Treatment Of HIV Patients Research Articles

HIV knowledge and preventive Standards Precautions Among Healthcare Workers in Blood Transfusion Centers

The number of instances of HIV has climbed considerably in the previous ten years, which is cause for alarm. Because healthcare workers are future healthcare professionals, they must have proper knowledge and preventive standards and precautions about HIV because they will play a vital role in the prevention of HIV transmission and treatment of HIV patients. The article aims to identify HIV knowledge and preventive standard precautions among healthcare workers in blood transfusion Centers. Cross-sectional descriptive research to characterize and provide information about the knowledge and preventive standards precautions among healthcare workers in blood transfusion Centers from March 25 to April 15, 2022. Participants from the described Studies (N = 34) provided data for these analyses. This result revealed that the participants' knowledge ranged between acceptable and good (47.05 and 52.95). Also, participants' knowledge of prevention strategies was similar, but the hand hygiene strategy was the most valuable (M: 3.62 and SD: 0.45). The instrument consists of 3 parts: part 1: demographical variables. Part two: healthcare workers' knowledge of HIV, Part 3: preventive standards precautions among healthcare workers. The current study of healthcare personnel shows that they have a decent understanding of HIV based on the precise results and adhere to the preventive measures during the blood transfusion. Keywords: HIV, knowledge, preventive Standards precautions, Healthcare Workers, Blood Transfusion Centers

Legacy of a magic gene—CCR5-∆32: From discovery to clinical benefit in a generation

The discovery of the 32-bp deletion allele of the chemokine receptor gene CCR5 showed that homozygous carriers display near-complete resistance to HIV infection, irrespective of exposure. Algorithms of molecular evolutionary theory suggested that the CCR5-∆32 mutation occurred but once in the last millennium and rose by strong selective pressure relatively recently to a ~10% allele frequency in Europeans. Several lines of evidence support the hypothesis that CCR5-∆32 was selected due to its protective influence to resist Yersinia pestis, the agent of the Black Death/bubonic plague of the 14th century. Powerful anti-AIDS entry inhibitors targeting CCR5 were developed as a treatment for HIV patients, particularly those whose systems had developed resistance to powerful anti-retroviral therapies. Homozygous CCR5-∆32/∆32 stem cell transplant donors were used to produce HIV-cleared AIDS patients in at least five "cures" of HIV infection. CCR5 has also been implicated in regulating infection with Staphylococcus aureus, in recovery from stroke, and in ablation of the fatal graft versus host disease (GVHD) in cancer transplant patients. While homozygous CCR5-∆32/32 carriers block HIV infection, alternatively they display an increased risk for encephalomyelitis and death when infected with the West Nile virus.

Distinct genetic clusters in HIV-1 CRF01_AE-infected patients induced variable degrees of CD4+ T-cell loss.

Retroviruses swiftly adapt, employing error-prone enzymes for genetic and phenotypic evolution, optimizing survival strategies, and enhancing virulence levels. HIV-1 CRF01_AE has persistently undergone adaptive selection, and cluster 1 and 2 infections display lower counts and fast loss of CD4+ T cells than other HIV-1 sub-types and CRF01_AE clusters. Its mechanisms are associated with increased CXCR4 tropism due to an envelope structure change favoring a tropism shift from CCR5 to CXCR4, thereby shaping viral phenotype features and impacting pathogenicity. This underscores the significance of consistently monitoring HIV-1 genetic evolution and phenotypic transfer to see whether selection bias across risk groups alters the delicate balance of transmissible versus toxic trade-offs, since virulent strains such as CRF01_AE clusters 1 and 2 could seriously compromise the efficacy of antiviral treatment. Only through such early warning and diagnostic services can precise antiviral treatments be administered to those infected with more virulent HIV-1 strains.

ЭФФЕКТИВНОСТЬ МОДЕЛИ ДЕЦЕНТРАЛИЗАЦИИ МЕДИЦИНСКОЙ ПОМОЩИ ЛЮДЯМ, ЖИВУЩИМ С ВИЧ, С ИНТЕГРАЦИЕЙ ВИЧ УСЛУГ В ПМСП ДУШАНБЕ

Objective: To evaluate the model of decentralization of medical care for people living with HIV (PLHIV), with the integration of HIV services into primary health care (PHC) by comparing the virologic efficacy of antiretroviral therapy (ART) between Dushanbe urban health centers (UHCs) and the Republican Center for AIDS Prevention and Control (RCAPC). Methods: The research was conducted using a cross-sectional design, with information gathered from the electronic HIV monitoring system and outpatient records of individuals living with HIV who were over 18 years old. The research examined clinical data on 220 patients (female-to-male sex ratio of 48:52) who were over 18 years old, had been on ART for more than two years, and was seen at 15 UHCs in Dushanbe, as well as 190 patients (female-to-male sex ratio of 48:52) from the RCAPC. The patients were categorized by age into three groups: 18-39, 40-49, and 50+ years. The study's objective was to assess these patients' viral load (VL) and CD4 counts in 2022. Descriptive statistics, computation of variable values, and correlation analysis were conducted, and a 95% confidence level interval was established for the variable considering VL suppression. The statistical significance of differences between data in groups was assessed using the Chi-square test (χ2 ) and Fisher's exact test (p). Results: Suppressed VL in patients was observed in 95.3% (p>0.05; 95% CI: 92.5-98.1) and 90.6% (p>0.05; 95% CI: 86.5-94.7) of cases in Dushanbe UHCs and at the RCAPC, respectively. In the meantime, unsuppressed VL was observed in 4.7% and 9.4% of cases in UHCs and at the RCAPC, respectively. In patients aged 18-39, 40-49, and 50+, suppressed VL was seen in 90%, 96%, and 99% at the UHCs, and the RCAPC – 93%, 90%, and 90% (p>0.05; p>0.05; p<0.05 respectively). CD4 counts of less than 350 cells/mm3 were found in 20.1% and 25.7% of patients in UHCs and at the RCAPC, respectively. In patients with viral hepatitis C (HCV), CD4 counts of less than 350 cells/mm3 were found in 37.7% and 23.2% of patients in UHCs and at the RCAPC, respectively. Spearman's rank correlation coefficient, denoted as rs , indicated a strong relationship between the proportions of HCV and CD4 counts of <350 cells/mm3 in different age subgroups within the UHCs and the RCAPC, with a correlation coefficient of 1.00 and a p-value of 0.01 in both groups. Conclusion: In Dushanbe's UHCs, the treatment of HIV patients with ART is more effective than at the RCAPC due to high patient adherence, resulting in VL suppression similar to 95-95-95 targets in the new UNAIDS Global AIDS Strategy (2021-2026). The proximity of HIV services to patients' homes likely contributes to treatment adherence, demonstrating the success of decentralized HIV care through integrated services in PHC in Dushanbe, Tajikistan. Keywords: HIV infection, people living with HIV, antiretroviral therapy, suppressed viral load, integration of HIV services, primary health care.

Prevalence and risk factors associated with tuberculosis and HIV coinfection in Iran: A multivariate firth logistic regression for rare events.

Among the complications caused by HIV infection, tuberculosis (TB) is the most important challenge. The study aimed to determine the predictors of TB and HIV coinfection by using Firth logistic regression analysis. This cross-sectional study was conducted on 32,168 HIV-positive patients diagnosed in Iran. The required information was obtained from the national HIV/AIDS surveillance data. The prevalence of TB in HIV patients was 3.2%; the prevalence of TB in males and females was 944 (91.83%) and 84 (8.17%), respectively. Based on results of multivariate Firth logistic regression, male gender OR male/female = 1.91; injecting drug use (IDU) OR YES/NO = 1.46; illiterate or primary groups OR illiterate or primary /university = 2.23; high school group OR high school/ university = 2.24 all increased the risk of TB and HIV coinfection (p < 0.05). Also, having CD4 > 500 [OR CD4 > 500 / < 200 = 0.39], CD4 351-500 [OR351 / < 200 = 0.65], and CD4 200-350 [OR200-350 / < 200 = 0.64] decreased the risk of TB and HIV coinfection (p < 0.001). According to the results of this study, male gender, low education, injecting drug users, and low CD4 count at the time of diagnosis, were significant predictors of TB and HIV coinfection. Therefore, regular and periodic screening programs and linkage to the care and treatment of HIV patients need special attention.

Care of the HIV patient. A view from the Nursing Care Process

The Nursing Care Process (NCP) is a systematic methodology to guide nursing professionals in the planning and execution of care, especially relevant in the management of HIV due to the complexity of the disease. HIV weakens the immune system, predisposing to infections and complications. Nursing care of HIV patients requires a thorough understanding of the pathophysiology of the virus and its psychological and social implications. The ECP includes a thorough initial assessment to identify specific needs, diagnosis of health problems, planning of realistic goals, implementation of personalized interventions, and ongoing evaluation of their effectiveness. This ensures comprehensive and tailored care, improving the quality of life and adherence to treatment of HIV patients.

An optimal combination of antiretroviral treatment and immunotherapy for controlling HIV infection

Antiretroviral (ART) drugs have been used to treat HIV patients over last two decades. But, the daily use of these drugs in order to control HIV load in patients’ body results different side effects and high cost over long period of time. Motivated by these, researchers have been trying to find other treatment strategy whose combination with antiretroviral treatments can control HIV without use of large quantities of drugs. Immunotherapy is one of such treatment which assist natural immune system of patients in order to get control over viral infection. Administration of immunotherapy in combination with antiretroviral drugs has been found safe and effective after different clinical trials on humans and other animals. In this paper, we propose a mathematical model to describe HIV dynamics under antiretroviral treatment and immunotherapy combination. We find that our model is biologically feasible and the findings of the clinical trials support the dynamics of our model. The stability analyses of HIV-free equilibrium point are performed and found the basic reproduction number as a threshold parameter. Also, we calculate a critical efficacy for overall antiretroviral treatment such that when the efficacy of overall treatment exceeds this value HIV will be completely removed. Also, we have found that critical drug efficacy for antiretroviral drugs decreases with increasing immunotherapy, which indicates combination of immunotherapy with antiretroviral treatments minimize the quantity of antiretroviral drugs for HIV eradication, hence minimize the side effects and cost of antiretroviral drugs. Numerical simulations are carried out to substantiate the analytical results and to illustrate different drug administration scenarios. Moreover, an optimal combination of drugs which can control HIV with lower costs and side effects, is obtained by solving an optimal control problem numerically.

Molecular Evaluation of the Efficacy of the TDF+3TC+EFV Therapeutic Regimen in the Treatment of HIV-1 Patients

Background: Antiretroviral therapy (ART) has played an important role in the response to HIV infection and has significantly reduced morbidity and mortality worldwide. It allows control of plasma viral load (CV) to an undetectable level CV&lt;50 copies/ml, an indicator of successful treatment. Assessing the effectiveness of ART makes it possible to make recommendations to limit failures in the treatment of HIV. Thus, the objective of this study is to evaluate the efficacy of the TDF+3TC+EFV therapeutic regimen in the treatment of HIV-1 infection. Materials and methods: This is a retrospective study of the treatment of HIV-1 seropositive patients, at the Molecular Biology Laboratory of HMO in Dakar, Senegal, from 2014 to 2021. The main criterion for evaluating the effectiveness of the treatment was the proportion of patients whose viral load value was undetectable (CV&lt;50 copies/ml) according to the duration of ART. Plasma viral load tests were performed on Abbott Real Time HIV-1® (m2000sp/rt) and COBAS®AmpliPrep/COBAS®TaqMan®(Roche) version 2.0. Variables with p&lt;0.05 were considered statistically significant for all comparisons between groups. Results: Of a cohort of 2,704 HIV+ patients, 2,078 met the inclusion criteria and 626 were excluded due to death, transfer or loss to follow-up. The median age was 38 years, women represented 71% patients. At 6 months of treatment, viral suppression was achieved in 8.9% of men and 6.5% of women (P=0.04) and it was significantly greater in young patients aged 0 to 25 years, 11.4% of patients. 79% of women and 75.2% of men had an undetectable viral load at 12 months of ART (P=0.01). Significantly the suppression was better in men in the first 6 months of treatment, they had more virological success, while women responded better to treatment for a duration of 12 months (P=0.01). At the end of the 18-month study period, 85.5% of patients had a suppressed viral load, 5.3% had a decrease in viral load levels and 7.2% of patients had ...

Pharmacological aspects and adherence to antiretroviral treatment in HIV patients

Introducción: la adherencia al tratamiento farmacológico favorece la supresión viral y reduce la resistencia a la terapia antirretroviral de gran actividad a largo plazo. Objetivo: determinar la relación entre los aspectos farmacológicos y la adherencia al tratamiento antirretroviral de una IPS colombiana. Metodología: estudio analítico transversal en 9835 pacientes con diagnóstico de VIH en tratamiento antirretroviral entre los años 2012 a 2020. Se utilizó un modelo de regresión logística binaria múltiple con fines explicativos. Resultados: la proporción de adherencia fue de 90,04% y en el modelo ajustado se evaluó su relación con los antecedentes de no adherencia (ORa:0,52 IC95%:0,40–0,66), grupo farmacológico (2 ITIAN + 1 IP u otro) (ORa:1,22 IC95%:0,99–1,76), dos tomas al día (ORa:1,02 IC95%:0,74–1,40), unidades al día (≥ 3) (ORa:0,69 IC95%:0,47–1,02), reacciones adversas a medicamentos (ORa:0,56 IC95%:0,40–0,78), polimedicación (ORa:1,36 IC95%:1,00–1,85), tiempo TAR (1 a 2 años) (ORa:1,63 IC95%:1,27–2,09),tiempo TAR (6 a 12 meses) (ORa:1,66 IC95%:1,27–2,18), tiempo TAR (&lt;6 meses) (ORa:1,36 IC95%:1,03–1,78), tasa de reclamación de los medicamentos (ORa:0,42 IC95%:0,32–0,55) y antecedentes PRUM (ORa:0,11 IC95%:0,09–0,14). Conclusión: los antecedentes de no adherencia, reacciones adversas, tasa de reclamación de los medicamentos y antecedentes de problemas relacionados con el uso de medicamentos son aspectos que reducen la probabilidad de adherencia; mientras que el mayor tiempo de uso del tratamiento aumenta la misma.

Model selection and identifiability analysis of HIV and SARS-CoV-2 co-infection model with drug therapy

Since the immune function of AIDS patients infected with SARS-CoV-2 is impaired, it is easier for SARS-CoV-2 to reproduce, replicate, and even mutate in the host. Therefore, the co-infection of SARS-CoV-2 and HIV in vivo deserves our attention. In this paper, a series of co-infection dynamic models of HIV, wild-type, and variant SARS-CoV-2 are developed and studied for four co-infected patients in South Africa. Based on the clinical data, such as the number of CD4+ T cells, HIV viral loads, and SARS-CoV-2 Ct value in four co-infected patients, we estimate the unknown parameters in the model by the affine invariant ensemble Markov chain Monte Carlo (GWMCMC) algorithm and select the best model for virus transmission in South African co-infected patients via the Akaike Information Criterion (AIC). The structural identifiability of the best model is investigated, and the model is qualitatively analyzed. Finally, we run sensitivity tests on the model parameters. The results show that SARS-CoV-2 mutates in vivo and quickly becomes the dominant strain for all four South African co-infected patients. In addition, it is shown that drugs used to treat HIV patients have no significant effect on the inhibition of the SARS-CoV-2 variant. Based on the theoretical analysis of the model, we obtain the basic reproduction number of the model and the stability of the equilibrium state, which qualitatively investigates the nature of co-infection dynamics. Moreover, we find that the systemic inflammation triggered by COVID-19 can cause the latent HIV reservoir’s reactivation and transiently increase viral loads. In terms of already-dead patient 1, if the drug that inhibits the replication of SARS-CoV-2 is used, then it can reduce the virus replication rate by 99%. Only in this way can the basic reproduction number of the SARS-CoV-2 infection be reduced to less than 1. That is, SARS-CoV-2 can be completely suppressed. This means that only by reducing the risk of COVID-19 infection in HIV patients as much as possible can we avoid the aggravation of the disease for such patients. Therefore, it is essential to increase vaccination coverage for COVID-19 in countries with a high prevalence of HIV.

Management of Medication Error Reporting in HIV/AIDS Patients

Background: One of the most frequent medical mistakes that lower patient safety and mortality is medication errors in HIV/AIDS patients. A structured reporting system is necessary for the efficient avoidance of these kinds of mistakes. In order to discover parameters influencing the management of medication mistake reporting in HIV-infected patients, the current research was carried out.&#x0D; Methods: The current research is an example of an applied study that was carried out between 2010 and 2019 utilizing a hybrid (quantitative-qualitative) methodology. First, the primary factors impacting the management of medication mistake reporting in HIV positive patients were collected from a study of the research literature and 35 interviews with experts in the area of treating HIV patients, and a research questionnaire was created utilizing them. Using the Lawshe approach, the questionnaire was sent to and collected from 31 experts in order to assess its content validity. SPSS23 was then used to determine the questionnaire's reliability, which resulted in a Cronbach's alpha value of 0.920. 400 workers who treated HIV/AIDS patients provided information for the data collection. Exploratory factor analysis was used to analyze the data, together with SPSS23 and Lisrel software.&#x0D; Results: Four factors were found to be important in managing medication mistake reporting in HIV patients, including organizational factors (18 variables), person factors (9 variables), educational factors (10 variables), and communication factors (6 variables). The management of medication mistake reporting in HIV patients was impacted most and least by personal and educational variables, with factor loadings of 0.784 and 0.754, respectively.&#x0D; Conclusion: It is preferable to concentrate on individual variables (employee-related hurdles, fear of the repercussions of reporting, and others' reactions) rather than addressing all four aspects at once in order to manage medication mistake reporting in HIV positive patients (managers, colleagues, patients). Managers, policymakers, specialists from behavioral disease counseling centers, and attending physicians should pay greater attention to both the individual (application and development of the integrated HIV management system).

Neurocognitive Impairment in Patients with HIV and Depression in Nigeria

HIV has been associated with neurocognitive impairment which may be due to the direct effect of the virus, indirect effect or due to medications side effects or due to a combination of factors. HIV and depression have been shown separately to have neurocognitive deficits.&#x0D; Aim: Determine the prevalence of NCI and factors associated with it among depressed and non-depressed patients with HIV on combined antiretroviral treatment (cART).&#x0D; Methodology. A descriptive comparative cross-sectional study was conducted among People living with HIV (PLHIV) at Aminu Kano Teaching Hospital in Kano State, northern Nigeria. Participants were grouped into HIV with depression and HIV without depression groups based on current diagnosis using the depression module of the MINI International Neuropsychiatric Interview (MINI)-7th edition. A multi-domain neuropsychological battery (MDNPT) of 5 tests (assessed 5 cognitive domains) was used to diagnose Neurocognitive impairment.&#x0D; Results: Fifty-seven percent of the study sample were females, and the mean age of the participants was 37.54 (±10.04) years with an age range of 18-65 years.&#x0D; The prevalence of NCI was 74% among the depressed 68.3% among the non-depressed group (p=0.484). Years of education and IHDS score were significantly associated with NCI in the depressed group (p &lt; 0.05 respectively). While among the non-depressed group, Years of education, average monthly income and IHDS score were significantly associated with NCI (p &lt; 0.05 respectively).&#x0D; Conclusion: Neurocognitive impairment occurs in HIV-positive patients but is worsened by a depressive disorder. There is a need to adequately assess and treat HIV patients with depression. Treatment may improve neurocognitive impairment in depressed HIV patients.

Quality of Life and Associated Factors of HIV Patients Under Treatment with First Line Regimens in Public Hospitals in Amhara Region, North-West Ethiopia.

The availability of medication related to HIV treatment in the world is one of the substantial improvements for reaching USAID's 90-90 targets. Among the 90% of patients who have awareness about their disease, 90% are accessing their treatment and patients who received appropriate treatment have a suppressed viral load and improved CD4 cell count. Therefore, the main objective of the current study was to investigate the quality of life and associated factors of people living with HIV receiving first-line regimens at public hospitals in the Amhara region, Ethiopia. A retrospective cohort study was conducted on 700 adult HIV-infected patients under treatment with first-line regimens, who were followed-up in 17 public hospitals in the Amhara region. A multivariate linear regression analysis was used for the current study. Of the 700 patients included in the current analyses, 59.5% (n=358) reported no impairment in self-care, while 63.1% (n=380) were extremely anxious/depressed. The overall expected EQ-5D utility score and visual analog scale (EQ-VAS) scores were 0.3880.41 and 66.2017.22 respectively. The current study indicated that the covariates sex, age of patient, level of education, appointment frequency, disclosure status of the disease, and substance use significantly affected the quality of life of people living with HIV and under treatment with first-line regimens. Hence, higher CD4 cell count and less detectable viral load lead to good quality of life of people living with HIV. This study indicates that certain covariates have been identified as statistically significant predictors of the study variable "quality of life" of HIV-positive people. The findings obtained in the current investigation can help policy-makers to revise the current directives. The result obtained in this study can also help health staff to conduct health-related education during the treatment of HIV patients.

Molecular Evaluation of the Efficacy of the AZT+3TC+NVP Therapeutic Regimen in the Treatment of HIV-1 Patients in Senegal

Molecular Evaluation of the Efficacy of the AZT+3TC+NVP Therapeutic Regimen in the Treatment of HIV-1 Patients in Senegal

Evaluation of absolute CD4 and CD4/CD8 ratios before and after antiviral treatment in HIV patients: A single-center experience

Evaluation of absolute CD4 and CD4/CD8 ratios before and after antiviral treatment in HIV patients: A single-center experience

Case Report: Lesson Learned from Delayed Definitive Treatment of Stage 4 HIV Patient with Cerebral Toxoplasmosis – A Case Report

Background: Cases of cerebral toxoplasmosis continue to burden people living with HIV/AIDS (PLWHA). This surge in cases is primarily due to patients’ delayed definitive treatment, missed follow-up, and insufficient diagnostic equipment in some regions, particularly in developing countries such as Indonesia.Case Presentation: We report on a 35-year-old male referred to the emergency department with impairment in four extremities from a secondary healthcare facility. Specific atypical symptoms that mimicked subacute meningitis were identified during the physical examination. Internists, neurologists, and rehabilitation medicine professionals were associated with the management.Conclusion: We suggest that improved early diagnosis and treatment of HIV patients to prevent opportunistic infections, including cerebral toxoplasmosis, is needed, particularly in primary healthcare facilities in developing countries.

A Predictive Model for Identifying the Most Effective Anti-CCR5 Monoclonal Antibody

CCR5 (R5) inhibition is increasingly being studied for its potential to prevent, treat, and cure illnesses. R5 is a transmembrane protein that interacts with the CD4 receptor and CXCR4 (X4) of T cells, allowing the attachment of HIV viruses to lymphocytes. Consequently, because R5 inhibition has performed well as a medicinal drug, such as maraviroc, many researchers have speculated that R5 inhibition via binding antibodies may effectively treat HIV patients. However, currently, there is a lack o

Predictors of Incomplete Adherence and Immuno-virologic Failure among HIV Infected Patients in Osun State, Nigeria

BACKGROUND: To identify and address modifiable baseline clinical and non- clinical predictors related to negative outcomes, and identify high risk patients who need priority attention in order to prevent future failure of treatment in HIV patients. METHODS: The study was a longitudinal clinical based cohort study of One hundred and forty (140) HIV infected adults who were initially ART naive and commenced ART in June- July 2013 were followed up to June 2014. Three out of the participants were lost to follow up, one participant died and 1 participant was transferred to another treatment centre, while a total of one hundred and thirty-five (135) patients were finally included in the immuno-virologic analysis. Adherence was assessed using both self-report questionnaire and measurement of Mean Cell Volume (MCV) which was obtained using automated haematology analyzer. CD4 counts were analyzed using flow cytometry method and HIV-RNA levels were measured by using the RT-Polymerase Chain Reaction technique. RESULTS: Incomplete adherence was recorded in 28 (20.7%) of the study participants, immunologic failure (decline in CD4 count to or below baseline or CD4 count change &lt; 50 cells/ul at 12 months) was observed in 39 (28.8%) of the participants. Virologic failure rate (viral load &gt; 400 copies/ml) was 27.4% and immuno-virologic failure rate was 31.9%. Using logistic regression model, immunologic failure was associated with male gender (OR=1.29; p=0.008), non-disclosure of status (OR=1.24; p=0.01), baseline anaemia (OR=1.15; p=0.009) and incomplete adherence by self-report (OR=3.28; p=0.001). Virologic failure was associated with no formal education (OR=2.29; p=0.01), non-disclosure of status (OR=1.04; p = &lt; 0.01), non-adherence (OR=2.74; p=0.015), being unemployed (OR=0.57; p=0.04). CONCLUSIONS: The study observed that immunologic recovery and virologic suppression rate within the first year of treatment was significant, although the rate of incomplete adherence obtained still needs improvement. Effort to promote social coping particularly to patients who were unemployed, re-strategizing on improving patient education and counseling especially to patients with no formal education, focusing on campaigns against stigmatization will help in addressing predictors of negative immuno-virologic outcomes. Baseline HIV-RNA level should also be considered in addition to CD4 testing in order to identify virological failure and thus preventing the emergence of drug resistance in HIV/AIDS management.

Piloting and validating the linkage of routine ART and laboratory records in an HIV endemic setting.

ObjectivesIntegrating clinical and laboratory data systems offers opportunities to understand disease aetiology and improve patient outcomes. We developed and piloted a data linkage algorithm to link HIV patient treatment records with routine laboratory service records in an HIV endemic setting in rural South Africa. ApproachWe used data from the South Africa’s National Health Laboratory Service (NHLS) and Three Integrated Electronic Registers (TIER.Net) databases for 17 primary healthcare clinics from uMkhanyakude district, South Africa. The two databases contained data on key demographic variables such as patient first name, surname, date of birth, sex, and health facility, and national ID numbers for a subset of the data. We adapted a probabilistic record linkage algorithm we previously developed for linkage of laboratory results. We trained and validated our algorithm using two approaches: 1) firstly, we constructed a quasi-gold standard based on manual review of potential matches for 1,061 randomly selected patients; 2) secondly, we constructed a quasi-gold standard based on records that contained national ID numbers. We calculated the probabilities that the algorithm could correctly identify a true match (sensitivity) and the probabilities that the match identified by the algorithm was truly a match (positive predictive value) using the two approaches. ResultsBetween 2015 and 2020, 55,077 patients were recorded in the HIV treatment database and 386,577 laboratory tests were recorded in the laboratory service database. The sensitivity and positive predictive value in the manually reviewed data were estimated to be 94.4% and 81.2% respectively. The sensitivity and positive predictive value in the matched individual identifiers were estimated to be 99.6% and 99.7% respectively. ConclusionsRecords can be linked successfully, but estimated performance of record linkage depends on the validation set used. Manually reviewed data contain noise and may underestimate performance, while national ID numbers may overestimate performance due to non-random patterns of missingness.

In vitro Azole antifungals susceptibility of Candida spp. isolates from HIV-infected patients with periodontitis.

The objective of the present study was to determine the in vitro Azole antifungals susceptibility of Candida spp. strains isolated from HIV-positive patients with periodontitis. Oral examination was performed in 500 HIV-positive patients, of which 228 were included in the study for having periodontitis which and separated in two groups based on their TCD4+ T-cells: (A) n=110 (≤200 CD4+); (B) n=118 (>200 CD4+). Candida spp. were isolated from the subgingival biofilm and crevicular fluid by seeding on CHROMagar plates and confirmed by endpoint PCR and MALDI-TOF. The susceptibility test in vitro for five antifungals was performed using the disc diffusion method. From the 228 HIV-positive patients with periodontitis, 174 were positive to Candida spp., and 204 isolations were obtained. 138 (67.64%) were C. albicans, and 66 (32.35%) were Candida non-albicans species. The most frequent Candida non-albicans species in order of frequency were C. glabrata with 48 (23.52%), C. tropicalis with 10 (4.9%), C. krusei with 7 (3.43%), and C. dubliniensis with 1 (0.49%). All species presented resistance to any antifungal: 149 to 5-fluorocytosine (73.0%), 149 to fluconazole (73.0%), and 144 to voriconazole (70.7%). Miconazole and econazole presented the highest susceptibility rates with 129 (63.2%) and 130 (63.7%) isolations, respectively. The Candida spp. involved in periodontitis of HIV-positive patients have a multi-resistant feature. It is necessary to implement recurrent research regarding the antifungal resistance of the Candida spp. that take part in periodontitis pathogenesis to promote an effective treatment in HIV patients.