Assessing a Couples-Based, Digital HIV Serostatus-Neutral Intervention (Para Ti, Para Mí, Para Nosotros) for Adult Cisgender Sexual Minority Male Couples in Lima, Peru: Protocol for a 6-Month Pilot Randomized Controlled Trial.

BACKGROUND: HIV disproportionately affects sexual minority men (SMM; eg, gay, bisexual, and other men who have sex with men) in Lima, Peru; epidemiological data estimate that 32% to 39% of new HIV infections occur among adult cisgender SMM within primary partnerships (ie, male couples). Most HIV prevention-care research in Lima, Peru, has focused on SMM as individuals and not couples. To help address this critical gap in prevention care, we developed Para Ti, Para Mí, Para Nosotros (P3): a couples-based, digital HIV serostatus-neutral intervention (DHI) for adult cisgender SMM couples in Lima, Peru. The P3 DHI is designed to facilitate couples with skill-building, communication, decision-making, and working together to form and adhere to a detailed prevention care plan that aligns with their explicit sexual agreement. The P3 DHI is theoretically informed, self-guided, directed, sequential, and fully automated. OBJECTIVE: This pilot randomized controlled trial (RCT) aims to examine the preliminary effects of P3 on couples' formation and adherence to a detailed prevention care plan containing evidence-based strategies that also aligns with their explicit sexual agreement over time. In addition, the feasibility of enrollment and retention and couples' acceptability of P3 will be assessed. METHODS: The research implements a prospective, 6-month pilot RCT with a 3-month delayed control condition. After baseline, 60 enrolled SMM couples will be randomized to 1 of 2 conditions. Couples randomized to the unmatched, delayed control condition will receive access to the P3 DHI to use during the last 3 months of the trial after the 3-month assessment. Couples randomized to the immediate intervention condition will immediately receive access to the P3 DHI for 6 months. Study assessments will occur at baseline and months 3 and 6. Descriptive, comparative, qualitative, and longitudinal analyses using generalized linear mixed-effect, multilevel, and actor-partner interdependence models will be conducted to address the specific aims. RESULTS: The 6-month pilot RCT is ongoing. Recruitment, enrollment, and data collection began in January 2023 and ended in April 2024. A total of 74 adult cisgender SMM couples met all inclusion criteria, provided consent, and were enrolled in the pilot RCT. Retention was 92% (68/74) at month 6. Data are currently being analyzed to address the 3 specific aims regarding feasibility, acceptability, and preliminary efficacy. CONCLUSIONS: Findings from this research will reveal whether couples deemed the P3 DHI to be acceptable. Findings will also highlight the preliminary efficacy of the P3 DHI on couples managing their vulnerability to HIV and other sexually transmitted infections (STIs) over time via alignment of their prevention-care plan and sexual agreement. Trial findings will help shape the future direction of the P3 DHI while addressing the existing gap in prevention and care services for couples in the local context. TRIAL REGISTRATION: ClinicalTrials.gov NCT05873855; https://clinicaltrials.gov/study/NCT05873855. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/63106.

Safe Injection Self-Efficacy is Associated with HCV and HIV Seropositivity Among People Who Inject Drugs in the San Diego-Tijuana Border Region.

Safe injection self-efficacy (SISE) is negatively associated with injection risk behaviors among people who inject drugs (PWID) but has not been examined in differing risk environments. We compared responses to a validated SISE scale between PWID in San Diego, California and Tijuana, Mexico, and examine correlates of SISE among PWID in Tijuana. PWID were recruited via street outreach for a longitudinal cohort study from October 2020-September 2021. We compared SISE scale items by city. Due to low variability in SISE scores among San Diego residents, we restricted analysis of factors associated with SISE to Tijuana residents and identified correlates of SISE score levels (low, medium, high) using ordinal logistic regression. Of 474 participants, most were male (74%), Latinx (78%) and Tijuana residents (73%). Mean age was 44. Mean SISE scores among San Diego residents were high (3.46 of 4 maximum) relative to Tijuana residents (mean: 1.93). Among Tijuana residents, White race and having previously resided in San Diego were associated with higher SISE scores. HCV and HIV seropositivity, homelessness, fentanyl use, polysubstance co-injection, and greater injection frequency were associated with lower SISE scores. We found profound inequalities between Tijuana and San Diego SISE, likely attributable to differential risk environments. Associations with fentanyl and polysubstance co-injection, injection frequency, and both HIV and HCV seropositivity suggest that SISE contribute to blood-borne infection transmission risks in Tijuana. SISE reflects an actionable intervention target to reduce injection risk behaviors, but structural interventions are required to change the risk environment.

RESUMEN: La autoeficacia de inyección segura (SISE, por sus siglas en inglés) se asocia negativamente con conductas de riesgo de inyección entre las personas que se inyectan drogas (PWID, por sus siglas en inglés), pero no se ha examinado en diferentes entornos de riesgo. Comparamos las respuestas a una escala validada de SISE entre PWID en San Diego, California, y Tijuana, México, y examinamos los correlatos de SISE entre PWID en Tijuana. Participantes fueron reclutados por medio de alcance callejero para un estudio de cohorte longitudinal entre octubre 2020 ­septiembre de 2021. Comparamos los ítems de la escala SISE por ciudad. Debido a la baja variabilidad en los puntajes SISE entre los residentes de San Diego, restringimos el análisis de factores asociados con SISE a los residentes de Tijuana e identificamos factores correlacionados con niveles de SISE (bajo, medio, alto) mediante regresión logística ordinal. De 474 participantes, la mayoría eran hombres (74%), latinx (78%) y residentes de Tijuana (73%). La edad promedio fue de 44 años. Los puntajes medios de SISE entre los residentes de San Diego fueron altos (3.46 de un máximo de 4) en comparación con los residentes de Tijuana (media: 1.93). Entre los residentes de Tijuana, la raza blanca y haber residido previamente en San Diego se asociaron con puntajes más altos de SISE. La seropositividad para HCV y VIH, la falta de vivienda, el uso de fentanilo, la co-inyección de múltiples sustancias y una mayor frecuencia de inyecciónes se asociaron con puntajes más bajos de SISE. Encontramos profundas desigualdades entre SISE en Tijuana y San Diego, probablemente atribuibles a diferentes entornos de riesgo. Las asociaciones con fentanilo y la co-inyección de múltiples sustancias, la frecuencia de inyección y la seropositividad tanto para VIH como para HCV sugieren que SISE contribuye a los riesgos de transmisión de infecciones transmitidas por la sangre en Tijuana. SISE refleja un objetivo de intervención accionable para reducir las conductas de riesgo de inyección, pero se requieren intervenciones estructurales para cambiar el entorno de riesgo.

HPV-DNA test access based on self-collection of vaginal samples from women living with HIV/AIDS: pilot implementation in Brazil / Autocoleta vaginal por mulheres vivendo com HIV/AIDS para testagem de HPV-DNA: implantação piloto no Brasil

Introduction: Women living with HIV/AIDS have a higher frequency of anogenital neoplasms resulting from human papillomavirus (HPV) infection. The World Health Organization recommends that cervical cancer screening uses molecular tests that amplify viral genetic material, such as HPV-DNA. In addition to collection by health professionals, self-collection of vaginal samples is a useful tool for expanding access to testing. Objective: To describe the results of the pilot study that evaluated the acceptability of self-collection of vaginal samples and the applicability of offering HPV-DNA tests with self-collection of vaginal samples for women living with HIV/AIDS in Brazil. Methods: Descriptive cross-sectional study involving women living with HIV/AIDS treated in eight HIV-specialty healthcare facilities distributed in all regions of the country from May 2021 to May 2022 and a central laboratory. Vaginal self-collection was offered, and participants were interviewed about sociodemographic data and impressions of self-collection. Results: In total, 1,919 women living with HIV/AIDS with an average age of 45 years participated in the study. Some type of HPV was detected in 66% (1,267) of cases. The majority (71.9%) said they preferred self-collection to sample collection by health care professionals. Only 53.8% of participants underwent cytology at the appropriate frequency, as recommended by the protocol. Conclusion: The results may support the implementation of molecular biology tests to detect HPV in women living with HIV/AIDS, including the possibility of vaginal self-collection, promoting increased access to cervical cancer screening. (AU)

Introdução: Mulheres vivendo com HIV/AIDS possuem maior frequência de neoplasias anogenitais decorrentes da infecção pelo papilomavírus humano (HPV). A Organização Mundial da Saúde recomenda que o rastreio de câncer do colo do útero seja utilizado por testes moleculares que amplificam o material genético viral, como o HPV-DNA. Além da coleta por profissionais da saúde, a autocoleta de amostras vaginais consiste em uma ferramenta útil para ampliação do acesso à testagem. Objetivo: Descrever os resultados do estudo piloto que avaliou a aceitabilidade da autocoleta de amostra vaginal e aplicabilidade da oferta de testes HPV-DNA com autocoleta de amostras vaginais para mulheres vivendo com HIV/AIDS no Brasil. Métodos: Estudo transversal descritivo envolvendo mulheres vivendo com HIV/AIDS atendidas em oito serviços ambulatoriais distribuídos em todas as regiões do país no período de maio/2021 a maio/2022 e um laboratório central. Realizou-se a oferta de autocoleta vaginal e uma entrevista com as participantes sobre dados sociodemográficos e impressões da autocoleta. Resultados: No total, 1.919 mulheres vivendo com HIV/AIDS com média de 45 anos participaram do estudo. Houve detecção de algum tipo de HPV em 66% (1.267) dos casos. A maioria (71,9%) afirmou preferir a autocoleta à coleta de amostras por profissionais da saúde. Apenas 53,8% das participantes realizaram citologia na periodicidade adequada, conforme recomendação do protocolo. Conclusão:Os resultados poderão apoiar a implementação dos testes de biologia molecular para detecção de HPV em mulheres vivendo com HIV/AIDS, incluindo a possibilidade de autocoleta vaginal, promovendo a ampliação do acesso ao rastreamento de câncer do colo do útero. (AU)

Prediction Models for Adverse Drug Reactions During Tuberculosis Treatment in Brazil.

BACKGROUND: Tuberculosis (TB) treatment-related adverse drug reactions (TB-ADRs) can negatively affect adherence and treatment success rates. METHODS: We developed prediction models for TB-ADRs, considering participants with drug-susceptible pulmonary TB who initiated standard TB therapy. TB-ADRs were determined by the physician attending the participant, assessing causality to TB drugs, the affected organ system, and grade. Potential baseline predictors of TB-ADR included concomitant medication (CM) use, human immunodeficiency virus (HIV) status, glycated hemoglobin (HbA1c), age, body mass index (BMI), sex, substance use, and TB drug metabolism variables (NAT2 acetylator profiles). The models were developed through bootstrapped backward selection. Cox regression was used to evaluate TB-ADR risk. RESULTS: There were 156 TB-ADRs among 102 of the 945 (11%) participants included. Most TB-ADRs were hepatic (n = 82 [53%]), of moderate severity (grade 2; n = 121 [78%]), and occurred in NAT2 slow acetylators (n = 62 [61%]). The main prediction model included CM use, HbA1c, alcohol use, HIV seropositivity, BMI, and age, with robust performance (c-statistic = 0.79 [95% confidence interval {CI}, .74-.83) and fit (optimism-corrected slope and intercept of -0.09 and 0.94, respectively). An alternative model replacing BMI with NAT2 had similar performance. HIV seropositivity (hazard ratio [HR], 2.68 [95% CI, 1.75-4.09]) and CM use (HR, 5.26 [95% CI, 2.63-10.52]) increased TB-ADR risk. CONCLUSIONS: The models, with clinical variables and with NAT2, were highly predictive of TB-ADRs.

Characterization of HIV-1 Reservoirs in Children and Adolescents: A Systematic Review and Meta-Analysis Toward Pediatric HIV Cure.

OBJECTIVE: To conduct a comprehensive, systematic review of the profile of HIV-1 reservoirs in children and adolescents with perinatally acquired HIV infection. STUDY DESIGN: Randomized and nonrandomized trials, cohort studies, and cross-sectional studies on HIV reservoirs in pediatric populations, published between 2002 and 2022, were included. Archived-drug resistance mutations (ADRMs) and the size of reservoirs were evaluated. Subgroup analyses were performed to characterize further the data, and the meta-analysis was done through random effect models. RESULTS: Overall, 49 studies from 17 countries worldwide were included, encompassing 2356 perinatally infected participants (48.83% females). There are limited data on the quantitative characterization of viral reservoirs in sub-Saharan Africa, with sensitive methodologies such as droplet digital polymerase chain reaction rarely employed. The overall prevalence of ADRMs was 37.80% (95% CI 13.89-65.17), with 48.79% (95% CI 0-100) in Africa, 42.08% (95% CI 6.68-82.71) in America, 23.88% (95% CI 14.34-34.90) in Asia, and 20.00% (95% CI 10.72-31.17) in Europe, without any difference between infants and adolescents (P = .656). Starting antiretroviral therapy (ART) before 2 months of age limited the levels of HIV-1 DNA (P = .054). Participants with long-suppressed viremia (>5 years) had lower levels of HIV-1 DNA (P = .027). Pre- and post-ART CD4 ≤29% and pre-ART viremia ≥5Log were all found associated with greater levels of HIV-1 DNA (P = .038, P = .047, and P = .041, respectively). CONCLUSIONS: The pooled prevalence of ADRMs is high in perinatally infected pediatric population, with larger proviral reservoir size driven by delayed ART initiation, a shorter period of viral suppression, and immunovirological failures. Thus, strategies for pediatric HIV functional cure should target children and adolescents with very early ART initiation, immunocompetence, and long-term viral suppression.

O cuidado de enfermagem nas relações sorodiferentes: uma análise à luz de Imogene King / Cuidados de enfermería en las relaciones serias: un análisis a la luz de Imagen King / Nursing care in serodifferent relationships: an analysis in the light of Imogene King

Resumo Objetivo refletir sobre a possibilidade de utilização dos pressupostos de Imogene King como fundamentação teórica para os cuidados de enfermagem a parceiros sexuais sorodiferentes ao HIV. Método estudo descritivo de caráter reflexivo, com o aporte teórico da Teoria do Alcance de Metas de Imogene King. Resultados as reflexões deram origem a dois eixos de análise: no primeiro, cumpre-se detalhar os pressupostos conceituais de Imogene King e o alcance de metas, e no segundo, explora-se a convergência da teoria de King no cuidado às relações sorodiferentes no que concerne aos seus limites, possibilidades e desdobramentos nos sistemas pessoal, interpessoal e social. Conceitos como percepção, interação e organização formam os eixos centrais dos sistemas e possibilitam a compreensão ampliada das demandas dos parceiros sorodiferentes com vistas ao equilíbrio dos fatores estressores à manutenção da saúde. Considerações finais e implicações para a prática o entendimento dos sistemas abertos aplicados à pessoa que vive com HIV individualmente e na díade com seu parceiro, ambos inseridos em grupos na sociedade, resulta em uma melhor compreensão de suas necessidades e, assim, contribuem com o planejamento de metas direcionadas.

Resumen Objetivo reflexionar sobre la posibilidad de utilizar los supuestos de Imogene King como base teórica para el cuidado de enfermería en parejas VIH-serodiferentes. Método estudio descriptivo de carácter reflexivo, con el aporte teórico de la Teoría del Logro de Metas de Imogene King. Resultados las reflexiones dieron lugar a dos ejes de análisis: en el primero, es necesario detallar los supuestos conceptuales de Imogene King y el logro de objetivos, y en el segundo, se explora la convergencia de la teoría de King en el cuidado de las relaciones serodiferentes en cuanto a sus límites, posibilidades y desarrollos en los sistemas personal, interpersonal y social. Conceptos como percepción, interacción y organización forman los ejes centrales de los sistemas y permiten una comprensión más amplia de las demandas de las parejas serodiferentes con vistas a equilibrar los factores de estrés para mantener la salud. Consideraciones finales e implicaciones para la práctica la comprensión de los sistemas abiertos aplicados a personas que viven con VIH individualmente y en pareja con su pareja, ambas insertadas en grupos de la sociedad, resulta en una mejor comprensión de sus necesidades y, así, contribuye a la planificación de objetivos específicos.

Abstract Objective to reflect on the possibility of using Imogene King's assumptions as a theoretical basis for nursing care in HIV-serodifferent partnerships. Method a descriptive study of a reflective nature, with the theoretical contribution of Imogene King's Goal Attainment Theory. Results the reflections gave rise to two axes of analysis: in the first, it is necessary to detail Imogene King's conceptual assumptions and goal attainment, and in the second, the convergence of King's theory in caring for serodifferent relationships is explored with regard to their limits, possibilities and developments in the personal, interpersonal and social systems. Concepts such as perception, interaction and organization form the central axes of the systems and enable a broader understanding of serodifferent partners' demands with a view to balancing stress factors for maintaining health. Final considerations and implications for practice the understanding of open systems applied to people living with HIV individually and in a dyad with their partner, both inserted in groups in society, results in a better understanding of their needs and thus contributes to planning targeted goals.

HIV with initial ocular Kaposi sarcoma / HIV com sarcoma de Kaposi ocular inicial

ABSTRACT We present an interesting case of a 62-year-old black female, presented to the ophthalmological hospital with a little "nevus" on the left eye previously visualized at the mirror, with one month of development. Physical examination with slit lamp (biomicroscopy) showed a group of painless veins, with vascular redness, and a mass nodular aspect in the mid temporal bulbar conjunctiva, of approximately 2mmx4mm.

RESUMO Apresentamos o interessante caso de uma mulher negra de 62 anos, que deu entrada no hospital oftalmológico com um pequeno nevo no olho esquerdo previamente visualizado ao espelho, com 1 mês de evolução. O exame físico com lâmpada de fenda (biomicroscopia) mostrou um grupo de veias indolor e vermelhidão vascular, com uma massa de aspecto nodular na conjuntiva bulbar temporal média, de aproximadamente 2mmx4mm.

Factores asociados a la mala adherencia al tratamiento antirretroviral en pacientes VIH positivo / Factors associated with poor adherence to antiretroviral treatment in HIV-positive patients

Introducción: La infección por el virus de inmunodeficiencia humana representa un problema de salud pública en el mundo. La adherencia a la terapia antirretroviral es necesaria para alcanzar un estado de supresión viral máxima y disminuir la tasa de infecciones oportunistas. Sin embargo, diversos son los factores que pueden influir en la adherencia terapéutica. Objetivo: Identificar los factores de riesgo asociados a la mala adherencia a la terapia antirretroviral en pacientes con el virus de inmunodeficiencia humana. Métodos: Se empleó un estudio con diseño observacional, analítico, de tipo casos y controles. El tamaño muestral fue de 276, a partir del cual 138 fueron casos y 138 controles. Los datos recolectados fueron analizados utilizando métodos de estadística descriptiva y estadística inferencial. Resultados: El análisis multivariado determinó una asociación estadísticamente significativa entre la variable adherencia al tratamiento antirretroviral y las variables depresión (odds ratio OR ajustado= 2,15), esquema de terapia antirretroviral alternativo (OR ajustado= 2,40), efectos secundarios (OR ajustado= 4,24) y cambio en la adherencia durante el estado de emergencia (OR ajustado= 5,67), independientemente de las otras variables intervinientes. Conclusiones: La depresión, el uso del esquema de terapia antirretroviral alternativo, la presencia de efectos secundarios a terapia antirretroviral y el cambio en la adherencia durante el estado de emergencia aumentan el riesgo de mala adherencia a la terapia antirretroviral(AU)

Introduction: Human immunodeficiency virus infection represents a public health public problem in the world. Adherence to antiretroviral therapy is necessary to achieve a state of maximum viral suppression and decrease the rate of opportunistic infections. However, there are several factors that can influence therapeutic adherence. Objective: To identify the risk factors associated with poor adherence to antiretroviral therapy in patients with the human immunodeficiency virus. Methods: A study with an observational, analytical, case-control type design was used. The sample size was 276, from which 138 were cases and 138 controls. The collected data was analyzed using methods of descriptive statistics and inferential statistics. Results: The multivariate analysis determined a statistically significant association between the variable adherence to antiretroviral treatment and the variables depression (adjusted Odds Ratio OR = 2.15), alternative antiretroviral therapy scheme (adjusted OR= 2.40), side effects (adjusted OR= 4.24), and change in adherence during the state of emergency (adjusted OR= 5.67) independently of the other intervening variables. Conclusions: Depression, the use of alternative antiretroviral therapy regimens, the presence of side effects to antiretroviral therapy, and the change in adherence during the state of emergency increase the risk of poor adherence to antiretroviral therapy(AU)

Molecular epidemiology of HIV-1 among adult female sex workers at the Guatemala-Mexico border.

ABSTRACTSex workers have been demonstrated to have increased vulnerabilities to HIV and a high population prevalence of the disease. Despite their increased risk, sex workers have been underrepresented in molecular epidemiology studies assessing HIV in Mesoamerica. This study aims to describe the sociodemographic characteristics and phylogenetic profile of HIV-1 within a cohort of HIV-positive female sex workers (FSW) situated at the Guatemala-Mexico border. HIV viral sequences were collected from a cohort of FSW ≥18 years of age from San Marcos, Guatemala (n = 6) and compared to viral sequences collected as part of the Mesoamerican Drug Resistance Monitoring Programme to assess HIV viral diversity in Mexico and Guatemala (n = 3956). All of the FSW sampled were determined to have genetically unrelated HIV infections, suggesting multiple introductions of the virus and/or the potential existence of populations not captured by current surveillance efforts. Many reported numerous vulnerabilities that may have heightened their risk of acquiring and transmitting HIV through sex work activities. Our phylogenetic analysis indicated that national surveillance programmes may not fully capture the viral diversity among FSW and their clients within this region. Additional research is needed to fully capture HIV diversity and transmission in Mesoamerica, especially in the Guatemala-Mexico border region.

The Association between CCL5/RANTES SNPs and Susceptibility to HIV-1 Infection: A Meta-Analysis.

Genetic polymorphisms in genes that encode natural ligands of CCR5 (the main human HIV coreceptor), such as CCL5/RANTES, can alter the levels of secretion of these peptides. This article sought to review the relationship between single nucleotide polymorphisms (SNPs) of CCL5/RANTES and HIV-1 disease susceptibility. A meta-analysis was conducted through 17 articles found from January 1999 to December 2022 in the PUBMED, Science Direct, Medline, and SciELO databases. A total of three SNPs were identified and investigated under their dominant genotypic model and through a fixed-effects model. In terms of the SNP rs2107538 (G > A), in Africa and Asia, it has a protective role (OR = 0.56; 95% CI = 0.41-0.76; p = 0.0002, and OR = 0.88; 95% CI = 0.76-1.02; p = 0.08, respectively). In terms of the SNP rs2280788 (C > G), in Europe and America, it shows a higher risk role (OR = 1.92; 95% CI = 1.06-3.47; p = 0.03, and OR = 0.94; 95% CI = 0.94-1.11; p = 0.04, respectively), but in the population of Asia, with its mutant allele, it has a protective role (OR = 0.76; 95% CI = 0.63-0.93; p = 0.007). In terms of the SNP rs2280789 (T > C), no significant associations were found. Both SNPs rs2107538 and rs2280788 have a positive transcriptional effect on the RANTES/CCL5 gene, while SNP rs2280789 causes a decrease in gene expression levels. This study suggests that there is an association between the increased expression of CCL5/RANTES and a lower risk of AIDS. Therefore, further studies are needed to arrive at a definitive conclusion, and these results may help establish scientific bases for effective HIV/AIDS control strategies.

Genomic Detection of the Emerging, Highly Pathogenic HIV-1 Subtype D in Bahia, Northeast Brazil.

(1) Background: The HIV subtype D is generally associated with a faster decline in CD4+ T cell counts, a higher viral load, and a faster progression to AIDS. However, it is still poorly characterized in Brazil. In this study, we used genomics and epidemiological data to investigate the transmission dynamics of HIV subtype D in the state of Bahia, Northeast Brazil. (2) Methods: To achieve this goal, we obtained four novel HIV-1 subtype D partial pol genome sequences using the Sanger method. To understand the emergence of this novel subtype in the state of Bahia, we used phylodynamic analysis on a dataset comprising 3704 pol genome sequences downloaded from the Los Alamos database. (3) Results: Our analysis revealed three branching patterns, indicating multiple introductions of the HIV-1 subtype D in Brazil from the late 1980s to the late 2000s and a single introduction event in the state of Bahia. Our data further suggest that these introductions most likely originated from European, Eastern African, Western African, and Southern African countries. (4) Conclusion: Understanding the distribution of HIV-1 viral strains and their temporal dynamics is crucial for monitoring the real-time evolution of circulating subtypes and recombinant forms, as well as for designing novel diagnostic and vaccination strategies. We advocate for a shift to active surveillance, to ensure adequate preparedness for future epidemics mediated by emerging viral strains.

Diabetes in a hospital cohort of persons living with HIV: a descriptive and comparative study in French Guiana.

BACKGROUND: In French Guiana (population 294,000) the prevalence of type 2 diabetes (10%) and of HIV(1.1%) are very high. Our objective was to determine the prevalence of diabetes and its complications in a HIV cohort. MATERIALS AND METHODS: We enrolled HIV-infected persons followed in Cayenne, Kourou, and Saint Laurent du Maroni hospitals between January 1, 1992 and December 31, 2021 in the French Hospital Database for HIV (FHDH) a national database compiling data from all French regions. RESULTS: There was no difference of diabetes prevalence between men (8.2%) and women (8.8%), P = 0.4. Patients with diabetes were older (56 years ± 13.4) than those without diabetes (44.7 years ± 13.6) and prevalence increased with age. The proportion of persons with diabetes was greater among virologically suppressed persons (10%) than those with a detectable viral load under antiretroviral treatment (5.8%). Persons with diabetes had substantially greater CD4 counts at diagnosis than persons without diabetes. The majority of macro and microvascular complications were observed in people with diabetes. Persons with diabetes and HIV were significantly less likely to have had AIDS (1.6 versus 2.2 per 100 person-years, respectively). Overall, 374 persons living with HIV of 4167 had died (9%) the proportion of persons with diabetes among the dead was greater than those who did not die 11.7% versus 8.1%, respectively, p = 0.017. However, persons with diabetes were older and hence died older, 62.3 years (SD = 1.9) for deceased persons with diabetes versus 50.4 years (SD = 0.8), P < 0.0001. However, using Cox regression to adjust for age, initial CD4 count, country of birth there was no significant difference in the Hazard for death between persons with diabetes and persons without diabetes (aHR = 0.99, 95%CI = 0.65-1.5), P = 0.9. CONCLUSIONS: The prevalence of diabetes in our HIV cohort was high. Persons with diabetes had greater CD4 counts, earlier care, and greater virological suppression than persons without diabetes. There were no significant differences between persons with diabetes and without diabetes in terms of survival.

Intergenerational sex and early sexual debut are associated with HIV infection among transgender women in Paraguay.

INTRODUCTION: HIV prevalence among transgender women is high worldwide. The objectives of the present study were to estimate the current prevalence of HIV and identify factors associated with high HIV burden among transgender women in Paraguay. METHODS: Transgender women aged ≥15 years in four regions of Paraguay were recruited by Starfish sampling between February and March 2021. RESULTS: In total, 322 transgender women were included. Mean age was 31 years (range 15-67), and 102 had positive HIV test results (31.7%, 95% confidence interval [CI] 26.6-37.1). In multivariable analysis, factors associated with HIV infection were age at first intercourse ≤17 years (adjusted odds ratio [aOR] 5.47; 95% CI 1.05-28.42), >10 years difference in age with the last sexual partner (aOR 1.60; 95% CI 1.04-2.46), substance use (mostly cocaine) (aOR 3.00; 95% CI 1.47-6.12), higher risk perception (aOR 3.08; 95% CI 1.53-6.17), not testing for HIV (aOR 1.23; 95% CI 1.09-1.39), and accessed by a peer educator (aOR 3.86; 95% CI 1.77-8.38). CONCLUSIONS: Sexual debut as a minor and a large age difference with sexual partners are associated with high burden of HIV among transgender women in Paraguay. Our study corroborates the finding of cocaine use during sex as a risk factor for HIV. Prevention programmes must address structural and social vulnerabilities to stem the tragically high burden of HIV among transgender women.

Evaluation of HIV-1 antiretroviral drug resistance profiles in the peripheral blood reservoir of successfully treated persons using massive sequencing and viral full genome characterization.

BACKGROUND: Antiretroviral therapy has revolutionized HIV treatment, increasing quality and life expectancy of people living with HIV (PLWH). However, the expansion of treatment has resulted in an increase in antiretroviral-resistant viruses, which can be an obstacle to maintenance of successful ART. OBJECTIVES: This study analysed the genetic composition of the HIV near full-length genome (NFLG) from archived proviruses of PLWH under successful ART, and determined the presence/frequency of drug resistance mutations (DRMs) and viral subtype. PATIENTS AND METHODS: Forty-six PLWH from Rio de Janeiro (RJ) and 40 from Rio Grande (RS) had proviral HIV NFLG PCR-amplified and ultradeep sequenced. The presence/frequency of DRMs were analysed in Geneious. Phylogenetic analyses were performed using PhyML and SimPlot. RESULTS: All samples included in the study were sequenced and 69 (80.2%) had the HIV NFLG determined. RJ and RS showed a predominance of HIV subtypes B (78.3%) and C (67.5%), respectively. Overall, 168 DRMs were found in 63 (73.3%) samples, and 105 (62.5%) of them were minority variants. Among DRMs, 41 (39.0%) minority variants and 33 (52.4%) variants with frequency above 20.0% in the viral population were able to confer some degree of resistance to at least one drug in use by respective patients, yet no one showed signs of therapeutic failure. CONCLUSIONS: Our study contributes to the understanding of the impact of DRMs on successful therapy and supports the sustainability of combinatorial ART, because all patients maintained their successful treatment despite the high prevalence of DRMs at low (62.5%) or high (37.5%) frequency.

Factors Associated with Spontaneous Clearance of Recently Acquired Hepatitis C Virus among HIV-Positive Men in Brazil.

INTRODUCTION: The objective of the present study was to describe the clinical and epidemiological aspects of recently acquired hepatitis C virus (HCV) infection and the frequency of its spontaneous clearance in a people living with the human immunodeficiency virus (PLWH) cohort. METHODS: We reviewed the medical records from all PLWH at the human immunodeficiency virus (HIV) outpatient reference clinic affiliated with the University of São Paulo, Brazil, and identified, by immunoassays and RNA-PCR individuals who acquired HCV infection between January 2015 and December 2017. The factors associated with subsequent spontaneous clearance of the infection in this group were identified and analyzed. RESULTS: Among 3143 PLWH individuals, 362 (11.5%) were coinfected with HCV. Forty-eight (13.2%) of these subjects first became HCV-positive between January 2015 and December 2017. Spontaneous HCV clearance was documented in 23 individuals (47.9%). The majority of this latter group were male (83.3%), and the median age was 31 years (23-39). The main risk group for HCV acquisition was men who had sex with men (MSM) (89.5%). In a multivariate analysis, only an elevated CD4+ T lymphocyte count at the time of seroconversion was found to be associated with subsequent HCV clearance (p = 0.025). CONCLUSIONS: In HIV-infected individuals in Sao Paulo, Brazil, most cases of recent HCV transmission were by sexual exposure. In PLWH, particularly in MSM, the individual's CD4+ T lymphocyte count is a determinant of whether an acquired HCV infection will be prolonged or will spontaneously clear.

Primary diffuse large B-cell lymphoma of the head and neck in a Brazilian single-center study.

OBJECTIVES: Lymphomas represent around 10% of head and neck neoplasms, among which the diffuse large B-cell lymphoma (DLBCL) is the most common histologic subtype. In the present study, we characterized demographic parameters, anatomical sites, and survival rates of patients in a Brazilian cancer center. MATERIALS AND METHODS: Single-center retrospective epidemiological study of 243 head and neck DLBCL patients. Demographic characteristics, tumor localization, HIV status, lactate dehydrogenase (LDH) activity, and treatment modality were obtained from electronic medical records. RESULTS: The most common primary head and neck tumor location in patients with DLBCL was Waldeyer's ring. Interestingly, age above 80 years, male gender, high LDH levels, and HIV positivity were significantly associated with shorter overall survival (OS) rates and increased risk of death. We further demonstrated that treatment had a protective effect, improving OS, and reducing risk of death. Notably, we found no benefit of combination of chemotherapy and radiotherapy versus isolated treatment modalities. CONCLUSION: The study showed that primary head and neck DLBCL is more incident in middle age and elderly patients with a small male patients' majority in a Brazilian population. Moreover, we observed a 3-year OS rate of almost 60% and multivariate analysis showed that treatment was the only protective factor.

Por uma decolonização do HIV e interseccionalização das respostas à aids / For an HIV Decolonization and intersectionalization of AIDS responses

Resumo Com o advento da aids, uma articulação discursiva jornalística-biomédica-midiática contribuiu para acentuar a estigmatização sobre determinadas populações implicando uma colonização do HIV em que o vírus atingiria algumas pessoas enquanto outras estariam livres. Através de uma Análise do Discurso Crítica (ADC) realizou-se uma análise de retórica de algumas rupturas e continuidades discursivas nas áreas acadêmica-jurídica-midiática a partir de uma revisão narrativa de literatura (RNL). Os referenciais teóricos, éticos e políticos dos estudos decoloniais foram utilizados para a presente análise por entenderem que a colonialidade se reproduz em uma tripla dimensão: a do poder, do saber e do ser. Estes estudos foram articulados à uma crítica interseccional em que múltiplas formas de discriminação podem se sobrepor e serem experimentadas em intersecção tendo a contextualização sobre o que representou a aids, no Haiti, como eixo central comparativa para análise. Interessou-nos pensar a contribuição dessas perspectivas para lançar algumas provocações às respostas ao HIV/aids numa tentativa de superação de uma visão reducionista propagada por discursos morais e criminalizantes que, ao se posicionarem através de uma suposta neutralidade, dissimulam a interseccionalidade de gênero, classe, raça e sexualidade, levantando barreiras para as políticas e estratégias de promoção da saúde e prevenção ao HIV/aids.

Abstract With the advent of AIDS, a discursive journalistic-biomedical-mediatic articulation contributed to accentuate stigmatization on certain populations, implying a colonization of HIV in which the virus would reach some people while others would be free. Through a Critical Discourse Analysis (CDA), a critical literature review was carried out in some academic-legal-media areas from a narrative literature review (NLR). The theoretical, ethical and political references of decolonial studies were used for the present analysis because they understand that coloniality is reproduced in a triple dimension: that of power, knowledge and being. These studies were linked to an intersectional criticism in which multiple forms of discrimination can overlap and be experienced in intersection having the contextualization about what aids represented, in Haiti, as a comparative central axis for analysis. We were interested in thinking about the contribution of these perspectives to launch some provocations to the responses to HIV/AIDS in an attempt to overcome a reductionist view propagated by moral and criminalizing discourses that, by positioning themselves through supposed neutrality, conceal the intersectionality of gender, class, race and sexuality, raising barriers to health promotion and HIV/AIDS prevention policies and strategies.

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

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

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

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

Gestação, Vírus da Imunodeficiência Adquirida (HIV) e COVID-19: desafios na assistência ao pré-natal / Embarazo, virus de la inmunodeficiencia adquirida y COVID-19: desafíos en la atención prenatal / Pregnancy, acquired immunodeficiency virus and COVID-19: challenges in prenatal care

Objetivo: evidenciar os desafios existentes durante o pré-natal em mulheres grávidas soropositivas para o Vírus da Imunodeficiência Adquirida durante um período pandêmico. Método: Trata-se de uma pesquisa quantitativa exploratória de caráter descritivo, utilizando-se de levantamento de dados através de entrevistas em campo com 19 gestantes com Vírus da Imunodeficiência Adquirida de um serviço de assistência especializada, entre julho de 2021 e julho de 2022. Resultados: apontaram dificuldades para agendar consultas, realizar exames e acesso aos resultados, dificuldades para conseguir transporte devido a distância da unidade de infectologia e dificuldade para agendar consultas na unidade básica de saúde. Conclusão:o serviço de assistência especializada realizou a reorganização da assistência para diminuir os desafios presentes, que foram dificuldade de acesso a unidade, marcação e acesso a resultado de exames pré-natal.

Objectives: to highlight the existing challenges during prenatal care in pregnant women seropositive for the Acquired Immunodeficiency Virus during a pandemic period. Method: This is a descriptive exploratory quantitative research, using data collection through field interviews with 19 pregnant women with Acquired Immunodeficiency Virus from a specialized assistance service, between July 2021 and July 2022. Results: they pointed out difficulties in scheduling consultations, performing tests and accessing the results, difficulties in getting transportation due to the distance from the infectology unit and difficulty in scheduling consultations at the basic health unit. Conclusion: the specialized assistance service carried out the reorganization of assistance to reduce the present challenges, which were difficulty in accessing the unit, scheduling and access to prenatal exam results.

Objetivos:resaltar los desafíos existentes durante la atención prenatal en gestantes seropositivas para el Virus de la Inmunodeficiencia Adquirida en período de pandemia. Método: Se trata de una investigación cuantitativa exploratoria descriptiva, utilizando la recolección de datos a través de entrevistas de campo con 19 gestantes con Virus de la Inmunodeficiencia Adquirida de un servicio de asistencia especializada, entre julio de 2021 y julio de 2022. Resultados:señalaron dificultades en la programación de consultas, realización de pruebas y acceso a los resultados, dificultades para conseguir transporte debido a la distancia de la unidad de infectología y dificultad para programar consultas en la unidad básica de salud. Conclusión: el servicio de asistencia especializada realizó la reorganización de la asistencia para reducir los desafíos presentes, que fueron la dificultad de acceso a la unidad, la programación y el acceso a los resultados del examen prenatal.

Condições de vida de pessoas vivendo com HIV em um município do Estado do Rio de Janeiro, Brasil / Life conditions of people living with HIV in a city of the state of Rio de Janeiro, Brazil / Condiciones de vida de las personas que viven con el VIH en un municipio del estado de Río de Janeiro, Brasil

Objetivo: discorrer sobre as condições de vida das pessoas vivendo com HIV em um município do estado do Rio de Janeiro, Brasil. Método: estudo do tipo transversal, descritivo, de natureza qualitativa. A coleta de dados foi através de entrevistas, sendo os achados submetidos à técnica de análise de conteúdo. A amostra foi composta por pessoas vivendo com HIV que eram abordados no momento que compareciam ao serviço de assistência especializada, sendo definida uma amostra de 20 participantes por técnica de saturação. Resultado: emergiram categorias com base nos temas abordados na entrevista relacionados à qualidade de vida (condição de alimentação, atividade física, lazer, religião e satisfação com a vida sexual) e à experiência de viver com HIV. Conclusão: as pessoas vivendo com HIV, em tratamento antirretroviral, podem usufruir de boas condições de vida tendo como principal fator impeditivo o medo de vivenciar situações de estigma e discriminação.

Objectives: investigate the implications for the life conditions of people living with HIV in a city of the State of Rio de Janeiro, Brazil. Method: cross-sectional, descriptive, and qualitative study. Data collection was conducted through interviews, and the findings were subjected to the content analysis technique. The sample comprised people living with HIV that were approached at the time they attended the specialized assistance service, and a sample of 20 participants was defined by saturation technique. Result: categories emerged based on the topics addressed in the interview related to quality of life (food condition, physical activity, leisure, religion, and satisfaction with sexual life) and the experience of living with HIV. Conclusion: people living with HIV in antiretroviral treatment can enjoy good living and the preventing potential factor is the fear of experiencing situations of stigma and discrimination.

Objetivos: conocer las implicaciones para las condiciones de vida de las personas que viven con el VIH en un municipio del Estado de Río de Janeiro, Brasil. Método: estudio de tipo transversal, descriptivo, de naturaleza cualitativa. La recolección de datos se realizó a través de entrevistas, y los hallazgos fueron sometidos a la técnica de análisis de contenido. La muestra se compuso por personas que viven con el VIH que fueron abordadas en el momento en que vinieron al servicio de asistencia especializada, y se definió una muestra de 20 participantes por la técnica de saturación. Resultado: emergieron categorías basadas en los temas abordados en la entrevista relacionados con la calidad de vida (condición alimentaria, actividad física, ocio, religión, y satisfacción con la vida sexual) y la experiencia de vivir con VIH. Conclusión: las personas que viven con el VIH en tratamiento antirretroviral pueden disfrutar de buenas condiciones de vida y salud, y el principal impedimento y el temor de experimentar situaciones de estigma y discriminación.