Human Immunodeficiency Virus Treatment Research Articles

Human immunodeficiency virus-1 core: The Trojan horse in virus-host interaction.

Human immunodeficiency virus-1 (HIV-1) is the major cause of acquired immunodeficiency syndrome (AIDs) worldwide. In HIV-1 infection, innate immunity is the first defensive line for immune recognition and viral clearance to ensure the normal biological function of the host cell and body health. Under the strong selected pressure generated by the human body over thousands of years, HIV has evolved strategies to counteract and deceive the innate immune system into completing its lifecycle. Recently, several studies have demonstrated that HIV capsid core which is thought to be a protector of the cone structure of genomic RNA, also plays an essential role in escaping innate immunity surveillance. This mini-review summarizes the function of capsid in viral immune evasion, and the comprehensive elucidation of capsid-host cell innate immunity interaction could promote our understanding of HIV-1’s pathogenic mechanism and provide insights for HIV-1 treatment in clinical therapy.

Independent actions by HIV-1 Tat and morphine to increase recruitment of monocyte-derived macrophages into the brain in a region-specific manner

Despite advances in the treatment of human immunodeficiency virus (HIV), approximately one-half of people infected with HIV (PWH) experience neurocognitive impairment. Opioid use disorder (OUD) can exacerbate the cognitive and pathological changes seen in PWH. HIV increases inflammation and immune cell trafficking into the brain; however, less is known about how opioid use disorder affects the recruitment of immune cells. Accordingly, we examined the temporal consequences of HIV-1 Tat and/or morphine on the recruitment of endocytic cells (predominantly perivascular macrophages and microglia) in the dorsal striatum and hippocampus by infusing multi-colored, fluorescently labeled dextrans before and after exposure. To address this question, transgenic mice that conditionally expressed HIV-1 Tat (Tat+), or their control counterparts (Tat−), received three sequential intracerebroventricular (i.c.v.) infusions of Cascade Blue-, Alexa Fluor 488-, and Alexa Fluor 594-labeled dextrans, respectively infused 1 day before, 1-day after, or 13-days after morphine and/or Tat exposure. At the end of the study, the number of cells labeled with each fluorescent dextran were counted. The data demonstrated a significantly higher influx of newly-labeled cells into the perivascular space than into the parenchyma. In the striatum, Tat or morphine exposure increased the number of endocytic cells in the perivascular space, while only morphine increased the recruitment of endocytic cells into the parenchyma. In the hippocampus, morphine (but not Tat) increased the influx of dextran-labeled cells into the perivascular space, but there were too few labeled cells within the hippocampal parenchyma to analyze. Collectively, these data suggest that HIV-1 Tat and morphine act independently to increase the recruitment of endocytic cells into the brain in a region-specific manner.

Adaptations to HIV services delivery amidst the COVID-19 pandemic restrictions in Kampala, Uganda: A qualitative study.

The enforcement of the coronavirus disease (COVID-19) pandemic restrictions disrupted health services delivery and currently, there is a limited understanding regarding measures employed by health facilities to ensure delivery of human immunodeficiency virus (HIV) services amidst the interruptions. We, therefore, designed a qualitative study to explore the measures for continuity of HIV services during the COVID-19 pandemic restrictions in Kampala, Uganda. This study was conducted at six large primary health care facilities in the Kampala Metropolitan area. Qualitative data were collected from anti-retroviral therapy (ART) focal persons and lay health workers namely linkage facilitators and peer mothers through key informant interviews (KIIs). Overall, 14 KIIs were performed, 10 with lay health workers and 4 with ART focal persons. Data were audio-recorded, transcribed verbatim, and analyzed using the content approach, and the results were presented as themes along with participant quotations. Five themes emerged to describe measures for continuity of HIV services. The measures included: 1) leveraging the use of mobile phone technology to support ART adherence counseling, psychosocial care, and reminders concerning clinic appointments and referrals; 2) adoption of novel differentiated service delivery models for ART like the use of motorcycle taxis and introduction of an individualized ART delivery model for patients with non-disclosed HIV status; 3) scale-up of existing differentiated service delivery models for ART, namely multi-month dispensing of antiretroviral drugs (ARVs), fast-track ARV refill, home-based ARV refill, peer ART delivery, use of community pharmacy model, and community client-led ART delivery model; and, 4) reorientation of health facility functioning to the COVID-19 pandemic restrictions characterized by the use of nearby health facilities for ARV refill and viral load monitoring, transportation of healthcare providers and flexible work schedules and reliance on shift work. We found several measures were adopted to deliver HIV care, treatment, and support services during the COVID-19 pandemic restrictions in Kampala, Uganda. We recommend the scale-up of the new measures for service continuity in the post-COVID-19 period.

811 Dermal Fillers and Delayed Hypersensitivity Following Influenza Vaccine: A Case Report

BackgroundDermal fillers can be used to improve cosmetic appearance of facial soft tissue in patients with Human Immunodeficiency Virus (HIV) associated lipodystrophy. There are documented cases of delayed hypersensitivity reaction to dermal fillers following influenza-like illness, and similarly following coronavirus vaccination, however none following the influenza vaccine.CaseA 52-year-old female was treated with dermal filler injections to her zygomatic and buccal regions for lipoatrophy secondary to HIV treatment. Her HIV was well controlled with a low viral load. Six months following dermal filler treatment she presented with periorbital and zygomatic arch swellings one week after vaccination for influenza. The swelling was initially treated as periorbital cellulitis with antibiotics; however, it did not resolve. The swelling was in the same distribution as her filler and as it did not appear to be an infection but rather a delayed hypersensitivity reaction, it was treated with prednisolone for one week. There was further reduction in nodules following intralesional triamcinolone injections and following weaning of prednisolone there was no recurrence of swelling.DiscussionTo our knowledge this is the first case of its type to be described; literature searching does not retrieve any reports to date of adverse events related to the influenza vaccine following the use of dermal fillers. This is an important consideration in terms of the risks posed by this treatment in immunocompromised patients, and detailed informed consent is an important component of treatment.

Magnitude and predictors of first-line antiretroviral therapy regimen change among HIV infected adults: A retrospective cross sectional study

BackgroundRegimen change remains a significant challenge towards the achievement of human immunodeficiency virus (HIV) treatment success. In developing countries where limited treatment options are available, strategies are required to ensure the sustainability and durability of the starting regimens. Nevertheless, information regarding the rate and predictors of regimen change is limited in these settings. ObjectiveThis study was undertaken to determine the prevalence and predictors of changes in ART regimens among patients initiating highly active antiretroviral therapy (HAART) at XX. Materials and methodsAn institutional based retrospective cross-sectional study was conducted among adult naïve HIV patients who had initiated HAART at XX between 2010. Data were extracted by reviewing their medical charts using a pretested structured check-list. The Kaplan–Meier survival analyses were used to describe the probability of ARV regimen changes while Cox proportional hazard regression models were employed to identify the predictors of ARV regimen modifications. Data were analyzed using SPSS version 21 software, and statistical significant was deemed at p < 0.05. ResultsA total of 770 patients were enrolled in this study of these 165 (21.43%) had their ART regimen modified at least once. Drug toxicity was the main reason for regimen change followed by TB comorbidity, and treatment failure. Positive baseline TB symptoms (aHR = 1.63, p = 0.037), and Zidovudine based regimen (aHR = 1.76, p = 0.011) as compared to Stavudine based regimen were at higher risk of ART modification. Conversely, urban residence, baseline World Health organization (WHO) stage 2 as compared to WHO stage 1, baseline CD4 count ≥301 as compared to CD4 count ≤200 were at lower risk of ART modification. ConclusionThe rate of initial HAART regimen change was found to be high. Thus, less toxic and better tolerated HIV treatment options should be available and used more frequently. Moreover, early detection and initiation of ART by the government is highly demanded to maximize the benefit and reduce risk of ART modifications.

Human Immunodeficiency Virus Status Does Not Independently Predict 2-Year Complications Following Total Knee Arthroplasty.

With improved treatment for human immunodeficiency virus (HIV), the demand for total knee arthroplasty (TKA) in this population has increased. Studying the relationship between HIV and postoperative complications following TKA will allow orthopaedic surgeons to accurately assess their patients' surgical risk and provide appropriate counseling. This study aims to understand how HIV impacts surgical and medical complications following TKA for osteoarthritis (OA). Patients identified in a national insurance database who underwent TKA for OA from 2010 to 2019 were divided into three cohorts: no HIV, asymptomatic HIV, and acquired immunodeficiency syndrome (AIDS). Univariate and multivariable regression analyses were performed to determine 90-day postoperative complications as well as 2-year surgical complications (revision surgery, prosthetic joint infection, aseptic loosening, and manipulation under anesthesia). A total of 855,373 patients were included, of whom 1,338 had asymptomatic HIV and 268 had AIDS. After multivariable regression analysis, patients with HIV had no difference in 2-year surgical complications relative to the control cohort. Within 90 days postoperatively, patients with asymptomatic HIV had increased odds of arrhythmia without atrial fibrillation and lower odds of anemia. Patients with AIDS had increased odds of anemia and renal failure. Patients with HIV and AIDS are at an increased risk for developing 90-day medical complications and 2-year surgical complications. However, after accounting for their comorbidities, the risk of 90-day complications was only mildly increased and the risk of 2-year surgical complications approximated the control cohort. Surgeons should pay particular attention to these patients' overall comorbidities, which appear to be more closely associated with postoperative risks than HIV status alone. Level of evidence: III.

Chronic Kidney Disease in a Large National Human Immunodeficiency Virus Treatment Program.

Tenofovir disoproxil fumarate (TDF) is associated with a risk of chronic kidney disease (CKD), especially in Asian populations. Data from the Thai national health insurance system was used to assess CKD incidence in patients receiving antiretroviral therapy in real-world practice. We analyzed data from patients who initiated one of the following first-line regimens: zidovudine + lamivudine + nevirapine (AZT + 3TC + NVP); zidovudine + lamivudine + efavirenz (AZT + 3TC + EFV); tenofovir + lamivudine + nevirapine (TDF + 3TC + NVP); tenofovir + lamivudine/emtricitabine + efavirenz (TDF + 3TC/FTC + EFV); and tenofovir +lamivudine +lopinavir/ritonavir (TDF + 3TC + LPV/r). CKD was defined as glomerular filtration rate <60 mL/min/1.73 m2 for >3 months, or a confirmed 2010 WHO diagnosis (ICD-10 code N183, N184, or N185). Death competing risk survival regression models were used. Among 27,313 participants, with a median age of 36.8 years and median follow-up of 2.3 years, 245 patients (0.9%) were diagnosed with CKD (incidence 3.2 per 1000 patient-years; 95% CI 2.8–3.6). Compared with patients receiving AZT + 3TC + NVP, the risk of CKD measured by adjusted sub-distribution hazard ratio (aSHR) was 6.5 (95% CI 3.9–11.1) in patients on TDF + 3TC + LPV/r, 3.8 (95% CI 2.3–6.0) in TDF + 3TC + NVP, and 1.6 (95% CI 1.2–2.3) in TDF + 3TC/FTC + EFV. Among patients receiving TDF, compared with those receiving TDF + 3TC/FTC + EFV, the aSHR was 4.0 (95% CI 2.3–6.8) in TDF + 3TC + LPV/r and 2.3 (95% CI 1.4–3.6) in TDF + 3TC + NVP. TDF was associated with an increased risk of CKD, especially when combined with LPV/r or NVP.

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

The relevance of communal altruism for sexual minority men in contemporary contexts.

There are many reasons why individuals engage in prosocial behavior; communal sexual altruism is based on the notion that some practice safer sex in the interest of promoting the well-being of their community/in-group. Given that definitions of what constitutes "safer sex" have changed with advances in human immunodeficiency virus(HIV) prevention, we investigated the importance of communal sexual altruism (herein "altruism") among urban gay, bisexual, and other sexual minority men (GBM) in the contemporary context. Using a sample of 2449 GBM we examined the association of both safer-sex-related attitudes (e.g., HIV treatment optimism-skepticism) and behaviors (e.g., condomless anal sex [CAS]) with altruism scores. Higher altruism scores were associated with a lower likelihood of CAS and a greater frequency of discussing HIV status with new partners. These findings demonstrate that many GBM are motivated to engage in several kinds of behaviors that improve the well-being of their in-group (i.e., the GBM community).

The reservoir of latent HIV.

The persistence of latent reservoir of the human immunodeficiency virus (HIV) is currently the major challenge in curing HIV infection. After HIV infects the human body, the latent HIV is unable to be recognized by the body’s immune system. Currently, the widely adopted antiretroviral therapy (ART) is also unble to eliminate it, thus hindering the progress of HIV treatment. This review discusses the existence of latent HIV vault for HIV treatment, its formation and factors affecting its formation, cell, and tissue localization, methods for detection and removing latent reservoir, to provide a comprehensive understanding of latent HIV vault, in order to assist in the future research and play a potential role in achieving HIV treatment.

Spatial accessibility to HIV testing, treatment, and prevention services in Illinois and Chicago, USA.

Accomplishing the goals outlined in “Ending the HIV (Human Immunodeficiency Virus) Epidemic: A Plan for America Initiative” will require properly estimating and increasing access to HIV testing, treatment, and prevention services. In this research, a computational spatial method for estimating access was applied to measure distance to services from all points of a city or state while considering the size of the population in need for services as well as both driving and public transportation. Specifically, this study employed the enhanced two-step floating catchment area (E2SFCA) method to measure spatial accessibility to HIV testing, treatment (i.e., Ryan White HIV/AIDS program), and prevention (i.e., Pre-Exposure Prophylaxis [PrEP]) services. The method considered the spatial location of MSM (Men Who have Sex with Men), PLWH (People Living with HIV), and the general adult population 15–64 depending on what HIV services the U.S. Centers for Disease Control (CDC) recommends for each group. The study delineated service- and population-specific accessibility maps, demonstrating the method’s utility by analyzing data corresponding to the city of Chicago and the state of Illinois. Findings indicated health disparities in the south and the northwest of Chicago and particular areas in Illinois, as well as unique health disparities for public transportation compared to driving. The methodology details and computer code are shared for use in research and public policy.

Traditional Human Immunodeficiency Virus treatment and family and social influence as barriers to accessing HIV care services in Belu, Indonesia.

Access to HIV care services, including antiretroviral therapy (ART), is essential for improving health outcomes of people living with HIV (PLHIV) and reducing HIV transmission and AIDS-related deaths. As a part of a qualitative study in Belu, this paper describes the use of traditional medicines for HIV treatment and family and social influence as barriers to access to HIV care services among PLHIV. One-on-one in-depth interviews were employed to collect data from 46 PLHIV (26 women and 20 men) and 10 healthcare professionals. They were recruited using the snowball sampling technique. The study information sheets were initially posted on information boards in healthcare facilities. Potential participants who contacted to confirm their participation were recruited for an interview and then asked for help to distribute the information sheets to their eligible colleagues who might be willing to participate. Data analysis was performed using NVivo 12 software and guided by a qualitative data analysis framework. The findings showed that the use of traditional medicines, a well-known cultural practice in Belu, was a barrier to access to HIV care services among PLHIV. The influence of family in determining the use of traditional medicines for HIV treatment, supported by the lack of knowledge of ART, effectiveness of traditional medicines in treating other health issues, and social influence of relatives, neighbours, and friends, were also significant barriers to PLHIV's access to HIV care services. The findings indicate the need for dissemination of HIV care-related information for PLHIV, family, and community members to increase their knowledge of the service, ART and its function, and to support and improve access to HIV care services especially ART by PLHIV.

Human Immunodeficiency Virus in Adults Undergoing Surgery for Brain Tumors.

IntroductionEarly diagnosis and treatment of human immunodeficiency virus (HIV) can improve outcomes. HIV prevalence in brain tumor patients and the impact of an HIV diagnosis on patient outcomes are poorly understood.Materials and methodsThis was a prospective study of 100 consecutive brain tumor patients admitted to a Greater London Tertiary Neurosurgical center for surgery between January 2021 and October 2021. All brain tumors were included. All patients have appropriately consented. Blood was tested to detect HIV antibodies and p24 antigen. Outcomes were noted at 30-day postoperative follow-up.ResultsIn 100 patients, there was one case of a known HIV-positive, seronegative patient, and no new diagnosis was made, giving a prevalence of 1%. The mean age of patients included was 61.7 ± 13.3, with 57% female. The patient with HIV suffered a postoperative pseudomonas infection, requiring intensive care, additional surgery, and antibiotics. This resulted in an inpatient stay of 55 days - an increase of 274% compared to patients without HIV.ConclusionLiterature regarding the prevalence of HIV in glioma patients is inconclusive, of low quality, and primarily out-of-date. Our literature search found no similar study of rates of HIV in brain tumor patients in the United Kingdom. The incidence of both HIV and brain tumors, particularly glioblastomas, is low.

Mother-to-Child Transmission of HIV Within 24 Months After Delivery in Women Initiating Lifelong Antiretroviral Therapy Pre/Post-Conception or Postnatally; Effects of Adolescent Girl and Young Woman Status and Plasma Viremia Late in Pregnancy

IntroductionMother-to-child-transmission (MTCT) of human immunodeficiency virus (HIV) can occur in pregnancy/in utero (IU), during childbirth/intrapartum (IP), or postpartum (PP) through breastfeeding from an infected mother to her infant. Burden of PP-MTCT and associated risk factors remain poorly described, especially in adolescent girls and young women (AGYW) aged 15–24 years. Furthermore, despite concerns on high postnatal seroconversions, there is paucity of data on the burden of subsequent MTCT rates.MethodsPregnant women ≥20 weeks of gestation were enrolled into the University of Zimbabwe Birth Cohort from four primary health centers in Harare, Zimbabwe. Mother–infant dyads were followed up from delivery, week(s) 1, 6, 10, 14, 24, 36, 48, 72, and 96 after birth. Women who were uninfected at baseline were re-tested for HIV on subsequent visits. Plasma HIV RNA was quantified using reverse transcriptase polymerase chain reaction. Exposed babies were tested for HIV using qualitative/quantitative proviral DNA PCR on dried blood spots. Maternal–infant factors were tested in univariable/multivariable regression analyses for HIV-MTCT predictors.ResultsA total of 600 HIV-uninfected and 608 HIV-infected pregnant women on Tenofovir/Lamivudine/Efavirenz regimen were enrolled from 2016 to 2019. Postnatal HIV incidence was 0.42 cases/100 women-years [95% confidence interval (CI): 0.12–1.1]. Postnatal seroconverters were less likely to have children/pregnancies sharing same father and unaware of their spouses/intimate partner’s HIV status: p = 0.008 and p = 0.02, respectively, compared with non-seroconverters.Overall HIV-MTCT rate was (15/549): 2.7% (CI: 1.3–4.1%); (7/93) 7.5% observed in AGYW against 1.7%; in women aged &amp;gt;24, p = 0.008. PP-MTCT was the predominant 9/15 (60%) route, followed by IP-MTCT 4/15 (26.6%), whereas IU and postnatal MTCT rates each contributed 6.7% of all infant infections. Postnatal MTCT incidence was 12.8 (CI: 0.3–71.4) infant HIV infections/100 child-years of breastfeeding; a rate 14 times higher than PP-MTCT rate in babies born to women HIV-infected pre/post-conception whose babies were HIV DNA PCR–negative at six weeks.Antenatal HIV RNA &amp;gt;1,000 copies/ml was independently associated with MTCT; odds ratio [CI: 9.3 (2.6–43.1)]. Infected infants’ pre–HIV treatment HIV RNA levels correlated positively with maternal viral load; Spearman’s rank correlation. r = 0.6; p = 0.03.DiscussionMothers were 9.3 times more likely to transmit if HIV RNA was &amp;gt;1,000 copies/ml, disproportionately occurring in vulnerable AGYW. Breastfeeding-associated PP-MTCT remains high; therefore, it is imperative that HIV-infected women commence antiretroviral therapy early in pregnancy to suppress HIV RNA until weaning to decrease the risk of MTCT and possibly reduce the severity of disease in infected infants. HIV-uninfected lactating mothers should be continuously counseled on the risks of postnatal seroconversion.www.clinicaltrials.gov, trial registration number: NCT04087239.

Exploring the impacts of and reactions to HIV diagnosis in older adults: narratives from Ga-Rankuwa, South Africa

There is an increase in prevalence of human immunodeficiency virus (HIV) infection among older adults. This new emerging social group is being overlooked, owing to the focus on groups that have traditionally been regarded as “high risk”. This article set out to explore the impact of and reaction to HIV infection among older adults at the point of diagnosis. This study used a qualitative exploratory design that included a purposive sample of older adults currently receiving HIV treatment. The researchers recruited 12 participants who met the study’s inclusion criteria. Face-to-face interviews were used to collect data. A thematic approach was used to analyse the data. The study found that the impact on and reaction of older adults following HIV diagnosis included anger and shock, feeling suicidal, blaming others, fear of stigma and discrimination, loss of trust and intimacy, fear of disclosure to new partners and denial. The study concluded that there is a need to improve sexual health and HIV services that cater for the needs of older adults as a new emerging group affected by HIV. Furthermore, HIV testing and prevention counselling should be offered to older adults just as it is to younger patients.

Hepatitis C and HIV Screening, Testing, and Risk Perceptions among South-Central Appalachian County Health Department Staff.

Hepatitis C virus (HCV) and human immunodeficiency virus (HIV) are significant public health concerns, especially given the risks for disease interactions. Rates of HCV and HIV are increasing, especially in rural areas. Local health departments (LHDs) play an important role in rural health care, offering screening, testing, and treatment for HCV and HIV. Gaps persist in LHD resources for meeting these demands, especially in Appalachia and the US South. To explore HCV/HIV screening, testing, and treatment approaches and perspectives in south-central Appalachian North Carolina, structured telephone questionnaires were administered to communicable disease nurses and other health department staff directly involved in screening and testing. Mixed-methods data analyses were conducted and triangulated with stakeholders. Eighteen participants representing 19 counties completed the questionnaire, achieving a saturation sample. Participants reported barriers to screening and testing, including housing insecurity, lack of transportation and insurance, unemployment, and the isolation of living in a rural area. Divergence in perceptions of barriers between public health regions emerged, as did perceptions of who is at risk and use of stigmatizing language about people at risk for HCV/HIV. This study highlights the impact of LHD behaviors and perceptions on screening and testing, and offers recommendations to improve HCV/HIV screening and testing accessibility in south-central Appalachia, a high-risk region.

HIV: What's Next.

In an era of complacency, concern exists that those who remain at high risk for human immunodeficiency virus (HIV) are not aware of methods of transmission and/or exposure. Awareness of the history of the epidemic is waning, and HIV has fallen off the radar of individuals and health care providers alike. Given that in some populations in the United States HIV infections are on the rise, educating individuals and health care providers on the continued risk is paramount. In addition to the many new treatments available, others are on the horizon through different levels of clinical trials. As such, this article addresses the history of HIV, the evolution of effective HIV treatments, the current treatment options available, and treatments in clinical trials.

MRNA-based vaccine technology for HIV.

Human immunodeficiency virus (HIV) poses a major health problem around the globe, resulting in hundred-thousands of deaths from AIDS and over a million new infections annually. Although the standard treatment of HIV infection, antiretroviral therapy, has proven effective in preventing HIV transmission, it is unsuitable for worldwide use due to its substantial costs and frequent adverse effects. Besides promoting HIV/AIDS awareness through education, there is hardly an alternative for inhibiting the spread of the disease. One promising approach is the development of an HIV vaccine. Unfortunately, the high variability of envelope proteins from HIV subtypes, their frequency of mutation and the lack of fully understanding the mechanisms of protection against the virus constitute an obstacle for vaccine development. Efforts for developing successful anti-HIV vaccines have been underway for decades now, with little success. Lately, significant progress has been made in adopting the novel mRNA vaccine approach as an anti-HIV strategy. mRNA vaccines received a great thrust during the COVID-19 pandemic. Now, several mRNA-based HIV vaccines are undergoing clinical trials to evaluate their safety and efficacy. This review offers an overview of the pathogenesis and treatment of HIV / AIDS, previous efforts of HIV vaccine development and introduces mRNA vaccines as a promising and potential game changing platform for HIV vaccination.

Estimating Costs of the HIV Comprehensive Intervention Using the Spectrum Model - China, 2015-2019.

IntroductionIn order to facilitate human immunodeficiency virus (HIV) treatment and prevention, the resource needs for HIV national strategic planning in developing regions were estimated based on Spectrum, the universal HIV cost-effectiveness analysis software.MethodsBased on the theoretical framework of Spectrum, the study developed a cost measurement tool for HIV, and calculated the cost of HIV prevention and control in 6 sampled cities in China during 2015–2019 using the Spectrum model.ResultsFrom 2015 to 2019, the average annual costs for HIV prevention and control for Shijiazhuang, Yantai, Ningbo, Zhenjiang, Foshan, and Wuxi cities were 46.78, 47.55, 137.49, 24.73, 74.37, and 58.30 million Chinese yuan (CNY), respectively. The per capita costs were 4.37, 6.73, 17.33, 7.77, 17.56, and 8.91 CNY, respectively. In terms of the cost structure, the ratio of preventive intervention funds to therapeutic intervention funds (antiviral treatment) varied in sampled cities.DiscussionDeveloping comprehensive and systematic HIV fund calculation methods can provide a research basis for rational resource allocation in the field of HIV.

Fighting a Plague: Doctors' Stories of Challenge and Innovation Combatting the AIDS Epidemic in 1980s New York City.

The human immunodeficiency virus (HIV) has devastated the United States for forty years. Though there are highly effective treatments for HIV and acquired immune deficiency syndrome (AIDS) today, the early years of the HIV/AIDS epidemic in New York City (NYC) were filled with uncertainty, fear, and death—not unlike the period we are now experiencing in the COVID-19 era. Existing scholarship captures the political discourse of the HIV/AIDS era and the narratives of physicians who specialized in HIV medicine. This essay uses eight in-depth interviews of physicians of various specialties who worked in NYC to understand the uncertainties and fears in daily work during the early AIDS epidemic. Their stories provide unique perspectives into the realities of working as physicians in the epicenter of a highly politicized epidemic with limited support, information, and treatments. They illustrate that HIV/AIDS provided unique biomedical, social, and political challenges to the physicians working in NYC during the 1980s. Over the course of the decade, these physicians adapted to meet challenges using methods that have since become commonplace in their clinical practice.