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.
Background:Dyslipidemia is a common metabolic complication among people living with HIV and a major contributor to cardiovascular morbidity and mortality. However, it remains insufficiently characterized in Ethiopia, particularly in contemporary urban ART settings. Methods:We conducted a facility-based cross-sectional study among 398 patients selected by systematic random sampling from November 1 to December 31, 2025. Data were collected using a structured data collection tool, entered into KoboToolbox, and analyzed in SPSS Version 27. Bivariable and multivariable logistic regression analyses were used to identify factors associated with dyslipidemia. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated, and p < 0.05 was considered statistically significant. Results:The median age of participants was 50 years (IQR: 42-56), and 66.8% (n = 266) were female. The median duration since HIV diagnosis was 19 years (IQR: 15-20). Predominant regimens included TDF+3TC+ DTG (72.8%). The prevalence of dyslipidemia was 65.3% (95% CI: 60.5-70.1), with elevated triglycerides (37.2%), total cholesterol (34.7%), high LDL-C (34.2%), and low HDL-C (28.1%). On multivariable analysis, dyslipidemia was significantly associated with history of ART change (AOR 2.62, 95% CI: 1.13-6.04), hypertension (AOR 2.45, 95% CI: 1.28-4.69), overweight (AOR 3.56, 95% CI: 1.44-8.81), obesity (AOR 5.15, 95% CI: 1.16-22.82), and sedentary and moderate physical activity (AOR 9.46, 95% CI: 2.46-36.32 and AOR 3.80, 95% CI: 1.77-8.18, respectively). Conclusion:Dyslipidemia was prevalent among approximately two in three HIV-positive patients receiving long-term ART at two tertiary hospitals in Addis Ababa, Ethiopia. These findings highlight the need for routine lipid monitoring and integrated cardiovascular risk management within HIV care settings in similar urban, tertiary-care contexts.
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.
