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Introduction: Because of socio-cultural factors, such as violence perpetrated by intimate partners, women continue to be disproportionately affected by the human immunodeficiency virus (HIV)/ acquired immune deficiency syndrome (AIDS) epidemic. Intimate partner violence has an impact on participation in treatment of HIV-positive women. The aim of this study was to estimate the prevalence of lifetime violence among Iranian women living with HIV, and to identify possible risk factors. Material and methods: The study was conducted among 135 HIV-positive women referring to the Counseling Center for Behavioral Diseases of Imam Khomeini Hospital in Tehran. In this study, a researcher-made questionnaire was used for collecting data through face-to-face interviews. The questionnaire included questions related to basic socio-demographic, sexual practices, stigma/ discrimination, and domestic violence. Results: Of the 135 interviewees, 91.5% had never experienced mental violence, and 84.4% had never experienced social violence, while 97.8% suffered from violence in their marriages. In our study, women's unemployment, low socio-economic status, and patriarchal dominance in families were the main predictors of intimate partner violence (IPV). We found a negative relationship between marital satisfaction and domestic violence. It was revealed that IPV also affects couples' ability to issues related to their sexual life, including negotiating condom use and monogamy. Conclusions: A high proportion of HIV-positive women in Iran reported an experience of IPV in their lives. IPV was associated with situations involving a woman having an intimate relationship with her male partner. Due to its' high prevalence, we recommend increasing knowledge about IPV among HIV healthcare providers and universal screening. [ABSTRACT FROM AUTHOR]

Introduction: Human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) is one of the major global health problems and stressful experience for individuals; therefore, different strategies are engaged to cope with the disease and associated problems. Each of these strategies may have different outcomes, including increased depression, anxiety, stress, and decreased social functioning, achieve full mental health, and social well-being. The aim of this study was to evaluate the coping strategies in HIV-positive patients, determine the prevalence of depression, anxiety, and stress in these patients as well as to investigate the relationship between coping strategies with the prevalence of depression, anxiety, and stress. Material and methods: In this study, 100 HIV-positive patients who were referred to voluntary counseling and testing (VCT) center from January to September 2019 were recruited by convenience sampling method to complete two validated questionnaires: ways of coping strategies (WOC) and depression, anxiety, and stress scale (DASS). Results: The findings showed that the mean score of emotion-focused and problem-focused strategies were 44.90 and 44.51, respectively. There was a significant relationship between problem-focused strategies and participants' gender and both strategies with age of patients. The prevalence of depression, anxiety, and stress was 68%, 76%, and 73%, respectively. The prevalence of all three psychological conditions were correlated with gender. In addition, depression and anxiety were significantly correlated with the last educational level. Results also showed that using emotion-focused coping strategies was associated with depression, anxiety, and stress. Conclusions: Considering the study results, it seems necessary to conduct regular screening programs, appropriate psychological interventions, and social support for this population. [ABSTRACT FROM AUTHOR]

Introduction: Hepatitis A is an acute viral infection involving hepatocytes, and it is transmitted through fecal-oral contacts. There is no difference between symptoms of hepatitis A in HIV-positive and HIV-negative people, but the duration of hepatitis A virus (HAV) viremia and stool shedding may be longer in HIV-positive patients. Also, HIV viral load could increase in co-infection with HAV. Therefore, HAV vaccination is suggested for people who are at higher risk of HIV infection in nonendemic countries. We aim to estimate the seroprevalence of anti-HAV IgG in Iranian HIV-positive population to evaluate the need for vaccination in this group. Material and methods: A cross-sectional study was conducted with 72 HIV-positive people who referred to a voluntary counseling and testing center in a referral hospital during 2019-2020. Participants answered a questionnaire about their demographic data, history of drug use, and HIV risk behaviors. Blood for anti-HAV IgG was tested, and last laboratory results of CD4+ count, HIV viral load, and hepatitis B and C panels from electronic medical records were collected. Results: The seroprevalence of anti-HAV IgG was 82.6%, and independently associated with older age and being married. The participants older than 45 years had significantly higher seropositivity among all age groups (89.7%). Conclusions: Hepatitis A is an endemic viral infection among the Iranian population. Therefore, HAV vaccination does not seem necessary at present. However, we suggest further studies on hepatitis A panel to re-evaluate the need for HAV vaccination in HIV-positive people in the future. We recommend HAV vaccination for travelers from non-endemic countries to Iran. [ABSTRACT FROM AUTHOR]

Introduction: A vast group of people carrying human immunodeficiency virus (HIV) is unaware of their HIV status. HIV self-testing (HIVST) is a key tool to achieve better expanding of testing by helping patients to be identified, but it faces its' challenges, which need to be carefully discussed. We aimed to introduce and debate the best options and strategies required to maximize the benefits of HIVST in Iran. Material and methods: The authors investigated the above-mentioned question based on a review of 32 articles published between 2007 and 2018 on HIVST. Moreover, focus group discussions (FGDs) and interviews were conducted within 20 people from key populations, with six experts involved. Results: A road map for actualizing HIVST program can be characterized in three major steps, which include: 1) HIVST training and preparing each component by healthcare team; 2) HIVST-assisted and facility-based programs in selected centers, in the presence of supportive consultant assisting each tested person; 3) public access to HIVST kits through pharmacies, internet, and cyberspace. Conclusions: It seems that the dangers and detriments of HIVST are extremely constrained in comparison with its' advantages. Overall, it can be considered as a feasible and effective approach in achieving the goal of identifying an increasing number of potential HIV-positive patients and support healthcare system. [ABSTRACT FROM AUTHOR]

Introduction: In human immunodeficiency virus (HIV)-positive patients, viral load replication in blood plasma (BP) and genital fluid, such as semen plasma (SP), are different. Several factors, including HIV concentration in semen, virus infectiousness, and susceptibility of host cells determine the risk of transmission from HIV male patients to their sexual partners. Previous studies had controversial results on the correlation of BP viral load and SP viral load and the impact of antiretroviral therapy (ART) on BP and SP viral load. The aim of the study was to evaluate the impact of different ART regimens on BP and SP viral loads. Material and methods: Nineteen HIV-positive male patients, with a mean age of 35.8 years, were included in the study, each of whom had been receiving various ART regimen for at least six months. Both whole blood and semen samples were collected on the same day and subsequently, HIV-1 RNA copy was measured in both samples for each patient. Results: Our results indicated that in patients who were at least six months under ART regimen, mean HIV RNA copy number in BP and SP were 1,371 copy/ml and 273 copy/ml, respectively. Our results demonstrated a significantly higher BP viral load level than SP viral load (p = 0.001). Moreover, a significant correlation between BP viral load and SP viral load was observed (Pearson correlation = 0.97). Conclusions: We conclude that SP viral load of HIV-positive patients with undetectable BP viral load was below detection range. This point should be communicated to sero-discordant couples who want to have a safe pregnancy and healthy offspring. [ABSTRACT FROM AUTHOR]

Introduction: Loss to follow-up (LTFU) slows the progress in reaching the goals of human immunodeficiency virus (HIV) prevention and treatment. Therefore, it is important to understand the causes behind this phenomena. Herein, we aimed to systematically review the prevalence of LTFU among people living with HIV and the reasons behind this event. Material and methods: A systematic search was conducted with key words applied in online databases, including PubMed, Web of Science, Scopus, UpToDate, and Science Direct, from January 2015 to March 2021. Most relevant papers were retrieved and screened in two phases against inclusion criteria, based on their title/abstract and their full texts, and eligible records were included in the review. Results: In this systematic review, 54 studies were included. Unfavorable socio-demographic and supportive status, distance to facility, age, gender, challenges related to antiretroviral therapy initiation and its' side effects, and CD4+ counts were among the most common reasons cited for LTFU in HIV clinics. Conclusions: LTFU remains a major factor halting the progress in the prevention and treatment of HIV. Great efforts are still needed to address this issue, especially in populations and regions with higher LTFU incidence. Accessibility of receiving care should be increased to encourage patients to continue their treatments. Upcoming follow-up studies are needed to re-evaluate the progress and to report future challenges and limitations. [ABSTRACT FROM AUTHOR]

Introduction: A mobile-based application is one of the potential solutions to manage conditions of people living with human immunodeficiency virus (HIV) in real-time. This study aimed to design and develop HIV self-management mobile application as a suitable solution for HIV self-management of people living with HIV. Material and methods: This study was a mixed-method in nature, carried out in five phases: 1) comparative study of existing mobile applications; 2) developed its’ object-oriented conceptual model; 3) developed the initial version approved for production; 4) implementation of the final version of Aysoo, and 5) evaluation. Statistical population consisted of HIV-positive people who attended the Iranian Research Center for HIV/AIDS (IRCHA) in 2019. Results: Aysoo was developed for appropriate HIV self-management, which provided the following main functionalities: registration of clinical symptoms, HIV/acquired immune deficiency syndrome (AIDS) management information, educational information in different stages of HIV, specific care plans based on HIV viral load, reminders to encourage medication adherence, physical activities, nutrition, and in-person visits. Conclusions: HIV mobile-based self-management application Aysoo, has been developed in compliance with health information management (HIM) and infectious diseases experts’ opinions. Aysoo is expected to be helpful in managing HIV condition and increase medication adherence of people living with HIV. [ABSTRACT FROM AUTHOR]

Introduction: The purpose of this research was to know the effectiveness of positive thinking training and acceptance and commitment therapy (ACT) on quality of life and resilience of people living with HIV (PLHIV). Material and methods: This study employed a quasi-experimental method, with pre-test/post-test design. Statistical sample size was 45 PLHIV, who were selected using purposive sampling method. They were randomly assigned into positive thinking (n = 15), ACT (n = 15), and control (n = 15) groups. Quality of life questionnaire by Ware and Sherbourne (1991) and Conner-Davidson resilience scale (2003) were used for all three groups (pre-test). Participants of the experimental groups attended eight 90-minute sessions of group training. Post-test was implemented two weeks after training. Multivariate and univariate analyses of variance (MANCOVA) were used to analyze the data. Results: The results showed that positive thinking group training was effective in promoting quality of life and resilience. The results also demonstrated that acceptance and commitment therapy was effective in promoting quality of life and resilience. According to the findings, there was no significant difference between the effectiveness of positive thinking group training and acceptance and commitment therapy on quality of life and resilience of PLHIV (p > 0.05). Conclusions: According to the obtained results, both training approaches (positive thinking and ACT) promoted quality of life and resilience of PLHIV, and there was no significant difference between the effectiveness of the two intervention approaches. Therefore, both interventions had beneficial impacts on lives of PLHIV. [ABSTRACT FROM AUTHOR]

Introduction: Men who have sex with men (MSM) are a vulnerable group, and their psychological, physical, and social well-being could be affected by various factors. They are also at higher risk of HIV and other sexually transmitted infections (STIs). This study was conducted to identify socio-demographic characteristics and HIV-related risk behaviors among MSM in Iran. Material and methods: A qualitative study was conducted among MSM attending a sexual health clinic in a referral hospital, in Tehran in 2018. Data was collected through four focus group discussions. Content analysis approach was used in data analysis. Results: One hundred MSM were enrolled in this study. Majority of them were 18-25 years old. Participants had numerous comments about their sexual identity and orientation; some were confused about it and mentioned stigma, discrimination, and lack of social and legal support as the most important contributing factors. Social media and parties were the most common places to find a partner. Moreover, majority had a negative attitude toward emotional attachment and marriage in sexual minorities; this was attributed to partner's infidelity, low commitment, and lack of family support by some participants. Conclusions: MSM is a vulnerable to psychosocial problems group due to low sexual knowledge and lack of community and legal supports. Data also indicated high probability of HIV transmission among this group because of risky sexual behaviors. [ABSTRACT FROM AUTHOR]

Introduction: Human immunodeficiency virus (HIV) test-treat-retain cascade analysis, is a model to identify gaps at every stage of service delivery, and formulate potential solutions to enhance coverage of these services, as we aimed to carry out in the present study. Material and methods: In order to detect problems, develop solutions, and further prioritize them at different stages of HIV cascade, Fishbone analysis model (WHO 2018) was used. At first, an Excel file including 15 sheets was constructed, each sheet for a significant demographic data of sub-group covering all key populations. Within each sheet, cascade diagram for diagnostic services, connection to services, treatment, and suppression of viral load was demonstrated. Excel file was sent to 28 key persons. Participants were instructed to identify problems in each stage and list all probable reasons for every specific problem. These reasons were classified into six groups based on Fishbone model, including: 1) policies/guidelines; 2) service/program management; 3) human resources; 4) supplies; 5) services delivery methods; and 6) patient/client-related factors. Subsequently, participants were instructed to propose their potential solutions to address these obstacles. Finally, four key informants prioritized the problems and suggested solutions. Results: Analysis of the most important solutions (with 10-12 scores) proposed by key persons of the five groups, including the increase of society awareness, addressing the stigma of HIV disease in mass media, collaboration between politics and health parties to enhance society knowledge, expanding the treatment and counseling centers and facilities across the country, healthcare workers training to provide valid and reliable guidance and information to people who live with HIV, and refer them to designated centers for care, counseling, and treatment as well as appropriate patient detection, mapping procedure, and gathering precise statistics, and finally, employment of professional caregivers in counseling and testing centers. Conclusions: Based on the identified gaps, innovative strategies to improve HIV testing and early case detection, particularly for key populations, are critical to reach the 90-90-90 target of the UNIAID. [ABSTRACT FROM AUTHOR]

Introduction: Human immunodeficiency virus (HIV)-positive patients experience various concerns and difficulties, including depression and anxiety, which affect their physical and mental health. Resilience is defined as successful coping with challenging life situations. Higher levels of resilience are associated with improved mental and physical health in chronic diseases. Material and methods: This randomized clinical trial included one intervention and one control groups, and it was conducted with 90 HIV-positive women presenting to the Behavioral Diseases Counseling Center of a teaching hospital affiliated to Tehran University of Medical Sciences in Tehran, Iran. Patients were randomly assigned into intervention and control groups. Participants in both groups completed a demographic questionnaire as well as Connor-Davidson resilience scale. Women in the intervention group participated in eight 60-minute sessions (one session per week). Connor-Davidson resilience scale was again completed by participants in both groups immediately, and 4 weeks and 8 weeks after the intervention. Results: There was no significant difference in the total score of resilience and its sub-scales between the two groups before the intervention, whereas right after, the total score of resilience and sub-scales of control and spiritual influences were significantly higher in the intervention group (p > 0.05). Repeated measures analysis of variance showed a significant difference in the mean score of resilience scale and sub-scales at four time-point measurements in the intervention group (p < 0.05), while no significant difference was observed in the control group (p > 0.05). Conclusions: The findings form the current study suggest that mindfulness-based stress reduction training could improve resilience in female HIV-positive patients. [ABSTRACT FROM AUTHOR]

Human T-cell leukemia/lymphoma virus type 1 (HTLV-1) infection is associated with myelopathy/tropical spastic paraparesis (HAM/TSP) and adult T cell leukemia/lymphoma (ATLL), which is a malignancy of mature T lymphocytes. HTLV-2 pathogenesis for humans remains undefined. As they share the same transmission routes, co-infection with human immunodeficiency virus (HIV) and HTLV-1 are often reported among the world, mainly among patients living in highly endemic areas like South America and sub-Saharan Africa. Nevertheless, many clinicians are not aware of the potential risks of co-infection with HTLV-1 when treating an HIV patient. Since both viruses infect CD4+ T lymphocytes, scientists have investigated interactions at the cellular and molecular levels, clinical associations, and related complications. Studies have shown that co-infection with HTLV-1 resulted in an increased CD4+ T lymphocyte count, which might be mistaken for immune compatibility, and lead to a delay in the establishment of antiretroviral therapy (ART) in HIV-positive patients. Some authors have observed that co-infection with HTLV-1/HIV-1 can lead to an acceleration of AIDS progression and lessening survival times. Even so, conflicting results and controversies have been reported. These conflicts highlight the requirement of further studies to provide valuable information within this area. In this systematic review, we summarize the current evidence on the co-infection with HTLV-1 among HIV-positive patients, its associated complications, and the impact on progression of AIDS. [ABSTRACT FROM AUTHOR]

Bartonella is an infrequent yet important pathogen in immunocompromised patients. Bartonella infections can cause serious morbidity and mortality in people living with human immunodeficiency virus (PLWH), particularly those with advanced immunosuppression. The prevalence of clinically evident Bartonella infections among PLWH is relatively low. Here, we reported a bacillary angiomatosis (BA) case in a homeless HIV-positive patient. A 31-year-old man with acquired immunodeficiency syndrome (AIDS) and advanced immunosuppression, who had discontinued antiretroviral therapy (ART) one year ago, referred to the hospital. At the admission, he had nausea, vomiting, anorexia, weight loss, occasional sputum cough, subjective fevers, and multiple skin lesions. Lesions' biopsies were non-diagnostic for routine bacterial, tuberculosis, and fungal infection. However, the diagnosis of Bartonella quintana was confirmed by serum polymerase chain reaction (PCR). After receiving a long course of antibiotic therapy, skin lesions resolved. The patient had a favorable outcome with supportive care and continuation of ART and doxycycline. While easily treated, an infection due to Bartonella may be clinically unrecognized, if skin lesions are absent or overlooked, and microbiologically unrecognized, if appropriate protocols are not followed. Because the fever caused by Bartonella infection is easily treated, it is essential that suspected clinical signs of Bartonella infection in immunocompromised hosts should be reported to the microbiology laboratory. Bartonella quintana infection can result in a broad range of often non-specific clinical manifestations; therefore, patients must be evaluated for suspected bacteremia, and clinical wariness is required for diagnosis. [ABSTRACT FROM AUTHOR]