HIV-positive Cohort Research Articles

Detection and consistency of mucosal fluid T lymphocyte phenotypes and their relationship with blood, age and gender

Innate and adaptive immune responses at mucosal surfaces play a role in protection against most infectious diseases. However, the relative importance either of mucosal versus systemic, or of cellular versus humoral immunity in protection against such infections remains unclear. We aimed to determine the relative percentages and reproducibility of detection of five major T lymphocyte phenotypes in stimulated whole mouth fluid (SWMF); to compare matched mucosal and blood phenotypes; to evaluate the consistency of phenotypes in SWMF over time; and to determine any associations with age or gender. Peripheral blood and SWMF samples were collected from 194 participants and sequential concomitant samples were collected from 27 of those and from 12 subjects living with HIV. CD3, CD4, CD8, Th1 and Th2 T lymphocyte phenotypes were determined by FACS. All the five T lymphocyte phenotypes were detected consistently by FACS in PBMC and SWMF with experimental replicates (N = 10; PBMC CV: 3–30%; SWMF CV: 12–36%). In longitudinal samples detection rates were reproducible in both fluids but variations were higher in SWMF (CV: 23–79.6%) than PBMC (CV: 9.7–75%). Statistically significant correlations of the percentages of all the T lymphocyte phenotypes except CD8 was seen between the two fluids. In PBMCs a negative correlation with age was found with CD3, CD4 and CD8 phenotypes, whilst a positive correlation was found in both SWMF and PBMC with the Th2 phenotype. CD3, CD4 and CD8 phenotypes in SWMF and PBMCs from an HIV-positive cohort were not significantly correlated in contrast with the HIV-negative controls. Our study provides a robust FACS protocol for the detection of the five major T lymphocyte phenotypes in SWMF which should prove useful for research with other mucosal fluids.

#2934 The risk of APOL1 variants in the development of ESKD—a case-control study among cohorts of ESKD with HIV and non-ESKD with and without HIV

Abstract Background and Aims Apolipoprotein 1 (APOL1) renal allelic risk variants are common in kidney disease patients of African ancestry. This study evaluated the prevalence of APOL1 variants and their influence on end-stage kidney failure (ESKD) and non-ESKD HIV-positive and HIV-negative study cohorts. Method This case‒control study enrolled 60 HIV-positive ESKD cases and 160 non-ESKD (80 HIV-positive and 80 HIV-negative) as controls. Participants’ demographic and clinical information and laboratory data as well as blood samples were collected. Genomic DNA was extracted, and purified, and APOL1 risk variants genotyped using TaqMan® predesigned commercial assays. Results Study participants in the case and two control cohorts were enrolled with a median age of 42.8 (IQR,38.47-48.57), 41 (IQR,37-46.5), and 41 (IQR,37–47) years, respectively; the frequencies of APOL1 risk variants (G1: rs73885319 and rs60910145 and G2: rs71785313) were 21.8% (48/220), 10.9% (24/220), and 26.4% (58/220), respectively, in the entire study population. The frequency of G1 variants was significantly increased among those with ESKD at 55.0% (33/60) compared to non-ESKD HIV-positive and HIV-negative cohorts at 13.8% (11/80) and 17.5% (14/80), respectively (p < 0.001). The presence of both G1 risk genotypes (rs73885319 and rs60910145) was higher among those with ESKD at 20% (12/60) compared to the two control cohorts without ESKD at rates of 3.8% (3/80) and 1.3% (1/80), respectively (p < 0.001). In logistic regression, the presence of both G1 (OR,14.6; p ≤ 0.001) and G1/G2 (OR,11.9; p ≤ 0.001) risk genotypes were strong predictors of ESKD development. Conclusion The presence of G1:rs73885319 and rs60910145 polymorphisms of the APOL1 gene is suggested to be a significant factor in the development of ESKD.

Linkage to HIV care and early retention in HIV care among men in the ‘universal test-and-treat’ era in a high HIV-burdened district, KwaZulu-Natal, South Africa

IntroductionDespite the numerous efforts and initiatives, males with HIV are still less likely than women to receive HIV treatment. Across Sub-Saharan Africa, men are tested, linked, and retained in HIV care at lower rates than women, and South Africa is no exception. This is despite the introduction of the universal test-and-treat (UTT) prevention strategy anticipated to improve the uptake of HIV services. The aim of this study was to investigate linkage to and retention in care rates of an HIV-positive cohort of men in a high HIV prevalence rural district in KwaZulu-Natal province, South Africa.MethodsFrom January 2018 to July 2019, we conducted an observational cohort study in 18 primary health care institutions in the uThukela district. Patient-level survey and clinical data were collected at baseline, 4-months and 12-months, using isiZulu and English REDCap-based questionnaires. We verified data through TIER.Net, Rapid mortality survey (RMS), and the National Health Laboratory Service (NHLS) databases. Data were analyzed using STATA version 15.1, with confidence intervals and p-value of ≤0.05 considered statistically significant.ResultsThe study sample consisted of 343 male participants diagnosed with HIV and who reside in uThukela District. The median age was 33 years (interquartile range (IQR): 29–40), and more than half (56%; n = 193) were aged 18–34 years. Almost all participants (99.7%; n = 342) were Black African, with 84.5% (n = 290) being in a romantic relationship. The majority of participants (85%; n = 292) were linked to care within three months of follow-up. Short-term retention in care (≤ 12 months) was 46% (n = 132) among men who were linked to care within three months.ConclusionWhile the implementation of the UTT strategy has had positive influence on improving linkage to care, men’s access of HIV treatment remains inconsistent and may require additional innovative strategies.

Prevalence of syphilis and associated risk factors among human immunodeficiency virus-infected patients at the Lagos University Teaching Hospital Nigeria: A cross-sectional study

Background: Worldwide, there was an estimated 7.1 million new cases of syphilis in 2020, and most of the infections were found in developing countries like Nigeria. The objective of the study was to determine the prevalence and risk factors for syphilis among human immunodeficiency virus (HIV)-infected patients in Lagos. Methods: A cross-sectional study was conducted in an HIV Clinic in Lagos, Nigeria, from April to June 2017 and 385 HIV-infected adult participants 18 years and above were recruited into the study. Structured questionnaires were used to collect data on sociodemographic and risk factors for syphilis. Blood samples were collected from all participants and tested for syphilis using rapid plasma reagin and Treponema pallidum hemagglutination assay test kits. Data were analyzed using SPSS (IBM) V. 20. Bivariate analysis was carried out using Chi-square, Fisher’s exact test, and Student’s t-test on sociodemographic and risk behavioral factors. Multivariable logistic regression analysis was performed with variables that were significantly associated with syphilis in bivariate analysis. A P < 0.05 was considered to be statistically significant. Results: Out of 388 HIV-infected patients recruited into the study, 262 (67.5%) were female. The mean age was 43.6 ± 10.1 years, and 137 (35.3%) of them were in the age group of 41–50 years. The prevalence of syphilis in HIV-infected patients was 1.8%. The prevalence of syphilis was significantly higher in males (4.8%) than females (0.4%). The prevalence of syphilis was higher in those with no education or primary school education, and multiple sexual partners were statistically significant in the bivariate analysis but not in the multivariate analysis. Male gender was the only independent risk factor for syphilis, with an odds ratio of 11.79 (95% confidence interval [1.26–106.5], P = 0.03) in multivariate analysis. Conclusion: The prevalence of syphilis in this study was lower than previous work done in other HIV-positive cohorts in Nigeria. Males were more affected significantly in this study. Routine screening and testing for syphilis should be integrated into HIV care, especially in males.

Risk of Multiple Sclerosis in People Living with HIV: An International Cohort Study.

There has been interest in a possible negative association between HIV and multiple sclerosis (MS). We aimed to compare the risk of MS in a cohort of individuals living with HIV to that in the general population. Population-based health data were accessed for 2 cohorts of HIV-positive persons from Sweden and British Columbia, Canada. Incident MS was identified using MS registries or a validated algorithm applied to administrative data. Individuals with HIV were followed from 1 year after the first clinical evidence of HIV or the first date of complete administrative health data (Canada = April 1, 1992 and Sweden = January 1, 2001) until the earliest of incident MS, emigration, death, or study end (Canada = March 31, 2020 and Sweden = December 31, 2018). The observed MS incidence rate in the HIV-positive cohort was compared to the expected age-, sex-, calendar year-, income-specific, and region of birth-specific rates in a randomly selected sample of >20% of each general population. The standardized incidence ratio (SIR) for MS following the first antiretroviral therapy exposure ("ART-exposed") was also calculated. The combined Sweden-Canada cohort included 29,163 (75% men) HIV-positive persons. During 242,248 person-years of follow-up, 14 incident MS cases were observed in the HIV-positive cohort, whereas 26.19 cases were expected. The SIR for MS in the HIV-positive population was 0.53 (95% confidence interval [CI] = 0.32-0.90). The SIR for MS following the first ART exposure was 0.55 (95% CI = 0.31-0.96). This international population-based study demonstrated a lower risk of MS among HIV-positive individuals, and HIV-positive ART-exposed individuals. These findings provide support for further exploration into the relationship among HIV, ART, and MS. ANN NEUROL 2024;95:487-494.

Prevalence of Monoclonal Gammopathy of Undetermined Significance in Eswatini: A Study of an African Population

Multiple myeloma and its precursor, monoclonal gammopathy of undetermined significance (MGUS), both occur twice as often within Black populations compared to White populations, suggesting that racial factors may influence the development of MGUS, not the progression from MGUS to malignancy. The landmark epidemiologic study that described the natural history of MGUS was conducted among 21,463 of the 28,000 residents in Olmsted County, Minnesota, a 97% White population, and found the age-standardized prevalence (including light-chain, LC, MGUS) to be 4.2% (Dispenzieri, et al, Lancet, 2010). Although MGUS disproportionately affects Black individuals, few studies have been conducted on MGUS in Africa, and no prior study has evaluated MGUS in a Black African cohort inclusive of both sexes. Using a population-based biorepository from Eswatini, a small country in southern Africa, we further explored the racial disparities related to plasma cell dyscrasias. Our primary objective was to determine the prevalence of MGUS in Eswatini, as compared to that found in Olmsted County. Additionally, we aimed to determine the association between MGUS and HIV status. From 2016 to 2017, over 15,000 individuals from a nationally representative selection of households participated in the Second Eswatini Population-based HIV Impact Assessment survey, SHIMS2 (phia.icap.columbia.edu/countries/eswatini). After providing informed consent, interviews were conducted and blood samples were collected. Samples were tested for HIV, and if positive, also for CD4+ cell counts and the serologic presence of antiretroviral therapy (ART). The remaining plasma aliquots were stored and linked to their de-identified corresponding survey data for future research endeavors. For our current study, all adults over the age of 35 years who had SHIMS2 specimens stored were included in the sampling frame. We randomly selected 515 plasma samples from the sampling frame, with the sample size determined to produce a two-sided 95% confidence interval (CI) with a width of 0.05 and power >80% for MGUS prevalence and comparison by HIV status. We performed protein electrophoresis with reflex immunofixation, as well as free light chain and creatinine quantification, and defined MGUS cases by the same criteria as the Olmsted County studies. If creatinine was greater than the upper limit of normal, then the renal reference range was used for free-light-chain ratios . Historical proportions and means were compared with z-tests and t-tests, respectively. To determine associations between categorical variables, odds ratios (OR) were calculated with logistic regressions or Fisher Exact tests. The study cohort (n=515) was 60% female (n=309) with a median age of 50 years (range 35-80); 199 (38.6%) were HIV-positive, of whom 82.4% (n=164) were on ART, and 8.5% (n=17) had a CD4+ cell count of <200 cells/ul. These numbers reflected the overall national estimates (Kingdom of Eswatini, SHIMS2 Final Report, 2019). The MGUS prevalence (including LC-MGUS) standardized for age and sex was 13.2% (95%CI: 10.5-16.5) (n=68), which was significantly greater than Olmsted County (RR 3.1, p<0.0001). Most (84%, n=57) MGUS cases were LC. Prevalence of non-light-chain (NLC) MGUS was 2.1% (n=11), which was similar to Olmsted County. Of the 11 participants with NLC MGUS, 4 were considered very low risk for progression to malignancy, 6 low risk, 1 intermediate risk, and 0 high risk by Mayo stratification (Rajkumar, et al., Blood, 2005). HIV status was not found to be significantly associated with MGUS (OR: 1.05, 95%CI: 0.62-1.77). However, within the HIV-positive cohort, the odds of MGUS were 69% lower among those on ART (OR: 0.31, 95%CI: 0.11-0.82) when adjusted for age, sex, and wealth quintile. Furthermore, MGUS was 2.8 times more frequent in those with untreated HIV when compared to those with treated HIV (95%CI: 1.1-7.2, p=0.031), and 2.3 times more frequent when compared to non-HIV (95%CI: 1.0-5.6, p=0.056); treated HIV was not significantly different from non-HIV (data not shown). In conclusion, the MGUS prevalence in Eswatini was more than three-fold higher than that in Olmsted County, largely due to those with LC-MGUS. The high rate of HIV in Eswatini did not explain the high prevalence of MGUS, as the majority of those with HIV were on ART and only untreated HIV was significantly associated with MGUS.

Cis-meQTL for cocaine use-associated DNA methylation in an HIV-positive cohort show pleiotropic effects on multiple traits

BackgroundCocaine use (CU) is associated with psychiatric and medical diseases. Little is known about the mechanisms of CU-related comorbidities. Findings from preclinical and clinical studies have suggested that CU is associated with aberrant DNA methylation (DNAm) that may be influenced by genetic variants [i.e., methylation quantitative trait loci (meQTLs)]. In this study, we mapped cis-meQTLs for CU-associated DNAm sites (CpGs) in an HIV-positive cohort (Ntotal = 811) and extended the meQTLs to multiple traits.ResultsWe conducted cis-meQTL analysis for 224 candidate CpGs selected for their association with CU in blood. We identified 7,101 significant meQTLs [false discovery rate (FDR) < 0.05], which mostly mapped to genes involved in immunological functions and were enriched in immune pathways. We followed up the meQTLs using phenome-wide association study and trait enrichment analyses, which revealed 9 significant traits. We tested for causal effects of CU on these 9 traits using Mendelian Randomization and found evidence that CU plays a causal role in increasing hypertension (p-value = 2.35E-08) and decreasing heel bone mineral density (p-value = 1.92E-19).ConclusionsThese findings suggest that genetic variants for CU-associated DNAm have pleiotropic effects on other relevant traits and provide new insights into the causal relationships between cocaine use and these complex traits.

Longitudinal analysis of immune reconstitution and metabolic changes in women living with HIV: A real-world observational study.

Women comprise more than half of people living with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) worldwide and incomplete immune recovery and metabolic abnormalities affect them deeply. Studies of HIV antiretroviral therapy (ART) have a low female representation in China, we aimed to investigate immune reconstitution and metabolic changes of female HIV-positive cohort in China longitudinally. HIV-positive women who initiated ART from January 2005 to June 2021 and were followed up regularly at least once a year were included in this study. Immunological indicators (cluster of differentiation 4 [CD4] counts and CD8 counts), viral load (VL), and metabolic indicators were collected at follow-up. All data were collected from the China Disease Prevention and Control Information System (CDPCIS). VL was tested half a year, 1 year after receiving ART, and every other year subsequently according to local policy. CD4/CD8 ratio normalization was considered as the primary outcome and defined as a value ≥1. Incidence rate and probability of CD4/CD8 ratio normalization were estimated through per 100 person-years follow-up (PYFU) and Kaplan-Meier curve, respectively. Multivariate Cox regression was used to identify independent risk factors associated with CD4/CD8 ratio normalization. We further studied the rate of dyslipidemia, hyperuricemia, diabetes, liver injury, and renal injury after ART initiation with the chi-squared tests or Fisher's exact probability tests, and a generalized estimating equation model was used to analyze factors of dyslipidemia and hyperuricemia. A total of 494 female patients with HIV/AIDS started ART within 16 years from January 2005 to June 2021, out of which 301 women were enrolled with a median duration of ART for 4.1 years (interquartile range, 2.3-7.0 years). The overall incidence rate of CD4/CD8 ratio normalization was 8.9 (95% confidence interval [CI], 7.4-10.6) per 100 PYFU, and probabilities of CD4/CD8 normalization after initiating ART at 1 year, 2 years, 5 years, and 10 years follow-up were 11.7%, 23.2%, 44.0%, and 59.0%, respectively. Independent risk factors associated with CD4/CD8 normalization were baseline CD4 cell counts <200 cells/μL, CD8 counts >1000 cells/μL, and more than 6 months from the start of combined ART (cART) to first virological suppression. Longitudinally, the rate of hypercholesterolemia (total cholesterol [TC]) and high triglyceride (TG) showed an increasing trend, while the rate of low high-density lipoprotein cholesterol (HDL) showed a decreasing trend. The rate of hyperuricemia presented a downtrend at follow-up. Although liver and renal injury and diabetes persisted during ART, the rate was not statistically significant. Older age and protease inhibitors were independent risk factors for increase of TC and TG, and ART duration was an independent factor for elevation of TC and recovery of HDL-C. This study showed that women were more likely to normalize CD4/CD8 ratio in comparison with findings reported in the literature even though immune reconstruction was incomplete.

Clinical outcomes of ventricular assist device support by HIV infection status: An STS-INTERMACS analysis

Cardiovascular disease remains the leading cause of mortality in human immunodeficiency virus-infected (HIV-positive) patients. Ventricular assist device therapy is rarely offered to these patients and data on outcomes are sparse. We investigated outcomes following ventricular assist device implants for HIV-positive as compared to non-HIV-infected (HIV-negative) patients. We analyzed 22,065 patients from the Interagency Registry for Mechanically Assisted Circulatory Support registry for outcomes by HIV status. A propensity-matched analysis adjusting for 21 preimplant risk factors was also conducted. Compared with 21,980 HIV-negative device recipients, the 85 HIV-positive recipients were younger (median age 58 years vs 59 years, p=0.02), had lower body mass index (26kg/m2 vs 29kg/m2, p=0.001), and had higher rates of prior stroke (8% vs 4%, p=0.02). In the matched HIV-positive and HIV-negative cohorts, there was significantly higher mortality in HIV-positive patients in earlier implant years, however, this association was not seen in later implant years (2018-2020). In both unmatched and matched cohorts, no significant differences in postimplantation stroke, major bleeding, or major infection were noted. With recent advancements in mechanical circulatory support and HIV treatment, ventricular assist device therapy is a viable therapeutic option for HIV-positive patients with end-stage heart failure.

HIV treatment-as-prevention and its effect on incidence of HIV among cisgender gay, bisexual, and other men who have sex with men in Australia: a 10-year longitudinal cohort study

Although HIV treatment-as-prevention reduces individual-level HIV transmission, population-level effects are unclear. We aimed to investigate whether treatment-as-prevention could achieve population-level reductions in HIV incidence among gay, bisexual, and other men who have sex with men (GBM) in Australia's most populous states, New South Wales and Victoria. TAIPAN was a longitudinal cohort study using routine health record data extracted from 69 health services that provide HIV diagnosis and care to GBM in New South Wales and Victoria, Australia. Data from Jan 1, 2010, to Dec 31, 2019, were linked within and between services and over time. TAIPAN collected data from all cisgender GBM who attended participating services, resided in New South Wales or Victoria, and were 16 years or older. Two cohorts were established: one included HIV-positive patients, and the other included HIV-negative patients. Population prevalence of viral suppression (plasma HIV viral load <200 RNA copies per μL) was calculated by combining direct measures of viral load among the HIV-positive cohort with estimates for undiagnosed GBM. The primary outcome of HIV incidence was measured directly via repeat testing in the HIV-negative cohort. Poisson regression analyses with generalised estimating equations assessed temporal associations between population prevalence of viral suppression and HIV incidence among the subsample of HIV-negative GBM with multiple instances of HIV testing. At baseline, the final sample (n=101 772) included 90 304 HIV-negative and 11 468 HIV-positive GBM. 59 234 patients in the HIV-negative cohort had two or more instances of HIV testing and were included in the primary analysis. Over the study period, population prevalence of viral suppression increased from 69·27% (95% CI 66·41-71·96) to 88·31% (86·37-90·35), while HIV incidence decreased from 0·64 per 100 person-years (95% CI 0·55-0·76) to 0·22 per 100 person-years (0·17-0·28). Adjusting for sociodemographic characteristics and HIV pre-exposure prophylaxis (PrEP) use, treatment-as-prevention achieved significant population-level reductions in HIV incidence among GBM: a 1% increase in population prevalence of viral suppression corresponded with a 6% decrease in HIV incidence (incidence rate ratio [IRR] 0·94, 95% CI 0·93-0·96; p<0·0001). PrEP was introduced in 2016 with 17·60% uptake among GBM that year, which increased to 36·38% in 2019. The relationship between population prevalence of viral suppression and HIV incidence was observed before the availability of PrEP (IRR 0·98, 95% CI 0·96-0·99; p<0·0001) and was even stronger after the introduction of PrEP (0·80, 0·70-0·93; p=0·0030). Our results suggest that further investment in HIV treatment, especially alongside PrEP, can improve public health by reducing HIV incidence among GBM. National Health and Medical Research Council of Australia.

Prevalence of Co-infection of Hepatitis B and C with HIV in HIV-Positive Adolescents in Anambra State, South-East Nigeria

Purpose: HIV accelerates the progression of HBV-related liver disease which may be as a result of the effect of HAART on the liver. This study evaluated the frequency of hepatitis B and C co-infection, and the viral load suppression rate among children and adolescents receiving ART in six HIV program centers in Anambra State, Nigeria. Methods: A multi-facility cross-sectional study was conducted among HIV-infected children and adolescents currently receiving antiretroviral treatment (ART) in six selected HIV/AIDS program healthcare facilities in Anambra State between March 2018 and February 2020. The HBsAg and HCV antibody screening were done using LabACON (HangzhouBiotest Biotech C0, China). The HIV viral load of the patients was determined according to the national HIV program algorithm using the RocheCOBASAmpliPrep COBAS TaqMan (CAP/CTM) HIV-1 test, version 2.0. All the patients Data were analyzed using SPSS version 23 and test of significance set at p-value of 0.05. Results: Of the 308 children and adolescent HIV positive cohorts tested for hepatitis B and C, 156/308 (50.6%) were males. Fourteen of the 308 (4.5%) tested positive for HBV while 34/308 (11.0%) tested positive for HCV. The male participants were frequently infected with HBV 10/156 (6.4) than their female counterparts 4/152(2. 6%). Among the children and adolescents, 3/94 (3.2%) and 11/214 (5.1%) were positive for HBV respectively, while the HCV antibody was present in 9/94 (9.6%) of children and 25/214 (11.7%) of adolescents (p = 0.24 and p = 0.72). Conclusions: The estimated prevalence of HIV/HBV and HIV/HCV dual infections in this cohort of Anambra HIV-infected children and adolescents on ART was 15.5%. Keywords: Seroprevalence, HBV, HCV, HIV, Children, Adolescents, ART, Anambra State

A comparison of lung cancer in HIV-positive and HIV-negative populations.

Background Lung cancer is the most common cancer worldwide and is the greatest contributor to malignancy-associated deaths. Human immunodeficiency virus (HIV) is an epidemic in many developing countries and South Africa carries the largest burden of this disease in the world. With the introduction of antiretroviral therapy (ART), acquired immune deficiency syndrome (AIDS)-defining malignancies (ADMs) are on the decline and non-AIDS-defining malignancies (NADMs) are becoming more common, with lung cancer being the most common among these. Objectives To describe and compare a cohort of HIV-positive lung cancer patients and a cohort of HIV-negative lung cancer patients. Methods A retrospective study of 188 patients with histologically confirmed bronchogenic carcinoma was conducted. Smoking history, cancer sub-type, cancer stage, HIV parameters and demographic data were collected. Results There were 31 (16.94%) HIV-positive patients. They presented at a younger age (53.94 years) than the HIV-negative group (61.64 years) (p=0.0001). Adenocarcinoma was the most common sub-type in the HIV-negative cohort while squamous cell carcinoma was slightly more common in the HIV-positive cohort. Both groups predominantly presented with locally advanced or metastatic disease. Conclusion HIV-positive patients present at a younger age than HIV-negative patients and both groups show a male-predominant pattern.

Change in Substance Use and the Effects of Social Distancing on Health-Related Quality of Life and Depressive Symptoms During the COVID-19 Pandemic in People Living With and Without HIV.

Little is known about the impact of social distancing on health-related quality of life and depressive symptoms in older people with HIV during the COVID-19 pandemic. HIV-positive and HIV-negative AGEhIV Cohort Study participants. In September-November 2020, participants completed questionnaires on social distancing, change in substance use, health-related quality of life (EQ-6D, including EQ-VAS), and depressive symptoms (PHQ-9). Associations between social distancing and (1) EQ-VAS or (2) PHQ-9 score ≥10 (clinically relevant depressive symptoms) were analyzed using fractional and binomial logistic regression, respectively. Two hundred fourteen HIV-positive and 285 HIV-negative participants were analyzed. 77.4% found social distancing important and 66.9% reported good adherence to these measures, without significant differences between HIV-positive and HIV-negative participants. In both groups, &amp;lt;5% reported increased smoking or recreational drug use, but more HIV-positive (12.2%) than HIV-negative (4.9%) participants (P = 0.005) reported increased/more frequent alcohol use. Median EQ-VAS was slightly lower in HIV-positive (80 IQR = 73-90) than HIV-negative (84 IQR = 75-90) participants (P = 0.041). The prevalence of clinically relevant depressive symptoms was similar (HIV-positive, 8.4% and HIV-negative, 8.8%). Worrying about contracting COVID-19 and having ≥3 (vs no) comorbidities were associated with lower EQ-VAS and finding social distancing easy with higher EQ-VAS. Worrying about contracting COVID-19 and younger than 60 years (vs ≥65) were associated with higher odds of clinically relevant depressive symptoms. HIV status was associated with neither outcome. Initially during the COVID-19 pandemic in the Netherlands, a similar majority of HIV-positive and HIV-negative participants reported adhering to social distancing. Irrespective of HIV status, concerns about contracting COVID-19 negatively affected participants' perceived current health and increased risk of depressive symptoms.

Impact of Human Immunodeficiency Virus on Postoperative Outcomes following Osteonecrosis-Indicated Total Hip Arthroplasty

AbstractOsteonecrosis (ON) of the femoral head in human immunodeficiency virus (HIV)-positive patients is often treated with total hip arthroplasty (THA). The purpose of this study was to determine the effect that HIV positive status and acquired immunodeficiency syndrome (AIDS) have on postoperative complication rates and outcomes in patients with ON treated with THA. Patients who underwent primary ON-indicated THA with a minimum of 2-year follow-up were identified in a national database (PearlDiver Technologies) using Current Procedural Terminology and International Classification of Diseases codes. These patients were stratified into two cohorts: those who were HIV-positive and those who were HIV-negative (control). The HIV-positive cohort was further stratified into those with AIDS and those with asymptomatic HIV at the time of THA. Univariate and multivariate analyses were conducted to determine associations between the three cohorts and their 90-day, and 2-year outcomes were each compared with HIV-negative patients. In this study, 1,163 patients were in the HIV-positive cohort and 34,288 were in the HIV-negative cohort. In the HIV-positive cohort, there were significantly higher 90-day rates of renal failure (odds ratio [OR] = 1.874; p &lt; 0.001), pneumonia (OR = 1.682; p = 0.002), and sepsis (OR = 1.975; p &lt; 0.001). The asymptomatic HIV cohort and AIDS cohort followed similar associations as the HIV cohort; however, the AIDS cohort also had significantly higher rate of blood transfusion (OR = 1.692; p = 0.012) and deep vein thrombosis (OR = 1.765; p = 0.036). HIV infection, whether symptomatic or not, and AIDS are associated with a higher risk of short-term complications after THA. Physicians must consider this risk and discuss with their patients to reduce future complications.

Neuropathologic Findings in Elderly HIV-Positive Individuals.

The elderly HIV-positive population is growing due to the widespread use of combination antiretroviral therapy (cART), but the effects of longstanding HIV infection on brain aging are unknown. A significant proportion of HIV-positive individuals develop HIV-associated neurocognitive disorder (HAND) even on cART, but the pathogenesis of HAND is unknown. Although neuroinflammation is postulated to play an important role in aging and neurodegenerative diseases such as Alzheimer disease (AD), it is unclear whether HIV accelerates aging or increases the risk for AD. We examined the brains of 9 elderly HIV-positive subjects on cART without co-infection by hepatitis C virus compared to 7 elderly HIV-negative subjects. Microglial and astrocyte activation and AD pathologic change in association with systemic comorbidities and neurocognitive assessment were evaluated. There was no difference in microglial or astrocyte activation between our HIV-positive and HIV-negative cohorts. One HIV-positive subject and 2 HIV-negative subjects demonstrated significant amyloid deposition, predominantly in the form of diffuse senile plaques, but these individuals were cognitively normal. Neurofibrillary tangles were sparse in the HIV-positive cohort. There was a high prevalence of cardiovascular comorbidities in all subjects. These findings suggest that multiple factors likely contribute to aging and cognitive impairment in elderly HIV-positive individuals on cART.

The lung microbiome in HIV-positive patients with active pulmonary tuberculosis

Tuberculosis poses one of the greatest infectious disease threats of our time, especially when associated with human immunodeficiency virus (HIV) infection. Very little data is available on the lung microbiome in pulmonary tuberculosis (PTB) in HIV-positive patients. Three patient cohorts were studied: (i) HIV-positive with no respiratory disease (control cohort), (ii) HIV-positive with pneumonia and (iii) HIV-positive with PTB. Sputum specimens were collected in all patients and where possible a paired BALF was collected. DNA extraction was performed using the QIAamp DNA mini kit (QIAGEN, Germany) and extracted DNA specimens were sent to Inqaba Biotechnical Industries (Pty) Ltd for 16S rRNA gene sequence analysis using the Illumina platform (Illumina Inc, USA). Data analysis was performed using QIMME II and R Studio version 3.6.2 (2020). The lung microbiomes of patients with PTB, in the context of HIV co-infection, were dominated by Proteobacteria, Firmicutes, Actinobacteria and Bacteroidetes. Loss of biodiversity and dysbiosis was found in these patients when compared to the HIV-positive control cohort. Microbial community structure was also distinct from the control cohort, with the dominance of genera such as Achromobacter, Mycobacterium, Acinetobacter, Stenotrophomonas and Pseudomonas in those patients with PTB. This is the first study to describe the lung microbiome in patients with HIV and PTB co-infection and to compare findings with an HIV-positive control cohort. The lung microbiomes of patients with HIV and PTB were distinct from the HIV-positive control cohort without PTB, with an associated loss of microbial diversity.

Detection and Prevalence of Macrolide and Fluoroquinolone Resistance in Mycoplasma genitalium in Badalona, Spain

Macrolide and fluoroquinolone resistance (MLr/FQr) in Mycoplasma genitalium (MG) infections is concerning worldwide. Current guidelines recommend performing MLr detection in MG-positive cases to adjust antimicrobial therapy. We aimed to evaluate the usefulness of PCR followed by pyrosequencing for MLr detection in comparison with a one-step commercial assay and to assess the prevalence of MLr and FQr in Badalona, Spain. A total of 415 MG-positive samples by Allplex STI-7 (Seegene) were analyzed for MLr detection by pyrosequencing. From those, 179 samples were further analyzed for MG and MLr by ResistancePlus® MG kit (SpeeDx) and 100 of them also for fluoroquinolone resistance (FQr) by sequencing the parC gene. Regarding MG detection, Allplex and Resistance Plus® showed an overall agreement of 87%, but this value rose to 95.4% if we compare them for MLr detection. Prevalence of MLr was 23.1% in Badalona, but this rate increased to 73.7% in the HIV-positive patients cohort. FQr detection showed 3% of resistant strains. Pyrosequencing is a convenient and cheap technique for MLr detection, but one-step tools should be considered in high-throughput laboratories. Despite the fact that MLr remained moderate and FQr was low in our study, simultaneous MG and MLr detection would improve patient’s management applying resistance-guided treatment strategies.

Increased CD4+ T cell count is associated with lower anal human papillomavirus prevalence among HIV-positive male cohort in Taizhou, China: a cross-sectional study

ObjectivesThis study aims to investigate the association between CD4+ T cell count and combined antiretroviral therapy (cART) with the prevalence of anal human papillomavirus (HPV) infection among HIV-positive male cohort in China.MethodsA survey was conducted in men from a HIV cohort in Taizhou, China between 2016 and 2019. A face-to-face questionnaire interview was administered, and an anal-canal swab was collected for HPV genotyping.ResultsA total of 766 HIV-positive men were recruited. The HPV prevalence was lower among those with increased CD4+ T cell count than those with decreased or unchanged (46.5 vs. 56.6%, p = 0.033) from baseline. In multivariable models, having the current CD4+ T cell count of 350–499 cells/µL (aOR 0.28, 95% CI 0.13–0.64), and of ≥ 500 cells/µL (aOR 0.26, 95% CI 0.11–0.60) were associated with lower prevalence of any type HPV infection compared with those with < 200 cells/µL. Having taken NVP + 3TC + AZT was inversely associated with any high-risk (HR)-HPV (aOR 0.47, 95% CI 0.25–0.90) and any low-risk (LR)-HPV infection (aOR 0.40, 95% CI 0.18–0.88), compared with those taking EFV + 3TC + TDF.ConclusionsIncreased CD4+ T cell count at follow-up was significantly associated with lower prevalence of anal HPV infection. Inverse associations between NVP + 3TC + AZT and HR-HPV or LR-HPV infecton were observed.

Neurocognitive outcomes of tuberculous meningitis in a primarily HIV-positive Ugandan cohort.

Background: The toll of tuberculous meningitis (TBM) in both mortality and disability is considerable, but advancements in rehabilitation have the potential to improve the functional abilities and the quality of survivors' lives. However, the typical phenotype of neurocognitive impairment in TBM survivors remains unstudied in HIV-predominant populations in sub-Saharan Africa. Methods: We tested 36 survivors of TBM in Uganda with a comprehensive battery of neurocognitive assessments at 8 and 24 weeks after diagnosis, and compared results to a representative cohort of HIV-uninfected Ugandans. Results: While participants had a broad range of impairments at eight weeks, there was marked improvement by 24 weeks, when a phenotype of impairment including deficits in motor functioning, verbal learning and memory, processing speed, and executive function emerged. These deficits were present despite good clinician-rated functional status. The majority (23/27, 85%) had evidence of moderate to severe depression at week 8, and at week 24 (18/24, 75%). Conclusion: These findings highlight the need for more comprehensive neurocognitive assessment in the survivors of TBM, and further investment in and study of rehabilitation, including management of depression, to improve long-term outcomes in this population.

Uncontrolled HIV and inflammation is associated with intracranial saccular aneurysm presence.

To study biomarkers of inflammation in cerebrovascular disease, exploring modifiable and non-modifiable biochemical and clinical risk factors associated with the presence of intracranial saccular aneurysms (ISAs) in an HIV-positive cohort. A cross-sectional community-based study was used to study blood biomarkers of inflammation as predictors of cerebrovascular disease, specifically the presence of ISAs in persons with HIV. Potential biochemical and clinical predictors of ISA presence were identified. Time of flight magnetic resonance angiography and magnetic resonance imaging data identified the presence of ISAs in an HIV-positive cohort. Quantitative assays for neuroinflammatory biomarkers were performed on plasma blood samples. Lasso regression models were used to identify neuroinflammatory biomarkers and clinical risk factors associated with ISAs. Eight of 72 participants had radiographically identified ISAs. ISAs were more common in non-Hispanic black participants (18.5% vs. 0% presence in nonblack patients). Participants with well controlled HIV (defined as CD4+ count >200 cells/ml and undetectable viral load at time of magnetic resonance imaging) had lower odds of ISAs (odds ratio: 0.19, 95% confidence interval 0.05-0.79) independent of age, sex, ethnicity and vascular risk factors. Macrophage inflammatory protein-1 p, an HIV- suppressive factor detected in participant blood samples, was inversely associated with aneurysm presence. Well controlled HIV is associated with fewer ISAs. The identification of non-modifiable and modifiable risk factors contributing to ISA formation may provide valuable insight to impact clinical practice and inform the pathophysiology underlying ISA formation.