ABSTRACT
Desde 2007, el Servicio de Epidemiología e Infectología, ha implementado un programa de transición que busca optimizar la atención de los adolescentes con infección por el HIV durante el paso de la atención pediátrica a la de adultos. Objetivo: Describir las características clínicas, epidemiológicas, virológicas y psicosociales de los adolescentes con infección HIV atendidos en el Programa y analizar el proceso de transición. Materiales y Métodos: Estudio de cohorte retrospectivo. Se incluyeron a los adolescentes, atendidos en el Programa de Transición entre enero de 2019 y diciembre de 2023, en el Hospital Garrahan, con al menos un resultado de CV y CD4+ en ese período. Se obtuvo la información de la historia clínica electrónica y se analizaron variables clínicas, epidemiológicas, virológicas, terapéuticas y psicosociales. Resultados: Se incluyeron 124 pacientes. La vía de transmisión fue vertical en el 92,74% y el estadio clínico e inmunológico era avanzado. En el momento de la transición 77,4% se encontraban con supresión virológica y con recuperación inmunológica. El 55,6% ya realizó la transición a un centro de adultos, 31,4% continúan en el programa, 11,3% se perdieron en el seguimiento y 1,7% fallecieron. Se recopilaron los datos de 31 pacientes transferidos. La mediana de seguimiento fue de 2 años; 25 pacientes (80,6%) continúan en seguimiento. Conclusiones: A pesar de la pandemia de COVID-19, el programa logró la retención de los adolescentes con infección por HIV y una transferencia sostenida en el tiempo. Además de un programa de transición estructurado para garantizar una atención continua y de calidad, es necesario continuar evaluando la evolución postransición (AU)
Since 2007, the Epidemiology and Infectious Diseases Department has implemented a transition program to optimize the care of adolescents with HIV infection during their transition from pediatric to adult care. Objective: To describe the clinical, epidemiological, virological, and psychosocial characteristics of adolescents with HIV infection treated in the program and to analyze the transition process. Materials and Methods: A retrospective cohort study was conducted. Adolescents followed in the Transition Program at Garrahan Hospital between January 2019 and December 2023, with at least one viral load and CD4+ result during that period, were included. Information was obtained from electronic medical records, and clinical, epidemiological, virological, therapeutic, and psychosocial variables were analyzed. Results: A total of 124 patients were included. The route of transmission was vertical in 92.74%, and the clinical and immunologic stage was advanced. At the time of transition, 77.4% were virologically suppressed and had achieved immunologic recovery. Of the patients, 55.6% had already transitioned to an adult center, 31.4% were still in the program, 11.3% were lost to follow-up, and 1.7% died. Data were collected from 31 transferred patients, with a median follow-up of 2 years; 25 patients (80.6%) remain in follow-up. Conclusions: Despite the COVID-19 pandemic, the program successfully retained HIVinfected adolescents and ensured sustained transition over time. In addition to a structured transition program to ensure continuous and quality care, it is necessary to continue evaluating post-transition outcomes (AU)
Subject(s)
Humans , Adolescent , Patient Care Team , HIV Infections/drug therapy , Continuity of Patient Care , Anti-Retroviral Agents/therapeutic use , Transition to Adult Care/organization & administration , Retrospective Studies , Cohort StudiesABSTRACT
El alelo HLA B*57:01 es un marcador genético asociado con la hipersensibilidad al fármaco anti-retroviral abacavir (ABC) y su frecuencia en la población peruana todavía es desconocida. El objetivo fue identificar el alelo HLA B*57:01 en una población militar de Lima, Perú. Se reclutaron 43 personas viviendo con VIH (PVV) quienes aceptaron participar a través de un consentimiento informado. La detección del alelo HLA B*57:01 se realizó mediante RPC en tiempo real (RT-PCR). Asimismo, se determinó la carga viral (CV), el recuento de linfocitos CD4 y la genotipificación del VIH. Se identificaron dos casos positivos al alelo HLA B*57:01 (4,7%). Además, uno de ellos presentó múltiples mutaciones de resistencia a los anti-retrovirales (ARV), incluyendo ABC. Se demostró por primera vez en el Perú la presencia del alelo HLA B*57:01.
The HLA B*57:01 allele is a genetic marker associated with hypersensitivity to the antiretroviral Abacavir (ABC) and its frequency in the Peruvian population is still unknown. The objective was to identify the HLA B*57:01 allele in a military population from Lima, Peru. Forty three people living with HIV (PLWH) were recruited, who agreed to participate through informed consent. Detection of the HLA B*57:01 allele was performed by real-time PCR (RT-PCR). Likewise, viral load (VL), CD4 lymphocyte count and HIV genotyping were determined. Two cases positive for the HLA B*57:01 allele (4.7%) were identified. In addition, one of them had multiple resistance mutations to antiretrovirals (ARVs), including ABC. The presence of the HLA B*57:01 allele was demonstrated for the first time in Peru.
Subject(s)
Humans , Male , Middle Aged , HIV Infections/genetics , Anti-HIV Agents/adverse effects , Drug Hypersensitivity/genetics , Military Personnel , Peru , HLA-B Antigens/genetics , Genetic Markers , HIV Infections/drug therapy , HIV/genetics , CD4 Lymphocyte Count , Viral Load/genetics , Genetic Predisposition to Disease , Cyclopropanes/adverse effects , Drug Hypersensitivity/immunology , Alleles , Real-Time Polymerase Chain Reaction , GenotypeABSTRACT
INTRODUCCIÓN: En las cuatro décadas de la epidemia por VIH, se han observado avances notables que han contribuido a una disminución progresiva en la incidencia de nuevas infecciones y en la mortalidad a nivel mundial. Sin embargo, no ha ocurrido lo mismo en Latinoamérica y en Chile. OBJETIVO: Esta revisión tiene como objetivo conocer la epidemiología actual a nivel global, latinoamericano y chileno. METODOLOGÍA: Se analizaron los informes epidemiológicos oficiales de infección por VIH emitidos por organismos nacionales e internacionales, más los estudios epidemiológicos nacionales. RESULTADOS: Se estima que 39 millones de personas viven con VIH en el mundo; no obstante, la mortalidad y la incidencia de nuevos casos han disminuido de forma notoria durante las últimas dos décadas, asociado a una expansión en al acceso a terapia antirretroviral en forma global. A diferencia del resto del mundo, América Latina presenta una tendencia de alza en las nuevas infecciones y Chile registra un aumento de 35% en nuevos casos durante los últimos 10 años, coincidiendo con un aumento en los flujos de migrantes que ha afectado a la región. Algunas estrategias preventivas como la profilaxis pre exposición se han implementa-do a un ritmo lento, tanto a nivel mundial, como latinoamericano. CONCLUSIONES: La epidemiología del VIH presenta características propias regionales y nacionales. En particular en Chile, diversos factores incluyendo déficit en políticas públicas de prevención y los recientes flujos migratorios han modelado nuestra actual epidemia. El desafío presente debe contemplar los esfuerzos multisectoriales para lograr los objetivos de ONUSIDA en esta década.
BACKGROUND: Over the course of the last four decades of global HIV epidemic, significant improvements have contributed to gradually reduce the frequency of new infections and global mortality rates. However, in Latin America particularly in Chile, new infections continue increasing. AIM: This review aims to comprehend the_epidemiology today on a worldwide, Latin American, and Chilean scale. METHODS: National epidemiology studies and official HIV reports from international and national organizations were reviewed. RESULTS: It is estimated that 39 million people live with HIV worldwide; however, mortality and the incidence of new cases have decreased markedly over the last two decades, associated with an expansion in access to antiretroviral therapy globally. In contrast to the rest of the world, Latin America shows an upward trend in new infections, with Chile registering a 35% increase in new cases over the last 10 years, coinciding with an increase in migratory flows that has occurred throughout the region. Some preventive strategies, such as pre-exposure prophylaxis, have been implemented at a slow pace, both globally and in Latin America. CONCLUSIONS: The epidemiology of HIV has regional and national characteristics. Specifically in Chile, several factors, including deficits in public prevention policies and recent migratory flows, have shaped our current epidemic. The present challenge must contemplate multisectoral efforts to achieve the UNAIDS objectives during this decade.
Subject(s)
Humans , HIV Infections/epidemiology , HIV Infections/prevention & control , HIV Infections/drug therapy , HIV Infections/transmission , Chile/epidemiology , Global Health , Infectious Disease Transmission, Vertical/statistics & numerical data , Anti-Retroviral Agents/therapeutic use , Latin America/epidemiologyABSTRACT
El enfrentamiento de las personas que viven con VIH es amplio y requiere dedicación en múltiples dimensiones, más allá de la terapia antirretroviral. Estas recomendaciones abordan el manejo desde el diagnóstico, primera visita, seguimiento, manejo de comorbilidades infecciosas y no infecciosas, tamizaje de neoplasias, profilaxis antimicrobiana y vacunas, entre otras.
Management of people living with HIV is broad and multiple dimensions must be considered, beyond antiretroviral therapy. These recommendations include management from diagnosis, first visit, patient follow-up, infectious and non-infectious comorbidities, malignancies screening, antimicrobial and immunizations prophylaxis, among others.
Subject(s)
Humans , HIV Infections/diagnosis , HIV Infections/therapy , Ambulatory Care/standards , ChileABSTRACT
El uso de antirretrovirales (ARV) en el embarazo, el parto y el recién nacido y la aplicación de tratamientos combinados en los niños se han asociado con una disminución del sida en pediatría y el aumento de la sobrevida. La introducción de los inhibidores de integrasa en una dosis diaria ha eliminado barreras para la adherencia, pero los medicamentos orales diarios continúan planteando problemas de privacidad y estigma. Las nuevas tecnologías de administración de los medicamentos y las nuevas drogas junto con la combinación de ARV y los anticuerpos ampliamente neutralizantes (bNAb), ofrecen un potencial de opciones futuras para el tratamiento pediátrico del HIV. Los bNAb son anticuerpos que pueden reconocer diferentes tipos de HIV, bloquear su entrada en las células sanas y ayudar a destruir las células ya infectadas, pueden administrarse por vía parenteral y constituyen un enfoque novedoso y seguro con potencial para el tratamiento y la prevención del HIV, incluida la transmisión vertical. En los lactantes que contraen HIV, los bNAb podrían ofrecer ventajas terapéuticas al reducir el reservorio del virus, mejorar la inmunidad adquirida y, en el futuro, proporcionar un camino hacia la cura funcional. Dentro de los ARV inyectables de acción prolongada, cabotegravir/ rilpivirina se ha incorporado en las guías internacionales de adultos y adolescentes tanto para el tratamiento como para la prevención. A medida que el tratamiento del HIV en adultos va evolucionando, es fundamental asegurar que los neonatos, lactantes, niños y adolescentes tengan acceso a las mejores opciones de tratamiento y prevención a lo largo de su vida (AU)
The use of antiretrovirals (ARVs) during pregnancy, delivery, and in the newborn and the use of combination therapy in children have been associated with a decrease in pediatric AIDS and increased survival. The introduction of once-daily integrase inhibitors has removed barriers to adherence, but daily oral medications continue to pose privacy and stigma issues. New drug delivery technologies and new drugs along with the combination of ARVs and broadly neutralizing antibodies (bNAbs) offer potential future options for pediatric HIV treatment. bNAbs are antibodies that can recognize different types of HIV, block their entry into healthy cells and help destroy already infected cells, can be delivered parenterally, and represent a novel and safe approach with potential for the treatment and prevention of HIV, including mother-to-child transmission. In infants who contract HIV, bNBAs could offer therapeutic advantages by reducing the viral reservoir, enhancing acquired immunity and, in the future, providing a pathway to a functional cure. Within the long-acting injectable ARVs, cabotegravir/rilpivirine has been incorporated into international guidelines for adults and adolescents for both treatment and prevention. As adult HIV treatment evolves, it is critical to ensure that newborns, infants, children and adolescents have access to the best treatment and prevention options throughout their lives (AU)
Subject(s)
HIV Infections/prevention & control , HIV Infections/drug therapy , Anti-Retroviral Agents/administration & dosage , Anti-Retroviral Agents/therapeutic use , Infectious Disease Transmission, Vertical/prevention & control , Drug CompoundingABSTRACT
Antecedentes: La sífilis es una infección sexualmente transmisible sistémica crónica que afecta a docenas de millones de personas al año. A nivel anorrectal, su manifestación polimórfica obliga al diagnóstico diferencial con enfermedades anorrectales benignas y malignas. Objetivo: Describir las diferentes presentaciones de la sífilis anorrectal a propósito de 5 casos clínicos. Método: Estudio observacional, retrospectivo, descriptivo. Resultados: La mayoría de los pacientes fueron VIH positivos en edad sexual activa. Las manifestaciones registradas, al igual que las reportadas en la bibliografía fueron las fisuras, úlceras perianales y pseudotumores. Conclusiones: La sífilis es considerada "la gran simuladora". En la localización anorrectal se requiere una alta sospecha diagnóstica para diferenciarla de presentaciones similares de otras enfermedades anales benignas, la enfermedad inflamatoria intestinal y el cáncer anorrectal, con el fin de evitar el consiguiente riesgo de sobretratamiento. (AU)
Background: Syphilis is a chronic systemic sexually transmitted infection that affects tens of millions of people annually. At the anorectal level, its polymorphic manifestation requires differential diagnosis with benign and malignant anorectal diseases. Objective: To review the presentation of anorectal syphilis from 5 clinical cases. Methods: Observational, retrospective, descriptive study. Results: Most of the patients were HIV positive in sexually active age. The manifestations recorded and reported in the literature were fissures, perianal ulcers, and pseudotumors. Conclusions: Syphilis is considered "the great pretender". In anorectal syphilis, a high diagnostic suspicion is needed to differentiate it from similar presentations due to other anal conditions, inflammatory bowel disease, and anorectal cancer, to avoid the consequent risk of overtreatment. (AU)
Subject(s)
Humans , Male , Female , Adult , Penicillin G Benzathine/administration & dosage , Rectal Diseases/diagnosis , Syphilis/diagnosis , Syphilis/drug therapy , Risk Groups , Syphilis Serodiagnosis , Comorbidity , HIV Infections , Retrospective Studies , Fissure in AnoABSTRACT
Se presenta el caso clínico de persona viviendo con VIH, con mala adherencia a tratamiento, sin vacunación previa para mpox, que evolucionó con un cuadro clínico probable de síndrome de reconstitución inmune posterior a reinicio de TAR, debido a la progresión de las lesiones cutáneas. Recibió tratamiento con tecovirimat por siete días, con evolución clínica favorable. Corresponde al primer caso reportado que recibió terapia con tecovirimat en Chile.
We report a clinical case of a person living with HIV with poor adherence to treatment, no previous mpox vaccination, who had a probable mpox syndrome immune reconstitution after restarting ART, due to worsening of skin lesions. He received treatment with tecovirimat for 7 days, clinically improved and was discharged in good condition. We reported this first clinical case that received tecovirimat in Chile.
Subject(s)
Humans , Male , Adult , HIV Infections/complications , Mpox (monkeypox)/complications , Mpox (monkeypox)/drug therapy , Immune Reconstitution Inflammatory Syndrome/etiology , Antiviral Agents/therapeutic use , Phthalimides/therapeutic use , Benzamides/therapeutic useABSTRACT
La resistencia a los antirretrovirales (ARV) es un problema de salud pública. Con el uso de inhibidores de la integrasa (INSTI) en pediatría, también comienzan a aparecer resistencias. El objetivo de esta comunicación es describir 3 casos con resistencia a los INSTI. Se describen 3 pacientes pediátricos con transmisión vertical del virus de la inmunodeficiencia humana (VIH). Iniciaron ARV de lactantes y preescolares, con mala adherencia al tratamiento, cursaron con diferentes planes secundarios a comorbilidades asociadas y fallas virológicas por resistencia. Los 3 casos clínicos describen la rápida aparición de resistencia frente a la falla virológica y el compromiso de los INSTI. La adherencia debe ser supervisada para detectar precozmente el aumento de la viremia. La falla virológica en un paciente tratado con raltegravir obliga a un rápido cambio de esquema ARV, ya que continuar utilizándolo podría favorecer nuevas mutaciones y resistencia a los INSTI de segunda generación.
Antiretroviral (ARV) drug resistance is a public health issue. Resistance has also been observed in the case of integrase strand transfer inhibitors (INSTIs) used in pediatrics. The objective of this article is to describe 3 cases of INSTI resistance. These are the cases of 3 children with vertically-transmitted human immunodeficiency virus (HIV). They were started on ARVs as infants and preschoolers, with poor treatment adherence, and had different management plans due to associated comorbidities and virological failure due to resistance. In the 3 cases, resistance developed rapidly as a result of virological failure and INSTI involvement. Treatment adherence should be monitored so that any increase in viremia can be detected early. Virological failure in a patient treated with raltegravir forces to a rapid change in ARV therapy because its continued use may favor new mutations and resistance to second-generation INSTIs.
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , HIV Infections/drug therapy , HIV-1/genetics , HIV Integrase Inhibitors/therapeutic use , HIV Integrase Inhibitors/pharmacology , Anti-HIV Agents/therapeutic use , Uruguay , Raltegravir Potassium/therapeutic use , Raltegravir Potassium/pharmacology , MutationABSTRACT
Objetivo: Nos últimos anos, a epidemia de HIV tem incidido consideravelmente e de forma silenciosa na população de mulheres gestantes, sobretudo devido à subnotificação, ao diagnóstico tardio e à negligência quanto à realização de teste anti-HIV pelas infectadas. Diante disso, este estudo tem por objetivo descrever o perfil clínico e epidemiológico de gestantes que vivem com HIV na Macrorregião Sul de Saúde de Santa Catarina. Métodos: Trata-se de um estudo ecológico, ana- lítico, retrospectivo, com base em dados secundários retirados das plataformas Sistema de Informações de Agravos de Notificação (Sinan) e Sistema de Monitora- mento Clínico das Pessoas Vivendo com HIV/AIDS (SIMC), acerca de gestantes que vivem com HIV na Macrorregião Sul de Saúde de Santa Catarina, no período entre 2019 e 2022. Resultados: A partir dos dados sociodemográficos, obteve-se um perfil epidemiológico prevalente de mulheres com idade entre 30 e 49 anos, brancas, com baixo nível de escolaridade e entre 1 a 13 semanas de gestação no momento da notificação de infecção por HIV. O perfil clínico apontou para a prevalência de mulheres em uso de terapia antirretroviral, com carga viral acima de 1.000 cópias/ mL e contagem de linfócitos T-CD4+ superior a 350 células/mm3. Conclusão: Apesar do baixo nível de escolaridade e da elevada carga viral, o resultado foi positivo para a população selecionada, uma vez que foi demonstrada boa adesão ao tra- tamento e alta contagem de linfócitos, sendo esses bons preditores de evolução clínica para o HIV.
Objective: In recent years, the HIV epidemic has significantly and silently affected the population of pregnant women, mainly due to underreporting, late diagnosis, and neglect of HIV testing among infected individuals. In light of this, the aim of this study is to describe the clinical and epidemiological profile of pregnant women living with HIV in the Southern Health Macroregion of Santa Catarina. Methods: This is an ecological, analytical, retrospective study based on secondary data retrieved from the Notifiable Diseases Information System (Sinan) and the Clinical Monitoring System for People Living with HIV/ AIDS (SIMC), regarding pregnant women living with HIV in the Southern Health Macroregion of Santa Catarina from 2019 to 2022. Results: Based on sociodemographic data, a prevalent epidemiological profile was identified, with women aged 30 to 49 years, white, with low educational level, and between 1 to 13 weeks of gestation at the time of HIV infection notifica- tion. The clinical profile revealed a prevalence of women on antiretroviral therapy, with a viral load above 1,000 copies/ mL and a T-CD4+ lymphocyte count above 350 cells/mm3. Conclusion: Despite the low educational level and high viral load, the outcome was positive for the selected population, as good treatment adherence and high lymphocyte count were demonstrated, both of which are good predictors of clinical progression for HIV.
Subject(s)
Humans , Female , Pregnancy , Health Profile , HIV Infections/epidemiology , Medical Records/statistics & numerical data , Public Health/statistics & numerical data , Antiretroviral Therapy, Highly Active/methods , Delayed Diagnosis , Health Information Systems/statistics & numerical data , Maternal Health/statistics & numerical data , HIV TestingABSTRACT
Background:Human immunodeficiency virus/ Acquired immunodeficiency syndrome (HIV/AIDS), has remained a disease of public health concern, with the largest burden being found in sub Saharan Africa. The advent of anti-retroviral therapy (ART) has significantly reduced the mortality of the disease, thereby transforming it to a chronic disorder, with significant co-morbid psychiatric sequalae.Objectives:To determine the prevalence and pattern of psychiatric morbidity among PLWHAattending Aminu Kano Teaching Hospital, Kano.Materials and methods:This was a cross sectional study of adult patients with HIV/AIDS attending outpatient clinic at the S.S. Wali Virology Centre of Aminu Kano Teaching Hospital who gave informed consent. Systematic random sampling technique was used.Patients aged 18years and above who had been on ARVdrugs for at least one year were included, while those who had a medical emergency and needed immediate attention were excluded.Socio demographic characteristics were obtained using a socio-demographic questionnaire and psychiatric morbidity was assessed with the MINI International Neuropsychiatry Interview.Results:Atotal of 420 participants were recruited in the study with a male to female ratio of 1:1.5 and mean age of 40.4±10.0 years. The prevalence of a psychiatric disorder was 22.1% out of whom 5.0% had more than one psychiatric diagnosis. Major depression was the most common (11%) psychiatric disorder. Generalized Anxiety disorder, substance abuse, post-traumatic stress disorder and alcohol abuse accounted for 7.6%, 5.5%, 2.4% and 1.7% of psychiatric disorders respectively.Conclusion:Psychiatric disorders are common in PLWHA, with major depression being the commonest.
Subject(s)
HIV Infections , Acquired Immunodeficiency SyndromeABSTRACT
Background: Despite measures put in place to combat teenage pregnancy, the rate remains high. Community health workers (CHWs) are a cadre of health workers that can help put measures in place to reduce teenage pregnancy in the communities in which they live and work. Aim: This article aims to gain a deeper understanding of CHWs' perceptions regarding teenage pregnancy in the rural districts of Limpopo province. Methods: An exploratory qualitative study approach was employed to collect data from CHWs in two rural districts of Limpopo. A non-probability purposive sampling approach was used to choose 81 CHWs. Eight focus group discussions (FGDs) were organised, and audio recorded to collect data from participants. The discussions were 23 h long and conducted in English, and data saturation was attained by the fifth FGDs. Results: An eight-step tech's content analysis approach was employed to deductively code, analyse and summarise data into themes. Three themes emerged: the prevalence of teenage pregnancy in rural villages, factors contributing to teenage pregnancy and challenges faced by CHWs when dealing with teenage pregnancy. Conclusion: The study's findings revealed that CHWs face challenges in their communities when offering appropriate teen pregnancy services and CHWs believe that teen pregnancy numbers remain high. There is a significant barrier in combating teenage pregnancy; if contraceptives are not acceptable to the community, the only solution and option for combating teenage pregnancy is abstinence. Contribution: The CHWs presented their insights of teenage pregnancy in rural communities. The outcomes of this study could help clinical practise, schools, communities, youth-friendly services, policymakers and other non-governmental organisations reduce teenage pregnancy.
Subject(s)
HIV Infections , Acquired Immunodeficiency Syndrome , Community Health Workers , Pregnancy in AdolescenceABSTRACT
Background: Hepatitis C virus (HCV) genome undergoes high rate of mutation, which results in generation of genetically diverse HCV isolates. There is paucity of data on mutations in the nonstructural 5b (NS5b) gene of circulating HCV and their implications in the Nigerian population. Here, we identified clinically-important mutations in HCV isolates, which may influence response to therapy and disease prognosis. Methodology: HCV RNA was extracted from a total of 301 blood samples collected from 99 symptomatic treatment-naïve hepatitis patients, 125 HIV-infected individuals and 77 asymptomatic blood donors in Ibadan, Nigeria. The RNA was reversetranscribed to complimentary DNA and HCV NS5B gene amplified by nested PCR. The amplified products of 42 HCV were sequenced and sequences were aligned with those from GenBank and HCV databases in MEGA 7.0. Nucleotide sequences were translated to amino acids while substitutions in the amino acids were analyzed with reference to H77 prototype strain of HCV. Results: A total of 10 amino acid polymorphisms were observed from the 42 sequenced NS5B gene, with the major clinically-important amino acid mutations being S15G in 28 (66.7%) participants, T7N (24, 57.1%), G61R (23, 54.8%), S54L (22, 52.4%), G89E (14, 33.3%), T79M (12, 28.6%), and T711 (11, 26.2%). Others were Q67R (7, 16.7%), Q47H (7, 16.7%) and S84F (2, 4.8%). S15G/A/V mutations were more predominant in patients with HIV (76.9%, 10/13) followed by patients with clinical hepatitis (75.0%, 12/16) and blood donors (46.1%, 6/13). Q67R and T71I mutations were not predominant in patients with clinical hepatitis as they were detected in only 31.3% (5/16) and 43.8% (7/16) participants respectively, compared to S15G (75.0%, 12/16), S54L (68.8%, 11/16), G61R/E (68.8%, 11/16) and T7N/S (56.3%, 9/16). There was no statistically significant difference in the distribution of each of the 10 amino acid polymorphisms detected within patients with symptomatic clinical hepatitis (x 2=9.311, p=0.409), HIV-infected patients (x 2=13.431, p=0.1440) and asymptomatic blood donors (x 2=3.775, p=0.9256). Similarly, there was no significant difference in the distribution between the 3 categories of the study participants except for T79M mutation, which was significantly higher in HIV-infected patients (61.5%, 8/13) compared to patients with clinical hepatitis (18.8%, 3/16) and asymptomatic blood donors (7.7%, 1/13) (x 2=10.456, p=0.0054). Conclusion: Mutations in the NS5B gene could be associated with worse prognosis of the disease or antiviral failure due to viral resistance in patients undergoing therapy. The absence of Q47H mutations in majority of the study participants in our study implies that they will not respond well to daprevir and mericitabine. Screening of patients for pre-existing resistant mutations before commencement of therapy and monitoring during and after therapy are recommended.
Subject(s)
Humans , Male , Female , Hepacivirus , HIV InfectionsABSTRACT
Introduction: sub-Saharan Africa is experiencing a boom in the number of adolescents and young adults living with HIV (AYALHIV). Existing HIV intervention programs are mainly for children and adults living with HIV, with little attention paid to AYALHIV. Characterizing this population is necessary for planning, and designing, AYALHIV-centered HIV intervention programs. Methods: a retrospective single-center, hospital-based chart review was conducted at the largest HIV clinic in Ghana. We examined routinely collected data for AYALHIV (aged 10-24 years) on antiretroviral therapy (ART) for at least 1 year and in active care from 1st January to 31st December 2019. Data was collected using a structured data extraction form. The Chi-square and the Student´s t-test were used to compare characteristics between adolescents and young adults. Results: of 252 AYALHIV, 68% (172/252) were adolescents with a median age of 17 years (IQR 13-19); 32% were young adults with a median age of 22 years (IQR: 20-24). Most (56.7% (143/252)) AYALHIV were female. Almost 40% were orphans. Eighty-six percent of AYALHIV had HIV type I infection. The commonest mode of HIV acquisition among adolescents was vertical transmission (70.5%) and that among young adults was via unprotected sex (31.3%). 88% of AYALHIV were on non-nucleoside reverse transcriptase inhibitors-based regimen. The viral suppression rate among AYALHIV was 78%. Conclusion: the study shows there is a growing population of AYALHIV most of which are adolescents. About two-fifths were orphans. Policymakers and HIV programs should ensure AYALHIV-centred interventions are developed for this vulnerable population.
Subject(s)
Humans , Male , Female , Adolescent , Antiretroviral Therapy, Highly Active , Health Profile , HIV Infections , Adolescent , Young AdultABSTRACT
Bien que le rôle des facteurs cliniques/biologiques associés à la mortalité ait déjà été exploré chez les patients infectés par le VIH sous traitement antirétroviral, peu d'attention a été accordée jusqu'à présent au rôle potentiel de la vulnérabilité sociale. Il s'agit d'une étude de cohorte rétrospective de 2017 à 2022. Les données ont été collectées à partir des dossiers de 292 patients. Les analyses statistiques ont été réalisées à l'aide du logiciel R version 4.2.2. Le modèle de Cox a été utilisé pour identifier les facteurs sociodémographiques associés à la mortalité.La prévalence des décès était de 33 %. Le taux brut de mortalité était de 24,42 pour 100 personnes-années. La durée médiane de suivi était de 9 mois avec IQR:[4 ;26], le sex-ratio H/F était de 0,9. En analyse multivariée, les variables significativement associées à la mortalité étaient : ne pas aller à l'école (HR=3.2,IC95% =[2,4.5],p=3.5e-5), vivre dans une zone rurale(HR=2.94,IC95%=[2,4.5],p=3.5e-5), chômeur (HR=2.94,IC95%=[2,4.5], p=3.5e-5), la non-participation à des activités associatives (HR=2.94 , IC95%=[2,4.5],p=3.5e-5), la non-participation à la vie de la communauté (HR=2.94 , IC95% =[2,4.5],p=3.5e-5) et le fait d'être célibataire, divorcé ou veuf (HR=2.94 ,IC95% =[2,4.5], p=3.5e-5). La vulnérabilité sociodémographique reste un facteur prédictif majeur de la mortalité chez les patients traités aux ARV. Il existe un réel besoin d'interventions innovantes ciblant les individus présentant de multiples sources de vulnérabilité sociale, afin de s'assurer que les inégalités sociales ne continuent pas à entraîner une mortalité plus élevée.
Although the role of clinical/biological factors associated with mortality has already been explored in HIV-infected patients on antiretroviral therapy, little attention has so far been paid to the potential role of social and demographic vulnerability. This is a retrospective cohort study from 2017 to 2022. Data were collected from the records of 292 patients. Statistical analyses were performed using R software version 4.2.2. The Cox model was used to identify sociodemographic factors associated with mortality. The prevalence of death was 33%. The crude mortality rate was 24.42 per 100 person-years. Median follow-up was 9 months with IQR: [4 ;26], sex ratio M/F was 0.9. In multivariate analysis, variables significantly associated with mortality were: not going to school (HR=3.2 , IC95% =[2,4.5], p=3.5e-5), living in a rural area (HR=2.94,IC95% =[2,4.5], p=3.5e-5), unemployed (HR= 2.94 , IC95% =[2,4.5], p=3. 5e-5), non-participation in associative activities (HR=2.94 ,IC95% =[2,4.5], p=3.5e-5), non-participation in community life (HR= 2.94 , IC95% = [2,4.5],p=3.5e-5) and being single, divorced or widowed (HR=2.94 ,IC95%=[2,4.5], p=3.5e-5). Socio-demographic vulnerability remains a major predictor of mortality in patients treated with ARVs. There is a real need for innovative interventions targeting individuals with multiple sources of social vulnerability, to ensure that social inequalities do not continue to lead to higher mortality.
Subject(s)
Therapeutics , HIV Infections , HIV SeropositivityABSTRACT
Introduction: The 2022 mpox global outbreak underscores the need for an improved understanding of mpox epidemiology, co-morbidities, and clinical management/outcome. We report a case of a30-year-old Nigerian antiretroviral treatment-experienced person living with human immunodeficiency virus (PLHIV) who had PCR-confirmed mpox and chickenpox co-infection. Case presentation: The patient presented with a generalized itchy rash of three weeks and antecedent low-grade fever. He had no recent travel, animal exposure, or same-sex relationship. Examination revealed generalized pustular and nodular eruptions without peripheral lymphadenopathy. Results: CD4 count was 78 cells/mm3, wound swab microscopy revealed Gram-positive cocci in clusters and Gram-negative bacilli while culture yielded Pseudomonas aeruginosa. Despite supportive care and definitive antimicrobial therapy, his clinical condition deteriorated with sepsis-related multi-organ dysfunction and ultimately death. Conclusions: Mpox and chickenpox co-infection may occur, with potentially fatal complications in the setting of advanced HIV disease. Increased surveillance for co-viral infections in PLHIV with febrile exanthema and aggressive management to improve outcome are recommended.
Subject(s)
HIV Infections , CoinfectionABSTRACT
Introduction: In Egypt, there is a paucity of new data regarding awareness of HIV/AIDS among physicians. This study aimed to assess the level of awareness, attitude, practice, and knowledge of a sample of Egyptian physicians regarding HIV regarding natural history, epidemiology, and virology, method of transmission, clinical manifestations, diagnosis, prevention, and management.Methodology: Sixty-eight Egyptian physicians were enrolled in an observational analytic multicenter cross-sectional KAP study in Egyptian tertiary health care facilities covering different localities, including New Valley University, Assiut University, South Valley University, Helwan University, Alexandria University, Aswan University, and Al-Azhar University.Results: The attitude of physicians towards the privacy of persons living with HIV, was the one with the highest percentage 85.3%. On the other hand, respondents think that only 25% of physicians do not stigmatize HIV patients. Moreover, only 25% of the study group do not stigmatize persons living with HIV. The highest proportion of favorable practice was 39.7% and the lowest was 17.6%. With regard to their knowledge about HIV, the lowest proportion of correct answers to a question was 4.4%, and the highest proportion was 92.6%. Most of the enrolled physicians were found to have a moderate knowledge score, 49/68 (72%). There was a significant difference between different specialties regarding knowledge scores.Conclusions: There are some knowledge gaps among a sample of Egyptian physicians with regard to HIV/AIDS. In addition, Egyptian physicians may have a moderate degree of undesirable attitude and practice toward HIV/AIDS
Subject(s)
HIV Infections , Health Knowledge, Attitudes, Practice , Delivery of Health Care , PhysiciansABSTRACT
Background: In Madagascar, no study has reported the impact of COVID-19 on people living with HIV (PLHIV). The present work aimed to analyze the seroprevalence of SARS-CoV-2 in Malagasy PLHIV before and during the three waves of COVID-19 pandemic. This is a retrospective study. Materials and Methods: We conducted a retrospective serological survey in PLHIV followed up for HIV viral load (VL) monitoring at the Centre d'Infectiologie Charles Mérieux Madagascar (CICM) between June 2019 and April 2022. The presence of IgM and/or IgG antibodies against SARS-CoV-2 nucleoprotein was detected using a rapid diagnostic test (COVID-PRESTO®). Results: A seroprevalence of 2.5% was found in the 877 patients tested before March 2020, compared to 25.4% (512/2,011) between March 2020 and April 2022. This seroprevalence was 21.7%, 22.3% and 60.1% after the first, second and third waves of COVID-19, respectively. We observed a marginally significant difference (p = 0.043) inSARS-CoV-2 seroprevalence between patients on highly active antiretroviral therapy (HAART) (27.5%) and those who were not (23.7%). No statistically significant difference was observed between PLHIV with undetectable HIV VL (27.4%) and the different detectable VL categories (p>0.05). Conclusions: Our data show the presence of antibodies to SARS-CoV-2 among PLHIV as early as December 2019 in Madagascar. At least 25.4% (512/2,011) of Malagasy PLHIV have been in contact with SARS-CoV-2 since March 2020. There is no significant relation between HIV-1 VL and SARS-CoV-2 seroprevalence. Additional studies with more robust assays in the general population are needed for a detailed knowledge of SARS-CoV-2 impact in Madagascar.
Subject(s)
Humans , Male , Female , HIV Infections , Surveys and Questionnaires , COVID-19ABSTRACT
Resumo Objetivo Mapear a produção científica sobre as estratégias educativas e os conteúdos abordados na educação de pessoas vivendo com HIV. Métodos Esta é uma revisão de escopo em que a seleção dos artigos foi realizada em abril de 2021 e atualizada em outubro de 2022 em dez fontes de dados; a revisão seguiu os pressupostos estabelecidos pelo Joanna Briggs Institute e o checklist dos Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. Os resultados foram analisados descritivamente e sintetizados em um quadro. Resultados Foram selecionados 17 estudos com publicação predominante em 2017; Estados Unidos da América e Brasil foram os países com a maior quantidade de produções. A maioria dos estudos buscou avaliar o impacto e a eficácia das estratégias e desenvolver ou validar instrumentos de educação em saúde e atividades de prevenção. Em relação ao conteúdo abordado pelas estratégias, foram formadas cinco categorias: orientação inicial sobre HIV/AIDS, cuidados gerais, vida saudável, saúde sexual e suporte emocional. As estratégias educativas que se destacaram em relação à maior adesão dos pacientes ao tratamento estão relacionadas com o desenvolvimento de sistemas, programas e multimídia. As cartilhas promoveram empoderamento e autonomia de pessoas vivendo com HIV. Conclusão Foram mapeadas as principais estratégias educativas, com destaque para cartilhas, material impresso, recursos multimídia, sistemas, formulários e oficinas/workshops, abordando orientação inicial sobre HIV/AIDS, tratamento farmacológico, cuidados gerais, vida saudável, saúde sexual e suportes social e emocional.
Resumen Objetivo Mapear la producción científica sobre las estrategias educativas y los contenidos abordados en la educación de personas que viven con el VIH. Métodos Esta es una revisión de alcance, cuya selección de artículos se realizó en abril de 2021 y se actualizó en octubre de 2022 en diez fuentes de datos. La revisión siguió las premisas establecidas por el Joanna Briggs Institute y la checklist de los Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. Los resultados fueron analizados descriptivamente y sintetizados en un cuadro. Resultados Se seleccionaron 17 estudios con publicación predominante en 2017. Estados Unidos de América y Brasil fueron los países con mayor cantidad de producciones. La mayoría de los estudios buscó evaluar el impacto y la eficacia de las estrategias y elaborar o validar instrumentos de educación para la salud y actividades de prevención. Con relación al contenido abordado por las estrategias, se formaron cinco categorías: instrucciones iniciales sobre VIH/SIDA, cuidados generales, vida saludable, salud sexual y apoyo emocional. Las estrategias educativas que se destacaron con relación a una mayor adhesión de los pacientes al tratamiento están relacionadas con el desarrollo de sistemas, programas y multimedia. Las cartillas promovieron empoderamiento y autonomía de personas que viven con el VIH. Conclusión Se mapearon las principales estrategias educativas, con énfasis en cartillas, material impreso, recursos multimedia, sistemas, formularios y talleres/workshops, que abordaron instrucciones iniciales sobre VIH/SIDA, tratamiento farmacológico, cuidados generales, vida saludable, salud sexual y apoyo social y emocional. Open Science Framework (OSF): https://osf.io/754uk/?view_only=6491865a3d12424d81af2c4099c112c3
Abstract Objective To map the scientific production on educational strategies and the content covered in the education of people living with HIV. Methods This is a scoping review in which the selection of articles was carried out in April 2021 and updated in October 2022 in ten data sources; the review followed the assumptions established by the Joanna Briggs Institute and the checklist of Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. The results were descriptively analyzed and summarized in a chart. Results A total of 17 studies were selected, predominantly published in 2017; The USA and Brazil were the countries with the largest number of productions. Most studies sought to evaluate the impact and effectiveness of strategies and develop or validate health education instruments and prevention activities. Concerning the content covered by the strategies, five categories were formed: initial guidance on HIV/AIDS, general care, healthy living, sexual health, and emotional support. The educational strategies that stood out concerning greater patient adherence to treatment are related to the development of systems, programs, and multimedia. The booklets promoted empowerment and autonomy for people living with HIV. Conclusion The main educational strategies were mapped, with emphasis on booklets, printed material, multimedia resources, systems, forms, and workshops, covering initial guidance on HIV/AIDS, pharmacological treatment, general care, healthy living, sexual health, and social and emotional support. Open Science Framework (OSF): https://osf.io/754uk/?view_only=6491865a3d12424d81af2c4099c112c3
Subject(s)
Humans , Teaching , HIV Infections , Health Education , Acquired Immunodeficiency Syndrome/prevention & control , Educational Technology/education , Medication Adherence , Treatment Adherence and Compliance , COVID-19ABSTRACT
RESUMO Objetivo construir e validar conteúdo de instrumento para avaliação socioestrutural e comportamental associado à infecção pelo HIV em jovens. Método estudo metodológico, desenvolvido em duas etapas: elaboração do instrumento; e validação de conteúdo. Os itens que compuseram o instrumento foram selecionados através de revisão literária, tendo como referencial os domínios multiníveis do Modelo Social Ecológico Modificado, categorizados em componentes socioestruturais e comportamentais. O conteúdo foi avaliado por especialistas em duas rodadas conduzidas pela técnica Delphi, admitindo-se um índice de concordância de, no mínimo, 80%. Resultados a primeira versão do instrumento continha 52 itens, distribuídos em três domínios. Na primeira rodada, 19 itens (36,5%) obtiveram Índice de Validade de Conteúdo inferior a 0,80, dois itens foram excluídos e os demais foram reformulados. Na segunda rodada, 2 itens foram excluídos e 3 foram incorporados como subitem, totalizando 45 itens. O Índice de Validade de Conteúdo do Instrumento foi de 95%. Conclusão e implicações para a prática as recomendações dos especialistas contribuíram para a qualificação do instrumento Avaliação Socioestrutural e Comportamental-HIV, possibilitando a reorganização do conteúdo. O instrumento é válido para a identificação de fatores socioestruturais e comportamentais associados à infecção pelo HIV em jovens, com potencial para constituir planejamento de cuidados preventivos.
RESUMEN Objetivo construir y validar el contenido de un instrumento de evaluación socioestructural y conductual asociada a la infección por VIH en jóvenes. Método estudio metodológico, desarrollado en dos etapas: elaboración del instrumento; y validación de contenido. Los ítems que conformaron el instrumento fueron seleccionados a través de una revisión literaria, tomando como referencia los dominios multinivel del Modelo Ecológico Social Modificado, categorizados en componentes socioestructurales y conductuales. El contenido fue evaluado por expertos en dos rondas realizadas mediante la técnica Delphi, suponiendo una tasa de acuerdo de al menos el 80%. Resultados la primera versión del instrumento contuvo 52 ítems, distribuidos en tres dominios. En la primera ronda, 19 ítems (36,5%) tuvieron un Índice de Validez de Contenido inferior a 0,80, dos ítems fueron excluidos y el resto fueron reformulados. En la segunda ronda, se excluyeron 2 ítems y se incorporaron 3 como subítems, totalizando 45 ítems. El Índice de Validez de Contenido del Instrumento fue del 95%. Conclusión e implicaciones para la práctica las recomendaciones de los expertos contribuyeron para la calificación del instrumento Evaluación Socioestructural y del Comportamiento-VIH, permitiendo la reorganización del contenido. El instrumento es válido para identificar factores socioestructurales y conductuales asociados a la infección por VIH en jóvenes, con potencial para constituir una planificación de atención preventiva.
ABSTRACT Objective to construct and validate the content of an instrument for sociostructural and behavioral assessment associated with HIV infection in young people. Method a methodological study developed in two steps: instrument elaboration; and content validity. The items that made up the instrument were selected through a literary review using the Modified Social Ecological Model multilevel domains as a reference, categorized into sociostructural and behavioral components. Content was assessed by experts in two rounds conducted using the Delphi technique, assuming an agreement rate of at least 80%. Results the first version of the instrument contained 52 items, distributed across three domains. In the first round, 19 items (36.5%) had a Content Validity Index lower than 0.80, two items were excluded and the rest were reformulated. In the second round, 2 items were excluded and 3 were incorporated as subitems, totaling 45 items. The Instrument Content Validity Index was 95%. Conclusion and implications for practice experts' recommendations contributed qualifying the Sociostructural and Behavioral Assessment-HIV instrument, enabling content reorganization. The instrument is valid for identifying socio-structural and behavioral factors associated with HIV infection in young people, with the potential to constitute preventive care planning.
Subject(s)
Humans , Male , Female , Adolescent , Adult , HIV Infections/epidemiology , HIV , Adolescent Health , Vulnerable Populations , Social Determinants of Health , Multilevel AnalysisABSTRACT
El objetivo del estudio fue describir los niveles de resistencia transmitida de VIH-1 en adultos atendidos en Unidades de Atención Integral de Guatemala. El estudio incluyó registros de 185 pacientes adultos VIH-1 positivo, de reciente diagnóstico sin antecedente de uso de TAR, de noviembre del 2019 a noviembre del 2020. El análisis se realizó en el software DeepChek® v2.0, para la clasificación de la resistencia se siguió el algoritmo de Stanford HIVdb (v9.4 - 07/12/2022). Se encontró 18.4% (IC 95% 13.1 - 24.7%) de resistencia general a alguna familia de ARVs. Se evidenció 15.1% (IC 95% 10.3 - 21.1%) de resistencia individual a la familia de INNTR afectando principalmente a NVP y EFV; 2.2% (IC 95% 0.6 - 5.4%) de resistencia a INTR, mayormente a FTC/3TC; y 2.7% (IC 95% 0.9 - 6.2%) de resistencia intermedia y baja los IP NFV y LPV/r. Tres casos presentaron resistencia múltiple a los INTR + INNTR. Las mutaciones más frecuentemente encontradas fueron K103N (41.2%), M184V/I (8.8%) y M46I (5.9%). La elevada resistencia transmitida del VIH-1 en pacientes atendidos en distintas Unidades de Atención Integral del VIH, demuestra la importancia de analizar periódicamente la tendencia de la resistencia en personas que no han estado expuestas a ARVs, lo cual a su vez es un marcador indirecto de presencia de resistencia adquirida en el país, datos que evidencian la necesidad de acciones e intervenciones prontas y efectivas dado su impacto en la salud pública.
The objective of this study was to describe the levels of transmitted HIV-1 resistance in patients with a recent HIV diagnosis before starting ART, treated in Comprehensive Care Units in Guatemala during the years 2019 and 2020. The study included records of 185 HIV-positive adult patients, recently diagnosed with HIV without a history of ART use. The analysis was carried out in the DeepChek® v2.0 software, the Stanford HIVdb algorithm (v9.4 - 07/12/2022) was followed to classify resistance. 18.4% (95% CI 13.1 - 24.7%) of general resistance to some family of ARVs was found. There was evidence of 15.1% (95% CI 10.3 - 21.1%) of individual resistance to the NNRTI family, mainly affecting NVP and EFV; 2.2% (95% CI 0.6 - 5.4%) resistance to INTR, mostly to FTC/3TC; and 2.7% (95% CI 0.9 - 6.2%) of intermediate and low resistance IP NFV and LPV/r. Three cases presented multiple resistance to NRTIs + NNRTIs. The most frequently found mutations were K103N (41.2%), M184V/I (8.8%) and M46I (5.9%). The high transmitted resistance of HIV-1 in patients treated in different Comprehensive HIV Care Units demonstrates the importance of periodically analyzing the trend of resistance in people who have not been exposed to ARVs, which in turn is an indirect marker. of the presence of acquired resistance in the country, data that demonstrate the need for prompt and effective actions and interventions given its impact on public health.
O objetivo deste estudo foi descrever os níveis de resistência transmitida ao HIV-1 em adultos tratados em Unidades de Cuidados Integrais na Guatemala. O estudo incluiu prontuários de 185 pacientes adultos HIV-1 positivos, recentemente diagnosticados sem histórico de uso de TARV, no período de novembro de 2019 a novembro de 2020. A análise foi realizada no software DeepChek® v2.0, para classificação da resistência, O algoritmo Stanford HIVdb (v9.4 - 07/12/2022) foi seguido. Foi encontrada 18.4% (IC 95% 13.1 - 24.7%) de resistência geral a alguma família de ARVs. Houve evidência de 15.1% (IC 95% 10.3 - 21.1%) de resistência individual à família de NNRTI, afetando principalmente NVP e EFV; 2.2% (IC 95% 0.6 - 5.4%) resistência ao INTR, principalmente ao FTC/3TC; e 2.7% (IC 95% 0.9 - 6.2%) de resistência intermediária e baixa ao IP NFV e LPV/r. Três casos apresentaram resistência múltipla a NRTIs + NNRTIs. As mutações mais frequentemente encontradas foram K103N (41.2%), M184V/I (8.8%) e M46I (5.9%). A elevada resistência transmitida do HIV-1 em pacientes atendidos em diferentes Unidades de Cuidados Integrados ao HIV demonstra a importância de analisar periodicamente a tendência de resistência em pessoas que não foram expostas aos ARVs, o que por sua vez é um marcador indireto da presença de ARVs adquiridos. resistência no país, dados que demonstram a necessidade de ações e intervenções rápidas e eficazes dado o seu impacto na saúde pública.