Treatment failure in second-line antiretroviral therapy (ART) among people living with HIV remains a critical concern in Zambia. This study investigated virological failure and factors associated with treatment failure among patients on second-line ART at two tertiary hospitals in Zambia. A cross-sectional study was conducted on 257 patient records from 1 January 2022 to 30 April 2025 on second-line ART from two tertiary hospitals. Multivariable logistic regression data analysis was performed using Stata 14.2. The prevalence of treatment failure was found to be 12.06% (95% CI 8 to 16%). Key predictors of treatment failure included younger age (<15-35 y), male gender (adjusted OR [aOR]-3.05; 95% CI 1.28 to 7.27) and ART initiation at WHO Clinical Stage 2 or above (aOR=1.62; 95% CI 0.68 to 3.82). Additionally, patients on a zidovudine/lamivudine/dolutegravir second-line regimen demonstrated significantly lower odds of failure compared with those on zidovudine/lamivudine/darunavir (aOR=0.34; 95% CI 0.16 to 0.77). This study found that treatment failure among people living with HIV on second-line ART in Zambia remains a significant concern. To improve treatment outcomes and reduce HIV-associated morbidity and mortality in Zambia, strengthening routine viral load monitoring and adherence support initiatives is essential.

Although ART has transformed HIV into a manageable chronic condition, significant cost and logistical challenges persist, threatening progress toward the UNAIDS 95-95-95 targets. Budget allocation to the health sector declined by over 30% in the last decade in Zimbabwe, attributed to donor fatigue and emergence of pandemics. The time-driven activity-based costing (TDABC) method was used to estimate the provider costs of ART and inform resource allocation for sustained ART programming. A descriptive cross-sectional study in 11 facilities across Zimbabwe’s four levels of care collected data using standardized instruments, capturing over 2,500 provider-recipient observations. Process maps of HIV care pathways were developed with subject matter experts to document resource use and standard of care. Time taken to deliver ART services, cost of space and cost of equipment were used to calculate costs and validated by national level stakeholders. In 2022, annual provider costs for ART in totalled $168.66 million for 1.2 million patients. National costs are projected to $192.44 million by 2026, attributed to declining HIV-related mortality and incidence. Primary care facilities bore 75% of costs due to higher patient volume. Provider costs averaged $57.05 for adult ART initiation and $62.70 for paediatric initiation. First-year ART costs per client were $252.78 (adult) and $450.56 (paediatric). Annual maintenance costs were $138.93 for first-line and $174.93 for second-line ART. Laboratory services ($30.72) contributed more to adult ART costs than medicines ($27.98). ART costs exceeded prior estimates, driven by facility-level differences, laboratory expenses, and paediatric formulations. Task-shifting proved cost-efficient, but sustainability is threatened by funding gaps and low health worker compensation. Optimizing laboratory systems and decentralizing services remain critical. External funding withdrawal created an annual gap of more than $50 million. Sustaining ART to 2030, requires improving domestic resource mobilization, strengthening ART decentralization, and designing cost-efficient laboratory models that preserve treatment quality.

Dolutegravir (DTG) is endorsed as a preferred option for both first- and second-line antiretroviral therapy (ART); however, comprehensive high-quality evidence regarding its virological effectiveness is still limited. This review evaluates and compares virological outcomes of DTG-based regimens with other ART options among people living with HIV. A comprehensive literature search was performed in PubMed/MEDLINE, the Cochrane Library, and Google Scholar. Randomized controlled trials (RCT) comparing DTG with other antiretroviral therapy regimens and reporting virological outcomes at 48 and/or 96 weeks were included. Study quality was evaluated using the Risk of Bias 2 tool. Fixed and random effects models were applied to calculate pooled proportions and risk differences (RD) with 95% confidence intervals, with a statistical significance defined as p < 0.05. A total of 15 RCTs including 8,360 participants were analyzed. In treatment-naïve adult individuals, DTG-based ART achieved significantly higher viral suppression than comparator ART at week 48 (RD; 0.03(95% CI 0.00, 0.05), P = 0.02 and week 96 (RD; 0.037(95% CI:0.012, 0.062). P < 0.001. In treatment-experienced adult individuals with suppressed baseline viral load, switching to DTG/lamivudine maintained virological suppression without increased risk of failure (RD; 0.00(95% CI: −0.03, 0.04), P = 0.9. Dolutegravir efficacy was consistent across baseline viral load and CD4 subgroups but superior to low-dose efavirenz-based ART (RD; 0.06(95%CI;0.01,0.11), P = 0.02. Dolutegravir-based ART provide superior viral suppression in treatment-naïve and maintain durable suppression in treatment-experienced adult individuals including those switching to DTG/lamivudine. These findings support DTG as a preferred first-line therapy and an effective option for regimen simplification. Not applicable.

ODYSSEY trial showed superior efficacy of dolutegravir-based antiretroviral therapy (ART) versus then-current, non-dolutegravir standard of care over 96 weeks in children and adolescents living with HIV. The aim of this ancillary analysis was to compare anthropometric and body composition outcomes, including weight, height, BMI-for-age Z score, weight-for-age and height-for-age Z scores (<14 kg), mid-upper-arm circumference (MUAC), waist circumference, hip circumference, and body fat percentage, as well as metabolic outcomes (lipids and glucose), between dolutegravir and standard of care over approximately 5 years of follow-up. In this open-label, randomised, non-inferiority trial, children (aged ≥4 weeks and <18 years), weighing 3 kg or more, starting first-line ART (ODYSSEY-A) or switching to second-line ART (ODYSSEY-B) were enrolled in 29 centres in Germany, Portugal, South Africa, Spain, Thailand, Uganda, Zimbabwe, and the UK in two cohorts (children weighing ≥14 kg and children weighing <14 kg). Treatment effects (dolutegravir vs standard of care) were estimated on randomised allocation, accounting for treatment switches (substantial in standard of care arm during extended follow-up) through censoring and inverse-probability-of-censoring-weights. Changes in continuous outcomes were compared using linear mixed models, accounting for correlated slope and baseline value. Proportions of participants with unfavourable outcomes were compared using logistic mixed models. ODYSSEY is registered with ClinicalTrials.gov, NCT02259127, EUDRACT, 2014-002632-14, and ISRCTN, ISRCTN91737921. Between Sept 20, 2016, and Aug 26, 2019, 792 children were randomly assigned (392 to dolutegravir and 400 to standard of care). Of 707 children in the 14 kg or more cohort, 311 received first-line ART (ODYSSEY-A; 145 [92%] of 157 received efavirenz-based ART as standard of care) and 396 received second-line ART (ODYSSEY-B; 195 [98%] of 200 received boosted protease inhibitors as standard of care). Of 85 children in the less than 14 kg cohort, 72 received first-line ART (32 [74%] of 43 received lopinavir-ritonavir as first-line or second-line standard of care). Median follow-up on randomised allocation was 287 weeks (IQR 240-311) on dolutegravir-based ART and 205 weeks (168-240) on standard of care in the 14 kg or more cohort, and 220 weeks (208-232) on dolutegravir-based ART and 144 weeks (127-192) on standard of care in the less than 14 kg cohort. In the 14 kg or more cohort, 345 (49%) were female and 362 (51%) were male, 623 (88%) were Black African, median enrolment age was 12·2 years (IQR 9·1 to 14·9), weight 30·7 kg (23·4 to 43·0), and BMI-for-age Z score -0·6 (-1·4 to 0·1); 35 (5%) were overweight and six (1%) were obese. At week 240, adjusted mean differences (dolutegravir minus standard of care) were 1·0 kg for weight (95% CI -0·2 to 2·2; p=0·095) and 0·4 cm for MUAC (0·0 to 0·8; p=0·030), driven by differences in first-line participants, where higher increases were also observed in height, waist circumference, and hip circumference. Increases in BMI-for-age Z score, body fat percentage, and cross-sectional waist-to-height ratio were similar on dolutegravir-based ART and standard of care. Total cholesterol (-15·3 mg/dL [-21·0 to -9·5]; p<0·0001), triglycerides (-14·4 mg/dL [-25·2 to -3·6]; p=0·0089), and glucose (-4·4 mg/dL [-6·8 to -1·9]; p=0·0004) were lower with dolutegravir than standard of care. In the less than 14 kg cohort, 44 (52%) were female and 41 (48%) were male, 83 (98%) were Black African, median enrolment age was 1·4 years (IQR 0·6 to 2·0), weight 8·1 kg (5·4-10·0) and BMI-for-age Z score -0·8 (-1·9 to 0·2); three (4%) were overweight and none obese. Changes in weight, weight-for-age, BMI-for-age and height-for-age Z scores by 192 weeks were similar on dolutegravir and standard of care; there were small differences in MUAC (0·6 cm [-0·1 to 1·3]; p=0·070) and height (-2·5 cm [-4·5 to -0·5]; p=0·016). No significant differences in lipid biomarkers were observed; glucose decreased with standard of care but not with dolutegravir. Over approximately 5 years, indices defining excessive weight gain and central adiposity were similar with dolutegravir and other anchor drugs, and lipid and glycaemia profiles with dolutegravir were reassuring, providing supporting evidence for dolutegravir-based ART as the preferred treatment in children and adolescents. Fondazione Penta ETS, ViiV Healthcare, and UK Medical Research Council.

Few studies have compared body composition changes in children living with HIV receiving integrase inhibitors or boosted protease inhibitors. Children switching to second-line antiretroviral therapy were randomized to dolutegravir (DTG), darunavir/ritonavir (DRV/r), atazanavir/ritonavir (ATV/r) or lopinavir/ritonavir (LPV/r), and to tenofovir alafenamide (TAF) or standard of care (abacavir or zidovudine) using a factorial design. Body composition was measured using bioelectric impedance analysis over 96 weeks. Associations between baseline characteristics and changes in fat mass, fat-free mass, muscle mass and body fat percentage were estimated using robust regression with multivariable fractional polynomial selection (exit P = 0.05). Eight hundred forty-one participants were included in the analysis. Females compared with males had greater fat accrual (+4.66% body fat, +1.32 kg fat mass; both P < 0.001). Compared with LPV/r, ATV/r and DTG exposures were associated with higher fat-free mass [+0.85 kg (95% confidence interval: 0.43-1.27) and +0.79 kg (0.37-1.21) respectively] and muscle mass [+0.82 kg (0.41-1.23) and +0.82 kg (0.42-1.22), respectively] (all P < 0.001). TAF and DRV/r exposures were associated with higher fat mass [+0.32 kg (0.12-0.52) P = 0.002; +0.33 kg (0.04-0.61) P = 0.025, respectively]. Prior nevirapine exposure was also associated with greater fat accrual [+0.36 kg (0.13-0.58) vs. efavirenz, P = 0.002]. Baseline CD4 and viral load, time on first-line antiretroviral therapy, and site were also associated with composition changes. DTG and ATV/r were associated with greater gains in fat-free mass and muscle mass than LPV/r, while DRV/r, TAF and prior nevirapine exposure were associated with fat mass accrual. Fat gain may initially reflect return to health but sustained increases may have metabolic implications. These findings suggest the need to monitor fat compartments with long-term exposure.

Retention in antiretroviral therapy (ART) is critical for HIV treatment success. Evidence on the impact of Test-and-Treat (TT) strategy in high-burden urban settings remains limited. We evaluated TT implementation effect on ART patients’ retention and identified predictors of loss-to-follow-up (LTFU) in Maputo, Mozambique. A retrospective cohort study (2013–2020) was conducted among ART patients aged 15–49 years using data from 12 health facilities (HFs). Patients were grouped into pre-Test-and-Treat (BTT, 2013–2016) and post-Test-and-Treat (ATT, 2017–2020) cohorts for comparative purposes. Retention probabilities were estimated using Kaplan–Meier methods, and predictors of loss to follow-up (LTFU) were assessed using Cox proportional hazards models. Population attributable fractions (PAFs) were calculated to quantify the population-level impact of Test-and-Treat implementation. Among 16,968 patients (9,036 BTT; 7,932 ATT), 7,908 experienced LTFU over 487,958 person-months. Loss to follow-up incidence decreased from 17.3 to 15.0 per 1,000 person-years in BTT versus ATT, a 13.3% reduction. Median retention time (MRT) increased from 39.8 to 49.0 months. Test-and-treat reduced LTFU hazard by 25% (adjusted PAF 23%). Higher LTFU risk was associated with male sex, WHO stage III/IV, HIV/TB co-infection, second-line ART, and non-membership in community ART groups (CAGs). Test-and-Treat substantially improved ART retention, particularly when combined with differentiated service delivery models (DSDMs). Targeted interventions for high-risk groups may further enhance retention. Future research should assess TT effects in specific subpopulations and account for undocumented deaths and self-transfers.

Second-line antiretroviral therapy (ART) failure remains a challenge in HIV Programs. We conducted a cross-sectional study among people living with HIV on second-line ART in Eastern Uganda to determine the prevalence and associated factors of virological failure and to assess elevated serum bilirubin as a surrogate marker of adherence. The prevalence of virological failure was 7.5%. Elevated bilirubin showed poor sensitivity and specificity for predicting adherence or virological failure. The findings highlight the need for routine viral load monitoring, as bilirubin is not a reliable surrogate marker of treatment adherence or virological failure.

Long-term impact of antiretroviral therapy (ART) on bone health in children living with HIV (CLWH) remains uncertain. We aimed to determine associations of change in bone mineral density (BMD) among CLWH in Uganda in a 2-year prospective sub-study in the CHAPAS-4 randomized trial (ISRCTN22964075). CLWH aged 3-15 years switched to second-line ART including tenofovir alafenamide fumarate-emtricitabine (TAF/FTC) or standard-of-care (SOC) (abacavir (ABC) or zidovudine (ZDV) with dolutegravir (DTG), atazanavir/ritonavir (ATV/r), darunavir/ritonavir (DRV/r) or lopinavir/ritonavir (LPV/r). BMD was assessed by dual-energy X-ray absorptiometry (DXA) at baseline, weeks 48 and 96 and bone turnover markers measured at baseline, week 24, 48, and 96. Robust regression analysis determined associations of BMD and bone turnover markers through week 96. Of 196 participants,167 contributed BMD measurements. Median (IQR) age was 9.9(7.0,12.3) years, 47% male, median (IQR) CD4 T-cell count 797(537,1140) cells/µl and mean (SD) viral load (log10 copies/ml) 4.3(0.8). Change in Procollagen type I N-terminal propeptide (PINP), C-terminal telopeptide of type I collagen (CTX) and height-adjusted (HA) BMD were similar between TAF/FTC and SOC. Greater declines in total-body-less-head (TBLH) BMD were associated with higher baseline TBLH (HA) BMD (Coef. -0.30,95% CI: -0.46, -0.15], p < 0.001) and first-line nevirapine (NVP) exposure (-0.25,95% CI: -0.43, -0.06, p = 0.009). Smaller TBLH HA BMD declines were associated with higher baseline fat-mass (0.06, 95% CI:0.01, 0.11, p = 0.021), higher lumbar spine (LS) HA BMD (0.17, 95% CI:0.03, 0.31, p = 0.015), DRV/r (0.46, p < 0.001,95% CI:0.21,0.71), DTG (0.26, p = 0.041,95% CI:0.01,0.51) or ATV/r (0.28, p = 0.026, 95% CI: 0.03, 0.52) use compared with LPV/r. Smaller declines in TBLH BMD were associated with higher baseline fat mass, higher LS HA BMD, and use of DRV/r, DTG, or ATV/r compared with LPV/r. These findings emphasize the importance of ART selection and body composition in supporting bone health among CLWH.

People living with HIV have a longer lifespan and a lower mortality rate due to advancements in antiretroviral therapy. However, the clinical signs of HIV and psychological difficulties continue to impair their health-related quality of life. Therefore, this study aimed to assess health-related quality of life and examine the direct and indirect factors influencing it among people living with HIV on second-line antiretroviral therapy in Dessie and Woldia Comprehensive Specialized Hospitals Northeast Ethiopia. An institutionally based cross-sectional study was conducted in Dessie and Woldia Comprehensive Specialized Hospitals in Northeast Ethiopia from January 13 to April 13, 2025, with 825 people living with HIV on second-line antiretroviral therapy selected through simple random sampling. Data were collected through face-to-face interviews, document reviews, and analyzed with STATA version 17. Quality of life was measured with the WHOQOL-HIV BREF, and depression with the PHQ-9. Structural equation modeling was employed to assess the direct and indirect effects of variables on quality of life. Statistical significance was declared at P < 0.05, and effect sizes are reported with 95% CIs. The findings were presented through text, tables, and graphs. The mean quality of life score was 48.7 (95% CI: (47.44, 49.96)). Internalized stigma had a direct [β ̂ = −0.59, (95% CI: -0.80, -0.381)] and indirect [β ̂ = −0.16, (95% CI: -0.249, -0.077)] negative effect on overall quality of life. The absence of opportunistic infection had a direct [β ̂ = 0.14, (95% CI: 0.028–0.248)] positive effect on overall quality of life. Depression had a direct [β ̂ = −0.54, (95% CI: -0.734, -0.339)] negative effect on the physical domain quality of life. Social support had a direct [β ̂ = 0.20, (95% CI: 0.046, 0.337)] positive effect on the social domain quality of life. Moreover, patients with nonworkable functional status had a 0.18 lower physical domain quality of life score [β ̂ = −0.18, (95% CI: -0.358, -0.008)]. Health-related quality of life for individuals living with HIV receiving second-line antiretroviral therapy was found to be significantly impacted psychosocial and clinical variables. It was predicted by opportunistic infections, social support, depression, internalized and perceived stigma, and functional status. Therefore, regular mental health screenings and interventions should be strengthened and integrated into HIV care programs at healthcare facilities.

BackgroundHypertension is a major health concern in Sub-Saharan Africa (SSA). People living with human immunodeficiency virus (PLHIV) face unique risks for cardiometabolic disorders. However, the factors associated with hypertension among PLHIV have been understudied in SSA. This study examines the prevalence and determinants of hypertension among PLHIV in Ghana.MethodsA total of 440 PLHIV aged 18 years and older receiving antiretroviral therapy (ART) for a minimum of six months were recruited in this hospital-based cross-sectional study. Variables assessed included blood pressure, alcohol consumption, type of antiretroviral therapy (ART) medication, duration of exposure to ART, smoking history, age, sex, level of education, and exercise. Binary logistic regression was used to determine the factors associated with hypertension.ResultsThe overall prevalence of hypertension was 33%. People living with HIV who were on second-line ART had a lower risk of hypertension compared to those on first-line ART (OR = 0.379; 95% CI: 0.169–0.846; p = 0.018). Similarly, participants with high muscle mass (OR = 0.177; 95% CI: 0.064–0.487; p < 0.01) and those with very high muscle mass (OR = 0.220; 95% CI: 0.051–0.943; p = 0.041) had a lower risk of hypertension compared to those with low muscle mass. In contrast, participants who were obese had approximately four times greater odds of hypertension compared to those with underweight (OR = 4.046; 95% CI: 1.018–16.083; p = 0.047). Additionally, participants with medium IDDS (OR = 1.968; 95% CI: 1.150–3.369; p = 0.014) and high IDDS (OR = 2.348; 95% CI: 1.078–5.115; p = 0.032) had about twice the risk of hypertension compared to those with low IDDS.ConclusionThis study found a high prevalence of hypertension among PLHIV. Second-line ART may reduce the risk of hypertension, while higher muscle mass may have a protective effect. Further research is needed to better understand the impact of dietary diversity and specific dietary components on hypertension in this population.

IntroductionFor people living with HIV (PLHIV) who are on second-line antiretroviral therapy (ART), attaining viral resuppression is vital to support immune recovery, avoid antiretroviral resistance, and lower HIV-associated morbidity, mortality, and onward transmission. However, evidence on the level of resuppression and its determinants in Ethiopia is limited.ObjectiveTo assess the viral resuppression rate and identify predictors among PLHIV on second-line ART at Gondar Comprehensive Specialized Hospital, Northwest Ethiopia.MethodsAn institution-based retrospective cohort study was conducted at the ART clinic of the University of Gondar Comprehensive Specialized Hospital from November 2021 to May 2022. Patient charts of 385 individuals receiving second-line ART were selected with simple random sampling technique. A validated questionnaire adopted from previous studies was used for data collection from patient records at the ART clinic. Collected data were entered into EpiData version 3.1 and analyzed using Stata version 14. Viral resuppression was defined as a viral load of <1000 copies/mL. In the statistical analysis, variables with a P-value < .20 in the bivariate analysis were included in the multivariable Cox proportional hazards regression model to identify independent predictors of viral resuppression.ResultsOut of the 385 patient charts initially selected, five charts were excluded because they had incomplete or missing key variables required for the study analysis. Therefore, the final analysis was conducted on 380 complete patient charts. The median age of the study participants was 41.41 years with an interquartile range (35.0-48.0). In the follow-up period, 297 patients (78.16%; 95% CI: 73.90-82.33) achieved viral resuppression. In multivariable Cox proportional hazards regression analysis, the factors significantly associated with viral resuppression were alcohol consumption (adjusted hazard ratio [AHR] = 1.55; 95% CI: 1.09-2.21), smoking (AHR = 1.49; 95% CI: 1.04-2.13), baseline viral load (AHR = 5.60; 95% CI: 2.07-15.12), good medication adherence (AHR = 1.63; 95% CI: 1.02-2.61), and history of drug substitution (AHR = 1.32; 95% CI: 1.02-1.72).Conclusion and RecommendationsThis study demonstrated that the viral resuppression rate among people living with HIV receiving second-line ART at Gondar Comprehensive Specialized Hospital remains low. Viral resuppression was significantly associated with alcohol consumption, smoking, medication adherence, prior drug substitution, and baseline viral load. Strengthening adherence support, minimizing unnecessary drug substitutions, and providing targeted follow-up for high-risk patients are critical to improving treatment outcomes.

Background/ObjectivesUndernutrition remains a major public health challenge among people living with HIV, particularly in low-income settings, where it adversely affects treatment outcomes, immunity, and survival, where it contributes to poor treatment outcomes, increased susceptibility to opportunistic infections, and higher mortality. Although several studies in Ethiopia have examined undernutrition among adults receiving first-line antiretroviral therapy (ART), evidence focusing specifically on individuals receiving second-line ART is limited. Therefore, this study aimed to assess the prevalence of undernutrition and identify factors associated with undernutrition among adults living with HIV receiving second-line ART in public health facilities of Debark town, Ethiopia.MethodsAn institution-based cross-sectional study was conducted from June 1 to June 30, 2025, among adults living with HIV receiving second-line ART in public health facilities of Debark town, Ethiopia. Participants were selected using a simple random sampling technique based on medical registration numbers. Data were collected using a structured interviewer-administered questionnaire and medical record review checklist adapted from previous studies. Nutritional status was assessed using body mass index (BMI). Data were entered into EpiData version 3.1 and analyzed using STATA version 14. Bivariable and multivariable logistic regression analyses were performed to identify factors associated with undernutrition.ResultsUndernutrition, defined as a BMI of < 18.5 kg/m2, was observed in 24% of the participants (95% confidence interval (CI) [20-28]). Factors significantly associated with undernutrition included poor ART adherence (adjusted odds ratio (AOR) = 4.10; 95% CI [1.64-10.27]), ART duration ≤24 months (AOR = 9.20; 95% CI [3.43-24.65]), presence of opportunistic infections (AOR = 2.35; 95% CI [1.11-4.96]), low dietary diversity score (AOR = 2.19; 95% CI [1.19-4.04]), moderate household food insecurity (AOR = 2.17; 95% CI [1.16-4.09]), and severe household food insecurity (AOR = 2.53; 95% CI [1.17-5.46]).Conclusion and recommendationsThe prevalence of undernutrition among adults receiving second-line ART was high. Poor treatment adherence, opportunistic infections, shorter duration of therapy, household food insecurity, and low dietary diversity were significantly associated with undernutrition. Strengthening nutritional counseling, promoting dietary diversification, linking food-insecure households to food support and social protection programs, and integrating routine nutritional assessment and support into HIV care are recommended to improve nutritional outcomes in this population.

ObjectiveThe aim of this study was to evaluate the long-term effect of Chinese medicine (CM) on the survival of people living with HIV (PLHIV) by investigating the potential synergistic effects of combining CM with antiretroviral therapy (ART).MethodsWe conducted a 17-year cohort study based on standardized case registry data, using various packages in the R software. PLHIV enrolled in the national CM HIV treatment trial were classified as the CM group, while PLHIV not enrolled were classified as the Non-CM group. CD4+T cell count and ART regimen were collected annually during the period from the cohort start to the endpoint. The cumulative observations of person-years and mortality were computed using life table analysis. The cumulative survival rates and survival curves were compared using Kaplan-Meier and log-rank tests. CD4+T cell count and ART regimen were time-dependent covariates, and a marginal structural Cox model was used to control for these variables in evaluating the effect of CM on the survival of PLHIV.ResultsA total of 2,924 PLHIV were included in the analysis, comprising 1,210 in the CM group and 1,714 in the Non-CM group. The mortality was significantly lower in the CM group than that in the Non-CM group (2.92/100 person-years vs. 3.86/100 person-years, P < 0.001). Multivariate analysis showed that the risk of death in the CM group was 0.86 compared with the Non-CM group (95% CI: 0.77–0.97, P < 0.05). The mortality risk of patients who received first-line ART and second-line ART was 0.47 (95% CI: 0.39–0.56, P < 0.05) and 0.49 (95% CI: 0.38–0.62, P < 0.001), respectively, compared with those who did not receive ART.ConclusionThe results demonstrate that after controlling the time-dependent covariates with a marginal structural Cox model, CM could improve the long-term survival rate of PLHIV by investigating the potential synergistic effects of combining CM with ART.

Background/Aim: The eye is a common site of manifestation of systemic diseases, particularly in immunocompromised individuals. Human immunodeficiency Virus (HIV) infection and its treatment with antiretroviral drugs (ARVs) have been associated with ocular changes, including variations in amplitude of accommodation (A.A) and intraocular pressure (IOP). While antiretroviral therapy (ART) has significantly improved survival, its long-term ocular effects remain underexplored. Methods: A hospital-based study was conducted among 102 HIV-positive subjects on first-line and second-line ART regimens. Convenience Sampling method was utilized to obtain data from these subjects at Imo State Specialist Hospital Umuguma Owerri Imo State and General Hospital Awo Omama Imo State. Standard optometric techniques were used to measure amplitude of accommodation (A.A), while non-contact tonometry was employed to assess intraocular pressure. Sociodemographic and clinical data were collected, using informed consent and case record reviews. Data were analysed using T-test. Results: The mean amplitude of accommodation was 7.62D among subjects on first-line ARV and 9.61D among those on second-line ARV, with no significant difference between the two groups and with P value = 1.00. The mean intraocular pressure was 21.30mmHg for first-line and 20.80mmHg for second-line ARV groups, showing a significant variation with P value of 0.001. There was no difference in A.A between immunocompromised subjects taking ARV1 and ARV2. There was a difference in IOP between immunocompromised subjects taking ARV1 and ARV2. Discussion: The study assessed the amplitude of accommodation (A.A) and intraocular pressure (IOP) among immunocompromised subjects taking antiretroviral drugs (ARVs). Immunocompromised subjects on first-line ARV (ARV1) and those on second-line ARV (ARV2) show no difference in A.A. Their A.A is more likely to be affected by age, systemic health status and ocular comorbidities than the ARV they are taking. ART itself does not appear to exert a direct pharmacological effect on the accommodative apparatus of the eye. However, there is a difference in IOP between immunocompromised subjects taking ARV1 drugs and those taking ARV2 drugs. This difference in IOP is closely associated with the drug regimen or type of therapy. Protease inhibitors in second line drugs (ARV2) tend to cause increase in IOP. Lower or stable IOP levels among subjects on first-line ART is possibly due to a lesser impact on aqueous outflow. Conclusion: Immunocompromised individuals on ART exhibit measurable changes in both amplitude of accommodation and intraocular pressure. The study concluded that there was no difference in A.A between immunocompromised subjects taking first line ARV drugs and those taking second line ARV drugs. The study also highlights that there is a difference in intraocular pressure between imunocompromised subjects taking first line ARV drugs (ARV1) and those taking second line ARV drugs (ARV2). These findings highlight the need for regular ocular assessments in HIV-positive patients receiving long-term ART to prevent potential visual impairment and improve quality of life.

Ritonavir is important in antiretroviral therapy (ART) because it is used to boost the drug exposure of its fellow protease inhibitors (PIs). While PIs are commonly used in children, ritonavir data in this population are quite scarce. We investigated the population pharmacokinetics of ritonavir given to boost exposures of lopinavir, atazanavir, or darunavir, and co-administered with nucleoside reverse transcriptase inhibitors (NRTIs) in African children, and investigated factors affecting its exposure. We conducted a pharmacokinetic sub-study within the CHAPAS-4 (ISRCTN22964075) trial, which randomized children to two NRTIs with twice-daily lopinavir/ritonavir, once-daily atazanavir/ritonavir, or once-daily darunavir/ritonavir, as second-line ART. Intensive pharmacokinetic blood samples were collected at week 6, and nonlinear mixed-effects modeling was used to identify factors affecting ritonavir pharmacokinetics. In all, 170 children were enrolled in the ritonavir-boosted PI arms of the CHAPAS-4 pharmacokinetic sub-study, with median age 10.6 (range 3.2-15.6) years and weight 26.0 (14.2-64.2) kg. Despite similar dose levels, ritonavir exposure varied widely depending on the companion PI. Compared to children on darunavir/ritonavir, those on atazanavir/ritonavir had 137% (95% CI 107%-190%) higher bioavailability and 20% (95% CI 11.3%-31.3%) faster clearance, while those on lopinavir/ritonavir had 23.4% (95% CI 8.20%-34.4%) lower bioavailability. No effect of NRTIs on ritonavir pharmacokinetics was observed. Ritonavir exposure is higher with atazanavir than with lopinavir or darunavir. These data provide greater insight into the use of ritonavir for boosting PIs in children and help reduce the knowledge gap regarding its exposure in children.

First-line antiretroviral therapy failure reduces the benefits of the antiretroviral therapy (ART) program and could lead to regimen change to a more expensive second-line ART. To identify ART failure, routine viral load monitoring is recommended as the gold standard and has been implemented in Ethiopia since 2017. However, evidence regarding the virological failure of the first-line ART is limited in the study setting, Dire Dawa Ethiopia. This study aimed to determine the magnitude and factors associated with virological treatment failure among adults on first-line ART follow-up in Dire Dawa between January 2017 and December 2019. A retrospective chart review was conducted among 272 randomly selected adults on first-line ART follow-up, between January 2017 to December 2019. Data were collected from patients’ medical records, entered into epi data version 3.02 and exported to Stata version 15 software for analysis. A bivariable and multivariable binary logistic regression model was used to identify factors associated with virological first-line ART failure. The goodness of fit of the model was assessed using the Hosmer–Lemeshow test. All statistical tests are declared significant at a P-value of < 0.05. A total of 257 ART patients’ records were included for final analysis. The magnitude of first-line ART virological failure was 11.28% (95% CI 7.69, 15.80). Baseline undernutritional status (AOR = 3.72: 1.05, 13.14), serostatus nondisclosure (AOR = 4.45: 1.34, 14.79), early (≤ 30 days) ART initiation (AOR = 0.235: 0.064, 0.859), history of missed any daily ART dose (AOR = 3.16: 1.01, 9.89) and dolutegravir-based regimen (AOR = 0.28: 0. 09, 0.90) were significantly associated with virological failure of first-line ART. The magnitude of virological first-line ART failure in this study was relatively high. Virological first-line ART failure was significantly associated with baseline BMI, HIV serostatus disclosure, duration of ART initiation after HIV diagnosis, history of missed ART doses, and substitution of DTG-based ART first-line regimens. To avoid treatment failure, it is crucial to disclose one's serostatus, encourage adherence initiatives, and early initiation of ART preferably a dolutegravir-based regimen.

Background:Virological failure in second-line antiretroviral therapy (ART) occurs when HIV patients have a viral load exceeding 1000 copies/ml, presenting significant public health challenges, including increased risk of transmission of HIV, heightened morbidity and mortality rates, and the risk of developing drug resistance. The extent of virological failure among second-line ART patients in the Harari region and Dire Dawa city of Eastern Ethiopia has not been thoroughly investigated. This study aimed to determine the prevalence of virological failure and its influencing factors from January 1 to December 31, 2023.Design and methods:A cross-sectional study was conducted among 478 adult second-line antiretroviral therapy users at an institution-based setting. A census was employed to recruit the study participants. Data was collected using a semi-structured data extraction checklist entered into EpiData version 4.6 and exported to SPSS version 26 for analysis. Descriptive statistics, along with bivariable and multivariable logistic regression analyses, were performed to determine the associations between virological failure and independent variables, using adjusted odds ratios with 95% confidence intervals. A p-value less than 0.05 was used to declare the statistical significance.Results:The overall prevalence of virological failure among adult second-line ART users was 12.76% (95% CI = 10.05–16.07). Smoking (AOR = 2.81), BMI status (AOR = 6.97), TB-HIV co-infection (AOR = 0.20), history of INH prophylaxis (AOR = 4.25), and enhanced ART adherence counseling (AOR = 7.02) were found to be significantly associated with virological failure among second-line ART users.Conclusion:Nearly 1 in 10 adults on second-line ART experienced virological failure. Factors such as smoking, nutritional status, TB-HIV co-infection, and adherence counseling significantly influenced outcomes. Continuous monitoring and clinical interventions are crucial to reduce virological failures in this population.

Comparative 10-year atherosclerotic cardiovascular disease risk in Ethiopian HIV patients on first-line versus second-line combined antiretroviral therapy.

BackgroundAligning with the World Health Organization, South Africa has replaced ritonavir-boosted lopinavir (LPV/r) with dolutegravir (DTG) in second-line antiretroviral therapy (ART) after treatment failure with tenofovir disoproxil fumarate (TDF)/lamivudine or emtricitabine (XTC)/efavirenz (EFV). Initial guidance included special considerations for DTG use among women.MethodsWe analyzed routine deidentified data of adults switched from TDF/XTC/EFV to second-line AZT/XTC/LPV/r, AZT/XTC/DTG, or TDF/XTC/DTG between December 2019 and December 2023 at 108 healthcare facilities in KwaZulu-Natal, South Africa. Among people switched before July 2021, we emulated a target trial comparing 24-month death or loss to follow-up (LTFU), and viremia (>50 copies/mL). We conducted intention-to-treat and per-protocol analyses using weighted logistic regression with bootstrapped CIs.ResultsOverall, women were less likely than men to switch to DTG (RR: 0.92 [95% CI: .88, .96]; N = 3649). Of 2321 people switched before July 2021, 915 (39%) switched to AZT/XTC/LPV/r, 415 (18%) to zidovudine (AZT)/XTC/DTG, and 991 (43%) to TDF/XTC/DTG. Median age was 36 years (IQR: 30, 43) and 1364 (59%) were women. In intention-to-treat analyses, the standardized 24-month risk of death or LTFU was similar with AZT/XTC/LPV/r (31%), AZT/XTC/DTG (30%), and TDF/XTC/DTG (34%). The standardized risk of 24-month viremia among those retained in care with a viral load result (N = 1270) was higher with AZT/XTC/LPV/r (50%) than with AZT/XTC/DTG (40%; aRD: −10% [95% CI −19%, −2%]) or TDF/XTC/DTG (39%; aRD: −11% [95% CI −18%, −5%]). Per-protocol analyses gave similar results.ConclusionsWhile retention was similar across regimens, viremia was less common on DTG-based ART, supporting current guidelines.

Abstract Background People living with HIV have a longer lifespan and a lower mortality rate due to advancements in antiretroviral therapy. However, the clinical signs of HIV and psychological difficulties continue to impair their health-related quality of life. Therefore, this study aimed to assess health-related quality of life and examine the direct and indirect factors influencing it among people living with HIV on second-line antiretroviral therapy. Method An institutionally based cross-sectional study was conducted from January 13 to April 13, 2025, with 825 people living with HIV on second-line antiretroviral therapy selected through simple random sampling. Data were collected through face-to-face interviews, document reviews, and analyzed with STATA version 17. Quality of life was measured with the WHOQOL-HIV BREF, and depression with the PHQ-9. Structural equation modeling was employed to assess the direct and indirect effects of variables on quality of life. Statistical significance was declared at P &lt; 0.05, and effect sizes are reported with 95% CIs. The findings were presented through text, tables, and graphs. Result The mean quality of life score was 48.7 (95% CI: (47.44, 49.96)). Internalized stigma had a direct [β ̂ = −0.59, (95% CI: -0.80, -0.381)] and indirect [β ̂ = −0.16, (95% CI: -0.249, -0.077)] negative effect on overall quality of life. The absence of opportunistic infection had a direct [β ̂ = 0.14, (95% CI: 0.028–0.248)] positive effect on overall quality of life. Depression had a direct [β ̂ = −0.54, (95% CI: -0.734, -0.339)] negative effect on the physical domain quality of life. Social support had a direct [β ̂ = 0.20, (95% CI: 0.046, 0.337)] positive effect on the social domain quality of life. Conclusion This study revealed that psychosocial factors significantly impacted the quality of people living with HIV on second-line antiretroviral therapy. Social support, depression, perceived stigma, internalized stigma, nonworkable functional status, and opportunistic infections were predictors of quality of life. Hence, healthcare facilities should integrate and strengthen routine mental health screenings and interventions in HIV care programs.