Ayda Mohammadnezamian,1 Keyghobad Ghadiri,2 Mosayeb Rostamian,2 Leila Solouki,3,4 Manizheh Azadian,1 Bahare Andayeshgar,3 Shahla Shahbazi,2 Roya Chegene Lorestani,1,5 Etrat Javadirad21Department of Pathology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran; 2Infectious Diseases Research Center, Health Policy and Promotion Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran; 3Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran; 4Health Data Science Research Center, Health Research Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran; 5Department of Microbiology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, IranCorrespondence: Roya Chegene Lorestani, Infectious Diseases Research Center, Health Policy and promotion Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran, Tel +98 8334262252, Email lorestani25@gmail.com Etrat Javadirad, Infectious Diseases Research Center, Health Policy and Promotion Institute, Kermanshah, Iran, Tel +98 8334262252, Email pathologist84@yahoo.comBackground and Objective: Considering the crucial role of CD4+ T-cell counts in disease control and management, the present study aimed to investigate changes in CD4+ T-cell counts among People Living with HIV (PLWH) at the Behavioral Diseases Counseling Center in Kermanshah Province. The study also assessed the impact of demographic and clinical factors, including age, gender, duration of infection, duration of antiretroviral therapy (ART), and CD4+ T-cell count, on changes in CD4+ T-cell counts during ART among PLWH.Methods: In this retrospective study, the medical records of 2909 PLWH who had attended the Kermanshah Behavioral Diseases Counseling Center between 2012 and 2023 were reviewed. Demographic, behavioral, and clinical data were extracted from the records. Ultimately, 728 individuals whose CD4+ T-cell counts were documented both at diagnosis and after treatment were included in the analysis. Data were analyzed using SPSS version 21. As CD4+ T- cell count changes were not normally distributed, robust linear regression was employed. Collinearity among independent variables and autocorrelation of errors were assessed and confirmed. The assumption of homoscedasticity of errors was also evaluated and satisfied.Results: Among the 728 PLWH, 519 (71.3%) were male and 209 (28.7%) were female. The mean age of the PLWH was 37.2 ± 11.5 years. The mean CD4+ T-cell count at diagnosis was 336.4 cells/μL, which increased to 526.4 cells/μL after treatment. The average duration of treatment was 57.8 months (SD = 34.5), and the average number of follow-up visits was 48.6 (SD = 36.9). Robust linear regression, with ART duration entered as a four-level category, showed that longer ART duration (1– 5 years: B=111.9; 5– 10 years: B=267.5; > 10 years: B=527.3, all vs < 1 year, p< 0.001), higher education (B=302.6, 95% CI: 171.5– 433.7), older age (B=5.3, 95% CI: 2.4– 8.3), and sexual transmission (B=101.6, 95% CI: 18.0– 185.2) were significantly associated with improved CD4+ T-cell recovery (p< 0.05). Female sex, more advanced clinical stage (III–IV), and certain occupational categories were also significantly associated with CD4+ T-cell recovery, while a longer duration of infection was associated with lower CD4+ T-cell recovery (all p< 0.05).Conclusion: Consistent with the well-established effect of antiretroviral therapy on CD4+ T-cell recovery, this study suggests that immune recovery is influenced by both treatment duration and patients’ demographic and clinical characteristics. These findings emphasize the importance of individualized HIV care, with closer monitoring and adherence support for patients at risk of poorer immune recovery.Keywords: HIV, CD4+ T cell counts, retrospective, Iran
Emmanuel Ndahiro ManirafashaCenter for Nursing and Midwifery, University of Global Health Equity, Kigali, RwandaCorrespondence: Emmanuel Ndahiro Manirafasha, Center for Nursing and Midwifery, University of Global Health Equity, Kigali, Rwanda, Tel +250 788 887 265, Email emmyndahiro14@gmail.comAbstract: Adolescents remain insufficiently addressed in the response to advanced HIV disease (AHD) in sub-Saharan Africa. Despite progress in HIV testing and antiretroviral therapy, gaps remain in early identification, integrated care, and continuity of care for adolescents at risk of severe disease. This commentary describes adolescents as a "missing middle” between pediatric and adult HIV services. It highlights how treatment interruption, fragmented services, psychosocial challenges, and weak follow-up can increase their vulnerability. We propose an adolescent-responsive AHD pathway focused on three priorities: early identification of adolescents at risk, integration of clinical and psychosocial care, and continuity after hospitalization or treatment interruption. The approach should be adapted to the available workforce, financing, technology, and health-system capacity. Strengthening these areas may help reduce preventable illness and deaths and improve retention and recovery among adolescents living with HIV in sub-Saharan Africa.Keywords: advanced HIV disease, adolescents, HIV, integrated care, sub-Saharan Africa, continuity of care
Introduction:In remote Ugandan settings, HIV care retention remains poor among men and pastoralists. Despite progress toward UNAIDS 95-95-95 targets, structural barriers, geographic isolation and stigma continue to undermine long-term retention. Case Presentation:In 2022, a male pastoralist in his early forties with heavy alcohol use presented to a rural health center in Karamoja with fever and weight loss, and was diagnosed with HIV. He declined antiretroviral therapy (ART) believing the drugs were "poisonous" and was lost to follow-up for 48 months. He re-presented in March 2026 with a one-year history of a scaly, pruritic lesion on his right hand extending to the face and neck, unresponsive to antifungal creams. Two days prior, he developed an acutely painful vesicular eruption in the right V1 trigeminal distribution, along with oropharyngeal candidiasis. CD4 count was 120 cells/μL and urine TB LAM was positive, indicating disseminated tuberculosis. While LAM is highly suggestive and warrants immediate empirical treatment, definitive diagnosis of dissemination ideally requires clinical and radiological correlation. He was treated with oral acyclovir (800 mg five times daily for 10 days), topical acyclovir, ibuprofen, intensive-phase anti-TB therapy, and fluconazole (200 mg daily for 14 days). ART was deferred for two weeks to manage acute opportunistic infections and monitor for IRIS. At two weeks, the zoster lesions had crusted, oral candidiasis cleared, and pain reduced to 2/10. ART was initiated on day 14 with village health team support. At three months, he remained adherent with no new opportunistic infections. Conclusion:Delayed ART initiation caused years of preventable suffering. This case highlights the urgent need in low-income settings for community re-engagement strategies, integrated HIV/co-infection screening, point-of-care diagnostics, and culturally tailored care. As the patient stated: "I was sick, and now I am well. The science of HIV treatment is a miracle, and I am living proof.".
Introduction:Long-acting injectable pre-exposure prophylaxis (LA-PrEP) is a major biomedical advance for HIV prevention, but efficacy alone does not deliver population-level impact. Oral PrEP performed well in trials yet persisted poorly in practice, including among young women in KwaZulu-Natal, South Africa. LA-PrEP reduces daily pill burden and improves discretion, but introduces implementation demands that oral PrEP did not: appointment-based adherence, product-specific delivery needs, workforce and task-shifting limits, financing vulnerability, HIV testing requirements and pharmacokinetic-tail management. Purpose:This paper develops the Access, Delivery Systems, Acceptability, Persistence and Transition Management (ADAPT) framework as a conceptual, practice-oriented model for LA-PrEP implementation in sub-Saharan Africa. Approach:ADAPT was developed through structured narrative synthesis of peer-reviewed and grey literature on oral PrEP scale-up, cabotegravir long-acting (CAB-LA) and lenacapavir (LEN) efficacy, HIV service delivery, task shifting and implementation frameworks, combined with non-research program experience from facility-facing implementation support in Uganda and Sierra Leone. The model is not empirically validated and should be tested through Delphi consensus, stakeholder consultation, prospective implementation studies and program evaluation. Discussion:ADAPT complements CFIR, RE-AIM, BLUPrInt and WHO guidance. Its contribution is product awareness, planner orientation and explicit recognition of Transition Management as a safety domain. It asks planners to align regulatory access, procurement and affordability; product-specific delivery systems; choice-based acceptability; appointment persistence; and protocols for stopping, switching and restarting. Conclusion:For sub-Saharan Africa, safer and more equitable LA-PrEP rollout requires deliberate design across financing, service delivery, community governance, persistence systems and transition protocols. ADAPT offers a testable organizing model for this work.
Introduction:Retention in HIV pre-exposure prophylaxis (PrEP) care among key populations is crucial to realize its benefits. Evidence is scarce on retention in PrEP care outcomes and associated factors among at-risk women in sub-Saharan Africa. We, therefore, evaluated the retention outcomes in the facility-based PrEP services delivery model and their associated factors among female sex workers in the city of Tanga, Tanzania. Methods:We analyzed data of 313 female sex workers of a control arm of a pragmatic trial. Participants were followed for 16 months from 2022 to 2023. We categorized retention in care outcomes PrEP services as being early and long-term. A multivariable log-binomial regression model was used to determine factors affecting retention in PrEP services at p<0.05. Results:Early and long-term retention in PrEP care was 38.0% (95% CI: 33.25-43.04) and 11.0% (95% CI: 7.67-15.61), respectively. Having sex work as the only source of income negatively affected early retention compared to those with alternative sources of income (aRR 0.58, 95% CI: 0.36-0.94, p=0.028). Having 10-29 sexual clients/month was 34% times lower risk of being retained compared to those with less than 10 sexual clients per month (aRR 0.66, 95% CI: 0.47-0.92, p=0.014). Self-perceived "high" PrEP stigma negatively affected long-term retention compared to perceiving "low" PrEP stigma (aRR 0.16, 95% CI: 0.03-0.99, p=0.049) and self-perceived "moderate" HIV risk was associated with increased retention compared to self-perceived "high" HIV risk (aRR 5.03, 95% CI: 1.37-18.47, p=0.015). Conclusion:The retention in facility-based HIV PrEP care among female sex workers was low. Having sex work as the only source of income, having sex with 10-29 clients, and self-perceived "high" PrEP stigma negatively affected retention in PrEP care. Self-perceived "moderate" HIV risk positively affected retention in PrEP care. Establishing client-centred approaches targeting PrEP stigma and HIV risk awareness is crucial to optimize retention in facility-based PrEP services. Trial Registration:Pan African Clinical Trials Registry PACTR202003823226570.
Introduction:This cross‑sectional study examined HIV/AIDS knowledge as a determinant of preventative and self‑protective sexual behaviour. The HIV Knowledge Questionnaire-18 (HIV-KQ-18) is one of the most widely used HIV knowledge scales. The objective of this study was to test the psychometric properties of the HIV-KQ-18 in Black people in Ontario. Methods:We analyzed the data from 1302 participants who completed the HIV-KQ-18 in a study conducted among Black people in Ontario. We estimated the internal consistency of this scale using Cronbach's alpha. We analyzed the construct validity of the scale, testing hypotheses about HIV knowledge and age, education, employment status, gender, language and city using one-way ANOVA and independent sample t-tests. Results:Cronbach's alpha for the scale was 0.82 (95% CI: 0.80-0.84) suggesting good internal consistency. We observed significant differences in HIV knowledge scores across age, employment status, education, and gender. Higher HIV knowledge scores were also observed among participants residing in Toronto compared to Ottawa and among those who completed the questionnaire in English compared to French. Conclusion:The HIV-KQ-18 is a valid instrument to assess the level of HIV/AIDS knowledge among Black Ontarians, with robust internal consistency and construct validity. The HIV-KQ-18 identified important differences in HIV knowledge based on the characteristics examined, indicating the need for targeted initiatives to increase HIV-related knowledge.
Background:In recent years, HIV-associated nephropathy (HIVAN) has significantly impacted the compliance, quality of life, and treatment outcomes for patients with AIDS. This study employs CiteSpace bibliometric analysis to predict emerging topics and research trends, thereby offering clear scientific navigation and strategic recommendations for HIVAN research. Methods:We retrieved publications related to HIVAN from the Web of Science Core Collection covering the period from 2015 to 2025. Utilizing CiteSpace, we analyzed the co-occurrence network, clustering,and timeline of research trends in this field to illustrate the knowledge evolution surrounding HIVAN. Results:A total of 1,470 publications were included from 2015 to 2025. The United States maintained its dominant position in medical research, while countries such as the United Kingdom, South Africa, France, and China emerged as key contributors in the field. Prominent institutions, including the University of California system, Johns Hopkins University, and University of the London, were central to HIVAN research. Scholars such as Estrella, Michelle M. Shlipak, Michael G. and Kopp, Jeffrey B exhibited substantial academic output and garnered considerable citation attention. Leading journals, including "Clinical Infectious Diseases", "PLOS ONE" and "AIDS" served as premier venues for review articles, providing essential platforms and establishing foundations for ongoing research. The research activity and academic impact of HIVAN within the sub-discipline of nephrology currently represent prominent areas of inquiry. Conclusion:This study examined the knowledge network structure of HIVAN from 2015 to 2025 examined bibliometric analysis. Future research should focus on enhancing international collaboration, particularly in resource limited regions, to investigate various intervention strategies aimed at improving compliance, quality of life, and treatment outcomes for HIVAN patients.
Background: Adolescents increasingly contribute to the global HIV epidemic, and the low HIV testing rates heighten transmission risks. Condom use is crucial in preventing HIV transmission and drug-resistant strains, yet its consistency among HIV-positive adolescents on antiretroviral therapy (ART) remains uncertain. This study investigates the prevalence of condom use and predictors among HIV-positive adolescents attending ART clinic in Uganda. Methods: A cross-sectional study was conducted from January to March 2025 among 165 HIV-positive adolescents (aged 10-19 years) at Tororo General Hospital ART clinic. Structured questionnaires were used for data collection, and multivariable logistic regression was used to determine predictors of condom use, using SPSS version 27. Results: Condom use prevalence was low at 10.9% among HIV-positive adolescents. On multivariable logistic regression, significant predictors of condom use included urban residence (aOR 2.67, 95% CI: 1.42-4.98), older age (15-19 years) (aOR 1.48, 95% CI: 1.12-2.36), secondary education (aOR 1.31, 95% CI: 1.02-2.62), Muslim religion (aOR 3.76, 95% CI: 1.98-6.75), having three or more sexual partners (aOR 2.17, 95% CI: 1.14-3.87), being on ART for more than five years (aOR 3.73, 95% CI: 1.15-6.21), and drug use (aOR 1.37, 95% CI: 1.16-2.11). Nearly all participants (99.4%) reported lack of access to free condoms, while 75.8% had never received counseling on condom use. Conclusion: Condom use among HIV-positive adolescents in Tororo district remains alarmingly suboptimal. Enhancing access to condoms, integrating targeted sexual health education, and addressing sociocultural barriers through community-based interventions are critical. Future research should explore tailored strategies to improve condom adherence in this population.
Purpose:This study aimed to determine the prevalence and associated factors of anemia among HIV-positive children receiving antiretroviral therapy (ART) at two urban clinics in Mbarara City, Southwestern Uganda. Patients and Methods:We conducted a cross-sectional study among 293 HIV-positive children (<18 years) attending ART clinics at Mbarara Municipal Health Center IV and Holy Innocent Children's Hospital between July and September 2025. A structured questionnaire captured sociodemographic and clinical data. Venous blood were collected for complete blood count (CBC) analysis, and stool samples were examined for intestinal parasites. Data on CD4 count and viral load were abstracted from medical records. Anemia was defined using age-specific WHO criteria. Bivariate and multivariate logistic regression analyses were performed to identify factors associated with anemia, with statistical significance set at p ≤ 0.05. Results:The overall prevalence of anemia was 6.14% (95% CI: 3.4% - 8.9%). Normocytic normochromic anemia was the predominant morphological type (72.2%). In the multivariate analysis, a recent episode of malaria (AOR = 9.61; 95% CI: 3.26-28.34), the presence of an opportunistic infection (AOR = 6.78; 95% CI: 1.28-35.83), and poor adherence to ART (AOR = 14.75; 95% CI: 1.31-165.65) were independently and significantly correlated with anaemia. Conclusion:While the prevalence of anemia in this cohort of HIV-infected children on ART was lower than global averages, it remains a significant clinical concern. The strong associations with malaria, opportunistic infections, and suboptimal ART adherence highlight critical areas for intervention. Targeted strategies, including integrated malaria control, enhanced prevention and management of OIs, and reinforced adherence support, are required to decrease the anaemia burden and optimize health outcomes in this at-risk population.
Background:Viral load suppression remains suboptimal among adolescents and young people living with HIV in Uganda (AYPLHIV). Although Intensive Adherence Counselling is recommended for individuals who remain virally non-suppressed while on antiretroviral therapy, its contribution to suppression among AYPLHIV is not well understood. This study aimed to determine the level of viral load suppression achieved following intensive adherence counselling among previously non-suppressed AYPLHIV in east central Uganda. Methods:We conducted a sequential explanatory mixed methods study among 580 participants aged 10-24 years receiving care at 32 health facilities. Quantitative data were abstracted covering a five-year period from 2019-2024. Suppression levels and subgroup differences were assessed using chi-square tests. A qualitative study was conducted with 12 purposively selected participants and thematic analysis were guided by the Capability, Opportunity, Motivation and Behavior framework. Results:Participants had a median age of 16.4 years and a median ART duration of 4 years. Overall, out of the 580 participants, 313 (53.9%) achieved viral load suppression after counselling. Participants living more than 5 km compared to less than 5km from a health facility (p=0.003) and those counselled by counsellors rather than nurses (p<0.001) had significantly higher suppression level. Lower suppression level was observed among participants who had not disclosed their HIV status versus those who disclosed (p=0.011) and those reporting fear or stigma compared to those not reporting (p=0.010). Qualitative findings indicated that understanding the purpose and benefits of intensive adherence counselling (Capability), financial barriers and provider interactions (Opportunity), and non-disclosure (Motivation) influenced suppression outcomes among AYPLHIV. Conclusion:IAC resulted in modest improvements in VL suppression among AYPLHIV. Low retention and contextual barriers, including distance, stigma and non-disclosure, limited its effectiveness. Tailored IAC strategies addressing subgroup-specific barriers are needed to improve VL suppression.
Purpose:To review published evidence on alternative administration methods for antiretroviral therapy in patients unable to swallow tablets. Methods:We conducted a scoping review using PubMed, Web of Science, and Google Scholar databases from 2011 to 2025. We included studies reporting pharmacokinetic data, clinical outcomes, or safety data on crushed, dispersed, or enterally administered antiretroviral formulations. Four independent reviewers screened 1,474 articles after duplicate removal, with 12 studies meeting selection criteria. Results:We identified 12 studies (8 case reports, 2 case series, 2 cohort studies) describing alternative administration of antiretrovirals. Key findings included: (1) Bictegravir/emtricitabine/tenofovir alafenamide was associated with viral suppression when dissolved and administered enterally; (2) Dolutegravir/abacavir/lamivudine crushed via nasogastric tube was associated with viral suppression within 10 months; (3) Dolutegravir requires separation from enteral feeds containing polyvalent cations to avoid chelation and reduced absorption. (4) Most nucleoside reverse transcriptase inhibitors (NRTIs) could be crushed or dissolved, while non-nucleoside reverse transcriptase inhibitors (NNRTIs) showed variable stability. (5) Therapeutic drug monitoring was recommended for integrase inhibitors administered enterally. Conclusion:This review provides evidence suggesting the use of modified ART formulations when standard oral administration is not possible. In situations where swallowing difficulties prevent the use of whole tablets, alternative methods such as crushing, or dissolving may offer a practical approach to maintain treatment continuity. Alternative administration ART, namely INSTI-based regimens and NRTIs, may help maintain viral suppression in these settings, provided that drug-specific pharmacokinetic considerations and enteral feeding interactions are addressed. Further prospective studies with therapeutic drug monitoring are needed to establish standardized protocols.
David Livingstone Ejalu,1,2 Peter Simon Okello,3 Sean Steven Puleh,1 Joanita Nangendo,1,4 Jonathan Izudi,5 Sabrina Bakeera-Kitaka,1 Achilles Katamba,1 Anne R Katahoire,1 Joan N Kalyango,1 Adithya Cattamanchi,6 Fred C Semitala,1,7 Moses R Kamya1,4 1School of Medicine, Makerere University, Kampala, Uganda; 2Faculty of Health Sciences, Uganda Martyrs University, Nkozi, Uganda; 3Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda; 4Infectious Diseases Research Collaboration, Kampala, Uganda; 5Directorate of Graduate Training, Research and Innovations, Muni University, Arua, Uganda; 6Department of Medicine, University of California, Irvine, Irvine, CA, USA; 7Makerere University Joint AIDS Programme, Kampala, UgandaCorrespondence: David Livingstone Ejalu, Clinical Epidemiology Unit, School of Medicine, Makerere University, Kampala, P.O Box 7072, Uganda, Email davidejalu@gmail.comBackground: Viral load suppression remains suboptimal among adolescents and young people living with HIV in Uganda (AYPLHIV). Although Intensive Adherence Counselling is recommended for individuals who remain virally non-suppressed while on antiretroviral therapy, its contribution to suppression among AYPLHIV is not well understood. This study aimed to determine the level of viral load suppression achieved following intensive adherence counselling among previously non-suppressed AYPLHIV in east central Uganda.Methods: We conducted a sequential explanatory mixed methods study among 580 participants aged 10– 24 years receiving care at 32 health facilities. Quantitative data were abstracted covering a five-year period from 2019– 2024. Suppression levels and subgroup differences were assessed using chi-square tests. A qualitative study was conducted with 12 purposively selected participants and thematic analysis were guided by the Capability, Opportunity, Motivation and Behavior framework.Results: Participants had a median age of 16.4 years and a median ART duration of 4 years. Overall, out of the 580 participants, 313 (53.9%) achieved viral load suppression after counselling. Participants living more than 5 km compared to less than 5km from a health facility (p=0.003) and those counselled by counsellors rather than nurses (p< 0.001) had significantly higher suppression level. Lower suppression level was observed among participants who had not disclosed their HIV status versus those who disclosed (p=0.011) and those reporting fear or stigma compared to those not reporting (p=0.010). Qualitative findings indicated that understanding the purpose and benefits of intensive adherence counselling (Capability), financial barriers and provider interactions (Opportunity), and non-disclosure (Motivation) influenced suppression outcomes among AYPLHIV.Conclusion: IAC resulted in modest improvements in VL suppression among AYPLHIV. Low retention and contextual barriers, including distance, stigma and non-disclosure, limited its effectiveness. Tailored IAC strategies addressing subgroup-specific barriers are needed to improve VL suppression.Keywords: viral load suppression, intensive adherence counselling, ART adherence
Introduction:This study addresses a research gap in cervical cancer screening for Women Living with HIV (WLHIV) in Puerto Rico, evaluating the associations between viral load (VL) thresholds, CD4 count, HPV detection, and the benefits of co-testing with cytology. Methods:We analyzed the HIV viral load (VL), HPV infection, CD4 counts, and cervical cytology in 354 WLHIV receiving consecutive comprehensive care, including Highly Active Antiretroviral Therapy (HAART). Retrospective data were obtained from visits from 2018 to 2023. Consecutive visits with ThinPrep co-testing for cytology and HPV were evaluated. Only one observation per woman was included to maintain a cross-sectional dataset. HPV was detected using Hologic ThinPrep Pap Test and PCR-based genotyping. Results:The prevalence of any HPV was 27% which correlated inversely with CD4 counts: 42.9% (≤200 cells/mm3), 35.5% (201-499 cells/mm3), and 23.2% (>500 cells/mm3) (p=0.017). Multivariate analysis demonstrated that HPV positivity was significantly associated with the likelihood of having an abnormal Pap result (OR = 6.35; 95% CI: 3.22-12.52; p < 0.001). Cytologic abnormalities were more frequent with lower CD4 counts: 32.1% (≤200 cells/mm3), 11.8% (201-499 cells/mm3), and 11.2% (>500cells/mm3) (p=0.007). HPV was detected more frequently among women with detectable VL > 201 copies/mL (35.4% vs 26.1%). Abnormal cytology occurred in 22.9% of women with VL > 201 copies/mL versus 11.4% with VL ≤ 200 copies/mL (p=0.028) and among 34.8% of women with negative HPV tests, underscoring the value of co-testing. Conclusion:WLHIV demonstrate higher HPV prevalence and abnormal cytology rates, with persistence inversely related to CD4 counts. Viral suppression correlates with lower HPV prevalence and fewer cytologic abnormalities. Co-testing identified 34.8% of WLHIV with abnormal cytology and HPV-negative results. This study supports consideration of co-testing for cervical cancer screening in WLHIV, even among those with high ART uptake. Further prospective and multi-site studies are warranted to confirm these observations and inform policy or guideline changes.
Introduction:People living with HIV (PLHIV) often have poorly controlled hypertension due to medication non-adherence, primarily caused by limited access to antihypertensive drugs. Peer support groups are being explored to improve access. We evaluated the feasibility and acceptability of peer support groups to improve access to anti-hypertensive drugs for PLHIV with hypertension. Methods:From December 2022 to April 2023, we conducted a cross-sectional survey and measurement of blood pressure among PLHIV in 26 health facilities to assess the accessibility of anti-hypertensive drugs in the peer support groups. The collected data was summarized using descriptive statistics. Results:Eight out of 26 health facilities formed peer support groups. Among 163 PLHIV interviewed only 64 participated in the peer support groups. Among those who participated in peer support groups 57% reported accessing anti-hypertensive drugs through the group. The peer support groups were affordable for most participants. Around 60% found the contributions manageable, with 79% contributing $1.3 or less. Most participants expressed confidence in the performance of the peer support groups. Conclusion:The results of the study suggest that patient-led peer support groups are a feasible intervention to improve access to hypertensive medications for PLHIV with Hypertension.
Background:Repeated monitoring of viral load (VL) among pregnant women living with HIV (WLWH) is critical in vertical transmission prevention. For women who are newly diagnosed with HIV during pregnancy, a subsequent VL is recommended three months after ART initiation, and for all women living with HIV, follow-up VL is required every six months throughout pregnancy and breastfeeding. Here, we describe the uptake and timing of VL testing and frequency and distribution of viraemic episodes during pregnancy. Methods:We linked prospective cohort data from WLWH whose infants were born at Rahima Moosa Mother and Child Hospital (RMMCH) in Johannesburg, South Africa (2013-2018) to laboratory data from the National Health Laboratory Services national HIV cohort. We report the uptake and timing of VL testing, and frequency of viremia and viral suppression. We applied the log binomial regression, to explore factors associated with having at least one or more VL test. Crude relative risks (RR) and adjusted relative risks (aRR) with 95% confidence intervals (CI) relative risk were reported. Results:Data from 4064 women with known dates of entry into antenatal care and delivery during the study period were analysed. Overall, less than half (46%) completed VL testing during pregnancy. Most VLs were conducted during the third trimester (67%). Only 5% (n = 100) were during the first trimester and 11% within 7 days of delivery. Three-quarters of tests during pregnancy indicated viral suppression (VL < 400 copies/mL), 7% viraemic (VL 400-1000 copies/mL), and 19% high-grade viraemia (VL > 1000 copies/mL). We found that being older (≥35) and being engaged in HIV care prior to pregnancy were significantly associated with VL testing during pregnancy. Conclusion:With less than half of pregnant women living with HIV in this study having a VL measure during their pregnancy, and VL testing occurring late in pregnancy, this study highlights critical gaps in providing quality HIV care to women and prevention of vertical transmission.
Aim:To develop and conduct a preliminary evaluation of a digital salutogenic intervention-"Towards the Sun"-aimed at enhancing sense of coherence (SOC) and improving health outcomes among newly diagnosed HIV-positive men who have sex with men (MSM). Methods:The initial intervention draft was developed using the systematic Intervention Mapping (IM) process, informed by preliminary research, literature review, and evidence-based needs assessment. Two rounds of expert panel review were then conducted to refine the draft, followed by a feasibility assessment among newly diagnosed HIV-positive MSM. Results:The final digital intervention consisted of a five-stage, eight-week program, focusing on stress management, resource activation, and meaning exploration to strengthen the three dimensions of SOC. After review by 8 experts, the mean importance ratings of the intervention items were all above 4 and the coefficients of variation (CV) were less than 0.20, indicating consensus. A pilot study involving 7 newly diagnosed MSM demonstrated feasibility: SOC-13 scores increased, levels of stress and depression decreased, and participants reported high satisfaction with the overall content, especially the modules on self-acceptance and resource orientation. Conclusion:This digital salutogenic intervention demonstrated good feasibility, user acceptance, and preliminary effectiveness among newly diagnosed HIV-positive MSM. As a strengths-based and innovative digital solution, it warrants further validation and dissemination in larger samples and randomized controlled designs. Reporting Guidelines:The study followed the TIDieR (Template for Intervention Description and Replication) Checklist.
Background:Bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) is a single-tablet regimen recommended as first-line HIV treatment in international guidelines. This analysis aimed to assess the effectiveness and safety of B/F/TAF in real-world Spanish clinical practice. Methods:This was an analysis of the Spanish subset from the BICSTaR study in treatment-naïve (TN) and treatment-experienced (TE) people with HIV who started treatment between November 2019 and July 2021 (European study registration: EUPAS22185). The primary endpoint was virologic suppression (HIV-1 RNA <50 copies/mL); additional endpoints included CD4 cell count changes, treatment persistence, adverse events, weight changes, and the 36-Item Short Form Survey mental and physical component summary (MCS/PCS) scores at 12 months. Results:In total, 249 people with HIV initiated B/F/TAF treatment (62 TN, 187 TE). At 12 months, virologic suppression was achieved by 86% of TN and 98% of TE participants, with 91% of those TE participants with baseline HIV-1 RNA ≥50 copies/µL achieving suppression. Median CD4 count increased by 296 cells/µL in TN (p<0.001) and 12 cells/µL in TE (p=0.302) participants. Persistence at 12 months was high in all participants, with 95% still on treatment. Overall, none of TN and less than 3% of TE participants discontinued B/F/TAF due to drug-related adverse events, all of which were mild or moderate. Median weight increase was 2.9 kg in TN (p<0.001) and 1.0 kg in TE (p<0.001) participants. Median MCS scores improved in the TN group (8.4-point increase, p<0.001) but not in the TE group (0.4-point increase, p=0.767), while PCS scores remained stable both among TN and TE. Conclusion:These real-world findings strongly support B/F/TAF use in TN and TE people with HIV in Spain, demonstrating high 12-month persistence and effectiveness, and mental health benefits in TN participants, with minimal adverse events.
Anogenital warts (AGW) are a common manifestation of human papillomavirus (HPV) infection, primarily caused by strains 6 and 11. According to results, mucosal HPV is transmitted through sexual contact, with risk factors including immunodeficiency, such as Human Immunodeficiency Virus (HIV). Individuals with HIV experience a higher incidence of AGW due to impaired immune function that hinders HPV clearance. There is currently no specific antiviral therapy available for HPV, although several management options exist. However, some of these treatments may cause pain and discomfort. Glycyrrhizinic acid (GA) has demonstrated potential in managing HPV infection because of its antiviral properties and minimal side effects. Despite these promising results, GA is not yet recognized as a standard therapy for AGW. This case report describes the effectiveness of Glizigen® (topical GA) combined with Viusid® (oral GA) in managing genital warts in a 28-year-old homosexual male living with HIV. The patient, examined by a dermatologist at Dr. Hasan Sadikin General Hospital, Bandung, Indonesia, presented with perianal warts that had developed over 3 months. According to the physical examination carried out, multiple flesh-colored papules were reported, while histopathological analysis showed koilocytes, and polymerase chain reaction (PCR) confirmed HPV types 6 and 11. The treatment process, carried out using topical and oral GA, was administered from August to October 2024. The improvement was reported only in smaller lesions, while larger ones persisted, leading to electrocautery scheduling. The limited response observed in this case might be influenced by the patient's low CD4+ count, which potentially affects HPV clearance. Factors such as age, number of sexual partners, circumcision status, HPV type, and anatomical location of the lesions may also have played a role.
