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
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
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
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
Eradicating tuberculosis in human immunodeficiency virus is all the more important to realise India’s ambitious goal of tuberculosis free India by 2025.Although,continuous efforts are being made to address tuberculos...Eradicating tuberculosis in human immunodeficiency virus is all the more important to realise India’s ambitious goal of tuberculosis free India by 2025.Although,continuous efforts are being made to address tuberculosis in human immunodeficiency virus co-infection,it is imperative to closely monitor the implemented strategies,encourage and validate disease notification system in the country,and bring about societal change to view this disease as an ailment only and not as a stigma.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
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
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
BACKGROUND Common variable immunodeficiency(CVID)is a primary antibody immunodeficiency disorder characterized by diminished IgG levels.Despite ongoing research,the precise pathogenesis of CVID remains unclear.Genetic...BACKGROUND Common variable immunodeficiency(CVID)is a primary antibody immunodeficiency disorder characterized by diminished IgG levels.Despite ongoing research,the precise pathogenesis of CVID remains unclear.Genetic factors account for only 10%-20%of cases,with an estimated incidence of 1 in 10000 to 1 in 100000,affecting individuals across all age groups.CASE SUMMARY We report the case of a 32-year-old man with CVID who presented with a chief complaint of“recurrent diarrhea and significant weight loss over the past 2 years”.Laboratory tests on admission showed fat droplets in stool,while other parameters were within normal ranges.Gastroscopy revealed a smooth gastric mucosa without bile retention or signs of Helicobacter pylori infection;however,the mucosa of the descending segment of the duodenum appeared rough.Further evaluation of the small intestine using computed tomography indicated no abnormalities.Finally,the whole-small bowel double-balloon enteroscopy(DBE)was performed,which revealed various phenotypic changes in the small intestinal mucosa.The patient was diagnosed with CVID,which improved after immunoglobulin therapy,with favorable follow-up outcomes.CONCLUSION Non-infectious enteropathy in CVID is rare.Therefore,DBE is essential for diagnosing small intestinal involvement in such cases.展开更多
BACKGROUND The World Health Organization(WHO)recommends lumbar puncture(LP)procedures to assess the diagnosis of cryptococcal meningitis(CM)among patients with advanced human immunodeficiency virus(HIV)disease(AHD)wit...BACKGROUND The World Health Organization(WHO)recommends lumbar puncture(LP)procedures to assess the diagnosis of cryptococcal meningitis(CM)among patients with advanced human immunodeficiency virus(HIV)disease(AHD)with positive serum cryptococcal antigen(CrAg)and do not have evidence of CM.AIM To estimate pooled prevalence of uptake of LP,CM and mortality among patients with AHD.METHODS PubMed,Cochrane Library and EMBASE were searched for articles published between January 2011 and December 2024.LP uptake was defined as percentage of people who underwent LP procedures among those with AHD(CD4≤200 cells/mm3 or WHO stage III/IV)and positive serum CrAg.Using random effects models,we computed the pooled estimate of LP uptake,CM and mortality and 95%CI.Stratified analyses were used to compare uptake of LP between studies that involved multiple vs single sites,and mortality analyses between patients with positive and negative serum CrAg were performed.Sensitivity analysis on LP uptake was done by excluding prospective cohort studies that reported 100%uptake.RESULTS A total of 32 studies with 46890 people with AHD screened for serum CrAg and 2730(5.8%)had positive serum CrAg.Overall,pooled prevalence of LP uptake was 67.7%(95%CI:54.0-81.5).The overall pooled prevalence of CM was 54.3%(95%CI:39.7-69.0),and mortality was 6.2%(95%CI:4.5-8.0).There is disparities in the pooled prevalence of LP uptake with studies involving multiple sites having lower prevalence compared to those that involved single sites(54.8%vs 84.7%,P=0.004).By excluding prospective cohort studies that reported 100%uptake,the overall LP uptake was 54.5%(95%CI:38.8-70.1).The pooled prevalence of CM was significantly lower among studies that involved multiple sites compared to those that involved single sites(6.8%vs 8.1%,P≤0.001).Mortality was significantly twice as high among patients who had positive serum CrAg compared to those who had negative serum CrAg[risk ratio=2.0(95%CI:1.6-2.5),P≤0.001].CONCLUSION Nearly three to five in 10 people with AHD with positive serum CrAg did not have LP procedures done,indicating significant gaps in identifying patients with CM.Establishing a confirmed diagnosis of CM is critical to avoid exposing patients to subtherapeutic levels of antifungals preemptively.Capacity to perform LP and patient refusals are among the reasons for not performing the procedure.Capacity building in training health care providers to perform LP procedures and professional counselling to obtain patient consent are critical for appropriate treatment to reduce mortality associated with CM infection.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
BACKGROUND Metabolic dysfunction-associated steatotic liver disease(MASLD)and poor sleep are common among people with human immunodeficiency virus(PWH)and may mediate the impaired health-related quality of life(HRQoL)...BACKGROUND Metabolic dysfunction-associated steatotic liver disease(MASLD)and poor sleep are common among people with human immunodeficiency virus(PWH)and may mediate the impaired health-related quality of life(HRQoL)seen in PWH and in people with MASLD.However,the prevalence and burden of poor sleep in PWH and MASLD is not well described.AIM To study the prevalence and multi-faceted relationship between MASLD,poor sleep,and HRQoL in PWH.METHODS In this cross-sectional,observational study,adult PWH and no other known cause of liver disease underwent controlled attenuated parameter(for hepatic fat)and liver stiffness measurement via vibration-controlled transient elastography at eight United States.centers(July 2021 to November 2024).Sleep quality was assessed by Pittsburgh Sleep Quality Index(PSQI)and HRQoL by Rand 36-Item Short Form Health Survey.Outcomes were compared using standard methods.Multivariate regression examined associations between sleep quality,HRQoL,and clinical factors.RESULTS PWH(n=1005)on suppressive antiretroviral therapy had mean age 55 years and were 65%non-White and 27%cisgender female;77%had body mass index(BMI)>25 kg/m2,44%had MASLD(controlled attenuated parameter≥263 dB/minute),13%liver fibrosis(liver stiffness measurement≥8 kPa)and 64%poor sleep quality(PSQI>5).The mean±SD of PSQI was 6.6±4.1,with no differences by MASLD status;MASLD+fibrosis was associated with poorer sleep.HRQoL was low(<50)overall:A step-wise decline in physical component summary(PCS)scores was associated with worse liver disease,from no MASLD to MASLD+fibrosis.Among poor sleepers,a similar step-wise PCS worsening occurred.In multivariate analysis,MASLD+fibrosis was associated with lower PCS and poor sleep was associated with worse physical and mental HRQoL.CONCLUSION In this cohort of PWH,there was no association between MASLD and sleep quality.Poor sleep,MASLD and liver fibrosis were independently associated with poor HRQoL.展开更多
BACKGROUND Human immunodeficiency virus(HIV)recency testing provides data that can be used to monitor the trend of new HIV infections.The effectiveness of using people identified with recent infection to identify part...BACKGROUND Human immunodeficiency virus(HIV)recency testing provides data that can be used to monitor the trend of new HIV infections.The effectiveness of using people identified with recent infection to identify partners with new HIV infection through partner notification services(PNS)is not well documented.AIM To determine the pooled prevalence of recency testing coverage,recent infection,reclassification(recent to longterm infection)and PNS cascade among newly diagnosed people living with HIV.METHODS PubMed,Cochrane Library and Embase were searched for articles published between January 2018 and November 2024.Studies were included if they reported recency coverage and/or PNS among people newly diagnosed with HIV and used recent infection testing algorithm(RITA).Recency coverage was defined as proportion of people tested using rapid testing for recent infection(RTRI)among those newly diagnosed with HIV.RITA further classifies RTRI results using viral load results(≥1000 copies/mL vs<1000 copies/mL)to confirm recency status.For studies with PNS,we evaluated the cascade:Number of partners elicited,successfully contacted,eligible for HIV testing,tested and HIV diagnosis.PNS effectiveness was measured by proportion of new HIV diagnoses from tested partners.Using random effects models,we computed the pooled estimate of recency outcomes and 95%confidence intervals(CIs).RESULTS Twenty-five studies from 17-low-and middle-income countries were included.Of 276315 newly diagnosed people living with HIV,79864 underwent RTRI with an overall pooled recency coverage of 87%(95%CI:67-96).The pooled prevalence of RTRI and RITA recency were 12%(95%CI:9-16)and 7%(95%CI:4-10),respectively.Pooled prevalence of RTRI reclassification was 34%(95%CI:22-49).Of the recent cases who agreed to PNS,253 partners were elicited with an estimated elicitation ratio of 1:1.6.Among partners elicited,99%were successfully contacted,75%were eligible for testing,68%tested for HIV,and 15%were diagnosed with HIV.CONCLUSION High recency testing coverage among newly diagnosed individuals demonstrates the feasibility of monitoring new HIV infections in LMIC.While PNS yielded moderate HIV diagnoses,its targeted approach remains a critical strategy for identifying undiagnosed cases.展开更多
BACKGROUND Chronic kidney disease is a progressive disease that evolves towards the deve-lopment of end-stage renal disease.The superimposition of renal impairment on a complex disease,namely human immunodeficiency vi...BACKGROUND Chronic kidney disease is a progressive disease that evolves towards the deve-lopment of end-stage renal disease.The superimposition of renal impairment on a complex disease,namely human immunodeficiency virus(HIV)infection,will raise the burden of comorbidities and,predict worse outcomes in this group of the population.AIM To evaluate the structural and functional defects of kidney in patients with HIV infection.METHODS This cross-sectional study involved 227 patients with HIV infection.Participants were selected by simple random sampling method.Eligible participants included HIV infection-positive adults aged 18 years and above.Exclusion criteria en-compassed individuals with preexisting hypertension,diabetes mellitus,chronic kidney disease,chronic liver disease,and those receiving nephrotoxic drugs.Informed consent was obtained.Data collection involved recording medical histories,conducting clinical examinations,and performing baseline blood investigations and ultrasono-graphy to assess renal function and structural abnormalities.RESULTS The mean age of participants was 41 years.Females constituted 66.5%;78% were on Tenofovir-based regimen.The mean duration of HIV infection was 5 years;mean duration of antiretroviral therapy was 4 years.67.4% had a body mass index over 25.World Health Organization staging of HIV infection revealed that 41.9%were in stage 3,30%in stage 2.35.7% had cluster differentiation 4 counts<200.The mean creatinine was 1 mg/dL and mean urea was 25.1 mg/dL.54.6%had estimated glomerular filtration rate of<60.Enlarged kidneys in 39.2%and increased echogenicity in 82.8%of participants.A decline in estimated glomerular filtration rate and an increase in kidney size was significantly associated with advancing HIV stages.CONCLUSION Both structural and functional kidney abnormalities are common in patients with HIV infection.These abnor-malities increase with disease progression,underscoring the need for regular and consistent renal monitoring.展开更多
The assays for bovine immunodeficiency virus (BIV) induced syncytium formation and BIV long terminal repeat (LTR) directed luciferase (Luc) gene expression were applied to screen and evaluate anti AIDS drugs. Frequen...The assays for bovine immunodeficiency virus (BIV) induced syncytium formation and BIV long terminal repeat (LTR) directed luciferase (Luc) gene expression were applied to screen and evaluate anti AIDS drugs. Frequency of the syncytium formation and BIV LTR directed Luc activity were in proportion to the number of input BIV infected cells. AZT inhibited the syncytium formation and the BIV LTR directed Luc gene expression level. Its inhibitory effects were dosedependent with the IC 50 being 0.24 and 0.052 mmol / L, respectively.展开更多
BACKGROUND The evidence on preferences for oral-vs blood-based human immunodeficiency virus self-testing(HIVST)has been heterogenous and inconclusive.In addition,most evaluations have relied on hypothetical or stated ...BACKGROUND The evidence on preferences for oral-vs blood-based human immunodeficiency virus self-testing(HIVST)has been heterogenous and inconclusive.In addition,most evaluations have relied on hypothetical or stated use cases using discreet choice experiments rather than actual preferences among experienced users,which are more objective and critical for the understanding of product uptake.Direct head-to-head comparison of consumer preferences for oral-versus bloodbased HIVST is lacking.AIM To examine the existing literature on preferences for oral-vs blood-based HIVST,determine the factors that impact these preferences,and assess the potential implications for HIVST programs.METHODS Databases such as PubMed,Medline,Google Scholar,and Web of Science were searched for articles published between January 2011 to October 2022.Articles must address preferences for oral-vs blood-based HIVST.The study used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist to ensure the quality of the study.RESULTS The initial search revealed 2424 records,of which 8 studies were finally included in the scoping review.Pooled preference for blood-based HIVST was 48.8%(9%-78.6%),whereas pooled preference for oral HIVST was 59.8%(34.2%-91%)across all studies.However,for male-specific studies,the preference for blood-based HIVST(58%-65.6%)was higher than that for oral(34.2%-41%).The four studies that reported a higher preference for blood-based HIVST were in men.Participants considered blood-based HIVST to be more accurate and rapid,while those with a higher preference for oral HIVST did so because these were considered non-invasive and easy to use.CONCLUSION Consistently in the literature,men preferred blood-based HIVST over oral HIVST due to higher risk perception and desire for a test that provides higher accuracy coupled with rapidity,autonomy,privacy,and confidentiality,whereas those with a higher preference for oral HIVST did so because these were considered non-invasive and easy to use.Misinformation and distrust need to be addressed through promotional messaging to maximize the diversity of this new biomedical technology.展开更多
BACKGROUND Pneumocystis jirovecii pneumonia(PJP)is an infectious disease common in immunocompromised hosts.However,the currently,the clinical characteristics of non-HIV patients with PJP infection have not been fully ...BACKGROUND Pneumocystis jirovecii pneumonia(PJP)is an infectious disease common in immunocompromised hosts.However,the currently,the clinical characteristics of non-HIV patients with PJP infection have not been fully elucidated.AIM To explore efficacy of trimethoprim–sulfamethoxazole(TMP-SMX)and caspofungin for treatment of non-human immunodeficiency virus(HIV)-infected PJP patients.METHODS A retrospective study enrolled 22 patients with non-HIV-infected PJP treated with TMP-SMX and caspofungin from 2019 to 2021.Clinical manifestations,treatment and prognosis of the patients were analyzed.RESULTS Five patients presented with comorbidity of autoimmune diseases,seven with lung cancer,four with lymphoma,two with organ transplantation and four with membranous nephropathy associated with use of immunosuppressive agents.The main clinical manifestations of patients were fever,dry cough,and progressive dyspnea.All patients presented with acute onset and respiratory failure.The most common imaging manifestation was ground glass opacity around the hilar,mainly in the upper lobe.All patients were diagnosed using next-generation sequencing,and were treated with a combination of TMP-SMX and caspofungin.Among them,17 patients received short-term adjuvant glucocorticoid therapy.All patients recovered well and were discharged from hospital.CONCLUSION Non-HIV-infected PJP have rapid disease progression,high risk of respiratory failure,and high mortality.Combination of TMP-SMX and caspofungin can effectively treat severe non-HIVinfected PJP patients with respiratory failure.展开更多
Alcohol use disorder(AUD) and hepatitis C virus(HCV) infection frequently co-occur. AUD is associated with greater exposure to HCV infection, increased HCV infection persistence, and more extensive liver damage due to...Alcohol use disorder(AUD) and hepatitis C virus(HCV) infection frequently co-occur. AUD is associated with greater exposure to HCV infection, increased HCV infection persistence, and more extensive liver damage due to interactions between AUD and HCV on immune responses, cytotoxicity, and oxidative stress. Although AUD and HCV infection are associated with increased morbidity and mortality, HCV antiviral therapy is less commonly prescribed in individuals with both conditions. AUD is also common in human immunodeficiency virus(HIV) infection, which negatively impacts proper HIV care and adherence to antiretroviral therapy, and liver disease. In addition, AUD and HCV infection are also frequent within a proportion of patients with HIV infection, which negatively impacts liver disease. This review summarizes the current knowledge regarding pathological interactions of AUD with hepatitis C infection, HIV infection, and HCV/HIV co-infection, as well as relating to AUD treatment interventions in these individuals.展开更多
The envelope protein （Env） of lentiviruses such as HIV, SIV, FIV and EIAV is larger than that of other retroviruses. The Chinese EIAV attenuated vaccine is based on Env and has helped to successfully control this vi...The envelope protein （Env） of lentiviruses such as HIV, SIV, FIV and EIAV is larger than that of other retroviruses. The Chinese EIAV attenuated vaccine is based on Env and has helped to successfully control this virus, demonstrating that envelope is crucial for vaccine. We compared Env variation of the four kinds of lentiviruses. Phylogenetic analysis showed that the evolutionary relationship of Env between HIV and SIV was the closest and they appeared to descend from a common ancestor, and the relationship of HIV and EIAV was the furthest. EIAV had the shortest Env length and the least number of potential N-linked glyeosylation sites （PNGS） as well as glyeosylation density compared to various immunodefieiency viruses. However, HIV had the longest Env length and the most PNGS. Moreover, the alignment of HIV and SIV showed that PNGS were primarily distributed within extraeellular membrane protein gp120 rather than transmembrane gp41. It implies that the size difference among these viruses is associated with a lentivirus specific function and also the diversity of env. There arc low levels of modification of glycosylation sites of Env and selection of optimal protective epitopes might be useful for development of an effective vaccine against HIV/AIDS.展开更多
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.
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Eradicating tuberculosis in human immunodeficiency virus is all the more important to realise India’s ambitious goal of tuberculosis free India by 2025.Although,continuous efforts are being made to address tuberculosis in human immunodeficiency virus co-infection,it is imperative to closely monitor the implemented strategies,encourage and validate disease notification system in the country,and bring about societal change to view this disease as an ailment only and not as a stigma.
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.
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Supported by National Natural Science Foundation of China,No.82360120Ten Thousand Doctor Plan in Yunnan Province,No.YNWRMY-2018-020Yunnan Provincial Key Laboratory of Clinical Virology,No.202205AG070053-07.
文摘BACKGROUND Common variable immunodeficiency(CVID)is a primary antibody immunodeficiency disorder characterized by diminished IgG levels.Despite ongoing research,the precise pathogenesis of CVID remains unclear.Genetic factors account for only 10%-20%of cases,with an estimated incidence of 1 in 10000 to 1 in 100000,affecting individuals across all age groups.CASE SUMMARY We report the case of a 32-year-old man with CVID who presented with a chief complaint of“recurrent diarrhea and significant weight loss over the past 2 years”.Laboratory tests on admission showed fat droplets in stool,while other parameters were within normal ranges.Gastroscopy revealed a smooth gastric mucosa without bile retention or signs of Helicobacter pylori infection;however,the mucosa of the descending segment of the duodenum appeared rough.Further evaluation of the small intestine using computed tomography indicated no abnormalities.Finally,the whole-small bowel double-balloon enteroscopy(DBE)was performed,which revealed various phenotypic changes in the small intestinal mucosa.The patient was diagnosed with CVID,which improved after immunoglobulin therapy,with favorable follow-up outcomes.CONCLUSION Non-infectious enteropathy in CVID is rare.Therefore,DBE is essential for diagnosing small intestinal involvement in such cases.
文摘BACKGROUND The World Health Organization(WHO)recommends lumbar puncture(LP)procedures to assess the diagnosis of cryptococcal meningitis(CM)among patients with advanced human immunodeficiency virus(HIV)disease(AHD)with positive serum cryptococcal antigen(CrAg)and do not have evidence of CM.AIM To estimate pooled prevalence of uptake of LP,CM and mortality among patients with AHD.METHODS PubMed,Cochrane Library and EMBASE were searched for articles published between January 2011 and December 2024.LP uptake was defined as percentage of people who underwent LP procedures among those with AHD(CD4≤200 cells/mm3 or WHO stage III/IV)and positive serum CrAg.Using random effects models,we computed the pooled estimate of LP uptake,CM and mortality and 95%CI.Stratified analyses were used to compare uptake of LP between studies that involved multiple vs single sites,and mortality analyses between patients with positive and negative serum CrAg were performed.Sensitivity analysis on LP uptake was done by excluding prospective cohort studies that reported 100%uptake.RESULTS A total of 32 studies with 46890 people with AHD screened for serum CrAg and 2730(5.8%)had positive serum CrAg.Overall,pooled prevalence of LP uptake was 67.7%(95%CI:54.0-81.5).The overall pooled prevalence of CM was 54.3%(95%CI:39.7-69.0),and mortality was 6.2%(95%CI:4.5-8.0).There is disparities in the pooled prevalence of LP uptake with studies involving multiple sites having lower prevalence compared to those that involved single sites(54.8%vs 84.7%,P=0.004).By excluding prospective cohort studies that reported 100%uptake,the overall LP uptake was 54.5%(95%CI:38.8-70.1).The pooled prevalence of CM was significantly lower among studies that involved multiple sites compared to those that involved single sites(6.8%vs 8.1%,P≤0.001).Mortality was significantly twice as high among patients who had positive serum CrAg compared to those who had negative serum CrAg[risk ratio=2.0(95%CI:1.6-2.5),P≤0.001].CONCLUSION Nearly three to five in 10 people with AHD with positive serum CrAg did not have LP procedures done,indicating significant gaps in identifying patients with CM.Establishing a confirmed diagnosis of CM is critical to avoid exposing patients to subtherapeutic levels of antifungals preemptively.Capacity to perform LP and patient refusals are among the reasons for not performing the procedure.Capacity building in training health care providers to perform LP procedures and professional counselling to obtain patient consent are critical for appropriate treatment to reduce mortality associated with CM infection.
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Supported by National Institutes of Health,No.R01DK121378,No.R01DK126042,and No.P30DK120515.
文摘BACKGROUND Metabolic dysfunction-associated steatotic liver disease(MASLD)and poor sleep are common among people with human immunodeficiency virus(PWH)and may mediate the impaired health-related quality of life(HRQoL)seen in PWH and in people with MASLD.However,the prevalence and burden of poor sleep in PWH and MASLD is not well described.AIM To study the prevalence and multi-faceted relationship between MASLD,poor sleep,and HRQoL in PWH.METHODS In this cross-sectional,observational study,adult PWH and no other known cause of liver disease underwent controlled attenuated parameter(for hepatic fat)and liver stiffness measurement via vibration-controlled transient elastography at eight United States.centers(July 2021 to November 2024).Sleep quality was assessed by Pittsburgh Sleep Quality Index(PSQI)and HRQoL by Rand 36-Item Short Form Health Survey.Outcomes were compared using standard methods.Multivariate regression examined associations between sleep quality,HRQoL,and clinical factors.RESULTS PWH(n=1005)on suppressive antiretroviral therapy had mean age 55 years and were 65%non-White and 27%cisgender female;77%had body mass index(BMI)>25 kg/m2,44%had MASLD(controlled attenuated parameter≥263 dB/minute),13%liver fibrosis(liver stiffness measurement≥8 kPa)and 64%poor sleep quality(PSQI>5).The mean±SD of PSQI was 6.6±4.1,with no differences by MASLD status;MASLD+fibrosis was associated with poorer sleep.HRQoL was low(<50)overall:A step-wise decline in physical component summary(PCS)scores was associated with worse liver disease,from no MASLD to MASLD+fibrosis.Among poor sleepers,a similar step-wise PCS worsening occurred.In multivariate analysis,MASLD+fibrosis was associated with lower PCS and poor sleep was associated with worse physical and mental HRQoL.CONCLUSION In this cohort of PWH,there was no association between MASLD and sleep quality.Poor sleep,MASLD and liver fibrosis were independently associated with poor HRQoL.
文摘BACKGROUND Human immunodeficiency virus(HIV)recency testing provides data that can be used to monitor the trend of new HIV infections.The effectiveness of using people identified with recent infection to identify partners with new HIV infection through partner notification services(PNS)is not well documented.AIM To determine the pooled prevalence of recency testing coverage,recent infection,reclassification(recent to longterm infection)and PNS cascade among newly diagnosed people living with HIV.METHODS PubMed,Cochrane Library and Embase were searched for articles published between January 2018 and November 2024.Studies were included if they reported recency coverage and/or PNS among people newly diagnosed with HIV and used recent infection testing algorithm(RITA).Recency coverage was defined as proportion of people tested using rapid testing for recent infection(RTRI)among those newly diagnosed with HIV.RITA further classifies RTRI results using viral load results(≥1000 copies/mL vs<1000 copies/mL)to confirm recency status.For studies with PNS,we evaluated the cascade:Number of partners elicited,successfully contacted,eligible for HIV testing,tested and HIV diagnosis.PNS effectiveness was measured by proportion of new HIV diagnoses from tested partners.Using random effects models,we computed the pooled estimate of recency outcomes and 95%confidence intervals(CIs).RESULTS Twenty-five studies from 17-low-and middle-income countries were included.Of 276315 newly diagnosed people living with HIV,79864 underwent RTRI with an overall pooled recency coverage of 87%(95%CI:67-96).The pooled prevalence of RTRI and RITA recency were 12%(95%CI:9-16)and 7%(95%CI:4-10),respectively.Pooled prevalence of RTRI reclassification was 34%(95%CI:22-49).Of the recent cases who agreed to PNS,253 partners were elicited with an estimated elicitation ratio of 1:1.6.Among partners elicited,99%were successfully contacted,75%were eligible for testing,68%tested for HIV,and 15%were diagnosed with HIV.CONCLUSION High recency testing coverage among newly diagnosed individuals demonstrates the feasibility of monitoring new HIV infections in LMIC.While PNS yielded moderate HIV diagnoses,its targeted approach remains a critical strategy for identifying undiagnosed cases.
文摘BACKGROUND Chronic kidney disease is a progressive disease that evolves towards the deve-lopment of end-stage renal disease.The superimposition of renal impairment on a complex disease,namely human immunodeficiency virus(HIV)infection,will raise the burden of comorbidities and,predict worse outcomes in this group of the population.AIM To evaluate the structural and functional defects of kidney in patients with HIV infection.METHODS This cross-sectional study involved 227 patients with HIV infection.Participants were selected by simple random sampling method.Eligible participants included HIV infection-positive adults aged 18 years and above.Exclusion criteria en-compassed individuals with preexisting hypertension,diabetes mellitus,chronic kidney disease,chronic liver disease,and those receiving nephrotoxic drugs.Informed consent was obtained.Data collection involved recording medical histories,conducting clinical examinations,and performing baseline blood investigations and ultrasono-graphy to assess renal function and structural abnormalities.RESULTS The mean age of participants was 41 years.Females constituted 66.5%;78% were on Tenofovir-based regimen.The mean duration of HIV infection was 5 years;mean duration of antiretroviral therapy was 4 years.67.4% had a body mass index over 25.World Health Organization staging of HIV infection revealed that 41.9%were in stage 3,30%in stage 2.35.7% had cluster differentiation 4 counts<200.The mean creatinine was 1 mg/dL and mean urea was 25.1 mg/dL.54.6%had estimated glomerular filtration rate of<60.Enlarged kidneys in 39.2%and increased echogenicity in 82.8%of participants.A decline in estimated glomerular filtration rate and an increase in kidney size was significantly associated with advancing HIV stages.CONCLUSION Both structural and functional kidney abnormalities are common in patients with HIV infection.These abnor-malities increase with disease progression,underscoring the need for regular and consistent renal monitoring.
文摘The assays for bovine immunodeficiency virus (BIV) induced syncytium formation and BIV long terminal repeat (LTR) directed luciferase (Luc) gene expression were applied to screen and evaluate anti AIDS drugs. Frequency of the syncytium formation and BIV LTR directed Luc activity were in proportion to the number of input BIV infected cells. AZT inhibited the syncytium formation and the BIV LTR directed Luc gene expression level. Its inhibitory effects were dosedependent with the IC 50 being 0.24 and 0.052 mmol / L, respectively.
文摘BACKGROUND The evidence on preferences for oral-vs blood-based human immunodeficiency virus self-testing(HIVST)has been heterogenous and inconclusive.In addition,most evaluations have relied on hypothetical or stated use cases using discreet choice experiments rather than actual preferences among experienced users,which are more objective and critical for the understanding of product uptake.Direct head-to-head comparison of consumer preferences for oral-versus bloodbased HIVST is lacking.AIM To examine the existing literature on preferences for oral-vs blood-based HIVST,determine the factors that impact these preferences,and assess the potential implications for HIVST programs.METHODS Databases such as PubMed,Medline,Google Scholar,and Web of Science were searched for articles published between January 2011 to October 2022.Articles must address preferences for oral-vs blood-based HIVST.The study used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist to ensure the quality of the study.RESULTS The initial search revealed 2424 records,of which 8 studies were finally included in the scoping review.Pooled preference for blood-based HIVST was 48.8%(9%-78.6%),whereas pooled preference for oral HIVST was 59.8%(34.2%-91%)across all studies.However,for male-specific studies,the preference for blood-based HIVST(58%-65.6%)was higher than that for oral(34.2%-41%).The four studies that reported a higher preference for blood-based HIVST were in men.Participants considered blood-based HIVST to be more accurate and rapid,while those with a higher preference for oral HIVST did so because these were considered non-invasive and easy to use.CONCLUSION Consistently in the literature,men preferred blood-based HIVST over oral HIVST due to higher risk perception and desire for a test that provides higher accuracy coupled with rapidity,autonomy,privacy,and confidentiality,whereas those with a higher preference for oral HIVST did so because these were considered non-invasive and easy to use.Misinformation and distrust need to be addressed through promotional messaging to maximize the diversity of this new biomedical technology.
文摘BACKGROUND Pneumocystis jirovecii pneumonia(PJP)is an infectious disease common in immunocompromised hosts.However,the currently,the clinical characteristics of non-HIV patients with PJP infection have not been fully elucidated.AIM To explore efficacy of trimethoprim–sulfamethoxazole(TMP-SMX)and caspofungin for treatment of non-human immunodeficiency virus(HIV)-infected PJP patients.METHODS A retrospective study enrolled 22 patients with non-HIV-infected PJP treated with TMP-SMX and caspofungin from 2019 to 2021.Clinical manifestations,treatment and prognosis of the patients were analyzed.RESULTS Five patients presented with comorbidity of autoimmune diseases,seven with lung cancer,four with lymphoma,two with organ transplantation and four with membranous nephropathy associated with use of immunosuppressive agents.The main clinical manifestations of patients were fever,dry cough,and progressive dyspnea.All patients presented with acute onset and respiratory failure.The most common imaging manifestation was ground glass opacity around the hilar,mainly in the upper lobe.All patients were diagnosed using next-generation sequencing,and were treated with a combination of TMP-SMX and caspofungin.Among them,17 patients received short-term adjuvant glucocorticoid therapy.All patients recovered well and were discharged from hospital.CONCLUSION Non-HIV-infected PJP have rapid disease progression,high risk of respiratory failure,and high mortality.Combination of TMP-SMX and caspofungin can effectively treat severe non-HIVinfected PJP patients with respiratory failure.
基金Supported by Ministry of Economy and Competitiveness,Institute of Health Carlos,ISCIII:European fund for regional development(FEDER)Nos.RETICS RD 12/0028/0006 and RD16/0017/0003Ministry of Health,Social Services,and Equality,Nos.PNSD 2014/042 and PNSD 2015/027
文摘Alcohol use disorder(AUD) and hepatitis C virus(HCV) infection frequently co-occur. AUD is associated with greater exposure to HCV infection, increased HCV infection persistence, and more extensive liver damage due to interactions between AUD and HCV on immune responses, cytotoxicity, and oxidative stress. Although AUD and HCV infection are associated with increased morbidity and mortality, HCV antiviral therapy is less commonly prescribed in individuals with both conditions. AUD is also common in human immunodeficiency virus(HIV) infection, which negatively impacts proper HIV care and adherence to antiretroviral therapy, and liver disease. In addition, AUD and HCV infection are also frequent within a proportion of patients with HIV infection, which negatively impacts liver disease. This review summarizes the current knowledge regarding pathological interactions of AUD with hepatitis C infection, HIV infection, and HCV/HIV co-infection, as well as relating to AUD treatment interventions in these individuals.
基金Natural Science Foundation of China(30970162)Tianjin Municipal Science and Technology Foundation(08ZCGHHZ01800)
文摘The envelope protein （Env） of lentiviruses such as HIV, SIV, FIV and EIAV is larger than that of other retroviruses. The Chinese EIAV attenuated vaccine is based on Env and has helped to successfully control this virus, demonstrating that envelope is crucial for vaccine. We compared Env variation of the four kinds of lentiviruses. Phylogenetic analysis showed that the evolutionary relationship of Env between HIV and SIV was the closest and they appeared to descend from a common ancestor, and the relationship of HIV and EIAV was the furthest. EIAV had the shortest Env length and the least number of potential N-linked glyeosylation sites （PNGS） as well as glyeosylation density compared to various immunodefieiency viruses. However, HIV had the longest Env length and the most PNGS. Moreover, the alignment of HIV and SIV showed that PNGS were primarily distributed within extraeellular membrane protein gp120 rather than transmembrane gp41. It implies that the size difference among these viruses is associated with a lentivirus specific function and also the diversity of env. There arc low levels of modification of glycosylation sites of Env and selection of optimal protective epitopes might be useful for development of an effective vaccine against HIV/AIDS.
