AIM To compare high-resolution computed tomography(HRCT) findings between humoral primary immunodeficiencies(hPIDs) subtypes; to correlate these findings to pulmonary function tests(PFTs).METHODS We retrospectively id...AIM To compare high-resolution computed tomography(HRCT) findings between humoral primary immunodeficiencies(hPIDs) subtypes; to correlate these findings to pulmonary function tests(PFTs).METHODS We retrospectively identified 52 consecutive adult patients with hPIDs who underwent 64-row HRCT and PFTs at the time of diagnosis. On a per-patient basis, an experienced radiologist recorded airway abnormalities(bronchiectasis,airway wall thickening, mucus plugging, tree-in-bud, and air-trapping) and parenchymal-interstitial abnormalities(consolidations, ground-glass opacities,linear and/or irregular opacities, nodules, and bullae/cysts) found on HRCT.The chi-square test was performed to compare the prevalence of each abnormality among patients with different subtypes of hPIDs. Overall logistic regression analysis was performed to assess whether HRCT findings predicted obstructive and/or restrictive PFTs results(absent-to-mild vs moderate-tosevere).RESULTS Thirty-eight of the 52 patients with hPIDs showed common variable immunodeficiency disorders(CVID), while the remaining 14 had CVID-like conditions(i.e., 11 had isolated IgG subclass deficiencies and 3 had selective IgA deficiencies). The prevalence of most HRCT abnormalities was not significantly different between CVID and CVID-like patients(P > 0.05), except for linear and/or irregular opacities(prevalence of 31.6% in the CVID group and 0 in the CVID-like group; P = 0.0427). Airway wall thickening was the most frequent HRCT abnormality found in both CVID and CVID-like patients(71% of cases in both groups). The presence of tree-in-bud abnormalities was an independent predictor of moderate-to-severe obstructive defects at PFTs(Odds Ratio, OR, of 18.75, P < 0.05), while the presence of linear and/or irregular opacities was an independent predictor of restrictive defects at PFTs(OR = 13.00; P < 0.05).CONCLUSION CVID and CVID-like patients showed similar HRCT findings. Tree-in-bud and linear and/or irregular opacities predicted higher risks of, respectively,obstructive and restrictive defects at PFTs.展开更多
Primary immunodeficiency disorders(PIDs)are rare inborn errors of the immune system.Patients with PIDs are unique models that exemplify the functional and phenotypic consequences of various immune defects underlying i...Primary immunodeficiency disorders(PIDs)are rare inborn errors of the immune system.Patients with PIDs are unique models that exemplify the functional and phenotypic consequences of various immune defects underlying infections,autoimmunity,lymphoproliferation,allergy and cancer.Over 150 PID syndromes were characterized in the past 60 years,with an ever growing list of new entities being discovered.Because of their rarity,multi-center collaboration for pooled data analysis and molecular studies is important to gain meaningful insights into the phenotypic and genetic diversities of PIDs.In this article,we summarize our research findings on PIDs in Chinese population in the past 20 years.Close collaboration among various immunology centers,cross-referrals and systematic data analysis constitute the foundation for research on PIDs.Future directions include establishment of a national PID registry,raising awareness of PIDs and securing sufficient resources for patient care and scientific research.展开更多
Despite effective antiretroviral therapy(ART),many individuals with human immunodeficiency virus(HIV)/acquired immune deficiency syndrome(AIDS)achieve viral suppression but fail to fully restore cluster of differentia...Despite effective antiretroviral therapy(ART),many individuals with human immunodeficiency virus(HIV)/acquired immune deficiency syndrome(AIDS)achieve viral suppression but fail to fully restore cluster of differentiation 4(CD4)^(+)T lymphocyte(CD4 cell)counts—a condition known as immunological non-response(INRs).INRs are associated with elevated health risks,including increased susceptibility to AIDS-related and non-AIDS-related complications.The pathogenesis of INRs remains incompletely understood,and no established therapeutic interventions exist,posing a major challenge in contemporary HIV/AIDS management.Emerging evidence indicates that INRs exhibit significant alterations in gut microbiota composition.Dysbiosis of the gut microbiota may contribute to persistent immune activation,cytokine imbalance,and cellular pyroptosis,all of which could impair immune reconstitution in people living with HIV/AIDS.Traditional Chinese medicine(TCM)has demonstrated potential immunomodulatory effects and is increasingly utilized in the management of INRs.Targeting the gut microbiota and elucidating the mechanisms by which TCM modulates this microbial ecosystem may offer new avenues for preventing and treating INRs.This review explores the interplay between gut microbiota and TCM,examines the association between gut dysbiosis and INRs,discusses the mechanistic pathways through which microbiota imbalance contributes to INRs development,and highlights how TCM interventions regulate gut microbiota to promote immune recovery.By focusing on the gut microbiota as a therapeutic interface,this article provides novel insights into TCM-based strategies for improving outcomes in INRs and supports the development of innovative treatment approaches.展开更多
Recent increases in infectious diseases affecting the central nervous system have raised concerns about their role in neuroinflammation and neurodegeneration.Viral pathogens or their products can invade the central ne...Recent increases in infectious diseases affecting the central nervous system have raised concerns about their role in neuroinflammation and neurodegeneration.Viral pathogens or their products can invade the central nervous system and cause damage,leading to meningitis,encephalitis,meningoencephalitis,myelitis,or post-infectious demyelinating diseases.Although neuroinflammation initially has a protective function,chronic inflammation can contribute to the development of neurodegenerative diseases.Mechanisms such as protein aggregation and cellular disturbances are implicated with specific viruses such as herpes simplex virus type 1 and Epstein-Barr virus being associated with Alzheimer's disease and multiple sclerosis,respectively.Extracellular nucleotides,particularly adenosine triphosphate and its metabolites are released from activated,infected,and dying cells,acting as alarmins mediating neuroinflammation and neurodegeneration.When viruses infect central nervous system cells,adenosine triphosphate is released as an alarmin,triggering inflammatory responses.This process is mediated by purinergic receptors,divided into two families:P1,which responds to adenosine,and P2,activated by adenosine triphosphate and other nucleotides.This review highlights how specific viruses,such as human immunodeficiency virus type 1,Theiler's murine encephalomyelitis virus,herpes simplex virus type 1,Epstein-Barr virus,dengue virus,Zika virus,and severe acute respiratory syndrome coronavirus 2,can initiate inflammatory responses through the release of extracellular nucleotides,particularly adenosine triphosphate,which act as critical mediators in the progression of neuroinflammation and neurodegenerative disorders.A better understanding of purinergic signaling pathways in these diseases may suggest new potential therapeutic strategies for targeting neuroinflammation to mitigate the long-term consequences of viral infections in the central nervous system.展开更多
BACKGROUND Transfusion transmissible infections(TTIs)are illnesses spread through contaminated blood or blood products.In India,screening for TTIs such as hepatitis B virus(HBV),hepatitis C virus(HCV),human immunodefi...BACKGROUND Transfusion transmissible infections(TTIs)are illnesses spread through contaminated blood or blood products.In India,screening for TTIs such as hepatitis B virus(HBV),hepatitis C virus(HCV),human immunodeficiency virus(HIV)-I/II,malaria,and syphilis is mandatory before blood transfusions.Worldwide,HCV,HBV,and HIV are the leading viruses causing mortality,affecting millions of people globally,including those with co-infections of HIV/HCV and HIV/HBV.Studies highlight the impact of TTIs on life expectancy and health risks,such as liver cirrhosis,cancer,and other diseases in individuals with chronic HBV.Globally,millions of blood donations take place annually,emphasizing the importance of maintaining blood safety.AIM To study the prevalence of TTIs,viz.,HBV,HCV,HIV I/II,syphilis,and malaria parasite(MP),among different blood donor groups.METHODS The study assessed the prevalence of TTIs among different blood donor groups in Delhi,India.Groups included total donors,in-house donors,total camp donors,institutional camp donors,and community camp donors.Tests for HIV,HBV,and HCV were done using enzyme-linked immunosorbent assay,while syphilis was tested with rapid plasma reagins and MP rapid card methods.The prevalence of HBV,HCV,HIV,and syphilis,expressed as percentages.Differences in infection rates between the groups were analyzed usingχ²tests and P-values(less than 0.05).RESULTS The study evaluated TTIs among 42158 blood donors in Delhi.The overall cumulative frequency of TTIs in total blood donors was 2.071%,and the frequencies of HBV,HCV,HIV-I/II,venereal disease research laboratory,and MP were 1.048%,0.425%,0.221%,0.377%,and 0.0024%,respectively.In-house donors,representing 37656 donors,had the highest transfusion transmissible infection(TTI)prevalence at 2.167%.Among total camp donors(4502 donors),TTIs were identified in 1.266%of donors,while community camp donors(2439 donors)exhibited a prevalence of 1.558%.Institutional camp donors(2063 donors)had the lowest TTI prevalence at 0.921%.Statistical analysis revealed significant differences in overall TTI prevalence,with total and in-house donors exhibiting higher rates compared to camp donors.CONCLUSION Ongoing monitoring and effective screening programs are essential for minimizing TTIs.Customizing blood safety measures for different donor groups and studying socio-economic-health factors is essential to improving blood safety.展开更多
BACKGROUND To prevent mother to child transmission(MTCT)of human immunodeficiency virus(HIV),sustained maternal viral load suppression(VLS)and early HIV testing among HIV exposed infants(HEI)is critical.AIM To investi...BACKGROUND To prevent mother to child transmission(MTCT)of human immunodeficiency virus(HIV),sustained maternal viral load suppression(VLS)and early HIV testing among HIV exposed infants(HEI)is critical.AIM To investigate maternal viral load results and infant HIV testing uptake at 6-weeks,and 9-months and 18-months in Rwanda.METHODS Between 2015 and 2022,VLS(<200 copies/mL)was measured among pregnant women living with HIV(WLHIV)from 38-healthcare facilities.Viral loads(VL)were measured at 6-months,12-months and 24-months,respectively.For maternal VL,the unit of analysis was visit-pair,and the pairs were created to define those with VL<200 copies/mL at two consecutive visits as having sustained VLS,persistent viremia(VL≥200 copies/mL at two consecutive visits),viral rebound(VL<200 copies/mL at prior visit only)and newly suppressed(VL<200 copies/mL at subsequent visit only).HEI were considered to have persistent HIV testing if they had all three HIV tests.Poisson regression models with generalized estimating equations were used to estimate the adjusted incidence rate ratio(aIRR)and 95%CI for factors associated with sustained VLS and persistent HIV testing.RESULTS A total of 1145 mother-infant pairs were analyzed.Infant HIV testing uptake at 6-weeks,9-months and 18-months was 1145(100.0%),1089(95.1%),1006(87.9%)respectively.Nine hundred ninety-nine HEI(87.3%)tested for HIV persistently.At 18-months,the incidence of HIV among HEI was 8(0.7%).Of 1145 mothers,1076(94.0%)had≥2 VL results making a total of 2010 visit-pairs(142-single;934-double visit-pairs).The incidence rate of sustained VLS,persistent viremia,viral rebound and new suppression were 91.0%,1.3%,3.6%and 4.0%respectively.Maternal disclosure of HIV status(aIRR=1.08,95%CI:1.02-1.14)was associated with increased likelihood of sustained VLS.Having peer support(aIRR=1.0595%CI:1.01-1.10)was associated with persistent HIV testing among HEI.CONCLUSION Sustained VLS is high among pregnant WLHIV in Rwanda.The low incidence of HIV among HEI may be attributed to high VLS levels.Targeted interventions,including enhanced HIV disclosure and peer support,are crucial for improving sustained VLS and increasing infant HIV testing uptake to reduce MTCT.展开更多
AIM:To investigate the etiology of ocular pathogens and to establish the various pathogens present in human immunodeficiency virus(HIV)patients with cytomegalovirus retinitis(CMVR).METHODS:A total of 17 HIV-infected p...AIM:To investigate the etiology of ocular pathogens and to establish the various pathogens present in human immunodeficiency virus(HIV)patients with cytomegalovirus retinitis(CMVR).METHODS:A total of 17 HIV-infected patients with concomitant eye disorders were enrolled.Patients were divided into CMVR group(10 patients,18 eyes)and non-CMVR group(7 patients,9 eyes)based on clinical manifestations and the presence of cytomegalovirus(CMV)-DNA in ocular specimens.The viral load of CMV was assessed using polymerase chain reaction in aqueous humor,vitreous fluid,and peripheral blood samples of patients in the CMVR group.Additionally,peripheral blood CD4^(+)T cell counts were measured in both groups.RESULTS:In the CMVR group,the CMV-DNA load in the vitreous and aqueous humor samples was substantially higher than in the peripheral blood samples(P<0.01).CMVDNA load in the aqueous humor and vitreous samples of the two eyes in the CMVR group was determined to be statistically significant(10 patients,16 eyes,P=0.018,0.012).Peripheral blood CD4^(+)T cell counts in the CMVR group were adversely linked with the CMV-DNA load in both the aqueous humor and peripheral blood(P=0.005,0.048).Compared with the non-CMVR group,the peripheral blood CD4^(+)T cell count in the CMVR group decreased significantly(P=0.014).The peripheral blood CD4^(+)T cell count exceeded 300 cells/μL in 85.71%of non-CMVR patients,whereas it was below 100 cells/μL in 90.00%of the CMVR group.The intraocular specimens of the patients who underwent CMVR testing did not include any additional infections.CONCLUSION:In HIV-associated CMVR patients,there may exist alternative,yet unidentified,infection pathways for intraocular CMV in addition to the conventional route.The substantial difference in CMV-DNA load between the eyes of most CMVR patients suggests that CMV may originate from different sources in each eye.The proportion of peripheral blood CD4^(+)T cells in HIV patients is negatively correlated with the quantity of CMV viruses in their eyes.The peripheral blood count of<100 cells/μL indicates a considerable increase in the risk of concurrent CMVR.Multi-ocular pathogen presentations are uncommon in HIV individuals with CMVR.展开更多
Human immunodeficiency virus(HIV)modifies CD4-positive cells,resulting in immunodeficiency and a wide range of gastrointestinal(GI)manifestations.The burden of HIV-related GI illnesses has significantly evolved with t...Human immunodeficiency virus(HIV)modifies CD4-positive cells,resulting in immunodeficiency and a wide range of gastrointestinal(GI)manifestations.The burden of HIV-related GI illnesses has significantly evolved with the widespread use of antiretroviral therapy(ART).While ART has effectively reduced the occurrence of opportunistic infections,it has led to an increase in therapy-related GI illnesses.Common esophageal conditions in HIV patients include gastroesophageal reflux disease,idiopathic esophageal ulcers,herpes simplex virus,cytomegalovirus(CMV),and candidal esophagitis.Kaposi’s sarcoma,a hallmark of acquired immunodeficiency syndrome,may affect the entire GI system.Gastritis and peptic ulcer disease are also frequently seen in patients with HIV.Diarrhea,often linked to both opportunistic infections and ART,requires careful evaluation.Bloody diarrhea,often a sign of colitis caused by bacterial infections such as Shigella or Clostridium difficile,is prevalent.Small bowel lymphoma,although rare,is increasing in prevalence.Anorectal disorders,including proctitis,fissures,and anal squamous cell carcinoma,are particularly relevant in homosexual men,underlining the importance of timely diagnosis.This review comprehensively explores the epidemiology,pathogenesis,and treatment considerations for the various GI disorders associated with HIV,highlighting the importance of accurate diagnosis and effective treatment to improve outcomes for HIV-infected patients.展开更多
This retrospective cohort study from Rwanda demonstrated the likelihood of maternal disclosure and peer support in preventing mother-to-child human immunodeficiency virus(HIV)transmission.High sustained maternal viral...This retrospective cohort study from Rwanda demonstrated the likelihood of maternal disclosure and peer support in preventing mother-to-child human immunodeficiency virus(HIV)transmission.High sustained maternal viral load suppression(91.0%)and exceptional infant testing uptake(100%at 6 weeks)correlated with a low 0.7%infant HIV incidence.To eliminate mother-to-child transmission of HIV,effective strategies must engage male partners in disclosure,reduce stigma,improve health literacy,and provide structural peer-support for enhancing adherence and mental health.展开更多
BACKGROUND Chronic diarrhoea in people living with human immunodeficiency virus(PLHIV)/acquired immunodeficiency syndrome presents a diagnostic challenge,often resulting from opportunistic infections(OIs),malignancies...BACKGROUND Chronic diarrhoea in people living with human immunodeficiency virus(PLHIV)/acquired immunodeficiency syndrome presents a diagnostic challenge,often resulting from opportunistic infections(OIs),malignancies,or disease progression itself.We present a case of an advanced human immunodeficiency virus(HIV)patient with chronic diarrhoea,significant weight loss,and antiretroviral therapy(ART)non-compliance,highlighting the diagnostic dilemma between HIV wasting syndrome,OIs,and malignancy.CASE SUMMARY A 36-year-old female,diagnosed with HIV five years ago on family screening,presented with three months of profuse watery diarrhoea,associated with crampy abdominal pain and weight loss(14 kg,30%in 3 months).She was non-compliant with ART.There was no history of recent travel,food contamination,or tuberculosis contact.Fever episodes were mild and transient.Physical examination revealed pallor and bilateral pedal oedema without lymphadenopathy or organomegaly.Genital examination was unremarkable.Routine investigations revealed severe anaemia and confirmed PLHIV status.CD4 count was<36 cells/μL.Empirical treatment with nitazoxanide was initiated for possible cryptosporidiosis.After ruling out OIs,ART was restarted.With treatment,her diarrhoea resolved,and she tolerated oral intake.Nutritional support was provided,and she was discharged in stable condition with ART,prophylactic antibiotics,and followup instructions for further evaluation.CONCLUSION In ART-noncompliant PLHIV with chronic diarrhoea,distinguishing between HIV wasting syndrome,OIs(Cryptosporidium,Mycobacterium avium complex,cytomegalovirus colitis)and malignancies(non-Hodgkin lymphoma and anal carcinoma)are critical.Gradual CD4 decline,systemic inflammation,and malnutrition favour progressive HIV/acquired immunodeficiency syndrome rather than an acute OI or malignancy.Early recognition and management,including ART reinitiation and nutritional support,are crucial for prognosis.展开更多
BACKGROUND Transition is a critical period for adolescents as they begin to assume responsibility for their own health.Similarly,the shift from pediatric to adult healthcare represents a vulnerable phase,marked by uni...BACKGROUND Transition is a critical period for adolescents as they begin to assume responsibility for their own health.Similarly,the shift from pediatric to adult healthcare represents a vulnerable phase,marked by unique challenges in adolescent health care.Despite its importance,only a few studies have explored healthcare transition among adolescents in Uganda.AIM To identify factors associated with the transition to adult human immunodeficiency virus(HIV)-centered care among adolescents attending HIV/AIDS clinics in Uganda.METHODS A cross-sectional mixed-methods study was conducted among 265 adolescents,randomly selected from three antiretroviral therapy(ART)clinics,using a structured questionnaire.Focus group discussions and key informant interviews were conducted.Individuals aged 10-20 years who were actively enrolled in the ART program between January 4,2022 and January 30,2023 were recruited.The primary outcome of interest was the transition to adult care.Bivariate and multivariate analyses were performed for quantitative data,while content analysis was used to analyze qualitative data.RESULTS The prevalence of transition to adult care was 40.6%.Most participants were male(53.6%)and fell within the 13-15 age group(35.6%).Multivariate logistic regression analysis identified several factors significantly associated with transition to adult care:Age group 10-12 years[prevalence ratio(PR)=2.525,95%CI:2.121-2.944,P=0.002],Age group 13-15 years(PR=1.900,95%CI:1.196-3.416,P=0.001),successful viral load suppression(PR=1.534,95%CI:1.173-1.648,P=0.016),disclosure of HIV status to relatives(PR=5.001,95%CI:3.411-3.611,P=0.000),being prepared for transitioning(PR=5.417,95%CI:3.468-7.135,P=0.041)and having skilled pediatric caregivers(PR=3.724,95%CI:2.084-4.105,P=0.005).CONCLUSION Transition to adult care among adolescents was low.Improving transition outcomes may require strengthening individual support within the family context and integrating transition-focused care into existing specialized clinical settings to enhance the delivery of adolescent-friendly services.展开更多
BACKGROUND People living with human immunodeficiency virus(HIV)are aging as a result the benefits of combination antiretroviral therapy.AIM To provide descriptions of eligible existing studies on demographics,methodol...BACKGROUND People living with human immunodeficiency virus(HIV)are aging as a result the benefits of combination antiretroviral therapy.AIM To provide descriptions of eligible existing studies on demographics,methodologies,and outcome measures related to health-related quality of life(HRQoL)in the context of HIV and aging.METHODS The MEDLINE,CINAHL,Scopus,and PsycINFO databases were systematically searched using the terms HIV,age,and HRQoL to find studies published between January 1995 and June 2022.Key variables of the eligible studies were identified and categorized into demographics(e.g.,study sites,study year),methodologies(e.g.,use of conceptual frameworks,measures used),and outcome measures[e.g.,HRQoL,quality of life(QoL)].The PRISMA 2009 checklist was followed.RESULTS A total of 68 published studies involving 53504 participants were included.The majority of the studies(55.88%)were conducted in North America,with relatively few studies conducted in Africa.The median age of participants was 51.0 years(IQR=11.0).Over one-third(32.56%)of all participants were older people living with HIV aged 50 years and older Four studies included only older female participants,and six studies included only men who have sex with men.Outcome mea-sures were assessed as HRQoL(26.47%)or QoL(36.76%).Overall,data from African studies,older women living with HIV,socioeconomic status(e.g.,employment,income,education),sexual behavioral risks,theoretical frameworks used,and follow-up studies were limited.CONCLUSION This narrative review highlights imbalances and gaps in research on HRQoL in the context of HIV and aging,providing direction for future studies in this area.展开更多
The drug lenacapavir(Yeztugo®;Gilead Sciences,USA),which targets the human immunodeficiency virus(HIV),has been hailed as“revolutionary,”“a miracle,”and“the most transformative prevention product we have had...The drug lenacapavir(Yeztugo®;Gilead Sciences,USA),which targets the human immunodeficiency virus(HIV),has been hailed as“revolutionary,”“a miracle,”and“the most transformative prevention product we have had in 44 years”of the HIV pandemic.Although other drugs can stop HIV transmission,people typically must take a pill every day(Fig.1)[1].展开更多
Human immunodeficiency virus continues to pose a severe global and national public health threat.In Pakistan,human immunodeficiency virus incidence has risen alarmingly,with over 9700 new cases reported in the first n...Human immunodeficiency virus continues to pose a severe global and national public health threat.In Pakistan,human immunodeficiency virus incidence has risen alarmingly,with over 9700 new cases reported in the first nine months of 2024 alone.Transmission is fueled by unsafe sex,needle-sharing,and systemic healthcare lapses,including unscreened transfusions and reused instruments.Sociocultural stigma,limited awareness,and poor treatment adherence especially in rural and underserved areas compound the crisis.Men,transgender individuals,and children represent increasingly affected groups.The role of international bodies such as World Health Organization,United Nations Development Programme,and United Nations Women has been critical in expanding community-based care and education programs.Effective biomedical tools like preexposure prophylaxis and post-exposure prophylaxis offer preventive pro-mise but remain underutilized.Pakistan urgently needs an integrated,multispectral response i.e.,enhancing surveillance,ensuring antiretroviral therapy access,improving healthcare worker training,and promoting harm reduction and eliminating certain stigmas to control the epidemic and prevent further escalation.展开更多
OBJECTIVE:To comprehensively evaluate randomized controlled trials(RCTs)investigating the effects of moxibustion on people with human immunodeficiency virus(HIV)disease.METHODS:A systematic search was conducted across...OBJECTIVE:To comprehensively evaluate randomized controlled trials(RCTs)investigating the effects of moxibustion on people with human immunodeficiency virus(HIV)disease.METHODS:A systematic search was conducted across eight electronic databases up to August 20,2024.The primary outcome were all-cause mortality and acquired immunodeficiency syndrome(AIDS)-related mortality.Two authors independently screened titles and abstracts,and extracted data onto a pre-designed datasheet.Discrepancies were resolved through consensus.The Cochrane risk-of-bias tool 2.0 was used to assess methodological quality,Meta-analysis was performed when appropriate,and the quality of evidence was assessed through Grading of Recommendations,Assessment,Development and Evaluations approach.RESULTS:Eleven RCTs(n=834)on moxibustion for HIV/AIDS were included,focusing on individuals with HIV infection(5 RCTs,n=426),AIDS patients(3 RCTs,n=223),or both(3 RCTs,n=185).Complications identified included diarrhea(5 RCTs),pulmonary infection(1 RCT),anxiety and depression(1 RCT)and peripheral neuropathy(1 RCT).The risk of bias in the included RCTs was assessed as either high or uncertain.No trial reported mortality or the incidence of AIDS-related complications following treatment.Wheat-grain sized cone moxibustion was associated with increased CD4+counts in patients with lung infections[1 RCT,n=36,mean difference(MD)=78.83 cells/μL].Individual studies reported improvements of quality of life,as measured by the World Health Organization Quality of Life-Brief Version(WHOQOL-BREF)and WHOQOL HIV instrument,with various moxibustion types,but clinical heterogeneity prevented data pooling.Additionally,some studies reported symptom improvement,each using different criteria for symptom improvement.Moxa stick moxibustion plus Western Medicine compared with Western Medicine alone showed a non-significant trend towards improved symptom resolution[2 RCTs,n=125,risk ratio=1.19,95%confidence interval(0.99,1.43)].Moxibustion plus antiretroviral therapy(ART)may reduce gastrointestinal adverse events compared to ART alone[1 RCT,n=10014%vs 32%,P<0.05].The quality of evidence was low to very low.CONCLUSION:This systematic review suggests that moxibustion as an adjunct therapy may have potential benefits in improving immune function and quality of life for HIV/AIDS patients.Limited quality of evidence precludes definitive conclusions,and further high-quality research is needed.展开更多
Objectives:This study aimed to describe the development process of the peer precision-matching and health management mobile platform"Aspark"for people living with human immunodeficiency virus(HIV)(PLWH)and t...Objectives:This study aimed to describe the development process of the peer precision-matching and health management mobile platform"Aspark"for people living with human immunodeficiency virus(HIV)(PLWH)and to evaluate its usability.Methods:The study assembled a multidisciplinary research and development team comprising researchers,software engineers,art designers,clinical nursing specialists,HIV peer volunteers,and psychological counselors.The team employed an agile development model to iteratively build the platform.Using the social determinants of health framework and the interpersonal circumplex,we identified 14 matching variables for the mobile platform.A video production team was formed to create peer training videos on health management for PLWH.We integrated relevant tools to provide PLWH with various types of support,including informational,instrumental,emotional,affiliational,and appraisal assistance.From March to May 2024,the research team used convenience sampling to select 130 platform users.It administered an electronic questionnaire based on the System Usability Scale to evaluate the platform's overall usability.Results:The platform incorporates multiple functional modules,including"Precision Matching,""Drug Interaction Query,""Medication Reminder,""Health Management,""Mood Diary,""Community Discussion,"and"Activity Center,"achieving comprehensive coverage across informational,emotional,instrumental,social,and appraisal support.The precision matching module facilitates intelligent pairing between patients and peer volunteers;the health management module allows for the entry of test results and trend analysis;medication reminders and check-in features enhance medication adherence;the mood diary supports emotional recording and expressive writing;while the community module offers functions such as topic discussions,appointment scheduling,and organization of offline activities.Among the 130 valid questionnaires,more than 83%of users scored above 68 on the System Usability Scale,indicating that the platform demonstrates favourable usability.Conclusions:The"Aspark"platform offers a feasible and promising digital solution for precision matching in HIV peer support and health management,enabling healthcare providers to deliver personalized and continuous health support to patients through its functions.Well-designed clinical trials should be conducted in the future to evaluate the effectiveness of this tool.展开更多
Treatment adherence among people living with human immunodeficiency virus(PLWH)is a critical determinant of viral suppression and improved quality of life.Medication literacy,as a key factor influencing adherence,is i...Treatment adherence among people living with human immunodeficiency virus(PLWH)is a critical determinant of viral suppression and improved quality of life.Medication literacy,as a key factor influencing adherence,is itself shaped by various psychosocial variables.Existing studies suggest that human immunodeficiency virus(HIV)-related stigma,self-efficacy,and trust in healthcare providers serve as significant mediators in the relationship between health literacy and treatment adherence.This review systematically explores how medication literacy affects treatment adherence in PLWH through intermediary psychosocial mechanisms such as depression,anxiety,and social support.By synthesizing current evidence,we aim to inform the development of targeted psychosocial interventions to enhance treatment outcomes and quality of life for this population.Our findings provide an evidence-based foundation for nursing practice and support innovative strategies in comprehensive HIV care.展开更多
Leukocyte adhesion deficiency type-1 is frequently associated with otorhinolaryngological manifestations,most notably a high prevalence of otitis media.Although multiple case reports have documented an increased preva...Leukocyte adhesion deficiency type-1 is frequently associated with otorhinolaryngological manifestations,most notably a high prevalence of otitis media.Although multiple case reports have documented an increased prevalence of acute otitis media and mastoiditis in patients with LAD-1,no clinical or experimental studies have fully elucidated the pathophysiological mechanisms underlying this association.Despite guideline recommendations for urgent antibiotic therapy in immunocompromised patients with acute otitis media,a standardized treatment protocol for its complications remains lacking.Moreover,no established consensus exists regarding the optimal therapeutic approach for Leukocyte adhesion deficiency type-1associated cases.This report contributes to the scarce literature on acute mastoiditis in LAD-1 and underscores the need for a tailored,multidisciplinary approach.In the absence of standardized treatment protocols,further research is crucial to refine management strategies and improve outcomes in immunocompromised patients with acute otitis media complications.展开更多
Severe combined immunodeficiency disease(SCID),characterized by profound immune system dysfunction,can lead to life-threatening infections and death.Animal models play a pivotal role in elucidating biological processe...Severe combined immunodeficiency disease(SCID),characterized by profound immune system dysfunction,can lead to life-threatening infections and death.Animal models play a pivotal role in elucidating biological processes and advancing therapeutic strategies.Recent advances in gene-editing technologies,including zincfinger nucleases(ZFNs),transcription activator-like effector nucleases(TALENs),CRISPR/Cas9,and base editing,have significantly enhanced the generation of SCID models.These models have not only deepened our understanding of disease pathophysiology but have also driven progress in cancer therapy,stem cell transplantation,organ transplantation,and infectious diseasemanagement.Thisreviewprovidesa comprehensive overview of current SCID models generated using novel gene-editing approaches,highlighting their potential applications in translational medicine and their role in advancing biomedical research.展开更多
The long-term effects of combined antiretroviral therapy(ART)on liver fibrosis patterns in adults living with human immunodeficiency virus(HIV)and chronic hepatitis B virus(HBV)are not well understood.Therefore,this s...The long-term effects of combined antiretroviral therapy(ART)on liver fibrosis patterns in adults living with human immunodeficiency virus(HIV)and chronic hepatitis B virus(HBV)are not well understood.Therefore,this study aimed to investigate the trajectories of liver fibrosis and identify the associations of baseline variables with different patterns of liver fibrosis evolution.A total of 333 individuals with HIV/HBV co-infection and undergoing long-term ART were enrolled in this study.Demographic,clinical,and biochemical data were collected at baseline and during annual visits.Group-based trajectory models(GBTMs)were used to detect the patterns of liver fibrosis evolution based on longitudinal data of fibrosis-4(Fib-4)and aspartate aminotransferase to platelet ratio index(APRI)scores.Logistic regression analysis was performed to identify baseline predictors of liver fibrosis evolution.The median age of all participants was 33 years.Among them,89.5%initially received TDF-containing ART.GBTMs identified two distinct patterns of liver fibrosis evolution using either APRI or Fib-4 scores.The majority of individuals(78.5%for APRI and 75.3%for Fib-4;pattern A)showed stable or low fibrosis with no progression,while the remaining participants showed regression from high fibrosis levels(21.5%for APRI and 24.7%for Fib-4;pattern B).Pattern A participants were younger and had higher CD4^(+)cell counts,higher lymphocyte cell counts,higher white blood cell counts,and lower platelet counts at baseline compared to pattern B participants.For HIV/HBV co-infected patients with varying degrees of initial liver fibrosis,long-term ART has shown distinct patterns of alleviating liver fibrosis.展开更多
基金funded by Department of Medicine, University of Udine (Udine, Italy) in accordance with Good Publication Practice (GPP3) guidelines (http://www.ismpp.org/gpp3)
文摘AIM To compare high-resolution computed tomography(HRCT) findings between humoral primary immunodeficiencies(hPIDs) subtypes; to correlate these findings to pulmonary function tests(PFTs).METHODS We retrospectively identified 52 consecutive adult patients with hPIDs who underwent 64-row HRCT and PFTs at the time of diagnosis. On a per-patient basis, an experienced radiologist recorded airway abnormalities(bronchiectasis,airway wall thickening, mucus plugging, tree-in-bud, and air-trapping) and parenchymal-interstitial abnormalities(consolidations, ground-glass opacities,linear and/or irregular opacities, nodules, and bullae/cysts) found on HRCT.The chi-square test was performed to compare the prevalence of each abnormality among patients with different subtypes of hPIDs. Overall logistic regression analysis was performed to assess whether HRCT findings predicted obstructive and/or restrictive PFTs results(absent-to-mild vs moderate-tosevere).RESULTS Thirty-eight of the 52 patients with hPIDs showed common variable immunodeficiency disorders(CVID), while the remaining 14 had CVID-like conditions(i.e., 11 had isolated IgG subclass deficiencies and 3 had selective IgA deficiencies). The prevalence of most HRCT abnormalities was not significantly different between CVID and CVID-like patients(P > 0.05), except for linear and/or irregular opacities(prevalence of 31.6% in the CVID group and 0 in the CVID-like group; P = 0.0427). Airway wall thickening was the most frequent HRCT abnormality found in both CVID and CVID-like patients(71% of cases in both groups). The presence of tree-in-bud abnormalities was an independent predictor of moderate-to-severe obstructive defects at PFTs(Odds Ratio, OR, of 18.75, P < 0.05), while the presence of linear and/or irregular opacities was an independent predictor of restrictive defects at PFTs(OR = 13.00; P < 0.05).CONCLUSION CVID and CVID-like patients showed similar HRCT findings. Tree-in-bud and linear and/or irregular opacities predicted higher risks of, respectively,obstructive and restrictive defects at PFTs.
文摘Primary immunodeficiency disorders(PIDs)are rare inborn errors of the immune system.Patients with PIDs are unique models that exemplify the functional and phenotypic consequences of various immune defects underlying infections,autoimmunity,lymphoproliferation,allergy and cancer.Over 150 PID syndromes were characterized in the past 60 years,with an ever growing list of new entities being discovered.Because of their rarity,multi-center collaboration for pooled data analysis and molecular studies is important to gain meaningful insights into the phenotypic and genetic diversities of PIDs.In this article,we summarize our research findings on PIDs in Chinese population in the past 20 years.Close collaboration among various immunology centers,cross-referrals and systematic data analysis constitute the foundation for research on PIDs.Future directions include establishment of a national PID registry,raising awareness of PIDs and securing sufficient resources for patient care and scientific research.
基金supported by the National Natural Science Foundation of China(No.82274474)。
文摘Despite effective antiretroviral therapy(ART),many individuals with human immunodeficiency virus(HIV)/acquired immune deficiency syndrome(AIDS)achieve viral suppression but fail to fully restore cluster of differentiation 4(CD4)^(+)T lymphocyte(CD4 cell)counts—a condition known as immunological non-response(INRs).INRs are associated with elevated health risks,including increased susceptibility to AIDS-related and non-AIDS-related complications.The pathogenesis of INRs remains incompletely understood,and no established therapeutic interventions exist,posing a major challenge in contemporary HIV/AIDS management.Emerging evidence indicates that INRs exhibit significant alterations in gut microbiota composition.Dysbiosis of the gut microbiota may contribute to persistent immune activation,cytokine imbalance,and cellular pyroptosis,all of which could impair immune reconstitution in people living with HIV/AIDS.Traditional Chinese medicine(TCM)has demonstrated potential immunomodulatory effects and is increasingly utilized in the management of INRs.Targeting the gut microbiota and elucidating the mechanisms by which TCM modulates this microbial ecosystem may offer new avenues for preventing and treating INRs.This review explores the interplay between gut microbiota and TCM,examines the association between gut dysbiosis and INRs,discusses the mechanistic pathways through which microbiota imbalance contributes to INRs development,and highlights how TCM interventions regulate gut microbiota to promote immune recovery.By focusing on the gut microbiota as a therapeutic interface,this article provides novel insights into TCM-based strategies for improving outcomes in INRs and supports the development of innovative treatment approaches.
基金supported by funds from the Conselho Nacional de Desenvolvimento Cientifico e Tecnologico do Brasil(CNPq)(312286/2023-6,307201/2023-6,and Instituto Nacional Saude Cerebral INSC,No.406020/2022-1)Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior(CAPES)Fundacao de Amparo a Pesquisa do Estado do Rio de Janeiro-FAPERJ(E-26/010.002260/2019,E-26/010.001652/2019,E-26/010.101036/2018,E-26/202.774/2018,E-26/210.240/2020,E-26/211.138/2021,26/210.823/2021,E-26/211.325/2021,E-26/210.779/2021,E-26/201.086/2022,E-26/210.312/2022,E-26/203.262/2023,E-26/200.195/2023)(to LEBS)。
文摘Recent increases in infectious diseases affecting the central nervous system have raised concerns about their role in neuroinflammation and neurodegeneration.Viral pathogens or their products can invade the central nervous system and cause damage,leading to meningitis,encephalitis,meningoencephalitis,myelitis,or post-infectious demyelinating diseases.Although neuroinflammation initially has a protective function,chronic inflammation can contribute to the development of neurodegenerative diseases.Mechanisms such as protein aggregation and cellular disturbances are implicated with specific viruses such as herpes simplex virus type 1 and Epstein-Barr virus being associated with Alzheimer's disease and multiple sclerosis,respectively.Extracellular nucleotides,particularly adenosine triphosphate and its metabolites are released from activated,infected,and dying cells,acting as alarmins mediating neuroinflammation and neurodegeneration.When viruses infect central nervous system cells,adenosine triphosphate is released as an alarmin,triggering inflammatory responses.This process is mediated by purinergic receptors,divided into two families:P1,which responds to adenosine,and P2,activated by adenosine triphosphate and other nucleotides.This review highlights how specific viruses,such as human immunodeficiency virus type 1,Theiler's murine encephalomyelitis virus,herpes simplex virus type 1,Epstein-Barr virus,dengue virus,Zika virus,and severe acute respiratory syndrome coronavirus 2,can initiate inflammatory responses through the release of extracellular nucleotides,particularly adenosine triphosphate,which act as critical mediators in the progression of neuroinflammation and neurodegenerative disorders.A better understanding of purinergic signaling pathways in these diseases may suggest new potential therapeutic strategies for targeting neuroinflammation to mitigate the long-term consequences of viral infections in the central nervous system.
文摘BACKGROUND Transfusion transmissible infections(TTIs)are illnesses spread through contaminated blood or blood products.In India,screening for TTIs such as hepatitis B virus(HBV),hepatitis C virus(HCV),human immunodeficiency virus(HIV)-I/II,malaria,and syphilis is mandatory before blood transfusions.Worldwide,HCV,HBV,and HIV are the leading viruses causing mortality,affecting millions of people globally,including those with co-infections of HIV/HCV and HIV/HBV.Studies highlight the impact of TTIs on life expectancy and health risks,such as liver cirrhosis,cancer,and other diseases in individuals with chronic HBV.Globally,millions of blood donations take place annually,emphasizing the importance of maintaining blood safety.AIM To study the prevalence of TTIs,viz.,HBV,HCV,HIV I/II,syphilis,and malaria parasite(MP),among different blood donor groups.METHODS The study assessed the prevalence of TTIs among different blood donor groups in Delhi,India.Groups included total donors,in-house donors,total camp donors,institutional camp donors,and community camp donors.Tests for HIV,HBV,and HCV were done using enzyme-linked immunosorbent assay,while syphilis was tested with rapid plasma reagins and MP rapid card methods.The prevalence of HBV,HCV,HIV,and syphilis,expressed as percentages.Differences in infection rates between the groups were analyzed usingχ²tests and P-values(less than 0.05).RESULTS The study evaluated TTIs among 42158 blood donors in Delhi.The overall cumulative frequency of TTIs in total blood donors was 2.071%,and the frequencies of HBV,HCV,HIV-I/II,venereal disease research laboratory,and MP were 1.048%,0.425%,0.221%,0.377%,and 0.0024%,respectively.In-house donors,representing 37656 donors,had the highest transfusion transmissible infection(TTI)prevalence at 2.167%.Among total camp donors(4502 donors),TTIs were identified in 1.266%of donors,while community camp donors(2439 donors)exhibited a prevalence of 1.558%.Institutional camp donors(2063 donors)had the lowest TTI prevalence at 0.921%.Statistical analysis revealed significant differences in overall TTI prevalence,with total and in-house donors exhibiting higher rates compared to camp donors.CONCLUSION Ongoing monitoring and effective screening programs are essential for minimizing TTIs.Customizing blood safety measures for different donor groups and studying socio-economic-health factors is essential to improving blood safety.
文摘BACKGROUND To prevent mother to child transmission(MTCT)of human immunodeficiency virus(HIV),sustained maternal viral load suppression(VLS)and early HIV testing among HIV exposed infants(HEI)is critical.AIM To investigate maternal viral load results and infant HIV testing uptake at 6-weeks,and 9-months and 18-months in Rwanda.METHODS Between 2015 and 2022,VLS(<200 copies/mL)was measured among pregnant women living with HIV(WLHIV)from 38-healthcare facilities.Viral loads(VL)were measured at 6-months,12-months and 24-months,respectively.For maternal VL,the unit of analysis was visit-pair,and the pairs were created to define those with VL<200 copies/mL at two consecutive visits as having sustained VLS,persistent viremia(VL≥200 copies/mL at two consecutive visits),viral rebound(VL<200 copies/mL at prior visit only)and newly suppressed(VL<200 copies/mL at subsequent visit only).HEI were considered to have persistent HIV testing if they had all three HIV tests.Poisson regression models with generalized estimating equations were used to estimate the adjusted incidence rate ratio(aIRR)and 95%CI for factors associated with sustained VLS and persistent HIV testing.RESULTS A total of 1145 mother-infant pairs were analyzed.Infant HIV testing uptake at 6-weeks,9-months and 18-months was 1145(100.0%),1089(95.1%),1006(87.9%)respectively.Nine hundred ninety-nine HEI(87.3%)tested for HIV persistently.At 18-months,the incidence of HIV among HEI was 8(0.7%).Of 1145 mothers,1076(94.0%)had≥2 VL results making a total of 2010 visit-pairs(142-single;934-double visit-pairs).The incidence rate of sustained VLS,persistent viremia,viral rebound and new suppression were 91.0%,1.3%,3.6%and 4.0%respectively.Maternal disclosure of HIV status(aIRR=1.08,95%CI:1.02-1.14)was associated with increased likelihood of sustained VLS.Having peer support(aIRR=1.0595%CI:1.01-1.10)was associated with persistent HIV testing among HEI.CONCLUSION Sustained VLS is high among pregnant WLHIV in Rwanda.The low incidence of HIV among HEI may be attributed to high VLS levels.Targeted interventions,including enhanced HIV disclosure and peer support,are crucial for improving sustained VLS and increasing infant HIV testing uptake to reduce MTCT.
基金Supported by the Self-funded Research Project of the Health and Family Planning Commission of Guangxi Zhuang Autonomous Region(No.Z2016325).
文摘AIM:To investigate the etiology of ocular pathogens and to establish the various pathogens present in human immunodeficiency virus(HIV)patients with cytomegalovirus retinitis(CMVR).METHODS:A total of 17 HIV-infected patients with concomitant eye disorders were enrolled.Patients were divided into CMVR group(10 patients,18 eyes)and non-CMVR group(7 patients,9 eyes)based on clinical manifestations and the presence of cytomegalovirus(CMV)-DNA in ocular specimens.The viral load of CMV was assessed using polymerase chain reaction in aqueous humor,vitreous fluid,and peripheral blood samples of patients in the CMVR group.Additionally,peripheral blood CD4^(+)T cell counts were measured in both groups.RESULTS:In the CMVR group,the CMV-DNA load in the vitreous and aqueous humor samples was substantially higher than in the peripheral blood samples(P<0.01).CMVDNA load in the aqueous humor and vitreous samples of the two eyes in the CMVR group was determined to be statistically significant(10 patients,16 eyes,P=0.018,0.012).Peripheral blood CD4^(+)T cell counts in the CMVR group were adversely linked with the CMV-DNA load in both the aqueous humor and peripheral blood(P=0.005,0.048).Compared with the non-CMVR group,the peripheral blood CD4^(+)T cell count in the CMVR group decreased significantly(P=0.014).The peripheral blood CD4^(+)T cell count exceeded 300 cells/μL in 85.71%of non-CMVR patients,whereas it was below 100 cells/μL in 90.00%of the CMVR group.The intraocular specimens of the patients who underwent CMVR testing did not include any additional infections.CONCLUSION:In HIV-associated CMVR patients,there may exist alternative,yet unidentified,infection pathways for intraocular CMV in addition to the conventional route.The substantial difference in CMV-DNA load between the eyes of most CMVR patients suggests that CMV may originate from different sources in each eye.The proportion of peripheral blood CD4^(+)T cells in HIV patients is negatively correlated with the quantity of CMV viruses in their eyes.The peripheral blood count of<100 cells/μL indicates a considerable increase in the risk of concurrent CMVR.Multi-ocular pathogen presentations are uncommon in HIV individuals with CMVR.
文摘Human immunodeficiency virus(HIV)modifies CD4-positive cells,resulting in immunodeficiency and a wide range of gastrointestinal(GI)manifestations.The burden of HIV-related GI illnesses has significantly evolved with the widespread use of antiretroviral therapy(ART).While ART has effectively reduced the occurrence of opportunistic infections,it has led to an increase in therapy-related GI illnesses.Common esophageal conditions in HIV patients include gastroesophageal reflux disease,idiopathic esophageal ulcers,herpes simplex virus,cytomegalovirus(CMV),and candidal esophagitis.Kaposi’s sarcoma,a hallmark of acquired immunodeficiency syndrome,may affect the entire GI system.Gastritis and peptic ulcer disease are also frequently seen in patients with HIV.Diarrhea,often linked to both opportunistic infections and ART,requires careful evaluation.Bloody diarrhea,often a sign of colitis caused by bacterial infections such as Shigella or Clostridium difficile,is prevalent.Small bowel lymphoma,although rare,is increasing in prevalence.Anorectal disorders,including proctitis,fissures,and anal squamous cell carcinoma,are particularly relevant in homosexual men,underlining the importance of timely diagnosis.This review comprehensively explores the epidemiology,pathogenesis,and treatment considerations for the various GI disorders associated with HIV,highlighting the importance of accurate diagnosis and effective treatment to improve outcomes for HIV-infected patients.
文摘This retrospective cohort study from Rwanda demonstrated the likelihood of maternal disclosure and peer support in preventing mother-to-child human immunodeficiency virus(HIV)transmission.High sustained maternal viral load suppression(91.0%)and exceptional infant testing uptake(100%at 6 weeks)correlated with a low 0.7%infant HIV incidence.To eliminate mother-to-child transmission of HIV,effective strategies must engage male partners in disclosure,reduce stigma,improve health literacy,and provide structural peer-support for enhancing adherence and mental health.
文摘BACKGROUND Chronic diarrhoea in people living with human immunodeficiency virus(PLHIV)/acquired immunodeficiency syndrome presents a diagnostic challenge,often resulting from opportunistic infections(OIs),malignancies,or disease progression itself.We present a case of an advanced human immunodeficiency virus(HIV)patient with chronic diarrhoea,significant weight loss,and antiretroviral therapy(ART)non-compliance,highlighting the diagnostic dilemma between HIV wasting syndrome,OIs,and malignancy.CASE SUMMARY A 36-year-old female,diagnosed with HIV five years ago on family screening,presented with three months of profuse watery diarrhoea,associated with crampy abdominal pain and weight loss(14 kg,30%in 3 months).She was non-compliant with ART.There was no history of recent travel,food contamination,or tuberculosis contact.Fever episodes were mild and transient.Physical examination revealed pallor and bilateral pedal oedema without lymphadenopathy or organomegaly.Genital examination was unremarkable.Routine investigations revealed severe anaemia and confirmed PLHIV status.CD4 count was<36 cells/μL.Empirical treatment with nitazoxanide was initiated for possible cryptosporidiosis.After ruling out OIs,ART was restarted.With treatment,her diarrhoea resolved,and she tolerated oral intake.Nutritional support was provided,and she was discharged in stable condition with ART,prophylactic antibiotics,and followup instructions for further evaluation.CONCLUSION In ART-noncompliant PLHIV with chronic diarrhoea,distinguishing between HIV wasting syndrome,OIs(Cryptosporidium,Mycobacterium avium complex,cytomegalovirus colitis)and malignancies(non-Hodgkin lymphoma and anal carcinoma)are critical.Gradual CD4 decline,systemic inflammation,and malnutrition favour progressive HIV/acquired immunodeficiency syndrome rather than an acute OI or malignancy.Early recognition and management,including ART reinitiation and nutritional support,are crucial for prognosis.
文摘BACKGROUND Transition is a critical period for adolescents as they begin to assume responsibility for their own health.Similarly,the shift from pediatric to adult healthcare represents a vulnerable phase,marked by unique challenges in adolescent health care.Despite its importance,only a few studies have explored healthcare transition among adolescents in Uganda.AIM To identify factors associated with the transition to adult human immunodeficiency virus(HIV)-centered care among adolescents attending HIV/AIDS clinics in Uganda.METHODS A cross-sectional mixed-methods study was conducted among 265 adolescents,randomly selected from three antiretroviral therapy(ART)clinics,using a structured questionnaire.Focus group discussions and key informant interviews were conducted.Individuals aged 10-20 years who were actively enrolled in the ART program between January 4,2022 and January 30,2023 were recruited.The primary outcome of interest was the transition to adult care.Bivariate and multivariate analyses were performed for quantitative data,while content analysis was used to analyze qualitative data.RESULTS The prevalence of transition to adult care was 40.6%.Most participants were male(53.6%)and fell within the 13-15 age group(35.6%).Multivariate logistic regression analysis identified several factors significantly associated with transition to adult care:Age group 10-12 years[prevalence ratio(PR)=2.525,95%CI:2.121-2.944,P=0.002],Age group 13-15 years(PR=1.900,95%CI:1.196-3.416,P=0.001),successful viral load suppression(PR=1.534,95%CI:1.173-1.648,P=0.016),disclosure of HIV status to relatives(PR=5.001,95%CI:3.411-3.611,P=0.000),being prepared for transitioning(PR=5.417,95%CI:3.468-7.135,P=0.041)and having skilled pediatric caregivers(PR=3.724,95%CI:2.084-4.105,P=0.005).CONCLUSION Transition to adult care among adolescents was low.Improving transition outcomes may require strengthening individual support within the family context and integrating transition-focused care into existing specialized clinical settings to enhance the delivery of adolescent-friendly services.
文摘BACKGROUND People living with human immunodeficiency virus(HIV)are aging as a result the benefits of combination antiretroviral therapy.AIM To provide descriptions of eligible existing studies on demographics,methodologies,and outcome measures related to health-related quality of life(HRQoL)in the context of HIV and aging.METHODS The MEDLINE,CINAHL,Scopus,and PsycINFO databases were systematically searched using the terms HIV,age,and HRQoL to find studies published between January 1995 and June 2022.Key variables of the eligible studies were identified and categorized into demographics(e.g.,study sites,study year),methodologies(e.g.,use of conceptual frameworks,measures used),and outcome measures[e.g.,HRQoL,quality of life(QoL)].The PRISMA 2009 checklist was followed.RESULTS A total of 68 published studies involving 53504 participants were included.The majority of the studies(55.88%)were conducted in North America,with relatively few studies conducted in Africa.The median age of participants was 51.0 years(IQR=11.0).Over one-third(32.56%)of all participants were older people living with HIV aged 50 years and older Four studies included only older female participants,and six studies included only men who have sex with men.Outcome mea-sures were assessed as HRQoL(26.47%)or QoL(36.76%).Overall,data from African studies,older women living with HIV,socioeconomic status(e.g.,employment,income,education),sexual behavioral risks,theoretical frameworks used,and follow-up studies were limited.CONCLUSION This narrative review highlights imbalances and gaps in research on HRQoL in the context of HIV and aging,providing direction for future studies in this area.
文摘The drug lenacapavir(Yeztugo®;Gilead Sciences,USA),which targets the human immunodeficiency virus(HIV),has been hailed as“revolutionary,”“a miracle,”and“the most transformative prevention product we have had in 44 years”of the HIV pandemic.Although other drugs can stop HIV transmission,people typically must take a pill every day(Fig.1)[1].
文摘Human immunodeficiency virus continues to pose a severe global and national public health threat.In Pakistan,human immunodeficiency virus incidence has risen alarmingly,with over 9700 new cases reported in the first nine months of 2024 alone.Transmission is fueled by unsafe sex,needle-sharing,and systemic healthcare lapses,including unscreened transfusions and reused instruments.Sociocultural stigma,limited awareness,and poor treatment adherence especially in rural and underserved areas compound the crisis.Men,transgender individuals,and children represent increasingly affected groups.The role of international bodies such as World Health Organization,United Nations Development Programme,and United Nations Women has been critical in expanding community-based care and education programs.Effective biomedical tools like preexposure prophylaxis and post-exposure prophylaxis offer preventive pro-mise but remain underutilized.Pakistan urgently needs an integrated,multispectral response i.e.,enhancing surveillance,ensuring antiretroviral therapy access,improving healthcare worker training,and promoting harm reduction and eliminating certain stigmas to control the epidemic and prevent further escalation.
基金High-level Traditional Chinese Medicine key subjects construction project of National Administration of Traditional Chinese Medicine-Evidence-based Traditional Chinese Medicine(zyyzdxk-2023249)vip Professor of Beijing University of Chinese Medicine(20210017)。
文摘OBJECTIVE:To comprehensively evaluate randomized controlled trials(RCTs)investigating the effects of moxibustion on people with human immunodeficiency virus(HIV)disease.METHODS:A systematic search was conducted across eight electronic databases up to August 20,2024.The primary outcome were all-cause mortality and acquired immunodeficiency syndrome(AIDS)-related mortality.Two authors independently screened titles and abstracts,and extracted data onto a pre-designed datasheet.Discrepancies were resolved through consensus.The Cochrane risk-of-bias tool 2.0 was used to assess methodological quality,Meta-analysis was performed when appropriate,and the quality of evidence was assessed through Grading of Recommendations,Assessment,Development and Evaluations approach.RESULTS:Eleven RCTs(n=834)on moxibustion for HIV/AIDS were included,focusing on individuals with HIV infection(5 RCTs,n=426),AIDS patients(3 RCTs,n=223),or both(3 RCTs,n=185).Complications identified included diarrhea(5 RCTs),pulmonary infection(1 RCT),anxiety and depression(1 RCT)and peripheral neuropathy(1 RCT).The risk of bias in the included RCTs was assessed as either high or uncertain.No trial reported mortality or the incidence of AIDS-related complications following treatment.Wheat-grain sized cone moxibustion was associated with increased CD4+counts in patients with lung infections[1 RCT,n=36,mean difference(MD)=78.83 cells/μL].Individual studies reported improvements of quality of life,as measured by the World Health Organization Quality of Life-Brief Version(WHOQOL-BREF)and WHOQOL HIV instrument,with various moxibustion types,but clinical heterogeneity prevented data pooling.Additionally,some studies reported symptom improvement,each using different criteria for symptom improvement.Moxa stick moxibustion plus Western Medicine compared with Western Medicine alone showed a non-significant trend towards improved symptom resolution[2 RCTs,n=125,risk ratio=1.19,95%confidence interval(0.99,1.43)].Moxibustion plus antiretroviral therapy(ART)may reduce gastrointestinal adverse events compared to ART alone[1 RCT,n=10014%vs 32%,P<0.05].The quality of evidence was low to very low.CONCLUSION:This systematic review suggests that moxibustion as an adjunct therapy may have potential benefits in improving immune function and quality of life for HIV/AIDS patients.Limited quality of evidence precludes definitive conclusions,and further high-quality research is needed.
基金funded by the National Natural Science Foundation of China(72204006).
文摘Objectives:This study aimed to describe the development process of the peer precision-matching and health management mobile platform"Aspark"for people living with human immunodeficiency virus(HIV)(PLWH)and to evaluate its usability.Methods:The study assembled a multidisciplinary research and development team comprising researchers,software engineers,art designers,clinical nursing specialists,HIV peer volunteers,and psychological counselors.The team employed an agile development model to iteratively build the platform.Using the social determinants of health framework and the interpersonal circumplex,we identified 14 matching variables for the mobile platform.A video production team was formed to create peer training videos on health management for PLWH.We integrated relevant tools to provide PLWH with various types of support,including informational,instrumental,emotional,affiliational,and appraisal assistance.From March to May 2024,the research team used convenience sampling to select 130 platform users.It administered an electronic questionnaire based on the System Usability Scale to evaluate the platform's overall usability.Results:The platform incorporates multiple functional modules,including"Precision Matching,""Drug Interaction Query,""Medication Reminder,""Health Management,""Mood Diary,""Community Discussion,"and"Activity Center,"achieving comprehensive coverage across informational,emotional,instrumental,social,and appraisal support.The precision matching module facilitates intelligent pairing between patients and peer volunteers;the health management module allows for the entry of test results and trend analysis;medication reminders and check-in features enhance medication adherence;the mood diary supports emotional recording and expressive writing;while the community module offers functions such as topic discussions,appointment scheduling,and organization of offline activities.Among the 130 valid questionnaires,more than 83%of users scored above 68 on the System Usability Scale,indicating that the platform demonstrates favourable usability.Conclusions:The"Aspark"platform offers a feasible and promising digital solution for precision matching in HIV peer support and health management,enabling healthcare providers to deliver personalized and continuous health support to patients through its functions.Well-designed clinical trials should be conducted in the future to evaluate the effectiveness of this tool.
基金Supported by Taizhou Municipal Hospital,No.2025JK317 and No.2025JK318.
文摘Treatment adherence among people living with human immunodeficiency virus(PLWH)is a critical determinant of viral suppression and improved quality of life.Medication literacy,as a key factor influencing adherence,is itself shaped by various psychosocial variables.Existing studies suggest that human immunodeficiency virus(HIV)-related stigma,self-efficacy,and trust in healthcare providers serve as significant mediators in the relationship between health literacy and treatment adherence.This review systematically explores how medication literacy affects treatment adherence in PLWH through intermediary psychosocial mechanisms such as depression,anxiety,and social support.By synthesizing current evidence,we aim to inform the development of targeted psychosocial interventions to enhance treatment outcomes and quality of life for this population.Our findings provide an evidence-based foundation for nursing practice and support innovative strategies in comprehensive HIV care.
文摘Leukocyte adhesion deficiency type-1 is frequently associated with otorhinolaryngological manifestations,most notably a high prevalence of otitis media.Although multiple case reports have documented an increased prevalence of acute otitis media and mastoiditis in patients with LAD-1,no clinical or experimental studies have fully elucidated the pathophysiological mechanisms underlying this association.Despite guideline recommendations for urgent antibiotic therapy in immunocompromised patients with acute otitis media,a standardized treatment protocol for its complications remains lacking.Moreover,no established consensus exists regarding the optimal therapeutic approach for Leukocyte adhesion deficiency type-1associated cases.This report contributes to the scarce literature on acute mastoiditis in LAD-1 and underscores the need for a tailored,multidisciplinary approach.In the absence of standardized treatment protocols,further research is crucial to refine management strategies and improve outcomes in immunocompromised patients with acute otitis media complications.
基金supported by the Postdoctoral Fellowship Program of CPSF (GZC20231064)China Postdoctoral Science Foundation (2024M761345)+3 种基金Guangzhou Basic and Applied Basic Research Foundation (2024A04J6615)Scientific Research Project of Southern Medical University Stomatological Hospital (PY2023004)National Key Research and Development Program of China (2021YFA0805300)National Natural Science Foundation of China (82171244,32470564)。
文摘Severe combined immunodeficiency disease(SCID),characterized by profound immune system dysfunction,can lead to life-threatening infections and death.Animal models play a pivotal role in elucidating biological processes and advancing therapeutic strategies.Recent advances in gene-editing technologies,including zincfinger nucleases(ZFNs),transcription activator-like effector nucleases(TALENs),CRISPR/Cas9,and base editing,have significantly enhanced the generation of SCID models.These models have not only deepened our understanding of disease pathophysiology but have also driven progress in cancer therapy,stem cell transplantation,organ transplantation,and infectious diseasemanagement.Thisreviewprovidesa comprehensive overview of current SCID models generated using novel gene-editing approaches,highlighting their potential applications in translational medicine and their role in advancing biomedical research.
基金financially supported by the National Natural Science Foundation of China(NSFC,82272312,82241072,82072271,and 82272319)the Shenzhen-Hong Kong-Macao Science and Technology Project(Category C project)(SGDX20220530111403024)+5 种基金the National Key R&D Program of China(2023YFC2307004,2021YFC2301900,and 2021YFC2301905)the 100 Top Talent Programs of Sun Yat-sen University(58000-12230029)the High-Level Public Health Specialized Talents Project of Beijing Municipal Health Commission(2022-2-018 and 2022-1-007)Beijing Health Technologies Promotion Program(BHTPP202002)the Climbing the peak(Dengfeng)Talent Training Program of Beijing Hospitals Authority(DFL20191701)Beijing Key Laboratory for HIV/AIDS Research(BZ0089).
文摘The long-term effects of combined antiretroviral therapy(ART)on liver fibrosis patterns in adults living with human immunodeficiency virus(HIV)and chronic hepatitis B virus(HBV)are not well understood.Therefore,this study aimed to investigate the trajectories of liver fibrosis and identify the associations of baseline variables with different patterns of liver fibrosis evolution.A total of 333 individuals with HIV/HBV co-infection and undergoing long-term ART were enrolled in this study.Demographic,clinical,and biochemical data were collected at baseline and during annual visits.Group-based trajectory models(GBTMs)were used to detect the patterns of liver fibrosis evolution based on longitudinal data of fibrosis-4(Fib-4)and aspartate aminotransferase to platelet ratio index(APRI)scores.Logistic regression analysis was performed to identify baseline predictors of liver fibrosis evolution.The median age of all participants was 33 years.Among them,89.5%initially received TDF-containing ART.GBTMs identified two distinct patterns of liver fibrosis evolution using either APRI or Fib-4 scores.The majority of individuals(78.5%for APRI and 75.3%for Fib-4;pattern A)showed stable or low fibrosis with no progression,while the remaining participants showed regression from high fibrosis levels(21.5%for APRI and 24.7%for Fib-4;pattern B).Pattern A participants were younger and had higher CD4^(+)cell counts,higher lymphocyte cell counts,higher white blood cell counts,and lower platelet counts at baseline compared to pattern B participants.For HIV/HBV co-infected patients with varying degrees of initial liver fibrosis,long-term ART has shown distinct patterns of alleviating liver fibrosis.
