Management Of Human Immunodeficiency Virus Research Articles

Bictegravir-Induced Drug Reaction With Eosinophilia and Systemic Symptoms in a Patient With Acute Human Immunodeficiency Virus.

Although drug reaction with eosinophilia and systemic symptoms (DRESS) is associated with antiretrovirals, there are no published reports of bictegravir-induced DRESS. Bictegravir is recommended as first-line treatment for patients with human immunodeficiency virus (HIV). Recognition of DRESS, its skin manifestations, and potential complications is vital for appropriate care and management of acute HIV.

HIV prevalence and access to HIV testing and care in patients with psychosis in South Africa.

Human immunodeficiency virus (HIV) and psychosis share a complex bidirectional relationship, with people living with HIV being at increased risk of psychosis and those with psychosis at increased risk of HIV. However, people living with severe mental illness often have limited or reduced access to HIV testing and care. This study aimed to determine the prevalence of HIV and describe the access to HIV testing and care among adult patients with recent-onset psychosis who were admitted to a psychiatric hospital in KwaZulu-Natal (KZN) province, South Africa. A psychiatric hospital in Pietermaritzburg, KZN province, South Africa. A retrospective chart review of 294 patients with recent-onset psychosis admitted between May 2018 and November 2020. A total of 291 (99%) patients had access to HIV testing during the study period, with the HIV seroprevalence rate being 21.5% among the 294 patients; HIV seropositivity was associated with the 25-49 age category (adjusted odds ratio [aOR] = 3.09, 95% confidence interval [CI] 1.27-7.50), female gender (aOR = 9.55, 95% CI 4.40-20.74), current alcohol and cannabis use (aOR = 3.43, 95% CI 1.01-11.62), family history of psychosis (aOR = 3.22, 95% CI 1.03-10.02) and no tertiary education (aOR = 3.7, 95% CI 0.14-0.99). All those living with HIV were on antiretroviral treatment. This study showed that HIV testing and care was accessible at a psychiatric hospital but the prevalence of HIV in people living with recent onset psychosis remains high. The study findings suggest the importance of integrating mental health and HIV management.

Long-acting injectable antiretroviral therapy: will it change the future of HIV treatment?

The treatment of human immunodeficiency virus (HIV) has greatly advanced over the past few decades from complex regimens, with high toxicities, multiple daily dosing, and incomplete viral suppression to more simplified, highly effective, daily oral regimens. Although these advancements greatly improved access and tolerability, the need for daily antiretroviral (ARV) administration remained until recently. With long-acting (LA) injectable ARV options emerging, patients may choose how they want to receive treatment. By eliminating the barrier of daily medication adherence, LA injectable ARV formulations have the potential to not only improve health outcomes for the individual, but also the community by reducing HIV transmission. At the time of this writing cabotegravir/rilpivirine (LA-CAB/RPV) is the only LA injectable ARV regimen approved as a complete regimen for the treatment of HIV in adults and adolescents (⩾35 kg and ⩾12 years of age) who are virologically suppressed. However, additional studies of LA-CAB/RPV in expanded populations, and of other LA ARVs, are underway. The goal of this article was to summarize clinical data and review pertinent clinical considerations for the use of LA-CAB/RPV in the management of HIV.

Identifying the Unmet Medical Needs of HIV-Positive Subjects in Korea: Results of a Nationwide Online Survey.

An online survey was conducted in Korea to identify the unmet medical needs of people living with human immunodeficiency virus (HIV) (PLWH). Participants (n = 105) were mostly male (93.3%), aged >40 years (75.2%), and treated for ≥6 years post-diagnosis (61.9%). Most PLWH (71.4%) were very satisfied/satisfied with their HIV management. Areas of concern were quality of life (QoL) and mental health. Characteristics of a long-term therapeutic agent were 'low risk of resistance', 'high long-term viral suppression efficacy', and 'high degree of safety'. Pre-consultation QoL and mental health screening would be beneficial for the long-term success of HIV management.

Revolutionizing antiretroviral therapy for human immunodeficiency virus/AIDS: A computational approach using molecular docking, virtual screening, and 3D pharmacophore building to address therapeutic failure and propose highly effective candidates.

In the context of human immunodeficiency virus (HIV) treatment, the emergence of therapeutic failures with existing antiretroviral drugs presents a significant challenge. This study aims to employ advanced molecular modeling techniques to identify potential alternatives to current antiretroviral agents. The study focuses on three essential classes of antiretroviral drugs: nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), and protease inhibitors (PIs). Computational analyses were performed on a database of 3,343,652 chemical molecules to evaluate their binding affinities, pharmacokinetic properties, and interactions with viral reverse transcriptase and protease enzymes. Molecular docking, virtual screening, and 3D pharmacophore modeling were utilized to identify promising candidates. Molecular docking revealed compounds with high binding energies and strong interactions at the active sites of target enzymes. Virtual screening narrowed down potential candidates with favorable pharmacological profiles. 3D pharmacophore modeling identified crucial structural features for effective binding. Overall, two molecules for class 1, 7 molecules for class 2, and 2 molecules for class 3 were selected. These compounds exhibited robust binding affinities, interactions with target enzymes, and improved pharmacokinetic properties, showing promise for more effective HIV treatments in cases of therapeutic failures. The combination of molecular docking, virtual screening, and 3D pharmacophore modeling yielded lead compounds that hold potential for addressing HIV therapeutic failures. Further experimental investigations are essential to validate the efficacy and safety of these compounds, with the ultimate goal of advancing toward clinical applications in HIV management.

Could Vhavenda initiation schools be a panacea for HIV and AIDS management in the Vhembe district of South Africa?

Several human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) prevention strategies have been implemented to counteract the impact of the disease, including the use of condoms, social marketing, testing, voluntary counselling and education programmes. One of the platforms which has not been fully explored is that of traditional initiation schools. This study aimed to explore and discuss Vhavenda traditional initiation schools, which can be used as panacea for HIV and AIDS management in the Vhembe district of South Africa. This ethnographic study was conducted in the Vhembe district of South Africa, among nine purposively sampled key informants drawn from a cohort of Vhavenda traditional healers and leaders. Data were collected using semistructured face-to-face interviews and analysed using ethnographic content analysis. The results indicate that Vhavenda traditional initiation schools positively affect the management of HIV and AIDS. Initiation schools are centres for cultural education and the formation of a cultural identity. During the initiation process, initiates are taught social norms, customs and values which will serve them well in adulthood. They are also taught matters of sexuality, courtship, marriage and respect for others. The positive attributes of Vhavenda initiation schools should be accommodated and implemented in curricula from the primary school level up to the tertiary level to reduce and curb the spread of HIV infection.Contribution:Improved expertise at the initiation schools will aid the Department of Health and Education and Training to develop and implement suitable cultural contextualised HIV and AIDS prevention strategies.

Impact of highly active antiretroviral drug therapy (HAART) on biochemical, hematologic, atherogenic and anthropometric profiles of human immunodeficiency virus patients at a tertiary hospital in Owo, Nigeria

BackgroundHighly active antiretroviral drug therapy (HAART) remains the only officially available option for the management of human immunodeficiency virus (HIV) infection at designated medical institutions in Nigeria. This study investigated the impact of HAART on glucose level, lipid profile, blood parameters and growth indices of HIV-infected patients at a tertiary health center in Nigeria. Biochemical and hematologic indices were determined in HIV patients on HAART at the Federal Medical Centre (FMC), Owo, Nigeria. Plasma glucose and lipid profile were biochemically determined in 140 age-matched individuals divided into three groups: Group I (n = 70) comprised seventy clinically diagnosed and laboratory-confirmed HIV-positive patients before receiving HAART (HIV-positive group); Group II (n = 70) comprised the same set of HIV-positive patients who had received HAART for 1 year (HAART group); and Group III (n = 70) comprised healthy controlled subjects who proved HIV-negative (HIV-negative group). Growth indices were used to monitor the changes in immune response (white blood cell counts) of the HIV-infected patients.ResultsHAART ameliorated reduced body mass index and disorder in white blood cell counts but not dyslipidemia and hyperglycemia caused by HIV infection. Results confirmed the effectiveness of HAART in preventing the development of full-blown acquired immune deficiency syndrome in HIV-positive patients. However, increases in cholesterol and low-density lipoprotein-cholesterol levels coupled with increased atherogenic index occasioned by HAART portend the risk of cardiovascular disease.ConclusionsHIV infection has a negative impact on the anthropometric, hematologic and biochemical indices of patients. Although HAART is helpful to improve anthropometric and hematological indicators, there is a need to improve drug regimens to reduce or eliminate undesirable metabolic complications.

An Integrated Reporting Tool for Management of Hiv And Non-communicable Diseases for Primary Health Care Facilities in Limpopo Province, South Africa

Introduction:Reporting of a health programme such as integrated management of the Human Immunodeficiency Virus (HIV) and Non-communicable Diseases (NCDs) is essential for programme evaluation to improve patient clinical outcomes. It is a criterion that all services that are provided in primary health care facilities and hospitals are monitored, evaluated and reported according to the approved reporting tools and approved health indicators.Aim:This study aimed to develop a reporting tool to report the implementation of integrated management of HIV and NCDs in Limpopo Province, South Africa.Methodology:The South African National Indicators Data Sets (NIDS) were adopted and used to develop the integrated management of HIV and NCDs reporting tool. A Delphi technique was used to validate the developed reporting tool. Eight (8) HIV and NCDs programme experts participated in the review process to establish the validity of the developed tool.Results:Eight integrated HIV and NCDs data elements reporting tool were developed and reviewed by eight (8) programme experts. The tool was found to be relevant and useful and likely to be adopted by Limpopo province for implementation.Conclusion:This was the first integrated HIV and NCDs reporting tool to be developed for Nurse Initiated Management of Antiretroviral Therapy (NIMART) Nurses in Limpopo Province to serve as a basic reporting tool to improve the integrated management of HIV and NCDs including patient outcomes.

SELECTED INFLAMMATORY AND THROMBOTIC INDICATORS AMONG PERSONS LIVING WITH HIV INFECTION IN SOUTHERN NIGERIA

Introduction: Although viremia has been greatly addressed in the management of human immunodeficiency virus (HIV) infection by the advancement in antiretroviral therapy, not all HIV-associated morbidities have been resolved. Observations of increased cardiovascular risk in relation to antiretroviral therapy have been reported. Full blood count continues to be useful in disease management, and efforts are directed towards optimising its utility in medical practice. Derivatives of blood cell counts have in recent times proved to be informative with regards to the inflammatory-thrombotic cycle. The utility of these derived parameters in HIV within the study locality is worth exploring. Methods: This single-site study was carried out at University of Calabar Teaching Hospital in Calabar, Cross River State of Nigeria. White blood cell and platelet counts were carried out by automation, while blood cell ratios were calculated. Statistical analysis of data was done using SPSS 22.0. A p-value of ≤ 0.05 was considered to infer a statistically significant difference. Results: Significant reductions of white blood cell parameters were recorded in HIV, particularly among infected persons on antiretroviral therapy. Platelet count and plateletcrit were significantly lower, while mean platelet volume and platelet distribution width were higher in newly diagnosed persons compared to HIV-infected subjects on therapy and control subjects. Platelet-to-lymphocyte ratio was significantly higher among subjects on therapy compared to the rest of the groups. Conclusion: Increase in platelet count following antiretroviral therapy could be posing a risk of platelet-driven morbidities as typified in the observed elevated thrombotic marker.

Adolescent on the bridge: Transitioning adolescents living with HIV to an adult clinic, in Ghana, to go or not to go?

BackgroundChildren survive into adult life with Human Immunodeficiency Virus (HIV), which previously would have been lethal in early childhood.MethodsThe study aimed to describe the current transitional process for Adolescents Living with HIV (ALHIV) in a resource-limited setting in Ashanti Region, Ghana. The study was an explorative study that used an interpretive paradigm. A semi-structured interview guide was used to interview ALHIV, selected by purposive sampling. The study was conducted at a tertiary hospital in Kumasi. Data were analysed using thematic analysis.ResultsTransitioning of ALHIV was done without any guide; the themes generated were on the process of transition in which they used age (13 and above) and disclosure as the criterion to move ALHIV to the adult clinic. Most adolescents complained about being stigmatised, the attitude of staff, interruption of school and separation anxiety as experiences they went through during the transitioning process. On improving transition, ALHIV felt sexual and reproductive health services, information on treatment, privacy, and support were necessary transition components.ConclusionThe use of age and disclosure of status as a criterion for transitioning ALHIV affects moving and retaining this age group in HIV management programs in the adult clinics. There is, therefore, an urgent need for a guideline as the current transition process defeats the purpose of providing adolescents with age-specific care in the Adult Clinic.

P232 Disseminated cryptococcosis in HIV due to different species — dissimilar yet alike!

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PMObjectiveTo present two cases of disseminated cryptococcosis caused by two different species in HIV patients, presenting from the same geographical location.IntroductionCryptococcal meningitis is the most frequent cause of adult meningitis in areas with a high prevalence of human immunodeficiency virus (HIV) and is one of the leading causes of HIV-related deaths worldwide. Cryptococcus gattii, the lesser prevalent species, ‘conventionally’ known to affect the non-HIV and otherwise immunocompetent population, may also cause disseminated infection in HIV patients. High MICs of antifungals, especially fluconazole, may pose challenges in the management. Here, we present two cases of HIV patients with disseminated cryptococcosis, who presented from the same geographical area of India in the months of February and March 2022, respectively.Case 1: A 34-year-old patient from the state of Rajasthan with a past history of abdominal tuberculosis and a defaulter of ART (ABC/3TC/EFV) presented with headache and vomiting for 3 weeks. After an MRI brain and CT scan of the thorax, he was diagnosed to have pulmonary and meningeal cryptococcosis based on CSF examination with a positive Gram's, and India ink stain (Fig. 1), positive cryptococcal antigen (CRAG) by lateral flow assay, and fungal culture positive for C. gattii (MALDI-TOF); and a paratracheal lymph node biopsy showing granulomatous inflammation with cryptococci (Fig. 2). Fluconazole MIC was 16 μg/ml. He was treated with liposomal amphotericin B with flucytosine for 2 weeks. After good clinical recovery and negative fungal culture, a high dose (1200 mg) of fluconazole was started. He is asymptomatic with repeated negative fungal culture on 2 months follow-up.Case 2: A 37-year-old patient from Rajasthan, on ART (TDF/3TC/DTV) for HIV-1 diagnosed a month ago, presented with cough, weight loss, and fever for 2 months with severe chest pain on drinking and eating. He was diagnosed to have cytomegalovirus esophagitis based on the CMV inclusion bodies in a biopsy from the esophageal ulcers and a positive quantitative serum CMV DNA PCR. Bronchoscopy with EBUS-guided lymph node biopsy was done to investigate cavitary lung consolidation and mediastinal lymphadenopathy. BAL CRAG was positive and biopsy showed inflammation with histiocytic aggregates and necrosis, and many encapsulated yeasts form suggestive of Cryptococcus, which was identified by MALDI-TOF as Cryptococcus neoformans. Serum CRAG was positive. Though patient did not have any neurological complaints, CSF examination was done and CRAG was positive. He was treated with injection of liposomal amphotericin B, flucytosine, and ganciclovir, along with ART.ConclusionDefault of ART by the patients, initiation of ART without investigation and treatment of opportunistic infections, and co-existence of multiple opportunistic infections, are still major challenges in the management of HIV, especially in developing countries. Though C. neoformans is the commonly isolated species, more and more cases of C. gattii are being reported. Identification of the species is important as there are differences in the epidemiology, clinical presentation, antifungal susceptibilities, and hence the treatment and prognosis.

High-level resistance to non-nucleos(t)ide reverse transcriptase inhibitor based first-line antiretroviral therapy in Ghana; A 2017 study.

Expanding access to effective antiretroviral therapy (ART) is a major tool for management of Human Immunodeficiency Virus (HIV) infection. However, rising levels of HIV drug-resistance have significantly hampered the anticipated success of ART in persons living with HIV (PLWH), particularly those from Africa. Though great strides have been made in Ghana toward achieving the UNAIDS “95-95-95” target, a substantial number of PLWH receiving ART have not attained viral suppression. This study investigated patterns of drug resistance mutations in ART naïve as well as ART-experienced PLWH receiving first-line regimen drugs from Ghana. In a cross-sectional study, blood samples were collected from HIV-1 infected adults (≥18 years) attending HIV/AIDS clinic at the Eastern Regional Hospital, Koforidua, Ghana from September to October 2017. Viral RNA isolated from plasma were subjected to genotypic drug resistance testing for Protease Inhibitors (PI), Reverse Transcriptase Inhibitors (RTI), and Integrase Strand Transfer Inhibitors (INSTI). A total of 95 (84 ART experienced, 11 ART naïve) HIV-1 infected participants were sampled in this study. Sixty percent (50/84) of the ART-experienced participants were controlling viremia (viral load < 1,000 copies/ml). Of the 95 patient samples, 32, 34, and 33 were successfully sequenced for protease, reverse-transcriptase, and integrase regions, respectively. The dominant HIV-1 subtypes detected were CRF02_AG (70%), and A3 (10%). Major drug resistance associated mutations were only detected for reverse transcriptase inhibitors. The predominant drug resistance mutations were against nucleos(t)ide reverse transcriptase inhibitors (NRTI)—M184V/I and non-nucleos(t)ide reverse transcriptase inhibitors (NNRTI)—K103N. In the ART-experienced group, M184V/I and K103N were detected in 54% (15/28) and 46% (13/28) of individuals, respectively. Both mutations were each detected in 33% (2/6) of ART naïve individuals. Multiclass resistance to NRTI and NNRTI was detected in 57% of ART-experienced individuals and two ART naïve individuals. This study reports high-level resistance to NNRTI-based antiretroviral therapy in PLWH in Ghana. However, the absence of major PI and INSTI associated-mutations is a good signal that the current WHO recommendation of Dolutegravir in combination with an NRTI backbone will yield maximum benefits as first-line regimen for PLWH in Ghana.

The effects of traditional healing on HIV and AIDS management: An ethnographic study.

BackgroundThis article presents the effects of traditional healing on the management of human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) in the Vhembe district, South Africa. The Vhembe district is one of the rural districts in Limpopo Province, South Africa, in which traditional healers are used as the first point of consultation for most ailments, regardless of their causes.MethodsThis ethnographic study was based on Leininger’s theory of culture care diversity and universality. It was carried out in selected villages in the Vhembe district. Observation and interviews with 15 purposively selected key informants, who are traditional healers, were used to collect data. Interviews were tape-recorded and field notes were also taken. The data were analysed using the ethnographic content analysis method.ResultsThe results suggest that traditional healing has both negative and positive effects on HIV and AIDS management. The positive effects are the effective treatment of some opportunistic infections, such as diarrhoea, skin lesions and childhood diseases. Negative effects, however, include incisions to let the ‘dirty blood flow out’ and inducing of vomiting and diarrhoea, which may lead to anaemia, dehydration and electrolyte imbalances. Some traditional healers are of the view that HIV does not exist and that people either have an ancestral calling or are bewitched. Even though their claims have not been scientifically proven, some traditional healers stated that they can heal HIV and AIDS.ConclusionThe research brings insight as to whether Vhavenda traditional healing has a favourable or unfavourable impact on HIV and AIDS management. Using Leininger’s steps for adaptation for culture care diversity and universality will help with re-Africanisation of HIV management. The researcher recommend the modification of practices with a high risk of HIV infection to reduce this risk, whilst also supporting the continuation of beneficial practices that reduce HIV mortality, such as diarrhoea management.

HIV infection and risk of heart failure: A meta-analysis and systematic review.

Heart failure (HF) is commonly seen in patients with human immunodeficiency virus (HIV) infection. We aimed to evaluate the potential correlations of HIV infection and risk of HF, to provide evidence to the management of HIV and HF. We searched PubMed and other databases to identify prospective cohort studies on the risk of HIV infection and heart failure, we used Stata 13 software for Meta-analysis, and we calculated the hazard ratio (HR) values and 95% confidence interval (CI) values for the risks of HF in patients with and without HIV infections. A total of five studies were included, with 8457 cases in the HIV-infection and 21917 cases in the non-HIV-infection group. Meta-analysis results showed that HIV infection can increase the risk of HF by 48% (HR=1.48, 95% CI1.31~1.67). Subgroups analyses by HIV-1 RNA viral load, CD4+ cell count, and study population also favored the overall results, and the research heterogeneity mainly come from the group of veterans in the research population. HIV infection is one of the risk factors for HF, which can increase the risk of heart failure, early preventions and interventions are needed for those populations.

Highly active antiretroviral therapy-silver nanoparticle conjugate interacts with neuronal and glial cells and alleviates anxiety-like behaviour in streptozotocin-induced diabetic rats

The inception of highly active antiretroviral therapy (HAART) has changed the management of human immunodeficiency virus (HIV) positive patients, with an improvement in life expectancy. However, neurological complications associated with high dosage and chronic administration of HAART have not been fully addressed. Therefore, this study evaluated the potential benefits of silver nanoparticles (AgNPs) conjugated-HAART (HAART-AgNPs) and its interaction with neuronal and glial cells in type-2 diabetic rats. Forty-two (n = 42) adult male Sprague-Dawley rats (250 ± 13 g) were divided into non-diabetic and diabetic groups. Each rat was administered with either distilled water, HAART, or HAART-AgNPs for eight weeks. After that, the prefrontal cortex (PFC) was excised for immunohistochemical, biochemical, and ultrastructural analysis. The formulated HAART-AgNPs were characterised by Ultraviolet-Visible, Transmission electron microscope, Energy Dispersive X-ray and Fourier transform infrared spectroscopy. Of the various concentrations of HAART-AgNPs, 1.5 M exhibited 20.3 nm in size and a spherical shape was used for this study. Administration of HAART-AgNPs to diabetic rats significantly decreased (p < 0.05) blood glucose level, number of faecal pellets, malondialdehyde (MDA), tumour necrosis factor-alpha (TNF-α), Interleukin-1 beta (IL-1β) compared with HAART-treated diabetic rats. Notably, there was a significant increase (p < 0.05) in antioxidant biomarkers (SOD and GSH), improvement in PFC-glial fibrillary acid protein (PFC-GFAP) positive cells and alleviation of anxiety-like behaviour in HAART-AgNPs treated diabetic rats. These results showed that HAART-AgNPs alleviates the anxiogenic effect and neuronal toxicity aggravated by HAART exposure via the reduction of oxidative and neuroinflammatory injury as well as preserving PFC GFAP-positive cells and neuronal cytoarchitecture.

Magnitude of antibiotic resistant bacterial colonization of women attending HIV clinic in Lagos, Nigeria

Opportunistic infections due microorganisms particularly bacteria have posed a threat and thus an addition burden on the management of human immunodeficiency virus (HIV) infections worldwide. The high prevalence of bacterial pathogens and the emergence of multiple drug resistance among such bacteria call for serious concern. Bacteriological examination of 320 women attending HIV clinics was carried out using standard microbiological techniques. The antimicrobial susceptibility testing was carried out by the disc diffusion technique by Bauer and CLSI. Of the 320 women, 200 (62.5%) had bacteria, 120 women were confirmed as HIV positive. Ninety (75%) of these women had both HIV-1 and HIV-2, twenty (16.7%) had only HIV-1 and 10 (8.3%) had only HIV-2. Staphylococcus aureus and Escherichia coli were the predominant bacteria. Antibiogram of the bacterial isolates determined by using the Kirby Bauer disk diffusion showed that most of them were susceptible to augmentin, gentamicin, peflacin, ciprofloxacin, ofloxacin and amoxicillin but were highly resistant to commonly used, over-the-counter drugs like chloramphenicol, tetracycline and streptomycin. This thus poses additional burden on the healthcare system in its attempt to manage HIV using anti-retroviral drugs among other methods, along with immunity enhancing drugs while the search for HIV vaccines still continues.

Health conditions in adults with HIV compared with the general population: A population-based cross-sectional analysis

SummaryBackgroundLife expectancy in adults with human immunodeficiency virus (HIV) has increased and managing other health conditions is increasingly important for patients and healthcare planning. The aim of this study was to examine the prevalence and association between different health conditions and HIV status.MethodsWe performed a cross-sectional analysis of adult UK Clinical Practice Research Datalink primary care electronic medical records linked to hospital admissions as of Nov 30, 2015. We examined 47 health condition groups and 304 physical and mental health conditions by HIV status, after adjustment for age, sex, social deprivation status using logistic regression.FindingsThere were 964 patients with HIV (61.7% male; 92.8% aged <65 years) and 941,113 non-HIV patients (49.4% male; 75.2% aged <65 years). Condition groups with the greatest prevalence in HIV that were also highly prevalent in adults without HIV included: lipid disorder (41.4% vs 40.2%), and hypertension (19.1% vs 24.6%). Following adjustment, 18 (37.5%) condition groups were more likely in adults with HIV and ten (20.8%) were less likely. Individual conditions that were less likely in adults with HIV included: atrial fibrillation (odds ratio [OR] 0.37 [95% CI 0.20–0.64]) and hypertension (OR_0.78 [0.65–0.94]); rheumatoid arthritis (OR 0.27 [0.05–0.84]); asthma (OR_0.65 (0.53–0.80]); and certain eye diseases such as macular degeneration (OR_0.30 [0.09–0.70]). Meanwhile individual conditions that were more likely included: liver fibrosis, sclerosis, and cirrhosis (OR_3.23 [1.85–5.20]); pulmonary embolism (OR_2.06 [1.15–3.36]); male infertility (OR_2.23 [1.50–3.16]) and female infertility (OR_2.01 [1.34–2.88]); bipolar disorder (OR_2.93 [1.52–5.05]) and depression (OR_1.49 [1.28–1.71]); cervical malignancy (OR_4.64 [1.15–12.15]); and infections.InterpretationComorbidity is common in adults with HIV, with physical and mental health conditions spanning a wide spectrum. HIV management should consider multidisciplinary care models to provide optimal patient care.FundingThe project was funded by the Bart’s Charity; DRM was funded by a Wellcome Trust Clinical Research Career Development Fellowship; DRM and DMM received funding from the HDR-UK Precision therapeutics programme.

HIV: the changing paradigm

The past four decades have seen enormous progress in the diagnosis and management of human immunodeficiency virus (HIV) infection. There have been significant advances spanning the approval of the first antiretroviral agents, the advent of combination antiretroviral therapy to single tablet regimens with minimal toxicity. Although these remarkable developments have on the surface led to the 'end of AIDS', there are still key populations being left behind. This clinical update will describe the diagnosis and management of HIV, and the changing paradigms that have seen HIV transform from a life-limiting condition to a manageable chronic disease over a few decades.

Special Considerations in the Management of HIV and Viral Hepatitis Coinfections in Liver Transplantation

Modern therapies for hepatitis B virus, hepatitis C virus, and human immunodeficiency virus have become so effective that patients treated for these conditions can have normal life-expectancies. Suitable livers for transplantation remain a scarce and valuable resource. As such, significant efforts have been made to expand donation criteria at many centers. This constant pressure, coupled with the increasing effectiveness of antiviral therapies, has meant that more and more patients infected with hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) may be considered appropriate donors in the right circumstances. Patients with these infections are also more likely to be considered appropriate transplantation recipients than in the past. The treatment of HBV, HCV, and HIV after liver transplantation (LT) can be challenging and complicated by viral coinfections. The various pharmaceutical agents used to treat these infections, as well as the immunosuppressants used post-LT must be carefully balanced for maximum efficacy, and to avoid resistance and drug–drug interactions.

Relationship of sleep disorders with long-term complications and health-related quality of life in people with well-controlled human immunodeficiency virus.

Although sleep disorders are common in patients with human immunodeficiency virus (HIV) infection, they have not been adequately evaluated under currently advanced treatments, mainly with integrase strand transfer inhibitors. However, the relationship of sleep disorders with long-term complications and quality of life (QOL) status in patients infected with HIV is still poorly understood. Such associations are important in the management of outpatients with HIV. Hence, this study aimed to evaluate these associations.This cross-sectional observational study assessed the QOL changes of patients with HIV before and after the treatment regimen change. Male patients with well-controlled HIV who attended our hospital and changed HIV medications for reasons other than treatment failure between October 2019 and September 2021 were included. At the time of regimen change, sleep disorder status was assessed according to the Pittsburgh sleep quality index (PSQI), and health-related QOL (HRQOL) was assessed using the medical outcomes study 8-item short form health survey. In addition, we collected information on age, blood tests, and long-term comorbid conditions present during the evaluation. The HIV treatment regimen was also reviewed.Out of 45 male Japanese patients with HIV that were included in this study, 24 (53.3%) and 21 (46.7%) were classified into the sleep disorder group and nonsleep disorder group, respectively, according to their PSQI scores. The sleep disorder group had a significantly lower HRQOL mental component summary (P = .0222) than the nonsleep disorder group. The prevalence rates of hypertension, dyslipidemia, and diabetes mellitus were not significantly different between the 2 groups. In addition, a significant correlation was observed between PSQI scores and the HRQOL status (mental component summary, P = .0450; physical component summary, P = .0350).Sleep disorders remain common in patients with well-controlled HIV infection receiving current treatment. Sleep disorder is significantly associated with a low HRQOL in these patients. Hence, sleep status evaluation is necessary to improve HIV management.