Number Of Human Immunodeficiency Virus Research Articles

Retrospective analysis of patients with hepatocellular carcinoma complicated with human immunodeficiency virus infection after hepatectomy.

Hepatocellular carcinoma (HCC) is the third leading cause of cancer death worldwide, with a 5-year relative survival rate of approximately 18%. The similarity between incidence and mortality (830000 deaths per year) underscores the bleak prognosis associated with the disease. HCC is the fourth most common malignancy and the second leading cause of cancer death in China. Most patients with HCC have a history of chronic liver disease such as chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infection, alcoholism or alcoholic steatohepatitis, nonalcoholic fatty liver disease, or nonalcoholic steatohepatitis. Early diagnosis and effective treatment are the keys to improving the prognosis of patients with HCC. Although the total number of human immunodeficiency virus (HIV)-infected patients is declining globally the incidence of HCC is increasing in HIV-infected patients, especially those who are coinfected with HBV or HCV. As a result, people infected with HIV still face unique challenges in terms of their risk of developing HCC. To investigate the survival prognosis and clinical efficacy of surgical resection in patients with HCC complicated with HIV infection. The clinical data of 56 patients with HCC complicated with HIV admitted to the Third Affiliated Hospital of Nantong University from January 2013 to December 2023 were retrospectively analyzed. Among these, 27 patients underwent hepatectomy (operation group) and 29 patients received conservative treatment (nonoperation group). All patients signed informed consents in line with the provisions of medical ethics. The general data, clinicopathological features and prognoses for the patients in the two groups were analyzed and the risk factors related to the prognoses of the patients in the operation group were identified. The median disease-free survival (DFS) and overall survival (OS) of HIV-HCC patients in the surgical group were 13 months and 17 months, respectively, and the median OS of patients in the nonsurgical group was 12 months. The OS of the surgical group was significantly longer than that of the control group (17 months vs 12 months, respectively; P < 0.05). The risk factors associated with DFS and OS in the surgical group were initial HIV diagnosis, postoperative microvascular invasion (MVI), a CD4+ T-cell count < 200/μL, Barcelona stage C-D, and men who have sex with men (MSM; P < 0.05). Hepatectomy can effectively prolong the survival of patients with HIV-HCC but MVI identified during postoperative pathological examination, late tumor detection, late BCLC stage, CD4+ T < 200/μL and MSM are risk factors affecting the survival and prognosis of patients undergoing hepatectomy. In addition, there were significant differences between the surgical group and the nonsurgical group in terms of the initial diagnosis of HIV, Child-Pugh score, alpha-fetoprotein measurement value, and HART-efficient antiretroviral therapy after the diagnosis of HIV (P < 0.05). Therefore, these factors may also affect the survival and prognosis of patients.

HIV knowledge, sexual attitudes, and PrEP-Eligible behaviors among college students in Southwest China: a cross-sectional study

BackgroundThere is an increasing number of human immunodeficiency virus (HIV) reported cases among students in Southwest China. However, the data on HIV/sex-related knowledge, attitude toward sex, sexual behaviors, and correlates of pre-exposure prophylaxis (PrEP)-eligible behaviors among college students in this area is still limited. This study aimed to assess the prevalence of HIV/sex-related knowledge, sexual attitudes, sexual behaviors, and factors associated with PrEP-eligible behaviors among college students.MethodAn online survey from 2020 to 2021 based on a multistage stratified and cluster sampling method was conducted among college students in Southwest China, and a well-designed questionnaire collected data. Propensity score matching (PSM), logistic, and log-binomial regression were used to identify the determinants of PrEP-eligible behaviors.ResultA total of 108,987 students participated in the survey, and 92,946 provided valid responses. 91.6% (85,145/92,946) had good HIV-related knowledge, while only 26.0% (24,137/92,946) reported awareness of sex-related knowledge. Furthermore, more than half of the participants (64.5%) held negative stances towards engaging in “one-night stand”, and 58.9% (617/1,047) reported PrEP-eligible behaviors. Log-binomial regression analysis indicated that unaware of HIV-related knowledge (aPR = 1.66, 95% CI:1.22–2.26, P = 0.001), not discussing about sex with their parent(s) (aPR = 1.16, 95% CI:1.01–1.33, P = 0.021), not receiving sex-related education in school(aPR = 1.24, 95% CI: 1.07–1.45, P = 0.005), not participating in HIV/AIDS prevention activities in the past year (aPR = 1.32, 95%CI:1.09–1.60, P = 0.004), experiencing forced sex (aPR = 2.08, 95% CI: 1.19–3.63, P = 0.010), and having the drug abuse (aPR = 22.21, 95% CI:5.59–88.31, P < 0.001) were significantly associated with increased odds of PrEP-eligible behaviors.ConclusionCollege students in Southwest China exhibited suboptimal HIV/sex-related knowledge, received limited sex education, reported conservative attitudes towards casual sex, and significant PrEP-eligible behaviors. These findings suggest that sexually experienced college students who were unaware of HIV-related knowledge, lacked sex education, experienced forced sex, and reported drug abuse were the key individuals for evaluating eligibility for PrEP initiation, and interventions aimed at increasing awareness of HIV/sex-related knowledge, promoting participation in sex education, addressing issues related to forced sex and tackling drug abuse could contribute to reducing the incidence of PrEP-eligible behaviors among college students.

Pattern of Changes in Some Biochemical Indicators and Prevalence of HIV Seropositive People Co-Infected with Tuberculosis at FMC, Owerri, Imo State

The purpose of this study was to count the number of human immunodeficiency virus (HIV) patients receiving antiretroviral therapy (ART) who were also infected with tuberculosis (TB) and to evaluate the patients’ changes in certain biochemical parameters at the Federal Medical Centre in Owerri, Imo State. For this study, 350 HIV-positive patients between the ages of 20 and 79 years old who gave their consent were enrolled. National serial algorithms (Determine, Unigold, and StatPak) were utilized for HIV testing, whereas the GeneXpert machine was used for TB testing. While 4 ml of blood was collected in simple vials and the serum used for biochemical analysis, the biochemical analyses were performed using autoanalyzers. The risk of having both TB and HIV was highest in people aged 70 to 79 (31.11%) and lowest in people aged 50 to 59 (10.0%). According to sex, ladies (15.7%) had a greater prevalence of co-infection than males (14.3%). Between ART and non-ART individuals in this study, the results of the biochemical examinations showed that the ART group’s (test subjects’) kidney indicators, urea, and creatinine, as well as their liver enzymes (AST, ALT, and ALP), were statistically higher (P &lt; 0.05) than those of non-ART patients (control group). TB co-infection is more likely to affect elderly HIV-positive individuals due to their weakened immune systems by nature. Additionally, people with HIV who are not on ART run the risk of developing opportunistic infections as well as anemia. In addition to the administration of highly active antiretroviral therapy (HAART), they should be managed with additional caution. Antiretroviral medications have the potential to negatively impact vital organs like the kidneys and liver, necessitating therapeutic drug monitoring. To ensure patient compliance, more measures need to be taken by those in charge of managing these patients.

Factors Associated with HIV Risk and Vulnerability Among Injecting Drug Users in Afghanistan: A Narrative Review.

The number of human immunodeficiency virus (HIV) cases in Afghanistan is increasing mainly associated with injecting drug use (IDU). This study aimed to explore the risk and vulnerability factors associated with HIV infection among injecting drug users (IDUs) in Afghanistan in order to contribute to improving the response and reversing the concentrated HIV epidemic among this group. A narrative review of the literature was conducted to reach the objective. The modified social ecological model was used as conceptual framework for analysis of the HIV risk and vulnerability factors among IDUs at five levels. At the “individual level”, the injecting risk behaviors among IDUs such as sharing the injecting equipment and their sexual risk behaviors like unprotected sexual contact with multiple partners identified as immediate factors that put them at risk of HIV infection. At the “network level”, lack of HIV knowledge and low uptake of the harm reduction services were identified as the factors that increase their vulnerability. At the “community level”, massive drug production and easy access to illicit drugs, armed conflicts, massive internal and external migration, unemployment and poverty, high stigma and discrimination against IDUs, unsafe injecting locations such as under the bridges; and at the “public policy level”, punitive drug laws, and weak national political response to HIV and IDU were identified as determinants that add to the IDUs vulnerability to HIV. At the “stage of epidemic level”, the concentrated HIV epidemic among IDUs in the country poses a potential risk to uninfected IDUs and beyond. In conclusion, the IDUs in Afghanistan are highly at risk and vulnerable to HIV. An informed and multisectoral response is required to control the epidemic. A rapid expansion of the harm reduction interventions is urgently needed.

HIV PrEP access and affordability: a multidisciplinary specialty pharmacy model

BackgroundIncreasing the number of human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) providers expands PrEP access to more eligible patients to help end the HIV epidemic. Previous studies have noted providers perceive financial barriers as a limitation to prescribing PrEP. ObjectiveThis study aimed to describe PrEP medication access and affordability in patients seen at a multidisciplinary PrEP clinic. MethodWe conducted a single-center, retrospective, cohort study of adults initiating tenofovir disoproxil fumarate/emtricitabine in the Vanderbilt PrEP Clinic between September 1, 2016, and March 31, 2019, with prescriptions filled by Vanderbilt Specialty Pharmacy. Data were gathered from the electronic health records and pharmacy claims. We evaluated 3 different time periods: initial evaluation to PrEP initiation, prescription of PrEP to insurance approval, and insurance approval to initiation. Treatment initiation was considered delayed when >7 days from initial evaluation, and reasons for delay were recorded. Continuous variables are presented as median (interquartile range [IQR]), and categorical variables are presented as percentages. ResultsWe included 63 patients; most were male (97%), white (84%), and commercially insured (94%) with a median age of 38 years (IQR 29–47). Primary indication for PrEP was men who have sex with men at high risk of acquiring HIV (97%). Median time from initial appointment to treatment initiation was 7 days (IQR 4–8). Treatment delays occurred in 25% of patients and were mostly driven by patient preference (50%). Insurance prior authorization was required in 27% of patients; all were approved. Median total out-of-pocket medication costs for the entire study period were $0 (IQR $0–$0). Most patients (86%) used manufacturer copay cards. ConclusionIn this cohort of mostly commercially insured men, the majority were able to access PrEP with low out-of-pocket costs facilitated by manufacturer assistance. Although generalizability beyond this population is limited, these results contradict perceived financial barriers to PrEP access.

Influence of boarding secondary school environment on HIV positive students in South Western Uganda

BackgroundThe number of human immunodeficiency virus (HIV) positive adolescents in secondary school has increased over the years. Little is known on how the students cope to the pressures and demands of their academic and health lives in the boarding secondary schools. This study explored the factors surrounding their anti-retroviral therapy adherence as well as their experiences.MethodsWe did a qualitative study that employed in-depth interviews amongst purposively selected 19 HIV positive adolescent students in boarding secondary school and seven key informants. Key informants were members of boarding secondary school staff directly taking care of the adolescents living with human immune virus and had spent at least two academic terms in that school.The study participants were recruited from four health facilities in Bushenyi district, southwestern Uganda, and key informants from five boarding secondary schools in Bushenyi. These were engaged in in-depth interviews using an interview guide. Data was transcribed, coded and the content analyzed thematically.ResultsAdolescents living with human immunodeficiency virus in boarding secondary school face challenges similar to adolescents outside boarding school settings. However, some challenges are unique to them. Students faced numerous barriers which made it difficult to adhere to their medication. Stigmatization in its different forms was also a major challenge amongst students. Willingness disclosure of serostatus was beneficial to the students since it guaranteed support while at school; facilitating adherence and better living. However, students were uneasy to disclose their status. Some students adopted negative coping mechanisms such as telling lies, escaping from school, and class to access medication.ConclusionsAdolescents in boarding secondary schools face similar challenges as compared to their counterparts with some being unique to them. Few school mechanisms help these students to cope while at school. Limited disclosure has proven useful but some adolescents have opted not to disclose their status and hence used negative coping mechanisms. These challenges need to be addressed and a safe environment to encourage limited disclosure should be made.

Renal Function among HIV Infected Patients on Combination Antiretroviral Therapy: ALongitudinal Cohort Study

Introduction: A large number of Human Immunodeficiency Virus (HIV) infected patients are taking combination Antiretroviral Therapy (cART) worldwide as it has led to dramatic improvements in them with a decreased viral load as well as an increase in Cluster of Differentiation (CD4+) T cell count. Though the incidence of HIV associated Chronic Kidney Disease (CKD) has decreased with the use of effective cART, the prevalence of End Stage Renal Disease (ESRD) in HIV positive patients has increased due to the risen longevity owing to them. Aim: To study the renal function abnormalities in HIV infected patients and to compare the change in renal function of treatment naïve patients with patients on triple drug regimen (cART). Materials and Methods: This prospective longitudinal cohort study was conducted on 54 Enzyme Linked Immunosorbent Assay (ELISA) positive HIV patients belonging to the age group of 18-70 years of both the genders over a period of two years from August 2017 to September 2019 in MKCG Medical College and Hospital, Berhampur, Odisha, India. Forty nine HIV infected patients naive to cART and five patients on cART for a minimum period of three months were included in this study. All patients were treated with triple therapy regimens of either ZLN (Zidovudine 300 mg+Lamivudine 150 mg+Nevirapine 200 mg) or TLE (Tenofovir 300 mg+Lamivudine 150+Efavirenz 600 mg) daily; in a single dose at bed time. Renal function parameters like serum urea, serum creatinine, Creatinine Clearance (CrCl), estimated Glomerular Filtration Rate (eGFR) and CD4+ T cell count of treatment naive patients were compared with the same patients on cART after six months duration. GFR was calculated by Modification of Diet in Renal Disease (MDRD) equation. Results were analysed using the Statistical Package for the Social Sciences (SPSS) software for Windows Version 17.0. Results: Out of 54 patients, 53.7% (n=29) were males and 46.3% (n=25) were females. The mean CrCl of HIV positive patients on cART (79.09±25.705 mL/min) was higher than treatment naive (69.65±25.506 mL/min) patients and was highly significant (p-value=0.003). The mean eGFR of HIV positive patients on cART (102.711±26.9424 mL/min/1.73 m2) was higher than treatment naïve (90.189±28.2575 mL/min/1.73 m2) patients and was highly significant (p-value=0.003). The mean serum urea of HIV positive patients on cART (25.78± 4.721 mg/dL) was lower than HIV positive treatment naïve (26.19±4.742 mg/dL) patients but was non-significant (p-value=0.640). The mean serum creatinine of HIV positive patients on cART (0.815±0.1393 mg/dL) was lower than HIV positive treatment naïve patients (0.906±0.1687 mg/dL) and was also highly significant (p-value=0.003). The mean CD4+ T cell count of HIV positive patients on cART (401.63±225.816 cells/μL) was higher than HIV positive treatment naïve (287.13±198.263 cells/μL) patients and was very highly significant (p=0.001). Conclusion: Renal impairment (CrCl &lt;60 mL/min) and eGFR (&lt;60 mL/min/1.73 m2) were higher in HIV positive treatment naive patients than those on cART. Radiological parameters like size of the kidney and cortical echogenicity became normal after six months on cART.

988. Overcoming Prescriber Concerns through Successful Access and Affordability of PrEP

BackgroundIncreasing the number of human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) providers expands PrEP access to more eligible patients and aids in ending the HIV epidemic. Non-prescribers of PrEP have noted perceived financial barriers as a limitation to prescribing. The purpose of this study is to describe the PrEP medication access process and outcomes in patients seen at a multidisciplinary PrEP clinic.MethodsWe conducted a single-center, retrospective, cohort study of patients prescribed PrEP with emtricitabine-tenofovir disoproxil fumarate from a multidisciplinary clinic with prescriptions filled by Vanderbilt Specialty Pharmacy between 9/1/2016 and 3/31/2019. Patient data were gathered from the electronic health records and pharmacy claims data. We evaluated three different time periods: patient initial evaluation to PrEP initiation, prescription of PrEP to insurance approval, and PrEP insurance approval to initiation. Treatment initiation was considered a delay of > 7 days from initial evaluation, and reasons for delay were recorded. Continuous variables are presented as median (interquartile range, IQR) and categorical variables are presented as percentages.ResultsCharacteristics of the 63 included patients are in Table 1; most were male (97%), white (84.%), commercially insured (94%) with a median age of 38 years (IQR 29—47). The primary indication for PrEP was men who have sex with men at high risk for acquiring HIV (97%). The median time from initial appointment to treatment initiation was 7 days (IQR 4—8); Figure 1. Treatment delays were observed in 25% of patients and were mostly driven by patient preference (50% of delays). Insurance prior authorization was required in 27% of patients, all of which were approved. Median total out of pocket medication costs for the entire study period were $0 (IQR $0 – $0); Figure 2. Most patients (86%) used a manufacturer copay card.Table 1 Patient Characteristics Figure 1 Time to Treatment Initiation Figure 2 Patient Out of Pocket Cost and Savings ConclusionIn our cohort of mostly commercially insured men, the majority were able to access PrEP with low out of pocket costs facilitated by manufacturer assistance. Though generalizability beyond this population is limited, these results contradict perceived financial barriers to PrEP access.Disclosures All Authors: No reported disclosures

Integrase-RNA interactions underscore the critical role of integrase in HIV-1 virion morphogenesis.

A large number of human immunodeficiency virus 1 (HIV-1) integrase (IN) alterations, referred to as class II substitutions, exhibit pleiotropic effects during virus replication. However, the underlying mechanism for the class II phenotype is not known. Here we demonstrate that all tested class II IN substitutions compromised IN-RNA binding in virions by one of the three distinct mechanisms: (i) markedly reducing IN levels thus precluding the formation of IN complexes with viral RNA; (ii) adversely affecting functional IN multimerization and consequently impairing IN binding to viral RNA; and (iii) directly compromising IN-RNA interactions without substantially affecting IN levels or functional IN multimerization. Inhibition of IN-RNA interactions resulted in the mislocalization of viral ribonucleoprotein complexes outside the capsid lattice, which led to premature degradation of the viral genome and IN in target cells. Collectively, our studies uncover causal mechanisms for the class II phenotype and highlight an essential role of IN-RNA interactions for accurate virion maturation.

Knowledge and Attitude on Human Immunodeficiency Virus among Migrant Worker Candidates in East Java, Indonesia

Background: In 2018, East Java province becomes the province with the highest number of Human Immunodeficiency Virus (HIV) cases in Indonesia with an incidence of more than 8,000 cases. This province has various groups of Indonesian Migrant Workers (Tenaga Kerja Indonesia, TKI) working in various sectors in different countries, making them prone to HIV infection. This study aimed to determine the level of knowledge and attitude towards HIV and Acquired Immune Deficiency Syndrome (AIDS) among migrant worker candidates in East Java. Methods: This was a cross-sectional descriptive study conducted in August 2018 in the Provincial Manpower and Transmigration Office of East Java, Indonesia. The knowledge and attitude towards HIV disease were assessed using a self-validated questionnaire distributed to 104 migrant worker candidates as the subjects of this study. Results: Eighty-nine percent of the subjects had good knowledge, while 98% of them had good attitudes towards HIV disease. Furthermore, 86% had good attitudes toward HIV transmission. However, no correlation was observed between the subjects’ level of knowledge and their attitude (p=0.334). Conclusions: In general, the level of knowledge and attitudes of migrant worker candidates in East Java towards HIV disease is good. Nevertheless, more knowledge and education on healthy behavior need to be envisaged for this group.

Costs and consequences of the Portuguese needle-exchange program in community pharmacies.

Needle-exchange programs (NEPs) reduce infections in people who inject drugs. This study assesses the impact community pharmacies have had in the Needle-Exchange Program in Portugal since 2015. Health gains were measured by the number of human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infections averted, which were estimated, in each scenario, based on a standard model in the literature, calibrated to national data. The costs per infection were taken from national literature; costs of manufacturing, logistics and incineration of injection materials were also considered. The results were presented as net costs (i.e., incremental costs of the program with community pharmacies less the costs of additional infections avoided). Considering a 5-year horizon, the Needle Exchange Program with community pharmacies would account for a 6.8% (n = 25) and a 6.5% reduction (n = 22) of HCV and HIV infections, respectively. The present value of net savings generated by the participation of community pharmacies in the program was estimated at €2,073,347. The average discounted net benefit per syringe exchanged is €3.01, already taking into account a payment to community pharmacies per needle exchanged. We estimate that the participation of community pharmacies in the Needle Exchange Program will lead to a reduction of HIV and HCV infections and will generate over €2 million in savings for the health system. The intervention is estimated to generate better health outcomes at lower costs, contributing to improving the efficiency of the public health system in Portugal.

Opportunistic parasitic infections in patients with human immunodeficiency virus/acquired immunodeficiency syndrome: A review.

The number of human immunodeficiency virus (HIV) cases increases annually, and Indonesia has become the country with the fastest HIV/acquired immunodeficiency syndrome (AIDS) epidemic spread among the five Southeast Asian countries. Indonesia entered the critical phase of HIV/AIDS infections after 5 out of the 33 provinces, namely, Papua, Jakarta, Bali, West Java, and East Java, reported HIV/AIDS epidemic since 2004. In AIDS pathophysiology and immune-suppression are severe, thus, opportunistic intestinal parasitic infections that cause diarrhea in HIV infection may be fatal. Several studies have suggested that Cryptosporidium parvum, Isospora belli, and Blastocystis hominis are the most common intestinal protozoan parasites categorized as AIDS associated illness. Diarrhea caused by parasites is considerably suspected in the cases of chronic and persistent diarrhea in adults, in an era of increasing HIV/AIDS cases nowadays. The present review highlights the current advances in etiologic agents of HIV/AIDS opportunistic infections among countries, epidemiology and prevalence, lifecycle, risk factors, examination methods, and treatment.

Deteksi Gen sHBsAg sebagai Penanda Koinfeksi Hepatitis B pada Pengidap HIV

&lt;p&gt;Bandung is the city with the highest number of Human Immunodeficiency Virus (HIV) sufferers in West Java. HIV patients often have co-infection with Hepatitis B Virus (HBV). This condition can increase the risk of cirrhosis, liver cancer, and death. Co-infection status can be detected by the presence of the HBsAg gene amplified using the nested Polymerase Chain Reaction (nested PCR) method. This study aimed to decide the number of HBV co-infection cases with the sHBsAg gene as a marker and factor influencing the presence of the gene in HIV patients in Bandung. This research used 50 human samples domiciled in Bandung which have been infected with HIV and never had a hepatitis test. Taking blood specimens was done on the people who had signed the informed consent. The detection of the sHBsAg gene started with genomic DNA isolation. Moreover, the purity and concentration of DNA isolation results were measured by the Nanodrop. The amplification process of the sHBsAg gene was done twice using two pairs of the specific primary. The amplification results were visualized by agarose electrophoresis method. Then, the data collected was analyzed by a logistic regression method. The laboratory results showed that 18 people (36%) had HIV-HBV co-infection, marked by the presence of the sHBsAg gene in their blood. Unsafe sexual activity, syringe drug use, and a vaccination profile were factors that significantly influence (p&amp;lt;0.05) on this co-infection.&lt;/p&gt;

Impact of a bottom-up community engagement intervention on maternal and child health services utilization in Ghana: a cluster randomised trial

BackgroundGhana is among African countries not likely to achieve the Sustainable Development Goal (SDG) three (3) target of reducing maternal mortality to 70 per 100,000 live births by the year 2030 if maternal and child health services utilization are not improved. Community engagement in health is therefore advocated to help address this challenge. This study evaluated the impact of a community engagement intervention on maternal and child health services utilization in Ghana.MethodsThis study was a cluster randomised trial among primary healthcare facilities (n = 64) in the Greater Accra and Western regions in Ghana. Multivariate multiple regression analysis and paired-ttest were used to determine impact of the community engagement intervention on maternal and child health indicators at baseline and follow-up.ResultsIntervention health facilities recorded significant improvements over control facilities in terms of average spontaneous vaginal deliveries per month per health facility (baseline mean = 15, follow-up mean = 30, p = 0.0013); child immunizations (baseline mean = 270, follow-up mean = 455, p = 0.0642) and female condoms distribution (baseline mean = 0, follow-up mean = 2, p = 0.0628). Other improved indicators in intervention facilities were average number of Human Immunodeficiency Virus (HIV) tests for non-pregnant women (baseline mean = 55, follow-up 104, p = 0.0213); HIV tests for pregnant women (baseline mean = 40, follow-up mean = 119, p = 0.0067) and malaria tests (baseline mean = 43, follow-up mean = 380, p = 0.0174). Control facilities however performed better than intervention facilities in terms of general laboratory tests, voluntary counselling and testing, treatment of sexually transmitted infections, male child circumcisions and other minor surgical procedures.ConclusionCommunity engagement in health has the potential of improving utilization of maternal and child health services. There is the need for multi-stakeholder dialogues on complementing existing quality improvement interventions with community engagement strategies.

How has the cost of antiretroviral therapy changed over the years? A database analysis in Italy

BackgroundThe number of human immunodeficiency virus (HIV)-related hospitalizations has decreased worldwide in recent years, due to the availability of combined antiretroviral therapies (cART). The present analysis aimed to analyse the economic, and clinical burden of HIV management, after the introduction of systematic use of cART.MethodsData from HIV-infected patients, treated at Policlinico San Martino Hospital in Genova (Italy) were retrospectively collected. A comparison between years 2009 and 2015 was performed. HIV-related admissions were identified by using the Diagnosis-Related Group (DRG) codes. The resource consumption of outpatient services was derived by using a modelling approach. Expenditure for drugs was also analysed, as aggregate data.ResultsThe number of HIV-infected patients was 898 in 2009 and 1006 in 2015. Overall, the virological success rate improved from 2009 to 2015, as the percentage of patients with HIV-RNA < 50 copies/mL increased from 79 to 89% (P < 0.05). The average incidence of hospitalizations per-patient decreased from 0.30 in 2009, to 0.13 in 2015. Average expenditure per-patient decreased from €10,107 in 2009 to €9063 in 2015.ConclusionsThe present analysis confirmed the role of cART in controlling HIV viral load and, consequently, in reducing hospitalizations, admissions to day-hospital and the use of outpatient services.Clinical improvements and economic savings more than compensated the investments required to treat HIV-infected patients with cART. Health Authorities should invest in modern cART supply and universal treatment, to use at best the available resources and obtain a cost-effective improvement of health in people living with HIV. Additional research, with the involvement of different centers and the use of patient-specific data, are recommended to consolidate the findings of this analysis.

Using the capture-recapture method to estimate the human immunodeficiency virus-positive population.

OBJECTIVESThe capture-recapture method was applied to estimate the number of human immunodeficiency virus (HIV)-positive individuals not registered with any data sources.METHODSThis cross-sectional study was conducted in Lorestan Province, in the west of Iran, in 2016. Three incomplete sources of HIV-positive individuals, with partially overlapping data, were used, including: (a) transfusion center, (b) volunteer counseling and testing centers (VCTCs), and (c) prison. The 3-source capture-recapture method, using a log-linear model, was applied for data analysis. The Akaike information criterion and the Bayesian information criterion were used for model selection.RESULTSOf the 2,456 HIV-positive patients registered in these 3 data sources, 1,175 (47.8%) were identified in transfusion center, 867 (35.3%) in VCTCs, and 414 (16.8%) in prison. After the exclusion of duplicate entries, 2,281 HIV-positive patients remained. Based on the capture-recapture method, 14,868 (95% confidence interval, 9,923 to 23,427) HIV-positive individuals were not identified in any of the registries. Therefore, the real number of HIV-positive individuals was estimated to be 17,149, and the overall completeness of the 3 registries was estimated to be around 13.3%.CONCLUSIONSBased on capture-recapture estimates, a huge number of HIV-positive individuals are not registered with any of the provincial data sources. This is an urgent message for policymakers who plan and provide health care services for HIV-positive patients. Although the capture-recapture method is a useful statistical approach for estimating unknown populations, due to the assumptions and limitations of the method, the population size may be overestimated as it seems possible in our results.

Prognostic Factors of Human Immunodeficiency Virus-Infected Patients on Chronic Hemodialysis

Background/Aims: The number of human immunodeficiency virus (HIV)-infected patients on hemodialysis (HD) have increased, and their prognostic factors are still poorly clarified. The study aimed to identify factors that can influence the survival of HIV-infected patients on HD. Methods: We performed a retrospective cohort study of 44 HIV-infected patients on HD. Results: A total of 17 patients (39%) died. Median survival on HD was 30.8 months and the survival rate at 1 and 5 years was 82.5 and 62.9%, respectively. Male (relative risk [RR] 3.1, p = 0.040) and blacks (RR 2.5, p = 0.037) had higher risk of death. The patients who died had a shorter duration of HIV infection (p = 0.028), had a higher viral load (p = 0.044), more opportunistic infections (p = 0.013), and a lower serum albumin (p = 0.009). Lower serum albumin, nonsexual HIV transmission, viral load, opportunistic infections, and usage of catheters were associated with lower survival. Conclusion: Several demographic, viral, and dialysis variables may help to predict survival of this population. The intervention in these factors could improve their prognosis.

Addressing Antiretroviral Therapy-Associated Drug-Drug Interactions in Patients Requiring Treatment for Opportunistic Infections in Low-Income and Resource-Limited Settings.

An increasing number of human immunodeficiency virus (HIV)-infected patients are achieving virologic suppression on antiretroviral therapy (ART) limiting the use of primary and secondary antimicrobial prophylaxis. However, in low-income and resource-limited settings, half of those infected with HIV are unaware of their diagnosis, and fewer than 50% of patients on ART achieve virologic suppression. Management of comorbidities and opportunistic infections among patients on ART may lead to inevitable drug-drug interactions (DDIs) and even toxicities. Elderly patients, individuals with multiple comorbidities, those receiving complex ART, and patients living in low-income settings experience higher rates of DDIs. Management of these cytochrome P450-mediated, nonmediated, and drug transport system DDIs is critical in HIV-infected patients, particularly those in resource-limited settings with few options for ART. This article critically analyzes and provides recommendations to manage significant DDIs and drug toxicities in HIV-infected patients receiving ART.

Virological and Social Outcomes of HIV-Infected Adolescents and Young Adults in The Netherlands Before and After Transition to Adult Care.

As a result of effective combination antiretroviral therapy (cART) and advanced supportive healthcare, a growing number of human immunodeficiency virus (HIV)-infected children survive into adulthood. The period of transition to adult care is often associated with impaired adherence to treatment and discontinuity of care. We aimed to evaluate virological and social outcomes of HIV-infected adolescents and young adults (AYAs) before and after transition, and explore which factors are associated with virological failure. We included 59 HIV-infected AYAs from the Netherlands who had entered into pediatric care and transitioned from pediatric to adult healthcare. We used HIV RNA load and cART data from the Dutch Stichting HIV Monitoring database (1996-2014), and collected social and treatment data from patients' medical records from all Dutch pediatric HIV treatment centers and 14 Dutch adult treatment centers involved. We evaluated risk factors for virological failure (VF) in a logistic regression model adjusted for repeated measurements. HIV VF occurred frequently during the study period (14%-36%). During the transition period (from 18 to 19 years of age) there was a significant increase in VF compared with the reference group of children aged 12-13 years (odds ratio, 4.26 [95% confidence interval, 1.12-16.28]; P = .03). Characteristics significantly associated with VF were low educational attainment and lack of autonomy regarding medication adherence at transition. HIV-infected AYAs are vulnerable to VF, especially during the transition period. Identification of HIV-infected adolescents at high risk for VF might help to improve treatment success in this group.

Genetic Analysis of HIV-1 in Japan: a Comprehensive Analysis of Donated Blood.

In Japan, the number of human immunodeficiency virus (HIV)-1 infections remains relatively low; nevertheless, the annual incidence of HIV-1 infection has not decreased. New infections remain a great concern, and an improved understanding of epidemiological trends is critical for public health. The env C2V3 and pol sequences of HIV-1 RNA from 240 early (1996-2001) and 223 more recent (2010-2012) blood donations were used to compare the distribution of virus subtypes and to generate phylogenetic trees. Subtype B was clearly predominant in both early and more recent donations (both were 88.3%), and CRF01_AE was the second most common subtype. Phylogenetic analysis revealed a peculiar epidemiological transition. Compared to early subtype B isolates from 2 major endemic areas (Tokyo and Osaka), the more recent subtype B isolates formed fewer tight clusters in phylogenetic trees (from 8 to 2 clusters in Tokyo and 5 to zero clusters in Osaka). Furthermore, mixing of HIV-1 infections between these 2 endemic areas appear to increase. Analysis of phylogenetic trees suggested that local outbreaks have become smaller in Japan; however, intermixing of viral types between these 2 areas was more evident in the more recent samples.