantly lower on depressive symptoms (PHQ-9 [F (1,50) = 12.0, p = 0.001, ƞp2 = 0.20]) and higher on adherence score (VAS [F (1,50) = 13.5, p = 0.001, ƞp2 = 0.22]) than the control group after 5 weeks. The post-hoc analysis showed that the significant improvements in depressive symptoms (z = − 4.03, p < 0.01, r [effect size] = 0.88) and adherence (z = − 4.05, p < 0.01, r = 0.88) at post-test in the intervention group were maintained at 24 weeks. This project was registered with ClinicalTrials.gov (NCT05482217).ConclusionThe 5-week PI showed promising effectiveness in addressing depression and adherence in adolescents living with HIV in Botswana.

Psychoactive Substance Use Disorder in HIV-Infected Adolescents in Botswana: A Comparison Between the Congenitally Infected and Behaviorally Infected Adolescents.

Substance use is a major obstacle to preventing and managing HIV among adolescents, who account for 30% of new infections in many parts of the world, including Botswana. Unfortunately, there is a paucity of data on adolescent substance use, especially in the region. Therefore, this study aimed to determine the pattern of psychoactive substance use in adolescents living with HIV (ALWHIV). It also aimed to compare and explore the pattern of substance use disorders and associated factors between congenitally infected adolescents (CIAs) and behaviorally infected adolescents (BIAs). Six hundred and thirty-four ALWHIV were interviewed using a sociodemographic questionnaire, the WHO drug questionnaire, and DSM-5 criteria for substance use disorder. The participants' mean age (SD) was 17.69 (1.6) years, with a male predominance (n = 336, 53%), and the majority (n = 411, 64.8%) were CIAs. Alcohol was the most used substance among the participants, with 15.8% admitting to its current use. The BIAs were more likely to have SUD (χ2 = 17.2, P < .01), use more than one substance (χ2 = 20.3, P < .01), and more likely to use all psychoactive substances except for inhalants. In the CIAs, regular participation in religious activities was negatively associated with SUD (AOR = 0.36; 95% CI: 0.17-0.77), while struggling with HIV status acceptance was positively associated with SUD (AOR = 2.54; 95% CI: 1.15-5.61) in the BIAs. This study showed a huge burden and similar pattern of substance use disorders among the ALWHIV in Botswana, as reported elsewhere. It also identified the dissimilarities between the BIAs and CIAs regarding substance-related issues and suggested the need for differentiated care.