Resistencia genotípica del HIV a los antirretrovirales en niños de Argentina entre 2006 y 2021 / HIV genotypic drug resistance to antiretrovirals in children in Argentina between 2006 and 2021

Introducción: La resistencia del HIV a los antirretrovirales (ARVs) es una de las principales causas de fallo terapéutico en niños, niñas y adolescentes que conviven con el virus. Desde el año 2006, el Laboratorio de Biología Celular y Retrovirus del Hospital Garrahan realiza el estudio genotípico de resistencia (ER) del HIV-1 a los ARVs a fin de identificar mutaciones que disminuyen la susceptibilidad del virus a los fármacos que componen el tratamiento ARV. Objetivos: El objetivo del trabajo fue estudiar el tipo y frecuencia de resistencia del HIV a los ARVs, a través de un análisis de 371 ER realizados entre los años 2006 y 2021 en niños, niñas y adolescentes con HIV-1 adquirido por transmisión vertical y con solicitud médica de ER por presentar fallo terapéutico. Resultados: Entre los años 2006 y 2013 la proporción de casos con resistencia a al menos una clase de fármaco ARV fue mayor al 90%, sugiriendo una asociación directa entre el fallo virológico y la disminución en la susceptibilidad del HIV-1 a uno o más componentes del TARV. A partir del año 2012, se observa una disminución progresiva del nivel de resistencia de HIV-1, llegando al 50% en 2021 (p<0.0001). La frecuencia de mutaciones de resistencia fue diferente para cada una de las clases de ARVs. Mientras que la resistencia a INNTR no sufrió cambios significativos a lo largo del período de estudio, oscilando entre 27% y 75%. La proporción de mutaciones a IPs en pacientes con fallo virológico disminuyó de 87% en 2006 a 17% en 2021 y para los INTR, disminuyó de 79% en 2006 a 45% en 2021. Conclusión: El nivel de resistencia a los ARVs ha disminuido de manera sustancial a lo largo de los últimos 16 años, probablemente por el uso de nuevos fármacos ARV con alta potencia que posibilitaron la intensificación de los tratamientos ARV y la implementación de criterios de fallo terapéutico más estrictos tanto a nivel clínico como virológico (AU)

Introduction: HIV resistance to antiretroviral (ARV) drugs is one of the main causes of therapeutic failure in children and adolescents living with the virus. Since 2006, the Cell Biology and Retrovirus Laboratory of the Garrahan Hospital has been performing the genotypic study of HIV-1 resistance to ARV drugs in order to identify mutations that reduce the susceptibility of the virus to the drugs that constitute ARV treatment. Objectives: The aim of this study was to assess the type and frequency of HIV resistance to ARV drugs through an analysis of 371 genotype studies performed between 2006 and 2021 in children and adolescents with HIV-1 acquired through motherto-child transmission and with medical request for genotype study due to therapeutic failure. Results: Between 2006 and 2013, the proportion of cases with resistance to at least one ARV drug class was greater than 90%, suggesting a direct association between virologic failure and decreased susceptibility of HIV-1 to one or more components of ART. From 2012 onwards, a progressive decrease in the level of HIV-1 resistance was observed, reaching 50% in 2021 (p<0.0001). The frequency of resistant mutations was different for each of the ARV classes, while resistance to non-nucleoside reverse transcriptase inhibitors (NNRTIs) did not change significantly over the study period, ranging from 27% to 75%. The proportion of drug-resistant mutations to protease inhibitors (PI) in patients with virologic failure decreased from 87% in 2006 to 17% in 2021 and for NNRTIs from 79% in 2006 to 45% in 2021. Conclusion: The level of resistance to ARV drugs has decreased substantially over the last 16 years, probably due to the use of new ARV drugs with high potency that allowed the intensification of ARV treatments and the implementation of stricter criteria for therapeutic failure both clinically and virologically (AU)

Interrelación entre Anatomía Patológica y Dermatología ilustrada mediante un caso clínico de sarcoma de Kaposi / Illustrating the relationship between Pathological Anatomy and Dermatology by means of a clinical case of Kaposi's Sarcoma

Se presenta el caso clínico de un paciente asistido en el servicio de Dermatología por tener lesión tumoral gigante en calcáneo derecho de instauración progresiva. La biopsia incisional muestra sarcoma de Kaposi endémico sin afectación visceral. El estadio tan avanzado de la enfermedad propició la evolución tórpida del paciente. El estudio histopatológico estableció el diagnóstico certero de la lesión tumoral; la biopsia fue el método auxiliar que estableció el vínculo necesario entre el examen macroscópico y microscópico de la piel, y la interrelación básico-clínica entre dos disciplinas: Anatomía Patológica y Dermatología.

We present a clinical case of a patient seen in the Dermatology service due to a progressive giant cell tumour in the right calcaneus. Incisional biopsy shows endemic Kaposi's sarcoma without visceral involvement. The advanced stage of the disease led to the torpid evolution of the patient. The histopathological study established the accurate diagnosis of the tumour lesion, the biopsy was the auxiliary method that established the necessary link between the macroscopic and microscopic examination of the skin and the basic and clinical relationship between two disciplines: Pathological Anatomy and Dermatology.

Longitudinal analysis of immune reconstitution and metabolic changes in women living with HIV: A real-world observational study / 中华医学杂志(英文版)

BACKGROUND@#Women comprise more than half of people living with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) worldwide and incomplete immune recovery and metabolic abnormalities affect them deeply. Studies of HIV antiretroviral therapy (ART) have a low female representation in China. We aimed to investigate immune reconstitution and metabolic changes of female HIV-positive cohort in China longitudinally.@*METHODS@#HIV-positive women who initiated ART from January 2005 to June 2021 and were followed up regularly at least once a year were included in this study. Immunological indicators (cluster of differentiation 4 [CD4] counts and CD8 counts), viral load (VL), and metabolic indicators were collected at follow-up. All data were collected from the China Disease Prevention and Control Information System (CDPCIS). VL was tested half a year, 1 year after receiving ART, and every other year subsequently according to local policy. CD4/CD8 ratio normalization was considered as the primary outcome and defined as a value ≥1. Incidence rate and probability of CD4/CD8 ratio normalization were estimated through per 100 person-years follow-up (PYFU) and Kaplan-Meier curve, respectively. Multivariate Cox regression was used to identify independent risk factors associated with CD4/CD8 ratio normalization. We further studied the rate of dyslipidemia, hyperuricemia, diabetes, liver injury, and renal injury after ART initiation with the chi-squared tests or Fisher's exact probability tests, and a generalized estimating equation model was used to analyze factors of dyslipidemia and hyperuricemia.@*RESULTS@#A total of 494 female patients with HIV/AIDS started ART within 16 years from January 2005 to June 2021, out of which 301 women were enrolled with a median duration of ART for 4.1 years (interquartile range, 2.3-7.0 years). The overall incidence rate of CD4/CD8 ratio normalization was 8.9 (95% confidence interval [CI], 7.4-10.6) per 100 PYFU, and probabilities of CD4/CD8 normalization after initiating ART at 1 year, 2 years, 5 years, and 10 years follow-up were 11.7%, 23.2%, 44.0%, and 59.0%, respectively. Independent risk factors associated with CD4/CD8 normalization were baseline CD4 cell counts <200 cells/μL, CD8 counts >1000 cells/μL, and more than 6 months from the start of combined ART (cART) to first virological suppression. Longitudinally, the rate of hypercholesterolemia (total cholesterol [TC]) and high triglyceride (TG) showed an increasing trend, while the rate of low high-density lipoprotein cholesterol (HDL) showed a decreasing trend. The rate of hyperuricemia presented a downtrend at follow-up. Although liver and renal injury and diabetes persisted during ART, the rate was not statistically significant. Older age and protease inhibitors were independent risk factors for increase of TC and TG, and ART duration was an independent factor for elevation of TC and recovery of HDL-C.@*CONCLUSIONS@#This study showed that women were more likely to normalize CD4/CD8 ratio in comparison with findings reported in the literature even though immune reconstruction was incomplete.

Analysis on survival time and influencing factors among reported HIV/AIDS in Yunnan Province, 1989-2021 / 中华流行病学杂志

Objective: To analyze the survival time of reported HIV/AIDS and influencing factors of Yunnan Province from 1989 to 2021. Methods: The data were extracted from the Chinese HIV/AIDS comprehensive response information management system. The retrospective cohort study was conducted. The life table method was applied to calculate the survival probability. Kaplan-Meier was used to draw survival curves in different situations. Furthermore, the Cox proportion hazard regression model was constructed to identify the factors related to survival time. Results: Of the 174 510 HIV/AIDS, the all-cause mortality density was 4.23 per 100 person-years, the median survival time was 20.00 (95%CI:19.52-20.48) years, and the cumulative survival rates in 1, 10, 20, and 30 years were 90.75%, 67.50%, 47.93% and 30.85%. Multivariate Cox proportional risk regression model results showed that the risk of death among 0-14 and 15-49 years old groups were 0.44 (95%CI: 0.34-0.56) times and 0.51 (95%CI:0.50-0.52) times of ≥50 years old groups. The risk for death among the first CD4+T lymphocytes counts (CD4) counts levels of 200-349 cells/μl, 350-500 cells/μl and ≥501 cells/μl groups were 0.52 (95%CI: 0.50-0.53) times, 0.41 (95%CI: 0.40-0.42) times and 0.35 (95%CI: 0.34-0.36) times of 0-199 cells/μl groups. The risk of death among the cases that have not received antiretroviral therapy (ART) was 11.56 (95%CI: 11.26-11.87) times. The risk for death among the cases losing to ART, stopping to ART, both losing and stopping ART was 1.66 (95%CI:1.61-1.72) times, 2.49 (95%CI:2.39-2.60) times, and 1.65 (95%CI:1.53-1.78) times of the cases on ART. Conclusions: The influencing factors for the survival time of HIV/AIDS cases were age at diagnosis in Yunnan province from 1989 to 2021. The first CD4 counts levels, antiretroviral therapy, and ART compliance. Early diagnosis, early antiretroviral therapy, and increasing ART compliance could extend the survival time of HIV/AIDS cases.

Inquérito de Conhecimento, Atitude e Prática sobre estilo de vida saudável em pessoas com HIV / Encuesta de Conocimientos, Actitudes y Prácticas sobre estilo de vida saludable en personas con VIH / Knowledge, Attitude and Practice survey on healthy lifestyle in people with HIV

Resumo Objetivo desenvolver e avaliar um inquérito de Conhecimento, Atitude e Prática sobre estilo de vida saudável em pessoas com vírus da imunodeficiência humana. Método estudo de desenvolvimento, com elaboração do inquérito por meio de revisão integrativa e análise das diretrizes; análise de conteúdo e aparência por 22 juízes especialistas; e análise semântica por 22 pacientes em acompanhamento ambulatorial. Mensurada a proporção de avaliações positivas dos itens, considerando-se percentual igual ou maior a 85%. Resultados o inquérito teve três domínios e sete eixos: doenças crônicas em pessoas com vírus da imunodeficiência humana; controle do peso corporal; alimentação saudável; prática de exercício físico; evitar fumo, álcool e drogas ilícitas; controle/redução do estresse; adesão aos antirretrovirais e outros medicamentos. Domínios conhecimento e atitude tiveram 10 perguntas, e o de prática, 11. Na avaliação pelos juízes especialistas, participaram enfermeiros, médicos e nutricionista, com concordância positiva dos itens acima de 85%. Os pacientes fizeram a análise semântica, com concordância positiva nos domínios de 100%. Conclusão e implicações para a prática o inquérito teve evidência de validade adequada, para ser utilizado por enfermeiros e outros profissionais de saúde, para subsidiar a assistência, estratégias educativas e pesquisas com pessoas vivendo com o vírus da imunodeficiência humana.

Resumen Objetivo elaborar y evaluar una encuesta de conocimientos, actitudes y prácticas sobre estilo de vida saludable en personas con virus de inmunodeficiencia humana. Método estudio de desarrollo, con la elaboración de la encuesta a través de una revisión y análisis integrador de las directrices; análisis de contenido y apariencia por 22 jueces expertos; y análisis semántico por 22 pacientes ambulatorios. Se midió la proporción de valoraciones positivas de los ítems, considerando un porcentaje igual o superior al 85%. Resultados la encuesta tuvo tres dominios y siete ejes: enfermedades crónicas en personas portadoras del virus de la inmunodeficiencia humana; control del peso corporal; alimentación saludable; ejercicio físico; evitación del tabaquismo, alcohol y drogas ilícitas; control/reducción del estrés; adherencia a los antirretrovirales y otros medicamentos. Los dominios conocimientos y actitudes tenían 10 preguntas y los dominios práctica tenían 11. En la evaluación de los jueces expertos, participaron enfermeros, médicos y nutricionistas, con concordancia positiva de los ítems superior al 85%. Los pacientes fueron sometidos a análisis semántico, con 100% de concordancia positiva en los dominios. Conclusión e implicaciones para la práctica la encuesta tuvo pruebas adecuadas de validez, para ser utilizada por enfermeros y otros profesionales de la salud, para apoyar la asistencia, las estrategias educativas y la investigación con personas que viven con el virus de la inmunodeficiencia humana.

Abstract Objective to develop and assess a Knowledge, Attitude and Practice survey on healthy lifestyle in people with human immunodeficiency virus. Method a development study, with the elaboration of survey through of an integrative review and analysis of the guidelines; content and appearance analysis by 22 expert judges; and semantic analysis by 22 outpatients. The proportion of positive assessments of the items was measured, considering a percentage equal to or greater than 85%. Results the survey had three domains and seven axes: chronic diseases in people with human immunodeficiency virus; body weight control; healthy eating; physical exercise; avoiding smoking, alcohol and illicit drugs; stress control/reduction; antiretroviral and other medication compliance. Knowledge and attitude domains had 10 questions, and practice domains had 11. In the assessment by expert judges, nurses, doctors and nutritionists participated, with positive agreement of items above 85%. Patients underwent semantic analysis, with 100% positive agreement in the domains. Conclusion and implications for practice the survey had adequate evidence of validity, to be used by nurses and other health professionals, to support care, educational strategies and research with people living with the human immunodeficiency virus.

Cotidiano de pessoas que vivem com VIH em Bissau, Guiné-Bissau: perspectivas, desafios e vulnerabilidades / Vida diaria de las personas que viven con VIH en Bissau, Guinea-Bissau: perspectivas, desafíos y vulnerabilidades / The daily life of people living with HIV in Bissau, Guinea-Bissau: perspectives, challenges and vulnerabilities

RESUMO Objetivo compreender as perspectivas e desafios no cotidiano de pessoas após a descoberta do viver com VIH em Bissau, Guiné-Bissau, tendo em vista diferentes contextos de vulnerabilidade. Método estudo exploratório-descritivo, que utilizou entrevista semiestruturada com 16 pessoas vivendo com VIH, acompanhadas em um hospital de Bissau. Empregou-se técnica de análise de conteúdo temática. Os relatos dos participantes foram analisados a partir de duas categorias empíricas: A descoberta, os impactos e os desafios de viver com VIH; e Experiência com o antirretroviral: recomeço e perspectivas. Resultados sinalizaram que os desafios iniciam com a revelação do diagnóstico que, geralmente, desperta uma diversidade de sentimentos e comportamentos. O estigma e a discriminação estimulam a adoção do sigilo sobre o status sorológico, resultando na fragilidade de suporte emocional no enfrentamento à soropositividade. A terapia antirretroviral foi vislumbrada como esperança para o enfrentamento da doença. A vulnerabilidade social foi a dimensão que mais se destacou, e violações dos direitos humanos foram constatadas. Conclusão e implicações para a prática o estudo permite compreender as perspectivas, desafios e vulnerabilidades de pessoas que vivem com VIH. O viver com VIH merece atenção especial por parte dos profissionais de saúde que atuam no cuidado dessas pessoas, destacando-se como contribuição a relevância de um cuidado de saúde integral, em que a ética e a subjetividade estejam presentes.

RESUMEN Objetivo este estudio cualitativo tuvo como objetivo comprender perspectivas y desafíos en la vida cotidiana de las personas que viven con VIH en Bissau, Guinea-Bissau, considerando diferentes contextos de vulnerabilidad. Método estudio exploratorio-descriptivo, que utilizó una entrevista semiestructurada con 16 personas que viven con el VIH, seguido en un hospital de Bissau. Se utilizó la técnica de análisis de contenido temático. Los informes de los participantes se analizaron a partir de dos categorías empíricas: El descubrimiento, los impactos y los desafíos de vivir con el VIH; y La experiencia antirretroviral: un nuevo comienzo y perspectivas. Resultados los resultados indicaron que los desafíos comienzan con la divulgación del diagnóstico, que generalmente suscita una diversidad de sentimientos y conductas. El estigma y la discriminación fomentan la adopción del secreto sobre el estado serológico, lo que resulta en un apoyo emocional débil para hacer frente a la seropositividad. La terapia antirretroviral es una esperanza para hacer frente a la enfermedad. La vulnerabilidad social fue la dimensión que más se destacó y se encontraron violaciones a sus derechos humanos. Conclusión e implicaciones para la práctica el estudio permite comprender las perspectivas, los desafíos y las vulnerabilidades de las personas que viven con el VIH. Vivir con VIH merece especial atención por parte de los profesionales de la salud que actúan en el cuidado de estas personas, destacando como aporte la relevancia de la atención integral en salud, en la que la ética y la subjetividad están presentes.

ABSTRACT Objective to understand perspectives and challenges in the daily lives of people after the discovery of living with HIV in Bissau, Guinea-Bissau, considering different contexts of vulnerability. Method an exploratory-descriptive study conducted through semi-structured interviews with sixteen people living with HIV attending a hospital in the city of Bissau. We used the thematic content analysis technique. Participants' reports were analyzed following two empirical categories: Discovery, impacts and challenges of living with HIV; and Experience with antiretroviral therapy: new beginning and perspectives. Results the results indicate that the challenges start with the disclosure of diagnosis, which arouses a diversity of feelings and behaviors. Stigma and discrimination encourage the adoption of confidentiality about serological status, which increases the fragility of emotional support in coping with seropositivity. Antiretroviral therapy was seen as a hope for coping with the disease. Social vulnerability was the dimension that stood out the most, and human rights violations involving people living with HIV were verified. Conclusion and implications for practice the study makes it possible to understand the perspectives, challenges and vulnerabilities of people living with HIV. Living with HIV deserves special attention from health professionals who work in the care of these people, highlighting as a contribution the relevance of comprehensive health care, in which ethics and subjectivity are present.

Itinerário terapêutico de idosos vivendo com HIV/Aids: perspectivas da história oral / Therapeutic Itinerary of Elderly Living with HIV/Aids: Oral History Perspectives

Resumo Objetivo: Analisar o itinerário terapêutico de idosos vivendo com HIV em assistência num município do Oeste Catarinense. Metodologia: Estudo qualitativo com método história oral temática. A população foi composta por idosos que vivem há mais de cinco anos com HIV/Aids, assistidos em um Serviço de Atendimento Especializado. Foram realizados dois encontros para aproximação e três momentos de entrevistas em profundidade abordando questões relacionadas as trajetórias assistenciais dos sujeitos e sua relação com a doença. A análise de dados foi realizada por meio da análise temática de conteúdo. Resultados e Discussão: Os idosos tiveram seu diagnóstico em fase tardia o que mostra a dificuldade dos serviços de saúde em identificar precocemente o HIV na pessoa idosa. O tratamento foi centralizado na medicação com antirretrovirais, de maneira setorializada em serviço especializado e com equipe constituída por profissional médico, enfermeiro e farmacêutico. Também foi evidenciado baixo acesso a recursos não farmacológicos, como assistência psicoterapêutica. Considerações finais: A trajetória assistencial precisa ser qualificada na direção de garantir maior acesso as redes de saúde e as equipes interprofissionais para uma atenção à saúde integral que realize o diagnóstico precoce com vistas a reduzir os riscos de complicações e ofereça um cuidado integral e humanizado, que extrapole o uso de medicamentos.

Abstract Objective: To analyze the therapeutic itinerary of elderly people living with HIV assisted in a municipality in Western Santa Catarina. Methodology: Qualitative study with thematic oral history method. The population was consisted of elderly people who have been living with HIV/Aids for more than five years, assisted in a Specialized Care Service. Two meetings were held for approximation and three moments of in-depth interviews. Data analysis was performed through thematic content analysis. Results and Discussion: The elderly had their diagnosis at a late stage, use antiretrovirals in their therapeutic journey, they have the specialized service as the central treatment space and greater contact with the medical professional, nurse and pharmacist. Final considerations: The therapeutic itineraries were built in a way that diagnoses happen late, with treatment focused on medication, in a sectorized way and without a diverse interprofessional team.

Le taux de lymphocytes T CD4 au diagnostic de la séropositivité au virus de l'immunodéficience humaine à Libreville, 2022 / CD4 T lymphocyte count at diagnosis of human immunodeficiency virus seropositivity in Libreville, 2022

Introduction. L'efficacité du traitement antirétroviral dans la restauration immunitaire dépend fortement du stade de l'infection et du taux de lymphocyte TCD4 au moment de l'introduction du traitement. Nous avons évalué le taux de lymphocytes TCD4 à la découverte de la séropositivité au VIH pour caractériser le niveau d'infection de chaque patient. Matériel et méthodes. C'est une étude transversale et descriptive qui s'est déroulée dans le laboratoire de virologie de la faculté de médecine de Libreville. Nous avons analysé les données de la cohorte DERIRADO. Résultats. Nous avons inclus 133 patients. L'âge médian était de 45 ans (Q1-Q3 :37 ; 52). La médiane de LTCD4 était de 388 cellules/mm3 (Q1-Q3 : 250 ; 556). Le diagnostic était avancé chez 112 (84%) patients. Conclusion. La découverte de la séropositivité au Virus de l'Immunodéficience Humaine est faite à un stade d'immunodépression avancé chez la majorité des patients. Ce constat relève la nécessité de mettre en route les politiques de sensibilisation pour cibler les populations clés et amener le plus grand nombre au dépistage de l'infection par le Virus de l'Immunodéficience Humaine si l'on veut diminuer la courbe de transmission.

Introduction. The effectiveness of antiretroviral therapy in immune restoration largely depends on the stage of infection and the TCD4 lymphocyte count at the time of treatment initiation. We evaluated the rate of TCD4 lymphocytes at the discovery of HIV seropositivity to characterize the level of infection of each patient. Methods. This was a cross sectional descriptive and analytic study whose setting was the laboratory of virology of the faculty of medicine of Libreville. Our data source was DERIRADO cohort. Results. We included 133 patients. The median age was 45 (Q1- Q3:37;52). The median LTCD4 was 388 cells/mm3 (Q1-Q3: 250; 556). The diagnosis was advanced in 112 (84%) patients. Conclusion. The diagnosis of seropositivity to the Human Immunodeficiency Virus is made at a stage of immunosuppression in the majority of patients. This highlights the need to implement sensitization policies to target key populations and bring as many people as possible to screening in order to reduce the transmission curve

Hypertension and associated factors among patients attending HIV clinic at KorleBu Teaching Hospita

Objectives: This study determined the prevalence of hypertension and its associated factors among patients attending the HIV clinic at the Korle-Bu Teaching Hospital (KBTH). Design: A hospital-based cross-sectional study was conducted at KBTH. The prevalence of hypertension was estimated among study participants, and socio-demographic, lifestyle, anthropometric, metabolic and HIV/ART-related factors associated with hypertension were determined by logistic regression modelling. Setting: Study participants were recruited from the HIV clinic at the KBTH. Participants: A total of 311 Persons Living with HIV were recruited as study participants Interventions: Simple random sampling technique was used to recruit study participants. A questionnaire adapted from the WHO STEPwise approach to chronic disease risk-factor surveillance was used to collect study participants' data. Results: The prevalence of hypertension was 36.7%, and the factors associated with hypertension were increasing age, positive family history of hypertension, minimal exercising, current BMI ≥25.0 kg/m2 , total cholesterol level ≥5.17 mmol/L, exposure to anti-retroviral therapy (ART) and increasing duration of ART exposure. Conclusions: This study shows a high prevalence of hypertension among patients attending the HIV clinic at KBTH,associated with exposure to ART and increasing duration of this exposure. Blood pressure monitoring should move from routine to a more purposeful screening of patients for hypertension. Patients with the identified risk factors should be encouraged to have regular blood pressure measurements at home and not only when they visit the HIV clinic.

Adolescents infectés par le VIH au cours de la transition des soins pédiatriques aux soins pour adultes dans un hôpital de référence à Abidjan (Côte d'Ivoire). Etudes des caractéristiques cliniques / Hiv-infected adolescents during the transition from paediatric to adult care in a referral hospital in abidjan (cote d'ivoire). Clinical characteristics study

Les adolescents vivant avec le VIH ont de moins bons résultats que les adultes en matière de soins, en particulier lors de la transition entre les soins pédiatriques et les soins aux adultes. L' Objectif était de décrire les particularités socio familiales, cliniques, para cliniques et thérapeutiques des adolescents au cours de cette phase charnière de leur prise en charge. Méthodes. Il s'agissait d'une étude rétrospective à visée descriptive qui s'est déroulé du 1er au 31 mars 2020 (1 mois) sur la cohorte d'enfants vivant avec le VIH suivi au CHU de Cocody (Abidjan) de novembre 2005 à mars 2020 (15 ans). Résultats. Trente-huit adolescents en phase de transition ont été inclus. L'âge moyen était de 17 ans avec des extrêmes de 15 et 20 ans. Le sex ratio était de 1,37. La majorité des enfants étaient scolarisé (81,57%) avec un retard scolaire chez plus de la moitié (58%). Près de la moitié des cas était orphelin d'un ou des 2 parents (47,4%). Les conditions socioéconomiques étaient modestes ou défavorable (73,7%). Près de la moitié des adolescents était suivi depuis plus de 10 ans (42%). Un surpoids a été retrouvé dans 21% des cas. On notait un échec immunologique dans 10,5% des cas et un échec virologique dans un tiers des cas (31,6%). L'observance était moyenne ou mauvaise chez près de la moitié des adolescents (44,7%). La majorité des adolescents (94,7%) n'avait jamais eu de contact avec un médecin d'adulte. Conclusion. La transition des soins pédiatriques aux soins pour adulte est un processus au cours duquel l'adolescent est confronté à des diffi cultés socio familiale et scolaire, a l'inobservance avec échec thérapeutique qui doit être repéré de façon précoce. Le succès de cette étape nécessite également le rapprochement entre pédiatres et médecins d'adultes pour une prise en charge optimal des patients.

An assessment on the implementation of same day antiretroviral therapy initiation in eThekwini clinics, KwaZulu­Natal, South Africa

The World Health Organization (WHO) recom mends same day initiation (SDI) of antiretroviral therapy (ART) for all individuals diagnosed with HIV irrespective of CD4+ count or clinical stage. Implementation of program is still far from reaching its goals. This study assessed the level of implementation of same day ART initiation. A longitudinal study was conducted at four primary healthcare clinics in eThekwini municipality KwaZulu Natal. Data was collected between June 2020 to October 2020 using a data extraction form. Data on individuals tested HIV positive, number of SDI of ART; and clinicians working on UTT program were compiled from clinic registers, and Three Interlinked Electronic Registers.Net (TIER.Net). Non governmental organisations (NGO) supporting the facility and services information was collected. Among the 403 individuals who tested HIV positive, 279 (69.2%) were initiated on ART on the same day of HIV diagnosis from the four facilities. There was a significant association between health facility and number of HIV positive individuals initiated on SDI (chi square=10.59; P value=0.008). There was a significant association between facilities with support from all NGOs and ART SDI (chi square=10.18; P value=0.015. There was a significant association between staff provision in a facility and SDI (chi square=7.51; P value=0.006). Urban areas clinics were more likely to have high uptake of SDI compared to rural clinics (chi square=11,29; P value=0.003). Implementation of the Universal Test and Treat program varies by facility indi cating the need for the government to monitor and standardize implementation of the policy if the program is to yield success.

Adherence to ART drugs among HIV-positive pregnant women at selected hospitals of East Ethiopia

Background: Substance abuse among Human Immune Deficiency Virus-positive patients causes depression, carelessness, and anxiety, which in common results in a decrease in adherence to antiretroviral treatment. The purpose of the study is to assess the prevalence of substance abuse and its association with adherence to ART drugs. Methods: The current study was conducted at three hospitals (Hiwot Fana Comprehensive University Hospital, Dillchora Hospital, and Jugal Hospital) located in East Ethiopia. Bivariate and multivariate logistic regression analysis was used to identify the association of independent variables with the dependent variables. Results: In this study, 119 HIV-positive pregnant patients were included. While 74.8% of the patients were adherent to their medication, the remaining 25.2% were nonadherent. The major reasons for nonadherence to ART medications prescribed were getting better (73.3%) and finishing medication (16.7%). Moreover, 96 (80.7%) respondents abused alcohol while 36 (30.3%) and 75 (35.6%) abused opioids and cigarette smoking, respectively. Mothers who abused alcohol were 38.1 times more likely to be nonadherent to ART medications for PMTCT [AOR = 38.1% CI: 21.47­56.54] compared to their counterparts. Additionally, mothers who abuse opioids were 19 times more likely to be nonadherent to ART treatment medication [AOR = 19, 95% CI: 2.46­ 19.46] than their counterparts. Furthermore, mothers who smoked cigarettes were 43.1 more likely to be nonadherent [AOR = 43.19, 95% CI: 8.42­187.84] than nonsmokers. Unemployment was also found to be associated with nonadherence to ART medication to PMTCT of HIV [AOR = 5.4, 95% CI: 2.8­5.7]. Smoking of marijuana/cannabis/hashish was not significantly associated with nonadherence to ART [AOR = 0.22, 95% CI: 0.084­0.355]. Conclusion: Abuse of alcohol, cigarette smoking, abuse of opioids, and joblessness were found to be significantly associated with nonadherence to ART medications prescribed to PMCT of HIV. Wheareas, smoking of marijuana/cannabis/hashish was not significantly associated with nonadherence to ART medications.

Lived experience of people living with HIV in Blantyre, Malawi: an exploratory qualitative study

Background People living with the Human Immunodeficiency Virus (HIV) encounter a range of complex challenges that impact their physical, psychological, and social well-being. The combined effects of these challenges significantly impact their daily functioning. Despite the relatively high prevalence of HIV in Malawi, there is limited knowledge on how the challenges experienced by people living with HIV correlate with their societal participation and performance of activities. Objectives This study aimed to explore the lived experience of people living with HIV and how the challenges experienced impact societal participation and activity performance. Method: A qualitative exploratory study design was used. Fourteen participants were purposefully selected for the study, with an equal number of males and females. The data was gathered through semi-structured interviews and manually analyzed using thematic analysis. Results It was found that participants faced discrimination, stigma, depression, anxiety, and worries. The study participants associated their taking of antiretroviral therapy with physical impairments such as dizziness, leg pain, yellow eyes, and fatigue. The physical impairments hampered participants' ability to walk, work, conduct business, perform household chores, and care for children. Conclusion This study identified the difficulties that people living with HIV faced in their communities and how these challenges impact societal participation and performance in activities. There is a need for a holistic approach to managing these challenges and making referrals to specialized professionals.

Proporción de infecciones oportunistas y factores de riesgo asociados a su aparición en pacientes con VIH / Proportion of opportunistic infections and risk factors associated with its appearance in patients with HIV

Antecedentes: Las infecciones oportunistas son la principal causa de morbilidad, discapaci- dad y mortalidad en pacientes con VIH, aumentando el número de hospitalizaciones y costos en la atención. Objetivo: Estimar la proporción de infecciones oportunistas e identificar los factores asociados a su aparición en pacientes con VIH atendidos en el Servicio de Atención Integral del Hospital Nacional Dr. Mario Catarino Rivas, San Pedro Sula, 2019-2020. Métodos: Estudio no experimental, analítico de casos (infección oportunista presente) y controles. Se evaluaron 40 casos y 120 controles, con un nivel de confianza de 95%, poder estadístico de 80%, con muestreo tipo aleatorio simple. Se utilizó la distribución de variables entre casos y controles para la obtención de Odds Ratio. Resultados: Las infecciones oportunistas incluyeron: 52.5% (21) tuberculosis, 15.0% (6) histoplasmosis, 12.5% (5) citomegalovirus, 10.0% (4) toxoplasmosis, 10.0% (4) candidiasis, 7.5% (3) criptococosis. El conteo de linfocitos T CD4 fue <200 cel/mm3 en 60.0% (24) de grupo casos y 10.8% (13) de grupo control. La carga viral ˃1000 copias/ml (OR 14.500 IC95% 6.109-34.415), el antecedente de abandono (OR 4.363 IC95% 1.928-9.872) y el no tomar tratamiento antirretroviral (OR 64.076 IC95% 8.063-509.165) se asociaron a infecciones oportunistas. La carga viral mayor de 1000 copias/mL predominó en el grupo de casos, y se encontró asociación de esta con la presencia de infecciones oportunistas con OR 14.500 (IC 95% 6.109-34.415, p=.0001). Conclusión: El no tomar ARV aumenta 64 veces más el riesgo de desarrollar infecciones oportunistas y el haber abandonado el tratamiento antirretroviral aumenta 4 veces más la probabilidad de desarrollar una infección oportunista. El tratamiento antirretroviral de gran actividad y el apego al mismo es la mejor estrategia para prevenir las infecciones oportunistas en pacientes infectados por el VIH...(AU)

Time trend and causes of HIV/AIDS mortality in the state of Santa Catarina, 2010­2019 / Tendência temporal e causas de mortalidade por HIV/AIDS no estado de Santa Catarina, 2010­2019

Introduction: Although the acquired immunodeficiency syndrome (AIDS) has no cure, antiretroviral treatment has considerably increased the survival of people living with the disease or with the human immunodeficiency virus (HIV), reducing the incidence of opportunistic infections in these patients. Thus, this treatment changed mortality rates and diversified the causes of death, including reasons related to increased longevity, such as chronic noncommunicable diseases, common in the uninfected population. Therefore, the current epidemiological transition motivated us to study the death profile of people with HIV/AIDS in the state of Santa Catarina. Objective: To investigate case characteristics, as well as the time trend and distribution of deaths, among people with HIV/AIDS in Santa Catarina between 2010 and 2019. Methods: In this ecological, epidemiological study, we consulted all death records from the Santa Catarina Mortality Information System that had HIV/AIDS among the causes and occurred between 2010 and 2019. Results: A total of 5,174 death records were analyzed. In the period, the mean mortality rate among people with HIV/AIDS was 7.64 deaths per 100 thousand inhabitants (95% confidence interval ­ 95%CI 6.61­8.67) ­ 8.99 in 2010 and 6.06 in 2019 ­, showing a downward trend of 0.38% per year. Conclusion: We identified a downward trend in mortality. Deaths were concentrated on the coast, in more populous cities. Furthermore, the finding of improper completion of the death certificate points to the need to invest in improving the training of professionals responsible for this document.

Introdução: Embora a síndrome da imunodeficiência adquirida (AIDS) não tenha cura, o tratamento antirretroviral aumentou consideravelmente a sobrevida das pessoas que vivem com a doença ou com o vírus da imunodeficiência humana (HIV), diminuindo a ocorrência de infecções oportunistas nesses pacientes. Assim, esse tratamento mudou as taxas de mortalidade e diversificou as causas de óbito, incluindo motivos relacionados ao aumento da longevidade, como doenças crônicas não transmissíveis comuns à população não infectada. Dessa forma, a atual transição epidemiológica motiva o estudo do perfil dos óbitos em pessoas com HIV/AIDS no estado de Santa Catarina. Objetivo: Investigar as características dos casos, a tendência temporal e a distribuição dos óbitos em pessoas com HIV/AIDS no estado de Santa Catarina entre os anos de 2010 e 2019. Métodos: Neste estudo epidemiológico com delineamento ecológico, foram consultados todos os registros de óbitos do Sistema de Informação sobre Mortalidade de Santa Catarina ocorridos entre os anos de 2010 e 2019 que apresentassem entre as causas o HIV/AIDS. Resultados: Foram analisados 5.174 registros de óbitos. A taxa de mortalidade média entre pessoas com HIV/AIDS do período foi de 7,64 óbitos a cada 100 mil habitantes (95% intervalo de confiança ­ IC95% 6,61­8,67), sendo de 8,99 em 2010 e 6,06 em 2019, mostrando tendência de queda de 0,38 pontos percentuais ao ano. Conclusão: Observou-se tendência de queda na mortalidade. A concentração dos óbitos foi na faixa litorânea, em cidades mais populosas. Ademais, a constatação do falho preenchimento da declaração de óbito aponta para a necessidade de investir no aprimoramento do treinamento dos profissionais responsáveis por esse documento.

Religiosidade/espiritualidade e adesão à terapia antirretroviral em pessoas vivendo com HIV / Religiosity/spirituality and antiretroviral therapy adherence in people living with HIV / Religiosidad/espiritualidad y adhesión a la terapia antirretroviral en personas viviendo con VIH

Dentre os fatores associados à adesão à Terapia Antirretroviral (TARV) em pessoas vivendo com HIV, destaca-se a religiosidade/espiritualidade (R/E). O objetivo deste estudo foi apresentar as evidências disponíveis sobre a relação entre a dimensão da R/E e a adesão aos antirretrovirais. Realizou-se uma revisão integrativa de literatura com buscas nas bases/bibliotecas CINAHL, LILACS, PePSIC, PsycINFO, PubMed, SciELO, Scopus e Web of Science. Foram selecionados artigos empíricos publicados entre janeiro de 2008 e junho de 2019, sendo recuperados 49 estudos após a aplicação dos critérios de inclusão/exclusão. Encontraram-se associações positivas, negativas e neutras entre R/E e adesão à TARV, evidenciando que a R/E é uma dimensão psicossocial que pode ser preditora da adesão aos antirretrovirais. O sentido dessa influência, no entanto, ainda não é um consenso na literatura científica. Recomenda-se que essas influências sejam compreendidas a partir de elementos contextuais dessa população e não apenas de marcadores pessoais (AU).

Religiosity and spirituality (R/S) have stood out among factors associated with adherence to antiretroviral therapy (ART) in people living with HIV. This study aimed to identify evidence on the relationship between R/S and adherence to ART. An integrative literature review was conducted within the CINAHL, LILACS, PePSIC, PsycINFO, PubMed, SciELO, Scopus, and Web of Science databases. Empirical articles published between January 2008 and June 2019 were selected, and 49 studies were retrieved after applying the inclusion/exclusion criteria. Positive, negative, and neutral associations were found between R/S and adherence to ART, showing that R/S is a psychosocial dimension that can be a predictor of adherence to antiretrovirals. The meaning of this influence, however, is not yet a consensus in the scientific literature. It is recommended that these influences be understood from the contextual elements of this population and not just from personal markers (AU).

Entre los factores asociados a la adherencia a la Terapia Antirretroviral (TARV) en personas diagnosticadas con VIH, destaca la religiosidad/espiritualidad (R/E). El objetivo de este estudio fue presentar las evidencias disponibles sobre la relación entre la dimensión de la R/E y la adherencia a los antirretrovirales. Se realizó una revisión integradora de la literatura con búsquedas en las bases de datos/bibliotecas CINAHL, LILACS, PePSIC, PsycINFO, PubMed, SciELO, Scopus y Web of Science. Se seleccionaron artículos empíricos publicados entre enero de 2008 y junio de 2019, y se recuperaron 49 estudios tras aplicar los criterios de inclusión/exclusión. Fueron encontradas asociaciones positivas, negativas y neutras entre la R/E y la adherencia al TARV, lo que demuestra que la R/E es una dimensión psicosocial que puede ser un predictor de la adherencia a los medicamentos antirretrovirales. Sin embargo, el significado de esta influencia aún no está consensuado en la literatura científica. Se recomienda que estas influencias se entiendan a partir de los elementos contextuales de esta población y no solo de los marcadores personales (AU).

Pharmacovigilance of antiretroviral dolutegravir in the state of Paraná

The aim of this study was to investigate adverse reactions to Dolutegravir, a drug recently made available by the Unified Health System (SUS) for treating HIV infections. The frequency, severity and sex distribution of adverse reactions to Dolutegravir were identified over the first 18 months of its availability in users in the state of Paraná. Information was obtained through the pharmacovigilance questionnaire prepared by the Ministry of Health, accessed through the Logistics Control System for Medicines(SICLOM). During the study period, dolutegravirwas dispensed to 9,865 patients in the state. However, 9,207 users (93.3%) answered the pharmacovigilance questionnaire. Among them, 1.75% reported 279 adverse reactions. This population was composed mainly of male people (69.57%), in the ratio of 2.29 men for each woman, white (67.08%), aged between 20 and 29 years (26.71%), single (45.34%) and with education between 8 and 11 years of study (41.61%). Gastrointestinal (36.92%) and nervous system (14.34%) disorders were the most prevalent. 77.78% adverse reactions were considered non-serious by users. It can be concluded that dolutegravirhad a low prevalence of adverse reactions in users in the state of Paraná, demonstrating to be safe for use by the population in therapy against HIV, in accordance with clinical trials.

Sociodemographic and pharmacoepidemiological profile of people on antiretroviral therapy in the coast of the state of Paraná

The aim of this study was to investigate possible factors related to antiretroviral therapy (ART) that contribute to the understanding of the highest rate of Aids detection on the coast of the state of Paraná, a port region identified administratively as the 1stRegional Health Division (1stHD) in the state of Paraná. Data on the sociodemographic profile of the population undergoing antiretroviral treatment (ART), medication changes, dropout of therapy, proportion of the population undergoing treatment and viral load were obtained through computerized systems. Between July 1, 2018 and June 31, 2019, 1,393 people were on ART in the 1stRS. Of these, 57.6% were male. During this period, 110 people started ART with a predominance of the age group between 30 and 39 years old. ART was switched for169 people and 211 patient dropouts were detected. The proportion of people diagnosed with HIV without treatment (gap) is still high, however 92.7% people on ART have suppressed viral load. It can be concluded that the lower educational level of the population undergoing treatment, the late diagnosis of those infected and the treatment gapprobably contribute to the highest rate of Aids detection in the 1stRS.

Evolução do cuidado continuo a pessoas infectadas com HIV e reflexos na taxa de detecção da AIDS no município de Paranaguá, Paraná / Continuous care for people infected with hiv and reflections on AIDS detection rate

Em razão da implantação da cascata de cuidado contínuo do HIV/AIDS, o estado do Paraná apresentou um declínio do número de casos de AIDS a partir do ano de 2012. Entretanto, na 1ª Regional de Paranaguá concentram-se as maiores taxas de incidência de casos de HIV no ano de 2014, além de possuir também o maior coeficiente de mortalidade por AIDS. Objetivos: Investigar a evolução de alguns parâmetros da cascata de cuidado das pessoas com HIV no município de Paranaguá, no Paraná. Método: Estudo observacional, descritivo, retrospectivo e de caráter quantitativo, realizado com dados secundários sobre indicadores clínicos de HIV/AIDS fornecidos pela Secretaria de Vigilância em Saúde do Ministério da Saúde, no período de 2015 a 2021. Resultados: Obteve-se uma redução progressiva da detecção de AIDS no município de Paranaguá. Entretanto, ainda com as maiores taxas de detecção do estado, além de uma proporção de pessoas com carga viral suprimida abaixo dos 90% propostos como meta pela Organização Mundial da Saúde. Conclusão: Reforça-se a necessidade de persistir e intensificar as ações voltadas ao diagnóstico, vinculação e tratamento correto das pessoas com HIV nos serviços de saúde de Paranaguá

Due to the implementation of the HIV/AIDS continuous care cascade, the state of Paraná showed a decline in the number of AIDS cases from the year 2012. However, the 1st Regional of Paranaguá concentrates the highest rates of infection cases in 2014, in addition to having the highest AIDS mortality rate. Objective: To investigate the evolution of some parameters of the cascade of care for people with HIV in the municipality of Paranaguá, Paraná.Methods: Observational, descriptive, retrospective and quantitative study, carried out with secondary data on clinical indicators of HIV/AIDS provided by the Health Surveillance Department of the Ministry of Health, from 2015 to 2021. Results: There was a progressive reduction in the detection of AIDS in the city of Paranaguá. However, still with the highest detection rates in the state, in addition to a proportion of people with suppressed viral load below the 90% proposed as a goal by the World Health Organization. Conclusion: The need to persist and intensify actions aimed at diagnosis, linking and correct treatment of people with HIV in the health services of Paranaguá is reinforced