IntroductionCurrently, many young people living with perinatally-acquired HIV (YPHIV) are adults. Living with HIV and chronic use of antiretroviral medication might increase the risk of metabolic and cardiovascular diseases and affect the physical fitness of individuals. This study assessed muscle strength and functional exercise capacity in YPHIV patients in Thailand. MethodsThe cross-sectional study was conducted at Chiang Mai University. Inclusion criteria were 1) YPHIV aged 16-30 years, 2) having perinatal HIV infection, and 3) receiving antiretroviral treatment and being clinically healthy. Those with active concurrent illnesses or physical disabilities were excluded. Anthometric measurements were performed, and data were collected using self-administered questionnaires. Handgrip strength was measured using a digital handgrip dynamometer (TKK 5401; Takei, Japan), with Korean reference ranges used. The six-minute walk test (6MWT) was performed to assess functional exercise capacity. The regression equation from a Singaporean study was adopted to calculate predicted values. ResultsThirty-four YPHIV were included; 19 (56%) were female. Their median age was 23.5 years (interquartile range, IQR 19.8, 26.6), and their median body mass index was 21.7 kg/m2 (IQR 18.6, 24.2). The median handgrip strength was 23.8 kilograms (IQR 20.8, 30.3) in females and 33.6 kilograms (IQR 26.1, 40.2) in males. There were 10 (29%) participants with suboptimal handgrip strength and 1 (2.9%) with low handgrip strength. The median 6-minute walk distances were 489 meters (IQR 447, 523) in females and 536 meters (IQR 485, 568) in males. 6 participants (18%) had walking distances < 10% of their predicted values. DiscussionIt was demonstrated that around two-thirds of YPHIV had optimal muscle strength, as most of them were found to have good physical fitness. Suboptimal strength in some participants could be related to HIV and its treatment, as well as other social factors. As low muscle strength was identified as a marker of cardiovascular risk and related to metabolic syndrome, YPHIV could benefit from age-appropriate exercise to minimize long-term health consequences. ConclusionDespite being clinically healthy and having good physical fitness, nearly one-third of YPHIV had suboptimal muscle strength for their age and gender. Physical activities and muscle-strengthening exercises should be encouraged.
Introduction Studies reveal that condomless sex is more common among sex workers with casual and steady partners than with commercial partners. There is limited research explaining condom use among sex workers with non-commercial casual partners. Therefore, this study aims to identify predictors of condom use among sex workers with non-commercial casual partners using an extended Information-Motivation-Behavioral Skills (IMB) model. Methods The research was conducted using a cross-sectional online survey between March and October 2022. Non-commercial casual partners were defined as sexual relationships without long-term commitments, including one-night stands, affairs, anonymous encounters, friends with benefits, and similar arrangements. Eligible participants were aged 16 or older, living in Switzerland, and had received money or gifts for sexual services in the past 12 months. The data were collected via a self-administered online questionnaire, developed in collaboration with partners of Non-Governmental Organizations (NGOs), pretested twice, and available in 11 languages. Recruitment was supported by local NGOs through advertising, social media, and outreach at sex worker drop-in centers, with options for independent completion or computer-assisted interviews. Using validated instruments, the researchers measured condom use frequency during vaginal or anal sex with non-commercial casual partners in the past 12 months and the variables of the extended IMB model. The convenience sample consisted of 386 sex workers (265 cisgender women, 82 cisgender men, 39 transgender) who had vaginal or anal sex with at least one non-commercial casual partner within the 12 months before the survey. Fifty-six percent were heterosexual, 16.3% were homosexual, and 14.8% were bisexual. Approximately 31% were migrants from HIV high-prevalence countries. Structural Equation Modeling (AMOS) was used to analyze predictors of condom use. Results Fifty-seven percent of the sex workers always used condoms when having sex with non-commercial casual partners. Higher condom use was associated with stronger intention to use condoms (β = 0.28, p < 0.001), more positive attitudes toward condoms (β = 0.22, p < 0.001), and higher perceived subjective norm supporting condom use (β = 0.12, p < 0.01). Older age (β = 0.11, p < 0.05) was associated with increased condom use frequency, while non-heterosexual orientation (β = −0.11, p < 0.05) and sex-related drug use (β = −0.14, p < 0.01) were associated with decreased condom use frequency. Higher intention to use condoms was associated with older age (β = 0.21, p < 0.001). Intention to use condoms was lower in sex workers with non-heterosexual orientation (β = −0.10, p < 0.05). A more positive attitude towards condoms was observed among cisgender females (β = 0.13, p < 0.05) and among sex workers with a higher level of education (β = 0.14, p < 0.01). Attitude was more negative in non-heterosexual sex workers (β = −0.20, p < 0.001). Greater experiences of sex worker-related discrimination were associated with more negative attitudes (β = −0.13, p < 0.01). Sex workers in committed relationships had a more positive subjective norm for condom use (β = 0.11, p < 0.05). Experiences of sex-work-related discrimination (β = 0.13, p < 0.01) and a suicide attempt in the last 12 months (β = 0.14, p < 0.01) were associated with more frequent sex-related drug use and a higher likelihood of having attempted suicide more often. The explained variance for condom use was 30%. Discussion Psychosocial factors, particularly intention, attitude, and subjective norm, emerged as crucial to condom use among sex workers, whereas information and behavioral skills had no effect. Lower condom use was observed among non-heterosexual and younger sex workers who engaged in sex-related drug use. The latter was more prevalent among younger, well-educated, cisgender male and transgender sex workers and was positively associated with discrimination experiences and suicide attempts. These findings underscore the intersecting vulnerabilities related to gender identity, sexual orientation, discrimination, and mental health. Nevertheless, the findings must be interpreted with caution, given the cross-sectional design, self-reported data, and limited generalizability due to convenience sampling. The unexplained variance suggests the presence of additional influences such as condom negotiation and power dynamics with non-commercial casual partners, which require further investigation through qualitative research. Conclusion The extended IMB model offers significant insights into condom use behavior among sex workers who have sex with non-commercial casual partners. Interventions should aim to strengthen intention and positive attitudes toward condoms, challenge prevailing discrimination, and address co-occurring issues such as sex-related drug use and mental health, with a focus on tailoring these interventions to diverse genders.
Introduction This study aimed to improve the attendance of people living with HIV (PLHIV) in the Risk of Treatment Failure (ROTF) support group via quality improvement initiatives at Delft Community Health Center, Western Cape, in South Africa. Methods A quality improvement approach (QI) was employed. The “five whys framework” was used to identify the root cause of low attendance of PLHIV in the ROTF support group. Plan–do–study–act (PDSA) cycles were conducted, and measures were set to monitor project outcomes. The project started with a baseline analysis with stakeholders to identify root causes and drivers of change. We implemented the required changes with continuous engagement of QI teams and PLHIV members. Results The number of PLHIV attendees in the ROTF support group increased with the implementation of the QI intervention, from non-attendance at baseline to improved attendance over subsequent months. One month after the QI intervention started in April 2023, 30% of the participants (3) attended the ROTF support group, and the number increased to five (100%) in the next month. It increased to thirteen in June 2023 (100%), and 19 attended the ROTF support group meeting in the final session. Three ROTF support group members attained the required VL suppression levels and graduated from the program. Discussion This QI project shows that structured, low-cost QI approaches can substantially improve attendance of people living with HIV in ROTF adherence support groups. Using the five whys framework to identify root causes and iterative PDSA cycles to address them led to improvements in participation, increasing from non-attendance at baseline to improved attendance within three months. Enhanced engagement was accompanied by meaningful clinical gains, including viral load suppression and graduation of three participants from the programme. These findings highlight the effectiveness of simple QI methods in strengthening adherence support and improving outcomes in resource-constrained primary healthcare settings when patient engagement, frontline involvement, and leadership support are prioritized. As a limitation, the study's small sample size and short study period make it difficult to ascertain clinical outcomes. Continuous quality improvement, scaled up with a larger sample size, could help to better ascertain clinical outcomes. Conclusion This study highlights the use of quality improvement approaches that improved PLHIV attendance in the ROTF adherence support group. Health and health outcomes can improve even in resource-constrained settings by optimally allocating available resources and adapting and adopting simple measures. The attendance of PLHIV in the ROTF adherence support group improved with the use of QI practices. Training in QI concepts and principles, as well as project implementation, is recommended to ensure QI sustainability through a robust methodology, skilled support structures, prioritization, and leadership involvement.
Background Oral Pre-Exposure Prophylaxis (PrEP) is a proven method for preventing HIV among women, including adolescent girls and young women who are categorised as priority populations due to a higher risk of HIV acquisition. However, the COVID-19 lockdown disrupted access to healthcare services, including those for HIV prevention and treatment. This study aimed to assess changes in PrEP outcomes before and during the COVID-19 lockdown period among women in the North-West Province, South Africa. Methods We conducted a retrospective analysis of programme data collected by TB HIV Care from December 2018 to December 2021 in the Dr Kenneth Kaunda District to assess changes in PrEP initiation, uptake, and adherence before (December 2018 - February 2020) and during (March 2020 - December 2021) the COVID-19 pandemic among women aged 16 years and above. The Department of Health electronic (Excel) register was used to collect data. The overdispersion tests conducted on three datasets, PrEP initiation, uptake, and adherence, showed significant overdispersion (with p -values less than 0.05). This indicates that the Negative Binomial regression model is more appropriate for these datasets. Additionally, the adherence dataset contained a high percentage of zero outcomes, underscoring the need for a zero-inflated model to address the excess zeros. Consequently, we implemented Bayesian negative binomial regression models for both the PrEP initiation and uptake datasets and a Bayesian Zero-Inflated Negative Binomial (ZINB) regression model for the adherence dataset. Results A total of 1339 women involved in transactional sex were counselled and offered PrEP services. Out of these, 776 were initiated on PrEP with a mean age of 33 years. PrEP initiation demonstrated a significant trend before the lockdown, an immediate effect during the lockdown, and a shift in trends afterwards, with all 95% credible intervals excluding zero. This suggests that the pandemic both disrupted and altered PrEP initiation patterns. The intervention did not lead to a significant increase in PrEP uptake among clients who returned for HIV testing within one month, as the 95% credible intervals included the value of 1. Nonetheless, there was a slight positive trend over time that was statistically significant, indicating a modest increase in uptake. Additionally, none of the estimated parameters for adherence achieved statistical significance, suggesting that the intervention did not have a meaningful impact on adherence levels. Conclusion The study revealed a decline in the initiation, uptake, and adherence to PrEP during the COVID-19 lockdown, although services were maintained through innovative interventions. These findings underscore the necessity for more innovative strategies to enhance PrEP outcomes, ensure effective HIV control, and prepare for potential future pandemics.
Introduction The study aimed to assess knowledge and perceptions regarding HIV/AIDS among adults in Saudi Arabia's Eastern Province, a region with a rising HIV burden and documented gaps in public awareness. Methods A cross-sectional study was conducted from March to July 2024 using anonymous online and paper-based questionnaires targeting residents aged 18–80 years in the Eastern Province. Convenience sampling recruited participants from community centers, public spaces, and social media platforms. The 21-item questionnaire assessed demographics and knowledge of HIV transmission, diagnosis, and treatment. Data were analyzed using descriptive statistics and Chi-square or Fisher's exact tests, with p ≤0.05 considered statistically significant. Results A total of 984 participants were included, predominantly female (61.0%) and Saudi nationals (85.4%), with 64.7% having postsecondary education. Most recognized sexual transmission (92.7%), availability of confidential diagnostic methods (94.2%), and that HIV can be controlled with treatment (84.6%). Misconceptions persisted, with 25.7% believing HIV is transmitted through casual contact and 27.7% through sharing public restrooms, and several perceptions showed significant associations with age, gender, education, nationality, marital status, and healthcare work status. Discussion Findings show high overall awareness but important misconceptions that may perpetuate stigma and hinder prevention, particularly among younger, less educated, and non-healthcare groups. Conclusion Targeted, culturally sensitive educational interventions, with a focus on younger and less educated populations and the active involvement of healthcare professionals as key educators, are needed to strengthen HIV prevention efforts and support national public health goals.
Introduction Young adults (YA) living with human immunodeficiency virus (HIV) experience significant challenges with healthcare engagement. This population experiences lower rates of retention in care compared to their adult counterparts, resulting in poor adherence to antiretroviral therapy, higher viral load, and lower CD4 counts that negatively impact their health. This study explored how involvement in a multidisciplinary healthcare program, the HIV Adolescent Provider and Peer Education Network for Services (HAPPENS) program, impacts healthcare engagement, and identified facilitators and barriers to retention of care from the perspectives of YA living with HIV. Methods Participants were recruited from the HAPPENS program embedded within an adolescent/young adult medicine clinical practice affiliated with an urban, tertiary care, academic free-standing children’s hospital. Semi-structured qualitative interviews were conducted with 20 YA living with HIV aged 21-32 years (65% Black, average age 25.8 years). Interview questions queried facilitators and barriers to care and recommendations for improving this multidisciplinary care model. Results Overall, participants reported positive experiences with the HAPPENS program, emphasizing how resources being linked to care motivated them to consistently attend medical appointments. Most participants commented on how mental health challenges were a barrier to consistently engaging in care. Some recommendations emerged, including creating an open access care model in terms of scheduling and being aware of and avoiding paternalistic care. Discussion: Participants’ narratives highlight the value of integrated, multidisciplinary care in supporting retention and re-engagement in HIV care—an ongoing challenge for YA living with HIV. Conclusion Multidisciplinary healthcare programs that focus on YA living with HIV can help improve healthcare engagement and retention for this vulnerable population.
IntroductionLesotho is making strides toward 95-95-95 targets for the population living with HIV and improved antenatal care coverage. However, challenges persist in new HIV infections, including vertical HIV infection. There is a paucity of evidence on the determinants of Viral Load (VL) suppression among pregnant and breastfeeding women living with HIV in Lesotho. The objective of the study was to determine VL suppression among pregnant and breastfeeding women living with HIV on ART in the Maseru district of Lesotho. MethodsA case‒control study employing 420 pregnant and breastfeeding women living with HIV was performed; 140 cases with VL > 1000 copies/ml and 280 in the control group with VL ≤ 1000 copies/ml were included. Bivariate and multivariate analyses were carried out to identify determinants of VL unsuppression via Adjusted Odds Ratios (AORs) with 95% Confidence Intervals (CIs). ResultsA total of 420 (140 cases and 280 controls), 263 (86.4%) were breastfeeding, and 57 (13.7%) were pregnant. The mean age was 29.21 ± 5.33 years (SD), two-thirds (66%) of women’s partners' HIV status was positive, and 21% of partners' HIV status was unknown. Two-thirds (64.3%) of women received ART from urban facilities. More than one-fifth (21.2%) of the women did not adhere to ART. The majority (60%) knew their HIV status during pregnancy. The partner's unknown HIV status, knowledge of HIV before pregnancy, transfer from other facilities, and adherence status were identified as independent predictors of VL suppression (AOR: 95% CI; p-value < 0.05). An unknown HIV status was 3 times more likely to indicate an unsuppressed VL: AOR = 3.08 (95% CI: 1.15–8.21, p-value < 0.05), and an HIV status before pregnancy was 4.6 times more likely to indicate an unsuppressed VL: AOR = 4.62 (95% CI: 2.50–8.48, p-value < 0.001). Transferring from facilities was 12.4 times more likely to have unsuppressed VL; AOR = 12.45 (95% CI: 5.04-30.75). Women who did not adhere to ART were 24.7 times more likely, AOR = 24.7 (95% CI: 12.3-60.9). DiscussionDespite national progress toward the 95-95-95 targets, gaps remain that increase the risk of mother-to-child transmission. Poor ART adherence, unknown partner HIV status, transfers between facilities, and knowing HIV status before pregnancy were major predictors of VL unsuppression. Addressing these factors is essential for sustaining maternal health gains and accelerating the elimination of vertical HIV transmission in Lesotho. ConclusionThis study identified modifiable determinants of VL suppression among pregnant and breastfeeding women with HIV. The study highlights the need for improved partner involvement in the HIV care continuum, encouraging their status to be known by their partners, posttest counseling strategies, and continuing psychosocial support for young and single women, ensuring that women know their HIV status and VL suppression before conception and ART adherence.
IntroductionVirological failure remains a major challenge in treating HIV. Lopinavir/ritonavir, a protease inhibitor, is a recommended second-line option in Malaysia for patients failing first-line regimens. This study investigated the use of Lopinavir/ritonavir in terms of its efficacy in viral suppression, CD4 response, metabolic side effects, and tolerability following first-line treatment failure. MethodsA retrospective review was conducted on adult HIV patients treated with Lopinavir/ritonavir for at least 6 months after confirmed virological failure (HIV viral load > 1000 copies/mL) on first-line therapy. Data were collected from 265 patients at Hospital Sultanah Aminah between January 2015 and December 2020, and 79 eligible patients were identified from the electronic database. Metabolic data, including lipid profile, were collected from case notes. ResultsAmong 79 patients who fulfilled the criteria, most were male (n=52, 65.8%) with a mean age of 41, and the majority were of Malay ethnicity (n=51, 64.5%). Unprotected sexual intercourse was the most common transmission mode (44.3%). After one year, 96% achieved viral suppression (VL <400 copies/mL). Non-suppression was linked to non-adherence due to pill burden. Metabolic complications were common: 77% developed hypertriglyceridemia (mean triglycerides: 3.6 mmol/L), 94% had elevated LDL (mean: 3.1 mmol/L), with smaller numbers developing transaminitis (7.6%), impaired glycaemia (10.1%), hypertension (6.3%), and lipodystrophy (1.3%). DiscussionOur study demonstrates that lopinavir/ritonavir (LPV/r) remains clinically effective at achieving viral suppression among HIV patients who have failed first-line therapy, with 76 subjects (96%) achieving viral suppression after 1 treatment. LPV/r continues to play a role in specific clinical contexts, particularly where newer antiretrovirals are not available or are contraindicated. However, LPV/r is associated with notable adverse events including GI intolerance, metabolic complications (most notably dyslipidemia), and high pill burden, all of which can negatively impact adherence and long-term treatment success. ConclusionLPV/r remains effective in achieving viral suppression but is associated with significant metabolic side effects. It should be reserved for individuals with limited treatment alternatives, and regimen selection should be guided by individual metabolic risk assessments. Regular metabolic monitoring and adherence support are essential, and multidisciplinary management together with further comparative studies are warranted to optimise treatment strategies that balance virological efficacy with long term metabolic safety.
Introduction Testosterone Deficiency (TD) is a frequent but often overlooked comorbidity among men living with HIV (MLWHIV). This study compared TD frequency using Total Testosterone (TT) and calculated Free Testosterone (cFT) and factors potentially associated with this condition. Methods This observational cross-sectional study included MLWHIV > 18 years receiving Antiretroviral Therapy (ART). Clinical and laboratory data were collected. Bone Mass (BM), Lean Mass (LM), and Fat Mass (FM) were assessed using Dual-energy X-ray Absorptiometry (DXA). TD was defined as Total Testosterone (TT) < 300 ng/dL and/or calculated Free Testosterone (cFT) < 6.4 ng/dL. Results Eighty-four participants were included from May 2014 to August 2015. TD prevalence was 22.6% by TT and 44% by cFT (p < 0.001). Participants with TD were older (50 vs. 45 years, p < 0.01), had a higher prevalence of metabolic syndrome (27% vs. 4.3%, p < 0.01), increased waist circumference (21.6% vs. 4.3%, p < 0.05), and a lower frequency of normal BM (37.5% vs. 67.5%, p < 0.05). Discussion TD was more frequent used with cFT criteria and was associated with older age, metabolic syndrome, abdominal obesity, and lower bone mass. No correlation was found with CD4 count or ART exposure, likely reflecting a virologically suppressed and homogeneous cohort. The single-center, cross-sectional design limits causal inference and external generalizability. Conclusion In MLWHIV, the cFT criterion identified more cases of TD than TT alone. TD is associated with low bone mass, increased waist circumference, and a higher prevalence of metabolic syndrome, highlighting the importance of systematic evaluation using cFT. Longitudinal studies are needed to clarify causal pathways and guide management.
Introduction Few published reports describe individual trajectories or heterogeneity in CD4+ T-cell count trends over time among virologically suppressed people living with HIV (PLWH). Methods We conducted a retrospective cohort study using administrative health claims among adults aged 18-65 years with a viral load of ≤ 200 copies/mL between January 1, 2012, and June 30, 2022. Among individuals with at least four CD4+ T-cell measurements, we described the proportion of individuals with both transient and sustained changes in cell counts of more than 30% overall. We stratified by baseline CD4+ T-cell count. Results A 30% increase or decrease from baseline was observed in 48.2% and 18.8% of individuals at a mean of 53.0 and 55.6 weeks of follow-up, respectively. Of people with a 30% decrease, 38.4% had at least two subsequent T-cell counts, and 24.3% did not return to within 30% of their baseline value. Discussion CD4+ T-cell counts continue to vary significantly after a year of suppressed viral load among people living with HIV. The proportion of PLWH with more than a 30% increase was more than twice that of those with more than a 30% decrease; a sustained decrease in CD4+ T-cell count was observed for 1.8% of the full cohort while they continued to be virally suppressed. Conclusion There is meaningful heterogeneity in CD4+ T-cell count trajectories, including significant drops while remaining virally suppressed, among PLWH with suppressed viral load that is infrequently described.
Introduction Despite the availability of HIV prevention medications (PrEP, PEP, and PIP), HIV rates among women continue to increase in Canada. This cross-sectional, survey-based study aimed to characterize women’s assessment of their HIV risk, along with their awareness of and access to medication-based HIV prophylaxis. Methods A 52-question survey was distributed at 15 community-based organizations in Ontario, Canada, including shelters, addiction treatment and recovery centres, and women’s drop-in programs, from June 2023 to February 2024. Eligible participants were self-identified women who were prophylaxis-naïve and sexually active and/or using drugs. Results Of the 318 participants recruited, self-reported knowledge of HIV transmission, risk, prevention, and testing was high, with multiple strategies to decrease risk reported. Of the 302 who responded, 93.7% assessed their HIV risk as low or average; 48.7% were not aware of PrEP or PEP; 73.3% were not aware of PIP; and 89.0% and 87.8% had never been offered PrEP or PEP, respectively, although interest in both oral and injectable medications was high. Nearly half (48.4%) believed they would not qualify for PrEP, with barriers cited including perceived lack of risk (40.9%), concerns about side effects (33.6%), affordability (26.1%), and potential adherence challenges (17.0%). Discussion Women’s self-perceived HIV risk was not congruent with objective HIV risk. Most women were unaware of HIV prevention medications and believed they would not be eligible; among those who perceived themselves as eligible, fewer than one-third had been offered HIV prevention options. Conclusion Additional clinical, public health, and policy efforts are needed to effectively engage women in HIV prevention care.
Introduction In India, approximately 4.7% of the 1.5 million people living with HIV (PLH) are on second-line (2L)-ART, highlighting the need for effective treatment strategies addressing ART-switches in the background of HIV drug resistance (HIVDR) following first-line (1L)-ART failure. Methods This single-arm, prospective pragmatic study was conducted at a tertiary care hospital in northern India from January 2020 to December 2022. Participants aged ≥13 years with documented 1L-ART failure (HIV RNA ≥ 1000 cp/mL) were enrolled. Eligible patients were grouped into four cohorts based on their prior ART and HIVDR profiles. The study regimen included a 2L-ART regimen comprising tenofovir (TDF/TAF), lamivudine (3TC)/emtricitabine (FTC), and dolutegravir (DTG). The primary endpoint was virological suppression (VS), defined as HIV RNA < 1000 cp/mL at 24 and 48 weeks. Results A total of 64 patients were included. At 24 weeks, the overall VS rate in the on-treatment analysis (OTT) was 94.6% (53/56), with 92.8% (52/56) achieving HIV RNA < 200 cp/mL. Among those with full TFV susceptibility, 97.1% (34/35) attained VS, while 90.5% (19/21) without predicted susceptibility achieved the same. For reccycled TFV, the OTT showed that 96.9% (31/32) attained VS, with 93.8% achieving HIV RNA level of < 200 cp/mL, compared to 91.7% (22/24) of first-time TFV users attaining HIV RNA level of < 200 cp/mL.At 48 weeks, the OTT indicated 100% VS among 52 patients, with 96.2% (50/52) attaining HIV RNA level of < 200 cp/mL. This included 93.8% (30/32) of patients with full TFV susceptibility and 93.8% (30/32) of those who received recycled TFV. Discussion Our findings demonstrate that DTG-based 2L-ART remains virologically effective even in patients with prior tenofovir (TFV) or zidovudine (AZT) exposure and in those lacking predicted TFV susceptibility based on drug resistance testing at 1L-ART failure. These results are consistent with findings from the ARTIST and NADIA trials and add novel Indian data to the growing body of evidence supporting TFV recycling in 2L-ART regimens. In resource-limited settings where resistance testing is often unavailable and AZT poses challenges related to toxicity, pill burden, and monitoring, this simplified once-daily regimen offers a practical alternative. Conclusion This study reinforces the viability of DTG-based second-line regimens with a TFV backbone as an effective and practical option, even in the presence of prior nucleoside reverse transcriptase inhibitor exposure or resistance. These findings support the use of simplified, once-daily fixed-dose combinations of TFV + 3TC/FTC + DTG as a durable and scalable 2L-ART strategy in resource-limited settings.
Introduction Pre-Exposure Prophylaxis (PrEP) is an effective HIV prevention strategy for populations at high risk, including men who have Sex with men (MSM) and Female Sex Workers (FSW). Despite being a proven HIV prevention tool and its effectiveness, the uptake of PrEP remains low in many settings, including Cameroon, posing challenges to HIV control. This study assessed PrEP uptake and associated factors among key populations in Nylon and New Bell Health Districts of Cameroon. Methods A cross-sectional study was conducted among 284 participants (91 MSM and 193 FSW) between January and June 2024, recruited through purposive and snowball sampling. PrEP eligibility was assessed based on self-reported risk behaviors, as outlined in World Health Organization (WHO) guidelines. Data on demographic characteristics, PrEP awareness, and uptake were collected through structured questionnaires. Logistic regression analyses identified factors associated with PrEP uptake. Results Among the 220 participants eligible for PrEP, only 62 (28.2%) accepted and were initiated on the medication. Significant predictors of uptake included monthly income above 100,000 FCFA (aOR = 4.37, 95% CI: 1.76–11.5, p = 0.002), MSM status (aOR = 2.97, 95% CI: 1.24–7.30, p = 0.015). Conversely, engaging in condomless sex (aOR = 0.35, 95% CI: 0.15–0.75, p = 0.009), higher education (aOR = 0.36, 95% CI: 0.13–0.92, p = 0.034), and relying on sex as the primary source of income (OR = 0.10, 95% CI: 0.02–0.37, p < 0.001) were negatively associated with PrEP uptake. Discussion PrEP uptake in Nylon and New Bell remains suboptimal, reflecting persistent economic, behavioral, and structural barriers. Higher income and MSM status predicted uptake, while condomless sex, sex as a source of income, and higher education were negative factors. Addressing stigma, financial vulnerability, and risk perception through tailored, community-based interventions is essential to strengthen PrEP utilization and HIV prevention outcomes in Cameroon. Conclusion PrEP uptake remains suboptimal among key populations in the Nylon and New Bell Health Districts. Financial barriers, socio-demographic factors, and sexual behavior have a significant influence on uptake. Tailored public health interventions addressing these barriers are essential for enhancing PrEP utilization and reducing HIV transmission in these vulnerable groups.
Background Pulmonary function assessment is essential for identifying respiratory diseases and understanding clinical changes that may lead to functional limitations. People living with HIV (PLHIV) may present respiratory impairments due to chronic immune and inflammatory alterations. Evaluating these changes is crucial for early clinical management. Objective To compare pulmonary function parameters between PLHIV and healthy controls, aiming to identify clinical patterns associated with HIV infection. Methods This cross-sectional study included 46 male participants aged 18 to 60 years, with 23 in the PLHIV group and 23 in the control group. Six women from each group were excluded to ensure sample homogeneity and proper matching. Pulmonary function was assessed using spirometry without bronchodilator, evaluating Forced Vital Capacity (FVC), Forced Expiratory Volume in the first second (FEV1), and the FEV1/FVC ratio. Anthropometric data and physical activity levels were also collected. Group comparisons were performed using the Wilcoxon test, with calculation of effect size and statistical power. Results PLHIV showed significantly lower pulmonary function compared to the control group, with reductions in both FVC and FEV1 (p < 0.01). The FEV1/FVC ratio remained preserved, indicating a restrictive pattern. A total of 56.25% of PLHIV presented restrictive changes in spirometry, while 100% of the control group had normal pulmonary function. The analysis revealed a large effect size (1.27), high statistical power (0.94), and an adjusted odds ratio of 49, calculated using the Haldane-Anscombe correction due to a zero count in the control group. Discussion The scientific literature has yet to reach a consensus on whether people living with HIV (PLHIV) predominantly present restrictive or obstructive respiratory patterns. The findings of this study, obtained through a mathematical analysis of effect size, suggest that restrictive patterns may occur frequently in this population. In cases of restrictive patterns, interventions aimed at pulmonary re-expansion may be useful in preventing long-term impairments. As limitations, this study highlights the exclusive comparison with individuals of female biological sex and the small sample size. Conclusion PLHIV exhibit restrictive pulmonary changes that may negatively impact their functional capacity over time. These findings highlight the importance of routine pulmonary monitoring in PLHIV, even in the absence of overt respiratory symptoms.
Introduction Tuberculosis (TB) and Human Immunodeficiency Virus (HIV) infection have been found to impact physical function significantly. However, data regarding the effect of TB/HIV co-infection on functional status remain limited. This study aimed to assess the impact of HIV co-infection on the functional independence and physical performance of TB patients during hospitalization, and associated mortality. Methods This cross-sectional study included hospitalized TB patients from the Brazilian infectious diseases reference center. Their sociodemographic and clinical characteristics were recorded. Functional independence was assessed using the Functional Independence Measure (FIM), and physical performance was evaluated with the Short Physical Performance Battery (SPPB). Results A total of 49 patients were included: 22 with TB/HIV co-infection and 27 with TB-only. The TB-only group showed significant increases in total FIM scores ( p =0.027) and SPPB ( p = 0.001) at discharge compared to admission, which was not observed in the TB/HIV co-infected group. Mortality occurred only in the TB/HIV co-infected group ( p =0.01). Discussion This study demonstrated that HIV co-infection impaired functional independence and physical performance in TB patients during hospitalization. This impairment was associated with poorer clinical outcomes, including elevated mortality, which aligns with previously documented HIV-related functional deficits. Our findings, which reveal higher mortality among co-infected individuals, are consistent with the widely recognized role of functional limitations in predicting poorer patient outcomes. Conclusion The present study highlights the detrimental effect of HIV co-infection on both functional outcomes and survival in hospitalized TB patients. This underscores the urgent need for integrated care strategies to enhance functional outcomes and reduce mortality in this population.
Initiation of several Integrase Strand-transfer Inhibitors (INSTIs) has been associated with weight gain in clinical trials. However, the data evaluating weight change with cabotegravir, the newest INSTI, is limited. The primary objective was to assess the real-world weight change in patients who switched to long-acting injectable (LAI) cabotegravir or cabotegravir-rilpivirine from another antiretroviral regimen. In this retrospective study, patients receiving HIV-1 treatment with cabotegravir-rilpivirine, or pre-exposure prophylaxis (PrEP) with cabotegravir, were identified through an Epic-generated report. Patients on a cabotegravir-containing regimen who met inclusion criteria were followed for 12 months from treatment initiation. The primary endpoint was weight change from month 0 of treatment initiation to 3, 6, and 12 months in all patients on cabotegravir-based LAI. A total of 48 patients were included in the study. At month 3, the mean weight change was 0.3 kg (95% CI, -0.8 to 1.4; p=0.56). At month 6, the mean weight change was 1.1 kg (95% CI, -0.4 to 2.7; p=0.14). At month 12, the mean weight change was 0.0 kg (95% CI, -2.5 to -2.3; p=0.97). Virologic failure was confirmed in 2 patients on cabotegravir-rilpivirine. Adverse events were documented in 28 patients (58%), including injection site pain, nodules at the injection site, and depression, and 10% discontinued therapy because of an adverse event. Bimonthly injections of cabotegravir and cabotegravir-rilpivirine were not associated with significant weight change. Adverse reactions were common and frequently led to discontinuation of therapy. This real-world data may be used to influence provider clinical decision-making.
Background In most countries, the prevalence of HIV among prisoners, particularly women, is higher than in the general population due to various risk factors both before and during incarceration. This study aims to investigate the prevalence of HIV and its associated factors among female prisoners in Shahr-e Rey in the year 2016. Methods This retrospective cross-sectional study was based on file reviews among female prisoners admitted to the quarantine unit of Shahr-e Rey Women's Prison from september 2016 to febuarary 2017. The participants were selected using a convenience sampling method. The study population consisted of women who visited the quarantine unit during the specified period. Data collection was conducted in two phases. First, after obtaining consent, participants were asked to respond to questions posed by the interviewer regarding their age and HIV-related risk factors. Then, a rapid HIV test was used, followed by ELISA and Western blot tests to confirm the diagnosis in HIV-positive patients. The collected data were entered into SPSS software version 26, and quantitative data were reported as mean and standard deviation, while qualitative data were reported as frequency and percentage. The chi-square and independent t-test were used to examine the association between various variables and HIV status. Results The prevalence of HIV infection among female prisoners was 1.7%. The prevalence of individual risk factors, including anal intercourse, injection drug use, and having sexual relations with more than one partner in the past six months, were 24%, 0.7%, and 21.6%, respectively. No significant relationship was found between age, history of injection drug use, anal intercourse, or having sexual relations with more than one partner in the past six months and HIV infection (P-value>0.05). Conclusion According to the present study, the prevalence of HIV infection among female prisoners is 1.7%, which is higher than that in the general population. This highlights female prisoners as a critical target group both for timely diagnosis and treatment of those infected and for preventing further spread of the infection.
Background People Living with HIV/AIDS (PLWHA) are at increased risk of developing malignancies, both AIDS-defining and non-AIDS-defining, and trends in incidence and severity have changed since the advent of Antiretroviral therapy (ART). This study aimed to analyze the spectrum of AIDS-defining and non-AIDS-defining malignancies in PLWHA. Methods A 6-year retrospective study was conducted in a tertiary care center by reviewing the medical records of PLWHA, which included those diagnosed with cancer. The data obtained were entered into an Excel spreadsheet, and descriptive statistical analysis was performed. Results Among the 627 PLWHA, 46 (7.3%) developed cancer, among whom 14 (30.4%) had AIDS-defining cancer, with the most common cancer being Non-Hodgkin Lymphoma (NHL) (71.4%). Non-AIDS-related cancer was reported in 32 patients (69.6%), with the most common factors being oral cavity and upper airway tract malignancies (21.9%), followed by haemato-lymphoid malignancies (18.8%). Conclusion The frequency of non-AIDS-defining malignancies mirrors that of the general population, which may be due to the increased survival rate of people living with HIV/AIDS. A multidisciplinary approach for early detection and cancer screening is recommended for people living with HIV.
Introduction Sleep disorders are considered as one of the most common illnesses among people with HIV. Due to this, using neurofeedback devices to alter brain waves is implemented as a complementary therapy. The aim of this study was to evaluate the effectiveness of neurofeedback on changes in interrupted sleep, duration of sleep, restless legs syndrome, and improve the quality of life in people with HIV with sleep difficulties. Methods The current study is a clinical trial and applied type of research in which the pre-test and post-test of two interventional and placebo groups were compared. The statistical population of all patients referred to the HIV Research Center of Imam Khomeini Hospital Complex was selected randomly. In this respect, 15 volunteer patients (9 volunteers in the treatment group and 6 volunteers in the placebo group) were chosen and placed into groups via random sampling. In addition, the Pittsburg Sleep Quality Index (PSQI) was used for the evaluation of sleep quality. Data were analyzed after statistical analysis through standard tests. Results The results of this study showed that neurofeedback was able to cause significant changes in reducing stress levels. This treatment was able to improve the quality of life indicators in participants. Also, there were changes in polysomnographic data; however, they were not significant. Conclusion Based on these data, Neurofeedback therapy could be considered a complementary therapy to improve sleep disorders in people with HIV.Moreover, this treatment was able to improve the quality of life and stress indicators in these patients by improving brain waves. Clinical Trial Registration No IR.TUMS.VCR.REC.1398.998.
Aims This study aims to understand how clinic-based Community Health Workers could address barriers to viral suppression and improve HIV management among Black people living with HIV. Background South Florida is home to the greatest number of people living with HIV (PLH) in Florida, and Black communities are disproportionately impacted. Among the most promising strategies to improve HIV outcomes among Black PLH (BPLH) are Community Health Worker (CHW) interventions. Traditionally, CHWs assist PLH in non-clinical environments, and little data exists on the effects of CHW strategies in clinical settings. Methods From March 2021 to January 2022, we administered semi-structured interviews to patients, caregivers, and clinic staff to assess their perceptions of barriers to HIV care, facilitators of HIV care, and views on CHWs using a rapid qualitative analysis framework. Results There was significant overlap between clients and providers regarding the perceived barriers and facilitators to HIV care. Emergent themes reflected concepts surrounding HIV policy and clinic limitations, stigma across clinic- and community-based settings, and suggestions on ways CHWs can address these concerns. Conclusion The results suggest embedding CHWs into HIV clinical teams may be an efficacious approach to address unmet social needs and overcome systemic barriers to HIV care, leading to improved care engagement and HIV outcomes among BPLH.
