Self-Reported Health-Related Quality of Life and Residual Symptoms among Virologically Suppressed People Living with HIV in the Era of Single-Tablet Regimens in Taiwan: A Cross-Sectional Study.

This study assessed the health-related quality of life (HRQoL) and residual symptom burden among virologically suppressed people living with human immunodeficiency virus (HIV) (PLWH) using a single-tablet regimen in Taiwan. This cross-sectional study administered a self-reported online survey between July and October 2021 to anonymised virologically suppressed PLWH aged ≥20 years. Demographic, HIV-related variables, EuroQol-5-dimensions (EQ-5D), visual analogue scale (VAS), and HIV Symptom Index were analysed. Bivariate analyses were performed to compare HRQoL differences between PLWH and non-PLWH. Among 120 PLWH, 80.9% had HIV diagnosis for <15 years, median antiretroviral therapy (ART) duration of 7.0 years (Q1-Q3:4.0-11.0), and 62.5% had ≥1 comorbidity. The most common comorbidities were depression (26.7%) and hyperlipidaemia (15.8%). About one-fifth of PLWH received constant family support (25.8%) and peer support (21.7%). Married individuals or individuals with higher incomes had significantly better family support status. There was no significant difference across the five dimensions between PLWH and non-PLWH. PLWH perceived being bothered by fatigue/lack of energy (63.3%), sleep difficulties (63.3%), feeling sad/low/unhappy (51.7%), and appearance changes (51.7%). PLWH could achieve similar HRQoL as non-PLWH with stable treatment, highlighting an opportunity to focus on person-centred holistic care beyond HIV, especially on the psychological aspect, for the best possible HRQoL for PLWH.

Staff perspectives on the feasibility of the person-centered care assessment tool (PCC-at) in HIV treatment settings in Ghana: a mixed-methods study.

Person-centered care (PCC) aims to improve client's experiences in HIV care while advancing outcomes. This study team developed the PCC assessment tool (PCC-AT) to assess PCC service performance in HIV treatment settings in Ghana. Study objectives aimed to describe the range of PCC-AT scores within and across study facilities and examine the feasibility of PCC-AT implementation in diverse HIV treatment settings. The PCC-AT was piloted at five health facilities providing HIV services among 37 staff. Immediately following each pilot, focus group discussions (FGDs) were conducted to gather feasibility data. Thematic qualitative analysis was conducted on translated FGD transcripts. Across facilities, providers scored highest in the staffing domain, followed by service provision, and direct client support. Time required to implement the PCC-AT averaged 62 minutes. Providers described the tool as well-structured, user-friendly, relevant, reflective of the core PCC delivery elements, and useful in elucidating actions to improve PCC service delivery across domains. The PCC-AT holds potential to strengthen activities that support clients' broader clinical, mental and psychosocial wellbeing by offering friendly services that attend to each client's holistic needs while contributing progress towards epidemic control.

Acceptability and Feasibility of a Tai Chi/Qigong Intervention for Older People Living With HIV.

Tai chi/qigong (TCQ) is a low impact, meditative movement with breathwork that may benefit people with HIV (PWH) over 50 years old. This study is a feasibility clinical trial of a remote TCQ intervention for older PWH. Participants (n = 48) were recruited via clinic sites and social media and randomized to a TCQ, sham qigong, or wait-list control group. The 12-week intervention included fourteen 45-60-minute sessions. Acceptability (satisfaction, attitudes, practice, attendance) and feasibility (retention rate, adverse events, remote delivery) data were surveyed. Overall retention rate was 72.9%, but 81.2% for the TCQ group. Most TCQ participants attended at least 10 sessions (62.5%) and were practicing TCQ after 2 weeks (72.7%). Over 92% of TCQ participants reported satisfaction and positive attitudes and preferred remote versus in person delivery (63.6%). Two mild intervention related adverse events occurred. Findings suggest that a remote TCQ intervention is acceptable, feasible, and safe among older PWH.

RESUMEN: Tai chi/qigong (TCQ) es un movimiento meditativo de bajo impacto con ejercicios de respiración que puede beneficiar personas que viven con VIH (PVV) mayores de 50 años. Este estudio es un ensayo clínico de viabilidad que evalúa una intervención de TCQ administrada remotamente para personas mayores que viven con VIH. Participaron personas (n = 48) reclutadas en clínicas y redes sociales, asignadas aleatoriamente a un grupo de TCQ, qigong falso, o control en lista de espera. La intervención duró 12 semanas con catorce sesiones de 45 a 60 minutos. Se encuestaron datos sobre aceptabilidad (satisfacción, actitudes, práctica, asistencia) y viabilidad (retención, eventos adversos, entrega remota). La tasa de retención general fue del 72,9%, pero del 81,2% para el grupo de TCQ. La mayoría de los participantes de TCQ asistieron a al menos 10 sesiones (62,5%) y continuaron practicando después de 2 semanas (72,7%). La satisfacción y las actitudes positivas hacia la intervención fueron reportadas por más del 92% de los participantes de TCQ quienes prefirieron la participación remota contra clases en persona (63,6%). Dos eventos adversos leves relacionados con la intervención ocurrieron. Los resultados sugieren que una intervención de TCQ administrada de forma remota es aceptable, viable y seguro para personas mayores que viven con VIH.

An overview of multimorbidity and polypharmacy in older people living with HIV.

The availability of effective antiretroviral therapy (ART) has revolutionized the care of people living with HIV (PLHIV). As a result, PLHIV now have a life expectancy comparable with that of the general population. PLHIV are increasingly confronted with age-related comorbidities and geriatric syndromes, including frailty and polypharmacy, which occur at a higher prevalence and set in at an earlier age compared with their uninfected counterparts. The underlying pathophysiology for multimorbidity and polypharmacy are multifactorial, multidimensional and complex. Therefore, regular review and optimization of risk factors to maintain physical function, social and psychological health is of utmost importance. With an ever-growing population of older PLHIV, there is a pressing need to provide holistic care to address these emerging issues. Accelerated aging observed in PLHIV suggests that early involvement of a multidisciplinary team, including geriatricians, and implementation of integrated models of care can potentially improve the care of older PLHIV, who are at increased risk of frailty and complex multimorbidity. This article reviews the current global situation, discusses the challenges involved and suggests approaches to deliver comprehensive care for older PLHIV. Geriatr Gerontol Int 2024; 24: 49-59.

Increasing trends of overweight and obesity in treatment-naive people living with HIV in Shenzhen from 2014 to 2020: an emerging health concern.

Background: With the early initiation of antiretroviral therapy (ART) in China, the demographics of treatment-naïve people living with HIV (PLWH) are moving closer to those of the general population, which is characterized by a gradual increase in metabolic indicators. However, the epidemic trends of overweight and obesity over the past decade in treatment-naïve PLWH ready to initiate ART have not yet been investigated. Methods: A cross-sectional study was conducted, including 12,135 consecutive treatment-naïve PLWH ready to initiate ART in Shenzhen, using data retrieved from the China National Free Antiretroviral Treatment Program database from 2014 to 2020. The chi-square test was used to examine the trends of overweight and obesity between age groups, and multivariate logistic regression was used to identify the association of overweight and obesity with hyperglycemia and dyslipidemia. Results: During the 7-year study period, 12,135 treatment-naïve PLWH ready to initiate ART were included, among whom 1,837 (15.1%) were overweight and 388 (3.2%) were obese. The prevalence of overweight rose from 11.4 to 17.3% (Z = -4.58, P for trend <0.01) and that of obesity from 2.0% to 4.2% (Z = -6.45, P for trend <0.01) from 2014 to 2020. The annual prevalence of overweight was the highest in the age group of participants >35 years compared to prevalence in other age groups during the period 2014-2020. Compared with those who were not overweight or obese, PLWH who were overweight or obese were more likely to have hyperglycemia (aOR 1.84, 95% CI: 1.37-2.49 for overweight; aOR 2.68, 95% CI: 1.62-4.44 for obesity), higher ALT level (aOR 2.70, 95% CI: 2.33-3.13 for overweight; aOR 3.85, 95% CI: 2.93-5.05 for obesity), higher TG levels (aOR 1.89, 95% CI 1.63-2.19 for overweight; aOR 2.56, 95% CI 1.97-3.32 for obesity), and lower HDL levels (aOR 1.67, 95% CI 1.44-1.95 for overweight; aOR 2.06, 95% CI 1.54-2.77 for obesity). Conclusion: The prevalence of overweight and obesity in treatment-naive PLWH increased steadily from 2014 to 2020 in Shenzhen. Overweight and obese in treatment-naive PLWH ready to initiate ART were associated with dyslipidemia and hyperglycemia. Public health authorities should take proactive steps to address these issues by implementing targeted screening, intervention programs including lifestyle modifications, and integrated healthcare services.

Lung Cancer Screening Adherence Among People with HIV Treated at an Integrated Health System in Florida.

We evaluated low-dose computed tomography (LDCT) adherence among people with HIV (PWH) treated at University of Florida (UF). From the UF Health Integrated Data Repository, we identified PWH who underwent at least one LDCT procedure (January 1, 2012-October 31, 2021). Lung cancer screening adherence was defined as having a second LDCT within recommended observation window, based on the Lung Imaging Reporting and Data System (Lung-RADS®). We identified 73 PWH with a history of at least one LDCT. PWH were mostly male (66%), non-Hispanic Black (53%), and living in urban (86%), high poverty (45%) areas. Almost 1 in 10 of PWH were diagnosed with lung cancer after their first LDCT. Overall, 48% and 41% of PWH were diagnosed with Lung-RADS categories 1 and 2, respectively. We observed that 12% of PWH were adherent to LDCT. Only 25% of PWH diagnosed with category 4A were adherent. PWH may have poor adherence to lung cancer screening.

Translocation of bacterial LPS is associated with self-reported cognitive abilities in men living with HIV receiving antiretroviral therapy.

BACKGROUND: Gut damage allows translocation of bacterial lipopolysaccharide (LPS) and fungal ß-D-glucan (BDG) into the blood. This microbial translocation contributes to systemic inflammation and risk of non-AIDS comorbidities in people living with HIV, including those receiving antiretroviral therapy (ART). We assessed whether markers of gut damage and microbial translocation were associated with cognition in ART-treated PLWH. METHODS: Eighty ART-treated men living with HIV from the Positive Brain Health Now Canadian cohort were included. Brief cognitive ability measure (B-CAM) and 20-item patient deficit questionnaire (PDQ) were administered to all participants. Three groups were selected based on their B-CAM levels. We excluded participants who received proton pump inhibitors or antiacids in the past 3 months. Cannabis users were also excluded. Plasma levels of intestinal fatty acid binding protein (I-FABP), regenerating islet-derived protein 3 α (REG3α), and lipopolysaccharides (LPS = were quantified by ELISA, while 1-3-ß-D-glucan BDG) levels were assessed using the Fungitell assay. Univariable, multivariable, and splines analyses were performed. RESULTS: Plasma levels of I-FABP, REG3α, LPS and BDG were not different between groups of low, intermediate and high B-CAM levels. However, LPS and REG3α levels were higher in participants with PDQ higher than the median. Multivariable analyses showed that LPS association with PDQ, but not B-CAM, was independent of age and level of education. I-FABP, REG3α, and BDG levels were not associated with B-CAM nor PDQ levels in multivariable analyses. CONCLUSION: In this well characterized cohort of ART-treated men living with HIV, bacterial but not fungal translocation was associated with presence of cognitive difficulties. These results need replication in larger samples.

A qualitative study exploring perceptions of people living with HIV using antiretroviral therapy on self-management of healthy nutrition and the related healthcare service in Ethiopia.

In Ethiopia, undernutrition is a quite common health problem among people living with HIV. Unlike in developed countries, nutritional counseling for people living with HIV has not received much attention. This study aimed to explore the perception of people living with HIV on their dietary practice and the existing health care service in Ethiopia. A phenomenological qualitative study was conducted in two hospitals in southern Ethiopia from March to June 2018. A pre-tested interview guide was prepared in English and translated into the Amharic language. The data were collected using key informant interviews, focus group discussions and observations in the ART clinics by six trained nurses. The data were analyzed thematically. Almost all focus group discussion participants mentioned that a healthy diet for ART patients is very important. The majority of the participants mentioned that they were not satisfied with the counseling service given at the ART clinics. Lack of training for health care professionals on nutritional counseling was also reported as a challenge by the nurses themselves. Nutritional counseling given by health care professionals at the ART clinic was poor. Emphasis should be given to the training of healthcare professionals working in ART clinics on nutritional counseling.

Changing co-morbidity and increasing deprivation among people living with HIV: UK population-based cross-sectional study.

BACKGROUND: The great success of HIV treatments means that, increasingly, people living with HIV (PLHIV) are growing old enough to develop age-associated comorbid conditions. We investigated the evolution of comorbid conditions and demographics among PLHIV in England. METHODS: In a cross-sectional study linking Clinical Practice Research Datalink (CPRD) primary care, hospitalization, death registry and Index of Multiple Deprivation data, we measured the prevalence of 304 individual health conditions, categorized into 47 condition groups (36 non-communicable, 11 communicable). Using logistic regression, we calculated odds ratios (ORs) for the likelihood of each condition and condition group in 2015 versus 2008, adjusting for age, sex and deprivation. RESULTS: In 2015, there were 964 CPRD-registered PLHIV compared with 1987 in 2008; 62% were male and 38% female in both cohorts. The 2015 cohort was older, with 51.1% aged 45-64 years and 7.2% aged 65-84 years compared with 31.8% and 3.2%, respectively, in 2008. Deprivation was higher in 2015, at 23.9% (quintile 4) and 28.7% (quintile 5) compared with 5.8% and 6.6%, respectively, in 2008. Of 36 non-communicable condition groups, 14 (39%) occurred in ≥ 10% of PLHIV in 2015, of which seven were more likely in 2015 than in 2008: renal-chronic-kidney-disease [odds ratio (OR) = 1.96 (95% CI: 1.33-2.90); endocrine-obesity [OR = 1.76 (1.12-2.77)]; rheumatology [OR = 1.64 (1.30-2.07)]; dermatology [OR = 1.55(1.29-1.85)]; genito-urinary-gynaecological [OR = 1.44(1.18-1.76)]; eyes-ears/nose/throat [OR = 1.31(1.08-1.59)]; and gastro-intestinal conditions [OR = 1.28 (1.04-1.58)]. Two condition groups, respiratory-chronic-obstructive-pulmonary-disease [OR = 0.36 (0.19-0.69)] and endocrine-diabetes [OR = 0.49 (0.34-0.70)], were less likely in 2015. Ten out of 11 communicable infectious condition groups were less likely in 2015. CONCLUSIONS: Although infections in PLHIV have fallen, chronic non-communicable comorbidity is increasingly prevalent. Alongside the marked increases in deprivation and ageing, this study suggests that socio-economic measures in addition to healthcare provision are needed to achieve holistic health for PLHIV.

Frailty in Aging HIV-Positive Individuals: An Evolving Healthcare Landscape.

The life expectancy of people living with HIV (PLWH) has greatly increased due to advancements in combination antiretroviral treatment (cART). However, this longer life has also increased the prevalence of age-related comorbidities, such as frailty, which now manifest sooner in this group. Frailty, a term coined by the insurance industry, has been broadened to include physical, cognitive, and emotional elements and has been recognized as a critical predictor of negative health outcomes. With the median age of PLWH now in the mid-50s, treating frailty is critical given its link to chronic diseases, cognitive decline, and even death. Frailty assessment tools, such as the Frailty Phenotype (FP) and the Frailty Index (FI), are used to identify vulnerable people. Understanding the pathophysiology of frailty in PLWH indicates the role of immunological mechanisms. Frailty screening and management in this group have progressed, with specialized clinics and programs concentrating on multidisciplinary care. Potential pharmacotherapeutic solutions, as well as novel e-health programs and sensors, are in the future of frailty treatment, but it is critical to ensure that frailty evaluation is not exploited to perpetuate ageist healthcare practices. This narrative review investigates the changing healthcare environment for older people living with HIV (OPLWH), notably in high-income countries. It emphasizes the significance of identifying and managing frailty as a crucial feature of OPLWH's holistic care and well-being.

HIV-related perceived stigma and associated factors among patients with HIV, Dilla, Ethiopia: A cross-sectional study.

INTRODUCTION: Understanding HIV-related perceived stigma has importance in improving the quality of patients and provides a better tackling of HIV stigma. Therefore; the study aimed to assess the prevalence and associated factors of perceived stigma among Patients with HIV attending the clinic at Dilla University Referral Hospital in Ethiopia 2019. METHOD: In this Institution based cross-sectional study, a 10-item perceived HIV stigma scale was used to assess HIV-related perceived stigma. Oslo social support scale was used to assess social support related factors. Bivariate and multivariate binary logistic analysis was done to identify associated factors to HIV-related perceived stigma. RESULTS: The prevalence of HIV-related perceived stigma by using perceived HIV stigma scale among patients with living HIV was 42.7%. Patients who are age groups 25-30 years (AOR = 2.8, 95% CI: 5.72-11.5), age groups 31-39 years (AOR = 1.11, 95% CI: 1.26,4.65), Females (AOR = 2.4, 95% CI: 1.28-4.33), divorced marital status (AOR = 8.9, 95% CI: 3.52-10.61), widowed marital status (AOR = 3.0, 95% CI: 2.74-7.60), Primary educational status (AOR = 7.5,95% CI: 3.45-9.74) and Study participants those who use alcohol (AOR = 1.0 95% CI: 1.57-2.11) were more likely to have HIV-related perceived stigma. CONCLUSION: This calls a holistic approach to the prevention and intervention of HIV-related perceived stigma. Emphasis should also be given for HIV-related perceived stigma. REGISTRATION: This study was registered research registry with the registration number (researchregistry7112).

The continuing role of communities affected by HIV in sustained engagement in health and rights.

INTRODUCTION: The meaningful involvement of persons affected by a disease is a unique aspect of the HIV response that places people living with (PLHIV) and those directly affected by HIV (peers) at the centre of the design, development and implementation of service delivery and research and policy making. The principle of greater involvement of PLHIV (GIPA) has and will increasingly ensure equitable access to services and engagement of marginalized groups in the HIV response, and to health services more broadly. This paper describes the history, current place in the HIV response and potential future role of PLHIV and communities in health responses. DISCUSSION: Historically, the role of communities of PLHIV and peers in service delivery, research and drug development, advocacy, social and political accountability, resource mobilization and social and human rights protection is well documented. Their leadership and engagement have contributed directly to improved outcomes in access to HIV treatment, prevention, support and care services around the world. Their continued and expanded role is especially important for the future success of HIV responses in sub-Saharan Africa, where the HIV burden remains the greatest. The lessons learned from the leadership and involvement of communities of PLHIV and peers in the HIV response hold value beyond HIV responses. The models and approaches they have efficiently and effectively utilized have relevant applications in addressing shortfalls in health systems in the COVID-19 era, as well as broader, more integrated health challenges as countries move to develop and operationalize universal health coverage (UHC). However, neither HIV nor other health and development targets can be met if their contributions are not adequately recognized, valued and funded. CONCLUSIONS: The past three decades have demonstrated that communities of PLHIV and their peers are instrumental in sustaining engagement and advocacy for health equity and financing for health and ensuring that the human rights of all people are recognized and upheld. Quality and effective integration of health systems and UHC can be more effectively designed, implemented and sustained with communities of PLHIV and peers at the centre.

Nutritional status and associated factors among people living with HIV/AIDS in Ghana: cross-sectional study of highly active antiretroviral therapy clients.

BACKGROUND: Nutrition among people living with HIV/AIDS (PLWHA) is essential in their care and management as it has implication for their immune function. We examined the nutritional status and associated factors among HIV positive clients accessing Highly Active Anti-Retroviral Therapy (HAART) at a public hospital in Ghana. METHODS: This was a descriptive cross-sectional study of 152 clients. Anthropometric measurements for weight and height were carried out in 2019. Data were analysed using SPSS 22.0. Descriptive and analytical statistics comprising frequency, percentage, and binary logistic regression were adopted in presenting the results. RESULTS: Seventy-nine percent and 74% of the clients had good nutrition knowledge and attitude, respectively. Also, 42% were malnourished (underweight = 13.8%, and overweight = 28.3%). Clients with primary (AOR = 0.36, 95% CI = 0.07-1.84), JSS/JHS (AOR = 0.26, 95% CI = 0.08-0.84), SSS/SHS (AOR = 0.22, 95% CI = 0.05-1.02) and tertiary (AOR = 0.26, 95% CI = 0.08-0.88) were less likely to be malnourished compared with those with no formal education. Those with good nutrition-related knowledge were 56% (AOR = 0.44, 95% CI = 0.18-1.09) less likely to be malnourished than those with poor knowledge; this was however, not statistically significant. CONCLUSION: We found a high prevalence of malnutrition among the clients which militates against progress towards achieving the Sustainable Development Goal targets 3.3 and 3.4 of stopping AIDS epidemic and preventing premature deaths from malnutrition. Our findings justify the need for the implementation of innovative interventions by stakeholders in Ghana's health industry to improve the nutritional status of people living with the disease.

Barriers and Enablers for Adherence to Antiretroviral Therapy Among People Living With HIV/AIDS in the Era of COVID-19: A Qualitative Study From Pakistan.

Background: With the increased availability of safe antiretroviral therapy (ART) in recent years, achieving optimal adherence and patient retention is becoming the biggest challenge for people living with HIV (PLWH). Care retention is influenced by several socioeconomic, socio-cultural, and government policies during the COVID-19 pandemic. Therefore, we aim to explore barriers and facilitators to adherence to ART among PLWH in Pakistan in general and COVID-19 pandemic related in particular. Methods: Semi-structured interviews were conducted among 25 PLWH from December 2020 to April 2021 in the local language (Urdu) at the ART centre of Pakistan Institute of Medical Sciences, Islamabad, Pakistan. Interviews were audio-recorded in the local Urdu language, and bilingual expert (English, Urdu) transcribed verbatim, coded for themes and sub-themes, and analyzed using a phenomenological approach for thematic content analysis. Results: Stigma and discrimination, fear of HIV disclosure, economic constraints, forgetfulness, religion (Ramadan, spiritual healing), adverse drug reactions, lack of social support, alternative therapies, and COVID-19-related lock-down and fear of lesser COVID-19 care due to HIV associated stigma were identified as barriers affecting the retention in HIV care. At the same time, positive social support, family responsibilities, use of reminders, the beneficial impact of ART, and initiation of telephone consultations, courier delivery, and long-term delivery of antiretrovirals during COVID-19 were identified as facilitators of HIV retention. Conclusion: Improving adherence and retention is even more challenging due to COVID-19; therefore, it requires the integration of enhanced access to treatment with improved employment and social support. HIV care providers must understand these reported factors comprehensively and treat patients accordingly to ensure the continuum of HIV care. A coordinated approach including different stakeholders is required to facilitate patient retention in HIV care and consequently improve the clinical outcomes of PLWH.

Immunological and Psychological Efficacy of Meditation/Yoga Intervention Among People Living With HIV (PLWH): A Systematic Review and Meta-analyses of 19 Randomized Controlled Trials.

BACKGROUND: An expanding number of mind-body therapies are being used to reduce the psychological burden of peoples living with human immunodeficiency virus (HIV). However, the effects on the immune system and mental health varied among studies. PURPOSE: This meta-analysis was conducted to summarize the randomized controlled trials to draw comprehensive conclusions regarding the psycho-immunological efficacy. METHODS: Random-effects models were used to assess the outcome of interest. Egger's tests were used to identify publication bias. Subgroup and meta-regression were used to explore potential moderators. This review was registered on the PROSPERO database (CRD42019148118). RESULTS: Nineteen randomized controlled trials with a total sample size of 1,300 were included in this meta-analysis. Regarding immune system outcome, mind-body therapy significantly improved CD4 T-cell counts (Cohen's d = 0.214, p = .027) and maintained (0.427, p = .049). In addition, baseline CD4 T-cell counts and years since HIV diagnosis significantly moderated the efficacy of mind-body practices on CD4 improvement (all ps < .001). Regarding mental health outcome, mind-body therapy significantly reduced stress, depression, and anxiety symptoms (0.422, p < .001; 0.506, p < .001, and 0.709, p < .001, respectively) while improving quality of life (0.67, p < .001). CONCLUSIONS: Meditation/yoga intervention could result in potential benefits with regard to improved CD4 T-cell counts immediately after the intervention and at long-term follow-up, while also improving their mental health. The cost-effective meditation/yoga intervention should be integrated into routine care for people living with HIV, especially for those with lower CD4 baseline and fewer years since diagnosis.

Socioeconomic disparity of immunologic outcome among people living with HIV in Guangxi, China.

The socioeconomic disadvantage may adversely affect HIV treatment outcomes, particularly in resource-limited settings. Data from people living with HIV (PLWH) who were receiving antiretroviral therapy (ART) in Guangxi, China were analyzed to investigate the impact of socioeconomic status (SES) on the immunologic outcome (i.e., CD4 counts). Among 1198 participants, 55.0% were having CD4 counts ≤500 cells/mm3 and over two-third (68.5%) were considered to have a low level of SES. PLWH with high SES were more likely to have higher CD4 counts (adjusted Odds Ratio [aOR]: 1.44, 95%CI: 1.08-1.91) than PLWH with low SES, after adjusting for potential confounders. CD4 counts were also significantly associated with certain socio-demographic characteristics such as age, gender, and sexual orientation. In order to reduce SES-related disparity, a holistic approach may be needed to address the barriers to successful HIV treatment and care among PLWH with low SES. Poverty reduction and other structural interventions in addressing the socioeconomic disadvantages among PLWH should be key components of the national response to improving HIV treatment outcomes and ending the HIV epidemic in China and other low- and middle-income countries.

High magnitude of food insecurity and malnutrition among people living with HIV/AIDS in Ethiopia: A call for integration of food and nutrition security with HIV treatment and care Programme.

BACKGROUND: Food insecurity and malnutrition has been reported to have a strong connection with human immunodeficiency viruses (HIV); this is more pervasive in Sub-Saharan Africa including Ethiopia. In this study, we examined the predictors of food insecurity and factors associated with malnutrition among people living with HIV (PLHIV) in Benishangul Gumuz Regional State, Ethiopia. METHODS: We conducted a cross-sectional study at outpatient antiretroviral therapy (ART) clinics. Data were collected using participant interview, anthropometry, and participants' chart review. Interviews were carried out with 390 PLHIVs who were on antiretroviral treatment follow-up. Four robust multivariate linear regression models were used to identify predictors of food insecurity and factors associated with malnutrition. RESULTS: The prevalence of food insecurity and malnutrition among PLHIV were found to be 76% and 60%, respectively. The predictors of food insecurity were: urban residence; household dependency; average monthly income below 53.19 USD; poor asset possession; CD4 count below 350 cell/µL; and recurrent episodes of opportunistic infections (OIs). Correspondingly, malnutrition among PLHIV was found strongly associated with: female gender; urban residence; income below 53.19 USD; poor asset possession; duration of less than one year on ART; and recurrent episodes of OIs. CONCLUSION: The study findings suggest that the higher prevalence of food insecurity and malnutrition among PLHIV underscore: the need for economic and livelihood intervention; addressing contextual factors including the gender dimensions; adoption of nutrition-specific and sensitive interventions; and integration of food and nutrition security with HIV treatment and care programmes.

Nutritional status and the associated factors among people living with HIV: an evidence from cross-sectional survey in hospital based antiretroviral therapy site in Kathmandu, Nepal.

BACKGROUND: Nutritional status is the key concern among the people living with HIV but this issue has been failed to be prioritized in HIV strategic plan of Nepal. This study aims to assess the nutritional status among people living with HIV and determine their associated factors. METHODS: A hospital based cross-sectional study was conducted where 350 people living with HIV attending the ART clinic were selected using systematic random sampling technique. Nutritional status among people living with HIV was assessed through anthropometry, body mass index; Underweight (body mass index < 18.5 kg/m2) and overweight/obesity (body mass index > 23 kg/m2). HIV related clinical factors such CD4 count, WHO stage, opportunistic infection, antiretroviral therapy regimen etc. were collected from the medical records. Socio-demographic data were collected using pretested structured questionnaire through interview technique. Multiple linear regression method was employed to determine the association between different independent factors and body mass index score. RESULTS: The prevalence of underweight was found to be 18.3% (95% CI: 14.3-22.6). Most of the study participants were overweight/obese (39.1%). After subjection to multiple linear regression analysis, it was found that age, being male, being married, being in business occupation, smoking, hemoglobin level and antiretroviral therapy duration were significantly associated with body mass index score. Majority of the participants in our study lacked diversified food (62.3%). CONCLUSION: Overweight/obesity is an emerging problem among people living with HIV. This group of participants should be screened for the presence of non-communicable disease. This study also highlights the importance of nutritional program being an integral part of HIV/AIDS continuum of care. Therefore, an effort should be made to address the burden of malnutrition by addressing the identified determinants.

Assessment and Management of HIV Distal Sensory Peripheral Neuropathy: Understanding the Symptoms.

Distal sensory peripheral neuropathy (HIV-DSP) affects upwards of 50% of people living with HIV. Causing often debilitating symptoms of tingling, numbness and burning, HIV-DSP can result in disability, unemployment and low quality of life. Comorbidities further complicate nursing care, heightening risk of polypharmacy and symptom exacerbation. Therefore, a neurological sensory assessment, combined with the patient's self-report of symptoms, can help nurse practitioners visualize, quantify and understand symptoms. Common pharmacological interventions include antiepileptics, antidepressants, analgesics and medical marijuana. The complexity of care for individuals with HIV-DSP merits a comprehensive approach. Implications for practice include interdisciplinary management with neurologists, podiatrists, mental health providers, and nurse-led counseling inclusive of patient safety teaching.

Acceptability of Cell and Gene Therapy for Curing HIV Infection Among People Living with HIV in the Northwestern United States: A Qualitative Study.

Multiple strategies to cure HIV infection are under investigation, including cell and gene therapy (C>) approaches. Research, and ultimately treatment, with these novel strategies will require patients' willingness to participate. To elicit the perspectives of people living with HIV specific to these novel approaches, we conducted 4 focus group discussions with a diverse group of 19 English-speaking men and women living with HIV in care at a large academic HIV clinic in the northwestern United States. Thematic analysis indicated participants expressed initial fear about C> research. They articulated specific concerns about risks, including analytical treatment interruptions, and thought only a person in desperate straits would participate. They voiced significant mistrust of research in general and believed there was already a cure from HIV that was being withheld from the poor. Overall, they were satisfied with their health and quality of life on antiretroviral therapy. These findings suggest the importance of community engagement and educational efforts about C> for HIV cure to ensure optimal collaborative partnerships.