Human Immunodeficiency Virus Treatment Research Articles

From Clinical to Non-clinical Outcomes in the Treatment of HIV: An Economic and Organizational Impact Assessment.

The aim of this study was to define the economic and organizational impacts related to a broader utilization of bictegravir/emtricitabine/alafenamide (BIC/FTC/TAF) in Italian clinical practice. A budget impact analysis-representing the evolution of the Italian National Healthcare Service (NHS) healthcare expenditure over 3years-was developed, considering the overall Italian population treated for human immunodeficiency virus (HIV). Model input variables were treatment history, therapeutic regimen, development of adverse events, achievement of an undetectable viral load and total direct healthcare costs. Besides the BIA, an organizational impact assessment was conducted to determine the impact on the use of healthcare resources, assessing the release of organizational hospital assets, focusing on the management of drug-related adverse events. Data were collected from scientific evidence, Italian national and regional legislations and healthcare professionals' reports. To verify the robustness of the economic and organizational impact assessment, sensitivity analyses were performed. Results demonstrate economic savings of about 26million euros in total health spending, assuming a higher penetration rate for BIC/FTC/TAF. This change in the current case mix would lead to a reduction in the specific costs related to adverse event management (0.9million euros; -2.09%) and in the medical management of patients (38million euros; -7.79%), with a positive impact on the achievement of virological control. From an organizational perspective, a wider use of BIC/FTC/TAF generates a reduction in the utilization of healthcare resources due to a decrease in adverse events and complications. The model estimated a 19.64% reduction in HIV-related inpatient days, which freed up healthcare professional time. Capable of improving both economic and organizational sustainability for the entire HIV care continuum, BIC/FTC/TAF is an efficient therapeutic strategy for people with HIV.

A dynamical optimal control theory and cost-effectiveness analyses of the HBV and HIV/AIDS co-infection model.

Studies have shown that the co-infection of Human Immunodeficiency Virus (HIV) and Hepatitis B Virus (HBV) poses a major threat to the public health due to their combined negative impacts on health and increased risk of complications. Even though, some scholars formulated and analyzed the HBV and HIV co-infection model they did not consider the compartment that contains protected individuals against both HBV and HIV infections. They incorporated the optimal control theory and cost-effectiveness analysis simultaneously. With this in mind, we are motivated to formulate and analyze the HBV and HIV co-infection model, considering the protected group and incorporating optimal control theory and cost-effectiveness. In this study, we have theoretically computed all of the models disease-free equilibrium points, all the models effective reproduction numbers and unique endemic equilibrium points. The two sub-models disease-free equilibrium points are locally as well as globally asymptotically stable whenever their associated effective reproduction numbers are less than one. We reformulated the optimal control problem by incorporating five time-dependent control measures and conducted its theoretical analysis by utilizing the Pontryagin's maximum principle. Using the fourth order Runge-Kutta numerical method and MATLAB ODE45, we performed the numerical simulations with various combinations of control efforts to verify the theoretical results and investigate the impacts of the suggested protection and treatment control strategies for both the HBV and HIV diseases. Also, we carried out a cost-effectiveness analysis of the proposed control strategies. Eventually, we compared our model results with other researcher similar model results whenever cost-effectiveness analysis is not carried out the findings of this particular study suggest that implementing each of the proposed control strategies simultaneously has a high potential to reduce and control the spread of HBV and HIV co-infections in the community. According to the cost-effectiveness analysis, implementing the HBV treatment and the HIV and HBV co-infection treatment measures has a high potential effect on reducing and controlling the HBV and HIV co-infection transmission problem in the community.

Aerobic exercise capacity improvement of patients with human immunodeficiency virus one year post-treatment initiation by integrase inhibitors

Abstract Background Infection by Human Immunodeficiency Virus (HIV) leads to chronic inflammation and subsequently to the early development of cardiovascular (CV) disease in young adults. Initiation of antiretroviral therapy (ART) usually leads to patient’s body weight and blood pressure increase. Cardiopulmonary exercise test (CPET) evaluates aerobic exercise capacity and subsequently cardiovascular and respiratory function. Aim of this study is the investigation of any treatment-induced changes in aerobic exercise capacity in treatment naïve young HIV patients’ at 1-year post HIV treatment initiation by different ART agents. Methods We studied 46 recently diagnosed and treatment naïve young HIV patients (37+10 years, 87% males, 62% smokers) at baseline and 1-year post ART initiation (integrase or protease inhibitors). Twenty-six (26) patients were randomly treated by the newer integrase inhibitor Dolutegravir (Group A, mean age=36+9 years, 100% males, 77% smokers) while 19 patients by the older protease inhibitor Darunavir/Cobicistat (Group B, mean age=37+10 years, 90% males, 47% smokers). All patients were submitted in CPET at baseline and 1-year post ART initiation. We estimated any changes in body mass index (BMI), systolic blood pressure (SBP) and CPET parameters (peak VO2, Oxygen pulse, WorkLoad, VE/VCO2) at 1-year post ART initiation. Results At baseline and 1-year re-evaluation, we found no differences between groups regarding age, BMI and CPET parameters. In the whole HIV population, we found an increase in body weight (76+12 vs. 82+15kg, p<0.001), SΒΡ (124+12 vs. 132+14mmHg, p<0.001), WorkLoad (176+35 vs. 186+35watt, p<0.001) and peak VO2 (2171+437 vs. 2299+491ml/min, p=0.03) at 1-year re-evaluation. In Group A, body weight (p<0.001), SBP (p=0.07), WorkLoad (p=0.006) and peak VO2 (p=0.01) were increased while in Group B, body weight (p<0.001), SBP (p=0.001) και WorkLoad (p=0.01) were also increased. Conclusions Aerobic exercise capacity is improved 1-year post-treatment initiation by the newer integrase inhibitor Dolutegravir in treatment-naïve HIV patients despite the adverse BMI and SBP increase. The newer Dolutegravir probably exhibits a more favorable CV profile in HIV patients compared to the older Darunavir/Cobicistat.Re-evaluation 1-year post ART initiation

Safety of Kidney Transplantation from Donors with HIV

BackgroundKidney transplantation from donors with human immunodeficiency virus (HIV) to recipients with HIV is an emerging practice. It has been performed since 2016 under the U.S. congressional HIV Organ Policy Equity Act and is currently approved for research only. The Department of Health and Human Services is considering expanding the procedure to clinical practice, but data are limited to small case series that did not include donors without HIV as controls.MethodsIn an observational study conducted at 26 U.S. centers, we compared transplantation of kidneys from deceased donors with HIV and donors without HIV to recipients with HIV. The primary outcome was a safety event (a composite of death from any cause, graft loss, serious adverse event, HIV breakthrough infection, persistent failure of HIV treatment, or opportunistic infection), assessed for noninferiority (margin for the upper bound of the 95% confidence interval, 3.00). Secondary outcomes included overall survival, survival without graft loss, rejection, infection, cancer, and HIV superinfection.ResultsWe enrolled 408 transplantation candidates, of whom 198 received a kidney from a deceased donor; 99 received a kidney from a donor with HIV and 99 from a donor without HIV. The adjusted hazard ratio for the composite primary outcome was 1.00 (95% confidence interval [CI], 0.73 to 1.38), which showed noninferiority. The following secondary outcomes were similar whether the donor had HIV or not: overall survival at 1 year (94% vs. 95%) and 3 years (85% vs. 87%), survival without graft loss at 1 year (93% vs. 90%) and 3 years (84% vs. 81%), and rejection at 1 year (13% vs. 21%) and 3 years (21% vs. 24%). The incidence of serious adverse events, infections, surgical or vascular complications, and cancer was similar in the groups. The incidence of HIV breakthrough infection was higher among recipients of kidneys from donors with HIV (incidence rate ratio, 3.14; 95%, CI, 1.02 to 9.63), with one potential HIV superinfection among the 58 recipients in this group with sequence data and no persistent failures of HIV treatment.ConclusionsIn this observational study of kidney transplantation in persons with HIV, transplantation from donors with HIV appeared to be noninferior to that from donors without HIV. (Funded by the National Institute of Allergy and Infectious Diseases; ClinicalTrials.gov number, NCT03500315.)

Interventions during Early Infection: Opening a Window for an HIV Cure?

Although combination antiretroviral therapy (ART) has been a landmark achievement for the treatment of human immunodeficiency virus (HIV), an HIV cure has remained elusive. Elimination of latent HIV reservoirs that persist throughout HIV infection is the most challenging barrier to an HIV cure. The progressive HIV infection is marked by the increasing size and diversity of latent HIV reservoirs until an effective immune response is mobilized, which can control but not eliminate HIV infection. The stalemate between HIV replication and the immune response is manifested by the establishment of a viral set point. ART initiation during the early stage limits HIV reservoir development, preserves immune function, improves the quality of life, and may lead to ART-free viral remission in a few people living with HIV (PLWH). However, for the overwhelming majority of PLWH, early ART initiation alone does not cure HIV, and lifelong ART is needed to sustain viral suppression. A critical area of research is focused on determining whether HIV could be functionally cured if additional treatments are provided alongside early ART. Several HIV interventions including Block and Lock, Shock and Kill, broadly neutralizing antibody (bNAb) therapy, adoptive CD8+ T cell therapy, and gene therapy have demonstrated delayed viral rebound and/or viral remission in animal models and/or some PLWH. Whether or not their application during early infection can improve the success of HIV remission is less studied. Herein, we review the current state of clinical and investigative HIV interventions and discuss their potential to improve the likelihood of post-treatment remission if initiated during early infection.

Barriers and facilitators to primary care for people living with HIV and diabetes in Harare.

People living with human immunodeficiency virus (HIV) and comorbid diabetes mellitus (DM) face significant challenges owing to the complex interplay between these chronic conditions and the need for comprehensive and integrated care. Service availability and readiness for primary care are essential for the health of individuals and populations. This study aimed to explore barriers and facilitators to the provision of care to the patients with HIV and T2DM comorbidity. The study was conducted at Primary health centres in Harare, Zimbabwe. A mixed-methods design was applied. An audit of primary care facilities identified that there was adequate infrastructure and equipment for HIV and T2DM diagnosis and treatment. However, there are gaps in the availability of essential medicines and supplies, such as test strips for blood glucose monitoring. The assessment also showed that the centres had a chronic shortage of healthcare providers, including doctors, nurses and counsellors, and there was a need for additional training and support for healthcare providers in the management of HIV and T2DM. The study concludes that the delivery of health services to patients with HIV and T2DM at primary care centres in Harare, Zimbabwe, faces significant challenges. Suggestions included improved resource allocation and multisectoral collaboration to improve the delivery of healthcare services.Contribution:The research contributes insight into disparities between urban and rural primary care facilities in providing services, emphasizing the need for targeted interventions to bridge gaps and enhance care quality.

Human Immunodeficiency Virus - a Review of the clinical aspects and detection of the infection

Introduction: Currently, many people are infected with the human immunodeficiency virus (HIV). Transmission is primarily through sexual contact, with additional routes including mother-infant exposure to needles and needle sharing. Since the HIV/AIDS pandemic was first identified in 1981, more than 75 million people have been infected. Numerous new cases continue to be reported, and infection can become the starting point for the development of HIV. Clinical manifestations include acute retroviral syndrome, opportunistic infections, and dermatological, neuromuscular, and other complications. Despite advances in antiretroviral therapy (ART), challenges remain, including drug resistance, opportunistic infections, and persistent HIV reservoirs in some cell types. Early and accurate diagnosis is essential, and recommended testing protocols include fourth-generation serological tests and point-of-care (POC) testing. ART, which includes combinations of antiretroviral drugs, is the standard treatment, and ongoing research into gene therapy shows promise for the future. Purpose of the work: The aim of this study is to review and characterize the clinical aspects and detection of human immunodeficiency virus infection. Materials and methods: A comprehensive analysis of research papers available on PubMed, Google Scholar, Web of Science, Embase and Scopus was undertaken using the searchterms encompassing the following keywords: HIV, human immunodeficiency virus, ART, HIV manifestation, HIV detection, HIV diagnosis, HIV treatment.

Global Progress in HIV Therapeutics: An In-Depth Analysis of Dispersible Fixed-Dose Antiretroviral Combination and Their Regulatory Pathways: A Review .

This review offers a detailed examination of recent advancements in human immunodeficiency virus (HIV) therapeutics, with a particular focus on dispersible fixed-dose combinations (FDCs) of antiretroviral drugs and their associated regulatory pathways. The paper highlights the global progress made in the development and implementation of these formulations, emphasizing their benefits in facilitating administration and enhanced patient adherence. Dispersible FDCs are especially beneficial for pediatric, geriatric, and bedridden patients, as they simplify dosing and improve medication compliance. The review explores the evolution of FDCs, assessing their clinical efficacy and safety profiles while also discussing the regulatory frameworks and approval processes employed by major health authorities across the globe, including the United States Food and Drug Administration (FDA) and the European Medicines Agency (EMA), and other key regulatory bodies. By analyzing these aspects, the review aims to illuminate the critical role that FDCs play in optimizing HIV treatment and their broader implications for public health. Antiretroviral therapy has significantly transformed HIV/AIDS management, leading to extended lifespan and a better enhanced well-being for patients. Fixed-dose combinations have simplified treatment regimens and improved adherence. However, the path to developing and approving antiretroviral FDC dispersible tablets is fraught with regulatory challenges. This review not only identifies these challenges but also proposes strategies to overcome them, with the goal of ensuring timely access to safe and effective medications for HIV/AIDS treatment. Through this analysis, the review contributes to understanding how regulatory practices can support the advancement of HIV therapies and enhance global health outcomes.

A qualitative study on reasons for women’s loss and resumption of Option B plus care in Ethiopia

Loss to follow-up (LTFU) from Option B plus, a lifelong antiretroviral therapy (ART) for pregnant women living with human immunodeficiency virus (HIV), irrespective of their clinical stage and CD4 count, threatens the elimination of vertical transmission of the virus from mothers to their infants. However, evidence on reasons for LTFU and resumption after LTFU to Option B plus care among women has been limited in Ethiopia. Therefore, this study explored why women were LTFU from the service and what made them resume or refuse resumption after LTFU in Ethiopia. An exploratory, descriptive qualitative study using 46 in-depth interviews was employed among purposely selected women who were lost from Option B plus care or resumed care after LTFU, health care providers, and mother support group (MSG) members working in the prevention of mother-to-child transmission unit. A thematic analysis using an inductive approach was used to analyze the data and build subthemes and themes. Open Code Version 4.03 software assists in data management, from open coding to developing themes and sub-themes. We found that low socioeconomic status, poor relationship with husband and/or family, lack of support from partners, family members, or government, HIV-related stigma, and discrimination, lack of awareness on HIV treatment and perceived drug side effects, religious belief, shortage of drug supply, inadequate service access, and fear of confidentiality breach by healthcare workers were major reasons for LTFU. Healthcare workers' dedication to tracing lost women, partner encouragement, and feeling sick prompted women to resume care after LTFU. This study highlighted financial burdens, partner violence, and societal and health service-related factors discouraged compliance to retention among women in Option B plus care in Ethiopia. Women's empowerment and partner engagement were of vital importance to retain them in care and eliminate vertical transmission of the virus among infants born to HIV-positive women.

A Review of the Therapeutical Perspective of Phytochemicals in the Treatment of HIV

Abstract: HIV/AIDS is one of the most widespread global diseases. It is caused by the human immunodeficiency virus (HIV), which leads to the development of acquired immunodeficiency syndrome (AIDS). In AIDS patients, the immune system progressively weakens, making them vulnerable to various infections and cancers. The virus can be transmitted through the exchange of bodily fluids such as blood, semen, vaginal fluid, and breast milk, where HIV can be found in both free virus particles and infected immune cells. Although drug resistance remains a challenge for HIV/AIDS treatment, researchers are exploring the use of natural substances in the development of anti-HIV drugs. Clinical trials based on plant-derived compounds are currently being conducted. Experimental research suggests that plants may have the potential to treat HIV. However, the identification of active compounds, testing of extracts, and creation of suitable bioassays are all complex processes. Natural product scientists face the challenge of separating these complicated extracts into their active components. Various phytochemicals found in Astragalus membranaceus Bunge, Chelidonium majus L, Combretum molle (R. Br. ex. G. Don.) Engl& Diels, Dittrichiaviscosa (L.) Greuter, Helichrysum populifolium, Hoodia gordonii (Masson) Sweet ex Decne, and Hypericumperf, have been investigated pharmacologically and pharmacokinetically. Further research is needed to optimize formulations and production in accordance with preclinical safety and efficacy studies.

Challenges and Opportunities for Consideration of Efavirenz Drug Repurposing for Alzheimer's Disease Therapeutics.

Therapeutic research and development for Alzheimer's disease (AD) has been an area of intense research to alleviate memory loss and neurodegeneration. There is growing interest in drug repositioning and repurposing strategies for FDA-approved medications as potential candidates that may further advance AD therapeutics. The FDA drug efavirenz has been investigated as a candidate drug for repurposing as an AD medication. The proposed mechanism of action of efavirenz (at low doses) is the activation of the neuron-specific enzyme CYP46A1 that converts excess brain cholesterol into 24-hydroxycholesterol (24-HC) that is exported to the periphery. Efavirenz at a low dose was found to improve memory deficit in the 5XFAD model of AD that was accompanied by elevated 24-HC and reduction in Aβ; furthermore, efavirenz reduced pTau and excess cholesterol levels in human iPSC-derived Alzheimer's neurons. The low dose of efavirenz used in the AD mouse model to increase 24-HC contrasts with the use of more than 100-fold higher doses of efavirenz for clinical treatment of human immunodeficiency virus (HIV) through inhibition of reverse transcriptase. Low doses of efavirenz may avoid neurotoxic adverse effects that occur at high efavirenz doses used for HIV treatment. This review evaluates the drug properties of efavirenz with respect to its preclinical data on regulating memory deficit, pharmacokinetics, pharmacodynamics, metabolites, and genetic variabilities in drug metabolism as well as its potential adverse effects. These analyses discuss the challenges and questions that should be addressed in future studies to consider the opportunity for low dose efavirenz as a candidate for AD drug development.

Emerging CRISPR-Based Therapeutics for HIV Eradication

Human Immunodeficiency Virus (HIV) continued to pose a major global health challenge, with current antiretroviral therapies unable to fully eradicate the virus due to latent reservoirs and potential drug resistance. Emerging CRISPR-based gene editing technologies had the potential to revolutionize HIV treatment by targeting and disrupting the viral genome or modifying host cells to confer resistance. This article explored the mechanisms of CRISPR in HIV therapeutics, including excision of integrated HIV proviruses and genetic editing of host immune cells. It reviewed progress in CRISPR-based research through in vitro studies, animal models, and early clinical trials, highlighting both promising advancements and ongoing challenges such as delivery efficiency, off-target effects, and viral escape. The methodology employed in writing this review paper involved a comprehensive literature review and synthesis of recent research findings to assess the current state and future directions of CRISPR-based HIV therapies. Despite significant progress, challenges remained, and future research will need to focus on improving delivery systems, combining CRISPR with other therapies, and optimizing gene editing in stem cells to achieve long-term HIV eradication. Keywords: CRISPR-Cas9, HIV Therapy, Gene Editing, Latent Reservoirs, CCR5 Receptor.

Combined bictegravir, emtricitabine and tenofovir alafenamide for treating people with HIV: a plain language summary of the BICSTaR study up to 1year.

This is a summary of an article about an ongoing study called the BICSTaR study.The BICSTaR study includes people with HIV (human immunodeficiency virus) who are taking a medicine called bictegravir/emtricitabine/tenofovir alafenamide (shortened to B/F/TAF). B/F/TAF is a single tablet that contains 3 different drugs for the treatment of HIV. The drugs work together to reduce the levels of HIV so that the virus can no longer be detected by a blood test.People taking part in the study are adults with HIV living in Europe, Canada, Israel, Japan, South Korea, Singapore and Taiwan. People take 1 tablet of B/F/TAF once a day. They are either taking B/F/TAF as their first treatment for HIV, or they have switched to B/F/TAF from another HIV treatment.Researchers looked at how well B/F/TAF worked and how safe it was in people who took B/F/TAF for a year. Researchers found that B/F/TAF worked well in almost all people in the study by reducing levels of HIV in the blood. The virus could not be found in the blood of more than 9 out of 10 (94%) people who were taking B/F/TAF as their first HIV medicine and more than 9 out of 10 people (97%) who had taken another HIV medicine before starting B/F/TAF. This is known as having an 'undetectable viral load' and is a major goal for HIV treatment success. Researchers did not find any evidence of HIV developing resistance to B/F/TAF, which might stop B/F/TAF from working properly.Around 1 out of 10 people (13%) had side effects (any unwanted sign or symptom that people have when taking a medicine that researchers think might be caused by the medicine) that might have been caused by B/F/TAF. Most of these side effects were not classified as serious. Less than 1 out of 100 (0.1%) people had serious side effects that might have been caused by B/F/TAF. Only 6 out of 100 people stopped taking B/F/TAF due to side effects caused by B/F/TAF. As a result, more than 9 out of 10 people (95%) took B/F/TAF for at least 1year. B/F/TAF worked well in people with HIV in this study. Most people (around 9 out of 10) did not have any side effects.

Innovations in HIV Prevention and Treatment: The Future of HIV Care

The Human Immunodeficiency Virus (HIV) continues to pose a significant global health challenge, despite substantial progress in treatment and prevention. This review explored recent innovations in HIV prevention and treatment, highlighting advancements such as long-acting pre-exposure prophylaxis (PrEP), long-acting injectable antiretroviral therapy (ART), and emerging research into potential cures. It also examined integrated care approaches, digital health innovations, and innovative financing models that are shaping the future of HIV care. The review synthesized recent research, evaluated the impact of these innovations, and discussed future directions to advance global health goals. The methodology for this review involved a comprehensive analysis of current literature, clinical trial data, and expert opinions to provide a holistic overview of how these advancements are transforming HIV care and addressing existing challenges. Keywords: HIV Innovations, Prevention Strategies, Long-Acting ART, Integrated Care Models, Digital Health Technologies.

The Intersection of HIV and Social Determinants of Health: A Comprehensive Review

The Human Immunodeficiency Virus (HIV) epidemic remained a profound global health challenge, significantly impacting marginalized and underserved populations. While advances in antiretroviral therapy (ART) and prevention strategies have transformed HIV into a manageable chronic condition, the epidemic’s persistence is deeply intertwined with social determinants of health (SDOH). This comprehensive review examined the intersection of HIV and SDOH, highlighting how factors such as poverty, education, gender inequality, healthcare access, and stigma influenced HIV vulnerability and outcomes. Through a synthesis of current research and data, and utilizing a methodology that includes a systematic review of peer-reviewed literature and global health reports, the review underscored the critical role of SDOH in shaping HIV dynamics. It explored regional and population-based disparities, discussed innovations and interventions in HIV prevention and treatment, and proposed strategies to address these underlying determinants. Understanding and addressing the intersection of HIV and SDOH is crucial for developing more effective, equitable, and sustainable HIV prevention and treatment approaches, ultimately advancing global health equity and moving closer to ending the HIV epidemic as a public health threat. Keywords: Social Determinants of Health (SDOH), HIV Prevention, Economic Inequality, Stigma and Discrimination, Innovative Interventions.

Drug-Related Problems in HIV Treatment Failure.

Background Antiretroviral therapy (ART) is used in human immunodeficiency virus (HIV) treatment to reduce morbidity and mortality rates among people living with the virus. The types of drug-related problems (DRPs) and their causes that contributed to HIV treatment failure were unknown. Thus, this study aimed to determine the types and causes of DRPs associated with HIV treatment failure. Methods A multicentre, retrospective cohort study was conducted at the Infectious Disease Centre of Sungai Buloh Hospital, Selangor, and Tuanku Ja'afar Hospital, Negeri Sembilan. Data were collected from patients' medical records by reviewing the medical progress notes, laboratory parameters, and treatment regimen. Pharmaceutical Care Network of Europe's (PCNE) classification system V9.1 was used to identify and classify the types and causes of DRPs. Patients were classified as having treatment failure if the HIV RNA viral load was more than 1000 copies/ml for two consecutive readings. Patients were categorized as treatment successful if there was a decrease in HIV RNA viral load suppression after six months of ART initiation and had no history of persistent HIV RNA viral load greater than 1000 copies/ml for two consecutive measurements. Data were analyzed using the chi-square test. Results The number of patients recruited for this study was 355 (treatment success group = 263, treatment failure group = 92). Almost all patients (n = 354, 99.7%) had experienced at least one DRP. A total of 811 problems and 1605 causes of DRPs were encountered. The occurrence of DRPs in the HIV treatment failure group was 5.77 DRPs per patient compared to the success group (4.08 DRPs per patient). In the treatment failure group, treatment effectiveness was identified as the most frequent domain of problems (P) (P1: n = 169, 59.93%), followed by treatment safety (P2: n = 111, 39.36%). The common domains of causes (C) include patient-related (C7: n = 367, 69.11%), other (C9: n = 105, 19.77%), and drug selection (C1: n = 49, 9.23%). Significant differences were found in several causes (C7.1, C7.10, and C9.1) between the two groups. Conclusion The occurrence of DRPs in HIV treatment failure was high, contributing to treatment effectiveness and treatment safety issues.

Atherosclerosis and Cardiovascular Complications in People Living with HIV: A Focused Review.

The intersection of Human Immunodeficiency Virus (HIV) infection and cardiovascular disease (CVD) represents a significant area of concern; advancements in antiretroviral therapy (ART) have notably extended the life expectancy of people living with HIV (PLWH), concurrently elevating the prevalence of chronic conditions such as CVD. This paper explores the multifaceted relationship between HIV infection, ART, and cardiovascular health, focusing on the mechanisms by which HIV and ART contribute to increased cardiovascular risk, including the promotion of endothelial dysfunction, inflammation, immune activation, and metabolic disturbances. We highlight the critical roles of HIV-associated proteins-Tat, Nef, and gp120-in accelerating atherosclerosis through direct and indirect pathways that exacerbate endothelial damage and inflammation. Additionally, we address the persistent challenge of chronic inflammation and immune activation in PLWH, factors that are strongly predictive of non-AIDS-related diseases, including CVD, even in the context of effective viral suppression. The impact of ART on cardiovascular risk is examined, with particular attention to the metabolic implications of specific ART regimens, which can influence lipid profiles and body composition, thereby modifying CVD risk. The therapeutic potential of statins, aspirin, and emerging treatments such as PCSK9 inhibitors in mitigating cardiovascular morbidity and mortality among PLWH is discussed, alongside considerations for their use in conjunction with ART. Our review underscores the necessity for a comprehensive, multidisciplinary approach to cardiovascular care in PLWH, which integrates vigilant cardiovascular risk assessment and management with HIV treatment. As we navigate the evolving landscape of HIV care, the goal remains to optimize treatment outcomes while minimizing cardiovascular risk, ensuring that the gains in longevity afforded by ART translate into improved overall health and quality of life for PLWH.

Five-Year Outcomes of Bariatric Surgery vs. Conservative Weight Management in People with HIV: A Single-Center Tertiary Care Experience

IntroductionIndividuals with human immunodeficiency virus (HIV) infection now have life expectancies similar to non-infected people but face increased obesity prevalence. The long-term effects of bariatric surgery (BS) and conservative weight therapy (CWT) in patients living with HIV (PLWH) remain unexplored.MethodsA retrospective review (2012–2018) at a Tertiary Centre for Bariatric Surgery and National Centre for HIV care examined the outcomes of BS and CWT. Parameters evaluated included weight loss and HIV metrics such as viral load and CD4 count.ResultsThe study included 24 chronic HIV patients, with 10 undergoing BS (5 laparoscopic adjustable gastric banding (LAGB), 3 laparoscopic sleeve gastrectomy (LSG), 2 Roux-en-Y gastric bypass (LRYGB) and 14 in CWT. The BS group showed significant BMI reduction (− 7.07, − 6.55, − 7.81 kg/m2 at 1, 3, and 5 years). The CWT group’s BMI reduction was non-significant. The BS group’s %TWL was 16%, 17.8%, and 15% at 1, 3, and 5 years, respectively; however, stapled procedures were more effective, at 1 year, %TWL was 17% LSG and 25% RYGB, at 3 years, 23% LSG, 30% RYGB and at 5 years 21% with LSG and 28% with RYGB. HIV outcomes remained stable with undetectable viral loads in the BS group.DiscussionBS appears to be a safe and effective medium-term treatment for obesity in PLWH, providing significant weight loss whilst maintaining the efficacy of HIV treatments. Although CWT has shown modest benefits, the outcomes from BS indicate that it could be a preferable option for managing obesity in PLWH based on this limited dataset.Graphical

Impact of the Coronavirus Disease 2019 Pandemic on Substance Use Disorder Risk Among People Living With Human Immunodeficiency Virus (HIV) Enrolled in HIV Care in the United States: An Interrupted Time Series Analysis.

Rising overdose deaths globally and increased social isolation during the coronavirus disease 2019 (COVID-19) pandemic may have disproportionately impacted people with human immunodeficiency virus (PWH) with substance use disorders (SUD). We examined trends in SUD risk among PWH before and after the COVID-19 shelter-in-place (SIP) mandate. Data were collected between 2018 and 2022 among PWH enrolled across 8 US sites in the Centers for AIDS Research Network of Integrated Clinical Systems cohort. We evaluated changes in moderate/high SUD risk after SIP using interrupted time series analyses. There were 7126 participants, including 21 741 SUD assessments. The median age was 51 (interquartile range, 39-58) years; 12% identified as Hispanic or Latino/Latina, 46% Black/African American, and 46% White. Moderate/high SUD risk increased continuously after the pandemic's onset, with 43% (95% confidence interval [CI], 40%-46%) endorsing moderate/high SUD risk post-SIP, compared to 24% (95% CI, 22%-26%) pre-SIP (P < .001). There were increases in the use of heroin, methamphetamine, and fentanyl, and decreases in prescription opioids and sedatives post-SIP. Further, there was a decrease in reported substance use treatment post-SIP compared to pre-SIP (P = .025). The rising prevalence of SUD through late 2022 could be related to an increase in isolation and reduced access to substance use and HIV treatment caused by disruptions due to COVID-19. A renewed investment in integrated substance use treatment is vital to address the combined epidemics of substance use and HIV following the COVID-19 pandemic and to support resilience in the face of future disruptions.

On characterizing gender and locational composition of adult PLHIV in Nigeria: Implications for HIV programming.

Human Immunodeficiency Virus (HIV) remains a global public health menace, and studies have suggested variations across demographic characteristics. This study attempted to characterize the gender and locational variations in the spread and control of HIV among adult Persons Living with HIV (PLHIV) to identify the clustering of PLHIV in Nigeria. We conducted an ecological analysis of data from the 2018 Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS) report. To examine the statistical significance of differences between groups (by gender and location), chi-square and Fisher exact tests were conducted using the Real Statistics Resource Pack in Excel, and ArcGIS for visualization. Significance level was set at 5%. Overall, prevalence of HIV among adult PLHIV was 1.4%-the prevalence was slightly higher among women (1.8%) compared to men (1.0%). About 3/10 (29.3%) self-reported having received HIV test results. In the past 12 months before the survey, only 10.0% self-reported HIV testing among the population, with a significant difference (p<0.001) observed in the urban and rural area (12.4% in urban compared to 8.2% in rural). Another significant finding was the difference in the timing of HIV diagnosis between urban and rural areas (p<0.001). Adult PLHIV residing in rural areas had a higher rate of early detection (94.1%) compared to those in urban areas (70.3%). About 40.0% of HIV positive mothers reported awareness of their HIV status-approximately 58.0% of mothers living in the urban were aware of their HIV status compared to 29.8% in the rural area. The concentration of HIV was disproportionately higher in the rural populations compared to the urban. Findings from this study also show gender-disparities in HIV prevalence, diagnosis, and treatment. Interventions to bridge this gap should be promptly embraced in order to effectively combat the HIV epidemic in Nigeria and achieve an AIDS-free generation.