Injection Drug Users Research Articles

Experience with direct-acting antivirals in genotype 1-5 infected chronic hepatitis C patients in Turkey.

Hepatitis C virus (HCV) can cause chronic liver disease, hepatic cirrhosis, hepatocellular carcinoma, liver transplantation, and death. Early diagnosis and treatment are thus vital. We aimed to investigate the sustained virological response (SVR) rates in chronic hepatitis C patients infected with different genotypes, receiving different direct-acting antiviral treatments (DAAs). Retrospective, observational SETTING: Clinic for infectious diseases and clinical microbiology PATIENTS AND METHODS: Patients diagnosed with chronic hepatitis C who applied to our outpatient clinic between January 2016 and November 2022 and were treated with a DAA were included in the study. Treatment responses were evaluated after each patient was treated with either ledipasvir plus sofosbuvir (LDV/SOF), LDV/SOF + ribavirin (RBV), SOF+RBV, ombitasvir/paritaprevir/ritonavir plus dasabuvir (OBV/PTV/r±DSV) ±RBV, or glecaprevir plus pibrentasvir (GLE/PIB). Sustained virological response (SVR) rates at 12 weeks (SVR12) post-treatment. 360 patients. Of 360 patients who met the inclusion criteria, 218 (60.6%) were male and 142 (39.4%) were female with no statistically significant differences in SVR between sexes (P=.252). Nearly all had a SVR (n=353, 98.1%). The median (IQR) age of the patients was 56 (30.3) years. There were 42 (11.7%), 199 (55.3%), 4 (1.1%), 106 (29.4%), 8 (2.2%) and 1 (0.3%) patient with genotypes 1a, 1b, 2, 3, 4 and 5, respectively, and SVR12 did not differ significantly between genotypes (P=.066). SVR12 response was higher in 246 (68.3%) non-injecting drug users compared to 114 (31.7%) injecting drug users (P=.005). The SVR12 response was achieved in 100% of patients with genotypes 1a, 2, 4, and 5. SVR12 response could not be obtained in 1 of 199 genotype 1b patients and 6 of 106 genotype 3 patients. The common feature of 6 reinfection patients with genotype 3 was that they were using intravenous drugs. These 6 patients were reinfected due to their continued intravenous drug use. In conclusion, DAAs provide high SVR12 rates in cirrhotic/non-cirrhotic, pegylated interferon-naive/experienced patient groups and in patients infected with all genotypes. DAAs have a high SVR12 rate in patients with chronic hepatitis C. Retrospective, single-center.

Prevalence of erythromycin-resistant emm92-type invasive group A streptococcal infections among injection drug users in West Virginia, United States, 2021-23.

Increasing incidence of invasive group A Streptococcus (iGAS) disease has been reported in Europe and the USA over the past several years. Coupled with this are observations of higher rates of resistance to erythromycin and clindamycin. To characterize iGAS and pharyngitis isolates from West Virginia (WV), a US state outside of the national Active Bacteria Core surveillance purview, where risk factors associated with iGAS infections are prevalent. Seventy-seven invasive group A Streptococcus isolates were collected from 67 unique patients at the J.W. Ruby Memorial Hospital Clinical Microbiology Laboratory in WV from 2021 to 2023. Invasive isolates and 20 unique pharyngitis isolates were tested for clindamycin and erythromycin susceptibility in the clinical laboratory. Patient demographic and clinical information was retrieved from patient electronic health records. Isolates were further characterized based on emm subtype and detection of MLSB resistance determinants. Twenty-six (39%) isolates were of a single emm92 type. All emm92 isolates were uniformly erythromycin/clindamycin resistant with inducible or constitutive MLSB resistance imparted by the plasmid-borne erm(T) gene. The majority of emm92 infections were associated with adult patients who reported IV drug use, whereas no pharyngitis infections were caused by an emm92 strain. Overall, 51 (76%) of the 67 iGAS isolates were determined to carry MLSB resistance. Isolates of emm92 type (clonal subtype emm92.0) were associated with iGAS infections in adult IV drug users, but not with paediatric pharyngitis, and were uniformly resistant to erythromycin and clindamycin.

Injection Drug Use Frequency Before and After Take-Home Naloxone Training

Concerns that take-home naloxone (THN) training may lead to riskier drug use (as a form of overdose risk compensation) remain a substantial barrier to training implementation. However, there was limited good-quality evidence in a systematic review of the association between THN access and subsequent risk compensation behaviors. To assess whether THN training is associated with changes in overdose risk behaviors, indexed through injecting frequency, in a cohort of people who inject drugs. This cohort study used prospectively collected self-reported behavioral data before and after THN training of participants in The Melbourne Injecting Drug User Cohort Study (SuperMIX). Annual interviews were conducted in and around Melbourne, Victoria, Australia, from 2008 to 2021. SuperMIX participants were adults who regularly injected heroin or methamphetamine in the 6 months preceding their baseline interview. The current study included only people who inject drugs who reported THN training and had participated in at least 1 interview before THN training. In 2017, the SuperMIX baseline or follow-up survey began asking participants if and when they had received THN training. The first THN training date that was recorded was included as the exposure variable. Subsequent participant interviews were excluded from analysis. Injecting frequency was the primary outcome and was used as an indicator of overdose risk. Secondary outcomes were opioid injecting frequency, benzodiazepine use frequency, and the proportion of the time drugs were used alone. Fixed-effects generalized linear (Poisson) multilevel modeling was used to estimate the association between THN training and the primary and secondary outcomes. Time-varying covariates included housing status, income, time in study, recent opioid overdose, recent drug treatment, and needle and syringe coverage. Findings were expressed as incidence rate ratios (IRRs) with 95% CIs. There were 1328 participants (mean [SD] age, 32.4 [9.0] years; 893 men [67.2%]) who completed a baseline interview in the SuperMIX cohort, and 965 participants completed either a baseline or follow-up interview in or after 2017. Of these 965 participants, 390 (40.4%) reported THN training. A total of 189 people who inject drugs had pretraining participant interviews with data on injecting frequency and were included in the final analysis (mean [SD] number of interviews over the study period, 6.2 [2.2]). In fixed-effects regression analyses adjusted for covariates, there was no change in the frequency of injecting (IRR, 0.91; 95% CI, 0.69-1.20; P = .51), opioid injecting (IRR, 0.95; 95% CI, 0.74-1.23; P = .71), benzodiazepine use (IRR, 0.96; 95% CI, 0.69-1.33; P = .80), or the proportion of reported time of using drugs alone (IRR, 1.04; 95% CI, 0.86-1.26; P = .67) before and after THN training. This cohort study of people who inject drugs found no evidence of an increase in injecting frequency, along with other markers of overdose risk, after THN training and supply. The findings suggest that THN training should not be withheld because of concerns about risk compensation and that advocacy for availability and uptake of THN is required to address unprecedented opioid-associated mortality.

Prevalence of HIV-1 infection and associated characteristics in a Brazilian indigenous population: a cross-sectional study

Despite significant progress in the areas of prevention, diagnosis, and treatment, HIV continues to result in a substantial number of fatalities on a global scale each year. Gaining insights from epidemiological data can prove instrumental in the development of health promotion strategies, particularly within vulnerable populations, such as indigenous groups. Consequently, our study aimed to investigate the prevalence of HIV infection within the indigenous population residing in the second-largest region of Brazil. Additionally, we sought to explore the subtypes of HIV-1 and detect any drug-resistance mutations present within this population. In this cross-sectional study, we aimed to evaluate the prevalence of HIV-1 infection and explore its associated characteristics within the indigenous population residing in the villages of Jaguapiru and Bororó, located in the Dourados area of Mato Grosso do Sul (MS), Brazil. Blood samples were collected for rapid HIV screening, serological tests, nucleic acid amplification, and HIV subtyping. Additionally, the HIV-1 viral load and CD4+ T lymphocyte count of the people living with HIV (PLHIV) were assessed at the time of recruitment and 24 weeks later. Out of the 2190 invited individuals, 1927 (88%) were included in this study. The average age of the participants was 34.2 (±13.8) years, with a majority of 74% being female. Moreover, 68.44% of the participants identified themselves as belonging to the Guarani-Kaiowa ethnic group. HIV seroprevalence was 0.93% (18/1927), and 73.22% (1411/1927) were unaware of their serological status. The prevalence of HIV-1 was higher in single indigenous people [10/617 (1.62%)], who received government benefits [14/1021 (1.37%)], had less than five years of formal education [11/685 (1.61%)], had sexual intercourse with users of injectable drugs [2/21 (9.52%)], with history of sexually transmitted infections (STIs) [10/62 (16.2%)] and incarceration [3/62 (4.84%)]. Of 18 positive samples, 44.4% (8/18) were successfully amplified, and HIV-1 subtype C was prevalent. Furthermore, we identified HIV-1 drug resistance mutations in four patients, specifically from the classes of Protease Inhibitor, Nucleoside Reverse Transcriptase Inhibitor, and Non-Nucleoside Reverse Transcriptase Inhibitor. Notably, three of these patients exhibited a high viral load even after 24 weeks of undergoing antiretroviral therapy. Out of the 18 PLHIV, 66.66% (12/18) had a viral load below 1000 copies/mL, while 50% (9/18) had a CD4+ T lymphocytes count greater than 350cells/mL after 24 weeks of treatment. Despite the concerted efforts to control HIV infection, the prevalence observed in the indigenous population under study surpassed that reported in other Brazilian indigenous groups. This disparity highlights the disproportionate impact of the disease on this particular group. The detection of drug-resistance mutations further emphasizes the critical need to expand diagnostic coverage, closely monitor treatment strategies, and maintain ongoing molecular surveillance. These measures are imperative for enhancing HIV management within this vulnerable population. This study was partially funded by Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Fundação de Apoio ao Desenvolvimento do Ensino, Ciência e Tecnologia do Estado de Mato Grosso do Sul (FUNDECT), Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Secretaria do Estado de Saúde (SES) of Governo do Estado de Mato Grosso do Sul, and Universidade Federal da Grande Dourados (UFGD).

The Effect of Harm-reducing Programs in Drop-in Centers on the Frequency of High-Risk Behaviors Among Injecting Drug Users in Hamadan

Background: It is necessary to study high-risk behaviors among intravenous drug users, as well as the effectiveness of the syringe-needle program to help health officials adopt appropriate health policies in order to promote public health services. Therefore, it is necessary to gather and present up-to-date evidence on the effectiveness of these interventions. Methods: The study aimed to evaluate a harm-reducing program using a self-report tool before and after implementing an interventional program, consisting of training on low-risk injection methods, sterilization methods for injection devices, reducing the risks of drug abuse and sexual behaviors, HIV and hepatitis B counseling and testing, apportioning sterile syringes, needles, cotton, alcohol, and condoms, offering methadone maintenance treatment, collecting and discarding contaminated needles, and referral of patients to specialized medical centers. These procedures were performed in two drop-in centers (DIC) in Hamadan. Participants were recruited by the census, including 188 volunteers from the DICs. Descriptive statistics for quantitative variables were mean and standard deviation. Absolute and relative frequencies were used for ranked and categorized variables. Analytical analysis for high-risk behaviors before and after the intervention was performed using the tests related to paired data and, if necessary, regression models (P ≤ 0.05). STATA version 12 was used to analyze the data. Results: A total of 188 people participated in this study, of whom 112 (59.6%) were male, and 76 (40.4%) were female. The mean ± standard deviation of the age of the participants was 47.72 ± 10.88. The results showed that the proportions of non-injecting drug users (P = 0.03), injecting drug users (P = 0.008), and co-injection users (P < 0.001) were significantly different compared before admission to the DICs and two months after discharge (P = 0.03). Conclusions: Programs of DICs, especially educational programs and distributing syringes and needles, play a significant role in reducing high-risk behaviors, at least in the short term. As a result, this practice may help reduce the incidence of HIV and other diseases transmitted through joint injections among drug users.

Drug use patterns and related factors among female sex workers in Iran in 2019–2020: results from Integrated Bio-Behavioral Surveillance-III (IBBS-III)

IntroductionDrug use is highly prevalent among female sex workers (FSWs). Some forms of drug use, such as injecting drug users (IDU), put them at greater risks for HIV and blood born disease (BBD). In this study, the pattern of drug use and its related factors among Iranian FSWs were investigated.Materials and methodsThis cross-sectional study was performed based on the data of the integrated bio-behavioral surveillance-III (IBBS-III) on FSWs in 8 cities of Iran using the respondent-driven sampling (RDS) method conducting in 2019–2020. Of the 1515 FSWs participating in the IBBS-III study, 1,480 answered questions about drug use. To calculate the prevalence of drug use lifetime and in the past month, weighted analysis was used. Univariate and multivariate logistic regression was used to investigate the factors related to drug use.ResultsThe prevalence of lifetime drug use and the prevalence of current drug use (single and poly drug use) among FSWs were estimated to be 29.3% and 18.86%, respectively. According to multivariate regression analysis, the odds ratio (odds) of lifetime drug use showed a statistically significant association with lower education (AOR = 1.18; 95% CI: 1.07–1.3), being a direct sex worker (AOR = 1.77; 95% CI: 1.21–2.61), working in team houses or hangouts (AOR = 1.51; 95% CI: 1.10–2.06), a history of intentional abortion (AOR = 1.41; 95% CI: 1.07–1.87), condom use in the last sex (AOR = 1.61; 95% CI: 1.19–2.17), a history of imprisonment (AOR = 3.05; 95% CI: 2.25–4.14), HIV positive tests (AOR = 8.24; 95% CI: 1.66–40.9), alcohol use (AOR = 1.69; 95% CI: 1.29–2.29), and finding sexual clients in places such as parties, shopping malls, streets, and hotels, or by friends (AOR = 1.46; 95% CI: 1.01–2.12).ConclusionGiven that drug use among FSWs is about 14 times higher than that of the Iranian general population, it is imperative that drug reduction programs be integrated into service packages. Specifically, prevention programs should be prioritized for occasional drug users within this population as they are at a greater risk of developing drug use issues compared to the general population.

Complicated infectious endocarditis in a patient with human immunodeficiency virus: A case report

INTRODUCTION: Infectious endocarditis (IE) in injecting drug patients with human immunodeficiency virus (HIV) is manifested predominantly by damage to the tricuspid valve (TV). The pathogen of the disease is Staphylococcus aureus. The IE peculiarities of the TV in this category of patients are multiple septic emboli in the small circulation, which may result from flotation vegetations, and predominance of pulmonary symptomatology over cardiac phenomena.
 CASE PRESENTATION: A 30-year-old female HIV-infected injecting drug user was dynamically monitored for the laboratory-confirmed IE development by transthoracic echocardiography during a year. The patient was twice admitted to the intensive care unit in a serious condition with purulent-septic complications in the lungs in the form of bilateral polysegmental destructive (septic) pneumonia confirmed by X-ray and multispiral computed tomography. After intensive therapy, the patient refused further ARV treatment and consultations with a cardiac surgeon. A clinical follow-up demonstrated IE of the TV and right-sided lower lobe pneumonia in an HIV-infected drug-dependent patient after a cesarean section. Immunodeficiency without appropriate ARV therapy had a negative impact on the course of the disease. According to transthoracic echocardiography, an increase in TV vegetations from 7 mm to 16 mm and regurgitation were observed, whereas left ventricular ejection fraction decreased from 60% to 47% during the follow-up. Complications of cesarean section, immunodeficiency, and absence of ARV therapy could be the trigger factors of the IE development. Injection drug use with possible violations of asepsis and circulation of microorganisms of the causative agents in the blood contributed to the rapid development of the disease and was a determining factor of the infectious process in the TV.
 CONCLUSIONS: Echocardiography remains the primary radiological diagnostic method for examining HIV-infected drug-dependent patients with fever and/or after medical manipulations. However, this group of patients more frequently clinically manifests the disease with bright pulmonary pathology. Therefore, radiological methods should necessarily be a priority during the diagnostic search. The sources of septic embolism in the small circulation in IE may be loose and floating TV vegetations.

Immunoreactivity and intoxication syndrome in patients with chronic viral hepatitis c

Method: Etiological, gender, age and laboratory characteristics of chronic viral hepatitis C (СVHC) were studied and analyzed. The distribution of patients depending on the virus genotype, the activity degree and the severity of liver fibrosis were found out. Indices of non-specific reactivity, endogenous intoxication and inflammation in the course of СVHC, their dependence on treatment were studied. Correlations between the values of non-specific reactivity, endogenous intoxication, inflammation and patients’ affiliation to the group of injecting drug users, the APRI score, the stage of liver fibrosis and the virus genotype were estimated. Significant increase in endogenous intoxication (LII, HII, ISS), non-specific immunoreactivity (IR, LMR, Ilymph, IA) and inflammation (ILG) at decrease in some endogenous intoxication indices (ISL, NRR) and inflammation (KI, ILESR) in patients with CHCV compared with healthy persons were established. Result: The decrease in endogenous intoxication indices (LII; HII; ISL; ISS; NRR) were observed during antiviral treatment. Such unambiguous reaction of non-specific immunoreactivity indices and inflammation indices were not observed: some of them increased (Ilymph, IA), some of them decreased (IR, NLR; ELR). KI decreased during the treatment, but ILG increased. Direct correlation between patients’ affiliation to a group of injecting drug patients and the values of HII, NRR (p<0.05), between the APRI score and Ilymph level (p<0.05) was identified. Conclusion: No correlation between the indices values and fibrosis severity (according to METAVIR) and virus genotype was found. Bangladesh Journal of Medical Science Vol. 22 No. 03 July’23 Page : 508-514

HIV-1 Transmission among Injecting Drug Users is Principally Derived from Local Circulating Strains in Guangxi, China

ObjectiveThe mode of human immunodeficiency virus (HIV) transmission via injection drug use (IDU) still exists, and the recent shift in IDU-related transmission of HIV infection is largely unknown. The purpose of this study was to analyze the spatiotemporal sources and dynamics of HIV-1 transmission through IDU in Guangxi. MethodsWe performed a molecular epidemiological investigation of infections across Guangxi from 2009 to 2019. Phylogenetic and Bayesian time-geographic analyses of HIV-1 sequences were performed to confirm the characteristics of transmission between IDUs in combination with epidemiological data. ResultsAmong the 535 subjects, CRF08_BC (57.4%), CRF01_AE (28.4%), and CRF07_BC (10.7%) were the top 3 HIV strains; 72.6% of infections were linked to other provinces in the transmission network; 93.6% of sequence-transmitted strains were locally endemic, with the rest coming from other provinces, predominantly Guangdong and Yunnan; 92.1% of the HIV transmission among people who inject drugs tended to be transmitted between HIV-positive IDUs. ConclusionHIV recombinants were high diversity, and circulating local strains were the transmission sources among IDUs in Guangxi. However, there were still cases of IDUs linked to other provinces. Coverage of traditional prevention strategies should be expanded, and inter-provincial collaboration between Guangxi, Yunnan, and Guangdong provinces should be strengthened.

Hepatitis B in Afghanistan

Background and Objectives: Hepatitis B Virus (HBV) infection is one of the major public health challenges worldwide, affecting over 350 million people. The prevalence of this virus varies in different countries. Afghanistan, as a less developed country, has limited information about the epidemiological status of Hepatitis B. This study analyzes the prevalence and pattern of this disease in Afghanistan by reviewing existing sources to provide a better understanding of its situation and contribute to planning for Hepatitis B prevention and control in the country.
 Research Methodology: This study conducted a review of articles related to the prevalence and risk factors of Hepatitis B between 2010 and 2023, obtained from databases such as Scopus, PubMed, and Google Scholar. Data from 9 articles were extracted and the results were reported in a narrative synthesis following the PRISMA guidelines.
 Findings: This table provides a summary of the findings from 9 studies regarding the prevalence and risk factors of Hepatitis B in Afghanistan. According to these studies conducted between 2011 and 2022, the prevalence of Hepatitis B surface antigen (HBsAg) in the general population varied between 1.9% to 6.3%. Additionally, the prevalence in injecting drug users and prisoners was reported to be 3.7%-6.5% and 4.4%, respectively. Major risk factors included contaminated injections, risky sexual behavior, and homosexuality.
 Conclusion: Hidden HBV infection in HBsAg-negative individuals but HBV DNA positive poses a high risk for liver diseases and should be considered in epidemiological studies. Injecting drug users, sex workers, blood donors, and high-risk refugees require education and awareness regarding HBV prevention. Further studies are necessary to determine the precise prevalence of HBV, with a focus on prevention and control programs for injecting drug users and individuals engaging in risky sexual behaviors.

HIV/AIDS in Afghanistan: A Review of Prevalence, Perspectives, and Associated Factors

AIDS, considered one of the leading causes of death worldwide, is not exempt in Afghanistan. This virus targets the human immune system, paving the way for various infections. The first AIDS case was reported in Afghanistan in 1989, and over time, due to increased migration and drug usage, the rate of HIV/AIDS prevalence increased dramatically. Although the prevalence of this disease in our country is relatively low on a global scale, Afghanistan is recognized as one of the high-risk areas for HIV/AIDS transmission.
 The virus spreads through activities such as blood transfusion and mucous membrane abrasions. The primary reason for the spread of HIV in our country is the presence of vulnerable populations (drug addicts, prisoners, sex workers, and returning migrants infected from neighboring areas). Additionally, low levels of medical knowledge, poor healthcare services, cultural pressures, and constant stigma against patients lead infected individuals to avoid healthcare facilities, thereby creating a conducive environment for the further spread of AIDS.
 To effectively combat the AIDS epidemic in Afghanistan, implementing comprehensive policies for HIV control and treating injecting drug users is essential. Stronger control and monitoring of returning migrants at the country's borderlines, the use of impactful graphic warning labels on advertisements, regular advertising campaigns through media and healthcare centers, and establishing well-equipped centers for patient treatment are crucial and supportive measures.

Looking at the Molecular Target of NS5A Inhibitors throughout a Population Highly Affected with Hepatitis C Virus.

Hepatitis C virus (HCV) is associated with liver damage and an increased progression rate to cirrhosis and hepatocellular carcinoma. In Portugal, it is prevalent in vulnerable populations such as injection drug users (IDU). HCV is characterized by a high intra-host variability, and the selecting driving forces could select variants containing resistance-associated substitutions (RAS) that reduce treatment effectiveness. The main goal of this study was to analyze the sequence variation of NS5A in treatment-naïve IDU. The epidemiological and clinical status of hepatitis C were analyzed, and samples were sequenced by Sanger and Next-Generation sequencing (NGS) to assess RAS and confirm HCV subtypes. Phylogenetic classification was concordant: 1a, 52.4%; 1b, 10.7%; 3a, 20.2%; 4a, 8.3%; 4d, 7.1%; and one 2k/1b recombinant. A 1a/3a mixed infection was detected by NGS. RAS were found in 34.5% (29/84) of samples using Sanger sequencing, while in 42.9% (36/84) using NGS. In sequences from subtypes 1a and 1b, RAS K24R, M28V, Q30H/R, H58D/P/Q/R, and RAS L31M and P58S were detected, respectively. In subtype 3a, RAS A30S/T, Y93H and polymorphisms in position 62 were identified. Additionally, RAS P58L was detected in genotype 4. The strategy used for the molecular survey of baseline HCV resistance is of particular importance to achieve treatment effectiveness and contribute to the elimination of hepatitis C.

FACTORS INFLUENCING HIV/AIDS PREVENTIVE MEASURES AMONG INJECTING DRUG USERS IN MAKASSAR CITY

Human Immunodeficiency Virus (HIV) is a serious infection that attacks the body's immune system, and its means of transmission include the use of injecting drugs. Effective preventive measures are crucial for reducing the prevalence of HIV in society. Therefore, this study aims to determine the factors influencing HIV/AIDS preventive measures among injecting drug users (IDUs) in Makassar City. A cross-sectional study design was employed, and 124 IDUs were enrolled as participants through an accidental sampling technique. The data collected were analyzed with chi-square bivariate analysis and multivariate logistic regression. The results showed knowledge (p-value = 0.005), attitude (p-value = 0.013), peer influence (p-value = 0.004), support from health workers and NGOs (p-value = 0.029), availability of sterile injecting equipment services (p-value = 0.029), and voluntary counseling and testing (VCT) services were significantly correlated with the preventive measures among IDUs in Makassar city (p-value < 0.001). Furthermore, VCT services were found to be the most influential factor in HIV/AIDS preventive measures (OR = 6.369; 95%CI = 2.181-18.597; p-value = 0.001). In conclusion, knowledge, attitudes, peer influence, support from health workers and NGOs, the availability of sterile injecting equipment services, and VCT services have a relationship with HIV/AIDS preventive measures among IDUs. Participants who engaged in VCT are advised to disseminate information about HIV and the associated services to their partners and communities.

The estimation of long and short term survival time and associated factors of HIV patients using mixture cure rate models

BackgroundHIV is one of the deadliest epidemics and one of the most critical global public health issues. Some are susceptible to die among people living with HIV and some survive longer. The aim of the present study is to use mixture cure models to estimate factors affecting short- and long-term survival of HIV patients.MethodsThe total sample size was 2170 HIV-infected people referred to the disease counseling centers in Kermanshah Province, in the west of Iran, from 1998 to 2019. A Semiparametric PH mixture cure model and a mixture cure frailty model were fitted to the data. Also, a comparison between these two models was performed.ResultsBased on the results of the mixture cure frailty model, antiretroviral therapy, tuberculosis infection, history of imprisonment, and mode of HIV transmission influenced short-term survival time (p-value < 0.05). On the other hand, prison history, antiretroviral therapy, mode of HIV transmission, age, marital status, gender, and education were significantly associated with long-term survival (p-value < 0.05). The concordance criteria (K-index) value for the mixture cure frailty model was 0.65 whereas for the semiparametric PH mixture cure model was 0.62.ConclusionThis study showed that the frailty mixture cure models is more suitable in the situation where the studied population consisted of two groups, susceptible and non-susceptible to the event of death. The people with a prison history, who received ART treatment, and contracted HIV through injection drug users survive longer. Health professionals should pay more attention to these findings in HIV prevention and treatment.

Mexican perspective on the Mosaico HIV vaccine trial

Disappointment among researchers and the community is inevitable following the decision to interrupt the Mosaico phase 3 HIV vaccine trial 1 HVTNPhase 3 Mosaic-based investigational HIV vaccine study discontinued following disappointing results of planned data review. https://www.hvtn.org/news/news-releases/2023/01/phase-3-mosaic-based-investigational-hiv-vaccine-study-discontinued-following-disappointing-results-planned-data-review.htmlDate: 2023 Date accessed: January 25, 2023 Google Scholar on the basis of the preplanned data and safety monitoring board analysis in January, 2023. After more than four decades of efforts to develop a vaccine to protect against HIV, Mosaico was the eighth clinical trial to reach an advanced stage in vaccine development (phase 2b/3). Failure to show efficacy is very frustrating after many years of sustained and committed work. 2 Flynn NM Forthal DN Harro CD Judson FN Mayer KH Para MF Placebo-controlled phase 3 trial of a recombinant glycoprotein 120 vaccine to prevent HIV-1 infection. J Infect Dis. 2005; 191: 654-665 Crossref PubMed Scopus (775) Google Scholar , 3 Pitisuttithum P Gilbert P Gurwith M et al. Randomized, double-blind, placebo-controlled efficacy trial of a bivalent recombinant glycoprotein 120 HIV-1 vaccine among injection drug users in Bangkok, Thailand. J Infect Dis. 2006; 194: 1661-1671 Crossref PubMed Scopus (680) Google Scholar , 4 Buchbinder SP Mehrotra DV Duerr A et al. Efficacy assessment of a cell-mediated immunity HIV-1 vaccine (the Step Study): a double-blind, randomised, placebo-controlled, test-of-concept trial. Lancet. 2008; 372: 1881-1893 Summary Full Text Full Text PDF PubMed Scopus (1407) Google Scholar , 5 Hammer SM Sobieszczyk ME Janes H et al. Efficacy trial of a DNA/rAd5 HIV-1 preventive vaccine. N Engl J Med. 2013; 369: 2083-2092 Crossref PubMed Scopus (455) Google Scholar , 6 Gray GE Bekker L-G Laher F et al. Vaccine efficacy of ALVAC-HIV and bivalent subtype C gp120-MF59 in adults. N Engl J Med. 2021; 384: 1089-1100 Crossref PubMed Scopus (79) Google Scholar

The Implementation of HIV Self-Testing in Resource-Limited Settings Where the HIV Disease Burden is High.

In resource-limited settings, there is growing evidence that HIV testing is lacking among high-risk key populations such as men having sex with men, injection drug users, and transgenders largely due to stigma, discrimination, and lack of confidentiality. Findings from recent studies among high-risk key populations and the general population from various regions including resource-limited settings support the need for wider accessibility of HIV self-testing (HIV-ST) to reach those who may not otherwise have access to testing. Therefore, HIV-ST has untapped potential as a strategy to improve access to HIV testing and to increase testing frequency among key high-risk populations and their partners. Though HIV-ST has emerged as a safe, acceptable, and effective way to reach people, there are several roadblocks to implementing the HIV-ST policy, and fast-track policy implementation needs to be necessitated with newer or modified strategic plans.

Changing our outlook towards vulnerable women for societal resilience

Abstract Background: The vulnerabilities and risks of women injecting drug users (WIDUs) are different compared to their male counterparts. In light of scant literature in this area, we carried out this qualitative study with the aim to explore the lived experiences of WIDUs in the North of Mauritius. Its objectives were (1) To get an insight into the risks taken during the injection practices of WIDUs and (2) To obtain an in-depth understanding of the gender-specific vulnerability of the sexual behaviours of WIDUs. Methods: A qualitative phenomenological approach was used for the research work. Study participants were recruited from a specific needle exchange site, by purposive sampling until saturation of data was reached. In-depth interviews conducted were transcribed for thematic analysis. Ethical clearance was obtained from the relevant authorities. Findings: The principal theme which emerged from the data collected was “Drug Injection Scenario”, with the following sub-themes: settings for drug injection; pre-injection rituals; third party assistance; sharing and recycling of injecting materials. The second theme which came out was “Sex Work and Drug Use Interplay” with either sex work preceding drug injection or drug injection preceding sex work. Finally, the third theme was “Sexual Behaviours Screenplay” with casual encounters and unprotected sex. Conclusions: This study filled the gap with respect to the absence of qualitative studies among WIDUs in Mauritius. It revealed their risky drug injecting practices and sexual behaviours. Their psychological and physical dependence on drug injection contributed to their stay within this vulnerable circle. Their inability to access adequate support hinders them from coming out of the clutches of their risky drug injection and sexual practices. For resilience of the society, there is need to address the needs of this vulnerable group of women.

Duration of delayed diagnosis in HIV/AIDS patients in Iran: a CD4 depletion model analysis

Delayed diagnosis of HIV can lead to an inappropriate response to antiretroviral therapy (ART), rapid progression of the disease, and death. It can also carry harmful effects on public health due to the increment of transmission. This study aimed to estimate the duration of delayed diagnosis (DDD) in HIV patients in Iran. This hybrid cross-sectional cohort study was conducted on the national HIV surveillance system database (HSSD). Linear mixed effect models with random intercept, random slope, and both were used to estimate the parameters required for the CD4 depletion model to determine the best-fitted model for DDD, stratified by the route of transmission, gender, and age group. The DDD was estimated in 11,373 patients including 4,762 (41.87%) injection drug users (IDUs), 512 (4.5%) men who had sexual contact with men (MSM), 3,762 (33.08%) patients with heterosexual contacts, and 2,337 (20.55%) patients who were infected through other routes of HIV transmission. The total mean DDD was 8.41 ± 5.97 years. The mean DDD was 7.24 ± 0.08 and 9.43 ± 6.83 years in male and female IDUs, respectively. In the heterosexual contact group, DDD was obtained as 8.60 ± 6.43 years in male patients and 9.49 ± 7.17 years in female patients. It was also estimated as 9.37 ± 7.30 years in the MSM group. Furthermore, patients infected through other transmission routes were found with a DDD of 7.90 ± 6.74 years for male patients and a DDD of 7.87 ± 5.87 years for female patients. A simple CD4 depletion model analysis is represented, which incorporates a pre-estimation step to determine the best-fitted linear mixed model for calculating the parameters required for the CD4 depletion model. Considering such a noticeably high HIV diagnostic delay, especially in older adults, MSM, and heterosexual contact groups, regular periodic screening is required to reduce the DDD.

Investigating rates and risk factors for hepatitis C virus reinfection in people receiving antiviral treatment in England.

England has committed to the World Health Organization target to eliminate hepatitis C virus (HCV) as a public threat by the year 2030. Given successful treatments for HCV in recent years, it is unclear whether HCV reinfection will impact England's ability to achieve HCV elimination. We aimed to estimate the HCV reinfection rate among a cohort of patients receiving antiviral treatment using available surveillance data. Linkage between a treatment dataset from 2015 to 2019 and an HCV RNA testing dataset were used to identify people who experienced reinfection using three criteria. A Cox proportional hazards model was used to determine risk factors associated with HCV reinfection among a cohort who received treatment and had follow-up HCV RNA testing. The reinfection rate among those receiving HCV treatment was 7.91 per 100 person-years (PYs, 95% confidence interval (CI) 7.37-8.49) and highest among current injecting drug users (22.55 per 100 PYs, 95% CI 19.98-25.46) and people who had been in prison (20.42 per 100 PYs, 95% CI 17.21-24.24). In the adjusted model, women had a significantly reduced risk of reinfection. Being of younger age, current injecting drug users, and receipt of first treatment in prison were each significantly associated with increased risk of reinfection. Two-fifths of those with reinfection (43%, n=329/767) were linked to treatment after reinfection, and of those starting treatment, three quarters (75%, n=222/296) achieved a sustained virologic response. Guidance for testing groups at risk of reinfection and harm reduction strategies to minimize transmission should be implemented if England is to achieve HCV elimination targets.

Immune profiling in Puerto Rican injection drug users with and without HIV-1 infection.

Antiretroviral therapy has been effective in suppressing HIV viral load and enabling people living with HIV to experience longer, more conventional lives. However, as people living with HIV are living longer, they are developing aging-related diseases prematurely and are more susceptible to comorbidities that have been linked to chronic inflammation. Coincident with HIV infection and aging, drug abuse has also been independently associated with gut dysbiosis, microbial translocation, and inflammation. Here, we hypothesized that injection drug use would exacerbate HIV-induced immune activation and inflammation, thereby intensifying immune dysfunction. We recruited 50 individuals not using injection drugs (36/50 HIV+) and 47 people who inject drugs (PWID, 12/47 HIV+). All but 3 of the HIV+ subjects were on antiretroviral therapy. Plasma immune profiles were characterized by immunoproteomics, and cellular immunophenotypes were assessed using mass cytometry. The immune profiles of HIV+/PWID-, HIV-/PWID+, and HIV+/PWID+ were each significantly different from controls; however, few differences between these groups were detected, and only 3 inflammatory mediators and 2 immune cell populations demonstrated a combinatorial effect of injection drug use and HIV infection. In conclusion, a comprehensive analysis of inflammatory mediators and cell immunophenotypes revealed remarkably similar patterns of immune dysfunction in HIV-infected individuals and in people who inject drugs with and without HIV-1 infection.