Persistent poor clinical outcomes of people living with HIV presenting with AIDS and late HIV diagnosis - results from the ICONA cohort in Italy, 2009-2022.

OBJECTIVES: Limited data are available on the long-term outcomes in recent years for late HIV diagnosis (LD). METHODS: All subjects with HIV enrolled in the ICONA cohort in 2009-2022 who started antiretroviral treatment (ART) within 4 months from diagnosis were included and divided into: (i) pre-ART CD4 count ≥350/mm3 without AIDS (non-LD), (ii) pre-ART CD4 count <350/mm3 without AIDS (LD asymptomatic), and (iii) with AIDS events pre-ART (LD-AIDS). The estimated probability and independent risk for mortality (all-cause and cause-specific) and treatment failure were evaluated. RESULTS: Of 6813 participants (2448 non-LD, 3198 LD asymptomatic, and 1167 LD-AIDS), 161 (2.4%) died after ART initiation. At survival analysis, a higher probability of all-cause mortality has been identified for LD than non-LD (P <0.001) and within the former, for LD-AIDS over LD asymptomatic (P <0.001). After adjusting for confounders, LD showed a higher risk of all-cause mortality (vs non-LD adjusted hazard ratio (aHR) 5.51, P <0.001) and, in particular, being an AIDS presenter predicted a greater risk of all-cause (aHR = 4.42, P <0.001), AIDS-related (adjusted subhazard ratio [aSHR] = 16.86, P <0.001), and non-AIDS-related mortality (aSHR = 1.74, P = 0.022) than the rest of the late presenters. Among the short-term survivors in the LD-AIDS group, the long-term mortality was mediated by the lack of immune recovery at 2 years. Finally, LD compared with non-LD and, particularly, among the former, LD-AIDS over LD asymptomatic showed a greater risk of treatment failure. CONCLUSIONS: In recent years, LD subjects, particularly, AIDS presenters, remained at a higher risk of poorer outcomes. Public health strategies for early HIV diagnosis are urgently needed to constrain the mortality gap.

Reduced HIV/AIDS diagnosis rates and increased AIDS mortality due to late diagnosis in Brazil during the COVID-19 pandemic.

The COVID-19 pandemic has severely affected global health, leading to the suspension of numerous routine healthcare services and posing challenges in efforts to control other diseases, such as HIV/AIDS. This study aimed to assess the impact of the COVID-19 pandemic on HIV/AIDS diagnoses and mortality rates in Brazil during 2020 and 2021. The percentage change was calculated to determine whether there was an increase or decrease in HIV/AIDS diagnoses and mortality, considering the average numbers from the last 5 years. Additionally, a Joinpoint regression model and an interrupted time series analysis were applied to assess time trends before and after the onset of the pandemic. Lastly, choropleth maps were prepared. We observed a reduction of 22.4% (2020) and 9.8% (2021) in the diagnosis of HIV/AIDS in Brazil. Conversely, there was a significant increase in the percentage change of late diagnosis of AIDS deaths in 2020 (6.9%) and 2021 (13.9%), with some states showing an increase of over 87%. Decreasing time trends in the diagnosis of HIV/AIDS were identified before the pandemic in Brazil, especially in the Southeast and South regions, and then time trends stabilized after including the pandemic years. Along with the dissemination of COVID-19, there was a reduction in the diagnosis of HIV/AIDS and an increase in late diagnosis AIDS deaths, signaling a serious impact of the pandemic on HIV/AIDS control strategies in Brazil. Therefore, we highlight the need for continuous efforts to control both diseases, that is, maintaining regular health services even in crisis situations.

KNOWLEDGE, ATTITUDE AND PRACTICE OF PREMARITAL SCREENING FOR HIV/AIDS AMONG RESIDENCE OF RURAL AREAS IN NORTH-EASTERN NIGERIA.

Introduction: One of the biggest health challenges threatening the human race in recent times is the HIV/AIDS pandemic. To know one's HIV status is a part of the human right to health. The disease has continued to be on the front burner for many years now, despite initial denials and cover-ups by some countries. Sub-Saharan Africa with just over 10 percent of the world's population has the greatest burden of this disease. It is estimated that close to two-thirds of all people living with HIV are in sub-Saharan Africa with South Africa having the highest number. Objective: This study assessed the knowledge, attitude, and practice of premarital screening of HIV/AIDS among residents of rural areas of Itas Gadau local government area of Bauchi state, North-eastern Nigeria. Methodology: A descriptive cross-sectional design was used for the study. A semi-structured questionnaire was used to collect data from 379 eligible respondents comprising residents of Itas and Gadau towns of Bauchi State. A multi-stage sampling procedure was used to select the participants for the study. Pearson's chi-square test was used in testing for the association between educational status and premarital screening for HIV/AIDS in rural areas. Results: The results show that all (100%) of the respondents have heard of HIV/AIDS and the dominant source of information was from friends (77.6%) followed by healthcare workers (17.4%). In addition, 90% of participants have good knowledge of premarital screening for HIV/AIDS. Majority of the study respondents had undergone premarital screening for HIV/AIDS (64.4%). The result also shows that there is a statistically significant relationship between educational status and the practice of premarital screening for HIV/AIDS in Itas/Gadau, Bauchi State with p-value of 0.001. Conclusion: The study found that there was a very high level of knowledge, good attitude, and practice for HIV/AIDS among the study respondents. Thus we recommend that the community should maintain the mandatory premarital screening and continue with regular health education on premarital screening for HIV/AIDS.

Twelve months antiretroviral therapy retention among clients newly enrolled to care and treatment services in Geita Regin, Tanzania: does universal test and treat matter?

Introduction: sustaining high rates of retention is critical for management of HIV clients, newly initiated antiretroviral therapy (ART). In low resource settings including Tanzania, retention among clients on ART was challenging due to inaccessible infrastructure, gender-based violence, inadequate skilled staff and socio-economic disparities. Low retention leads to increased morbidity and mortality. Tanzania adopted universal test and treat (UTT) strategy in mid of 2016 as recommended by Joint United Nations Program on HIV/AIDS (UNAID) that set goals for HIV epidemic control globally. Studies demonstrated controversial findings on whether UTT strategy improves retention, until now there is limited information on the effect of UTT on retaining HIV patients in our settings. Methods: a retrospective cohort study was conducted between July 2014 to June 2015 and July 2017 to June 2018 to determine 12 months ART retention among clients newly initiated ART prior and during universal test and treat (UTT) strategy in Geita Region, Tanzania. A total of 13,649 newly clients-initiated ART were extracted from the National AIDS control care and treatment database (CTC2 database). Among these clients 4,624 initiated ART prior the UTT strategy and clients 9,025 start ART after the rollout of UTT strategy. Chi-square test was deployed to determine the significant difference of proportion within categories for each UTT group. Kaplan-Meier curve and long rank test were used to determine significant differences of retention rate prior and during UTT program. Cox regression models were used to estimate the association between exposure variables and ART retention with 95% confidence intervals and p-value of p<0.05. Results: the overall mean age at ART initiation was 38 years (SD=11.6) with observed significant mean difference between two cohorts (prior UTT, mean=41, SD=11.7 Vs during UTT, mean=37, SD=11.3). The cumulative retention was 83.1% among newly initiated ART clients in both cohorts with significant difference observed between two cohorts (69.7% for prior UTT and 89.9% during UTT, p-value<0.001). The overall person year of follow up was 127,209.3 with an incidence rate of ART retention of 86 per 1000 person-year. It was significantly higher among clients enrolled during UTT strategy than clients enrolled prior UTT strategy (95.1 per 1000 PY Vs 69.6 per 1000 PY, p-value<0.001). The log rank test and Kaplan-Meier survival curve demonstrated clients enrolled in the UTT program had greater probability of retention than clients enrolled prior UTT treatment program (log rank X2 test = 599.2, p value < 0.001). Newly HIV clients who initiated ART after the rollout of UTT strategy had 27% higher likelihood to be retained in care and treatment as compared to clients who were enrolled prior UTT strategy, (HR=1.27; 95% CI [1.21 -1.33], p value < 0.001). Sex, District councils, World health Organisation (WHO) stage and client's visit type were significant factors associated with retention among clients newly initiated to care for both arms. Conclusion: this results, showed that probability of ART retention increased after the rollout of UTT strategy. There is a need to promote universal test and treat strategy in line with other intervention to control HIV epidemic in Geita, Tanzania.

Factors Associated with Late Diagnosis of Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) in a University Hospital in Brazil: Challenges to Achieving the 2030 Target.

INTRODUCTION: This study aimed to identify factors associated with late diagnosis and clinically monitor newly diagnosed HIV/AIDS patients. METHOD: Retrospective study, based on secondary data from a specialized unit at the Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto of the University of Sao Paulo. Data collection included sociodemographic, behavioral, clinical, and laboratory data of newly diagnosed HIV patients between 2015 and 2019. Data analysis was undertaken using inferential statistical tests. RESULTS: A total of 314 individuals were newly diagnosed with HIV/AIDS, 86.6% (272) had a late diagnosis and 53.8% (169) were diagnosed very late. Using the adjusted odds ratio, we observed that bisexual and MSM patients were less likely to have a late diagnosis compared to straight patients. Individuals who entered through the emergency department and Outpatient Clinic had a lower chance of having a very late diagnosis compared to those diagnosed in the ward/inpatient unit. Having a higher education and university education were protective factors against having a very late diagnosis of HIV infection compared to elementary school education only. In addition, male patients were more likely to have a very late diagnosis compared to female patients. CONCLUSIONS: This study evidenced a high prevalence of late and very late diagnoses. Therefore, attention should be directed towards factors related to late and very late presentation.

Survival times of HIV/AIDS in different AIDS Diagnostic and Treatment Guidelines from 2006 to 2020 in Liuzhou, China.

BACKGROUND: To compare the survival rates of four timing of treatment initiation for people living with HIV/AIDS provided in China in 2006, 2011, 2015, and 2018, and to investigate the factors impacting survival time. METHODS: A people living with HIV/AIDS retrospective cohort study was in Liuzhou City from April 2006 to December 2020. The information was obtained from the National Comprehensive AIDS Prevention and Control Information System. Life tables and the Kaplan-Meier method were used to calculate participant survival rates and time. The univariate and multivariate Cox regression models were used to investigate the factors related to survival. RESULTS: 18,543 participants were included in this study. In four periods, the 1-year survival rates were 81%, 87%, 95%, and 95%. The 2-year survival rates were 76%, 85%, 93%, and 94%. The 3-year survival rates were 73%, 84%, 92%, and 94%. Results of multivariate Cox regression showed that sex, age of HIV diagnosis, ethnicity, household registration, occupation, marital status, the timing of treatment, education level, route of HIV transmission, whether receiving antiretroviral therapy (ART), and the count of CD4+T cells at baseline (count of CD4+T cells at HIV diagnosis) were factors that are significantly correlated with mortality caused by HIV infection. CONCLUSIONS: With the Guidelines updated from 2006 to 2020, the 1-, 2-, and 3-year survival rates of people living with HIV/AIDS in four periods tended to increase. The timing of treatment initiation of the updated edition of the AIDS Diagnostic and Treatment Guidelines (Guidelines) significantly prolonged the survival time of people living with HIV/AIDS.

Knowledge of HIV and/or AIDS and HIV testing services among young men in South Africa.

BACKGROUND: The youth is at a heightened risk of immunodeficiency virus and/or acquired immunodeficiency syndrome (HIV and/or AIDS) infection because of risk-taking behaviour. There remains a gap in understanding young men's knowledge of HIV and/or AIDS and HIV testing services (HTS) in hard-to-reach communities in South Africa. AIM: This article aimed to explore young men's knowledge of HIV and/or AIDS, including HTS in Ladysmith, KwaZulu-Natal (KZN). SETTING: Rural and peri-urban areas around the town of Ladysmith. METHODS: Employing a qualitative descriptive research design, 17 young men aged between 18 and 30 years were purposively and conveniently sampled and interviewed using WhatsApp and landline audio calls to collect their data, which was thematically analysed. RESULTS: Young men had good knowledge of HIV and/or AIDS but lacked knowledge about HTS and HIV self-testing (HIVST). They obtained their information about HIV and/or AIDS and HTS from various sources and were aware of where to access HTS. They were generally unaware and supportive of HIVST. CONCLUSION: Male-targeted HIV and/or AIDS knowledge and testing interventions are needed to encourage and support young men to test for HIV. Human immunodeficiency virus self-testing should be explored as an alternative to clinic-based service to encourage young men to know their status, specifically those with limited access to or are reluctant to attend clinics. Strengthening HIV and/or AIDS education could facilitate better decision-making towards HIV testing among young men.Contribution: This study contributes to an understanding of young adult men's knowledge of HIV and/or AIDS and HTS in underserved settings in South Africa.

O diagnóstico do HIV na atenção primária à saúde: uma revisão realista / HIV diagnosis in primary health care: a realistic review / El diagnóstico de VIH en atención primaria de salud: una revisión realista

É fundamental a identificação e a compreensão das estratégias empregadas na atenção primária à saúde para a oferta do diagnóstico do vírus da imunodeficiência humana (HIV), de modo a possibilitar o planejamento de políticas que promovam o início oportuno da terapia antirretroviral para garantir uma melhor qualidade de vida às pessoas que vivem com HIV. Desse modo, o estudo objetivou elaborar preceitos teóricos a partir das evidências científicas acerca das estratégias para a oferta do diagnóstico do HIV na atenção primária. Trata-se de uma revisão realista, realizada a partir de levantamento conduzido em seis bases de dados no ano de 2022, que teve como questão norteadora: quais são as estratégias para a oferta do diagnóstico da infecção pelo HIV na atenção primária à saúde? Foram incluídos oito estudos. No que se refere a estratégias empregadas e público-alvo, observou-se o predomínio de testes de rotina (n = 5) nas unidades básicas de saúde para a população adscrita, sem especificação de idade e/ou grupo (n = 4). A partir disso emergiu o seguinte preceito teórico: estratégias para a oferta de testes de HIV na atenção primária à saúde, com abordagens holísticas, pautadas na relação profissional-usuário e em condições rotineiras apresentam melhor receptividade pela população adscrita e contribuem para a redução do estigma associado. Sugere-se, assim, que as ações de testagem de HIV valorizem práticas integrais ao usuário em suas consultas de rotina e sejam livres de discriminação e julgamento, a fim de que o estigma associado à infecção deixe de ser um fator limitador para a testagem.

It is essential to identify and understand the strategies employed in primary health care to offer diagnosis of human immunodeficiency virus (HIV), to enable the planning of policies that promote the timely initiation of antiretroviral therapy to guarantee a better quality of life for people who live with HIV. Thus, the study aimed to develop theoretical precepts based on scientific evidence about strategies for offering HIV diagnosis in Primary Care. This is a realistic review, carried out from a screening in six databases in the year 2022, which had as its guiding question: what are the strategies for offering the diagnosis of HIV infection in primary health care?. A total of eight studies were included. Regarding the strategies employed and the target audience, there was a predominance of routine tests (n = 5) in basic health units for the enrolled population, without specifying age and/or group (n = 4). From this, the following theoretical precept emerged: strategies for offering HIV tests in primary health care, with holistic approaches, based on the professional-user relationship and under routine conditions show more receptivity of the enrolled population and contribute to reduce the associated stigma. It is suggested, therefore, that HIV testing actions should value integral practices for the user in their routine consultations and be free of discrimination and judgments, so that the stigma associated with the infection ceases to be a limiting factor for testing.

Es fundamental identificar y comprender las estrategias empleadas en la atención primaria de salud para ofrecer el diagnóstico del virus de la inmunodeficiencia humana (VIH), con el fin de posibilitar la planificación de políticas que promuevan el inicio oportuno de la terapia antirretroviral y, así, garantizar una mejor calidad de vida a las personas que viven con el VIH. Así, este estudio tuvo como objetivo desarrollar preceptos teóricos basados en evidencia científica sobre estrategias para ofrecer el diagnóstico de VIH en la atención primaria. Se trata de una revisión realista, realizada en seis bases de datos en el año 2022, que se basó en la siguiente pregunta orientadora: ¿Cuáles son las estrategias para ofrecer el diagnóstico de infección por VIH en la atención primaria de salud? Se incluyeron ocho estudios. En cuanto a las estrategias empleadas y el público objetivo, hubo predominio de las pruebas de rutina (n = 5) en las unidades básicas de salud para la población en estudio, sin precisar edad y/o grupo (n = 4). De allí surgió el siguiente precepto teórico: las estrategias de oferta de pruebas de VIH en la atención primaria de salud, con enfoques holísticos, basadas en la relación profesional-usuario y en condiciones de rutina son más receptivas a la población inscrita y contribuyen a la reducción del estigma asociado. Se recomienda, por tanto, que las acciones de prueba del VIH deben valorar prácticas integrales para el usuario en sus consultas de rutina y estar libres de discriminación y juicios, para que el estigma asociado a la infección deje de ser un factor limitante para la prueba.

Information shocks and celebrity exposure: The effect of "Magic" Johnson on AIDS diagnoses and mortality in the U.S.

We present evidence that Earvin "Magic" Johnson's announcement that he contracted HIV served as a public-health catalyst for rapidly correcting the public's understanding of who was at risk of infection. Using a novel identification strategy, we present evidence that there was a large but temporary increase in the number of AIDS diagnoses for heterosexual men following the announcement. This effect was concentrated in areas with greater prior exposure to Johnson. We show that these men were both more likely to have been diagnosed via a formal blood test and less likely to die within 1 decade of their initial diagnosis-suggesting that Johnson's announcement caused an intertemporal substitution in testing which prolonged patients' lifespans as a result of earlier access to medical care. We estimate that Johnson's announcement caused approximately 800 additional heterosexual males in the United States in metropolitan statistical areas with National Basketball Association franchises men to discover their underlying AIDS diagnosis and, of whom, were more likely to live at least 1 decade beyond their initial diagnosis date.

Patient Living with Human Immunodeficiency Virus with Gingival Pain and Oral Soreness (Red and White Lesions).

A 34-year-old male patient with poorly controlled HIV/AIDS presented with symptoms consistent with oral candidiasis and necrotizing ulcerative gingivitis. He was treated with systemic antifungal agent and topical and systemic antibiotics.

Design and implementation of a global site assessment survey among HIV clinics participating in the International epidemiology Databases to Evaluate AIDS (IeDEA) research consortium.

INTRODUCTION: Timely descriptions of HIV service characteristics and their evolution over time across diverse settings are important for monitoring the scale-up of evidence-based program strategies, understanding the implementation landscape, and examining service delivery factors that influence HIV care outcomes. METHODS: The International epidemiology Databases to Evaluate AIDS (IeDEA) consortium undertakes periodic cross-sectional surveys on service availability and care at participating HIV treatment sites to characterize trends and inform the scientific agenda for HIV care and implementation science communities. IeDEA's 2020 general site assessment survey was developed through a consultative, 18-month process that engaged diverse researchers in identifying content from previous surveys that should be retained for longitudinal analyses and in developing expanded and new content to address gaps in the literature. An iterative review process was undertaken to standardize the format of new survey questions and align them with best practices in survey design and measurement and lessons learned through prior IeDEA site assessment surveys. RESULTS: The survey questionnaire developed through this process included eight content domains covered in prior surveys (patient population, staffing and community linkages, HIV testing and diagnosis, new patient care, treatment monitoring and retention, routine HIV care and screening, pharmacy, record-keeping and patient tracing), along with expanded content related to antiretroviral therapy (differentiated service delivery and roll-out of dolutegravir-based regimens); mental health and substance use disorders; care for pregnant/postpartum women and HIV-exposed infants; tuberculosis preventive therapy; and pediatric/adolescent tuberculosis care; and new content related to Kaposi's sarcoma diagnostics, the impact of COVID-19 on service delivery, and structural barriers to HIV care. The survey was distributed to 238 HIV treatment sites in late 2020, with a 95% response rate. CONCLUSION: IeDEA's approach for site survey development has broad relevance for HIV research networks and other priority health conditions.

Impacto psicosocial del diagnóstico del VIH/sida en la familia / Psychosocial Impact of the HIV/AIDS Diagnosis on the Family

Introducción: En la historia de la humanidad nunca antes una pandemia había causado tanta desolación y tristeza ni destruido a tantas familias con un impacto psicosocial tan alarmante. Objetivo: Determinar el impacto psicosocial del diagnóstico del VIH/sida en las familias de pacientes con ese diagnóstico. Métodos: Se realizó un estudio observacional, descriptivo transversal en las familias de pacientes con el diagnóstico del VIH/sida en el policlínico Armando García Aspurú, de Santiago de Cuba, desde enero del 2018 a enero del 2019. El universo estuvo constituido por las 26 familias que tuvieran al menos un miembro enfermo. Resultados: Las vías más frecuentes de información por las que la familia se enteró fueron por el mismo paciente, seguido de la información por los servicios de salud. La reacción de la familia ante la noticia fue la esperanza de que no fuera cierto, seguido por la depresión y la angustia. En las creencias que manifiesta la familia sobre el VIH prevalecieron las opiniones de que la enfermedad la adquieren personas de vida desorganizada. Sobre las pérdidas laborales, académicas y/o sociales sufridas por la aparición del VIH, 84,6 por ciento refirió rechazo a nivel de la pareja. Ante la estigmatización, la familia determina no hablar de la enfermedad por miedo al rechazo y sensación de vergüenza. Conclusiones: La infección por VIH/sida trasciende con multiplicidad de consecuencias en variados niveles. Los grandes impactos se relacionan con la familia, donde la estigmatización juega un papel fundamental como intensificador de la conducta familiar y social(AU)

Introduction: Never before in the history of humankind had a pandemic caused so much desolation and sadness or destroyed so many families with such an alarming psychosocial impact. Objective: To determine the psychosocial impact of the HIV/AIDS diagnosis on the families of patients with this diagnosis. Methods: An observational, descriptive and cross-sectional study was carried out in the families of patients with the HIV/AIDS diagnosis in the Armando García Aspurú polyclinic, of Santiago de Cuba, from January 2018 to January 2019. The study universe was made up of the 26 families with at least one sick member. Results: The most frequent ways of information by which the family found out were from the patient herself/himself, followed by information from the health services. The family's reaction to the news was hope that it was not true, followed by depression and anguish. In the beliefs expressed by the family about HIV, there was a prevalence of opinions related to the idea that the disease is acquired by people with a disorganized life. Regarding occupational, academic or social losses suffered due to the appearance of HIV, 84.6 percent reported rejection from her/his couple. Before stigmatization, the family determines not to talk about the disease, due to fear of rejection and the feeling of shame. Conclusions: HIV/AIDS infection transcends with a multiplicity of consequences at various levels. The major impacts are related to the family, where stigmatization plays a fundamental role as an intensifier of family and social behavior(AU)

Epidemiological and Clinical Profile of Newly Diagnosed HIV/AIDS Patients: A Retrospective Analysis of Changing Trends Over 16 Years.

OBJECTIVE: To evaluate the epidemiological profile and clinical findings of newly diagnosed HIV-infected patients in terms of changing trends over 16 years. METHODS: A total of 748 patients (mean ± SD age: 34 ± 11.6 years, 88.9% were males) newly diagnosed with HIV/AIDS at a tertiary care hospital located in Istanbul province between 2002 and 2017 were included in this retrospective study. Data on sociodemographic characteristics, potential routes of transmission, the reason for HIV testing, time from diagnosis to treatment onset, and the HIV RNA values and CD4+ T cell count (at diagnosis and treatment onset) were recorded in each patient and compared between the diagnoses made within the 2002-2009 (n = 141) vs. 2010-2017 (n = 607) periods. RESULTS: When compared to HIV diagnoses within the 2002-2009 period, the diagnoses made within the 2010-2017 period were associated with a significantly higher percentage of males (78.7 vs. 91.3%, p < 0.001), 18-29 years age group (23.6% vs. 35.5%, p = 0.029), singles (34.0 vs. 49.6%, p = 0.004), university graduates (9.9 vs. 23.4%, p < 0.001) and students (0.7 vs. 8.2%, p < 0.001) along with an increased likelihood of voluntary testing (6.4 vs. 15.2%, p = 0.048) and a lower percentage of heterosexual individuals (63.8 vs. 47.0%, p < 0.001). Sexual contact (88.0%) was the leading transmission route, and the presence of complaints (44.3%) was the leading reason for HIV testing. Overall, the time from diagnosis to treatment onset was a median 1 month (range, 1 to 97 months), and the median HIV RNA level at the time of diagnosis was 208065 copies/mL with no significant difference between study periods. The diagnoses within the 2010-2017 vs. 2002-2009 period were associated with significantly higher median (min-max) CD4+ T cell counts (378(0-2522) vs. 319(4-1270) cells/mm3, p < 0.001) and a lower percentage of patients with CD4+ T cell count < 200 cells/mm3 (22.1 vs. 39.0%, p = 0.002) at the time of diagnosis. CONCLUSION: In conclusion, our findings on the epidemiological profile and clinical characteristics of newly diagnosed HIV patients over 16 years (2002-2017) in a tertiary care center in Turkey revealed a considerable increase in the number of new diagnoses, an improved earlier diagnosis and a change in epidemiologic profile over the years with increased likelihood of disease to be more commonly diagnosed among males, 18-29 years age group and MSM.

Diagnósticos de Enfermagem a partir de narrativas de pessoas vivendo com HIV/AIDS em Guiné-Bissau / Nursing diagnosis from narratives of people living with hiv/aids in Guinea-Bissau / Diagnósticos de enfermería a partir de los relatos de personas que viven con el vih/sida en Guinea-Bissau

Objetivo: identificar e analisar os diagnósticos de Enfermagem mais frequentes de pessoas vivendo com HIV/aids em atendimento ambulatorial em Guiné-Bissau por meio de suas narrativas. Método: trata-se de uma análise secundária dos dados de um estudo com abordagem qualitativa, cujos participantes foram 16 pessoas vivendo com HIV/aids. Para identificar os diagnósticos de Enfermagem, foi utilizado o Processo Diagnóstico, que é um processo intelectual complexo na aplicação do Pensamento Crítico. Resultados: havia 16 participantes, sendo 12 do sexo feminino, e a mediana de idade foi de 33,5 anos. A partir das narrativas dos participantes, foram identificados 26 diferentes diagnósticos de Enfermagem, dos quais 10 tiveram frequência igual ou superior a 10%. Os 10 diagnósticos mais frequentemente identificados pertencem aos seguintes domínios: autopercepção; enfrentamento/tolerância ao estresse; promoção da saúde; conforto; percepção/cognição; e papéis e relacionamentos. Embora os diagnósticos identificados com significado mais positivo tenham aparecido em 50% dos participantes (disposição para o autoconceito melhorado e disposição para cuidado da saúde melhorado), as narrativas também indicaram que o processo de viver com HIV/aids tem sido bastante desafiador para o guineenses participantes no estudo, com presença de diagnóstico de risco de dignidade humana comprometida (50% dos participantes) e resiliência prejudicada (43,7% dos participantes). Conclusões: os diagnósticos de Enfermagem mais frequentes das pessoas vivendo com HIV/aids participantes deste estudo foram: disposição para autoconceito melhorado; risco de dignidade humana comprometida; e disposição para cuidado da saúde melhorado. Implicações para a prática de Enfermagem: na assistência de Enfermagem, é fundamental a implementação integral do Processo de Enfermagem, pois, dessa forma, a prestação de cuidados não ocorre apenas na esfera biológica, mas também na promoção de cuidados que atendam às necessidades dos pacientes, visando mais dignidade, cidadania e qualidade de vida.(AU)

Objective: to identify and analyze the most frequent Nursing diagnoses of people living with HIV/Aids in outpatient care in Guinea-Bissau through their narratives. Method: this is a secondary analysis of data from a study with a qualitative approach whose participants were sixteen people living with HIV/Aids. To identify the Nursing diagnoses, the Diagnostic Process was used, which is a complex intellectual process in the application of Critical Thinking. Findings: there were sixteen participants, twelve were female, and the median age was 33.5 years old. From the participants' narratives, 26 different Nursing diagnoses were identified. Of these, 10 had a frequency equal to or greater than 10%. The 10 most frequently identified diagnoses belong to the following Domains: Self-perception, Coping/stress tolerance, Health Promotion, Comfort, Perception/cognition and Role relationship. Although the diagnoses identified with the most positive meaning appeared in 50% of the participants (Readiness for enhanced self-concept and Readiness for enhanced health management), the narratives also indicated that the process of living with HIV/Aids has been quite challenging for the Guineans participating in the study, with presence of the Risk for compromised human dignity (50% of the participants) and Impaired resilience (43.7% of the participants) diagnoses. Conclusions: the more frequent Nursing diagnoses of people living with HIV/Aids that participate in this study were Readiness for enhanced self-concept, Risk for compromised human dignity and Readiness for enhanced health self-management. Implications for the Nursing practice: in Nursing care, the full implementation of the Nursing Process is fundamental since, in this way, provision of care not only occurs in the biological sphere but also in the promotion of care that meets the patients' needs, aiming for more dignity, citizenship and quality of life.(AU)

Objetivo: identificar y analizar los diagnósticos de enfermería más frecuentes de las personas que viven con VIH/SIDA en atención ambulatoria en Guinea-Bissau a través de sus narrativas. Método: se trata de un análisis secundario de datos de un estudio con enfoque cualitativo cuyos participantes fueron dieciséis personas que viven con VIH/SIDA. Para identificar los diagnósticos de enfermería se utilizó el Proceso Diagnóstico, que es un proceso intelectual complejo en la aplicación del Pensamiento Crítico. Resultados: hubo dieciséis...(AU)

Epidemiological investigation and proteomic profiling of typical TCM syndrome in HIV/AIDS immunological nonresponders.

HIV/AIDS pandemic remains the world's most severe public health challenge, especially for HIV/AIDS immunological nonresponders (HIV/AIDS-INRs), who tend to have higher mortality. Due to the advantages in promoting patients' immune reconstitution, Traditional Chinese medicine (TCM) has become one of the mainstays of complementary treatments for HIV/AIDS-INRs. Given that effective TCM treatments largely depend on precise syndrome differentiation, there is an increasing interest in exploring biological evidence for the classification of TCM syndromes in HIV/AIDS-INRs. In our study, to identify the typical HIV/AIDS-INRs syndrome, an epidemiological survey was first conducted in the Liangshan prefecture (China), a high HIV/AIDS prevalence region. The key TCM syndrome, Yang deficiency of spleen and kidney (YDSK), was evaluated by using a tandem mass tag combined with liquid chromatography-tandem mass spectrometry (TMT-LC-MS/MS). A total of 62 differentially expressed proteins (DEPs) of YDSK syndrome compared with healthy people were screened out. Comparative bioinformatics analyses showed that DEPs in YDSK syndrome were mainly associated with response to wounding and acute inflammatory response in the biological process. The pathway annotation is mainly enriched in complement and coagulation cascades. Finally, the YDSK syndrome-specific DEPs such as HP and S100A9 were verified by ELISA, and confirmed as potential biomarkers for YDSK syndrome. Our study may lay the biological and scientific basis for the specificity of TCM syndromes in HIV/AIDs-INRs, and may provide more opportunities for the deep understanding of TCM syndromes and the developing more effective and stable TCM treatment for HIV/AIDS-INRs.

Barreiras e facilitadores do enfrentamento de HIV/aids e sífilis por venezuelanas residentes no Brasil / Barriers and facilitators to confronting HIV/aids and syphilis experienced by Venezuelan women living in Brazil / Factores facilitadores y barreras que tienen las mujeres venezolanas residentes en Brasil respecto de la infección por el VIH/sida y la sífilis

RESUMO Objetivo. Descrever a percepção de mulheres venezuelanas sobre o acesso aos serviços de saúde, ao diagnóstico e ao tratamento de HIV/aids e sífilis no Brasil. Métodos. Trata-se de um estudo descritivo e exploratório, com abordagem qualitativa, realizado no período de fevereiro a maio de 2021 nos municípios de Manaus, estado do Amazonas, e Boa Vista, estado de Roraima. As entrevistas com as participantes foram transcritas na íntegra, com levantamento de temas a partir de análise de conteúdo. Resultados. Foram entrevistadas 40 mulheres (20 em Manaus e 20 em Boa Vista). A partir da transcrição e tradução das falas, foram identificadas duas categorias de análise de conteúdo: barreiras de acesso aos serviços de saúde, com quatro subcategorias — idioma, custos com saúde, reações adversas ao medicamento e pandemia de covid-19; e facilitadores do acesso, com quatro subcategorias — Sistema Único de Saúde, Política Nacional de Atenção Integral à Saúde da Mulher, Política Nacional de Assistência Social e relação entre profissional de saúde e usuária do Sistema Único de Saúde. Conclusão. Os resultados mostraram a necessidade de elaborar estratégias para mitigar as dificuldades enfrentadas pelas mulheres migrantes da Venezuela residentes no Brasil quanto ao diagnóstico e tratamento de HIV/aids e sífilis, indo além do amparo à saúde garantido pela lei.

ABSTRACT Objective. To describe the perception of Venezuelan women regarding access to health care, diagnosis, and treatment of HIV/aids and syphilis in Brazil. Method. This is a descriptive, exploratory study employing a qualitative approach, performed from February to May 2021 in the municipalities of Manaus, state of Amazonas, and Boa Vista, state of Roraima. The interviews with participants were fully transcribed, with identification of themes based on content analysis. Results. Forty women were interviewed (20 in Manaus and 20 in Boa Vista). Following transcription and translation of the accounts, two analytical categories were identified: barriers to healthcare access, with four subcategories — language, cost, adverse drug reactions, and COVID-19 pandemic; and facilitators of healthcare access, again with four subcategories — Unified Health System (SUS), National Policy of Comprehensive Women's Health, National Social Assistance Policy, and relationship between healthcare professionals and SUS users. Conclusion. The results showed the need to design strategies to mitigate the difficulties faced by migrant women from Venezuela living in Brazil regarding the diagnosis and treatment of HIV/aids and syphilis, going beyond the healthcare support guaranteed by law.

RESUMEN Objetivo. Describir la percepción de las mujeres venezolanas sobre el acceso a los servicios de salud, al diagnóstico y al tratamiento de la infección por el VIH/sida y la sífilis en Brasil. Métodos. Se trata de un estudio descriptivo y exploratorio, con enfoque cualitativo, realizado entre febrero y mayo del 2021 en los municipios de Manaos, estado de Amazonas, y Boa Vista, estado de Roraima. Las entrevistas con las participantes se transcribieron en su totalidad, y se exploraron los puntos de interés según el análisis del contenido. Resultados. Se entrevistaron 40 mujeres (20 en Manaos y 20 en Boa Vista). A partir de la transcripción y la traducción de las conversaciones, se establecieron dos categorías para el análisis del contenido: las barreras de acceso a los servicios de salud (subcategorías: idioma, costos relacionados con la salud, reacciones adversas a los medicamentos y pandemia de COVID-19); y los factores facilitadores del acceso (cuatro subcategorías: Sistema Único de Salud, Política nacional de Atención Integral a la Salud de la Mujer, Política Nacional de Asistencia Social y relación entre los profesionales de salud y las usuarias del Sistema Único de Salud). Conclusión. Los resultados mostraron la necesidad de formular estrategias para mitigar las dificultades que enfrentan las mujeres migrantes de Venezuela residentes en Brasil en relación con el diagnóstico y el tratamiento de la infección por el VIH/sida y la sífilis, más allá de la protección de la salud garantizada por la ley.

[Characteristics of mortality density of HIV/AIDS cases after diagnosis in Jiamusi of Heilongjiang province, 2010-2020].

Objective: To analyze characteristics of mortality density and the influencing factors of HIV/AIDS after diagnosis in Jiamusi of Heilongjiang province. Methods: The data were retrieved from HIV/AIDS Comprehensive Response Information System and selected cases diagnosed with HIV/AIDS in Jiamusi of Heilongjiang province during 2010-2020 and aged 15 years or older as the study objects. The method of retrospective cohort study was used to collect baseline and follow-up information, and characteristics of mortality density after HIV diagnosis were described. Death after HIV diagnosis was divided into 1-6 months, 7-12 months, and ≥13 months after HIV diagnosis. The Cox proportional hazards model was used to analyze the associated factors of mortality density within six months after HIV diagnosis. Excel 2019 and SPSS 22.0 software were used for data processing and statistical analysis. Results: A total of 953 HIV/AIDS with 173 deaths were included during the study period. Most HIV/AIDS were men (89.19%, 850/953), single or divorced or widowed (76.50%, 729/953), educated in middle school and lower level (51.84%, 494/953), and men who have sex with men (77.02%, 734/953). There was a cumulative follow-up of 3 944.59 person-years, with an overall mortality density of 4.39 (95%CI: 3.79-5.07)/100 person- years. The mortality density was highest in 21.60 (95%CI: 18.04-25.86) 100 person-years within the first six months after diagnosis, then decreased to 2.02 (95%CI: 1.59-2.58)/100 person-years over 13 months or more after HIV diagnosis. HIV/AIDS who died within the first six months after diagnosis had a higher proportion of first CD4+T lymphocytes (CD4) counts untested (51.61%, 48/93) and AIDS-related deaths (32.26%, 30/93). In the multivariate analysis of the Cox proportional hazards regression model, mortality density within the first six months after HIV diagnosis was greater among HIV/AIDS who were older at diagnosis, detected by medical institutions, with lower first CD4 counts or no testing, and never receiving antiretroviral therapy (ART). Conclusions: Mortality density was generally low in Jiamusi of Heilongjiang province during 2010-2020 and declined over the follow-up time. However, early diagnosis and immediate ART initiation should be strengthened. Attention should also be paid to follow-up care management and referral services for HIV/AIDS within the first six months after HIV diagnosis to reduce the risk of death after HIV diagnosis.

Diagnostic value of EBV-DNA in CSF for PCNSL in AIDS patients with focal brain lesions: A meta-analysis of diagnostic test.

BACKGROUND: Epstein-Barr virus (EBV) infection plays a crucial role in the progression of acquired immunodeficiency syndrome related primary central nervous system lymphoma (AR-PCNSL). This study aimed at evaluating the diagnostic value of cerebrospinal spinal fluid (CSF) EBV-deoxyribonucleic acid (DNA) for PCNSL in patients with infection of human immunodeficiency (HIV) virus through a meta-analysis of diagnostic test. METHODS: A systematic search in PubMed, Embase, Web of Science, Wanfang, Chinese Biomedical Database and Chinese National Knowledge Infrastructure was conducted before May 10, 2022. Heterogeneity among the studies was assessed using Q test and I2 statistics. Publication bias was assessed using the Deek's funnel plot asymmetry test. Statistical analyses were performed using Stata 16.0 software. The pooled sensitivity, specificity, positive and negative likelihood ratios (PLR and NLR), diagnostic odds ratios (DOR) and 95% confidence intervals (CI) were caculated to evaluate the diagnostic value. A symmetric receiver operating characteristic (SROC) curve and the area under the SROC curve (AUC) were constructed to evaluate the test-performance. RESULTS: Twelve studies were included in the final analyses, with a total of 141 patients with AR-PCNSL and 590 controls. The pooled diagnostic values were sensitivity of 0.83 (95% CI: 0.73-0.90), specificity of 0.95 (95%CI: 0.89-0.98), PLR of 17.8 (95%CI: 6.8-46.1), NLR of 0.17 (95%CI: 0.10-0.30), DOR of 102 (95%CI: 28-379), and AUC of 0.94 (95%CI: 0.91-0.96). CONCLUSION: In summary the overall diagnostic value of CSF EBV-DNA is very high and it can be a reliable diagnostic biomarker for AR-PCNSL.