Hepatoprotective effect of methanol fruit extract of Punica granatum L in highly active antiretroviral therapy-induced toxicity in Wistar rats.

Prolonged use of Highly Active Antiretroviral Therapy (HAART) has been linked to toxicity, particularly hepatotoxicity. There are few effective drugs for HAART patients that promote hepatic cell regeneration and prevent liver injury. Therefore, the purpose of this study was to investigate the hepato-protective activity of Methanol fruit extract of Punica granatum (MFEPG) in HAART-administered rats. Thirty rats weighing between 150-200 g were randomly divided into six groups and each group comprised of five rats. Distilled water was given to the rats in group one. Only HAART was given to the rats in group two. MFEPG at doses of 100 and 400 mg/kg was given to the rats in groups three and four. MFEPG dosages of 100 and 400 mg/kg along with HAART were given to the rats in groups five and six, respectively. All treatments were via oral gavage daily for 40 days. Under halothane anesthesia, all rats were sacrificed on day 41. Liver tissues were utilized for lipid peroxidation marker; Malondialdehyde (MDA), antioxidant enzymes; Superoxide dismutase (SOD) and Catalase (CAT) and histological evaluation, while blood samples were examined for biochemical parameters (AST, ALT, ALP, Total cholesterol, Total protein, and Albumin). The HAART-treated group exhibited a significantly higher amount of the lipid peroxidation end product; MDA, and significantly lower levels of antioxidant enzymes; SOD, and CAT. Liver enzymes and total cholesterol were significantly increased with a significant reduction in Total protein and Albumin levels in the HAART-treated group. Conversely, the liver function biomarkers were returned to normal levels in the HAART and MFEPG-treated groups. Histopathological studies revealed that when HAART-exposed rats were treated with MFEPG, both the biochemical and histological results significantly improved. Thus, the antioxidant activity of MFEPG provides protection against HAART-induced liver oxidative damage. More research is needed to determine the safety of using MFEPG in humans.

HIV/AIDS Curability Study, Different Approaches and Drug Combination.

AIM: HIV infection is currently an incurable disease characterized by life-long drug utility. Its incurable causality and mechanism are still unknown to us. METHODS: To overcome this therapeutic setback, some breakthroughs should be made by utilizing different approaches. How to plan some experimental and clinical novelty for HIV curability is a modern challenge. In this article, new ideas and approaches for global HIV/AIDS therapeutic strategies are proposed and represented by scientific insights. RESULTS: Pharmaceutical characteristics, herbal medicine, novel drug targets, cutting-edge biotherapy, drug combination, animal modalities, and immune-stimuli for HIV latency, as well as clearance, are highlighted. DISCUSSION: To elucidate our understanding of curative treatment for HIV/AIDS, many new pathological discoveries, expansion, technical advances, and potential drug targets are constructed. After the discovery of novel pathogenesis and therapeutic evolution, HIV/AIDS therapeutic curability may become achievable and a reality. CONCLUSION: Transformation from animal model investigation to widespread therapies for larger volume of human population is a necessity in modern medicine. In this infectious treatment scenario, major breakthroughs in medicine and drug development are anticipated.

Selenium and Omega-3 Fatty Acids Ameliorate Highly Active Anti-Retroviral Therapy (HAART)-induced Reproductive Impairment in Male Wistar Rats.

Highly active anti-retroviral therapy (HAART) is currently the main stay in the treatment of Human Immunodeficiency Virus (HIV) disease. This treatment regimen typically combines three or more antiretroviral drugs and like most drug combinations or polypharmacy, has side effects including those on reproductive function which could place HIV patients on HAART under double risk in terms of reproductive function. Part of tissue damage following HAART administration is blamed on oxidative stress. We therefore sought to explore effects of Omega 3 and Selenium, two common antioxidants on HAART-induced male reproductive impairment in a non-HIV animal model. Sixteen male adult Wistar rats weighing 120g to 250g used for the study were grouped into 4 groups of four rats each (control, HAART-only, HAART + Omega 3 and HAART + Selenium groups). Duration of daily administration was six weeks. Results showed no significant changes in pH of epidydimal semen among the groups. Sperm count and viability were significantly reduced in HAART-only compared with control (p<0.05) but increased in HAART + Omega 3 and HAART + Selenium groups compared with HAART-only group (p< 0.05). Sperm motility was significantly reduced in HAART-only compared with control group (p< 0.05). A significantly higher percentage of total sperm defects was observed in HAART-only group compared with control (p <0.05) but significantly lower in the HAART + Selenium compared with HAART-only groups (p<0.05). Serum testosterone was significantly reduced in HAART-only compared with control groups (p<0.05) but significantly increased in HAART + Omega 3 and HAART + Selenium groups compared with HAART- only group (p<0.05). Serum concentration of luteinizing and follicle stimulating hormones were not significantly different among the groups. Testicular concentration of malondialdehyde was significantly increased in HAART-only compared with control (p<0.05) but significantly reduced in HAART + Omega 3 and HAART + Selenium groups compared with HAART-only group (p<0.05 in each). Testicular glutathione peroxidase activity was significantly reduced in HAART-only and HAART + Selenium groups compared with control (p< 0.05), but significantly higher in HAART + Omega 3 and HAART + Selenium compared with HAART-only groups (p<0.05 each). Testicular superoxide dismutase activity was significantly lower in the HAART-only and HAART + Selenium compared with control (p<0.05) but significantly higher in HAART + Omega 3 and HAART + Selenium compared with HAART-only groups (p<0.05 each). Level of tumour necrosis factor - alpha in testes was significantly higher in HAART-only (p<0.05) but lower in the HAART + Selenium (p<0.05) groups compared with control. Tumor necrosis factor-alpha was however significantly reduced in HAART + Omega 3 and HAART + Selenium groups compared with HAART-only (p<0.05 each) groups. Interleukin-6 levels were significantly increased in all HAART-administered groups compared with control (p<0.05 each) though significantly reduced in HAART + Omega 3 and HAART + Selenium compared with HAART-only groups (p<0.05 each). In conclusion, co-administration of Omega 3 or Selenium with HAART ameliorates HAART-induced male reproductive impairment, alteration in redox and inflammatory status in rats. Keywords: HAART, male reproductive impairment, Omega 3, Selenium.

Moringa supplementation improves immunological indices and hematological abnormalities in seropositive patients receiving HAARTs.

Background: Moringa oleifera Lam. is known to be of high nutritional and medicinal importance and has been demonstrated to possess a variety of biological activities. Objective: This study investigated the beneficial role of M. oleifera (moringa) supplementation in HIV positive subjects receiving antiretroviral drugs. Methods: Adult HIV positive individuals (104) attending the medical outpatient clinic in a tertiary health institution in Nigeria receiving highly active anti-retroviral therapies (HAARTs) were recruited in a randomized fashion for the study. Half of the subjects received moringa supplement (20 mg daily) additionally, while the others received only HAART and represented the control group. All subjects were monitored for 3 months during which their immunological status (CD4 counts and TNF-α), and hematological abnormalities at pre (baseline) and post study periods were determined. Results: Baseline levels of CD4 increased while TNF-α decreased significantly in control and moringa supplemented groups (p < 0.01). However, the post study CD4 values in the moringa group were higher and TNF-α values were lower compared to the control group (p < 0.01). In addition, baseline hematological abnormalities (anemia, thrombocytopenia, leucopenia, lymphopenia, and neutropenia) were improved but most significantly in the moringa supplemented subjects. Conclusion: The results suggest that moringa has immune-beneficial properties and improved hematological abnormalities in HIV positive individuals receiving antiretroviral therapy.

The Potential of Moringa oleifera to Ameliorate HAART-Induced Pathophysiological Complications.

Highly active antiretroviral therapy (HAART) comprises a combination of two or three antiretroviral (ARV) drugs that are administered together in a single tablet. These drugs target different steps within the human immunodeficiency virus (HIV) life cycle, providing either a synergistic or additive antiviral effect; this enhances the efficiency in which viral replication is suppressed. HIV cannot be completely eliminated, making HAART a lifetime treatment. With long-term HAART usage, an increasing number of patients experience a broadening array of complications, and this significantly affects their quality of life, despite cautious use. The mechanism through which ARV drugs induce toxicity is associated with metabolic complications such as mitochondrial dysfunction, oxidative stress, and inflammation. To address this, it is necessary to improve ARV drug formulation without compromising its efficacy; alternatively, safe supplementary medicine may be a suitable solution. The medicinal plant Moringa oleifera (MO) is considered one of the most important sources of novel nutritionally and pharmacologically active compounds that have been shown to prevent and treat various diseases. MO leaves are rich in polyphenols, vitamins, minerals, and tannins; studies have confirmed the therapeutic properties of MO. MO leaves provide powerful antioxidants, scavenge free radicals, promote carbohydrate metabolism, and repair DNA. MO also induces anti-inflammatory, hepatoprotective, anti-proliferative, and anti-mutagenic effects. Therefore, MO can be a source of affordable and safe supplement therapy for HAART-induced toxicity. This review highlights the potential of MO leaves to protect against HAART-induced toxicity in HIV patients.

Study of 172 Cases of AIDS Associated Cancers.

OBJECTIVE: This retrospective study was conducted to evaluate the behaviour of AIDS associated cancers treated with comprehensive cancer treatment along with highly active anti-retroviral therapy (HAART). METHODS: 172 AIDS-associated cancers were diagnosed and treated during 2003 to 2021. HIV status was evaluated by ELISA, viral load and CD4/CD8 counts. They were treated with different cancer treatment modalities for cancers, HAART for HIV infection and followed up periodically. RESULTS: Of 172 cases of AIDS associated cancers, AIDS-Defining Cancers (ADCs) were seen in 84 (48.84%) and non-AIDS-Defining Cancers (NADC) in 88 patients (51.16%). Non-Hodgkin Lymphoma was the commonest AIDS-defining cancer in 58 (69.05%) patients. Extranodal presentations of ARLs was seen in 28 cases (19.86%) followed by cervical cancers in 26 (30.95%) women with HIV infection. Kaposi's sarcoma was not found. Head and neck cancers were the most common cancers in NADCs, followed by breast cancers and other types of cancers. Only two patients had HIV-2 associated cancers. One patient had immune reconstitution syndrome (IRIS).Long-term non-progressor HIV infection with cancer was seen in one patient. 49 patients (28.49%) were receiving HAART. CONCLUSIONS: AIDS-associated cancers are seen in advanced stage of HIV infection. Concurrent chemotherapy and anti-retroviral therapy for ADCs show good control of both diseases. Non-AIDS-defining cancers do not show predictable response to anti-retroviral therapy. KS is not seen in our study.

Identifying barriers to ART initiation and adherence: An exploratory qualitative study on PMTCT in Zambia.

BACKGROUND: Though antiretroviral therapy (ART) is widely available, HIV positive pregnant women in Zambia are less likely to start and remain on therapy throughout pregnancy and after delivery. This study sought to understand readiness to start ART among HIV pregnant women from the perspectives of both women and men in order to suggest more holistic programs to support women to continue life-long ART after delivery. METHODS: We conducted a qualitative study with HIV positive pregnant women before and after ART initiation, and men with female partners, to understand readiness to start lifelong ART. We conducted 28 in-depth interviews among women and 2 focus group discussions among male partners. Data were transcribed verbatim and analyzed in NVivo 12 using thematic analysis. Emerging themes from the data were organized using the social ecological framework. RESULTS: Men thought of their female partners as young and needing their supervision to initiate and stay on ART. Women agreed that disclosure and partner support were necessary preconditions to ART initiation and adherence and, expressed fear of divorce as a prominent barrier to disclosure. Maternal love and desire to look after one's children instilled a sense of responsibility among women which motivated them to overcome individual, interpersonal and health system level barriers to initiation and adherence. Women preferred adherence strategies that were discrete, the effectiveness of which, depended on women's intrinsic motivation. CONCLUSION: The results support current policies in Zambia to encourage male engagement in ART care. To appeal to male partners, messaging on ART should be centered on emphasizing the importance of male involvement to ensure women remain engaged in ART care. Programs aimed at supporting postpartum ART adherence should design messages that appeal to both men's role in couples' joint decision-making and women's maternal love as motivators for adherence.

Adesão ao tratamento com terapias antirretrovirais por pacientes soropositivos atendidos no município de Catanduva-SP / Adhesion to treatment with antiretroviral therapies by seropositive patients attended in the municipality of Catanduva-SP / Adhesión al tratamiento con terapias antirretrovirales por pacientes seropositivos atendidos en el municipio de Catanduva-SP

Introdução: Após o surgimento e a evolução dos antirretrovirais para o tratamento do HIV, vidas foram transformadas, pois o que antes era uma infecção quase sempre fatal, causando muitos óbitos, hoje se tornou uma condição crônica controlável, apesar de ainda não haver cura. Nesse contexto, a adesão do paciente ao tratamento é considerada de elevada importância para garantir o sucesso da farmacoterapia. Objetivo: Verificar a adesão ao tratamento medicamentoso de pacientes soropositivos para HIV, em uso de antirretrovirais, atendidos no município de CatanduvaSP. Material e Método: Pesquisa de campo quantitativa, descritiva, retrospectiva, realizada através da análise de 50 prontuários de pacientes atendidos de junho/2019 a junho/2021. Resultados: Os dados coletados indicaram que dos 50 prontuários analisados, 60% dos pacientes apresentaram adesão integral ao tratamento, com carga viral indetectável. Cerca de 70% apresentam comorbidades, como diabetes, hipertensão e dislipidemia e fazem uso de polifarmácia, 27% relataram contrair alguma infecção oportunista e apenas 16% relataram efeitos adversos durante a terapia antirretroviral, como dor de cabeça, cansaço e desconforto abdominal. Conclusão: O presente estudo constatou que sempre é preciso falar sobre a importância da prevenção do HIV e sobre a eficácia do tratamento com as terapias antirretrovirais. E que a boa adesão ao tratamento oferece mais tempo de vida ao paciente, pois mantém a carga viral indetectável, eliminando as chances de infecções oportunistas surgirem, concedendo uma vida mais segura e saudável aos pacientes e seus parceiros, inibindo a transmissão do vírus em massa.(AU)

Introduction: After the emergence and evolution of antiretroviral drugs for the treatment of HIV, lives were transformed, because what was once an almost always fatal infection, causing many deaths, today has become a controllable chronic condition, although there is still no cure. In this context, patient adherence to treatment is considered of high importance to ensure the success of pharmacotherapy. Objective: To verify the adherence to drug treatment of HIV-positive patients using antiretroviral drugs, treated in the city of Catanduva-SP. Material and Method: Quantitative, descriptive, retrospective field research, performed through the analysis of 50 medical records of patients seen from June/2019 to June/2021. Results: The data collected indicated that of the 50 medical records analyzed, 60% of the patients showed full adherence to treatment, with undetectable viral load. About 70% have comorbidities such as diabetes, hypertension and dyslipidemia and use polypharmacy, 27% reported contracting some opportunistic infection and only 16% reported adverse effects during antiretroviral therapy, such as headache, tiredness and abdominal discomfort. Conclusion: The present study found that it is always necessary to talk about the importance of HIV prevention and the effectiveness of treatment with antiretroviral therapies. And that good adherence to treatment offers more life to the patient, as it keeps the viral load undetectable, eliminating the chances of opportunistic infections arise and granting a safer and healthier life to patients and their partners, inhibiting the mass transmission of the virus.(AU)

Introducción: Tras el surgimiento y evolución de los medicamentos antirretrovirales para el tratamiento del VIH, vidas se transformaron, pues lo que antes era una infección casi siempre fatal, que causaba muchas muertes, hoy se ha convertido en una condición crónica controlable, aunque aún no tiene cura. En este contexto, la adherencia del paciente al tratamiento se considera de gran importancia para asegurar el éxito de la farmacoterapia. Objetivo: Verificar la adhesión al tratamiento farmacológico de pacientes VIH seropositivos, en uso de antirretrovirales, atendidos en el municipio de Catanduva-SP. Material y Método: Investigación de campo cuantitativa, descriptiva, retrospectiva, realizada a través del análisis de 50 prontuarios de pacientes atendidos entre junio/2019 y junio/2021. Resultados: Los datos recogidos indicaron que de las 50 historias clínicas analizadas, el 60% de los pacientes presentaban total adherencia al tratamiento, con carga viral indetectable. Cerca del 70% presenta comorbilidades como diabetes, hipertensión y dislipidemia y utiliza polifarmacia, el 27% reportó haber contraído alguna infección oportunista y solo el 16% reportó efectos adversos durante la terapia antirretroviral, como cefalea, cansancio y malestar abdominal. Conclusión: El presente estudio encontró que siempre es necesario hablar sobre la...(AU)

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).

Moringa oleifera restored semen quality, hormonal profile, and testicular morphology against Highly Active Antiretroviral Therapy-induced toxicity in adult male Wistar rats.

OBJECTIVE: Reproductive toxicity has been greatly linked with Highly Active Antiretroviral Therapy (HAART) use. This study investigated the effects of Moringa oleifera Leaf Extract (MOE) on HAART-induced testicular toxicity in adult male Wistar rats. METHODS: Twenty adult male Wistar rats (150-200 g) were assigned into four groups (n=5). Group A received distilled water; Group B received (orally) 200 mg/kg BW HAART only; Group C received (orally) 200 mg/kg BW HAART and 100 mg/kg BW MOE (low dose group) and Group D received (orally) 200 mg/kg BW HAART and 300 mg/kg BW MOE. At the end of the 28-day experiment, body and testicular weights were measured; serum and testis obtained were subjected to hormone profiling, biochemical and histological studies. RESULTS: HAART caused a significant decrease in body and testicular weight, testicular distortion and spermatogenic cell disorganization, altered semen quality and function, hormonal profiles, and oxidative stress markers (SOD, CAT, GSH) were significantly decreased with the concurrent increase in MDA level. However, treatment with MOE improved sperm parameters, testis morphology, antioxidants markers, and hormones assessments. CONCLUSIONS: The exposure to HAART produced marked testicular toxicity, ameliorated using Moringa oleifera leaf extract, thereby preserving testicular physiological function and morphology.

Recognition of infants at high risk for vertical HIV transmission at delivery in rural Western Cape Province, South Africa

Despite South Africa's substantial reduction in vertical HIV transmission (VHT), national paediatric HIV elimination is not yet attained. National and Western Cape Province (WC) HIV guidelines recommend enhanced postnatal prophylaxis for infants at high risk for VHT, identified in the WC 2015/2016 guidelines by any single high-risk criterion (maternal antiretroviral therapy (ART) <12 weeks, absent/ unsuppressed maternal HIV viral load (HIV-VL) <12 weeks before/including delivery, spontaneous preterm labour, prolonged rupture of membranes, chorioamnionitis). Accuracy of high-risk infant identification is unknown. Objectives. Primarily, to determine the proportion of infants at high risk for VHT, the accuracy of labour-ward risk classification, the criteria determining high-risk statuses and the criteria missed among unrecognised high-risk infants; secondarily, to determine maternal factors associated with high-risk infants. Methods. Infants born to women living with HIV at a rural regional hospital (May 2016 - April 2017) were retrospectively evaluated using data from the labour ward VHT register, standardised maternity case records, National Health Laboratory Service database and WC Provincial Health Data Centre. The study-derived risk status for each infant was determined using documented presence/absence of risk criteria and compared with labour ward assigned risk to determine accuracy. Proportions of high-risk and unrecognised high-risk infants with each high-risk criterion were determined. Maternal characteristics associated with having a high-risk infant were evaluated using multivariable logistic regression. Results. For liveborn infants, labour ward assigned risk classifications were 40% (n=75/188) high risk, 50% (n=94/188) low risk and 10% (n=19/188) unclassified. Study-derived risk was high risk for 69% (n=129/188) and low risk for 31% (n=59/188), yielding a high-risk classification sensitivity of 51% (95% confidence interval (CI) 42 - 60) and specificity of 69% (95% CI 56 - 80). Absent/unsuppressed HIVVL <12 weeks before delivery accounted for 83% (n=119/143) of study-derived high-risk exposures and 81% (n=60/74) of missed high-risk exposures. Fewer mothers of high-risk infants had >4 antenatal visits (38% v. 81%, p<0.01) and first antenatal visit <20 weeks' gestation (57% v. 77%, p=0.01). Only the number of antenatal visits remained associated with having a high-risk infant after adjusting for gestation at first visit and timing of HIV diagnosis and ART initiation: each additional antenatal visit conferred a 39% (95% CI 25 - 50) reduction in the odds of having a high-risk infant. Conclusion. Labour ward risk classification failed to recognise half of high-risk infants. Infant high-risk status as well as non-detection thereof were driven by suboptimal maternal HIV-VL monitoring. Reinforcing visit frequency later in pregnancy may improve antenatal HIV-VL monitoring, and point-of-care HIV-VL monitoring at delivery could improve recognition of virally unsuppressed mothers and their high-risk infants

Efficacy and safety of traditional Chinese herbal medicine combined with HAART in the treatment of HIV/AIDS: A protocol for systematic review and meta-analysis.

BACKGROUND: Acquired immunodeficiency syndrome (AIDS) is one of the infectious diseases pandemic in the word. Traditional Chinese herbal medicine, as an alternative and complementary therapy of highly active antiretroviral therapy (HAART), has been put into the treatment of human immunodeficiency virus (HIV)/AIDS over 30 years due to its good therapeutic effects and high safety, while there is a lack of evidence-based medicine support. The purpose of this study is to explore the efficacy and safety of traditional Chinese herbal medicine combined with HAART for HIV/AIDS patients. METHODS: We will search all randomized controlled trials of Chinese herbal medicine combined with HAART in the treatment of HIV/AIDS from electronic databases including PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure, WanFang, China Science and Technology Journal Database and Chinese Biomedical Literature Database from inception to December 31, 2021. Literature screening will be conducted through EndNote software, and data extraction will be processed according to inclusion and exclusion criteria by two independent researchers. We will use Review Manager 5.4 and Stata 16 software for data analysis and publication bias test. RESULTS: This systematic review and meta-analysis will provide a high-quality evidence for the efficacy and safety of traditional Chinese herbal medicine combined with HAART in the treatment of HIV/AIDS. CONCLUSION: The conclusion of this review will provide an objective assessment to evaluate whether Chinese herbal medicine integrated with HAART has the effect of improving the efficiency and depressing the toxicity. REGISTRATION NUMBER: INPLASY2021110082.

[Evolution of nutritional status, immunological and virological parameters in children with vertically transmitted HIV under antiretroviral treatment] / Evolución del estado nutricional, parámetros inmunológicos y virológicos en niños con VIH de transmisión vertical bajo tratamiento antirretroviral.

Introduction: continuous growth monitoring allows the identification of anthropometric and metabolic disorders as an integral part of HIV treatment. It was proposed to analyze the evolution of nutritional status, with the immunological and virological parameters in children infected with vertically transmitted HIV and its association with highly active antiretroviral treatment (HAART). Material and Methods: were included 56 children aged 0 to 12 years, attending the Hospital Materno Neonatal of Córdoba, Argentina between 1998-2014. Anthropometric and biochemical, immunological, virological nutritional status and clinical manifestations were evaluated by age group (younger or older than 6 years) and HAART administered in three medical controls. Results: in the third control the analysis of the anthropometric nutritional status according to the body mass index (BMI) diagnosed 47 children (83.93%) with a normal BMI and 6 (10.71%) overweight/obesity, without statistically significant difference by age group (p=0.10). Thirty six children (64.29%) presented hypertriglyceridemia, with higher concentrations at the second (p=0.003) and third control (p=0.06) in those treated with scheme II and III with protease inhibitors (PI), unlike scheme I without IP. Normoglycemia prevailed in 54 children (96.43%) and anemia in 29 (51.79%). The clinical manifestations decreased in the successive controls and in the last one, 3 children (5.36%) older than 6 years, had pneumonia and one (1.79%) severe immunosuppression. Conclusions: hypertriglyceridemia was the main adverse effect of the medication, which, added to the high prevalence of anemia, constitute important parameters for interdisciplinary treatment

Introducción: la vigilancia del crecimiento de manera continua permite la identificación de alteraciones antropométricas y metabólicas como parte integral del tratamiento en VIH. Se propuso analizar la evolución del estado nutricional, con los parámetros inmunológicos y virológicos en niños infectados con VIH de transmisión vertical y su asociación con el tratamiento antirretroviral de gran actividad (TARGA). Material y Métodos: se incluyeron 56 niños de 0-12 años, asistentes al Hospital Materno Neonatal de Córdoba, Argentina entre 1998-2014. Se evaluó, por grupo etario (menor o mayor de 6 años) y TARGA administrado, el estado nutricional antropométrico y bioquímico, inmunológico, virológico y manifestaciones clínicas en tres controles médicos. Resultados: en el tercer control el análisis del estado nutricional antropométrico según el índice de masa corporal (IMC) diagnosticó 47 niños (83,93%) con un IMC normal y 6 (10,71%) sobrepeso/obesidad, sin diferencia estadísticamente significativa por grupo etario (p=0,10). Treinta y seis niños (64,29%) presentaron hipertrigliceridemia, siendo mayores las concentraciones al segundo (p=0,003) y tercer control (p=0,06) en los tratados con esquema II y III con inhibidores de proteasa (IP), a diferencia del esquema I sin IP. La normoglucemia prevaleció en 54 niños (96,43%) y la anemia en 29 (51,79%). Las manifestaciones clínicas disminuyeron en los sucesivos controles y en el último, 3 niños (5,36%) mayores de 6 años, tuvieron neumonía y uno (1,79%) inmunosupresión grave. Conclusiones: la hipertrigliceridemia fue el principal efecto adverso de la medicación que, sumados a la alta prevalencia de anemia, constituyen parámetros importantes para el tratamiento de manera interdisciplinaria.

Effects of Probiotic Mixture Supplementation on the Immune Response to the 13-Valent Pneumococcal Conjugate Vaccine in People Living with HIV.

BACKGROUND: In people living with HIV, combination antiretroviral therapy (cART) reduces the risk of death, but the persistent immune-deficient state predisposes them to pneumococcal infections. Current guidelines encourage administering pneumococcal vaccine Prevenar 13 to patients living with HIV. Since probiotic supplementation could act as adjuvants and improve vaccine immunogenicity by modulating gut microbiota, the present study aimed to assess whether the effect of a formulation containing a combination of specific probiotics (Vivomixx®) could improve the immune response to 13-valent pneumococcal conjugate vaccine (PCV13) in adult people living with HIV. METHODS: Thirty patients who were clinically stable and virologically suppressed, without opportunistic infections during this time and no ART changes in the 12 months before the study started were enrolled. Patients were divided into two groups: (1) received a placebo dose and (2) received Vivomixx® (1800 billion CFU) for four weeks before and after the vaccination with a single dose of PCV13. RESULTS: Vivomixx® supplementation induced a better response to PCV13 immunization, as shown by greater change in anti-Pn CPS13 IgG and increase in salivary IgA, IL-10 and IL-8. CONCLUSIONS: Additional investigations will help to clearly and fully elucidate the optimal strains, doses, and timing of administration of probiotics to improve protection upon vaccination in immunocompromised individuals and the elderly.

Prevalence, beliefs and impact of drug-drug interactions between antiretroviral therapy and illicit drugs among people living with HIV in Spain.

Drug use implies important challenges related to HIV management, particularly due to an increased risk of potential interactions between antiretroviral therapy (ART) and illicit drugs (pDDIs). This study analyses the prevalence and severity of pDDIs among people living with HIV (PLHIV). It also explores their awareness of pDDIs and their beliefs about the toxicity that they may cause, as well as the impact of pDDIs on selected health variables. We conducted an on-line cross-sectional survey across 33 Spanish hospitals and NGOs to collect demographics and clinical data. pDDIs were checked against the Interaction Checker developed by Liverpool University. The sample of the present study was composed of 694 PLHIV who used illicit drugs. They represented 49.5% of the 1,401 PLHIV that participated in the survey. After excluding 38 participants due to lack of information on their ART or illicit drug use, 335 (51.1%) participants consuming drugs presented with some potentially significant pDDIs between their ART and illicit drugs, with a mean of 2.1±1.7 (1-10) pDDIs per patient. The drugs most frequently involved in pDDIs were cocaine, cannabis, MDMA and nitrates ("poppers"). The prevalence of pDDIs across ART regimens was: protease inhibitors (41.7%); integrase inhibitor-boosted regimens (32.1%), and non-nucleoside reverse transcriptase inhibitors (26.3%). An awareness of pDDIs and beliefs about their potential toxicity correlated positively with intentional non-adherence (p<0.0001). Participants with pDDIs exhibited a higher prevalence of intentional non-adherence (2.19±1.04 vs. 1.93±0.94; p = 0.001). The presence of pDDIs was not associated with poorer results in the clinical variables analysed. A significant proportion of PLHIV who use drugs experience pDDIs, thereby requiring close monitoring. pDDIs should be considered in the clinical management of HIV patients. Adequate information about pDDIs and indicators about how to manage ART when PLHIV use drugs could improve ART non-adherence.

Antiretroviral therapy outcomes among adolescents and young adults in a Tertiary hospital in Kenya.

BACKGROUND: Limited data is available on the treatment outcomes of HIV infected adolescents and young adults (AYA) in sub-Saharan Africa. HIV-infected adolescents and young adults (AYA) are at high risk of developing antiretroviral treatment failure. OBJECTIVE: To determine the clinical, immunological and virologic outcomes of AYA at a tertiary hospital in Kenya. METHODOLOGY: A longitudinal study was conducted among AYA age 10-24 years attending Kenyatta National Hospital comprehensive care center. Clinical data was abstracted from electronic medical records for study participants with at least 6 months of follow-up using a structured data abstraction sheet. RESULTS: A total of 250 AYA age 10 to 24 years were included. The median age was 16 years. The median CD4 cell count was 650.6 cells/mm3 (IQR 350.7-884.0). More than half (60.6%) of AYA had a CD4 cell count higher than 500 cells/mm3. Overall, 76.9% of AYA had achieved viral suppression (viral load <1000 copies/ml). There was a significant increase in virologic failure with higher age and late adolescents and young adults were more likely to have a viral load > 1000 copies/ml p<0.012. CONCLUSION: The overall virologic suppression in this cohort of AYA was sub-optimal. Both immunological and virologic outcomes were worse among late adolescents (18-19 years) and young adults (20-24 years).

Factors affecting adherence to antiretroviral therapy among children and adolescents living with HIV in the Mbita Sub-County Hospital, Homa Bay- Kenya.

BACKGROUND: Adequate adherence to antiretroviral therapy (ART) is key to the successful treatment of children and adolescents living with HIV. Continuous ART Adherence is the key factor for virologic suppression and stability of the immune system and prevents the occurrence of opportunistic infections. Children and adolescents struggle with adherence to ART for various reasons, including a poor psychosocial support system and clinic attendance. OBJECTIVES: To describe the uptake of HIV treatment services among children and adolescents in the Mbita Sub-County Hospital, Homa Bay and determine how schooling, clinic attendance, and type of pill/regimen affect adherence to ART and viral suppression. METHODS: This retrospective study was conducted at the Mbita Sub-County Hospital. Medical chart data was abstracted from the hospital files of children and adolescents between the ages of 0-19 years on antiretroviral therapy, between the periods of October 2016 and September, 2017. Data was analyzed using measures of central tendency, and cross-tabulations were done to compare schooling, clinic attendance, type of pill/regimen and viral suppression. Univariate and multivariate logistic regression analyses were conducted to determine associations between groups. RESULTS: According to patient files reviewed, majority of patients, 244(91.4%) were enrolled into care within 2 weeks of HIV diagnosis according to guidelines, and 193(73.1 %) remained enrolled in care at end of study period. An overall viral suppression of 74.2 %( 132) was recorded. Of all the files reviewed, 121(74.7%) of patients attending school suppressed against 11(68.8 %) out of school, p=0.280. Suppression among Day and boarding reported at 78.6 %( 11) and 74.8 %( 113) of those out of school, respectively, p=0.533. Participants in primary school, 17(85.0%) suppressed better than those in secondary school, 102(73.4%), p=0.263. Keeping clinic appointments among eligible patient files reviewed decreased from 83.1% at 3 months, p=0.016, to 76.6%, p=0.526 at 6 months and to 52.9% at 12 months, p=0.278. Only 3- month clinic appointment return rates and Enhanced Adherence Counseling (EAC) were significant predictors of viral supression χ2 (2) = 0.280, p = 0.869 (> 0.05). CONCLUSION: The clinic attendance rate within the first 3 months, and Enhanced Adherence Counseling (EAC) were significant predictors of viral suppression, and therefore adherence to antiretroviral therapy.

Motherhood and decision-making among women living with HIV in developed countries: a systematic review with qualitative research synthesis.

BACKGROUND: Women living with HIV (WLH) lack evidence-based information about reproductive options while managing pressures from family, clinicians, and communities to give up the idea of having children. As the reproduction intentions of WLH are not well understood, stigmatizing behaviors force them to hide their disease to avoid rejection by their family, partner, and social networks. Compliance with social norms, fear of stigma, and discrimination influence their experience. Current research is individual qualitative studies lacking the synthesis perspective necessary to guide intervention development. The purpose of this study was to synthesize the evidence to explain the reproductive decision-making process for WLH in developed countries. METHODS: A systematic review with qualitative research synthesis was conducted through searches in 10 electronic databases (CINAHL, EMBASE, MEDLINE, Scopus, Social Science Citation Index, Web of Science, Google Scholar, Cuidatge, Cuiden Enfispo, and SciELO). Studies published in journals from 1995 to 2019 with qualitative data about reproductive decision-making among WLH in developed countries were eligible for inclusion. Developed country was operationalized by membership in the OECD for comparative conditions of social wellbeing and economic stability. The CASP and JBI checklists for qualitative research were used to assess study quality and methodological integrity. Thematic analysis and qualitative meta-summary techniques were used for the synthesis. RESULTS: Twenty studies from 12 developed countries were included in the synthesis. Findings were organized into 3 meta-themes from 15 themes and 45 subthemes, including: (1) Shattered identity, (2) Barriers, inequities, and misinformation, (3) Coping, resiliency, and support. Reproductive decision-making was perceived as a complex process influenced by facilitators and barriers. The facilitators helped WLH cope with their new situation to become more resilient, while the barriers made their situation more difficult to manage. CONCLUSION: WLH encounter reproductive decision-making with knowledge deficits and limited social support. An integrated approach to holistic care with comprehensive multidisciplinary counseling is needed to support WLH. Clinicians could benefit from professional development to learn how to be authentically present for WLH, including engaging in conversations, demonstrating compassion, and understanding situations. Evidence-based clinical practice guidelines need to be tailored for the family planning and sexual health needs of WLH.

RESUMEN: ANTECEDENTES: Las mujeres que viven con el VIH (MVV) carecen de información basada en evidencias sobre las opciones reproductivas mientras son presionadas por la familia, los profesionales de la salud y los miembros de la comunidad para renunciar a la idea de tener hijos. Como las intenciones reproductivas de las MVV no son comprendidas, las conductas estigmatizantes las obligan a ocultar su enfermedad para evitar el rechazo de su familia, pareja y grupos sociales. El cumplimiento de las normas sociales, el miedo al estigma y la discriminación influyen en su experiencia. La presente investigación está compuesta por estudios cualitativos que de forma individual carecen de la perspectiva de síntesis necesaria para guiar el desarrollo de las intervenciones. El propósito de este estudio fue sintetizar la evidencia para explicar el proceso de toma de decisiones reproductivas para las MVV en los países desarrollados. MéTODOS: Se realizó una revisión sistemática con síntesis de investigación cualitativa mediante búsquedas en 10 bases de datos electrónicas (CINAHL, EMBASE, MEDLINE, Scopus, Social Science Citation Index, Web of Science, Google Scholar, Cuidatge, Cuiden Enfispo y SciELO). Los estudios publicados en revistas de entre 1995 y 2019 que contuvieran datos cualitativos sobre la toma de decisiones reproductivas entre las MVV en países desarrollados fueron elegibles para su inclusión. Se consideraron países desarrollados aquellos que pertenecieran a la OCDE con el objetivo de comparar condiciones de bienestar social y estabilidad económica. Las listas de verificación CASP y JBI para la investigación cualitativa se utilizaron para evaluar la calidad del estudio y la integridad metodológica. Para la síntesis se utilizaron técnicas de análisis temático y metanálisis cualitativo. RESULTADOS: En la síntesis se incluyeron veinte estudios de 12 países desarrollados. Los hallazgos se organizaron en 3 metatemas de 15 temas y 45 subtemas, incluyendo: (1) Identidad fragmentada, (2) Barreras, inequidades y desinformación, (3) Afrontamiento, resiliencia y apoyo. La toma de decisiones reproductivas se percibió como un proceso complejo influenciado por factores facilitadores y barrera. Los facilitadores ayudaron a las MVV a afrontar su nueva realidad para volverse más resilientes, mientras que las barreras hicieron que su situación fuera más difícil de manejar. CONCLUSIóN: Las MVV enfrentan la toma de decisiones reproductivas con déficits de conocimiento y apoyo social limitado. Es necesario adoptar un enfoque holístico de atención integral con asesoramiento multidisciplinario para acompañar a las MVV. Los clínicos podrían beneficiarse del desarrollo profesional para aprender a estar verdaderamente presentes para las MVV, participando en reflexiones, demostrando compasión y comprendiendo sus situaciones. Las guías de práctica clínica basadas en la evidencia deben adaptarse a las necesidades de planificación familiar y salud sexual y reproductiva de las MVV. Plain Language Summary Women living with HIV can become pregnant and deliver a healthy baby due to advances in medicine. Being a mother is an important role that gives meaning to life for most women. For women living with HIV thinking about having a baby is difficult because HIV complicates many areas of daily living. When women living with HIV try to speak with physicians and nurses about having a baby, they often do not feel supported and report feeling stigmatized. This review of the scientific literature summarizes the experiences of women living with HIV in developed countries as they considered having a baby. Ten electronic databases were searched for studies published between 1995 and 2019 reporting interviews with women living with HIV about becoming pregnant and having a baby. From the 4519 articles identified, 20 were included for review with 1395 participants from 12 developed countries. After abstracting and analyzing the interviews, three themes were developed to summarize the process described by women living with HIV as they considered pregnancy and the possibility of having a baby, including: (1) Shattered identity, (2) Barriers, inequities, and misinformation, and (3) Coping, resiliency, and support. When women living with HIV consider having a baby, they need to feel comfortable and safe speaking with physicians and nurses about family planning. They also need more support from their partner, as well as family and friends. Strategies need to be implemented to improve the family planning process for women living with HIV, including education health care providers about speaking to women about pregnancy and having a healthy baby.

Integration of Early Infant Diagnosis of HIV Services Into Village Health Clinics in Ntcheu, Malawi: An Exploratory Qualitative Study.

Integration of Early Infant Diagnosis(EID) of HIV into Village Health Clinics (VHCs) would increase the uptake of services. This study assessed mothers and health care workers' acceptability of integration of EID of HIV services into VHCs in Ntcheu, Malawi. We conducted an exploratory qualitative study in the phenomenological tradition among 20 mothers of either HIV exposed or non-exposed infants and 18 health care workers (HCWs) from February to July 2019. We analyzed the data using a thematic approach and guided by the theoretical framework for acceptability. There were positive perceptions of the integration of services. Acceptability is influenced by attitudes, perceived burden, intervention coherent services, and perceived effectiveness of services. The successful integration of EID of HIV into VHCs requires strengthening of the health system and community awareness. Efforts to mitigate stigma should be prioritized when integrating the services to optimize uptake of the services at a community level.