Until now, human immunodeficiency virus type 1 infection monitoring is based on plasma viral load and cluster of differentiation (CD)4-positive cells from thymus (CD4+ T cells) count. However, it is increasingly accepted that this biological monitoring should be strengthened with other markers that would reinforce the management. Therefore, we addressed this task by assessing the risk associated with therapeutic failure/success linked to the dynamic of immunological parameters in people living with HIV-1 (PLHIV-1) and on antiretroviral therapy (ART) in order to identify their prognostic values. Ninety enrolled PLHIV-1 were classified according to their therapeutic status. Twenty healthy persons were also recruited as a control group. Serum cytokine levels and immune cell frequencies were determined, and the risk of therapeutic failure associated with immunological parameters was assessed. We observed low frequencies of CD4+ T, natural killer (NK), natural killer T (NKT) cells, classical monocytes, nonclassical monocytes, granulocytes, and high frequency of CD8+ T cells in all PLHIV-1 groups in treatment failure under dolutegravir (DTG) and efavirenz (EFV) regimens compared to control participants. Moreover, interferon-gamma (IFN-γ) levels decreased in PLHIV-1 with therapeutic success under the DTG regimen, while interleukin-4 (IL-4) increased in treatment success under the EFV regimen. Proinflammatory tumor necrosis factor-alpha (TNF-α), IL-6, and IL-7 significantly increased in therapeutic failure groups under both regimens. IL-5 concentrations increased in all PLHIV-1, while IL-13 levels did not change. Logistic regression analysis revealed a positive correlation between the risk of treatment failure and proinflammatory cytokines IFN-γ, TNF-α, IL-6, IL-7, eosinophils, and CD8+ T cells in PLHIV-1 under EFV and DTG regimes. In contrast, the risk of therapeutic failure decreased with increasing numbers of CD4+ T cells, neutrophils, and the anti-inflammatory IL-4 in PLHIV-1 treated with the same antiretroviral molecules. Collectively, these results indicated that pro- and anti-inflammatory cytokines and immune cells could serve as prognostic factors for monitoring HIV-1 disease progression and response to ART. However, further studies with a larger sample size would be needed to confirm our data.
Objective:To analyze the clinical characteristics of patients with acute immunodeficiency syndrome (AIDS) combined with Talaromyces marneffei (TM) infection of the central nervous system (CNS), thereby improving awareness toward early diagnosis and treatment. Methods:The clinical data of eight patients with AIDS who were treated for CNS TM infection in the Guiyang Public Health Treatment Center from May 2021 to November 2022 were retrospectively analyzed. Results:The median age of the patients was 43.50 (range: 35.00-58.00) years, and all eight were male. TM infection was confirmed via metagenomic next-generation sequencing (mNGS) in three cases, positive cerebrospinal fluid (CSF) cultures of TM in four cases, and both in one case. CSF and blood cultures were both positive for one patient, whereas multiple blood cultures were negative for the other seven. The number of nucleated cells and the protein level in the CSF were elevated in five and six patients, respectively, and the CSF levels of glucose and chloride were low in four patients each. Seven patients had intracranial lesions upon head imaging, and all eight were discharged from the hospital with improvement after antifungal treatment. The median CD4+ T-cell count was 58.50/μL (range: 39.00-73.00/μL), indicating severe immunosuppression. Conclusion:The clinical characteristics and CSF-related examinations of patients with AIDS combined with CNS TM infection are not distinct, complicating diagnosis and increasing the likelihood of misdiagnosis. Early diagnosis and systemic antifungal therapy can improve patients' prognosis.
Background:Advanced HIV disease (AHD) remains a major contributor to HIV-related morbidity and mortality. While HIV screening strategies in Brazil emphasize populations traditionally considered at high risk, a significant number of individuals without previous HIV infection present with AHD despite lacking recognized risk profiles. This study aimed to define the sociodemographic and behavioral characteristics of patients presenting with advanced HIV at diagnosis, with the goal of identifying gaps in current HIV screening efforts. Methods:We conducted a retrospective cohort study of patients hospitalized in the infectious diseases ward of a tertiary referral hospital between January 2015 and December 2024. We included individuals previously unaware of their HIV status who met World Health Organization (WHO) criteria for AHD, defined as CD4 count < 200 cells/mm3 and/or a WHO Clinical Stage 3 or 4 condition. Sociodemographic characteristics, behavioral risk factors, and clinical data were abstracted from medical records and standardized epidemiologic intake forms. Descriptive analyses compared characteristics across sexuality and gender groups. Results:Among 1615 unique patients hospitalized with AHD, 407 (25%) were newly diagnosed with HIV during hospitalization. The median CD4 count at diagnosis was 53 cells/mm3 (IQR 27-110), reflecting profound immunosuppression. Most patients identified as heterosexual men (49%), while only 10% identified as sexual or gender minorities. Fewer than one-quarter (24%) had psychosocial risk factors commonly emphasized in HIV screening strategies. Heterosexual men were predominantly employed, married or partnered, and had children, while women and sexual and gender minority patients were older and younger, respectively, and reported fewer risk factors. Injection drug use history and homelessness were rare across all groups. Conclusions:AHD at first diagnosis was not concentrated within traditionally recognized high-risk populations. The diversity of patients presenting with AHD at first diagnosis suggests that reliance solely on traditional risk-based screening strategies may be insufficient to ensure timely detection. Expanded routine, opt-out HIV testing across healthcare settings, as well as indicator-based testing, self-testing, and pharmacy-based testing may help reduce missed opportunities for diagnosis and prevent severe immunosuppression.
Background:People living with HIV (PLHIV) often face nutritional deficiencies resulting from reduced food intake, malabsorption, and increased metabolic demands. Adequate nutrition is essential for optimizing antiretroviral (ARV) drug absorption, reducing treatment side effects, managing HIV-related malnutrition, and supporting immune recovery. In 2012, the Khomas Regional Council introduced a food support program for PLHIV on antiretroviral therapy (ART); however, its impact has not been systematically evaluated. This study aims to explore key informants' perspectives on the program's impact on the well-being of PLHIV receiving ART in the Khomas Region, Windhoek, Namibia. Methods:A qualitative phenomenological design was employed. Sixteen purposively selected key informants from eight constituencies in the Khomas Region participated in in-depth, semistructured interviews. Data collection occurred in two phases: June-August 2024 (n = 8) and October 2025 (n = 8). Interviews followed a guiding framework with probing questions, and data saturation determined sample adequacy. Ethical procedures, including informed consent, confidentiality, and the protection of participants' rights, were rigorously upheld. Results:Three overarching themes emerged: (1) Positive impacts of the food support program, including noticeable weight gain among beneficiaries, improved ART adherence, reduced ART dropout rates, and increased confidence among PLHIV; (2) challenges affecting the program implementation, which included insufficient food supplies, limited funding resources, migration of beneficiaries, lack of transport for field workers, and persistent self-stigma among PLHIV; and (3) Strategies for strengthening the program, such as increasing the quantity of food provided, ensuring consistent and frequent food distribution, promoting income-generating activities, updating the beneficiary database, and intensifying efforts to address HIV-related stigma. Conclusions:Despite challenges, the food support program positively influenced the health and well-being of PLHIV. Strengthened collaboration between the Khomas Regional Council and ART clinics as well as awareness campaigns are recommended to broaden the program's reach.
Background:Women with HIV (WWHIV) are a vulnerable group that faces medical challenges as well as psychological, social, and spiritual pressures that affect quality of life. Improving their quality of life requires a holistic approach that considers nonmedical factors alongside social and cultural ones. This study aims to evaluate the association between spiritual coping, duration since diagnosis, and quality of life among WWHIV. Methods:This study employed a cross-sectional design and was conducted at a government hospital from March 2024 to August 2024. A total of 120 WWHIV were recruited through purposive sampling based on predefined inclusion and exclusion criteria. Quality of life was assessed with an adapted instrument based on the WHOQOL framework, and spiritual coping was measured with a modified spiritual coping scale. Data were analyzed using Spearman's rank correlation and ordinal logistic regression. Results:Spiritual coping was positively related to quality of life (r = 0.560, p < 0.001). The duration since diagnosis was also positively associated with quality of life (r = 0.402, p < 0.001). Ordinal logistic regression showed that low spiritual coping was associated with lower odds of a higher quality of life (OR = 0.014, 95% CI = 0.002-0.096, p < 0.001). Participants diagnosed for < 6 months and 7-12 months also had lower odds of higher quality of life than those diagnosed for more than 2 years (OR = 0.157, 95% CI = 0.034-0.727 and OR = 0.067, 95% CI = 0.011-0.425, with p < 0.05). The model explained 47.5%-55.8% of the variance in quality of life (Nagelkerke R 2 = 0.558). Conclusion:Spiritual coping and duration since diagnosis were significantly associated with quality of life among WWHIV. These findings highlight the importance of integrating psychosocial and spiritual support into HIV care, particularly during the early postdiagnosis period.
Background:Persistent intestinal inflammation remains a significant concern in HIV-infected patients despite effective antiretroviral therapy (ART). Calprotectin (S100A8/A9), a calcium-binding protein complex involved in inflammatory signaling, has emerged as a potential biomarker in various inflammatory disorders; however, its role in HIV-related intestinal inflammation has not been extensively studied. Methods:This study recruited 15 AIDS-stage patients, 15 asymptomatic HIV-infected patients, and 10 healthy controls from Chengdu Anal and Intestinal Specialized Hospital between April and August 2023. Serum, fecal samples, and colonic mucosal biopsies were collected. Calprotectin expression was quantified using enzyme-linked immunosorbent assay (ELISA), immunohistochemistry, and Western blot analysis. Histopathological evaluation was performed using hematoxylin and eosin staining. Statistical correlations between calprotectin levels and clinical indicators, including CD4+ T-cell counts, were analyzed. Results:Serum and fecal calprotectin concentrations were significantly elevated in HIV-infected groups compared with controls, with the highest levels observed in AIDS-stage patients (p < 0.05). Colonic mucosal inflammation severity correlated positively with S100A8/A9 protein expression (p < 0.05). Calprotectin expression inversely correlated with CD4+ T-cell counts (serum: r = -0.509; feces: r = -0.520, both p < 0.001). Strong correlations were observed between calprotectin expression in serum, feces, and intestinal mucosal tissues. Conclusions:Calprotectin serves as a sensitive biomarker reflecting intestinal inflammation severity and immune dysfunction in HIV-infected individuals. Serum and fecal calprotectin assays offer noninvasive, reliable methods for evaluating disease progression and inflammatory status and potentially guiding clinical management in HIV.
Background:Adherence to antiretroviral therapy (ART) is an essential component in the global response to HIV/AIDS. Despite increased access to ART in Cameroon, maintaining adherence to ART remains a significant challenge, jeopardising progress toward the global 95-95-95 HIV treatment targets. Objectives:To assess the level of adherence to ART and associated factors among people living with HIV at Yaounde Military Hospital in Cameroon. Methods:A cross-sectional study was conducted from January to June 2025 among people living with HIV (PLHIV) aged 10 years and above receiving ART at the Yaounde Military Hospital. A simple random sampling technique was employed, whereby all eligible participants presenting for ART refill during the study period were invited to participate. A total of 356 PLHIV were interviewed using a structured questionnaire. Adherence to ART was measured using pill count and viral suppression. Descriptive statistics summarised demographic and clinical variables, Chi-square tests assessed associations between categorical variables, and logistic regression identified factors associated with adherence. Statistical significance was set at p < 0.05. Results:The mean age of participants was 46.5 ± 15.1 years, ranging from 10 to 84 years, and the mean duration on ART was 9.4 ± 5.8 years, ranging from 0 to 24 years. An overall adherence rate, measured by pill count, was 86.0% (95% CI: 82.35-89.57), while out of 356 participants, 344 (96.6%; 95% CI: 94.7-98.3) were virally suppressed. Factors significantly associated with adherence included smoking (AOR = 5.27, 95% CI = 1.72-16.13, p = 0.004), male gender (AOR = 2.8, 95% CI = 1.12-7.31, p = 0.027) and ART adverse effects (AOR = 0.35, 95% CI = 0.14-0.87, p = 0.023). Conclusion:ART adherence in this study fell below the UNAIDS optimal target of ≥ 95%. Factors such as smoking, male gender and ART adverse effects significantly influence adherence. Targeted interventions addressing these barriers are essential to optimise adherence and sustain progress toward the 95-95-95 HIV treatment targets in Cameroon.
Introduction:Metabolic comorbidities are significant health challenges for older people living with HIV (PLHIV). This systematic review and meta-analysis aimed to synthesize existing evidence and provide the pooled prevalence of metabolic comorbidities among older PLHIV worldwide. Methods:We searched PubMed, Web of Science, Embase, Scopus, and Google Scholar for English-language documents from 2013 to 25 December 2023. To identify unpublished documents for a grey literature review, we reached out to well-known experts in HIV and aging, asking them to provide and share unpublished records, and we searched the first 300 articles in Google Scholar. We included cross-sectional studies and baseline data from cohort studies to measure the prevalence of metabolic comorbidities, including hypertension, obesity, diabetes, and high cholesterol. The pooled prevalence and 95% confidence interval (CI) of metabolic comorbidities were estimated using random effects meta-analysis. Results:Of the 915 articles recruited articles for full text, 26 studies (including 10 in developed countries) met the inclusion criteria and were included in the analysis. Most of the studies were conducted in North America. The pooled prevalence of individual metabolic comorbidities was as follows: diabetes (20 articles) 13.5% (95% CI: 10.0, 17.4), high cholesterol (eight articles) 47.3% (95% CI: 36.3, 58.4), hypertension (22 articles) 40.7% (95% CI:30.2, 51.2), and obesity (10 articles) 26.1% (95% CI:20.3, 32.4). The results showed that the prevalence of all metabolic comorbidities was higher in North America. Conclusion:We found that metabolic comorbidities are a common condition among older PLHIV and represent a significant risk factor for various diseases. Policymakers should consider implementing practical interventions, including prevention strategies, periodic screenings, and lifestyle modifications focused on promoting a healthy diet and regular exercise to manage metabolic comorbidities in older PLHIV effectively. Most studies have been conducted in developed countries; there is a need for increased research efforts in other regions.
Dolutegravir (DTG) is widely used in antiretroviral therapy (ART) for its high efficacy and favorable tolerability. However, emerging evidence has raised concerns regarding weight gain and potential metabolic consequences associated with DTG use, with limited longitudinal data from Asian populations. This study aimed to evaluate longitudinal weight changes among people living with HIV (PLWH) receiving DTG-containing regimens and to determine whether weight trajectories differ across key demographic and clinical subgroups. We conducted a retrospective cohort study of adult PLWH who initiated DTG-based ART at a tertiary referral center between January 2020 and June 2022, with follow-up through June 2024. Participants with complete weight data at baseline, 6, 12, 18, and 24 months were included. Weight trajectories were analyzed using repeated-measures ANCOVA, adjusting for sex, age group, ART backbone (TDF-based vs. non-TDF-based), baseline body mass index (BMI), baseline weight, and baseline CD4 cell count. A total of 157 participants (59.2% male; mean age 50.4 years) were included. Mean body weight increased significantly over 24 months in both sexes. Greater numerical weight gain was observed among participants aged ≥ 50 years and those receiving non-TDF-based regimens. However, only ART backbone demonstrated a significant time-by-subgroup interaction. Participants with baseline CD4 counts < 200 cells/mm3 and lower baseline BMI demonstrated numerically greater weight increases over time. No significant time-by-sex, time-by-age, time-by-BMI, or time-by-CD4 interactions were observed, indicating broadly similar longitudinal trajectories across these subgroups after adjustment. DTG-containing ART was associated with modest but significant weight gain over 24 months in this Thai cohort. ART backbone, differences between TDF-based and non-TDF-based regimens, was the primary factor associated with differential weight trajectories. These findings support monitoring of routine weight and metabolic parameters and highlight the importance of individualized ART selection to optimize long-term metabolic health.
Objective:Human immunodeficiency virus (HIV) infection remains highly prevalent and represents a significant economic burden on healthcare systems. The World Health Organization (WHO) reported 39 million people living with HIV (PLWH) in 2023. In Colombia, 185,954 prevalent cases were reported during 2024. Diarrhea affects up to 50% of PLWH. This study aimed primarily to estimate the prevalence of infectious versus noninfectious etiology of diarrhea among adults with HIV and to compare immunological and clinical events. Design/Method:Cross-sectional observational study included adult patients with HIV and diarrhea who received care at Fundación Valle del Lili between 2014 and 2022. Clinical variables, diarrhea etiology, treatment, and clinical events were analyzed according to the chronologic classification of diarrhea using chi-squared and F tests for qualitative variables and Kruskal-Wallis and ANOVA tests for quantitative variables. Effect sizes are reported as odds ratios (ORs) with 95% confidence intervals (CIs) for binary outcomes between infectious and noninfectious diarrhea. Limitations include the cross-sectional design, single-center setting, and convenience sampling. Results:Among the patients, 73.8% were male, and the mean age was 42 years. De novo diagnosis was made in 26.2% and 90.5% of previously diagnosed individuals receiving antiretroviral therapy. The 23% had AIDS-defining conditions. One-third of the patients had acute diarrhea. Infectious etiology was found in 65.5% of patients and was associated with higher viral loads and lower CD4 (+) T-cell counts compared to noninfectious diarrhea. Antibiotic therapy was used in 57%, and diarrhea had resolved in 77/84 (91.7%) by discharge. Associated mortality was 2.8%. Conclusions:The predominant cause of diarrhea was infectious. Infectious etiology and persistent diarrhea were associated with higher viral loads and lower CD4 (+) T-cell counts, which may be linked to poorer clinical outcomes in HIV-infected patients. Further studies are required to better understand these relationships.
Background:Resource-limited settings face challenges in applying evidence to end the HIV/AIDS epidemic by 2030. Implementation research (IR) has emerged as a promising approach to translate evidence into practice. This review explores how IR has been utilized in sub-Saharan Africa (SSA) to support efforts to end the HIV/AIDS epidemic. Methods:The review protocol was registered with PROSPERO (CRD42024515975). Articles were searched in PubMed, Embase, Scopus, and Web of Science, with a focus on HIV/AIDS evidence-based intervention studies in SSA. Results:Out of the 2055 retrieved articles, 41 (2%) qualified for final analysis. The findings identify 11 key implementation strategies, including decentralized service delivery, task shifting, integrated HIV service delivery, capacity strengthening in diagnostics and treatment support, health system strengthening, promotion of pre-exposure prophylaxis, prevention of vertical transmission, youth-friendly services, community engagement, innovative technologies, and operational research. These approaches improved access to HIV testing, treatment, and prevention services, enhanced adherence and retention in care, and supported early diagnosis and continuity of care. However, implementation was influenced by cross-cutting barriers such as limited resources and infrastructure, workforce constraints, inadequate training, stigma, weak coordination systems, and policy and funding limitations. Conclusion:IR provides a structured approach to identifying, adapting, and scaling effective HIV interventions within real-world settings. The evidence highlights its role in supporting diverse strategies across health system levels while accounting for contextual barriers and facilitators. These findings highlight the importance of continued investment in IR and targeted capacity building to strengthen the effectiveness and sustainability of HIV/AIDS programs in SSA.
IntroductionToday, HIV infection is considered among the most important infectious diseases worldwide. This study aimed to explore the challenges of people living with HIV (PLHIV) on treatment journey.MethodsThis study was conducted using a qualitative approach and the content analysis method at the Behavioral Diseases Consultation Center and the Positive Club of Kerman, Iran, from September 2023 to August 2024. A total of 27 individuals, including 17 PLHIV, 5 caregivers, and 5 social work and HIV professionals, were recruited using purposive sampling. Data were collected using individual semistructured interviews, field attendance, and note-taking.ResultsData analysis resulted in 1258 primary codes, which were categorized with the theme of challenges of living with HIV into 30 subcategories and 7 main categories, including emotional and psychological tensions, objective and behavioral reflections, social deprivation, unfavorable social policies, changes in life, labeling, poor quality, and insufficient medical services.ConclusionDue to the numerous problems and challenges faced by PLHIV during their treatment, they need comprehensive support from their families, caregivers, and society. Ensuring access to appropriate medical services and enhancing public awareness and understanding of PLHIV and their caregivers through education are essential. Such measures can contribute to improved treatment adherence, better quality of life, and more effective patient-centered care for PLHIV.
Background:HIV/AIDS remains a significant public health challenge, with many individuals developing advanced HIV disease despite the scale-up of antiretroviral therapy worldwide. Determinants related to sociodemographics, clinical practice and laboratory service associated with advanced HIV disease are not well known in sub-Saharan Africa, such as Ethiopia. This study examines the potential sociodemographics and clinical practice of determinants of advanced HIV disease among adults on antiretroviral therapy in the West Oromia Region, Ethiopia. Methods:A hospital-based retrospective study was employed. The Raosoft online sample calculator was used to estimate a sample of 544 patient medical records in the study. A systematic sampling technique was used to select participants who met the inclusion criteria from three purposively selected public hospitals between January 2017 and December 2021. Descriptive statistics were applied to the dataset after it was cleaned and validated in EpiData, and the final analysis was performed in SPSS Version 29. Bivariate and multivariate logistic regression models were used to analyse sociodemographic and clinical practice factors associated with advanced HIV disease, with p < 0.05. Results:The study revealed sociodemographic and clinical practice determinants associated with advanced HIV disease among adults, which includes male sex (adjusted odds ratio [AOR] = 1.85 and 95% confidence interval [CI] 1.18-2.90), the presence of HIV signs and symptoms (AOR = 2.83 [95% CI 1.74-4.61]) and OIs (AOR = 3.44 [95% CI 2.01-5.92]) at the time of antiretroviral therapy enrolment, bedridden and ambulatory health conditions (AOR = 3.58 [95% CI 1.76-7.31]), and low CD4 cell count of less than 200 cells/mm3 accounted for 127 (36.5%) at treatment initiation while having CD4 test results at baseline data collections participants (AOR = 1.97 [95% CI 1.20-3.23]), and 84 (37%) of those delayed ART initiation (AOR = 1.75 [95% CI 1.08-2.83]). 42 (7.7%) had ART on ≤ 1-7 days and 143 (26.3%) in > 7 days. These significantly correlated with the development of advanced HIV disease or OIs at a p value of < 0.05 among this study population. Only 359 (66%) had same-day ART. Conclusion:The findings highlight the importance of early HIV diagnosis and initiation of antiretroviral therapy, adherence to treatment regimens and monitoring for OIs in the prevention and management of advanced HIV disease. Therefore, the study calls for male-targeted interventions, strengthening the capacity of healthcare providers, and a review of protocols for early HIV diagnosis and care to enhance patient health outcomes.
Introduction:Multimonth dispensing (MMD) is a strategy in the HIV care continuum for people living with HIV (PLWH), especially for those who are virally suppressed. With the increase in MMD following the COVID-19 pandemic, there is a dearth of data on its impact on HIV care outcomes, such as viral suppression. Therefore, we conducted a qualitative systematic review to explore how PLWH and healthcare workers (HCWs) perceive the uptake, barriers, challenges, and benefits of MMD, as well as its effects on viral suppression. Methods:In January 2025, following the PRISMA approach, we searched CINAHL, Embase, PubMed, and Scopus databases for articles. Two reviewers independently performed the screen, extraction, and appraisal processes. We descriptively reported the findings in line with our objectives. Results:Of the 3521 studies found, only 15 were included in this review, and most were from sub-Saharan Africa. HCWs initiated PLWH on MMD because of the COVID-19 pandemic, particularly to reduce clinic traffic, even when they did not meet the criteria for MMD. The barriers to PLWH initiating MMD, confirmed by HCWs, include privacy concerns and the stigma associated with having multiple antiretroviral therapy (ART) medication bottles and the stockout of ART medications in clinics. Furthermore, some PLWH refused MMD because plenty of ART bottles can increase the risk of unintended HIV disclosure. Confirmed by HCWs, PLWH share their medication with others and, at times, misuse it. Regarding MMD benefits, PLWH reported job stability as a benefit because of reduced permission from work to refill ART medication and waiting time in the clinics, a decrease in stigma and discrimination, and a generally improved HIV care experience; all confirmed by HCWs. Furthermore, HCWs reported benefits, including reduced workload and burnout. Interestingly, unlike PLWH's claim that MMD improved adherence and viral suppression, HCWs reported the opposite. Conclusion:The COVID-19 pandemic increased MMD rollout to those who met and those who did not meet its criteria, leading to shorter waiting times, job stability, and reduced HCWs' burnout. However, HIV clinics should initiate MMD for PLWH who meet the criteria, which allows for closer monitoring of the unsuppressed PLWH.
Background:Globally, South Africa has the highest number of people living with HIV (PLHIV) and the largest HIV treatment programme. Adherence to antiretroviral therapy (ART) is a key factor in achieving viral load suppression and positive health outcomes and is, therefore, a crucial component in managing the HIV epidemic. Methods:The survey data were collected using a two-stage stratified cluster random sampling design. Descriptive statistics were used to summarise the sample characteristics including the prevalence of nonadherence to ART. Pearson chi-square was used to test for differences in categorical variables. Bivariate modified Poisson regression analysis was used to investigate factors associated with nonadherence to ART, and statistically significant variables were included in a multivariate modified Poisson regression model. Results:Of 3737 participants who self-reported ever taking ART, 11.6% were classified as nonadherent (no antiretroviral [ARV] drugs detected in the dry blood spot). In the final model, participants with secondary or Grade 12 education had significantly higher prevalence of nonadherence than those with no or primary education (adjusted prevalence ratio [aPR] = 1.82; 95% CI: 1.12-2.95; p = 0.015). Decreased prevalence of ART nonadherence was associated with those aged 35-44 years (aPR = 0.48; 95% CI: 0.28-0.82; p = 0.007) and 55-64 years (aPR = 0.39; 95% CI: 0.18-0.84; p = 0.016) compared to those aged 15-24 years, and those residing in rural formal/farm areas compared to those living in urban areas (aPR = 0.27; 95% CI: 0.14-0.54; p < 0.001). Conclusion:The study highlights higher risk of nonadherence to ART among youth and those who reside in urban areas which could be improved through youth-friendly interventions and ongoing tailored interventions for PLHIV in urban areas.
Purpose:To determine whether sociodemographic factors, including residence in rural/frontier versus urban settings, are associated with differences in HIV viral suppression rates among people living with HIV in Wyoming with one or more reported viral load results in 2023. Methods:Wyoming Department of Health databases were used to identify people living with HIV in Wyoming who had a viral load reported between January 1, 2023, and December 27, 2023. Demographic information was obtained, including county of residence, sex, age, insurance status, and Ryan White HIV and AIDS Program participation. Multiple logistic regression models were developed to conduct a cross-sectional examination of the effect of geographic location on the viral suppression status. Findings:A total of 272 people were identified as having one or more viral load results in 2023 and were included in the study. A total of 248 study participants were virally suppressed. There was no significant association between rural/frontier and urban county of residence and the odds of being virally suppressed (OR = 1.066, 95% CI: [0.447-2.617], and p = 0.886). There was a significant association between age and viral suppression status, with the odds of being virally suppressed increasing as age increases (OR = 1.046, 95% CI: [1.012-1.082], and p = 0.008). Conclusions:There was no statistically significant association in HIV viral suppression between rural/frontier and urban people living with HIV in Wyoming who had a viral load result in 2023. There was a statistically significant association between age and odds of viral suppression, with the odds of viral suppression increasing as age increases.
Introduction:Despite advancements in antiretroviral therapy (ART) availability, maintaining optimal adherence remains difficult, especially in low- and middle-income countries (LMICs). This literature review synthesized evidence on barriers and interventions influencing adherence to ART among children and adolescents with HIV, focusing on studies conducted in LMICs, particularly in Africa and Asia, where adherence and challenges are more prevalent. Methods:This narrative review draws on peer-reviewed studies to identify barriers to ART adherence, such as medication complexity, caregiver-related issues, socioeconomic factors, and healthcare infrastructure limitations. A thorough search was conducted using electronic databases like PubMed, Google Scholar, and Scopus, covering relevant primary and secondary literature from 2010 to 2023 in LMICs in Africa and Asia. It also evaluates the effectiveness of digital tools and psychosocial interventions in enhancing adherence to ART among children with HIV. Results and Discussion:Findings reveal that adherence remains suboptimal, with rates ranging from 62% to 95% across settings. Major barriers include regimen complexity, psychosocial stressors, and limited healthcare access, while interventions such as digital adherence tools, caregiver education, and community-based programs demonstrate measurable improvements. Evidence highlights that targeted interventions can improve outcomes. Family support programs in Uganda increased adherence from 66% to 83%, and SMS reminder systems improved adherence by up to 5.5% among adolescents. Nevertheless, recent reductions in international funding pose a substantial threat to the sustainability of these gains in resource-limited settings. Conclusion:Improving adherence among children and adolescents requires not only simplified regimens and psychosocial support but also sustainable financing mechanisms. Future strategies must anticipate barriers related to funding cuts, drug resistance, and the transition from pediatric to adult care.
Background:Opportunistic infections (OIs) play a crucial role in the morbidity and mortality of HIV-infected individuals. Despite the increasing use of antiretroviral therapy, there remains a lack of comprehensive data on the incidence of OIs to provide a clearer national picture. Therefore, this systematic review and meta-analysis aim to determine the pooled incidence and identify the predictors of OIs among people living with HIV in Ethiopia. Method:A systematic search was conducted across multiple electronic databases to identify relevant studies. The degree of heterogeneity across studies was assessed using the I 2 statistic. Subgroup analyses were conducted to explore sources of heterogeneity. A funnel plot and Egger's test were used to assess publication bias. Adjusted hazard ratio with 95% CI was used to assess the relationship between predictors and OIs occurrence. Result:In total, 24 studies met the inclusion criteria and were analyzed. The pooled incidence rate of OIs among people living with HIV in Ethiopia was found to be 6.96 per 100 person-years (95% CI: 5.14-8.78) based on a random-effects model. The meta-analysis identified predictors of OIs among people living with HIV, including poor adherence (pooled AHR 1.42, 95% CI: 1.12, 1.80), CD4 count < 200 cells/mm3 (AHR 1.49, 95% CI: 1.25, 1.78), being bedridden (AHR 1.45, 95% CI: 1.10, 1.90), and advanced WHO clinical stage (AHR 1.57, 95% CI: 1.24, 1.98). Conclusion:The burden of OIs continues to be a major health concern among people living with HIV/AIDS. Low CD4 count, poor adherence to ART, being bedridden, and advanced clinical stage were significantly associated with the occurrence of OIs.
Background:Ethiopia started the human immunodeficiency virus (HIV) case-based surveillance (CBS) system along with Research Electronic Data Capture (REDCap) in June 2021. From January to June 2022, only five out of 14 CBS implementing health facilities in Dire Dawa City, Ethiopia, reported 35 newly diagnosed HIV patients through the REDCap Database compared to 314 in the District Health Information System (DHIS-2). This study aimed to evaluate the CBS system, its usefulness, and reasons for underreporting in Dire Dawa City, Ethiopia. Methods:We used a descriptive cross-sectional study design. We customized the data collection tools from the Centers for Disease Control and Prevention (CDC), a guideline for evaluating public health surveillance systems. Questionnaires were administered to 36 healthcare workers involved in supporting CBS. Completed HIV CBS case reporting forms were also assessed for completeness. EPI Info software was used for data entry and analysis. Descriptive statistics, such as frequencies and proportions, were used to describe the findings. Results:Interviews were successfully conducted with 34 health workers. The lack of CBS reporting guidelines for healthcare facilities was 22 (61%). Limited coordination between technical staff and health facilities 19 (53%) and limited competency in REDCap 23 (64%) were also observed. CBS data timeliness, completeness, and validity were 89%, 87%, and 99%, respectively, in the REDCap. There is a lack of standard operating procedures during system interruption. The overall health facility representativeness was 368 of 757 (49%). Acceptability was 100%, mainly due to reduced paperwork and the ability to generate simple reports. Conclusion:and Recommendations: The HIV CBS system was timely and acceptable. However, its representativeness was poor owing to limited competency in the REDCap. We recommend that health workers receive further training for case-based HIV surveillance.
Background:Elderly people living with HIV-1 (PLWH) are more prone to HIV-related complications. Methods:We investigated the creatinine and blood lipids of 153 PLWHs receiving an ANV regimen and 315 PLWHs receiving an EFV regimen. Results:The results showed that the abnormal rates of creatinine were very low in both groups, and ANV had a lower triglycerides abnormality than EFV. No evident difference in high-density lipoprotein, low-density lipoprotein, and total cholesterol was observed between the two groups. The abnormal body mass index of the ANV group aged 66 and above was much less than that of the EFV group. Conclusion:Both the ANV and EFV regimens did not cause severe kidney damage. ANV had an advantage in controlling dyslipidemia. We strongly recommend elderly PLWHs to choose the ANV regimen.
