HIV Population Research Articles

Clinical profile and predictors of viral suppression in HIV-infected older adults at a University Hospital in Kumasi, Ghana

ABSTRACT Availability of effective antiretroviral therapy (ART) has improved patient survival and older adults (≥50 years old) constitute 10% of the world’s HIV population. However, data on this population are lacking, especially in sub-Saharan Africa. To identify the profile of older adults with HIV infection receiving ART and factors associated with viral suppression. A retrospective cross-sectional study involving HIV patients ≥50 years, registered at a University Hospital in Kumasi, Ghana from January 2010 to July 2020. All study participants had been on ARTs for ≥12 months. Data were analysed using STATA® and multivariate logistic regression was done to determine the association between variables. We recruited 132 study participants with a mean age of 58.1 years (±6.8). Non-communicable diseases (NCD) comprised the commonest comorbidity (67.4%; n = 89) and hypertension was the most prevalent (47.2%). The mean duration of ART was 63.2 months (±32.0) and approximately 84.1% (n = 111) achieved viral suppression (≤50 copies/ml). After adjustment, factors independently associated with viral suppression were widow(ed) (aOR = 0.23; 95% CI = 0.07–0.72) and good ART adherence (aOR = 3.51; 95% CI = 1.03–11.99). Hypertension is prevalent among this cohort of HIV patients. Approximately 84% of elderly patients on ARTs achieve viral suppression, influenced by widowhood and good drug adherence.

An overview of implementing an evidence based program to increase HPV vaccination in HIV community clinics

BackgroundHPV-related anal cancer occurs in excess rates among people living with HIV (PLWH) and has been increasing in incidence. The HPV vaccine is an effective and safe approach to prevent and reduce the risk of HPV-related disease. Yet, HPV vaccine programs tailored and implemented in the HIV population are lagging for this high-risk group.MethodsA pre-post intervention study design will be used to tailor, refine, and implement the 4 Pillars™ Practice Transformation Program to increase HPV vaccination among PLWH. Guided by the RE-AIM framework, the CHAMPS study will provide training and motivation to HIV providers and clinic staff to recommend and administer the HPV vaccination within three HIV clinics in Georgia. We plan to enroll 365 HIV participants to receive HPV education, resources, and reminders for HPV vaccination. Sociodemographic, HPV knowledge, and vaccine hesitancy will be assessed as mediators and moderators for HPV vaccination. The primary outcome will be measured as an increase in uptake rate in initiation of the HPV vaccine and vaccine completion (secondary outcome) compared to historical baseline vaccination rate (control).DiscussionThe proposed study is a novel approach to address a serious and preventable public health problem by using an efficacious, evidence-based intervention on a new target population. The findings are anticipated to have a significant impact in the field of improving cancer outcomes in a high-risk and aging HIV population.Trial registrationNCT05065840; October 4, 2021.

BODY MASS INDEX AND CD4 COUNT IN PATIENTS UNDERGOING HIGHLY ACTIVE ANTIRETROVIRAL TREATMENT AT THE BAMENDA REGIONAL HOSPITAL, CAMEROON

Background: The long-term effect of highly active antiretroviral treatment (HAART) has caused weight gain among HIV-infected individuals, leading to an increased prevalence of overweight and obesity. Increased Body Mass Index (BMI) has been associated with adverse health outcome in non-HIV and HIV populations.
 Aim of the Study: To evaluate the relationship between BMI, and CD4 count among HIV infected subjects undergoing treatment with HAART.
 Methodology: This was a cross-sectional retrospective study involving 205 HIV-infected adults receiving antiretroviral therapy (ART) from the Day Hospital of the Bamenda Regional Hospital (BRH). Past medical records were used to gather demographic, clinical and anthropometric information dating from August 2014 to September 2015. Records for CD4 counts were taken at 2 instances (first and second CD4 count) per patient after a strict interval of 6 months. Data was analysed using EPI Info version 3.5.1 and Excel 2007. Descriptive and inferential statistical analyses were used to measure proportions and associations respectively.
 Results: Of the 205 subjects, 69.8 % (n = 143) were women and 30.2 % (n = 62) were men. Subjects were aged from 22 - 72 years. The prevalence of the weight categories were: obese (21.5 %), overweight (35.1 %), normal weight (42.4 %) and underweight (1 %). Women had significantly higher CD4 counts than men (P = 0.05 and P = 0.002 respectively). BMI was positively associated with CD4 count (P = 0.002). Normal weight was a protective factor for the outcome of a CD4 decrease (OR = 0.5033 95 % CI 0.29-0.89).
 Conclusion: This study demonstrated that there was a direct and significant association between CD4 count and BMI in HIV-infected persons. However more research is needed to prove the credibility of obesity, as a protective factor for HIV infected person especially.

Projection of age of individuals living with HIV and time since ART initiation in 2030: estimates for France.

IntroductionThanks to antiretroviral treatment (ART), people living with HIV (PLHIV) are living longer and ageing. However, ageing involves increased risks of co‐morbidities, which also depend on when PLHIV individuals started ART. To tackle the HIV age‐related upcoming challenges, knowledge of the current and future age structure of the HIV population is needed. Here, we forecast the demographic profile of the adult population living with diagnosed HIV (aPLdHIV) in France until 2030, accounting for the impact of the ART initiation period on mortality.MethodsWe used national data from the French Hospital Database on HIV (ANRS CO4‐FHDH) and a sample of the National Health Data System to, first, characterize the aPLdHIV in 2018 and estimate their mortality rates according to age, sex and ART initiation period. Second, we used national HIV surveillance data to define three scenarios for the numbers of newly diagnosed HIV cases over 2019–2030: 30% decrease in HIV cases (S1), status quo situation (S2) and epidemic elimination (S3). We then combined these data using a matrix model, to project the age structure of aPLdHIV and time since ART initiation.ResultsIn 2018, there was an estimated 161,125 aPLdHIV (33% women), of which 55% were aged 50 or older (50+), 22% aged 60+ and 8% aged 70+. In 2030, the aPLdHIV would grow to 195,246 for S1, 207,972 for S2 and 167,221 for S3. Whatever the scenario, in 2030, the estimated median time since ART initiation would increase and age distribution would shift towards older ages: with 65–72% aPLdHIV aged 50+, 42–48% 60+ and 17–19% 70+. This corresponds to ∼83,400 aPLdHIV (28% women) aged 60+, among which ∼69% started ART more than 20 years ago (i.e. before 2010) and ∼39% ≥30 years ago (i.e. before 2000), and to ∼33,100 aPLdHIV (27% women) aged 70+, among which ∼72% started ART ≥20 years ago and ∼43% ≥30 years ago.ConclusionsBy 2030, in France, close to 20% of the aPLdHIV will be aged 70+, of which >40% would have started ART more than 30 years ago. These estimates are essential to adapt co‐morbidities screening and anticipate resource provision in the aged care sector.

Imaging and biopsy of HIV-infected individuals undergoing analytic treatment interruption.

BackgroundHIV persistence during antiretroviral therapy (ART) is the principal obstacle to cure. Lymphoid tissue is a compartment for HIV, but mechanisms of persistence during ART and viral rebound when ART is interrupted are inadequately understood. Metabolic activity in lymphoid tissue of patients on long-term ART is relatively low, and increases when ART is stopped. Increases in metabolic activity can be detected by 18F-fluorodeoxyglucose Positron Emission Tomography (FDG-PET) and may represent sites of HIV replication or immune activation in response to HIV replication.MethodsFDG-PET imaging will be used to identify areas of high and low metabolic uptake in lymphoid tissue of individuals undergoing long-term ART. Baseline tissue samples will be collected. Participants will then be randomized 1:1 to continue or interrupt ART via analytic treatment interruption (ATI). Image-guided biopsy will be repeated 10 days after ATI initiation. After ART restart criteria are met, image-guided biopsy will be repeated once viral suppression is re-achieved. Participants who continued ART will have a second FDG-PET and biopsies 12–16 weeks after the first. Genetic characteristics of HIV populations in areas of high and low FDG uptake will be assesed. Optional assessments of non-lymphoid anatomic compartments may be performed to evaluate HIV populations in distinct anatomic compartments.Anticipated resultsWe anticipate that PET standardized uptake values (SUV) will correlate with HIV viral RNA in biopsies of those regions and that lymph nodes with high SUV will have more viral RNA than those with low SUV within a patient. Individuals who undergo ATI are expected to have diverse viral populations upon viral rebound in lymphoid tissue. HIV populations in tissues may initially be phylogenetically diverse after ATI, with emergence of dominant viral species (clone) over time in plasma. Dominant viral species may represent the same HIV population seen before ATI.DiscussionThis study will allow us to explore utility of PET for identification of HIV infected cells and determine whether high FDG uptake respresents areas of HIV replication, immune activation or both. We will also characterize HIV infected cell populations in different anatomic locations. The protocol will represent a platform to investigate persistence and agents that may target HIV populations.Study protocol registrationIdentifier: NCT05419024.

Temporal trends and outcomes of peripheral artery disease revascularization and amputation among the HIV population.

With antiretroviral therapy, people with HIV (PWH) are developing age-related diseases, including peripheral arterial disease (PAD). This study examined frequency and outcomes of peripheral vascular intervention (PVI) and primary amputation in PWH. We used the National Inpatient Sample (NIS) database to examine demographics, comorbidities, and temporal trends among PVI and primary amputation admissions by HIV status from 2012 to 2018. Inverse probability of treatment weighting was used to calculate adjusted odds of in-hospital death and amputation. Cost of hospitalization and length of stay were compared by HIV status and revascularization approach. Of the 347 824 hospitalizations for PVI/amputation, 0.6% were PWH, which was stable over time. PWH had more renal and hepatic disease, whereas uninfected individuals had more traditional PAD risk factors. 55.2% of HIV+ admissions were endovascular compared with 49.3% in HIV- admissions, and 28.9% of the HIV+ admissions were elective compared with 42.1% among HIV-. HIV status did not impact amputation following PVI. In-hospital death was similar between groups following PVI or primary amputation. PWH had lower costs of hospitalization and a trend towards shorter hospital stays. Although PWH are developing more age-related chronic illnesses, the number of PAD-associated procedures has remained flat. Despite being younger with fewer traditional PAD risk factors, PWH had higher rates of unplanned PVI admissions and endovascular revascularization but similar in-hospital outcomes. These findings suggest PWH have different risk factors for PAD and are likely underdiagnosed and undertreated, whereas those who are treated have similar outcomes to the general population.

AN-UNUSUAL PRESENTATION OF LUNG-MALIGNANCY IN A HIV-PATIENT

Malignancies of the Lung are a major source of morbidity and mortality in person with HIV infection. In the Pre ART ERA, AIDS-Dening-Cancers (ADC) were prominent. NADCs are mostly comprised of NON- SMALL-Cell Lung Cancer followed by Small-Cell-Carcinoma. Within HIV population incidence of lung-cancer estimated approximately 2-4 times that of general population. Multiple pulmonary nodules or Cannon Ball opacities in LUNG particularly originates from malignant, non-malignant, infective etiology and connective tissue disorders also may cause it.

ДОСЛІДЖЕННЯ СТАНУ НАДАННЯ ПОСЛУГ ДОГЛЯДУ ТА ПІДТРИМКИ ВІЛ-ПОЗИТИВНИХ ЛЮДЕЙ У ДЕРЖАВНО-ГРОМАДСЬКОМУ СЕКТОРІ

The article proposes ways to solve the problem of organizing comprehensive care and support for HIV-positive people from the experience of the public sector, which is reflected in the analysis of quantitative and qualitative research on the provision of care and support for HIV-positive people in the public sector and helped to identify gaps in this system. The research base was the office of trust of the polyclinic of the Berdyansk Territorial Medical Association, whose tasks include mass screening of the population for HIV and providing medical and socio-psychological assistance to people with HIV-positive status. It was found that medical workers and a social worker of the office (representative of the NGO «100% Life Network. Zaporizhzhya») accompanies 347 patients with HIV-positive status (323 of them are receiving ART therapy); the dispensary register includes: injecting drug users – 57 people; homosexuals – 2 people; pregnant women – 33 people. The study was conducted using quantitative and qualitative methods. The quantitative component was the collection of information on the prevalence of various manifestations of HIV on the basis of HIV status using the method of structured face-to-face interviews (a total of 316 interviews were conducted). The obtained quantitative data were supplemented by qualitative information. To this end, 24 in-depth life story interviews were conducted. In the process of analysis of the obtained data was characterized a sample of subjects who are on the dispensary account of the office of trust of Berdyansk Territorial Medical Association (middle age, life expectancy with HIV, close relationship and HIV status of partner, level of education, employment, affiliation to key groups of the population, experience of stigmatization and discrimination due to HIV status by the social environment, reasons for postponing HIV treatment, etc.). Key words: HIV-positive people, care and support, public sector, stigma and discrimination.

Enhancement of CD4 Binding, Host Cell Entry, and Sensitivity to CD4bs Antibody Inhibition Conferred by a Natural but Rare Polymorphism in the HIV-1 Envelope.

A rare but natural polymorphism in the HIV-1 envelope (Env) glycoprotein, lysine at position 425 was selected as a mutation conferring resistance to maraviroc (MVC) in vitro. N425K has not been identified in HIV-infected individuals failing an MVC-based treatment. This study reports that the rare K425 polymorphism in an HIV-1 subtype A Env has increased affinity for CD4, resulting in faster host cell entry kinetics and the ability to scavenge for low cell surface expression of CD4 to mediate entry. Whereas the subtype A wild-type isolate-74 Env (N425) is inhibited by soluble (s) CD4, HIV-1 with K425 A74 Env shows enhanced infection and the ability to infect CCR5+ cells when pretreated with sCD4. Upon adding K425 or N425 HIV-1 to CD4+/CCR5+ cells along with RANTES/CCL3, only K425 HIV-1 was able to infect cells when CCR5 recycled/returned to the cell surface at 12 h post-treatment. These findings suggest that upon binding to CD4, K425 Env may maintain a stable State 2 "open" conformation capable of engaging CCR5 for entry. Only K425 was significantly more sensitivity than wild-type N425 A74 to inhibition by the CD4 binding site (bs) compound, BMS-806, the CD4bs antibody, VRC01 and N6, and the single-chain CD4i antibody, SCm9. K425 A74 was also capable of activating B cells expressing the VRC01 surface immunoglobulin. In summary, despite increased replicative fitness, we propose that K425 HIV-1 may be counterselected within infected individuals if K425 HIV-1 is rapidly eliminated by CD4bs-neutralizing antibodies. IMPORTANCE Typically, a natural amino acid polymorphism is found as the wild-type sequence in the HIV-1 population if it provides a selective advantage to the virus. The natural K425 polymorphism in HIV-1 Env results in higher host cell entry efficiency and greater replicative fitness by virtue of its high binding affinity to CD4. The studies presented herein suggest that the rare K425 HIV-1, compared to the common N425 HIV-1, may be more sensitive to inhibition by CD4bs-neutralizing antibodies (i.e., antibodies that bind to the CD4 binding pocket on the HIV-1 envelope glycoprotein). If CD4bs antibodies did emerge in an infected individual, the K425 HIV-1 may be hypersensitive to inhibition, and thus this K425 virus variant may be removed from the HIV-1 swarm despite its higher replication fitness. Studies are now underway to determine whether addition of the K425 polymorphism into the Envelope-based HIV-1 vaccines could enhance protective immunity.

A pretest-posttest design to assess the effectiveness of an intervention to reduce HIV-related stigma and discrimination in healthcare settings in Vietnam.

IntroductionStigma and discrimination are important barriers to HIV epidemic control. We implemented a multi‐pronged facility‐level intervention to reduce stigma and discrimination at health facilities across three high‐burden provinces. Key components of the intervention included measurement of stigma, data review and use, participatory training of healthcare workers (HCWs), and engagement of people living with HIV and key populations in all stigma reduction activities.MethodsFrom July 2018 to July 2019, we assessed HIV‐related stigma and discrimination among patients and HCWs at 10 facilities at baseline and 9 months following an intervention. A repeated measures design was used to assess the change in stigma and discrimination among HCWs and a repeated cross‐sectional design assessed the change in stigma and discrimination experienced by PLHIV. HCWs at target facilities were invited at random and PLHIV were recruited when presenting for care during the two assessment periods. McNemar's test was used to compare paired proportions among HCWs, and chi‐square test was used to compare proportions among PLHIV. Mixed models were used to compare outcomes before and after the intervention.ResultsSemi‐structured interviews were conducted with 649 and 652 PLHIV prior to and following the intervention, respectively. At baseline, over the previous 12 months, 21% reported experiencing discrimination, 16% reported self‐stigma, 14% reported HIV disclosure without consent and 7% had received discriminatory reproductive health advice. Nine months after the intervention, there was a decrease in reported stigma and discrimination across all domains to 15%, 11%, 7% and 3.5%, respectively (all p‐values <0.05). Among HCWs, 672 completed the pre‐ and post‐intervention assessment. At baseline, 81% reported fear of HIV infection, 69% reported using unnecessary precautions when caring for PLHIV, 44% reported having observed other staff discriminate against PLHIV, 54% reported negative attitudes towards PLHIV and 41% felt uncomfortable working with colleagues living with HIV. The proportions decreased after the intervention to 52%, 34%, 32%, 35% and 24%, respectively (all p‐values <0.05).ConclusionsA multi‐pronged facility‐level intervention was successful at reducing healthcare‐associated HIV‐related stigma in Vietnam. The findings support the scale‐up of this intervention in Vietnam and highlight key components potentially applicable in other settings.

The HIV Epidemic in South Africa: Key Findings from 2017 National Population-Based Survey.

South Africa has the largest number of people living with HIV worldwide. South Africa has implemented five population-based HIV prevalence surveys since 2002 aimed at understanding the dynamics and the trends of the epidemic. This paper presents key findings from the fifth HIV prevalence, incidence, and behaviour survey conducted in 2017 following policy, programme, and epidemic change since the prior survey was conducted in 2012. A cross-sectional population-based household survey collected behavioural and biomedical data on all members of the eligible households. A total of 39,132 respondents from 11,776 households were eligible to participate, of whom 93.6% agreed to be interviewed, and 61.1% provided blood specimens. The provided blood specimens were used to determine HIV status, HIV incidence, viral load, exposure to antiretroviral treatment, and HIV drug resistance. Overall HIV incidence among persons aged 2 years and above was 0.48% which translates to an estimated 231,000 new infections in 2017. HIV prevalence was 14.0% translating to 7.9 million people living with HIV. Antiretroviral (ARV) exposure was 62.3%, with the lowest exposure among those aged 15 to 24 years (39.9%) with 10% lower ARV coverage among males compared to females. Viral suppression among those on treatment was high (87.3%), whilst HIV population viral load suppression was much lower (62.3%). In terms of risk behaviours, 13.6% of youth reported having had an early sexual debut (first sex before the age of 15 years), with more males reporting having done so (19.5%) than females (7.6%). Age-disparate relationships, defined as having a sexual partner 5+ years different from oneself,) among adolescents were more common among females (35.8%) than males (1.5%). Self-reported multiple sexual partnerships (MSPs), defined as having more than one sexual partner in the previous 12 months, were more commonly reported by males (25.5%) than females (9.0%). Condom use at last sexual encounter was highest among males than females. Three quarters (75.2%) of people reported they had ever been tested for HIV, with more females (79.3%) having had done so than males (70.9%). Two-thirds of respondents (66.8%) self-reported having tested for HIV in the past 12 months. Finally, 61.6% of males in the survey self-reported as having been circumcised, with circumcision being more common among youth aged 15–24 years (70.2%), Black Africans (68.9%), and those living in both rural informal (tribal) areas (65%) and urban areas (61.9%). Slightly more (51.2%) male circumcisions were reported to have occurred in a medical setting than in traditional settings (44.8%), with more young males aged 15–24 (62.6%) and men aged 25–49 (51.5%) reporting to have done so compared to most men aged 50 and older (57.1%) who reported that they had undergone circumcision in a traditional setting. The results of this survey show that strides have been made in controlling the HIV epidemic, especially in the reduction of HIV incidence, HIV testing, and treatment. Although condom use at last sex act remains unchanged, there continue to be some challenges with the lack of significant behaviour change as people, especially youth, continue to engage in risky behaviour and delay treatment initiation. Therefore, there is a need to develop or scale up targeted intervention programmes to increase HIV testing further and put more people living with HIV on treatment as well as prevent risky behaviours that put young people at risk of HIV infection.

HIV drug resistance in various body compartments.

HIV drug resistance testing using blood plasma or dried blood spots forms part of international guidelines. However, as the clinical utility of assessing drug resistance in other body compartments is less well established, we review this for blood cells and samples from other body compartments. Although clinical benefit is not clear, drug resistance testing in blood cells is often performed when patients with suppressed plasma viral loads require a treatment substitution. In patients with HIV neurocognitive disease, cerebral spinal fluid (CSF) drug resistance is rarely discordant with plasma but has nevertheless been used to guide antiretroviral drug substitutions. Cases with HIV drug resistance in genital fluids have been documented but this does not appear to indicate transmission risk when blood plasma viral loads are suppressed. Drug-resistant variants, which may be selected in tissues under conditions of variable adherence and drug penetration, appear to disseminate quickly, and become detectable in blood. This may explain why drug resistance discordance between plasma and these compartments is rarely found. Partial compartmentalization of HIV populations is well established for the CSF and the genital tract but other than blood plasma, evidence is lacking to support drug resistance testing in body compartments.

Evaluating Diversity in Randomized Clinical Trials of Dolutegravir-Based Antiretroviral Therapy Regimens: Pooled 48-Week Analyses by Race, Sex, and Regional Subgroups.

BackgroundIn HIV clinical trials, proportions of Black and female participants achieving virologic suppression (VS) are often lower compared with White and male participants. As the antiretroviral therapy (ART) landscape continues to evolve, addressing existing challenges in clinical trial diversity will be critical to effectively translate results into clinical practice. Here, we pooled data to evaluate the efficacy and safety of dolutegravir (DTG)-containing regimens by race, sex, and regional subgroups.MethodsThree pooled analyses were conducted using 48-week results from phase 3/3b trials: DTG 3-drug vs non-DTG-containing 3- or 4-drug regimens in ART-naive participants (ARIA, FLAMINGO, SINGLE, SPRING-2), DTG-containing 2-drug vs 3-drug regimens in ART-naive participants (GEMINI-1, GEMINI-2), and DTG 3-drug vs non-DTG-containing 3- or 4-drug regimens in ART-experienced participants (SAILING, DAWNING). Proportions of participants with VS, safety, and change from baseline in CD4+ cell count were analyzed.ResultsProportions of participants achieving VS were high among those receiving DTG vs comparator regimens. Proportions of participants achieving VS were generally lower in Black (vs non-Black), female (vs male), and US (vs non-US) subgroups. No new safety signals emerged from any subgroup in pooled analyses.ConclusionsThese analyses confirm that, across subgroups, DTG has robust efficacy and a good safety profile at week 48 relative to comparator regimens. Achieving VS may vary by participant characteristics, highlighting the urgent need for enrollment to reflect the demographics of global HIV populations more accurately. Future studies should strive to support participants throughout the trial to ensure optimal representation, inclusion, and retention.

Factors associated with early biological aging in older people with HIV

ABSTRACT Advances and availability of antiretroviral treatment has enabled a longer life expectancy for HIV population. However, with its chronicity, premature aging challenges the management of people living with HIV. This study, conducted between 2018–2020, aimed to identify an association between risk factors and premature aging, using the biological age estimated by artificial intelligence (AI) based on deep learning (Aging 3.0). This was a cross-sectional, analytical study, involving older people living with HIV (OPLHIV), 66.1% of whom were men. Premature aging was identified in 67.8%. The presence of cannabis and diabetes were significant (p = 0.045 and p = 0.042, respectively). For current and nadir CD4 + cell counts, participants were divided into groups comparing biological age (BA) and chronological age (CA). Just one group presented no premature aging, whereas the group with premature aging was subdivided into BA > CA up to 4 years and BA > CA in 5 or more years. In conclusion, premature aging was present in most of the OPLHIV. The use of cannabis was self-reported in those with higher BAs and those with a lower BA presented a higher prevalence of diabetes. Factors directly linked to HIV infection, lower current and nadir CD4 + counts were associated with premature aging.

Differences in prevalence and risk factors of non-communicable diseases between young people living with HIV (YLWH) and young general population in Cambodia.

Understanding non-communicable diseases (NCDs) among young people living with HIV (YLWH) is critical given the potential for aging-associated comorbidities resulting from HIV, especially in Cambodia where such data are limited. Therefore, we examined the prevalence and correlates of NCDs in YLWH and compared it to a nationally representative sample of young people not otherwise infected. We collected data from a sample of 370 YLWH aged 18–29 years attending three HIV clinics in Cambodia between 2019 and 2020. Our comparison group were 486 young people who participated in the Ministry of Health/WHO 2016 Noncommunicable Disease Risk Factor Surveillance (STEP survey). Both surveys used a standardized questionnaire to collect information on lifestyle factors and World Health Organization protocols for physical and biochemical measurements. We compared the prevalence of diabetes, hypertension, and high cholesterolemia between the two groups and examined the relationship between these conditions and HIV. We found 16 (4%), 22 (6%), and 72 (20%) had diabetes, hypertension, and high cholesterolemia, respectively, among YLWH, compared to 4 (1%), 22 (4%), and 49 (11%) among the general population. In logistic regression, YLWH were at higher odds of diabetes/prediabetes and high cholesterolemia compared with the young general population, aOR = 6.64 (95% CI 3.62–12.19) and aOR = 7.95 (95% CI 3.98–15.87), respectively. Our findings demonstrate that YLWH in Cambodia face multiple metabolic disorders and NCDs despite their young age and that accessible screening measures and treatment for these conditions are needed in order to combat NCDs in the future.

Vitamin D Level in Patients Receiving Highly Active Antiretroviral Therapy in LAUTECH Teaching Hospital, Ogbomoso

Background and objective: Hypovitaminosis D is a worldwide disorder, with a high prevalence in the general population. This study aims to assess the serum vitamin D level and its relationship with cluster for differentiation; CD4+T cells among HIV infected individuals on HAART.&#x0D; Methods: This is a cross-sectional study conducted among 150 subjects attending the infectious disease Clinic of LAUTECH Teaching Hospital, Ogbomoso and presently on antiretroviral treatment. Serum from blood samples collected was analyzed and diagnostic cut-off of (&lt;30ng/ml) and (&gt; 30ng/ml) were used as Deficient and Sufficient vitamin D respectively. Variables such as duration on ART, CD4 count and viral load were extracted from case notes of subjects.&#x0D; Results: There was disproportionately more female than malesubjects with a male to female ratio of 1:3. Subjects were aged between 16 and 73 years with a mean age of 41.57 ± 10.62. Few subjects (5.3%) were underweight, 23.3% were overweight, and 26% were obese. The median CD4 count was 241.5 cells/mm3 and 72% of subjects were immunosuppressed. The prevalence of vitamin D deficiency was 45.3% (n=68). CD4 count was associated with the level of serum vitamin D, p-value &lt; 0.05.&#x0D; Conclusion: Vitamin D deficiency was prevalent among the studied HIV population. Our study found a significant correlation between serum vitamin D level and CD4 counts. It may be concluded that highly antiretroviral therapy HAART, improves CD4 level when there is sufficient vitamin D level, however, this merits further extensive exploration.&#x0D; Authors&#x0D; A A Salawu 1, T W Oloyede 2, E O Oke 3, O T Oladibu 4, S A Ojedokun 5, S O Oiwoh 6, K I Oreagba 7

Male Circumcision: A Means to Reduce HIV Transmission between Truckers and Female Sex Workers in Kenya

Kenya records over 1.5 million cases of HIV-infected people with a prevalence of 4.8% among adultsin 2019, ranking Kenya as the seventh-largest HIV population in the world. A recent study showed that55.9% of Kenyan truckers pay for sex in while 46.6% had a regular partner along their trucking route inaddition to a wife or girlfriend at home. The complexity in the sexual network of Truckers, which can be aconduit for the widespread of HIV, necessitated the need to better understand the dynamics of transmissionof HIV/AIDS between truckers and female sex workers. In this study, a model is formulated for HIV/AIDSdynamics along the Northern corridor highway in Kenya. The reproduction number, disease-free equilibriumand endemic equilibrium points were determined and their stabilities were also determined using the nextgenerationmatrix method. The disease-free equilibrium is stable when R0u &lt; 1, R0c &lt; 1 and R0f &lt; 1 whilethe endemic equilibrium point is stable when R0u &gt; 1, R0c &gt; 1 and R0f &gt; 1. It is found that circumcision canbe used as an intervention to minimize the infection of HIV among truckers and female sex workers.

Discordance between HIV-1 Population in Plasma at Rebound after Structured Treatment Interruption and Archived Provirus Population in Peripheral Blood Mononuclear Cells.

ABSTRACTAntiretroviral therapy (ART) can sustain the suppression of plasma viremia to below detection levels. Infected individuals undergoing a treatment interruption exhibit rapid viral rebound in plasma viremia which is fueled by cellular reservoirs such as CD4+ T cells, myeloid cells, and potentially uncharacterized cellular sources. Interrogating the populations of viruses found during analytical treatment interruption (ATI) can give insights into the biologically competent reservoirs that persist under effective ART as well as the nature of the cellular reservoirs that enable viral persistence under ART. We interrogated plasma viremia from four rare cases of individuals undergoing sequential ATIs. We performed next-generation sequencing (NGS) on cell-associated viral DNA and cell-free virus to understand the interrelationship between sequential ATIs as well as the relationship between viral genomes in circulating peripheral blood mononuclear cells (PBMCs) and RNA from rebound plasma. We observed population differences between viral populations recrudescing at sequential ATIs as well as divergence between viral sequences in plasma and those in PBMCs. This indicated that viruses in PBMCs were not a major source of post-ATI viremia and highlights the role of anatomic reservoirs in post-ATI viremia and viral persistence.IMPORTANCE Even with effective ART, HIV-1 persists at undetectable levels and rebounds in individuals who stop treatment. Cellular and anatomical reservoirs ignite viral rebound upon treatment interruption, remaining one of the key obstacles for HIV-1 cure. To further examine HIV-1 persistence, a better understanding of the distinct populations that fuel viral rebound is necessary to identify and target reservoirs and the eradication of HIV-1. This study investigates the populations of viruses found from proviral genomes from PBMCs and plasma at rebound from a unique cohort of individuals who underwent multiple rounds of treatment interruption. Using NGS, we characterized the subtypes of viral sequences and found divergence in viral populations between plasma and PBMCs at each rebound, suggesting that distinct viral populations appear at each treatment interruption.

Digitally supported HIV self-testing increases facility-based HIV testing capacity in Ekurhuleni, South Africa.

BackgroundHIV testing is the first step for linkage to HIV prevention or treatment services. Facility-based HIV testing is the most utilised method, but faces challenges such as limited work space and human resources. Digitally supported HIV self-testing (HIVST) provided in clinics shifts testing to the client, potentially empowering the client, and addresses such constraints.ObjectivesThe study primary objective was to determine the feasibility of integrating digitally supported HIVST into the clinic. Secondary objectives were to describe HIV testing volume, populations reached, and antiretroviral treatment (ART) initiation.MethodWe conducted an analysis of prospectively collected data during implementation of digitally supported HIVST in two healthcare facilities based in South Africa from June 2019 to September 2019. We described implementation and client characteristics using HIVST and compared testing before and during implementation.ResultsDuring the 4-month implementation period there were 35 248 client visits. A total of 6997 (19.9%) of these visits involved HIV testing. Of those testing, 2278 (32.5%) used HIVST. Of the 2267 analysed, 264 (11.6%) were positive: 182 (12%) women and 82 (11%) men. Of those, 230 (95.4%) were confirmed HIV positive and 150 (65%) initiated ART within 14 days. During a four-month pre-implementation period, 14.5% of the clients tested for HIV. Compared to the pre-implementation period, we observed a 25% increase in HIV testing.ConclusionDigitally supported HIVST increased the number of clients completing HIV testing in the health facility, without a need to significantly increase staff or space. Facility-based digitally assisted HIVST has the potential to increase HIV testing in high HIV prevalence clinic populations.

Considering whether countries participating in clinical trials can afford the intervention.

... Clinical trials often recruit from a diverse array of countries to help researchers understand the generalizability of their intervention. The economic circumstances in participating countries may vary substantially. This raises the issue of whether the intervention, even if proven to be effective and cost-effective in wealthy countries, would be cost-effective among resource-limited participant countries. It is only fair that states who help establish an intervention benefit from that intervention immediately after the trial concludes and over an extended period. However, this may be difficult to achieve, particularly for interventions that are inexpensive and exhibit small absolute health gains (cost-effectiveness ratios are generally easier to improve upon for expensive and/or highly effective interventions). Here, we provide an example. It is well established that HIV infection, even when well treated, increases the risk of atherosclerotic cardiovascular disease (ASCVD; Shah et al., 2018). In 2015, a large clinical trial, the Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE), was launched to test the effectiveness of statins for primary prevention of ASCVD in people living with HIV (PLHIV) at low to moderate risk of cardiovascular disease based on an assessment of traditional risk factors (ClinicalTrials.gov, 2020). Generic statins cost <$1 per day in most parts of the world and typically reduce ASCVD incidence by between 10% and 30% (Cholesterol Treatment Trialists’ Collaborators, 2012). Estimates of primary ASCVD incidence in the current HIV population range from 3 to 6 per 1000 person-years (Friis-Moller et al., 2016; Boettiger et al., 2020). REPRIEVE has now recruited 7770 participants from 11 countries, 9 of which are classified as low- or middle-income (The World Bank, 2020). The results are expected in 2023.