Health-related quality of life among women aging with and without HIV in Peru.

BACKGROUND: Studies have shown that women aging with HIV have significantly lower health-related quality of life (HRQoL) compared to women without HIV. However, no studies have examined this issue in Latin America and the Caribbean. We aimed to explore HRQoL measured by the 36-Item Short Form Health Survey (SF-36) among women aging with and without HIV in Peru. MATERIALS AND METHODS: We conducted a cross-sectional study at a large HIV-clinic in Peru. Outcomes of the SF-36 were evaluated, exploring the relationship between physical activity (International Physical Activity Questionnaire), sociodemographic factors (ethnicity, alcohol/tobacco use, age, BMI) and clinical data (AIDS progression, treatment duration, CD4+ cell count and viral load, years since HIV diagnosis) with HRQoL using regression analysis. Statistical significance was set with a two-tailed p-value <0.05. RESULTS: We enrolled 427 women (175 HIV-infected) with mean age of 54±8 years. From the SF-36 individual domains: physical functioning, role limitations due to physical and emotional health, and emotional wellbeing were significantly lower for HIV-infected women. Summary component scores were lower for the HIV-subset for both physical (45.8 vs 47.3) and mental (45.1 vs 45.8) components, although they did not achieve statistical significance. Regression analysis of the HIV-infected women revealed that the physical component score was significantly associated with physical activity, ethnicity, and chronic comorbidities while the mental component was significantly associated with physical activity, employment, and CD4+ cell count. CONCLUSION: In our study, HIV-infected women scored lower in both physical and mental component scores. Important determinants for each component included CD4+ cell count as an assessment of HIV severity for the mental component, and ethnicity, reflecting socio-cultural factors, for the physical component. These results reveal the importance of a holistic approach to addressing HRQoL in this population. Better understanding of these factors will help shape future policies and interventions to improve HRQoL of women aging with HIV.

Aging with HIV in Latin America and the Caribbean: a Systematic Review.

PURPOSE OF REVIEW: With the establishment of antiretroviral treatment (ART) programs in low- and middle-income countries, people with HIV (PWH) in Latin America and the Caribbean (LAC) are living longer, subsequently developing chronic non-communicable diseases (NCDs). Few studies focus on the impact of aging among older LAC PWH. This systematic review aims to fill this information gap and understand the burden of aging with HIV in LAC. We identified peer-reviewed literature published in English, Spanish, or Portuguese from several databases to assess currently available evidence on the burden of aging with HIV in LAC and selected six common NCDs found in older PWH (cardiovascular disease [CVD], bone and musculoskeletal [MSK] disorders, cancer, renal disease, neurocognitive impairment [NCI], and depression). RECENT FINDINGS: Of the 5942 publications reviewed, only 53 articles were found with populations 40 years and older or age-related findings (27 CVD, 13 NCI or depression, 6 MSK disorders, 4 renal disease, 3 cancer). Most (79%) publications were from Brazil with few longitudinal studies on aging with HIV. Prevalence of illnesses such as CVD, NCI, depression, or osteoporosis varied widely depending on the screening instrument utilized and geographic population surveyed. Age was a significant predictor of comorbidity in nearly all studies. Our results demonstrate the need for longitudinal studies and validated screening instruments appropriate for use among PWH in LAC. Understanding the mechanisms behind aging in HIV and the roles of sociocultural factors and genetic diversity specific to LAC is needed to appropriately manage chronic comorbidities as PWH age.

Incidencia y factores de riesgo de infecciones del torrente sanguíneo asociadas a catéter central / Incidence and risk factors of central line catheter-related bloodstream infections

RESUMEN Las infecciones del torrente sanguíneo asociadas a catéter central (ITSACC) generan gran morbimortalidad y elevados costos hospitalarios. Estudios sobre su incidencia y comportamiento clínico-epidemiológicos en la población neonatal en el Perú son escasos y no está del todo claro su impacto actual. Se realizó un estudio de cohorte prospectivo durante un año (2017-2018) en la unidad de cuidados intensivos (UCI) neonatales de un hospital público de Lima, Perú. Se incluyeron 167 pacientes (52,7% varones) con edades gestacionales entre las 24-41 semanas, se registraron 1999 días-catéter y 16 casos de ITSACC. La incidencia fue de 8/1000 días-catéter. El uso de catéter umbilical (p=0,005) y el uso de múltiples catéteres (p<0,001) mostraron relación estadísticamente significativa respecto al desarrollo de ITSACC. Es necesario ampliar el estudio a otras UCI y establecer sistemas eficientes y duraderos de monitoreo que permitan la evaluación de intervenciones para reducir las ITSACC.

ABSTRACT Central line catheter-related bloodstream infections (CLABSI) burdens great morbidity, mortality and unnecessary hospital expenses. Studies related to its incidence and epidemiological and clinical profile among neonates in Peru are scarce, not being clear it's actual impact. A prospective cohort study was conducted in a neonatal intensive care unit (ICU) of a public hospital in Lima, Peru between 2017-2018. 167 patients were included (52,7% male) with gestational age between 24-41 weeks, obtaining 1999 catheter-days and 16 cases of CLABSI. The incidence rate was 8/1000 catheter-days. Use of umbilical catheter (p=0,005) and multiple catheters (p<0,001) both showed a statistically significant correlation regarding the development of CLABSI. It's necessary to extend the study to other ICUs and stablish solid, efficient and long-lasting system of CLABSI surveillance that allows the evaluation of possible interventions to reduce the incidence of CLABSI.

Los desafíos en la continuidad de atención de personas viviendo con VIH en el Perú durante la pandemia de la COVID-19 / Challenges to the continuity of care of people living with HIV throughout the COVID-19 crisis in Peru

RESUMEN La pandemia por la COVID-19 y las medidas restrictivas de distanciamiento social pueden interactuar con la epidemia de VIH de múltiples formas. Existen aproximadamente 87 000 personas viviendo con VIH (PVV) en el Perú quienes están en riesgo de contraer la COVID-19; 67 000 de ellas que reciben tratamiento antirretroviral (TAR) podrían tener limitaciones en el acceso a sus medicamentos, comprometiendo su adherencia y su salud. Además, el efecto que podría tener la pandemia en la salud mental de PVV en Perú aún no está esclarecido. Este artículo tiene como finalidad describir las implicancias clínicas de la coinfección VIH/SARS-CoV-2; discutir los desafíos en la continuidad de atención de las PVV en el Perú durante la crisis sanitaria por la COVID-19; y comentar las posibles implicancias de las medidas restrictivas sobre la salud mental de las PVV.

ABSTRACT The COVID-19 pandemic and societal response implemented may interact with the ongoing HIV epidemic in multiple ways. There are approximately 87000 people living with HIV (PLWH) who are at risk of developing COVID-19 in Peru and 67,000 of them are on antiretroviral therapy (ART) and at risk of limitations in their access to ART, compromising their adherence and their health during the pandemic. Finally, the potential effect of the pandemic on the mental health of PLWH is not documented. This opinion aims to: describe the clinical implications of the HIV/SARS-CoV-2 coinfection; discuss the challenges to the continuity of care of PLWH in Peru during the COVID-19 crisis; and comment possible implications that the COVID-19 crisis may pose on the mental health of PLWH.

Incidencia y factores de riesgo de infecciones del torrente sanguíneo asociadas a catéter central / Incidence and risk factors of central line catheter-related bloodstream infections

RESUMEN Las infecciones del torrente sanguíneo asociadas a catéter central (ITSACC) generan gran morbimortalidad y elevados costos hospitalarios. Estudios sobre su incidencia y comportamiento clínico-epidemiológicos en la población neonatal en el Perú son escasos y no está del todo claro su impacto actual. Se realizó un estudio de cohorte prospectivo durante un año (2017-2018) en la unidad de cuidados intensivos (UCI) neonatales de un hospital público de Lima, Perú. Se incluyeron 167 pacientes (52,7% varones) con edades gestacionales entre las 24-41 semanas, se registraron 1999 días-catéter y 16 casos de ITSACC. La incidencia fue de 8/1000 días-catéter. El uso de catéter umbilical (p=0,005) y el uso de múltiples catéteres (p<0,001) mostraron relación estadísticamente significativa respecto al desarrollo de ITSACC. Es necesario ampliar el estudio a otras UCI y establecer sistemas eficientes y duraderos de monitoreo que permitan la evaluación de intervenciones para reducir las ITSACC.

ABSTRACT Central line catheter-related bloodstream infections (CLABSI) burdens great morbidity, mortality and unnecessary hospital expenses. Studies related to its incidence and epidemiological and clinical profile among neonates in Peru are scarce, not being clear it's actual impact. A prospective cohort study was conducted in a neonatal intensive care unit (ICU) of a public hospital in Lima, Peru between 2017-2018. 167 patients were included (52,7% male) with gestational age between 24-41 weeks, obtaining 1999 catheter-days and 16 cases of CLABSI. The incidence rate was 8/1000 catheter-days. Use of umbilical catheter (p=0,005) and multiple catheters (p<0,001) both showed a statistically significant correlation regarding the development of CLABSI. It's necessary to extend the study to other ICUs and stablish solid, efficient and long-lasting system of CLABSI surveillance that allows the evaluation of possible interventions to reduce the incidence of CLABSI.

Los desafíos en la continuidad de atención de personas viviendo con VIH en el Perú durante la pandemia de la COVID-19 / Challenges to the continuity of care of people living with HIV throughout the COVID-19 crisis in Peru

RESUMEN La pandemia por la COVID-19 y las medidas restrictivas de distanciamiento social pueden interactuar con la epidemia de VIH de múltiples formas. Existen aproximadamente 87 000 personas viviendo con VIH (PVV) en el Perú quienes están en riesgo de contraer la COVID-19; 67 000 de ellas que reciben tratamiento antirretroviral (TAR) podrían tener limitaciones en el acceso a sus medicamentos, comprometiendo su adherencia y su salud. Además, el efecto que podría tener la pandemia en la salud mental de PVV en Perú aún no está esclarecido. Este artículo tiene como finalidad describir las implicancias clínicas de la coinfección VIH/SARS-CoV-2; discutir los desafíos en la continuidad de atención de las PVV en el Perú durante la crisis sanitaria por la COVID-19; y comentar las posibles implicancias de las medidas restrictivas sobre la salud mental de las PVV.

ABSTRACT The COVID-19 pandemic and societal response implemented may interact with the ongoing HIV epidemic in multiple ways. There are approximately 87000 people living with HIV (PLWH) who are at risk of developing COVID-19 in Peru and 67,000 of them are on antiretroviral therapy (ART) and at risk of limitations in their access to ART, compromising their adherence and their health during the pandemic. Finally, the potential effect of the pandemic on the mental health of PLWH is not documented. This opinion aims to: describe the clinical implications of the HIV/SARS-CoV-2 coinfection; discuss the challenges to the continuity of care of PLWH in Peru during the COVID-19 crisis; and comment possible implications that the COVID-19 crisis may pose on the mental health of PLWH.