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In a large, multiregional cohort of African infants with human immunodeficiency virus (HIV) exposure, 44% of those with a positive HIV polymerase chain reaction test lacked a confirmatory positive test. Efforts are needed to ensure high-fidelity implementation of HIV testing algorithms so that all positive results are confirmed. [ABSTRACT FROM AUTHOR]

Despite access to antiretroviral therapy (ART), South Africa has a high human immunodeficiency virus (HIV) burden. Treatment outcomes among individuals on highly active ART (HAART) in KwaZulu‐Natal, with a higher incidence of HIV, are not fully known. This study evaluated the impact of HAART outcomes and identified and analyzed the factors associated with the outcomes in people living with HIV and AIDS (PLWHA) in the high‐incidence region of KwaZulu‐Natal Province, South Africa. This retrospective medical record review was conducted at King Edward VIII Hospital in South Africa. Data analysis was performed using STATA software Version 18.0 and Microsoft Excel 2021. The estimates used were 95% confidence intervals, and a p value < 0.05 was considered statistically significant. A total of 707 clinical records of PLWHA were examined and analyzed; less than half of them (44.98%, n = 318) achieved the benchmark of two consecutive instances of suppressed viral loads. The CD4 greater than or equal to 500 cells/mm3 at baseline average of 22.91% (n = 162) registered an increase to 48.94% (n = 346) in the 6th month and further escalated to 79.49% (n = 562) by the 12th month following ART initiation. A total of 160 deaths (mortality rate of 22.63%) were recorded within the study period. The percentage of HIV‐infected patients attaining viral suppression at 6 and 12 months after initiating the treatment was respectively 44.98% and 67.04%, below the 90% target established by the Joint United Nations Program on HIV/AIDS (UNAIDS). The proportion of favorable immunological responses for individuals on ART increased over time. [ABSTRACT FROM AUTHOR]

Background: Co-infections associated with Immune Reconstitution Inflammatory Syndrome (IRIS) have been described in literature, however they constitute an uncommon finding in the medical community. Case presentation: Here we report a rare case of a 55-year-old woman from Cuba with prior medical history of HIV/AIDS adherent to her antiretroviral therapy (ART) regimen, who was hospitalized in Miami, Florida because of fluid dysphagia, odynophagia and right-sided cervical lymphadenopathy. A prior biopsy of the right cervical lymph node performed in an outside hospital found evidence of non-caseating granulomas with budding yeast, which was later confirmed to be disseminated histoplasmosis by a positive (1-3) -β-glucan assay and histoplasmosis urine antigen in this admission. Furthermore, after multiple imaging testing due to her clinical condition, a brain MRI demonstrated findings concerning for cerebral toxoplasmosis, which was supported by serology findings. Treatment with liposomal amphotericin B and TMP-SMX led to clinical and radiological improvement of this patient's conditions, and she was discharged with an appointment for follow-up in the clinic. Conclusion: This case highlights the complexities and challenges in managing opportunistic infections (OIs) during immune recovery in HIV/AIDS patients on ART, and emphasizes the necessity of continuous, vigilant monitoring and having a broad differential diagnosis in this group of patients. [ABSTRACT FROM AUTHOR]

The major objectives of the present study were (a) to explore the perception of stigma associated with HIV/AIDS among people living with HIV/AIDS (PLWHAs); (b) to investigate the relationship between stigma, self-esteem and psychological health, and; (c) to examine the mediating role of self-esteem in the relationship between (a) felt stigma and psychological health, and; (b) enacted stigma and psychological health. The sample consisted of 200 HIV positive individuals (100 females and 100 males) from Prayagraj (North India). Data were collected using a set of questionnaires (self-report measure). It contained questions related to demographic information (age, gender, marital status, education and income), the experience of stigma, self-esteem and psychological health. Results revealed that perceived and enacted stigma were negatively correlated with self-esteem and psychological health. Enacted stigma emerged as a significant predictor (negative) of self-esteem and psychological health. Self-esteem also emerged as a significant predictor of psychological health. It also revealed that the relationship between enacted stigma and psychological health was significantly mediated by self-esteem. Based on the findings, it is suggested that PLWHAs should be treated with respect and dignity, and efforts should be made to align them with the mainstream. Further, they should be encouraged to think above stigma in order to have a better quality of life. [ABSTRACT FROM AUTHOR]

Estimation of Quality Adjusted Life Years (QALYs) is pivotal toward cost-effectiveness analysis (CEA) of medical interventions. The popular multi-state decision analytic modeling approach to CEA uses standard utility values assigned to each disease state to estimate QALY. In this paper, we have formulated a new approach to estimate QALY by defining utility as a function of a longitudinal covariate significantly associated with disease progression. Association parameter between the longitudinal covariate and survival times has been estimated through joint modeling of the longitudinal and the Weibull accelerated failure time survival model. MCMC techniques have been used to predict expected survival times of each censored case using the fitted model. Time-dependent utility values, calculated using projected values of the longitudinal covariate, have been used to evaluate QALYs for each patient. Proposed methodology has been demonstrated on a retrospective survival data of HIV/AIDS patients. A simulation exercise has also been carried out to gauge the predictive capability of the joint model in projecting the values of the longitudinal covariate. Results show that the proposed dynamic approach to estimate QALY can be a promising alternative to the popular multi-state decision analytic modeling approach, especially when the standard utility values are not available. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to describe the clinical and laboratory outcomes of patients with Acquired Immunodeficiency Syndrome (AIDS) presenting multifocal choroiditis secondary to Cryptococcus sp. infection. Methods: We reviewed the clinical records of AIDS patients diagnosed with cryptococcal multifocal choroiditis at the Laboratory of Infectious Disease in Ophthalmology, Oswaldo Cruz Foundation, from January 2022 to March 2024. Patients meeting the criteria of typical fundus appearance associated with disseminated cryptococcosis laboratory diagnosis were included. Data collected included age, gender, symptoms, plasma HIV viral load, serum T-CD4+ cell count (cells/mm3), initial visual acuity (VA), laboratory methods for cryptococcosis diagnosis, treatment, and final VA. All patients underwent multimodal evaluation including spectral domain optical coherence tomography, fluorescein angiography (FA), and indocyanine green angiography (ICG). Results: Six patients were evaluated, comprising five males (83%) and one female (17%), with a mean age of 36.5 years (standard deviation, SD: 10,46). Five patients (83%) presented with meningeal syndrome. Mean HIV plasma viral load was 262.959 copies/mm3 (SD: 209.469), and the mean serum T-CD4 count was 13.33 cells/mL (SD: 14,63). All patients tested positive for serum cryptococcal antigen (CRAG). Four patients (67%) had positive cerebrospinal fluid (CSF) culture and CRAG. Treatment included intravenous Amphotericin B and oral Fluconazole. Among twelve eyes (100%), four (33%) achieved visual recovery, while eight (67%) maintained initial VA. Lesions were more numerous and distinct on ICG compared to fundus examination and FA. Conclusion: This study underscores the importance of clinical, laboratory, and multimodal evaluations in AIDS patients presenting with cryptococcal multifocal choroiditis. [ABSTRACT FROM AUTHOR]

The HIV/AIDS model was dynamically analyzed in this study. The model has seven compartments: the uneducated, the educated, the HIV-positive who take antiretroviral therapy (ART), the HIV-positive who do not take ART, people receiving ART treatment, people with AIDS who do not receive any treatment (full-blown AIDS), and the recovered. This model takes into account the analysis of the multiple interactions between the uneducated and the educated subpopulations, the HIV-positive who take and who do not take ART. The free-disease and endemic equilibrium points, as well as the basic reproduction number ( R 0) as a limit condition for infection-free and endemic occurrence, were produced by a mathematical analysis. The center-manifold hypothesis was used to prove that a backward bifurcation exists. The free-disease and endemic equilibrium points coexist when R 0 < 1. This means that HIV/AIDS is still spreading. A basic reproduction number below one is insufficient to constitute a free-disease condition. In order to determine essential parameters that significantly contribute to HIV/AIDS transmission, we computed sensitivity index values using a sensitivity analysis. The HIV/AIDS model and bifurcation parameter both identified the rate of HIV transmission from uneducated individuals to HIV-positive individuals who do not receive ART as the most crucial parameter. A numerical simulation supports the dynamical analysis. [ABSTRACT FROM AUTHOR]

Background: People living with HIV (PLHIV) have historically faced a range of challenges negotiating satisfying sex lives in the context of virus transmission risks and HIV-related stigma. We examine the experience of sexual satisfaction among PLHIV in an era of pre-exposure prophylaxis (PrEP) and undetectable=untransmissible (U=U)/treatment as prevention. Methods: Data are derived from HIV Futures 9, a cross-sectional survey of PLHIV in Australia conducted between December 2018 and May 2019. Logistic regression was used to identify factors associated with sexual satisfaction, including awareness of/engagement with U=U and PrEP as well as experiences that denote HIV-related stigma. Results: Over half (56.5%) of the total sample (n = 715) reported they were not satisfied with their sex lives. Those who avoided sex because of their HIV status (44.4%) were more likely to report sexual dissatisfaction, as were those who were aged 50 years or over and those with worse self-reported health. Participants who expressed a concern about their drug use were more likely to report sexual dissatisfaction when compared with those who expressed no such concern. Conclusions: Concerns about HIV continue to be present in the lives of PLHIV and can interrupt or undermine intimate and sexual relationships. Although biomedical prevention technologies such as PrEP and antiretroviral therapy may alleviate anxiety relating to onward transmission of HIV, these findings indicate that concerns about HIV status, which may be related to experiences of stigma, are still adversely associated with enjoyment of sex for those living with HIV. For people living with HIV (PLHIV), sexual satisfaction can be challenging because of stigma, discrimination, or fears surrounding onward transmission. This article investigates sexual satisfaction among PLHIV, demonstrating high levels of sexual dissatisfaction associated with avoiding sex due to HIV status, concerns about drug use, older age, and poor self-reported health. These findings highlight that supporting PLHIV extends beyond biomedical considerations (e.g. HIV treatment), demanding a holistic approach that tackles stigma and other health concerns. [ABSTRACT FROM AUTHOR]

Background: Since human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) infection have been identified, significant improvements have been made concerning its diagnosis and treatment. Few contributions have been made in the area of quality indicators in the Democratic Republic of Congo (DRC). To address this gap, a recent study conducted in the said area in 2023 resulted in the development of a comprehensive list of 88 indicators for assessing the quality of clinical care for HIV and AIDS. Out of these, 66 were identified as a core set of quality indicators for the assessment of HIV and AIDS clinical care. The aim of this study was to evaluate compliance with these quality indicators and determine those that are associated with mortality among people living with HIV and AIDS (PLWHA) in the DRC. Methods: A retrospective cohort study was conducted at Panzi Hospital in Bukavu, South Kivu province of the DRC. The study population included PLWHA adult patients who were followed for a period of five years at the antiretroviral (ARV) clinic from January 2017 to December 2021. Descriptive analysis was performed to evaluate essential characteristics, and inferential statistics were performed including a multivariable logistic regression analysis performed to assess the association between selected clinical care indicators and PLWHA mortality, to estimate the odds ratios of mortality based on various factors, and to control for confounding variables. Results: A total of 884 PLWHA were included. The level of compliance with the quality indicators was 78.79%. In the multivariate analysis, the quality-of-care indicators associated with mortality in the follow-up PLWHA on treatment were items 12 (Late diagnosis of HIV infection in specialized care), 24 (Assessment of resistance in cases of virologic failure), and 38 (Evaluation of Cardiac risk). Other factors associated with mortality were male sex, lower CD4 (< 500mm3) and high viral load (> 50 copies/ml). Conclusion: The level of compliance with the indicators was moderate. Some quality indicators were associated with mortality. These indicators are associated with delayed diagnosis of HIV infection, assessment of resistances in case of virologic failure, and evaluation of cardiac risk. Addressing gaps in adherence to these quality of care indicators (clinical care standards) could potentially reduce mortality rates and enhance the overall management of HIV and AIDS, particularly at Panzi Hospital in Bukavu, South Kivu Province, and in general in the DRC. [ABSTRACT FROM AUTHOR]

Background: This study aimed to explore the mechanism of action of DiWuYangGan (DWYG) capsule in improving Immunological non-responder (INR) by analyzing the active ingredients of DWYG. Methods: The study employed a randomized, controlled, double-blind, single-simulation method. Patients were randomly divided into control and trial groups and treated with the primal highly effective antiretroviral therapy. To demonstrate the effect of DWYG on INR, patients in the control group were administered simulated DWYG, whereas patients in the trial group were administered DWYG capsules (ChiCTR1900024673). The chemical composition of DWYG was analyzed using ultra-performance liquid chromatography-high-resolution mass spectrometry. Potential targets of DWYG in the treatment of INR were identified and predicted using network pharmacology and molecular docking. The molecular mechanisms underlying the effects of DWYG were validated using a peripheral blood monocyte model. Results: The CD4:CD8 ratio in the trial group was significantly higher than that in the control group (p < 0.01). A total of 210 DWYG compounds were identified and network pharmacology revealed 182 potential therapeutic targets for DWYG and INR. The results of Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analyses showed that the toll-like receptor signaling pathway is one of the key pathways. This study demonstrated that DWYG reduced the expression level of TLR4 and the levels of IL-2, IL-10, and TNF-α, which are important cytokines involved in the immune response. Conclusion: The efficacy of DWYG in the treatment of INR confirmed the potential practical components of DWYG. Moreover, the results of network pharmacology and experimental validation showed that DWYG could restore the immune function of acquired immune deficiency syndrome patients by inhibiting the expression of TLR4 and related signaling pathways and the overactivation of immune function. Clinical Trial Registration: https://www.chictr.org.cn/index.html, identifier ChiCTR1900024673. [ABSTRACT FROM AUTHOR]

Objective To systematically evaluate the incidence of self-harm behavior and self-harm ideation among HIV/AIDS patients, providing evidence-based support for effectively improving their mental health. Methods A comprehensive search of relevant studies was conducted in databases including CNKI, CBM, VIP, WanFang Data, PubMed, Embase, Cochrane Library, Web of Science, and PsyclNFO, covering literature up to August 20, 2024. Two researchers independently screened the literature, extracted data, and assessed the quality. Meta-analysis was performed using Stata 17.0 software. Results A total of 9 studies were included, with a sample size of 17 414. Meta-analysis of the random effects model showed that the combined incidence of self-harm behaviors and self-harm ideation in HIV/AIDS patients was 12.3% (95%CI: 9.2%-15.4%), the incidence of self-harm behaviors was 12.4% (95%CI: 7.2%-17.6%), and the incidence of self-harm ideation was 13.3%(95%CI: 8.2%-18.5%). Subgroup analyses showed that the prevalence of self-harm behaviors and self-harm ideation was higher among HIV/AIDS patients in Asia and was higher in moderate-quality studies than in high-quality studies. In addition, higher prevalence rates were also observed in studies published before 2015, in people aged 18-24 years, and in studies with <50% males, but these results need to be interpreted with caution in conjunction with the results of the heterogeneity analysis. Conclusion The incidence of self-harm behavior and self-harm ideation is relatively high among HIV/AIDS patients, particularly in Asia. Further research is needed to validate differences among various groups and to develop effective intervention strategies. [ABSTRACT FROM AUTHOR]

Introduction: There are many problems regarding the leakage of personal data in Indonesia, one of which is the leakage of medical data. Patient data is listed in a document called medical records. This paper discusses HIV/AIDS patient data privacy and public information disclosure. Materials and methods: This was dogmatic research which employed a statutory approach and a conceptual approach. Results: Regulations for medical data specifically regarding HIV/AIDS patient data in Indonesian laws and regulations are contained in Law Number 17 of 2023 which regulates health workers. Concerning the legal aspects of personal data protection, there must be special attention to HIV/AIDS patient data, privacy, and public information disclosure, especially the data protection. The data leakage case from the National Health Security (BPJS Health) which leaked hundreds of millions of data should be used as learning material for the government to increase data security, including data on medical colleagues for HIV/AIDS patients after it is established. Discussion: Data protection provisions regarding patient data are listed in the Personal Data Protection (PDP) Law. Medical records of HIV/AIDS patients are included in a specific data category in the PDP Law. The PDP Law has very strict regulations on the disclosure of specific data based on its management and processing. Conclusion: The author sees that there are limitations in the aspect of public information disclosure regulated in the Public Information Disclosure Act. Medical records are information that can be exempted from being disclosed to the public for certain reasons. [ABSTRACT FROM AUTHOR]

Introduction: Identifying strategies to further reduce AIDS‐related mortality requires accurate estimates of the extent to which mortality among people living with HIV (PLHIV) is due to AIDS‐related or non‐AIDS‐related causes. Existing approaches to estimating AIDS‐related mortality have quantified AIDS‐related mortality as total mortality among PLHIV in excess of age‐ and sex‐matched mortality in populations without HIV. However, recent evidence suggests that, with high antiretroviral therapy (ART) coverage, a growing proportion of excess mortality among PLHIV is non‐AIDS‐related. Methods: We searched Embase on 22/09/2023 for English language studies that contained data on AIDS‐related mortality rates among adult PLHIV and age‐matched comparator all‐cause mortality rates among people without HIV. We extracted data on the number and rates of all‐cause and AIDS‐related deaths, demographics, ART use and AIDS‐related mortality definitions. We calculated the proportion of excess mortality among PLHIV that is AIDS‐related. The proportion of excess mortality due to AIDS was pooled using random‐effects meta‐analysis. Results: Of 4485 studies identified by the initial search, eight were eligible, all from high‐income settings: five from Europe, one from Canada, one from Japan and one from South Korea. No studies reported on mortality among only untreated PLHIV. One study included only PLHIV on ART. In all studies, most PLHIV were on ART by the end of follow‐up. Overall, 1,331,742 person‐years and 17,471 deaths were included from PLHIV, a mortality rate of 13.1 per 1000 person‐years. Of these deaths, 7721 (44%) were AIDS‐related, an overall AIDS‐related mortality rate of 5.8 per 1000 person‐years. The mean overall mortality rate among the general population was 2.8 (95% CI: 1.8–4.0) per 1000 person‐years. The meta‐analysed percentage of excess mortality that was AIDS‐related was 53% (95% CI: 45–61%); 52% (43–60%) in Western and Central Europe and North America, and 71% (69–74%) in the Asia‐Pacific region. Discussion: Although we searched all regions, we only found eligible studies from high‐income countries, mostly European, so, the generalizability of these results to other regions and epidemic settings is unknown. Conclusions: Around half of the excess mortality among PLHIV in high‐income regions was non‐AIDS‐related. An emphasis on preventing and treating comorbidities linked to non‐AIDS mortality among PLHIV is required. [ABSTRACT FROM AUTHOR]

Cytomegalovirus retinitis (CMVR) is a significant cause of blindness in patients with advanced acquired immunodeficiency syndrome (AIDS). There are no established guidelines for its treatment, resulting in varied antiviral approaches. We pooled data from 59 studies (4501 patients) to evaluate treatment variations and outcomes (CRD42022321088). Overall pooled estimates showed visual acuity improvement at 18 % (95 % CI: 7–41 %), inflammation resolution at 90 % (95 % CI: 81–95 %), retinal detachment at 11 % (95 % CI: 8–14 %), and recurrence at 19 % (95 % CI: 11–31 %). The main antiviral treatment approaches identified were: (1) intravenous antivirals alone in 33 studies, (2) intravitreal antivirals alone in 26 studies, (3) oral antivirals alone in 3 studies, and (4) a combination of systemic (oral or intravenous[IV]) and intravitreal antivirals in 7 studies, with varying schemes and durations. Ganciclovir was the predominant antiviral, with intravenous administration being the most reported (in 23 studies), followed by intravitreal administration (in 20 studies). While visual acuity improvement was comparable, inflammation resolution tended to be higher with intravitreal than with IV antivirals, though not statistically significant (88 %, 95 % CI: 69–96 % vs 75 %, 95 % CI: 35–94 %, p = 0.38). Retinitis progression rate for IV ganciclovir was lower than for those without ganciclovir. Inflammation recurrence was significantly lower in antiretroviral (ART)-treated compared to non-ART-treated HIV/AIDS patients (10 % (95 % CI: 4–20 %) vs 33 % (95 % CI: 19–50 %), p < 0.01). Neutropenia, particularly with ganciclovir, was the most reported adverse effect (up to 50 %). [ABSTRACT FROM AUTHOR]

Background: The ICH E9 (R1) addendum on Estimands and Sensitivity analysis in Clinical trials proposes a framework for the design and analysis of clinical trials aimed at improving clarity around the definition of the targeted treatment effect (the estimand) of a study. Methods: We adopt the estimand framework in the context of a study using "trial emulation" to estimate the risk of pneumocystis pneumonia, an opportunistic disease contracted by people living with HIV and AIDS having a weakened immune system, when considering two antibiotic treatment regimes for stopping antibiotic prophylaxis treatment against this disease. A "while on treatment" strategy has been implemented for post-randomisation (intercurrent) events. We then perform a sensitivity analysis using reference based multiple imputation to model a scenario in which patients lost to follow-up stop taking prophylaxis. Results: The primary analysis indicated a protective effect for the new regime which used viral suppression as prophylaxis stopping criteria (hazard ratio (HR) 0.78, 95% confidence interval [0.69, 0.89], p < 0.001). For the sensitivity analysis, when we apply the "jump to off prophylaxis" approach, the hazard ratio is almost the same compared to that from the primary analysis (HR 0.80 [0.69, 0.95], p = 0.009). The sensitivity analysis confirmed that the new regime exhibits a clear improvement over the existing guidelines for PcP prophylaxis when those lost to follow-up "jump to off prophylaxis". Conclusions: Our application using reference based multiple imputation demonstrates the method's flexibility and simplicity for sensitivity analyses in the context of the estimand framework for (emulated) trials. [ABSTRACT FROM AUTHOR]

Background: Immune reconstitution inflammatory syndrome (IRIS) is an inflammatory reaction that occurs in HIV/AIDS patients after antiretroviral therapy (ART) initiation. Along with immune system recovery, IRIS can overreact to existing infections or latent pathogens, causing symptoms that mimic those infections. Few studies elucidated the clinical features and prognosis of Talaromycosis marneffei (TSM)-associated IRIS in HIV/AIDS patients. The aim of our study was to evaluate the incidence, clinical characteristics, and prognosis of TSM-associated IRIS by retrospectively analyzing the clinical data of HIV/AIDS patients with TSM. Methodology/Principal findings: A total of 224 HIV/AIDS inpatients with TSM were enrolled, aged between 19 and 81 years. Among them, 86.6% were male and 13.4% were female, of which 24 (10.7%) patients developed IRIS. In IRIS group, the median time from ART initiation to IRIS occurrence was 9.0 days (IQR, 5.0–16.8 days), with 87.5% (21/24) occurring within 2 weeks. Primary clinical manifestations included recurrent fever and exacerbation of pulmonary infection. At the onset of IRIS, 54.2% (13/24) patients were treated with intravenous dexamethasone, and 12.5% (5/24) patients were treated with oral prednisone for 1–3 weeks. No significant differences in baseline characteristics or ART regimens were observed between IRIS and non-IRIS groups; however, patients in IRIS group had higher levels of CRP, CD4+ count, and CD4+/CD8+ ratio than non-IRIS group (equivalent time point: 1–2 weeks after ART initiation) at IRIS onset. The IRIS group exhibited longer hospital stays and higher readmission rates, but equivalent mortality rates compared with non-IRIS group. Conclusions/Significance: IRIS is a common complication in HIV/AIDS patients with TSM, often occurring within 2 weeks after ART initiation and exhibiting more pronounced immune reconstitution. The occurrence of IRIS significantly extended the hospitalization duration and increased the rate of readmission but had no influence on the mortality rate. Author summary: Immune reconstitution inflammatory syndrome (IRIS) is an inflammatory reaction that occurs in HIV/AIDS patients after antiretroviral therapy (ART) initiation. Along with immune system recovery, IRIS can overreact to existing infections or latent pathogens, causing symptoms that mimic those infections. The clinical characteristics of IRIS depend on the causative pathogen. Talaromycosis marneffei (TSM) is one of the common opportunistic infections in HIV/AIDS patients, and often presents a disseminated form of infection, affecting multiple organs throughout the body. However, few reports on TSM-associated IRIS lead to challenges in clinical management. In this study, we carried out a retrospective analysis of TSM-associated IRIS, elucidated the occurrence and clinical features of TSM-associated IRIS, and compared the laboratory examination data and outcomes in TSM patients with or without IRIS. This study aims to review clinical data from HIV/AIDS patients with TSM to assess the frequency, features, and outcomes of TSM-associated IRIS, to improve understanding of the condition, and to facilitate clinical treatment effectively. [ABSTRACT FROM AUTHOR]

Introduction: Quality of life (QoL) is a vital healthcare indicator among people living with human immunodeficiency virus (PLWHA). Assessing the effects of comorbidities on QoL among PLWHA is of clinical and public health importance. This study compared the QoL of comorbid and non-comorbid PLWHA at St. Gerard's Catholic Hospital (SGCH), Kaduna. Methods: This was a prospective cross-sectional study of 178 conveniently selected and stratified comorbid PLWHA and 172 non-comorbid PLWHA receiving care at the facility. Data was collected using a structured, interviewer-administered instrument. The QoL scores were statistically compared using the Mann‒Whitney U test. P <0.05 was considered statistically significant for all the analyses. Results: Most respondents were aged 35 – 54 years (65.2% and 66.4% for comorbid and non-comorbid patients respectively), were female (70.8% and 69.2% for comorbid and non-comorbid patients respectively) and married (67.4% and 59.3% for comorbid and non-comorbid patients respectively). For all QoL domains (perception of QoL and general health, physical health, psychological health, level of independence, social relationship, environment, and spirituality/religion/personal beliefs), there was evidence the distribution of values was significantly lower in the comorbid PLWHA compared to the non-comorbid PLWHA (p<0.001), with the largest difference seen for physical health. The mean physical health (interquartile range) was 9 (7-10) and 17 (15-19) for comorbid and non-comorbid PLWHA respectively. The most prevalent comorbidities among the PLWHA were hypertension 97 (54.49%) and diabetes 36 (20.22%). Conclusion: Non-comorbid PLWHA had better QoL than comorbid PLWHA in all the QoL domains and the greatest difference was observed in physical health. Special efforts should be made to improve the QoL of comorbid PLWHA. [ABSTRACT FROM AUTHOR]

Introduction: The intersection of infectious diseases, such as HIV, with chronic conditions like hypertension and diabetes poses a significant challenge in global health. While advancements in antiretroviral therapy have transformed HIV into a manageable chronic condition, a growing number of individuals with HIV now grapple with coexisting non-communicable diseases, impacting their Health-Related Quality of Life (HRQoL). Despite strides in HIV care, there is a notable policy gap that undermines efforts to address HIV-associated co-morbidities, particularly hypertension and diabetes, especially efforts to improve access, early detection, and ultimately HRQoL for individuals with HIV and co-morbidities. This study seeks to explore policy interventions aimed at improving the quality of life of HIV patients with hypertension or diabetes. Methods: The study utilized a qualitative descriptive design to explore the experiences and perspectives of healthcare professionals and support staff regarding policy interventions for managing HIV patients with hypertension and/or diabetes co-morbidities in three regions of Ghana. The research was conducted in the Upper West, Ashanti, and Greater Accra regions among 11 participants, chosen purposively from professions involved in HIV patient care to understand their views on the implementation of policy interventions to HRQoL for individuals with HIV and co-morbidities. In-depth interviews were conducted face-to-face and tape-recorded. Thematic analysis approach was used to analyze the data. Results: The study involved 11 participants from three regions with varied years of experience. Implemented policies that potentially improve the HRQoL for individuals with HIV and co-morbidities involve support groups, home visits, provision of free drugs, and counselling. Barriers to policy implementation included non-adherence to medication, stigma, cost of non-communicable diseases (NCDs) medications, accessibility issues to NCDs services, lack of interest or understanding among implementers, and high staff turnover. Facilitators encompassed in-service training, guidelines in common platforms, knowledge sharing, external resources, regular check-ups, and motivational packages for patients. Conclusion: Individuals with HIV and comorbidities face complex challenges impacting their HRQoL, including emotional and financial dimensions. The study identifies critical policies and barriers, underscoring the need for tailored, patient-centered approaches. Facilitators like in-service training and regular check-ups offer actionable insights for effective policy implementation, emphasizing improved health outcomes for those with comorbid conditions. The study recommends integrated care approach and adherence support programs that address the unique challenges faced by people living with HIV. [ABSTRACT FROM AUTHOR]

Background: HIV has an effect on lowering CD4 cell count, which lowers the ability to resist contamination. For patients on ART in areas with limited resources, the CD4 cell count assessment is crucial for determining treatment responses and therapeutic decisions. The volatility of CD4 counts following the introduction of ART over time is still largely uncharacterized, and there are few fresh datasets on CD4 cell count progressions. The goal of this study was to identify the key factors that change over time in CD4 cells for HIV/AIDS patients receiving ART follow-up in northern Ethiopia. Methods: A total of 216 HIV/AIDS patients who initiated ART in the Mekelle General Hospital between 2013 and 2016 were involved using systematic random selection techniques. An examination of exploratory data was used to describe the individual profiles of HIV patients. A multivariable random intercept and slope linear mixed regression analysis regarded predictor variables to be statistically significant if their p-value was less than 0.05. Results: The random intercept and slope linear mixed model result indicated that there were statistically significant predictors of baseline CD4 cell count (β = 0.0125, P-value = 0.001*) and bedridden functional status (β = -2.459, p = 0.02*) on the change of CD4 cell count over time in HIV/AIDS patients at the 5% significance level. Conclusions: Changes in CD4 counts were influenced by the baseline CD4 cell count and the functional status of being bedridden. Because their CD4 cell counts were lower at baseline and they had a functional status of bedridden, the majority of HIV/AIDS patients on ART had substantial predictors on the change of CD4 cell count over time. So, public health service providers should give exceptional guidance and attention is also necessary for those patients who have lower baseline CD4 cell count and bedridden functional status. [ABSTRACT FROM AUTHOR]

In this study, a numerical method based on the Pell-Lucas polynomials (PLPs) is developed to solve the fractional order HIV/AIDS epidemic model with a treatment compartment. The HIV/AIDS mathematical model with a treatment compartment is divided into five classes, namely, susceptible patients (S), HIV-positive individuals (I), individuals with full-blown AIDS but not receiving ARV treatment (A), individuals being treated (T), and individuals who have changed their sexual habits sufficiently (R). According to the method, by utilizing the PLPs and the collocation points, we convert the fractional order HIV/AIDS epidemic model with a treatment compartment into a nonlinear system of the algebraic equations. Also, the error analysis is presented for the Pell-Lucas approximation method. The aim of this study is to observe the behavior of five populations after days when drug treatment is applied to HIV-infectious and full-blown AIDS people. To demonstrate the usefulness of this method, the applications are made on the numerical example with the help of MATLAB. In addition, four cases of the fractional order derivative () are examined in the range. Owing to applications, we figured out that the outcomes have quite decent errors. Also, we understand that the errors decrease when the value of N increases. The figures in this study are created in MATLAB. The outcomes indicate that the presented method is reasonably sufficient and correct. [ABSTRACT FROM AUTHOR]

We conducted a retrospective, observational study among acquired immune deficiency syndrome (AIDS) patients with cryptococcal meningitis or talaromycosis to assess AmB formulations-related adverse events (AEs). Total 205 eligible patients were enrolled. Of them, 139 received AmB therapy, 51 received liposomal AmB (L-AmB) therapy, and 15 received AmB cholesteryl sulfate complex (ABCD) therapy. The incidences of total AEs between the AmB, L-AmB and ABCD group had no significant differences. The ABCD group had significantly higher incidences of hepatotoxicity and hematological toxicity than the AmB and L-AmB groups. The incidence of grade 3–4 hematological toxicity in the ABCD group was significantly higher than that in the AmB and L-AmB groups. Multinomial logistic regression models showed that compared with AmB, ABCD had a higher risk for the occurrence of grade 3–4 hematological toxicity (aOR = 43.924, 95%CI 6.296-306.418; p < 0.001). We demonstrated that ABCD was more prone to hepatotoxicity and hematological toxicity than AmB and L-AmB among AIDS patients, which is worth noting. [ABSTRACT FROM AUTHOR]

Background: Transgender women (TGWs) constitute one of the key populations for HIV prevention and control and constitute a high-risk group due to a lack of health services. The aim of this study was to investigate knowledge, attitudes and practices (KAPs) related to HIV and knowledge access and needs amongst transgender women in Chongqing, China. Methods: A cross-sectional study was conducted from October 2022 to March 2023. A total of 128 self-identified TGWs were recruited in Chongqing, China, via snowball sampling, and a KAP-related questionnaire was completed via Questionnaire Star. Results: For the 128 TGWs surveyed effectively, the total knowledge of AIDS-related knowledge was 82.03%, with significant differences in age, education level, marital status, occupation and average monthly income (p < 0.05). Significant differences were obtained in terms of personal attitudes toward AIDS and place of domicile and literacy (p < 0.05) and subjective norms in terms of literacy (p < 0.05). No significant difference was observed between the groups in terms of HIV-related practices. The corresponding values were assigned to knowledge, attitudes or practices. The total scores of the three aspects were 6.77 ± 1.47 (95% confidence interval [CI]: 3.89–9.65) (range: 0–8), 14.22 ± 2.37 (95% CI: 9.57–18.87) (range: 0–18) and 6.66 ± 1.79 (95% CI: 3.16–10.17) (range: 0–9), respectively. The main approaches for TGWs to acquire AIDS knowledge are 'Internet/smartphone' (81.68%), 'TV/radio' (49.62%) and 'special education on AIDS prevention in schools' (48.09%). TGW is more inclined to accept promotional activities such as 'WeChat push' (58.02%), 'peer education' (44.27%) and 'mobile app management' (37.40%). AIDS knowledge indicates that TGW needs to strengthen publicity, including 'transmission routes' (71.76%), 'voluntary counselling and testing knowledge' (67.94%) and 'virus-related knowledge' (64.89%). Conclusions: First, the knowledge rate of AIDS amongst TGWs in Chongqing, China, still has room for improvement, and there is a gap between knowledge and behavior. Second, TGWs are tolerant of AIDS and people living with AIDS and have a strong awareness of AIDS prevention. Third, the health department should attach importance to the group of TGW over 35 years old, low-income, and low-educated, and promote social organizations and network platforms to further strengthen the health education and publicity of AIDS from the perspectives of knowledge acquisition and needs. [ABSTRACT FROM AUTHOR]

Background: This study evaluated the gender-dependent potency and side effects of Highly Active Antiretroviral Therapy regimens (i) Zidovndine/Lamuvidine/ Nevirapine (ii) Tenofovir/Emtricitabine/Effavirenz on HIV-positive/AIDs patients attending Nsukka district hospital Enugu, from January 2013 to December 2013. Method: A retrospective study of two hundred (200) patients of both sexes within the age bracket of 15 -- 70 years attending Nsukka District hospital who were treated with HAART was conducted. Clinical and laboratory data were obtained through self developed validated data collection form. Results: Abdominal pains and diarrhea (3.3%) were the most reported clinical manifestations in regimen 1, followed by headache and chills (2.2%) while in regimen 2, headache, hotness and dizziness (2.4%) were the most reported clinical manifestations followed by pruritis. HAART 1 showed more adverse effects than HAART 2 on both sexes on most of the biochemical variables; glucose (34.57±95.97 - 4.89±0.3 mmol/l), cholesterol (17.33±39.87 - 3.63±0.62 mmol/l), serum glucotransaminase (SGOT) (36.78±27.76 - 32.83±17.10 iu/l), blood urea nitrogen (BUN), (18.66±13.33 - 15.14±6.01mg/dl) and amylase (126.29±186.21 - 104.43±31.38 µg/l).While both regimens showed improved immunological and hematological outcomes: CD4+; 282.03±219.57 - 380.89±241.21 cells/µl (HAART1), 312.09±242.60-404.15±253.17 cells/µl (HAART2), hemoglobin(Hb) 10.60±1.74 - 10.93±1.81 g/dl (HAART1), 10.46 ±2.00 - 11.46±1.85 g/dl (HAART2). Conclusion: The adverse effects on clinical manifestation were more noticeable in regimen 1 in the study population, with the female population being the greater affected. Comparison of the two regimens with respect to their adverse effects on clinical manifestation favors regimen 2. [ABSTRACT FROM AUTHOR]

This article examines the first decade of the HIV/AIDS epidemic in the United States with an emphasis on welfare by focusing on women with HIV and AIDS and their struggle to be recognized. Topics include the Social Security Act, the Center for Disease Control’s role in defining HIV/AIDS classification and its surveillance of them, and the Ryan White CARE Act’s passage in 1990.

Background Anal cancer risk is elevated among people with HIV. Recent anal cancer incidence patterns among people with HIV in the United States and Canada remain unclear. It is unknown how the incidence patterns may evolve. Methods Using data from the North American AIDS Cohort Collaboration on Research and Design, we investigated absolute anal cancer incidence and incidence trends nationally in the United States and Canada and in different US regions. We further estimated relative risk compared with people without HIV, relative risk among various subgroups, and projected future anal cancer burden among American people with HIV. Results Between 2001 and 2016 in the United States, age-standardized anal cancer incidence declined 2.2% per year (95% confidence interval = ‒4.4% to ‒0.1%), particularly in the Western region (‒3.8% per year, 95% confidence interval = ‒6.5% to ‒0.9%). In Canada, incidence remained stable. Considerable geographic variation in risk was observed by US regions (eg, more than 4-fold risk in the Midwest and Southeast compared with the Northeast among men who have sex with men who have HIV). Anal cancer risk increased with a decrease in nadir CD4 cell count and was elevated among those individuals with opportunistic illnesses. Anal cancer burden among American people with HIV is expected to decrease through 2035, but more than 70% of cases will continue to occur in men who have sex with men who have HIV and in people with AIDS. Conclusion Geographic variation in anal cancer risk and trends may reflect underlying differences in screening practices and HIV epidemic. Men who have sex with men who have HIV and people with prior AIDS diagnoses will continue to bear the highest anal cancer burden, highlighting the importance of precision prevention. [ABSTRACT FROM AUTHOR]

Foucault's philosophical theories and sociological boundaries are not mutually exclusive, and his idea of "micro-power" breaks through the traditional sociological perspective of power studies to reveal a set of hidden mechanisms of power operation and networks of power relations, as well as an anthropological examination of how to regulate the human physical and mental spheres. In modern society, as sexual minorities, addicts, AIDS patients and criminal ex-convicts are typical marginalized figures under different social types and community governance. Therefore, this paper aims to analyze how individuals become marginalized and excluded in the social order of functioning through the transformative mechanism from punishment to regulation in Foucault's micro-power, and to reveal how abnormal people, behaviors and phenomena are regulated and implicitly dismembered by the rapidly constructed new social order in China's transition period through the documentary the two lives of Li Ermao. [ABSTRACT FROM AUTHOR]

This article examines the papers of friends and fellow San Francisco Art Institute students Jerome Caja and Charles Sexton at the Archives of American Art. Both Caja and Sexton died of AIDS but not before they forged an agreement that the "winner"—the one who died first—would leave their bodily remains to the "loser." Their close friendship thus culminated in an extraordinary posthumous collaboration where Caja used Sexton's ashes to create a series of depictions of his late friend. This work was contemporaneous with ACT UP's activist deployment of the remains of People with AIDS in their first Ashes Actions. The author contextualizes the friends' art and life practices in the dynamic queer subcultural activity taking place in San Francisco in the early 1990s, particularly at and around Kiki Gallery. The article also reflects on the meanings of Caja's and Sexton's incorporation into the Archives and the continuing power that their transgressive archival "remains" exert today. [ABSTRACT FROM AUTHOR]

Background and Aims: A growing number of acquired immunodeficiency syndrome (AIDS) patients suffer from opportunistic intestinal coccidian infections. Instead of human immuno deficiency virus (HIV) infection itself, opportunistic infections like intestinal coccidian parasites cause death of over 80% AIDS patients. Factors like exposed drinking water sources and poverty aid the prevalence of opportunistic intestinal coccidian parasitic infections in HIV/AIDS patients. The goal of this study was to determine the prevalence of intestinal coccidian parasites and associated factors in HIV/AIDS patients. Methods: A health facility based cross sectional study was conducted from 140 HIV/AIDS patients attending ART clinic in Debre Tabor Comprehensive Specialized Hospital, Northwest Ethiopia from September to December 2023. The sociodemographic characteristics were collected through face‐to‐face interviews. Stool samples were processed with Modified Acid Fast staining technique. Statistical Package for Social Sciences software version 20 was used to analyze the data. Logistic regression was used to assess factors associated with dependent variable and p < 0.05 was considered significantly associated. Results: The total prevalence of opportunistic intestinal coccidian parasites (OICPs) in HIV/AIDS patients was 16.4% (23/140). Drinking surface water [p = 0.015, COR = 3.4] compared to tape water, drinking alcohol [p = 0.001, COR = 18] compared to not drinking alcohol, diarrhea [p = 0.005, COR = 1] compared to non‐diarrheic, drug dropout [p = 0.01, COR = 11] compared to regular drug intake and low CD4 count [p = 0.042, COR = 9] compared to CD4 > 500/µL showed significant association with increased prevalence of OICPs in HIV/AIDS patients. Conclusions: OICPs are still the common causes of morbidity and mortality in HIV/AIDS patients. Surface water consumption, alcoholism, interruption of treatment drugs, diarrhea, and reduced CD4+ T‐cells significantly contribute to acquisition and prevalence of OICPs in HIV/AIDS patients. Routine screening of OICPs with sensitive diagnostic techniques in HIV/AIDS patients regardless of symptoms is crucial and has to be practiced in health settings. [ABSTRACT FROM AUTHOR]

Neurocognitive disorders are mental health conditions that are caused by medical illnesses and can lead to several acquired cognitive deficits, which represent a decline from a previously attained level of functioning. The principal domains of cognitive functions include complex attention, executive function, learning and memory, language, perceptual–motor function, and social cognition. Studies have shown that people living with human immunodeficiency virus (HIV) are at a heightened risk of experiencing cognitive challenges across multiple domains. Given that, a substantial number of people live in Amhara region, assessing cognitive domains to estimate the current magnitude and factors associated with neurocognitive disorders among HIV/AIDS patients is crucial. An institutional-based cross-sectional study was conducted among 569 participants adults living with HIV attending the city's selected health facilities from March 20 to April 30, 2023. A multistage sampling technique was used. The International HIV Dementia Scale (IHDS) was used to measure the outcome of interest. The data were collected using a structured questionnaire and document review. The data were analyzed using STATA version 14. Multiple binary logistic regressions were used as the final model. A total of 501 individuals, with a response rate of 88.04% participated in the study. The overall proportion of HIV patients with neurocognitive impairment was 54.7% (95% CI 50.62–58.77). Factors associated with the neurocognitive impairment were: being widowed AOR = 3.05 (95% CI 1.47–6.31), divorced AOR = 1.95 (1.16–3.28), rural residence AOR = 2.28 (95% CI 1.02–5.09), CD4 count below 500 cells/dl AOR = 1.61 (95% CI 1.03–2.50), history of opportunistic infection AOR = 2.21 (95% CI 1.42–3.41), being in first-line drug regimen AOR = 2.92 (95% CI 1.22–7.00), being in a first-line regimen with Efavirenz AOR = 4.36 (95% CI 1.07–17.73), and impairment in daily living AOR = 2.64 (95% CI 1.39–4.99). In this study, the proportion of neurocognitive impairment was greater than that in most previous studies conducted in Ethiopia. The factors associated with the disorder were: being widowed or divorced, living in a rural area, having low CD4, having a history of opportunistic infection, receiving a first-line drug regimen, receiving efavirenz-containing drugs, and having impaired daily living. Hence, routine neuropsychological screenings should be integrated into comprehensive ART care by the regional health bureau and implemented by hospitals and health centers. [ABSTRACT FROM AUTHOR]

Objective: Human-immunodeficiency virus (HIV) infection initiates the dysregulated production of pro-inflammatory cytokines. Moreover, unsuccessful treatment for HIV might be due to the drug resistance mutations (DRM) against anti-retroviral therapy (ART). This study aimed to compare pro-inflammatory cytokines levels of HIV patients, who received first line ART and patients, with mutations of M184V and K103N. Materials and Methods: This was a case-control study which involved eighty patients with AIDS who received first-line anti-retroviral therapy for at least 6 months. The respondents were divided into two groups of patients with HIV with DRM and the ones with HIV without DRM. M184V and K103N drug resistance mutations to ART were analyzed using reverse transcription-polymerase chain reaction (RT-PCR) meanwhile tumour necrosis factor alpha (TNF-α) and interleukin (IL)-6 as pro-inflammatory cytokines were measured using enzyme linked immunosorbent assay. Results: Most of the patients were men with an average age of 35.5 ± 9.2 years. The median levels for TNF-α and IL-6 were found 43.3 (4.3-96.1) pg/mL and 46.2 (15.5-158.1) pg/mL, respectively. The results showed that the DRM group got higher values compared to the non-DRM group, but there was no statistically significant difference found between both groups. Conclusion: There were no differences in pro-inflammatory cytokines between the DRM AIDS patients group compared to the non-DRM who received first-line ART with mutations of M184V and K103N. [ABSTRACT FROM AUTHOR]

The study aimed to analyze changes in the clinical and epidemiological aspects of HIV-associated cryptococcal meningitis (CM) patients and to identify factors influencing their prognosis. Clinical data of patients with HIV-associated CM treated in Shanghai, China between 2013 and 2023 were collected. This study included 279 cases, 2.89% of AIDS patients, showing a yearly decrease in CM prevalence among AIDS patients (p < 0.001). Overall mortality was 10.39% with rates declining from a 2013 peak of 15.38% to 0% in 2023 despite no significant temporal pattern (p = 0.265). Diagnosis took an average of 18 ± 1 days post-symptoms, and admission CD4 counts averaged 29.2 ± 2.5 cells/μL, hinting at a non-significant decline. Frequent symptoms included fever (62.4%), headache (61.6%), fatigue (44.1%), and appetite loss (39.8%), with younger patients more likely to initially show signs of meningeal irritation. Logistic regression analysis underscored the prognostic importance of cerebrospinal fluid (CSF) white blood cell (WBC) count and procalcitonin levels. Over the decade spanning from 2013 to 2023, the incidence and mortality rates of CM among AIDS patients exhibited a downward trend. The average duration from the onset of CM to confirmation of diagnosis remained prolonged. CSF WBC count and procalcitonin levels were associated with unfavorable outcomes. [ABSTRACT FROM AUTHOR]

Background: Non-tuberculous mycobacteria (NTM) are a group of mycobacteria that are commonly found in the environment and can cause disease in humans. The symptoms of NTM infection can be similar to those of tuberculosis, making diagnosis challenging. The morbidity associated with NTM is increasing, and clinical management can be challenging. Case Description: This report details the case of a 32-year-old male who was found to have multiple enlarged and partially necrotic lymph nodes in the neck, axilla, mediastinum, and retroperitoneum. The causative agent was rapidly identified as Mycobacterium paracondontium through pathogen-targeted sequencing (tNGS). After two weeks of treatment with azithromycin, moxifloxacin, rifabutin, and amikacin, the patient's uncomfortable symptoms had resolved, and he is currently undergoing further review. Conclusion: It is imperative that clinicians remain vigilant for the presence of NTM, particularly those that are rare, given their pervasiveness in the environment. Prompt diagnosis is of paramount importance, and molecular identification techniques represent a crucial tool in this regard. In vitro drug sensitivity testing should be conducted whenever feasible to guarantee the administration of an efficacious treatment regimen. [ABSTRACT FROM AUTHOR]

Background: Despite the global increase in human immunodeficiency virus (HIV) prevalence, there is little knowledge regarding the nature of the HIV clinical profile and patients' sociodemographic characteristics in Upper Egypt. This study aimed to describe the sociodemographic and clinical profile of HIV-infected patients registered in treatment centers in Upper Egypt over the past 7 years. Methods: Data were collected from the available medical records for 650 patients at the three main HIV healthcare centers in Upper Egypt from January 2015 until December 2021. The collected sociodemographic variables included age, sex, occupation, educational level, residence, and risk factors. In addition, clinical examination data, treatment regimens, laboratory investigations, and outcome data were obtained. Results: The study found that most patients (85.5%) were male, with ages ranging from 3 to 78 years and a median age of 33. Intravenous drug use (44.5%) was the most common transmission route, and fever (84.3%) was the most frequently reported symptom. Pneumonia (24.3%) was the most registered opportunistic infection. Median CD4 cell counts were 299 cells/mm3 before treatment and 366 cells/mm³ after treatment. PCR values were available for 631 patients (97%), with viremia evident in 630 patients (99.8%) before treatment. 73.2% of patients showed improvement in outcomes, while 8.3% died. Conclusion: The current study findings provide relevant information for the National AIDS Program (NAP) to design HIV education messages and apply preventive measures accordingly. [ABSTRACT FROM AUTHOR]

Background: People living with HIV (PLWH) are susceptible to social isolation as a result of stigma and discrimination, which not only diminishes adherence to antiretroviral therapy but also heightens the risks of hospital readmission, depression, and mortality. However, there is currently no systematic review addressing the occurrence and impact of social isolation in individuals with HIV. Therefore, this study undertook a comprehensive systematic review and meta-analysis of existing literature to examine the prevalence and influencing factors associated with social isolation among PLWH. Methods and analysis: PubMed, EMBASE, CINAHL, Cochrane Library, Web of Science, Google Scholar, China Science and Technology Journal Database, The China National Knowledge Infrastructure, WanFang Data and Chinese Biomedicine Literature Database will be searched from the establishment of the database to the latest search date. Literature screening, data extraction and literature quality assessment will be done independently by two researchers and results will be cross-referenced. Data analysis will be performed using stata15.1 software. Risk of publication bias will be assessed using Begg's and Egger's methods. Heterogeneity between studies will then be assessed using the I2 index and its 95% CI and Q statistics. Sources of heterogeneity will be accounted for by subgroup and sensitivity analyses. Results: The results may reveal the prevalence of social isolation among PLWH and provide data support for understanding its etiology and prevention. Conclusion: By systematically reviewing the existing literature on social isolation among PLWH, this study aims to provide a comprehensive understanding of the prevalence of social isolation within this population, elucidate the detrimental effects it poses for people affected by HIV, and effectively inform targeted interventions for high-risk groups. Furthermore, these findings offer valuable insights to support evidence-based decision-making in public health policy. Systematic review registration: PROSPERO registration number: CRD42024499044 [ABSTRACT FROM AUTHOR]

Objective To explore the impact of perceived HIV-related discrimination on antiretroviral therapy (ART) adherence among middle-aged and elderly individuals living with HIV/AIDS and the modifying effect of social support, so as to provide guidance for improving ART treatment success rates. Methods By using cluster random sampling method, a questionnaire survey was conducted among middle-aged and elderly HIV/AIDS patients in the city of Mianyang. The survey assessed their sociodemographic characteristics, social support, perceived discrimination, and treatment adherence. Logistic regression models were used to analyze the relationship between these factors and ART adherence. Results The study included 401 middle-aged and elderly HIV/AIDS patients receiving ART. Good adherence was observed in 69.82% of participants, while 30.18% had poor adherence. Univariate analysis revealed that patients with effective viral suppression (viral load ≤20) demonstrated better adherence compared to treatment failure patients (viral load >20). Adherence was also higher among those following single or dual antiretroviral drug regimens. Logistic regression results indicated that fear of disclosure (OR=1.116, 95% CI: 1.023–1.217), public discrimination (OR=1.105, 95% CI: 1.008–1.211), and internal shame (OR=1.119, 95% CI: 1.022–1.225) significantly influenced treatment adherence. Stratified analysis further revealed that fear of disclosure (OR=1.159, 95% CI: 1.034–1.299), public discrimination (OR=1.128, 95% CI: 1.004–1.267), and internal shame (OR=1.150, 95% CI: 1.021–1.297) were associated with adherence. Conclusion Enhancing social support, particularly at the individual and family levels, is crucial to mitigate the impact of fear of disclosure, public discrimination, internal shame, and treatment regimens on HIV/AIDS treatment adherence. Public education and support programs should aim to reduce discrimination, strengthen viral load monitoring, and adjust personalized treatment plans promptly. [ABSTRACT FROM AUTHOR]

Background: Mycobacterium avium complex (MAC) is an uncommon clinical pathogen, especially in the central nervous system (CNS), and carries a poor prognosis. MAC infections commonly present as immune reconstitution disease (IRD) in HIV patients. Herein, we report a case of intracranial infection caused by MAC in an AIDS patient without disseminated MAC (DMAC) and immune reconstitution inflammatory syndrome (IRIS). Case presentation: A 31-year-old HIV-positive male presented us with progressively worsening CNS symptoms, and neuroimaging revealed ring-enhancing lesions. The intracranial lesions worsened after the empirical therapy for toxoplasma encephalitis and fungal infection. Due to the rapid progression of the disease, the patient died. Mycobacterium avium was the only pathogen in brain tissue after cultures and molecular biology tests. Conclusion: MAC infection in CNS is challenging to diagnose in HIV patients. Our findings emphasize that obtaining tissue samples and applying molecular biology methods is essential to help diagnose the patient as soon as possible to receive adequate treatment. [ABSTRACT FROM AUTHOR]

Background: Given the critical importance of medication adherence in HIV/AIDS treatment, this study aims to compare medication adherence measured by self-report (SR) and indirect measurement among antiretroviral therapy (ART) patients, exploring the differences of adherence results measured by different tools. Methods: We systematically searched PubMed, Embase, and the Cochrane Library to identify all relevant literature published up to November 22, 2023, without language restrictions, reporting adherence to ART measured by both SR and indirect measurement methods, while also analyzing individual and group adherence separately. Discrepancies between SR and indirect measurement results were assessed using the Mann–Whitney U test or Wilcoxon signed-rank test, with correlations evaluated using the Pearson correlation coefficient. Following one-to-one comparisons, meta-epidemiological one-step analysis was conducted, and network meta-analysis techniques were applied to compare results obtained through specific adherence assessment tools reported in the identified articles. Results: The analysis encompassed 65 original studies involving 13,667 HIV/AIDS patients, leading to 112 one-to-one comparisons between SR and indirect measurement tools. Statistically significant differences were observed between SR and indirect measurement tools regarding both individual and group adherence (P < 0.05), with Pearson correlation coefficients of 0.843 for individual adherence and 0.684 for group adherence. During meta-epidemiological one-step analysis, SR-measured adherence was determined to be 3.94% (95% CI: -4.48–13.44%) higher for individual adherence and 16.14% (95% CI: 0.81–18.84%) higher for group adherence compared to indirectly measured results. Subgroup analysis indicated that factors such as the year of reporting and geographic region appeared to influence the discrepancies between SR and indirect measurements. Furthermore, network meta-analysis revealed that for both individual and group adherence, the results obtained from most SR and indirect measurement tools were higher than those from electronic monitoring devices, with some demonstrating statistical significance (P < 0.05). Conclusions: The findings underscored the complexity of accurately measuring medication adherence among ART patients. Significant variability was observed across studies, with self-report methods showing a significant tendency towards overestimation. Year of reporting, geographic region, and adherence measurement tools appeared to influence the differences between SR and indirect measurements. Future research should focus on developing and validating integrated adherence measurements that can combine SR data with indirect measures to achieve a more comprehensive understanding of adherence behaviors. [ABSTRACT FROM AUTHOR]

People with HIV / AIDS are vulnerable in living their lives. The presence of a viral load in him causes physical disorders due to the progressive influence of the body's immunity resulting in opportunistic infections with various symptoms that appear. As a result, a reaction appears to the emotional or psychological aspects of the sufferer due to the influence of the sufferer's physical disorders. The aim of the research is to analyze the effect of quality of life on HIV / AIDS patients at Teladan Community Health Centers in 2020 The research design is an analytical survey with a cross sectional approach. The population was 360 people with a probability sampling technique of 78 people. Data analysis used univariate, bivariate with chi-square test and multivariate with multivariable logistic regression test. The results of research using bivariate tests using Chi-Square obtained a p - value of 0.002 < 0.05, meaning that there is an influence of the level of independence of HIV/AIDS patients on the quality of life at the Teladan Medan Community Health Center in 2020. There is an influence of intellectual function on the quality of life of HIV/AIDS patients. The p - value obtained was 0.011<0.05. There was an influence of depression in sufferers on the quality of life of HIV/AIDS sufferers, the p - value obtained was 0.010<0.05. The factor that has the most influence on the quality of life of HIV/AIDS patients is the level of independence factor which has a value of Exp(B)/OR = 3.943, meaning that the level of independence of those experiencing dependency means they have a chance of having a weight quality of life that is 3.9 times higher than those who are independent. It is recommended to involve HIV/AIDS sufferers in every service related to the sufferer's treatment program and provide understanding to the family and community to help and interact with sufferers so that they do not feel ostracized. [ABSTRACT FROM AUTHOR]

This study aimed to estimate the prevalence of cryptococcal antigenemia detected by lateral flow assay (LFA) in AIDS patients and its accuracy in the diagnosis of cryptococcosis. Conducted at a university hospital in Brazil from March 2015 to July 2017, it included AIDS patients over 18 years old with a CD4+ count ≤ 200 cells/mm3. Cryptococcal antigen (CrAg) detection using LFA and latex agglutination (LA), along with blood and urine cultures, were performed. The reference standard was the identification of Cryptococcus spp. in clinical specimens through microbiological or histopathological examination. Among 230 patients, the prevalence of CrAg detected by LFA (CrAg LFA) was 13.0%. Factors associated with cryptococcal antigenemia included fever, vomiting, seizures, and a lack of antiretroviral therapy. The sensitivity and specificity of CrAg LFA were 83.9% and 98.0%, respectively. The positive predictive value (PPV) was 86.7%, the negative predictive value (NPV) was 97.5%, and overall accuracy was 96.1%. Cross-reactions were observed in patients with histoplasmosis and paracoccidioidmycosis, but not with aspergillosis or positive rheumatoid factor. The study concludes that the LFA is a useful tool for detecting cryptococcal antigenemia in severely immunocompromised AIDS patients due to its high NPV, specificity, and PPV. [ABSTRACT FROM AUTHOR]

Primary gaseous air pollutants have been associated with death from multiple causes, however, it remains unknown if they play a role in premature mortality among individuals living with HIV/AIDS. Data on HIV/AIDS patients were collected from the Hubei Provincial Center for Disease Control and Prevention, with a total of 1,467 AIDS-related deaths (ARD) between 2013 and 2020. Daily mean sulfur dioxide (SO2), nitrogen dioxide (NO2), and carbon monoxide (CO) were generated by artificial intelligence algorithms combined with big data. We employed a time-stratified case-crossover approach and conditional logistical regression models to investigate the acute effects of primary gaseous air pollutants on ARD. Per interquartile range increase in the concentrations of SO2 was significantly linked with ARD, with a corresponding odds ratio (OR) of 1.17 [95% confidence intervals (CIs): 1.01, 1.35] at lag 4 day. Furthermore, our findings indicated that males exhibited a heightened vulnerability to the adverse effects of SO2 and NO2, for example, the ORs were 1.24 (95% CIs: 1.05, 1.47) and 1.16 (95% CIs: 1.01, 1.34), respectively. Moreover, individuals aged over 65 years were more susceptible to SO2 and CO. Additionally, we identified the warm season as a sensitive period for mortality associated with SO2 and NO2. Our study furnished fresh evidence regarding the detrimental effects of primary gaseous air pollutants on ARD. [ABSTRACT FROM AUTHOR]

Background: Even though the survival of people living with HIV/AIDS (PLWHA) has improved by ART, their lifestyles and quality of life are affected by several factors like family and community support, and their socio-economic status. Hence, this study was undertaken to estimate the quality of life of HIV/AIDS patients based on the World Health Organization Quality Of Life-Human Immunodeficiency Virus Brief (WHOQOL-HIV BREF) questionnaire and to assess the association of quality of life with socio-demographic variables. Materials and Methods: A cross-sectional study was conducted from April 2019 to December 2020 in a sample of 220 HIV/AIDS patients of age more than 18 years, taking treatment at ART center, Tertiary Care Hospital in Tirupati. The data were collected using a standardized instrument (WHOQOL-HIV BREF). Socio-demographic details of the subjects were also obtained. Data were analyzed using Epi info software 7.2.2.6 version. Results: The overall mean QOL score is 59.3 ± 10.3. The highest mean QOL observed in the physical domain and the most affected domain is the social relationship's domain. Lower levels of QOL were seen in females, residing in rural areas, illiterates, separated/divorced, who does not reveal their HIV status to their family members, who does not have family support, and these are found to be significantly associated with QOL (P < 0.05). Conclusion: The most affected domain is social relationship's domain. Age, residence, educational status, marital status, knowledge of HIV status to family members, and their family support were found to be significantly associated with QOL among PLWHA. [ABSTRACT FROM AUTHOR]

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Background: Patients living with HIV (PLHIV) often face challenges that contribute to missed clinical care which can impact their health outcomes. Methods: This retrospective quantitative study comprised 5338 adults living with HIV who received antiretroviral treatment (ART) for 12 months, from July 2018 to June 2019 in Kinshasa and Haut-Katanga provinces of the Democratic Republic of Congo. Descriptive statistics were computed to show the level of missed appointments for ART. Multivariable associations of clinical and sociodemographic factors with a tendency to miss scheduled visits after adjusting for the covariates were examined using multivariable logistic regression analysis. Results: Six percent of PLHIV experienced at least one missed visit while 94% did not miss any visits. A small proportion (20%) of PLHIV had a viral load ≥1000 copies/mL. PLHIV receiving ART from urban clinics showed significantly higher odds of missed visits compared to those from rural areas (AOR = 4.18, 95% CI [1.84–9.511]; p < 0.0001). Similarly, patients from semi-rural/semi-urban clinics showed significantly higher odds of missed visits compared to those from rural areas. (AOR = 2.57, 95% CI [1.08–6.141]; p = 0.03). Additionally, older PLHIV (18–34 years old) demonstrated increased odds of missed visits (AOR= 1.71, 95% CI [1.0078–2.697]; p = 0.02) compared to those under 18 years old. Conclusions: The findings from this study strongly suggest that there is a significant association between certain demographic factors, such as age and rurality-urbanicity, and missed visits. The study findings have implications for policy and interventions targeting PLHIV at higher risk of missed visits. [ABSTRACT FROM AUTHOR]

Objectives: To describe how people living with HIV/ AIDS (PLWHA) make decisions using the diffusion of innovation theory model. Decisions occur when individual decision makers engage in activities that guide choices to adopt or reject a particular innovation. Methods: This is a descriptive analysis research using a survey method. Data collection was carried out using a decision making questionnaire. The subjects in this research were HIV/AIDS sufferers (PLWHA) who lived in Turen, Indonesia. The number of research subjects was 36 respondents obtained using the purposive sampling technique on January 2023. Original Article Results: The research design used the correlation method with a cross sectional approach and the Spearman correlation coefficient statistical test. The research results show significance (2-tailed) of 0.934 (p>0.05). The correlation coefficient results are negative. Where the direction of the correlation produces showed a very weak relationship with a value of 0.014 and the results of the analysis between variables are not the same. This is because the persuasion stage was not tested in the analysis. Research shows that 8 (22.2%) patients rejected the decision making of PLWHA using the diffusion of innovation theory model at the Western Provident Association Turen Foundation, Turen, Indonesia, while 28 (77.7%) patients accepted it. It can be concluded that the majority of decisions made by HIV/AIDS patients at the ADIS Turen Peduli Warga Foundation are accepted. Conclusion: Knowledge of HIV/AIDS sufferers is at a good level, their decision making is mostly accepted and there is a meaningful relationship between knowledge and decision making in using a chatbot innovation. The suggestion from the research is that this chatbot innovation can be a source of further research and help provide education for PLWHA patients in everyday life. [ABSTRACT FROM AUTHOR]

Histoplasmosis is a frequent cause of infections in people living with HIV/AIDS (PLWHA). This study introduces the application of a Histoplasma capsulatum urine antigen lateral flow assay (LFA) for diagnosing disseminated histoplasmosis in PLWHA in Suriname. The LFA's diagnostic accuracy was compared with the current diagnostic approach, aiming to assess whether this test resulted in improved early detection and management. Additionally, the prevalence of histoplasmosis among advanced stage HIV patients without clinical suspicion of infection was evaluated using the same LFA. In total, 98 patients were included in the study, of which 58 were classified as "possible disseminated histoplasmosis (DH)" based on clinical criteria and 40 as 'controls". Of these possible DH cases, only 19 (32.7%) had a positive LFA. During the study, decisions for treatment were made without the treating physician being aware of the LFA result. Only 55% of the patients who started treatment for histoplasmosis based on clinical criteria had a positive LFA, and 21% of untreated patients had a positive LFA. This study shows that combining clinical signs with LFA results enhances diagnostic accuracy and is cost effective, resulting in better treatment decisions. Author summary: People living with HIV in Suriname often present to care in a late stage of their infection. A common infection in these patients is Disseminated Histoplasmosis (DH). This is caused by a fungus, Histoplasma capsulatum. DH is currently difficult to diagnose. This study evaluated the use of a urine test for the diagnosis of DH, called LFA, in patients with advanced-stage HIV-infection. In the study, 98 advanced-stage HIV infected patients were included. Of these, 58 had signs and symptoms that could be attributable to DH. The other 40 patients were not suspected of DH. In all these patients the usual workup was done. The urine histoplasmosis LFA was carried out afterwards, so the result did not influence clinical decisions. We compared the clinical diagnoses of all patients to the results of the LFA. The results show that only 55% of the patients with a clinical diagnosis of DH and who started antifungal treatment had a positive LFA. Of the untreated patients 21% had a positive LFA. We conclude that treatment decisions solely based on clinical signs and symptoms lead to both over- and undertreatment and that adding this test to the clinical workup of patients suspected of DH, is cost-effective. [ABSTRACT FROM AUTHOR]

Background: Nocardia species can affect both immunocompetent and immunocompromised people. Method: This retrospective study, from 2009 to 2022, aims to compare the survival analyses of pulmonary nocardiosis in AIDS and non-AIDS patients in northeastern Thailand. Results: A total of 215 culture-confirmed cases of pulmonary nocardiosis: 97 with AIDS and 118 without AIDS. The median CD4 count of AIDS patients was 11 cells/µL (range: 1–198), and 33% had concurrent opportunistic infections. 63.6% of 118 non-AIDS patients received immunosuppressive medications, 28.8% had comorbidities, and 7.6% had no coexisting conditions. Disseminated nocardiosis and pleural effusion were more prevalent among AIDS patients, whereas non-AIDS patients revealed more shock and respiratory failure. One hundred-fifty patients underwent brain imaging; 15 (10%) had brain abscesses. Patients with pulmonary nocardiosis have overall 30-day and 1-year mortality rates of 38.5% (95% CI: 32.3%, 45.4%) and 52.1% (95% CI: 45.6%, 58.9%), respectively. The Cox survival analysis showed that AIDS patients with disseminated nocardiosis had a 7.93-fold (95% CI: 2.61–24.02, p < 0.001) increased risk of death within 30 days compared to non-AIDS patients when considering variables such as age, Charlson comorbidity index, concurrent opportunistic infections, duration of illness, shock, respiratory failure, multi-lobar pneumonia, lung abscesses, and combination antibiotic therapy. While AIDS and pulmonary nocardiosis had a tendency to die within 30 days (2.09 (95% CI, 0.74–5.87, p = 0.162)). Conclusion: AIDS with pulmonary nocardiosis, particularly disseminated disease, is a serious opportunistic infection. Early diagnosis and empiric treatment with a multidrug regimen may be the most appropriate approach in a resource-limited setting. [ABSTRACT FROM AUTHOR]