Low Human Immunodeficiency Virus Research Articles

Assessment of the relationship between Epstein–Barr virus major types and genovariants as well as clinical and laboratory parameters in HIV-infected adults

Introduction. People living with human immunodeficiency virus (HIV) are more likely to experience Epstein–Barr virus (EBV) reactivation and develop EBV-associated diseases. In Russia, the clinical significance of EBV genetic diversity in HIV-infected patients has not been assessed. The aim was to analyze a relationship between the major EBV types and LMP-1 genovariants with clinical and laboratory parameters in HIV-infected persons. Materials and methods. Peripheral blood leukocytes were collected from 138 HIV(+) individuals aged 20–69 years. Association between EBV types, LMP-1 variants and subvariants with clinical and laboratory parameters (CD4+ T-lymphocyte count, HIV and EBV viral load, use and adherence to antiretroviral therapy (ART)), was performed using the principal component analysis method and the Mann–Whitney U test. Results. It has been shown that detectable HIV viral load increases in patients with low CD4+ T-lymphocyte counts, high EBV viral load, and low or no ART adherence. In general, infection with EBV-2 or the LMP-1 B95-8 alone resulted in lower EBV and HIV viral loads compared with other variants. Significant EBV-1 LMP-1 subvariants were identified, the biological potential of which was enabled in immunodeficiency state (CD4+ T-lymphocyte count ≤ 200 cells/μl). In “naive” patients, EBV-1/LMP-1 (S309N)+HIV co-infection occurred with a higher, and EBV-1/LMP-1(E328Q)+HIV with the lowest HIV viral load. The highest EBV DNA concentrations were observed with EBV-1/LMP-1(Q334R)+HIV. In “experienced” patients, the level of EBV DNA was significantly lower when infected with EBV-1/LMP-1(E328Q)+HIV and, conversely, higher in case of detected EBV-1/LMP-1(H358P)+HIV. Conclusion. The features of clinical and laboratory parameters EBV+HIV co-infection caused by different EBV-1 LMP-1 subvariants (at the level of amino acid substitutions S309N, E328Q, Q334R, H358P) have been identified. It is necessary to study the functional role of such mutations in vitro and in vivo. In the context of assessing a clinical significance of EBV molecular genetic diversity, it is advisable to conduct larger-scale studies in different territories of Russia.

MicroRNA levels in patients with chronic hepatitis B virus and HIV coinfection in a high-prevalence setting; KwaZulu-Natal, South Africa

BackgroundHepatitis B virus (HBV) and human immunodeficiency virus (HIV) co-infection are significant public health issues, despite the availability of an effective HBV vaccine for nearly three decades and the great progress that has been made in preventing and treating HIV. HBV and HIV both modulate micro-ribonucleic acids (microRNA) expression to support viral replication. The aim of this study was to describe the pattern of microRNA expression in patients coinfected with chronic HBV and HIV with varying disease severity, as indicated by Hepatitis B e antigen (HBeAg) status, HBV viral load, alanine transaminase (ALT) levels, and HIV viral load.MethodsPlasma microRNAs, specific to HBV, were measured by quantitative real-time polymerase chain reaction (qRT-PCR) in HBV and HIV-negative healthy controls (n = 23) and patients coinfected with chronic HBV-HIV (n = 50). MicroRNA expression levels were compared between patients with high vs low HBV viral load, HBeAg positive vs HBeAg negative, high vs low ALT levels, and high vs low HIV viral load. Additionally, HBV viral load, ALT levels, and HIV viral load were correlated with microRNA expression levels.ResultsSignificantly higher expression levels of selected microRNAs were observed in chronic HBV-HIV coinfected patients compared to healthy controls. Significantly higher expression levels of hsa-miR-122-5p, hsa-miR-192-5p, and hsa-miR-193b-3p were observed in patients with high HBV viral load compared with low HBV viral load patients, and the levels of these microRNAs were correlated with HBV viral load levels. Significantly higher levels of hsa-miR-15b-5p and hsa-miR-181b-5p were observed in HBeAg-negative patients.ConclusionThis study demonstrates the potential use of hsa-miR-15b-5p, hsa-miR-122-5p, hsa-miR-181b-5p, hsa-miR-192-5p and hsa-miR-193b-3p as additional diagnostic biomarkers in chronic HBV disease progression.

Why some countries but not others? Urbanisation, GDP and endemic disease predict global SARS-CoV-2 excess mortality patterns

ContextThe global impact of the SARS-CoV-2 pandemic has been uneven, with some regions experiencing significant excess mortality while others have been relatively unaffected. Yet factors which predict this variation remain enigmatic, particularly at large spatial scales.ObjectivesWe aimed to uncover the key drivers of excess mortality across countries and regions to help understand the factors contributing to the varied impacts of the pandemic worldwide.MethodsWe used spatially explicit Bayesian models that integrate environmental, socio-demographic and endemic disease data at the country level to provide robust global estimates of excess SARS-CoV-2 mortality (P-scores) for the years 2020 and 2021.ResultsWe find that urbanization, gross domestic product (GDP) and spatial patterns are strong predictors of excess mortality, with countries characterized by low GDP but high urbanization experiencing the highest levels of excess mortality. Intriguingly, we also observed that the prevalence of malaria and human immunodeficiency virus (HIV) are associated with country-level SARS-CoV-2 excess mortality in Africa and the Western Pacific, whereby countries with low HIV prevalence but high malaria prevalence tend to have lower levels of excess mortality. While these associations are correlative in nature at the macro-scale, they emphasize that patterns of endemic disease and socio-demographic factors are needed to understand the global dynamics of SARS-CoV-2.ConclusionsOur study identifies factors associated with variation in excess mortality across countries, providing insights into why some were more impacted by the pandemic than others. By understanding these predictors, we can better inform global outbreak management strategies, such as targeting medical resources to highly urban countries with low GDP and high HIV prevalence to reduce mortality during future outbreaks.

Epidemiological Distribution of Human Immunodeficiency Virus (HIV) among Residents of Port Harcourt Metropolis in Rivers State Nigeria

Background: Human Immunodeficiency Virus is a lentivirus, a member of Retroviridae family that causes Acquired Immune Deficiency Syndrome. Globally, it was estimated that about 0.7% adult, aged 15- 49 years are living with HIV, with a prevalence of about 1.4% in Nigeria. However, a challenge lies in the insufficient and unreliable data present in much of the epidemiological research conducted in various countries and states. Therefore, this study aims to tackle this issue by focusing on gathering comprehensive demographic data and examining the distribution's impact of HIV among the subjects. Aim: To examine the Epidemiological Distribution of HIV among Residents of Port Harcourt Metropolis in Rivers State, Nigeria. Methodology: A cross-sectional study was conducted in the Port Harcourt metropolis, involving adult participants aged 20 years and above selected by simple randomized method among outpatients attending the Rivers State University Teaching Hospital, Port Harcourt. A total of 392 individuals provided consent and were recruited at the hospital. The study investigated variables such as age, gender, marital status, education level and occupation. Samples were collected and examined using the ELISA method under aseptic conditions. Statistical analysis was performed using SPSS version 28, including the calculation of Mann-Whitney U and Kruskal-Wallis test values. Results: The overall study revealed a prevalence of 1.02%, with only 4 individuals testing positive. Participants were grouped based on various demographics: age (P= .503), gender (P= .142), educational levels (P= .028), marital status (P= .000), and occupation (P= .733), with corresponding p-values indicating significance levels (P<0.05=Significant, P>0.05=Not Significant). Two demographic categories showed statistical significance: marital status, with higher prevalence among singles than married individuals, and educational level, with higher prevalence among those with no formal education. Conclusion: This study showed low HIV prevalence in Port Harcourt. Marital and educational demographics impacted infection distribution such that married, single, and formal education level increases HIV risk. Health education, community HIV testing, consistent monitoring, and regular data updates are strongly advised as crucial measures in the fight against HIV infection.

Diagnostic tests of HIV infection and AIDS

Background: Human immunodeficiency virus (HIV) infection presents a major global health challenge. According to the World Health Organization, approximately 39.0 million people have HIV, as of 2022, with 1.3 million new infections annually. In Korea, the first HIV cases were reported in 1985, and the number of cases has increased continuously since 1988. In 2022, 1,066 cases were newly diagnosed, increasing the total number of cases to approximately 15,880.Current Concepts: Diagnostics play a crucial role in the management of HIV, for early diagnosis and initiation of antiretroviral therapy. Approval of the first HIV antibody test in 1985 by the US Food and Drug Administration marked a notable advance in the ability to diagnose HIV infection. The screening test for HIV infection typically consists of a two-step approach, in which a fourth-generation combination HIV-1/2 immunoassay is followed by a confirmatory Western blot. Despite its high accuracy for chronic infections, the window period and the early-stage of HIV infections are problematic, and populations with low HIV prevalence show a low positive predictive value. A false positive result can occur from blood transfusions, vaccinations, and autoantibodies. Novel diagnostic tools, such as nucleic acid testing for viral RNA/DNA and antigen testing for p24 antigen have reduced the window period, allowing for earlier detection and differentiation between HIV-1 and HIV-2. Pointof-care tests are beneficial in resource-limited settings although their lower sensitivity and specificity require additional confirmatory follow-up testing.Discussion and Conclusion: In this review, we provide a historical perspective on the evolution of HIV diagnostics (serological and molecular) and describe the roles of conventional and point-of-care testing within the laboratory diagnostic network.

HIV knowledge, self-perception of HIV risk, and sexual risk behaviors among male Tajik labor migrants who inject drugs in Moscow

BackgroundThe interplay of human immunodeficiency virus (HIV) knowledge and self-perception of risk for HIV among people who inject drugs is complex and understudied, especially among temporary migrant workers who inject drugs (MWID) while in a host country. In Russia, Tajik migrants make up the largest proportion of Moscow’s foreign labor. Yet, HIV knowledge and self-perceived risk in association with sexual risk behavior among male Tajik MWID in Moscow remains unknown.ObjectiveThis research examines knowledge about HIV transmission, self-perception of HIV risk, and key psychosocial factors that possibly contribute to sexual risk behaviors among male Tajik labor MWID living in Moscow.MethodsStructured interviews were conducted with 420 male Tajik labor MWID. Modified Poisson regression models investigated possible associations between major risk factors and HIV sexual risk behavior.ResultsOf the 420 MWID, 255 men (61%) reported sexual activity in the last 30 days. Level of HIV knowledge was not associated in either direction with condom use or risky sexual partnering, as measured by sex with multiple partners or female sex workers (FSW). Lower self-perceived HIV risk was associated with a greater likelihood of sex with multiple partners (aPR: 1.79, 95% CI: 1.34, 2.40) and FSW (aPR: 1.28, 95% CI: 1.04, 1.59), but was not associated with condom use. Police-enacted stigma was associated with sex with multiple partners (aPR: 1.22, 95% CI: 1.01, 1.49) and FSW (aPR: 1.32, 95% CI: 1.13, 1.54). While depression and lower levels of loneliness were associated with condomless sex (aPR: 1.14, 95% CI: 1.05, 1.24; aPR: 0.79, 95% CI: 0.68, 0.92, respectively), only depression was associated with condomless sex with FSW (aPR: 1.26, 95% CI: 1.03, 1.54).ConclusionsHIV prevention programing for male Tajik MWID must go beyond solely educating about factors associated with HIV transmission to include increased awareness of personal risk based on engaging in these behaviors. Additionally, psychological services to counter depression and police-enacted stigma are needed.

Factors influencing repeat HIV testing among mothers in perinatal clinics of rural and urban settings in Kisumu County, Kenya

Background : Over one million children are living with Human Immunodeficiency Virus (HIV), predominantly acquired from their mothers during the perinatal period. Most infections are in the developing world with over 90% of children with HIV being in sub-Saharan Africa. This study aimed to determine factors associated with low repeat HIV testing among mothers going to perinatal clinics. We looked into individual, provider and facility factors associated with repeat HIV testing.
 Methods : The study adopted a facility-based cross-sectional survey and a convergent mixed method. The study population were Women of Reproductive Age living in Kisumu County. Simple random sampling was used for quantitative analysis and an open-ended interview guide for qualitative analysis.
 Results : Out of the 407 respondents, 82 (20.15%) had received the full course of repeat HIV tests up to the postnatal visit. Repeat testing was significantly associated with; Level of education (AOR=4.32,95%CI=1.57–11.87), marital status (AOR=10.51,95%CI=1.70–6.87), accompaniment by spouse (AOR=2.33, 95%CI=1.31 – 4.17), privacy of the counselling rooms AOR=5.10, 95%CI=0.32– 0.80) and waiting time before receiving clinic services AOR=0.31,95%CI=0.14– 0.68) and design of the book from IDI.
 Conclusions and Recommendations : Low levels of repeat HIV testing were observed among mothers attending perinatal clinics within Kisumu County. low education level, long waiting times, privacy of the rooms and design of the mother and child booklet were associated with it. Mothers and health workers are to be educated on the benefits of repeat HIV testing during ANC and post-natal clinics.

Trends and correlates of low HIV knowledge among ever-married women of reproductive age: Evidence from cross-sectional Bangladesh Demographic and Health Survey 1996-2014.

The human immunodeficiency virus (HIV) burden has frequently been changing over time due to epidemiological and demographic transitions. To safeguard people, particularly women of reproductive age, who can be exposed to transmitting this burden to the next generation, knowledge regarding this life-threatening virus needs to be increased. This research intends to identify the trends and associated correlates of "low" HIV knowledge among ever-married women of reproductive age in Bangladesh from 1996 to 2014. We analyzed data derived from six surveys of Bangladesh Demographic and Health Surveys conducted in 1996, 1999, 2004, 2007, 2011, and 2014. Analyses were primarily restricted to ever-married women aged 15-49 years who had ever heard of HIV. The correlates of "low" HIV knowledge were investigated using multiple binary logistic regression models. The study found that the proportion of women with "low" HIV knowledge decreased from 72% in 1996 to 58% in 2014. In adjusted models, age at first marriage, level of education, wealth quintile, and place of residence (except in the survey year 2011) were found to be potential correlates of "low" HIV knowledge in all survey years. In the pooled analysis, we found lower odds of "low" HIV knowledge in the survey years 1999 (Adjusted Odds Ratio: 0.67; 95% CI: 0.57, 0.78), 2004 (AOR: 0.60; 95% CI: 0.52, 0.70), 2007 (AOR: 0.51; 95% CI: 0.44, 0.60), 2011 (AOR: 0.36; 95% CI: 0.32, 0.42) and 2014 (AOR: 0.47; 95% CI: 0.41, 0.54) compared to the survey year 1996. The proportion of "low" HIV knowledge has declined over time, although the proportion of women with "low" HIV knowledge still remains high. The prevention of early marriage, the inclusion of HIV-related topics in the curricula, reduction of disparities between urban-rural and the poorest-richest groups may help to improve the level of HIV knowledge among ever-married Bangladeshi women.

Prevention of mother-to-child transmission of HIV at the second immunization visit: a cross-sectional study, Burkina Faso.

To evaluate the performance of the cascade of activities for prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV) at the second immunization visit in Burkina Faso. In a cross-sectional study, we recruited mothers attending the second immunization visit for their infant in 20 health centres of Bobo-Dioulasso city, Burkina Faso over 12 months (2019-2020). We administered a short questionnaire to 14 176 mothers and performed HIV serological tests on mothers who had not been tested in the last 3 months. All mothers were asked about their attendance for antenatal care and HIV rapid testing. HIV-infected mothers were also asked about the timing of their HIV diagnosis, antiretroviral therapy, pre-exposure prophylaxis initiation at birth and infant diagnosis of HIV. Of 14 136 respondents, 13 738 (97.2%) had at least one HIV serological test in their lifetime. Of 13 078 mothers who were never tested or were HIV-negative, 12 454 (95.2%) were tested during or after their last pregnancy. Among HIV-infected mothers already aware of their status, 110/111 (99.1%) women were on antiretroviral therapy. Among HIV-exposed infants, 84/101 (83.2%) babies received 6weeks of antiretroviral prophylaxis at birth and 58/110 (52.7%) had a blood sample collected for early infant diagnosis. Only two mothers received their child's test results at the time of the second immunization visit. Four mothers were newly diagnosed as HIV-positive during the study. Collecting data at the second immunization visit, a visit rarely missed by mothers, could be useful for identifying gaps in the PMTCT cascade in settings where mothers are difficult to reach, such as in low-income countries with intermediate or low HIV prevalence.

Characteristics of COVID-19 (Delta Variant)/HIV Co-infection: A Cross-sectional Study in Henan Province, China

BackgroundSince the end of July 2021, SARS-CoV-2 (Delta variant) invaded Henan Province, China, causing a rapid COVID-19 spread in the province. Among them, the clinical features of COVID-19 (Delta Variant)/HIV co-infection have attracted our attention.MethodsWe included 12 COVID-19 patients living with HIV (human immunodeficiency virus) from July 30, 2021 to September 17, 2021 in Henan Province, China. Demographic, clinical, laboratory, and computed tomography (CT) imaging data were dynamically collected from first nucleic acid positive to hospital discharge. Laboratory findings included SARS-CoV-2 viral load, HIV viral load, IgM, IgG, cytokines, lymphocyte subpopulation, ferritin, etc. Statistical analyses were performed using IBM SPSS version 26·0 and GraphPad Prism version 9·0.ResultsIt was founded that the low Ct value persisted for about 21 days, and the viral shedding time (turn negative time) of the patients was 32·36 ± 2·643 days. Furthermore, chest CT imaging revealed that lesions were obviously and rapidly absorbed. It was surprising that IgM levels were statistically higher in patients taking azvudine or convalescent plasma than in patients not taking these drugs (P < 0·001, P = 0·0002, respectively). IgG levels were significantly higher in patients treated with the combined medication of BRII/196 and BRII/198 than in those not treated with these drugs (P = 0·0029). IgM was significantly higher in those with low HIV viral load than those with high HIV viral load (P < 0·001). In addition, as treatment progressed and patients' condition improved, IL-17a showed a decreasing trend.ConclusionsBased on this study, we found that HIV infection might not exacerbate COVID-19 severity.

Correlation of Whole Blood Zinc Levels, CD4 Cell Count, Disease Stage, and Dermatologic Manifestations Among HIV Patients: A Single Center Experience in Philippines

Objective: Zinc deficiency is the most common micronutrient abnormality seen in human immunodeficiency virus (HIV) infection. Depletion of CD4 cells is a hallmark of HIV infection. The study aims to determine the association between whole blood zinc levels and CD4 cell count and stage of HIV infection among patients in a tertiary hospital in the Philippines. Methods: Sixty-five newly diagnosed HIV-positive patients of the institution were recruited. Demographic profile, whole blood zinc levels, CD4 cell count level, HIV disease stage, and presence of any dermatologic manifestations were noted. Prevalence of zinc deficiency and correlation between whole blood zinc levels and CD4 cell count were determined. The data were analyzed by chi-square and pearson correlation analysis. Results: Among the 65 patients, overall zinc deficiency was noted at 33.8%. Low CD4 count and HIV disease stage IV participants had the highest percentage of zinc deficiency at 54.6% and 50%, respectively. A correlation coefficient at r = 0.3364 was noted between whole blood zinc levels and CD4 cell count (P = 0.006). Twenty-nine patients presented with dermatologic manifestations, with 10 patients being zinc deficient. Conclusion: A weak positive correlation was seen between zinc levels and CD4 count. There is an increasing frequency of zinc level deficiency with a higher HIV disease stage. Dermatologic manifestations of HIV may be present in both patients with normal and deficient zinc levels.

‘It never rains, but it pours’–Disasters triggered by natural hazards, sexual risk-taking behavior, and the role of health systems: A worldwide ecological analysis

Natural hazards have become more frequent and more severe as a result of climate change. Their increasing impact has a negative effect on people's health, including mental health. The aim of this ecological study is to investigate the association between exposure to disasters triggered by natural hazards and higher sexual risk-taking behavior as measured by one of its consequences, increased human immunodeficiency virus (HIV) incidence, at the country-level, worldwide. All data were extracted from publicly available sources. Crude and adjusted linear regression models were built to explore the association between the proportion of people affected by natural hazards and HIV incidence. Multivariable models included socio-demographic variables (literacy, income and age), and therapy coverage and the healthcare access and quality index. In the crude regression model, the total number of people affected by natural hazards over a 5 year time period is positively associated with HIV incidence. For every 10 new people per 100,000/year affected by natural hazards, the HIV incidence in the country was 1.5 higher per 1,000 uninfected. However, when adjusting for socio-demographic variables, the association is lost. In the fully adjusted multivariable model, only antiretroviral therapy coverage and health care access and quality were significantly positively and negatively associated with HIV incidence. No interaction was found by income groups, world regions or categories of high and low HIV prevalence. No association between exposure to natural hazards and increased sexual risk-taking behavior at country level worldwide was detected after accounting for socio-demographic variables. Nonetheless, countries with a higher proportion of the population affected by disasters triggered by natural hazards were also those witnessing a higher incidence rate of HIV, possibly through the mediating effect of disrupted health system coverage, highlighting the coexistence of different vulnerabilities for public health.

Circumventing HIV-1 immune evasion strategies: utilizing broadly neutralizing antibodies to bolster current drug treatments and develop novel vaccines

Human immunodeficiency virus (HIV) attacks the human immune system and if left untreated, causes acquired immunodeficiency syndrome (AIDS). Since its discovery, HIV has quickly become a major public health concern, infecting roughly one million people worldwide each year. HIV employs several immune evasion mechanisms including the targeting of key immune cells, integration of its genome into the host, and infection of uninfected cells through virologic synapses. Advances in antiretroviral therapy (ART) and knowledge of HIV-1 immune evasion strategies have improved our clinical understanding of its pathogenesis and informed new approaches towards developing a vaccine. The primary objective of ART treatment is to lower HIV viral loads and slow the progression to AIDS though the high mutation rate associated with retroviruses facilitates the creation of drug resistant strains. While this presents a challenge to the development of novel drug therapies, there have been several recent breakthroughs using the infusion of broadly neutralizing antibodies (bnAbs) to support ART regimens. Unfortunately, bnAbs are rare and HIV patients have weakened natural immunity to the virus, which complicates vaccine development. Recently, researchers have seen encouraging concentrations of HIV-specific antibodies using a rubella-based live attenuated vaccine in non-human primates though the transition from animal models to human clinical trials has been traditionally cumbersome. Given more recent advancements in our understanding of viral shell disorder, perhaps it is time to consider why the development of an HIV vaccine has been so problematic and to devise new strategies to combat this disease moving forward.

Medical Care for Tuberculosis-HIV-Coinfected Patients in Russia with Respect to a Changeable Patients' Structure.

To date, tuberculosis (TB) remains the primary cause of mortality in human immunodeficiency virus (HIV) patients in Russia. Since the beginning of 2000, a sharp change in the HIV patients’ structure, to the main known risk factors for HIV infection has taken place in Russia. The transmission of HIV through injectable drug use has begun to decline significantly, giving way to the prevalence of sexual HIV transmission today. These changes may require adjustments to organizational approaches to anti-TB care and the treatment of HIV-positive patients. Our study is aimed at identifying changes in TB-HIV coinfection patients’ structures in 2019 compared to 2000. Based on the results obtained, our goal was to point out the parameters that need to be taken into account when developing approaches to improve the organization of TB control care for people with HIV infection. We have carried out a cross-sectional, retrospective, epidemiological study using government TB registry data from four regions in two federal districts of Russia in 2019. The case histories of 2265 patients from two regions with high HIV prevalence, which are part of the Siberian Federal District of Russia, and 89 patient histories from two regions of low HIV prevalence, which are part of the Central Federal District of Russia, were analyzed. We found that parenteral transmission (69.4%) remains the primary route of HIV transmission among the TB-HIV coinfected. The unemployed of working age without disability account for 80.2% of all coinfected people, while the formerly incarcerated account for 53.7% and the homeless account for 4.1%. Those with primary multidrug-resistant TB (MDR-TB) comprise 56.2% of HIV-TB patients. When comparing the incidence of coinfection with HIV among TB patients, statistically significant differences were obtained. Thus, the chances of coinfection increased by 4.33 times among people with active TB (95% CI: 2.31; 8.12), by 2.97 times among people with MDR-TB (95% CI: 1.66; 5.32), by 5.2 times in people with advanced processes in the lungs, including destruction, (95% CI: 2.78; 9.7), as well as by 10.3 times in the case of death within the first year after the TB diagnosis (95% CI: 2.99; 35.5). The absence of data for the presence of TB during preventive examination was accompanied by a decrease in the chances of detecting coinfection (OR 0.36; 95% CI: 0.2; 0.64). We have identified the probable causes of the high incidence of TB among HIV-infected: HIV-patient social maladaptation usually results in delayed medical care, leading to TB treatment regimen violations. Furthermore, self-administration of drugs triggers MDR-TB within this group. Healthcare providers should clearly explain to patients the critical importance of immediately seeking medical care when initial TB symptoms appear.

Contribution of Sex Differences to HIV Immunology, Pathogenesis, and Cure Approaches.

Approximately 38 million people were living with human immunodeficiency virus (HIV) in 2020 and 53% of those infected were female. A variety of virological and immunological sex-associated differences (sexual dimorphism) in HIV infection have been recognized in males versus females. Social, behavioral, and societal influences play an important role in how the HIV pandemic has affected men and women differently. However, biological factors including anatomical, physiologic, hormonal, and genetic differences in sex chromosomes can each contribute to the distinct characteristics of HIV infection observed in males versus females. One striking example of this is the tendency for women to have lower HIV plasma viral loads than their male counterparts early in infection, though both progress to AIDS at similar rates. Sex differences in acquisition of HIV, innate and adaptive anti-HIV immune responses, efficacy/suitability of specific antiretroviral drugs, and viral pathogenesis have all been identified. Sex differences also have the potential to affect viral persistence, latency, and cure approaches. In this brief review, we summarize the major biological male/female sex differences in HIV infection and their importance to viral acquisition, pathogenesis, treatment, and cure efforts.

Frequency of Extrapulmonary TB among Human Immunodeficiency Virus (HIV) patients at Lady Reading Hospital, Peshawar

Background: Human immunodeficiency virus/acquired immunodeficiency syndrome (AIDS) has now infected nearly 80 million people around the world since it first appeared. The HIV epidemic has had a profound effect on the global tuberculosis (TB) crisis attributing to 20% of all AIDS-related deaths. Less than one-tenth of one percent of Pakistan's population was estimated to have HIV. However, Pakistan has gone from having a low HIV prevalence to a high HIV epidemic. Pakistan is the sixth most problematic country in the world for TB because it accounts for about 63% of the TB load in the Eastern Mediterranean Region. Aim: To determine the prevalence of extrapulmonary tuberculosis among HIV patients. Study design: Prospective, cross-sectional study. Place and duration of study: Department of Medicine, Lady Reading Hospital, Peshawar from 17th April 2020 to 16th October 2020. Methodology: Seventy eight HIV patients were recruited to determine the frequency of extrapulmonary tuberculosis. Results: There were 34.6% males and 65.4% females with mean age was 45.44±5 years. The frequency of extrapulmonary tuberculosis in HIV was found to be 44.9%. Conclusion: Extrapulmonary tuberculosis is a significant problem among human immunodeficiency virus patients. Key words: HIV, Extrapulmonary tuberculosis, Pakistani patients

Preexposure Prophylaxis Acceptability Among Pregnant Individuals and Implications for Human Immunodeficiency Virus Prevention.

To understand perspectives on and preferences for preexposure prophylaxis (PrEP) for pregnant individuals who are at risk for human immunodeficiency virus (HIV) infection. In this qualitative study, we purposively sampled and conducted in-depth interviews with pregnant participants at risk of HIV infection (indicated by a recent sexually transmitted infection [STI]) from a U.S. urban obstetrics clinic. Interview questions focused on perceived HIV risk, knowledge and perceptions of PrEP, and preferences for different PrEP formulations. We coded data using deductive and inductive codes, created matrices to explore patterns in findings, and wrote memos to interpret emergent themes. Twenty patients were enrolled. Median age of the participants was 24 years (interquartile range 19-26 years), 95.0% were African American, 65.0% were high school graduates, and 70.0% had unplanned pregnancies. Participants had low knowledge of PrEP and most saw themselves at low to no risk of HIV acquisition, despite their recent STI. Further, participants' low HIV risk perception and medication safety concerns reduced PrEP acceptability. Moreover, very few had discussed PrEP with their obstetrician-gynecologists (ob-gyns) during antenatal care, which further affected perceived acceptability. However, participants who did discuss PrEP with their ob-gyns had favorable perceptions of it. These participants indicated that they would choose a formulation based on individual preferences, which were largely shaped by perceived ease of use, acceptability, and prior experience with other medication regimens. Obstetrician-gynecologists may play an important role in increasing pregnant individuals' knowledge of and access to PrEP during pregnancy among those who are at risk of HIV acquisition. To maximize uptake and adherence during this time, PrEP formulations should be tailored to individual preferences. Prevention of HIV during this critical life transition is important not only for the long-term health and well-being of pregnant individuals and their infants, but to the plan to end the HIV epidemic in the United States by 2030.

Outcomes of interventions to optimize linkage to HIV care and antiretroviral therapy (ART) initiation after HIV self-testing: A scoping review.

Human immunodeficiency virus (HIV) self-testing is an innovative solution to the problem of low HIV testing coverage. It can help in realizing the first "95" of the Joint United Nations Programme on HIV/AIDS targets in the HIV treatment cascade. However, there is limited information to guide how those who self-test and show positive results can successfully be linked to HIV care and treatment. Therefore, this scoping review aimed at synthesizing available evidence of the outcomes of intervention strategies to optimize linkage to HIV care after HIV self-testing. Our methodology followed Arksey and O'Malley's methodological framework. Two independent reviewers screened and extracted data based on predetermined criteria. The databases searched included PubMed, EBSCOhost, Web of Science, Cochrane Library, Scopus, Mednar, and the International Clinical Trials Registry Platform. A total of 4809 records were retrieved. After full-text screening, 14 studies met the inclusion criteria for the review. The intervention strategies reported were classified into four main categories: technology-assisted interventions, innovative HIV self-testing kits distribution mechanisms, financial incentive, social entrepreneurship models, and the use of key community opinion leaders and social media influencers. This scoping review found men who have sex with men as the main recipients of the interventions to improve the rate of linkage to HIV care following HIV self-testing. Studies that met the inclusion criteria reported mixed findings on the outcomes of interventions to improve the rate of linkage to HIV care following HIV self-testing. Financial incentives, interventions leveraging technology, and key opinion leaders were the most effective strategies. Given that the included studies did not employ a uniform system of measurement of effectiveness, there is a need for identification of standardized definitions and clear indicators for evaluating linkage to care and antiretroviral therapy (ART) initiation following HIV self-testing.

Effects of Patient Sexual Orientation and Gender Identity on Medical Students' Decision Making Regarding Preexposure Prophylaxis for Human Immunodeficiency Virus Prevention: A Vignette-Based Study.

Preexposure prophylaxis (PrEP) is a pillar of our national strategy to end the human immunodeficiency virus (HIV) epidemic. However, one of the largest obstacles to realizing the effectiveness of PrEP is expansion of prescription to all patients at risk for HIV. In this vignette-based study, we sought to investigate medical students' decision making regarding PrEP by presenting fictional patients, all of whom had HIV risk factors based on sexual behavior. We systematically varied patients' sexual orientation or gender identity (heterosexual female, gay male, bisexual male, transgender male, transgender female, gender nonbinary person). We assessed the medical students' willingness to prescribe PrEP to the patients, as well as their perceptions of the patients' HIV risk and behavior. A total of 670 US medical students completed the study. The heterosexual female patient was least frequently identified as a PrEP candidate, was viewed as least likely to adhere to PrEP, and the most likely to engage in condomless sex if prescribed PrEP; however, was considered at lower overall HIV risk. Lower perceived HIV risk and anticipated PrEP adherence were both associated with lower willingness to prescribe PrEP. Willingness to prescribe PrEP was highest for the gay male patient and lowest for the heterosexual female. These analyses suggest that assumptions about epidemiological risk based on patients' gender identity or sexual orientation may reduce willingness to prescribe PrEP to heterosexual women, ultimately hindering uptake in this critical population.

Human Papillomavirus Infection Among HIV-positive Women in Lubumbashi, Democratic Republic of the Congo

<i>Background</i>: Human Papillomavirus (HPV) infection is the most common sexually transmitted infection in the world, particularly affecting people living with human immunodeficiency virus (HIV). A synergy between the two viruses is however described by several authors but very little is known in women living with HIV-HPV co-infection in Lubumbashi in the South of the Democratic Republic of Congo (DRC). <i>Objective</i>: The purpose of this study was to determine the prevalence of HPV infection in women living with HIV, to define the socio-demographic profile of HPV infection and to analyze certain clinical and paraclinical parameters. <i>Methodology</i>: A total of 77 women, including 58 HIV-infected women (group 1) and 19 HIV-free women (group 2), were included in a cross-sectional descriptive study that was conducted from November 01 to 30, 2019 at the HIV-AIDS Mother-Child Transmission Prevention Unit (MCTPU) of the Lubumbashi University Clinics (LUC). HPV was tested on cervical-vaginal secretions obtained either by self-sampling or by a sample taken by a previously trained examiner. HPV was investigated by the INNO-LIPA (PCR) method at the Microbiology, Bioorganic Chemistry and Macromolecular Unit laboratory of the Free University of Brussels in Belgium (FUB) while the diagnosis of HIV infection (PCR), viral load determination and CD4 level assay was performed in the LUC laboratory. <i>Results</i>: The overall frequency of HPV infection was 74.03%. It was significantly higher in HIV-infected women than in non-HIV-infected women (81.08% vs. 52.63%). The socio-demographic profile of the HPV-infected patient was made up of predominantly married, multi-parented women, aged on average 35, with a secondary education level and an average socio-economic level. Low monthly incomes and HIV infection were almost 4 times at risk for HPV infection (OR 4.2 [1,439-12,262] and OR 3.75 [1,269-11,080] respectively). Finally, HIV-positive patients infected with HPV had overall low levels of Lymphocyte T CD4 compared to those not infected with HPV. <i>Conclusion</i>: Our study shows that in Lubumbashi, HPV infection is present in both HIV-positive and negative women but its prevalence is distinctly higher in HIV-positive patients than those without HIV infection. It is interesting to determine in subsequent studies the different genotypes of HPV circulating in Lubumbashi and to define the proportion of genotypes at high carcinogenic risk.