Impact of the COVID-19 pandemic situation on HIV care in Liège, Belgium.

BACKGROUND: Background: The COVID-19 pandemic and associated containment measures dramatically affected the health care systems including the screening of human immunodeficiency virus and the management people living with HIV around the world by making the access to preventive care services and specific medical monitoring more difficult. OBJECTIVE: Objective: To study the impact of the COVID-19 pandemic on the holistic care of people living with HIV in Liège (Belgium). METHODS: Methods: In this retrospective observational study conducted in Liège University Hospital, we compared the out-patient follow-up of HIV-infected individuals as well as the number of new HIV diagnoses between 2019 and 2020 and between the different waves of the COVID-19 pandemic in 2020. RESULTS: Results: In 2020, when compared to 2019, we observed a significant decrease in the number of new HIV diagnoses, especially during the first wave of the pandemic, and in the number of consultations undertaken by sexual health services, psychologists and specialists in infectious diseases at our HIV clinic. We also observed a decrease in the number of viral load assays and blood CD4 + T-cells count analyses performed, although we found less patients with HIV plasma viral load above 400 copies per mL in 2020. Finally, we noted a significant reduction in terms of screening of our HIV-infected patients for hepatitis C, syphilis, colorectal and anal cancers and hypercholesterolemia. CONCLUSIONS: Conclusions: Our experience exhibits the deleterious impact of the COVID-19 pandemic on the HIV care and the need to implement new strategies to guarantee its continuum.

HIV policy in Italy and recommendations across the HIV care continuum.

The HIV epidemic has not yet ended, and there are ever more challenges: the recent Italian National Plan of Interventions against HIV and AIDS (Piano Nazionale di Interventi Contro HIV e AIDS (PNAIDS) 2017-2019) was hailed for its comprehensiveness. Its likelihood of success across the HIV care continuum was therefore assessed. Awareness interventions are sporadic and continue to miss high risk populations; if effectively implemented, the prescriptive detail in PNAIDS may help address this. Combined prevention needs greater focus and investment. However, there has been recent progress: free anonymous testing is available at multiple settings although improvements to provide access to key vulnerable populations are needed. Clinical management is available to a high standard across the country, with some areas for improvement in ensuring equality of access. Long-term management of people living with HIV is often effective, but discrepancies exist across regions and settings of care. It is recommended to enable implementation of PNAIDS as a matter of urgency, develop integrated awareness and testing interventions for STIs and HIV, make condoms free for high-risk populations, and develop a network of multidisciplinary services for long-term holistic care of people living with HIV.

Use of a human-centered design approach to adapt a nurse-led cardiovascular disease prevention intervention in HIV clinics.

Stakeholder-informed strategies addressing cardiovascular disease (CVD) burden among people living with HIV (PWH) are needed within healthcare settings. This study provides an assessment of how human-centered design (HCD) guided the adaptation of a nurse-led intervention to reduce CVD risk among PWH. Using a HCD approach, research staff guided two multidisciplinary "design teams" in Ohio and North Carolina, with each having five HCD meetings. We conducted acceptability and feasibility testing. Six core recommendations were produced by two design teams of key stakeholders and further developed after the acceptability and feasibility testing to produce a final list of 14 actionable areas of adaptation. Acceptability and feasibility testing revealed areas for adaptation, e.g. patient preferences for communication and the benefit of additional staff to support patient follow-up. In conclusion, along with acceptability and feasibility testing, HCD led to the production of 14 key recommendations to enhance the effectiveness and scalability of an integrated HIV/CVD intervention.

Revisiting Successful Aging With HIV Through a Revised Biopsychosocial Model: An Update of the Literature.

The concept of successful aging was recognized only recently by HIV researchers because people living with HIV (PLWH) in the early epidemic were not expected to survive. With the introduction of antiretrovirals that block viral replication, PLWH are now aging with HIV. Given the complex nature of HIV within the social, economic, and political climates in which it occurs, a holistic model of successful aging is needed to guide researchers and clinicians. Several overarching models exist, but must be updated for rapidly advancing HIV and aging research agendas. We provide an updated, adapted, and integrated biopsychosocial model of successful aging with HIV based on the principles of Baltes and Baltes (1998) on 8 essential components of successful aging: (a) length of life, (b) biological health, (c) mental health, (d) cognitive efficiency, (e) social competence, (f) productivity, (g) personal control, and (h) life satisfaction. Clinical practice and research implications are highlighted.

"The Journey I Have Been Through": The Role of Religion and Spirituality in Aging Well Among HIV-Positive Older Adults.

The National Institutes of Health human immunodeficiency virus (HIV) and Aging Working Group identified spirituality as a research emphasis. This qualitative study examines the importance of religion and spirituality among 30 HIV-positive older adults. Using modified grounded theory, adults 50+ were recruited in Ontario, Canada, through AIDS service organizations, clinics, and community agencies. Descriptions of religion and spirituality encapsulated the idea of a journey, which had two components: the long-term HIV survivor profile combined with the experience of aging itself. A final category of HIV as a spiritual journey was finalized through consensus and included the properties of (1) being rejected by as well as rejection of formalized religion, (2) differentiating spirituality from religion, (3) having a connection, (4) feeling grateful, and (5) mindfulness and learning new skills. Interventions fostering resilience and strengths in HIV-positive older adults using spirituality should be considered, including the promotion of person-centered spirituality and interventions that include mindfulness and skill building.

Long-Term Survival of AIDS Patients Treated with Only Traditional Chinese Medicine.

Traditional Chinese herbal medicine (TCM) has been used in Chinese society for more than 5,000 years to treat diseases from inflammation to cancer. Here, we report the case of nine living AIDS patients in the age range of 51 to 67 who were treated with either a unique formula of TCM alone from 2001 to 2009 or the TCM from 2001 to 2006 and then switched to occasional antiretroviral therapy. Surprisingly, the viral loads of eight patients were at undetectable levels on June 28, 2016, while the remaining patient had a low viral load of 29 copies/ml. The CD4+ counts (170-592 cells/µl) and CD4+/CD8+ ratios (0.21-0.90) of the nine patients are excellent, contributing to their current good health. Thus, the case study suggests that the TCM has the potential to become a functional cure for HIV/AIDS.

O autocuidado de idosos com HIV/aids: contribuições de Enfermagem / Self-care of elderly people with HIV/AIDS: nursing contributions

Pesquisa de abordagem qualitativa com o objetivo de discutir como idosos com HIV/aids realizam o autocuidado, quais as implicações para sua saúde e para o cuidado de enfermagem. Aprovada pelos Comitês de Ética em Pesquisa EEAN/HESFA e HUCFF/UFRJ, utilizou o método Grounded Theory (GT) ou Teoria Fundamentada em Dados (TFD) para guiar a coleta, análise e discussão dos dados de 25 idosos com HIV/aids, usuários do ambulatório de Doenças Infecciosas e Parasitárias do HUCFF/UFRJ. Na entrevista e pesquisa documental foram utilizados dois instrumentos: o roteiro da entrevista, com seções semiestruturada e estruturada, e a planilha de registro de informações nos prontuários. Do total de idosos entrevistados, 60% eram homens, 48% entre 60 e 64 anos, 68% heterossexuais, 32% solteiros e 32% viúvos, 84% aposentados ou pensionistas, 48% frequentaram a escola de nove (09) a onze (11) anos,e 68% informaram renda entre um (01) e três (03) salários mínimos. O tempo de diagnóstico HIV/aids variou de dois (02) a 30 anos, a idade no momento do diagnóstico de 30 a 70 anos, com 100% fazendo uso da TARV por períodos entre um (01) e 25 anos. As doenças oportunistas mais frequentes foram pneumonia, tuberculose e herpes zoster e as comorbidades foram hipertensão arterial sistêmica, diabetes mellitus e dislipidemia. A partir dos dados submetidos aos processos analíticos da TFD, emergiram 47 códigos, agrupados em oito (08) subcategorias - (1) O Mim, (2) Diagnóstico, (3) Saúde Mental, (4) Saúde Física, (5) Espiritualidade, (6) Sexualidade, (7) O Outro, (8) Preconceito - e três (03) categorias - "Idoso com HIV/aids", "Interação Social" e a categoria central "Autocuidado", ilustradas pelo diagrama de Venn. Em conclusão, dentre as demandas de cuidado físico e psicossocial de enfermagem aos idosos com HIV/aids, emergiram necessidades de instrumentalização para a adoção e sustentação do autocuidado e de fomentar a autoestima para o enfrentamento do preconceito.

Qualitative approach research with the objective to discuss how older adults with HIV/aids practice self-care, its health and nursing care implications. Approved by the EEAN/HESFA and HUCFF/UFRJ Institutional Review Boards (IRBs), used Grounded Theory (GT) or Teoria Fundamentada em Dados (TFD) to guide data collection, analysis and discussion of 25 older adults with HIV/aids, outpatients at the Infectious and Parasitic Diseases at the HUCFF/UFRJ ambulatory. Two instruments were used on the interview and documental research: the interview guide with two sections, one semi-structured and one structured, and a spreadsheet for data entry of information on patient files. From the overall number of participants, 60% were men, 48% between 60-64 years old, 68% heterosexuals, 32% single and 32% widowers, 84% were retired or received pensions, 48% attended school between nine (09) and eleven (11) years, and 68% declared income between one (01) e three (03) minimum wages. HIV/aids time of known diagnosis varied from two (02) to 30 years; age at the time of diagnosis between 30-70 years old, with 100% in use of Antiretroviral Therapy (ART) for periods varying between one (01) and 25 years long. The most frequent opportunist diseases were pneumonia, tuberculosis and herpes zoster and the comorbidities were systemic hypertension, diabetes mellitus and dyslipidemia. From the data submitted to GT analytic processes, emerged 47 codes, groups into eight (08) subcategories - (1) The Me, (2) Diagnose, (3) Mental Health, (4) Physical Health, (5) Spirituality, (6) Sexuality, (7) The Other, (8) Prejudice- and three (03) categories- "Older with HIV/aids", "Social Interaction" and the central category "Self-care", illustrated by a Venn diagram. In conclusion, among the nursing physical and psychosocial care demands of older adults with HIV/aids, emerged needs for effective support towards(i) the adoption and sustainingof self-care practices and (ii) the building up of self-esteem for coping against prejudice.

Investigación de abordaje cualitativa com el objetivo de discutir como ancianos con VIH/sida realizan el autocuidado, cuales las implicaciones para su salud y para el cuidado de enfermería. Aprobada por los Comités de Ética em Investigación EEAN/HESFA y HUCFF/UFRJ, utilizo el método Grounded Theory (GT) o Teoría Fundamentada em Datos (TFD) para conducir la recolección, análisis y discusión de los datos de 25 ancianos con VIH/sida, usuários del ambulatorio de Enfermedades Infecciosas y Parasitarias del HUCFF/UFRJ. En la entrevista e investigación documental fueron utilizados dos instrumentos: el guión de la entrevista, con secciones semiestructurada y estructurada, y una hoja de trabajo para registro de informaciones em los historiales clínicos. En la totalidad de participantes entrevistados, 60% eran hombres, 48% entre 60 y 64 años, 68% heterosexuales, 32% solteros y 32% viudos, 84% eran jubilados o pensionistas, 48% con nueve (09) a once (11) años de escolaridad, y 68% informaron renta entre una (01) y tres (03) remuneraciones mínimas. El tiempo de diagnóstico VIH/sida varió de dos (02) a 30 años, la edad en el momento del diagnóstico de 30 a 70 años, con 100% haciendo uso de la Terapia Antirretroviral (TAR) por periodos entre uno (01) y 25 años. Las enfermedades oportunistas más frecuentes fueronpulmonía, tuberculosis y herpes zóster y las comorbilidades fueron hipertensión arterial sistémica, diabetes mellitus y dislipimia. A partir de los datos sometidos a los procesos analíticos de la TFD, emergieron 47 códigos, agrupados en ocho (08) subcategorias - (1) El Mí, (2) Diagnóstico, (3) Salud Mental, (4) Salud Física, (5) Espiritualidad, (6) Sexualidad, (7) El Otro, (8) Prejuicio ­ y tres (03) categorías ­ "Anciano con VIH/sida", "Interacción Social" y la categoría central "Autocuidado", ilustradas por el diagrama de Venn. En conclusión, de las demandas del cuidado físico y psicosocial de enfermería a los ancianos con VIH/sida, emergieron necesidades de instrumentalización para la adopción y sustentación del autocuidado y de fomentar la autoestima para el enfrentamiento del prejuicio.

Saving the sick and improving the socio-economic conditions of people living with HIV in Ethiopia through traditional burial groups.

Poverty and limited availability of health facilities are major barriers to health care in resource-poor countries. For people living with HIV (PLHIV), these factors are compounded by social stigma and decreased mobility, making delivery of public health services a greater challenge. In 2003, the international development organization FHI (formerly known as Family Health International and now known as FHI 360) collaborated with the Ethiopian government, local non-governmental organizations and traditional burial societies (Idirs) to implement community and home-based care interventions for PLHIV in Addis Ababa and 13 other major cities. Programme activities included capacity building, care and support, stigma reduction, resource mobilization, support of orphans and vulnerable children, and income generation through community savings and loans groups. Programme results from 2003 to 2010 were evaluated using a quasi-experimental design with an intervention group (PLHIV who received community and home-based care programme services) and a control group (PLHIV who did not receive programme interventions). Propensity score matching was used to select matched intervention and control pairs for analysis. McNemar and Wilcoxon signed-ranks tests were used to determine outcomes and impact. Findings from routine monitoring data and a population survey showed that individuals who received the integrated community and home-based care services from Idirs reported significantly more savings, better social relations, more independence and better environments for PLHIV. Programme clients were also shown to have known their HIV status longer than the control respondents. However, a higher percentage of control respondents reported not having had an opportunistic infection in the past 6 months. We conclude that volunteer-based community organizations can be empowered to deliver and sustain health interventions for PLHIV. We also conclude that targeting the multiple needs of PLHIV enables holistic improvements in the quality of life and socio-economic conditions of PLHIV.

Perfil dos pacientes, em geral e HIV positivos, atendidos em uma unidade de práticas integrativas e complementares da rede municipal de São Paulo / Profile of patients, in general and HIV positives, treated at an integrative and complementary health practices public unit, São Paulo City

Introdução: As práticas integrativas e complementares em saúde (PIC), entre as quais se inclui a acupuntura, vêm ganhando espaço nas últimas décadas no serviço público no Brasil. Em 2006 foi aprovada a lei que regulamenta a Política Nacional de Práticas Integrativas e Complementares (PNPIC), proporcionando maior impulso para essas práticas no SUS. Alinhada com essa política, a Unidade de Medicinas Tradicionais (UMT), no município de São Paulo, vem oferecendo desde 2005 atendimento com as PIC de maneira ampla e contínua. Entre os pacientes atendidos na UMT, há uma parcela de pacientes HIV positivos, cujo perfil é desconhecido. Objetivo: Descrever o perfil dos pacientes atendidos na Unidade de Medicinas Tradicionais e, em particular, dos pacientes HIV positivos, caracterizando: origem do encaminhamento, queixas, expectativas em relação ao tratamento e aspectos que mais influenciam negativamente a qualidade de vida desses pacientes. Métodos: Foi realizado um estudo transversal descritivo, analisando-se todos os prontuários dos pacientes atendidos na UMT entre 2006 e 2009. Os pacientes HIV positivos foram identificados e contatados para entrevista, para que informações detalhadas fossem obtidas. Foram usados um questionário de qualidade de vida específico para pacientes HIV positivos (HIV/AIDS-Targeted Quality of Life Instrument HAT-QoL) e um questionário desenvolvido pelo pesquisador. Resultados Foram incluídos 1960 pacientes, dos quais 81 por cento eram mulheres; 68,3 por cento acima dos 50 anos; e 74,1 por cento com demanda espontânea. As queixas principais foram dor (66 por cento ) e queixas mentais (26 por cento ), com duração mediana de 24 meses. Foram identificados 57 pacientes soropositivos, dos quais 71,9 por cento eram do sexo masculino. As queixas principais também foram dor (22 por cento ) e queixas mentais (21,3 por cento ), sendo 72,1 por cento com demanda espontânea. Entre as expectativas, estavam: alívio das queixas, melhora da qualidade de vida, bem-estar e melhora da imunidade. Na avaliação das dimensões de qualidade de vida, as mais afetadas foram função sexual e preocupação em revelar a doença.

High frequency of gross deletions in 5' LTR/gag and nef genes in patients infected with CRF02_AG of HIV type 1 who survived for over 20 years: an association with Korean red ginseng.

Abstract We have shown that Korean red ginseng (KRG) intake is associated with gross deletions in the 5' LTR/gag (gDeltaLTR/gag) and nef genes (gDeltanef) of patients infected with subtype B of HIV-1. Here, we investigated these effects in three long-term survivors (LTSs) of subtype CRF02_AG of HIV-1. The three LTSs were diagnosed with HIV in 1987, 1988, and 1989, and have been treated with KRG for 7-15 years. Thirty-two samples of peripheral blood mononuclear cells were obtained from the subjects and used to amplify the 5' LTR/gag and nef genes via nested PCR. We obtained 88 amplicons in 5' LTR/gag and 128 amplicons in nef. The frequency of gDeltaLTR/gag was significantly higher (37.5%) in three LTSs than in control patients (8.6%, p < 0.01). Eight amplicons (9.5%) contained premature stop codon(s) in the gDeltaLTR/gag in three LTSs. Fourteen of the 128 nef amplicons (10.9%) contained the gDeltanef, which was present in only two (7.7%) of the 26 amplicons from control subjects. Interestingly, gDeltanef was detected 7 years after the reinitiation of KRG intake in an LTS and, coincidently, CD4 T cell counts and CD4/CD8 ratios rapidly increased. These data indicate that long-term intake of KRG has the therapeutic potential to induce gross deletions in HIV-1.

'Doing' chronic illness? Complementary medicine use among people living with HIV/AIDS in Australia.

This article takes the use of complementary medicine by a group of people living with HIV/AIDS as the starting point for exploring the options for living with chronic illness in contemporary western societies. Some authors have suggested that the situation of living with chronic illness may not be a significant departure from the process of negotiating choice that is theorised to be a defining feature of late-modern society and that there are now many ways of living with or 'doing' chronic illness. This article uses these theoretical concepts to explore the experiences of people who have lived with HIV/AIDS for a number of years. It is argued that while different options for managing chronic illness may exist, it is not always possible or desirable for individuals to put these choices into practice. The article is based on 18 qualitative interviews with people living with HIV/AIDS who were using complementary medicine.

High frequency of grossly deleted nef genes in HIV-1 infected long-term slow progressors treated with Korean red ginseng.

To investigate the association between Korean red ginseng (KRG) intake in HIV-1 infected patients and the occurrence of grossly deleted nef genes (gDeltanef), we characterized nef genes in 10 long-term slow progressors (LTSP) infected with HIV-1 subtype B and 34 control patients. LTSP was defined by the annual decrease in CD4 T cells being less than 20/microl over 10 years in the absence of antiretroviral therapy. They were treated with KRG for a prolonged period. Nef genes were amplified from peripheral blood mononuclear cells (PBMC) using nested PCR and the products were sequenced directly. It was observed that the patients CD4 T cell counts decreased from 444 +/- 207/microl to 294 +/- 177/microl over 136 +/- 23 months of KRG intake. This corresponds to an annual decrease in the level of CD4 T cells of 13.3/microl. A total of 479 nef genes were amplified from 137 PBMC samples. Nine out of the 10 patients, 47 (34.3%) out of the 137 samples, and 90 out of the 479 genes revealed gDeltanef. The deletion extended outside the nef gene in 25 gDeltanef obtained from 6 patients. The proportion of samples with gDeltanef (34.3%) was significantly higher than 4.8% in control patients (P < 0.001). In addition, it significantly increased as the duration of KRG intake prolongs (P < 0.01). These data suggest that the occurrence of gDeltanef might be associated with long-term intake of KRG.