Human Immunodeficiency Virus Population Research Articles

Skin manifestations and human immunodeficiency virus infection in the Tigray region, Ethiopia: Implications for clinical management and epidemiologic surveillance

AbstractBackgroundPatients with human immunodeficiency virus (HIV) infection may present a large variety of skin manifestations, often associated with significant morbidity. In turn, dermatological diseases may represent an early sign of HIV infection, particularly in resource‐limited settings.ObjectivesThis study aimed to assess the spectrum of dermatological diseases and their potential value as clinical proxies for the early detection and management of HIV in a rural region of Ethiopia.MethodsThe study was performed on a population of 67,161 patients with skin diseases attending the Italian Dermatological Center in Mekele, Tigray region, Ethiopia. HIV infection was diagnosed in 1892 individuals (1065 female), all naïve to antiretroviral therapy.ResultsInfectious skin diseases were present in 57.2% of the total HIV population. Among the infectious skin manifestations, dermatophytosis (20.5%), impetigo (5.9%), candidiasis (4.7%) and molluscum contagiosum (4.7%) were significantly more represented in patients with HIV infection (p < 0.001). Regarding the noninfectious manifestations, pruritus and atrophy of the papillae on the tongue were significantly associated with HIV (p < 0.001). Notably, females had a significantly higher incidence of dermatophytosis and seborrheic dermatitis as compared to their male counterparts (p < 0.001), whereas scabies, psoriasis and leishmaniasis were significantly more frequent in males (p < 0.001).ConclusionsSkin manifestations are common in HIV patients, often reflecting compromised immune status. In addition, Dermatophytosis and pruritus were the most frequently reported manifestations of HIV, thus representing useful clinical proxies to raise the suspicion of an underlying HIV infection. Besides, gender differences in skin manifestations should also be considered in the clinical evaluation.

Prevalence of Malnutrition and Associated Factors among HIV Seropositive Adults on Antiretroviral Therapy at the Regional Hospital, Buea, Cameroon

Introduction: Malnutrition refers to deficiencies, excesses, or imbalances in a person’s intake of energy and/or nutrients and HIV which infects CD4 cells causes immune suppression which can further be worsened by poor nutrition. More than 37.7 million people are living with HIV in the world out of which about 36 million are adults. Aims: The study aimed to determine the prevalence of malnutrition and associated factors among human immunodeficiency virus (HIV) seropositive adults on antiretroviral therapy at the HIV care and treatment center of the Buea Regional hospital, Cameroon. Study Design: A Hospital-based Cross sectional study design. Place and duration of study: Buea regional hospital at the HIV care and treatment centre, South West Region of Cameroon between April 2022 to June 2022. Materials and method: We included 139 HIV seropositive individuals (17 men, 177 women age range 26 to 59 years). Nutritional status was assessed using anthropometric and clinical methods. A 24-hour dietary diversity was assessed using a questionnaire. Data was analyzed using SPSS version 25.0. Results: The prevalence of underweight, overweight and obesity among the participants were 1.4 %, 38.8%, and 24.4% respectively. In the bivariate analysis, sex of the participants (χ2 = 4.715, p = 0.030) and attendance to HIV-related counseling sessions (χ2 = 4.512, p = 0.034) were significantly associated with malnutrition. The mean dietary diversity score of the study respondents was 4.97±1.6 with only 37% of the respondents achieving a minimum dietary diversity. In the multivariate logistic regression analysis, the odds of those who received HIV-related counselling being malnourished(overweight) was 3.29 times more than those who did not receive HIV-related counselling (AOR=3.29, p=0.036). Conclusions: There is a high burden of overweight and obesity in the HIV population of the Regional Hospital Buea. The only factor independently associated to malnutrition(overweight) was uptake of nutrition related counselling. Majority of the HIV seropositive patients in the Regional Hospital Buea had a poor dietary diversity. Nutritional counseling should be an important part of persons living with HIV/AIDS (PLWHA) routine follow-up.

Trends in Sexually Transmitted Infection Cases in HIV Populations in Indonesia: Need Firm Roadmaps and Actions

Human immunodeficiency virus (HIV) infection and sexually transmitted infections (STIs) remain a public health problem and extend to social, economic, and cultural issues. HIV cases in the Southeast Asia region account for 10% of the total global HIV burden. In Indonesia, there are five provinces with the highest number of HIV cases as of December 2021, including DKI Jakarta (73,442), East Java (68,112), West Java (49,435), Central Java (42,012), and Papua (40,277). In Indonesia in 2021, the number of people living with HIV (ODHIV) reported was 36,902 and in 2022 up to the third quarter (July - September 2022) there were 34,213 people. New HIV infections in Indonesia continue to decline, in line with the global decline in new HIV infections. However, this decline has not been as large as expected.

Malaria, HIV, and Intestinal Coccidian Parasites Mixed-Infections in Adult Patients in the Fundong Health District, Northwest Region, Cameroon

Background: Malaria and intestinal coccidian parasites are both protozoan and their interaction in co-infected patients is still not clear. Patients infected with both malaria and coccidian parasites experience diarrhoea, gastro-intestinal and health problems that maybe life threating. We studied opportunistic intestinal coccidian parasites (OIPs) and the human immunodeficiency virus (HIV) in adult patients with malaria in Fundong Health District, Northwest of Cameroon. The objectives was to determine prevalence, and distribution of the diseases in adult population. 
 Methods: A prospective cross-sectional study carried out between April and December 2022. Malaria patients were identified by the presence of the Plasmodium parasite in Giemsa blood-stained films. HIV status was determined using the rapid diagnostic test (RDT). Stool samples were subjected to wet preparation and formol-ether concentration technique to detect intestinal coccidian parasites. Pearson’s Chi-Square (χ2) and binary logistic regression were performed as part of the statistical analysis. Statistical significance was set a P-value<0.05.
 Results: Three hundred and thirty (330) adult patients all infected with malaria took part in the study, 115(35%) males and 215 females (65%). The adult were of age 21 years and above. The mean age of participant was 37.02(±15.235) years. Malaria co-infection with coccidian parasites was observed in 19.4%. Malaria co-infection with other gastro-intestinal intestinal parasite capable causing pathological conditions in patients was 5.5%. The study showed the prevalence of malaria co-infections with HIV was 8.2%. The mixed infections observed were domestically acquired (57.8%) as well as travel related (46.2%). Fever was most reported in severe malaria 315/330 (95%), followed by those who reported abdominal pains 85/330 (26%), while diarrhoea was reported in 35/330 (11%) of the study participants. Fever, and abdominal pain significantly associated with malaria status (simple or severe malaria) p-value=, P-value= respectively (5.915) 0.015, P-value= (8.3) 0.004, as well as the HIV status P-value= (11.798) 0.003. The odds of developing severe malaria from fever was 3.533(CI: 1.204-10.366) times higher compared to those who did not have fever. The odds of developing severe malaria from abdominal pain was 0.420(CI: 0.230-0.767) less. Results showed living with child<2 years, water treatment methods, material use in hand washing, predicted the probability of coccidian infection in the final logistic regression model accounting for 23.6% of the variance in the coccidian infections was explained by the model.
 Conclusion: Prevalence of malaria, and opportunistic intestinal coccidian infections in adult patients was significantly influenced by migration, seasonal variation and the individual’s immune status. Routine clinical practice have often ignore the investigation of possible mixed infections especially in persons with compromised immunity including HIV. Screening patients suspected of malaria should include investigation for opportunistic intestinal coccidian parasites especially for HIV and other vulnerable populations. An integrated prevention and control strategy need to be considered.

Genetic polymorphisms in the C19orf66 gene influenced HIV-1 infection in a Yunnan population.

Due to the deficiencies of vaccines and effective medicine, the human immunodeficiency virus (HIV) infection mechanism should be studied. The C19orf66 gene, one of the interferon-stimulated genes (ISGs), expresses broad-spectra anti-viral activity, including inhibiting HIV replication. In this study, we collect 421 HIV-1 infected patients and 448 controls to genotype three SNPs in the C19orf66 gene. Then, the association between SNPs and biochemical indices/ HIV-1 subtypes are analyzed. Genotypes CC and CT of rs12611087 show statistically lower and higher frequencies in HIV-1 infected patients than in controls, respectively. Alleles C and T of rs12611087 play protective and risk roles in Yunnan HIV population, respectively. Biochemical indices analysis shows that HIV-1 infected persons carried genotype TT of rs77076061 express significantly lower CD3+/CD45+ ratio level and higher IBIL level. The epidemic subtypes of HIV-1 patients in this study are CRF 07_BC and CRF 08_BC. Moreover, subtype CRF 08_BC tends to infect persons with genotype CC of rs12611087. The genetic polymorphisms of the C19orf66 gene are firstly studied and reported to associate with HIV-1 infection and biochemical indices of patients in Yunnan. Furthermore, subtype CRF 08_BC infection could be influenced by genotypes of SNP in the C19orf66 gene.

Analysis of inpatient complications in HIV/AIDS patients undergoing total hip arthroplasty – A propensity matched cohort study

Patients with human immunodeficiency virus (HIV) are at higher risk for orthopedic related diseases due to dysregulation in bone metabolism and metabolic effects related to their medication regimen. Furthermore, the rate of hip arthroplasty in HIV patients is increasing. With the recent changes in THA methodologies and improvements in HIV treatment, there is a need for updated research analyzing hip arthroplasty outcomes in this high-risk patient population. In this study, we used a national database to evaluate postoperative outcomes in HIV patients undergoing THA compared to THA patients without HIV. We use a propensity algorithm to create a cohort of 493 HIV negative patients for matched analysis. Among the 367,894 THA patients included in this study, 367,390 patients were HIV negative and 504 were HIV positive. The HIV cohort had a lower mean age (53.34 vs 65.88, p < 0.001), lower proportion of females (44% vs 76.4%, p < 0.001), lower incidence of diabetes without complications (5% vs 11.1%, p < 0.001) and a lower incidence of obesity (0.544 vs 0.875, p = 0.002). In the unmatched analysis, the incidence of acute kidney injury (4.8% vs 2.5%, p = 0.004), pneumonia (1.2% vs 0.2%, p = 0.002), periprosthetic infection (3.6% vs 1%, p < 0.001), and wound dehiscence (0.6% vs 0.1%, p = 0.009) were higher in HIV cohort, most likely due to inherent demographic variances present in the HIV population. In the matched analysis, the rates of blood transfusion (5.0% vs 8.3%, p = 0.041) were lower in the HIV cohort. Other post-operative variables, such as rates of pneumonia, wound dehiscence, and surgical site infections were not statistically significant between the HIV positive population and HIV negative matched cohort. Our study found similar rates of postoperative complications in HIV positive and HIV negative patients. The rate of blood transfusions in HIV positive patients was also noted to be lower. Our data suggests that THA is a safe procedure in patients infected with HIV.

A case of apparent ART-associated immune reconstitution inflammatory syndrome in a patient with Strongyloides stercoralis infection

Introduction: Strongyloides infection is most commonly caused by Strongyloides stercoralis (S. stercoralis). It often causes asymptomatic chronic infection but through the translocation of the parasite into the bloodstream, it can lead to disseminated strongyloidiasis (DS). We describe a case of a patient with human immunodeficiency virus (HIV) who developed Strongyloidiasis with the complication of vancomycin-resistant Enterococcus (VRE) meningitis. Notably, the clinical condition of the patient worsened after commencing anti-retroviral therapy (ART), raising concern for ART-associated immune reconstitution inflammatory syndrome (IRIS) to S. stercoralis. Case Report: A 51-year-old African female with a past medical history of HIV presented with a 1-week history of abdominal pain and a 2-month history of generalized malaise, constipation, and weight loss. She improved with symptomatic management and commenced Biktarvy. She re-presented one month later with worsening gastrointestinal symptoms. Her hospital course was complicated by septicemia with worsening mentation. Her repeat abdominal imaging showed ascending and transverse colitis and cerebrospinal fluid analysis was positive for vancomycin-resistant Enterococcus faecium (VRE). During her re-admission, the patient developed persistent watery diarrhea which was found to be positive for S. stercoralis. Despite medical therapy she demised on day 28 of admission. Conclusion: Literature is very scarce concerning the progression of S. stercoralis infection to Strongyloides disseminated strongyloidiasis (DS) as a result of IRIS. As clinicians, we must have a high index of suspicion in our HIV population as DS can lead to fatal complications. It can also help guide management decisions concerning ART until complete eradication of S. stercoralis infection is obtained.

A Systematic Review of How To Reduce Morbidity in HIV Patients With Cardiovascular Diseases.

The human immunodeficiency virus (HIV) is known to cause cardiovascular diseases in patients infected with HIV. The pathology ranges from atherosclerosis to cardiomyopathy. There are several factors that could possibly cause cardiovascular diseases in the HIV population, including malnutrition and vitamin deficiency (for example, thiamine, B12, and zinc deficiencies); a lifestyle including increased prevalence of alcoholism and illicit drug usage; viral infection; and medication combinations that could cause sudden cardiac deaths. Cardiovascular diseases contribute to major morbidity in these populations and could have a reflection on the global financial burden, thus emphasizing the importance of prevention strategies. In this article, we focused on several factors that contribute to coronary artery disease and other cardiovascular diseases. We found that HIV has direct and indirect effects on the development of coronary artery diseases; furthermore, antiretroviral therapy adds to the deleterious effects of HIV and increases the risk of cardiovascular diseases. We further assessed the causal relationships and associations to understand the research gaps. In conclusion, this paper acknowledges and summarizes the current management strategies and the need to develop future strategies focusing on the prevention of cardiovascular diseases and tailoring the regimens according to the patient's clinical and socio-economic background.

Cost-effectiveness analysis of 'test and treat' policy for antiretroviral therapy among heterosexual HIV population in India.

The World Health Organisation recommended immediate initiation of antiretroviral therapy (ART) in all adult human immunodeficiency virus (HIV) patients regardless of their CD4 cell count. This study was undertaken to ascertain the cost-effectiveness of implementation of these guidelines in India. A Markov model was developed to assess the lifetime costs and health outcomes of three scenarios for initiation of ART treatment at varying CD4 cell count <350/mm[3], <500/mm[3] and test and treat using health system perspective using life-time horizon. A few input parameters for this model namely, transition probabilities from one stage to another stage of HIV and incidence rates of TB were calculated from the data of Centre of Excellence for HIV treatment and care, Chandigarh; whereas, other parameters were obtained from the published literature. Total HIV-related deaths averted, HIV infections averted and incremental cost-effectiveness ratio per quality adjusted life years (QALYs) gained were calculated. Test and treat intervention slowed down the progression of disease and averted 18,386 HIV-related deaths, over lifetime horizon. It also averted 16,105 new HIV infections and saved 343,172 QALYs as compared to the strategy of starting ART at CD4 cell count of 500/mm[3]. Incremental cost per QALY gained for the immediate initiation of ART as compared to ART at CD4 cell count of 500/mm[3] and 350/mm[3] was ₹ 46,599 and 80,050, respectively at reported rates of adherence to the therapy. Immediate ART (test and treat) is highly cost-effective strategy over the past criteria of delayed therapy in India. Cost-effectiveness of this policy is largely because of reduction in the transmission of HIV.

A hybrid of long short-term memory neural network and autoregressive integrated moving average model in forecasting HIV incidence and morality of post-neonatal population in East Asia: global burden of diseases 2000–2019

BackgroundTo forecast the human immunodeficiency virus (HIV) incidence and mortality of post-neonatal population in East Asia including North Korea, South Korea, Mongolia, Japan and China Mainland and Taiwan province.MethodsThe data on the incidence and mortality of HIV in post-neonatal population from East Asia were obtained from the Global Burden of Diseases (GBD). The morbidity and mortality of post-neonatal HIV population from GBD 2000 to GBD 2013 were applied as the training set and the morbidity and mortality from GBD 2014 to GBD 2019 were used as the testing set. The hybrid of ARIMA and LSTM model was used to construct the model for assessing the morbidity and mortality in the countries and territories of East Asia, and predicting the morbidity and mortality in the next 5 years.ResultsIn North Korea, the incidence and mortality of HIV showed a rapid increase during 2000–2010 and a gradual decrease during 2010–2019. The incidence of HIV was predicted to be increased and the mortality was decreased. In South Korea, the incidence was increased during 2000–2010 and decreased during 2010–2019, while the mortality showed fluctuant trend. As predicted, the incidence of HIV in South Korea might be increased and the mortality might be decreased during 2020–2025. In Mongolia, the incidence and mortality were slowly decreased during 2000–2005, increased during 2005–2015, and rapidly decreased till 2019. The predicted incidence and mortality of HIV showed a decreased trend. As for Japan, the incidence of HIV was rapidly increased till 2010 and then decreased till 2015. The predicted incidence of HIV in Japan was gradually increased. The mortality of HIV in Japan was fluctuant during 2000–2019 and was slowly decreased as predicted. The incidence and mortality of HIV in Taiwan during 2000–2019 was increased on the whole. The predicted incidence of HIV during was stationary and the mortality was decreased. In terms of China Mainland, the incidence and mortality of HIV was fluctuant during 2000–2019. The predicted incidence of HIV in China Mainland was stationary while the mortality was rapidly decreased.ConclusionOn the whole, the incidence of HIV combined with other diseases in post-neonatal population was increased before 2010 and then decreased during 2010–2019 while the mortality of those patients was decreased in East Asia.

Endothelial glycocalyx improvement after six months and one-year of antiretroviral therapy in treatment naive patients with human immunodeficiency virus

Abstract Background Chronic inflammation induced by Human Immunodeficiency Virus (HIV) plays a key role in the development of early cardiovascular (CV) disease. The impact of currently recommended first line antiretroviral therapy (ART) on CV risk early after treatment initiation is still under investigation. We aimed to explore any treatment-induced changes in endothelial function through endothelial glycocalyx measurement (EG) in treatment naïve HIV patients' one year post HIV treatment initiation by different ART agents. Methods We estimated endothelial function by endothelial glycocalyx integrity measurement in 58 recently diagnosed and treatment naïve HIV patients (mean age=38+10 years, 91% males, 61% smokers) at baseline and at 1-year post ART initiation (integrase or protease inhibitors). Increased perfusion boundary region (PBR) of the sublingual arterial microvessels (ranged from 5–25 micrometers) using Sideview Darkfield imaging (Microscan, Glycocheck) was measured as a non-invasive accurate index of reduced EG thickness. Results From a total population of 54 HIV patients, 35 patients were randomly treated by the newer integrase inhibitor Dolutegravir (Group A, mean age = 37±10 years, 89% males, 54% smokers) while 22 patients by the older protease inhibitor Darunavir/Cobicistat (Group B, mean age = 38±10 years, 95% males, 74% smokers). No differences were found between groups regarding age, weight, lipid profile (LDL-C, HDL-C, triglycerides), office (SBP, DBP) and central (cBP) blood pressure. We found that weight (76±14 vs. 81±16 kg, p&amp;lt;0.001), SBP (125±12 vs. 130±14 mmHg, p=0.003) and cBP (116±12 vs. 121±12 mmHg, p=0.001) were increased in the entire HIV population, at 1 year post-treatment. At 6 months evaluation, PBR5–25 was decreased in the entire HIV population and Group A (2.18±0.3 μm vs. 2.05±0.3 μm, p=0.01 and 2.19±0.3 μm vs. 2.02±0.3 μm, p=0.02, respectively). However, at 1-year post treatment evaluation, PBR5–25 was decreased in all groups, total HIV population, Group A and Group B (2.18±0.3 μm vs. 1.96±0.3 μm, p&amp;lt;0.001, 2.19±0.3 μm vs. 1.93±0.3 μm, p=0.003 and 2.17±0.3 vs. 1.99±0.3, p=0.04, respectively). Conclusions Endothelial function, estimated by endothelial glycocalyx integrity, is improved in newly diagnosed and treatment naïve HIV patients, evaluated at 6 and 12 months post-treatment initiation by integrase or protease inhibitors despite weight and blood pressure increase. Funding Acknowledgement Type of funding sources: None.

The Use of ICT in Providing HIV Services during the COVID-19 Pandemic: A Qualitative Study among Filipino HIV Volunteers

Background: The COVID-19 public health crisis has caused disruptions in the continuum of Human Immunodeficiency Virus (HIV) services. Hence, HIV advocates and care providers must innovate to ensure the health and welfare of people living with HIV (PLHIVs) and other at-risk populations. There is a lack of empirical research that explores the experiences and perspectives of HIV volunteers in adapting to pandemic-related challenges.Purpose: This qualitative study aimed to describe the use of information and communications technology (ICT) in the provision of HIV services of Filipino volunteers during the pandemic. Methods: Qualitative descriptive study design was used, focusing on ICT use for HIV care. Sixteen (16) purposively selected volunteers from three community-based organizations (CBO) were interviewed using a semi-structured guide via videoconference. Inductive qualitative content analysis was used to draw insights from the data.Results: Findings revealed that volunteers used various ICTs such as social media, videoconferencing, dating sites, and online-based courier services to ensure continuity of HIV services. However, volunteers noted challenges in using ICT for HIV services, such as limited access to digital resources, increased work demands, and lack of human connection.Conclusion: Various tools and implementations of ICTs have been used by volunteers to ensure the continuity of services of PLHIVs. This study provides insights to nurses and informaticists in implementing digital technologies in caring for vulnerable clients during outbreaks like COVID-19.

Nutritional Aspects of People Living with HIV (PLHIV) Amidst COVID-19 Pandemic: an Insight.

Purpose of ReviewThis review elaborates the role of malnutrition in PLHIV (people living with HIV) in the context of COVID-19 and emphasis the need of supplementation, dietary intervention, and nutritional counselling in the post-COVID era. One of the most critical challenges among HIV/AIDS patients is malnutrition since it weakens the immune system and increases risk to opportunistic infections. In HIV (human immunodeficiency virus) infection, weight loss is prevalent due to reduced nutritional consumption, malabsorption, abnormal metabolism, and antiretroviral therapy. Sufficient nutrition is required for optimal immune function, as a result, food therapy is now considered an important adjuvant in the treatment of HIV patients.Recent FindingsNutritional intervention, such as the use of dietary supplements, can help to prevent nutrient deficiency, lowering the death risk among malnourished HIV population. Immunocompromised individuals are at very high risk for COVID-19 and malnutrition increases the risk of infection by multiple folds. Interventions, such as nutrition education and counselling are important, to improve the condition of HIV Patients by optimising their nutritional status.SummaryA balanced diet should be one of the most important priorities in preventing PLHIV against the potentially deadly consequences of COVID-19. It is to be ensured that HIV-positive persons continue to get enough and appropriate assistance, such as nutrition and psychological counselling, in the context of COVID-19 infection. The use of telemedicine to maintain nutritional intervention can be beneficial. To meet their nutritional needs and minimise future difficulties, PLHIV infected with COVID-19 should get specialised nutritional education and counselling.Graphical abstract

Risk factors for subclinical atherosclerosis in HIV-infected patients in Burundi: A cross sectional study

Background and Aims : Several studies have demonstrated higher incidence, prevalence and progression of subclinical atherosclerosis in HIV infected individuals. Chronic disease of people living with human immunodeficiency virus (HIV) infection are now approaching those of the general population. Previous, in vitro studies shown that HIV causes arterial injuries resulting in inflammation and atherosclerosis but direct relationship between HIV infection clinical stages and lower extremity arterial disease (LEAD) remain controversial. No study assessed, with an accurate method, both the prevalence of LEAD and the influence of HIV severity on LEAD in HIV outpatients in Central Africa.Methods: A cross-sectional study was conducted among 1250 HIV-infected outpatients in Burundi. Inclusion criteria were as follows: age ≥ 20 years, positive HIV status, and currently receiving ART. Clinical data were extracted from Centre records. Personal information and details of PAD-related symptoms were obtained through face-to-face interviews. All patients underwent ankle-brachial index (ABI) measurement and LEAD was diagnosed by ABI≤0.9.Results: The prevalence of LEAD was 14.72 % (CI 95%: 13.2-22.1). The mean age was 42, 8±7, 4 years. On multivariable analysis, factors associated with LEAD were diabetes (OR= 1.7; 95% CI: 1.09–2.79), obesity (OR=2.5, 95% CI: 1.27–5.02) and stage IV HIV clinical infection (OR=4.7, 95% CI: 2.29–9.85).Conclusions: This is the first study performed on a large HIV population in Central Africa, reporting high LEAD prevalence. It underlines the influence of HIV infection on peripheral atherosclerosis at latest clinical stage and the need for LEAD screening in HIV-infected patients. Background and Aims : Several studies have demonstrated higher incidence, prevalence and progression of subclinical atherosclerosis in HIV infected individuals. Chronic disease of people living with human immunodeficiency virus (HIV) infection are now approaching those of the general population. Previous, in vitro studies shown that HIV causes arterial injuries resulting in inflammation and atherosclerosis but direct relationship between HIV infection clinical stages and lower extremity arterial disease (LEAD) remain controversial. No study assessed, with an accurate method, both the prevalence of LEAD and the influence of HIV severity on LEAD in HIV outpatients in Central Africa. Methods: A cross-sectional study was conducted among 1250 HIV-infected outpatients in Burundi. Inclusion criteria were as follows: age ≥ 20 years, positive HIV status, and currently receiving ART. Clinical data were extracted from Centre records. Personal information and details of PAD-related symptoms were obtained through face-to-face interviews. All patients underwent ankle-brachial index (ABI) measurement and LEAD was diagnosed by ABI≤0.9. Results: The prevalence of LEAD was 14.72 % (CI 95%: 13.2-22.1). The mean age was 42, 8±7, 4 years. On multivariable analysis, factors associated with LEAD were diabetes (OR= 1.7; 95% CI: 1.09–2.79), obesity (OR=2.5, 95% CI: 1.27–5.02) and stage IV HIV clinical infection (OR=4.7, 95% CI: 2.29–9.85). Conclusions: This is the first study performed on a large HIV population in Central Africa, reporting high LEAD prevalence. It underlines the influence of HIV infection on peripheral atherosclerosis at latest clinical stage and the need for LEAD screening in HIV-infected patients.

Dolutegravir in Mexico for special populations: A cost analysis perspective.

Integrase strand-transfer inhibitors (INSTI) are the latest class of antiretrovirals registered in Mexico. They include raltegravir (RAL), elvitegravir/cobicistat (EVG/c), dolutegravir (DTG) and bictegravir (BIC). Along with international guidelines, Mexico adopted the use of INSTI about two years ago as initial antiretroviral therapy (ART). This is partially due to the increase in the pre-treatment resistance to non-nucleoside reverse transcriptase inhibitors (NNRTI), mainly efavirenz (EFV). Furthermore, INSTI depict greater efficacy, safety and less drug-drug interactions than NNRTI and protease inhibitors (PI). DTG is a second generation INSTI with a high barrier to resistance. It is recommended in international and national guidelines in a wide variety of clinical scenarios for persons living with human immunodeficiency virus (HIV) (PLWHIV), including treatment-naïve, first-line NNRTI treatment failure, simplification switch in suppressed patients, pregnancy, women with childbearing potential, adolescents and children over 6 years of age. DTG is mostly metabolized by the liver UDP-glucuronosyltransferase, and exhibits low drug-drug interactions overall; on the other hand, it has an extremely low renal elimination, therefore may be used in PLWHIV with advanced kidney disease without dose modification. Tuberculosis is a common coinfection in Mexico that requires rifampin-based anti-tuberculosis therapy, which requires increasing DTG to double dosing (50 mg BID). In Mexico, DTG-based regimens are likely to be cost-effective in many scenarios, given its acquisition costs and the particularities of the HIV population and associated clinical conditions, including a relatively high proportion of the following: i) new HIV diagnoses presenting at acquired immunodeficiency syndrome (AIDS) stage; ii) high rate of tuberculosis coinfection; iii) frequent first-line NNRTI treatment failures; and iv) relatively high proportion of infected children and adolescents.

The Evolving Landscape of ASCVD Risk Among Patients With HIV.

Summarize the multiple atherosclerotic cardiovascular disease (ASCVD) risk factors commonly present in persons living with human immunodeficiency virus (HIV). Identify factors for clinical assessment and risk stratification in persons with HIV (PWH). Discuss the clinical challenges of dyslipidemia management among the HIV population, including avoidance of major drug-drug interactions (DDIs). Implement appropriate and safe statin therapy in PWH and elevated ASCVD risk.

Simulating Facebook Advertisements to Establish Cost per New HIV Diagnosis Using Routine and Targeted Models in a Local Population.

Background: Undiagnosed human immunodeficiency virus (HIV) infection remains a public health challenge. We explore Facebook (FB) advertisement (Ads) cost per new HIV diagnosis using non-targeted Ads, a routine testing model against targeted Ads, and a focused testing model in Texas. Methods: On 14 October 2021, we created (without launching) Texas-based, USD 10 targeted (using criteria matching HIV populations at risk) and non-targeted FB Ads for 10 days. In the process of creating the Ads, we collected estimated audience size, daily reach, and daily clicks. We estimated Ad cost for each new HIV diagnosis for targeted and non-targeted Ads using new HIV diagnosis rates from focused and routine testing campaigns. Results: The Ad costs per new HIV diagnosis from the targeted model were 4.74, 2.86, 5.28, and 2.88 times lower for men, Black, Hispanic, and all age groups, respectively, when compared to the non-targeted model. The wider the gap was between new HIV diagnosis rates in a population for focused and routine testing, the more cost-effective targeted Ads became. Conclusions: Among HIV populations at risk, targeted FB Ads are more cost-effective for detecting new HIV infections than non-targeted Ads. This cost-effectiveness increases in locations where focused testing increases new HIV diagnosis rates, compared to routine testing.

PADAYON: A PHENOMENOLOGICAL STUDY OF WOMEN LIVING WITH HIV IN THE PHILIPPINES

The Philippines has registered the highest prevalence of human immunodeficiency virus (HIV) infection in Asia and the Pacific Region (UNAIDS, 2022) with 273% increase in the number of new infections from 2010 to 2020 (DOH, 2021). As women comprise very small proportion of Filipinos living with HIV population, information about their mental health, well-being and quality of life tend be very minimal as well (Melgar et al., 2021). This study aimed to provide Filipino women a voice to express their individual experiences in coping with HIV and to gain a deeper understanding of the meanings of their personal experiences. How these women make sense of their HIV experiences could be helpful for other women living with HIV (WLWH) who need to effectively deal with this dreaded health condition. This study also aimed to identify gaps in the existing literature on health behaviors and outcomes of PLWH, contribute to the pool of information which would be useful in strengthening their intervention efforts and provide recommendations for future research. Keywords: lived experiences, women living with HIV, interpretative phenomenological analysis

Neurocognitive decline as a major predictor of nonadherence to antiretroviral therapy among adults living with HIV in Dodoma region, central Tanzania.

BackgroundThe survival of people living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome largely depends on good adherence to antiretroviral medications. Neuropsychiatric conditions such as major depressive disorders (MDDs) and neurocognitive disorders, in particular, are common in the HIV population and attributed to suboptimal adherence to antiretroviral treatment and overall poor clinical outcomes. This study aimed to determine the association between neurocognitive disorders and nonadherence to antiretroviral therapy (ART) in the Dodoma region's adult population living with HIV.MethodsThe study was conducted in Dodoma Regional Referral Hospital using a cross‐sectional design to assess 397 participants through a systematic sampling approach. Montreal Cognitive Assessment was used to determine neurocognitive function, while the Simplified Medical Adherence Questionnaire was used to assess nonadherence to ART. Logistic regression analysis was computed to determine the association between cognitive decline and nonadherence to ART while controlling for sociodemographic and clinical confounders.ResultsOut of the 397 recruited participants, 266 (67.00%) and 41 (10.33%) met the criteria for neurocognitive decline and nonadherence to ART. Participants with cognitive impairment had a significantly poorer adherence rate than those without, even after controlling for confounders adjusted odds ratio (aOR): 2.183 (95% confidence interval [CI]: 1.031, 4.630, p = 0.0413). MDD was the only additional factor that remained significantly associated with ART nonadherence (aOR: 4.332, 95% CI: 1.634, 11.485, p = 0.0032).ConclusionNeurocognitive disorders are strong predictor of suboptimal adherence to ART; a comorbid neuropsychiatric condition such as MDD may further compromise the ART adherence rate leading to poor HIV care and poor clinical outcome. Further research with systematic and more robust studies in the field will provide a baseline to design and integrate appropriate care models to maximize ART adherence in HIV care. Integration of psychiatric services in HIV care can benefit the overall patient outcome.

Update on the Epidemiological Features and Clinical Implications of Human Papillomavirus Infection (HPV) and Human Immunodeficiency Virus (HIV) Coinfection.

Human papillomavirus (HPV) infection is the most common sexually transmitted infection (STI) worldwide. Although most HPV infections will spontaneously resolve, a considerable proportion of them will persist, increasing the risk of anogenital dysplasia, especially within certain populations, such as patients infected with human immunodeficiency virus (HIV). Furthermore, high-risk oncogenic HPV types (HR-HPV) are the main cause of cervix and other anogenital cancers, such as cancer of the vagina, vulva, penis, or anus. HIV and HPV coinfection is common among people living with HIV (PLWH) but disproportionally affects men who have sex with men (MSM) for whom the rate of persistent HPV infection and reinfection is noteworthy. The molecular interactions between HIV and HPV, as well as the interplay between both viruses and the immune system, are increasingly being understood. The immune dysfunction induced by HIV infection impairs the rate of HPV clearance and increases its oncogenic risk. Despite the availability of effective antiretroviral therapy (ART), the incidence of several HPV-related cancers is higher in PLWH, and the burden of persistent HPV-related disease has become a significant concern in an aging HIV population. Several public health strategies have been developed to reduce the transmission of HIV and HPV and mitigate the consequences of this type of coinfection. Universal HPV vaccination is the most effective preventive tool to reduce the incidence of HPV disease. In addition, screening programs for HPV-related cervical and vulvovaginal diseases in women are well-recognized strategies to prevent cervical cancer. Similarly, anal dysplasia screening programs are being implemented worldwide for the prevention of anal cancer among PLWH. Herein, the main epidemiological features and clinical implications of HIV and HPV coinfection are reviewed, focusing mainly on the relationship between HIV immune status and HPV-related diseases and the current strategies used to reduce the burden of HPV-related disease.