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.
IntroductionSustained antiretroviral therapy (ART) adherence is fundamental to managing HIV, yet it remains a significant challenge, particularly in resource-limited settings. Adherence is shaped by a complex interplay of support systems, which can be categorized as "microsupport": immediate, informal assistance from personal networks, and "macrosupport": formal, structural interventions from healthcare systems. The interaction and comparative impact of these two systems on long-term adherence are not well understood.ObjectiveThis study aimed to explore the lived experiences of people living with HIV in Ghana as they navigate both micro- and macrosupport systems to inform the development of more effective, multilevel adherence strategies.MethodsA qualitative descriptive design was employed at the Cape Coast Teaching Hospital in Ghana. Data were collected between June and September 2025 through semistructured in-depth interviews and a focus group discussion with 21 purposively sampled adults who had been on ART for at least six months. Thematic analysis, facilitated by NVivo software, was used to analyze the data.ResultsAnalysis revealed that adherence is sustained by a delicate balance between the two support systems. Microsupport, manifesting as timely financial lifelines, spousal reminders, and quiet familial aid, was described as an immediate and critical "first line of defence" against missed doses. In contrast, macrosupport, such as peer groups and clinic-based care, was valued for its broad reach but often perceived as unreliable due to structural inefficiencies, such as long wait times and inconsistent resource provision. Consequently, participants expressed a strong desire for combined approaches that integrate the personal, responsive nature of microsupport within the formal structure of macrosupport.ConclusionEffective ART adherence depends not on choosing between micro- and macrosupport but on innovatively weaving them together. Microsupport provides an essential, agile safety net, while macrosupport offers a broader structural foundation. To build a resilient ecosystem of care, healthcare systems must formally recognize and bolster microsupport networks while making macrolevel interventions more reliable, personalized, and responsive to patient needs.
IntroductionAdolescents living with HIV (ALHIV) face unique psychosocial and structural challenges affecting ART adherence and engagement in care. Despite Zambia's expansion of adolescent-friendly HIV services, adolescents continue to experience poorer adherence and treatment outcomes than adults, including lower viral suppression and retention in care and limited understanding remains around the experiences of ALHIV and their caregivers. This study explored multilevel factors influencing ART adherence in Lusaka district from the perspectives of ALHIV and their caregivers.MethodsWe conducted an exploratory qualitative study on psychosocial, behavioral, and structural factors influencing ART adherence and experiences of HIV services among ALHIV in Lusaka, Zambia. Between February and July 2025, 35 in-depth interviews (20 ALHIV who were already aware of their HIV status and engaged in long-term care and 15 caregivers) were conducted across six health facilities (four PHC and two first-level facilities). Interviews were held in English or Nyanja, audio-recorded, transcribed, and analyzed using ATLAS.ti v24. A hybrid inductive-deductive approach, informed by the socioecological model, guided coding. Themes were organized in an analytical matrix showing multilevel influences on adherence, including emotional burden, stigma, support systems, and structural barriers. Trustworthiness was ensured through triangulation, peer debriefing, and iterative codebook development.ResultsThe themes identified spanned intrapersonal (individual), interpersonal, organizational/institutional, community, and structural/policy-level factors influencing ART adherence, alongside participant-generated cross-cutting recommendations to strengthen adolescent HIV service delivery. Many adolescents struggled with stigma, emotional distress, and challenges of consistent medication adherence, while others adapted through acceptance, spirituality, and counseling. Supportive relationships with family, peers, and healthcare workers fostered adherence, but stigma, school challenges, inconsistent caregiving, and limited privacy remained significant barriers. Socioeconomic issues, such as transport costs, hindered treatment continuity. Helpful strategies included routine-building, reminders, and increased health literacy. Participants recommended improving adolescent-friendly services by integrating mental health support, strengthening provider communication, expanding peer networks, and reactivating support groups to better support ART adherence among ALHIV.ConclusionAddressing psychological, social, service delivery, and structural barriers such as coordination between schools and the health system is vital to improving ART adherence among ALHIV in Zambia. A multilevel approach is needed to support sustainable treatment outcomes.
Liver complications in human immunodeficiency virus (HIV) patients coinfected with hepatitis B and C viruses (HBV and HCV) have increased. Also, HBV and/or HCV coinfection influences the outcome of antiretroviral therapy (ART). This study determined the impact of HBV and HCV infection on the prognosis of HIV patients on ART. In this prospective cohort study, 100 ART-naive HIV patients were recruited. Questionnaires were administered to collect sociodemographic data. Venous blood was collected to screen for HBsAg and anti-HCV IgM antibodies. Also, haematological and liver function parameters, as well as the HIV load, were assessed before ART initiation. The patients were monitored for 6 months after ART initiation. The overall prevalence of viral hepatitis was 22%, with 11%, 9% and 2% coinfected with HBV, HCV and HBV-HCV. No significant changes in haematological parameters were observed among patients over the 6 months, except in the HIV-HCV coinfected patients, whose platelet count significantly declined, and the HIV-HBV and HIV-HBV-HCV coinfected patients, whose WBC count significantly increased. The AST and ALT levels of the HIV-HBV and HIV-HCV coinfected patients, and ALT levels for the HIV-HBV-HCV coinfected patients, significantly increased after 6 months. The HIV load among patients decreased significantly after 6 months post-ART initiation. However, the HIV load in coinfected patients was higher than in HIV mono-infected patients at baseline through the 6 months. In conclusion, ART efficacy was influenced by HBV and/or HCV coinfection. Moreover, liver transaminases significantly increased in the HIV patients with coinfection. The findings bolster the implications of HBV and/or HCV coinfection on ART and liver function. It is recommended that HIV patients be screened for HBV and HCV infection before initiating therapy to ensure better disease management. Furthermore, studies involving larger cohorts are advised to inform policy on viral hepatitis screening among HIV patients in Ghana.
BackgroundRisk perception influences the uptake of HIV prevention interventions among key populations (KPs). Despite the disproportionately high burden of HIV among KPs in Nigeria, data on their HIV risk perception remain limited. This study aimed to assess (i) self-perceived HIV risk and its associated factors and (ii) the discordance between self-perceived HIV risk and HIV serostatus among KPs in Nigeria.MethodsThis study was a secondary analysis of the 2020 Integrated Behavioral and Biological Surveillance Survey conducted among female sex workers (FSW), men who have sex with men (MSM), people who inject drugs (PWID), and transgender (TG) people in Nigeria. The analysis was restricted to 14,649 KPs (4348 FSW, 3617 MSM, 3444 PWID, and 3240 TG). Risk perception was based on responses to the question, 'Do you feel at risk of HIV infection?' Discordance was defined as reporting no risk of HIV infection while testing HIV positive. Weighted descriptive statistics and univariate and multivariable logistic regression analyses were conducted.ResultsApproximately 37% of KPs perceived themselves to be at risk of HIV. Compared with FSW, MSM had higher odds of perceived risk (aOR = 1.5, 95% CI: 1.30-1.66), while TG people had lower odds (aOR = 0.8, 95% CI: 0.74-0.96). Older age (>= 25 years) (aOR = 1.4, 95% CI: 1.29-1.54), unemployment (aOR = 1.2, 95% CI: 1.07-1.29), residence in the North East zone (vs South South) (aOR = 1.6, 95% CI: 1.29-2.08), exposure to HIV information (aOR = 2.1, 95% CI: 1.96-2.32), and comprehensive HIV knowledge (aOR = 1.2, 95% CI: 1.14-1.34) were associated with higher odds of perceived HIV risk. Conversely, being currently married (aOR = 0.5, 95% CI: 0.43-0.58) or formerly married (aOR = 0.9, 95% CI: 0.76-0.98), residence in the South West (aOR = 0.6, 95% CI: 0.55-0.69), North Central (aOR = 0.9, 95% CI: 0.77-0.98), or North West zones (aOR = 0.7, 95% CI: 0.59-0.80), and consistent condom use (aOR = 0.8, 95% CI: 0.69-0.82) were associated with lower odds of perceived HIV risk. Overall, 13.5% of participants who perceived themselves not at risk of HIV tested positive, with the highest discordance observed among TG people (20.7%) and MSM (14.2%).ResultsApproximately 37% of KPs perceived themselves to be at risk of HIV. Compared with FSW, MSM had higher odds of perceived risk (aOR = 1.5, 95% CI: 1.30-1.66), while TG people had lower odds (aOR = 0.8, 95% CI: 0.74-0.96). Older age (>= 25 years) (aOR = 1.4, 95% CI: 1.29-1.54), unemployment (aOR = 1.2, 95% CI: 1.07-1.29), residence in the North East zone (vs South South) (aOR = 1.6, 95% CI: 1.29-2.08), exposure to HIV information (aOR = 2.1, 95% CI: 1.96-2.32), and comprehensive HIV knowledge (aOR = 1.2, 95% CI: 1.14-1.34) were associated with higher odds of perceived HIV risk. Conversely, being currently married (aOR = 0.5, 95% CI: 0.43-0.58) or formerly married (aOR = 0.9, 95% CI: 0.76-0.98), residence in the South West (aOR = 0.6, 95% CI: 0.55-0.69), North Central (aOR = 0.9, 95% CI: 0.77-0.98), or North West zones (aOR = 0.7, 95% CI: 0.59-0.80), and consistent condom use (aOR = 0.8, 95% CI: 0.69-0.82) were associated with lower odds of perceived HIV risk. Overall, 13.5% of participants who perceived themselves not at risk of HIV tested positive, with the highest discordance observed among TG people (20.7%) and MSM (14.2%).ConclusionThe majority of KPs in Nigeria did not perceive themselves to be at risk of HIV, with notable variation across the typologies. These findings highlight the need for targeted education and counseling strategies to improve HIV risk awareness among KPs in Nigeria.
Background and Objective : Human immunodeficiency virus (HIV) infection leads to a gradual decline in immune function, increasing vulnerability to opportunistic infections, including urinary bacterial growth (UBG). In immunocompromised individuals, asymptomatic UBG may develop into symptomatic infection. This study investigated the occurrence of UBG among HIV-infected patients in Ho Municipality and evaluated its association with CD4 cell count, viral load, and the antimicrobial resistance profile of the isolated bacteria. Methods : A cross-sectional study was conducted over three months (December 2018-February 2019) among HIV-infected individuals receiving care at the antiretroviral therapy (ART) units of Ho Teaching Hospital (HTH) and Ho Municipal Hospital (HMH), Ghana. The samples were cultured on CLED agar, taking through available relevant biochemical testing for identification following standard protocols. Participants' current CD4(+) T-cell count, viral load, WHO clinical stage, and ART regimen were extracted from medical records at the time of the study. Results : The total prevalence of UBG was 18.5%. The most prevailing Gram-negative bacteria was Escherichia coli (32.14%), whereas the most prevailing Gram-positive bacteria was Staphylococcus aureus (16.07%). There was statistically significant association between viral load (> 1000 copies/mL) and TDF/3TC/NVP ART regimen with UBG in this study. Nitrofurantoin and piperacillin/tazobactam were the most susceptible antibiotics. Conclusion : This study demonstrates that UBG remains a significant clinical problem among the study population, with Escherichia coli identified as the predominant uropathogen. Gram-negative bacteria were the principal contributors to urinary bacterial proliferation, although Gram-positive organisms also accounted for a notable proportion of isolates. The significant association of the elevated viral load (> 3 log) with UBG may be explained by viral replication and its effects on immune function. Nitrofurantoin and piperacillin/tazobactam exhibited the highest in vitro activity against the isolates. Furthermore, a high prevalence of multidrug resistance was detected. These findings collectively underscore the significance of regular microbiological surveillance and the implementation of targeted antimicrobial therapy for the effective management of urinary bacterial infections in individuals living with HIV.
