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1.
West Afr J Med ; 39(9): 973-981, 2022 Sep 16.
Artículo en Inglés | MEDLINE | ID: mdl-36128886

RESUMEN

INTRODUCTION: Substance use is an increasing menace in Nigeria. It is common and even higher among PLWHIV compared to the general population. Substance use increases a person's chance of acquiring HIV due to increased risky behaviours. Gap exists on our understanding of why some clients fail on Antiretroviral Therapy (ART) adherence or appointment. Exploring psychoactive substance use among people living with HIV (PLWHIV) and their effect on treatment outcome may help in addressing these problems. METHODS: The study was at Military Hospital in Makurdi, Benue state, Nigeria. It involved 700 HIV positive clients >18 years selected using simple random sampling method. Analytical cross-sectional study using questionnaire (WHO ASSIST V3.1) was done. Chi-square test was used for association of characteristics of clients with substance use and treatment outcome (CD4 count and Viral load) at p < 0.05. Binary logistic regression was used to identify predictors. RESULTS: Prevalence of ever used and current use of any psychoactive substance were 539(77.0%) and 459(65.6%) respectively. Commonest used substances were alcohol 445(63.6%), Bitter cola/Kola nut 260(37.1%) and tobacco products 138(19.7%). Predictors of ever used substance were; Males (AOR 2.21; 95% CI 1.41-3.49), single (AOR 3.63; 95% CI 1.58-18.38), Christians (AOR 8.88; 95% CI 1.19-66.31), keeping to appointments (AOR 2.26; 95% CI 1.37-12.01). Ever used substance was predictor for CD4 count increase (AOR 1.45; 95% CI 1.22-1.83) and viral load suppression (AOR 0.40; 95% CI 0.12-0.75). CONCLUSION: There was a high prevalence of substance use. Ever used psychoactive substance were determinants for treatment outcome. There is need for new strategy and involvement of mental health professional in the care of PLWHIV to address this.


INTRODUCTION: La consommation de substances psychoactives est une menace croissante au Nigeria. Elle est courante et même plus élevée chez les PVVIH que dans la population générale. La consommation de substances psychoactives augmente le risque de contracter le VIH en raison de l'augmentation des comportements à risque. VIH en raison de l'augmentation des comportements à risque. Il existe des lacunes dans notre compréhension des raisons pour lesquelles certains clients n'adhèrent pas à la thérapie antirétrovirale (TAR) ou ne prennent pas de rendez-vous. L'étude de la consommation de substances psychoactives chez les personnes vivant avec le VIH (PVVIH) et de son effet sur le résultat du traitement peut aider à résoudre ces problèmes. MÉTHODES: L'étude a été menée à l'hôpital militaire de Makurdi, dans l'État de Benue, au Nigeria. Elle a porté sur 700 clients séropositifs de plus de 18 ans sélectionnés par une méthode d'échantillonnage aléatoire simple. Une étude transversale analytique a été réalisée à l'aide d'un questionnaire (WHO ASSIST V3.1). Le test du chi carré a été utilisé pour l'association des caractéristiques des clients avec la consommation de substances et les résultats du traitement (numération des CD4 et charge virale) à p < 0,05. Une régression logistique binaire a été utilisée pour identifier les prédicteurs. RÉSULTATS: La prévalence de l'utilisation antérieure et actuelle de toute substance psychoactive était de 539 (77,0%) et 459 (65,6%) respectivement. Les substances les plus fréquemment consommées étaient l'alcool (445, 63,6 %), le cola amer/la noix de kola (260, 37,1 %) et les produits du tabac (138, 19,7 %). Les facteurs prédictifs de la consommation de substances étaient les suivants : hommes (AOR 2,21; IC 95% 1,41-3,49), célibataires (AOR 3,63 ; IC 95% 1,58-18,38), chrétiens (AOR 8,88 ; IC 95% 1,19-66,31), respect des rendez-vous (AOR 2,26 ; IC 95% 1,37-12,01). Le fait d'avoir déjà consommé une substance était un facteur prédictif de l'augmentation du nombre de CD4 (AOR 1,45 ; IC 95 % 1,22-1,83) et de la suppression de la charge virale (AOR 0,40 ; IC 95 % 0,12-0,75). CONCLUSION: La prévalence de la consommation de substances psychoactives était élevée. Les substances psychoactives déjà consommées étaient déterminantes pour les résultats du traitement. Pour y remédier, il est nécessaire d'adopter une nouvelle stratégie et d'impliquer les professionnels de la santé mentale dans la prise en charge des PVVIH. Mots-clés: Substances psychoactives, PVVIH, résultats du traitement, Makurdi, Nigeria.


Asunto(s)
Infecciones por VIH , Trastornos Relacionados con Sustancias , Estudios Transversales , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Hospitales , Humanos , Masculino , Nigeria/epidemiología , Trastornos Relacionados con Sustancias/complicaciones , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/psicología , Resultado del Tratamiento
3.
BMJ Paediatr Open ; 6(1)2022 04.
Artículo en Inglés | MEDLINE | ID: mdl-36053605

RESUMEN

OBJECTIVE: Although HIV infection, severe malnutrition and hypoxaemia are associated with high mortality in children with WHO-defined severe pneumonia in sub-Saharan Africa, many do not have these conditions and yet mortality remains elevated compared with high-resource settings. Further stratifying mortality risk for children without these conditions could permit more strategic resource utilisation and improved outcomes. We therefore evaluated associations between mortality and clinical characteristics not currently recognised by the WHO as high risk among children in Malawi with severe pneumonia but without HIV (including exposure), severe malnutrition and hypoxaemia. METHODS: Between May 2016 and March 2018, we conducted a prospective observational study alongside a randomised controlled trial (CPAP IMPACT) at Salima District Hospital in Malawi. Children aged 1-59 months hospitalised with WHO-defined severe pneumonia without severe malnutrition, HIV and hypoxaemia were enrolled. Study staff assessed children at admission and ascertained hospital outcomes. We compared group characteristics using Student's t-test, rank-sum test, χ2 test or Fisher's exact test as appropriate. RESULTS: Among 884 participants, grunting (10/112 (8.9%) vs 11/771 (1.4%)), stridor (2/14 (14.2%) vs 19/870 (2.1%)), haemoglobin <50 g/L (3/27 (11.1%) vs 18/857 (2.1%)) and malaria (11/204 (5.3%) vs 10/673 (1.4%)) were associated with mortality compared with children without these characteristics. Children who survived had a 22 g/L higher mean haemoglobin and 0.7 cm higher mean mid-upper arm circumference (MUAC) than those who died. CONCLUSION: In this single-centre study, our analysis identifies potentially modifiable risk factors for mortality among hospitalised Malawian children with severe pneumonia: specific signs of respiratory distress (grunting, stridor), haemoglobin <50 g/L and malaria infection. Significant differences in mean haemoglobin and MUAC were observed between those who survived and those who died. These factors could further stratify mortality risk among hospitalised Malawian children with severe pneumonia lacking recognised high-risk conditions.


Asunto(s)
Infecciones por VIH , Malaria , Desnutrición , Neumonía , Niño , Estudios de Cohortes , Infecciones por VIH/complicaciones , Hemoglobinas , Hospitales de Distrito , Humanos , Hipoxia/complicaciones , Malaria/complicaciones , Malaui/epidemiología , Desnutrición/complicaciones , Neumonía/complicaciones , Ruidos Respiratorios , Factores de Riesgo , Organización Mundial de la Salud
4.
BMC Neurol ; 22(1): 335, 2022 Sep 06.
Artículo en Inglés | MEDLINE | ID: mdl-36068544

RESUMEN

BACKGROUND: Stroke is the second leading cause of death above the age of 60 years, and the fifth leading cause in people aged 15 to 59 years old as reported by the World Health Organization global burden of diseases. Stroke in the young is particularly tragic because of the potential to create long-term disability, burden on the victims, their families, and the community at large. Despite this, there is limited data on stroke in young adults, and its risk factors in Uganda. Therefore, we determined the frequency and risk factors for stroke among young adults at Mulago hospital. METHODS: A case control study was conducted among patients presenting consecutively to the general medical wards with stroke during the study period September 2015 to March 2016. A brain Computerized Tomography scan was performed to confirm stroke and classify the stroke subtype. Controls were patients that presented to the surgical outpatient clinic with minor surgical conditions, matched for age and sex. Social demographic, clinical and laboratory characteristics were assessed for both cases and controls. Descriptive statistics including frequencies, percentages, means, and standard deviation were used to describe the social demographics of case and controls as well as the stroke types for cases. To determine risk factors for stroke, a conditional logistic regression, which accounts for matching (e.g., age and sex), was applied. Odds ratio (with 95% confidence interval) was used as a measure for associations. RESULTS: Among 51 patients with stroke, 39(76.5%) had ischemic stroke and 12(23.5%) had hemorrhagic stroke. The mean age was 36.8 years (SD 7.4) for stroke patients (cases) and 36.8 years (SD 6.9) for controls. Female patients predominated in both groups 56.9% in cases and 52.9% in controls. Risk factors noted were HIV infection, OR 3.57 (95% CI 1.16-10.96), elevated waist to hip ratio, OR 11.59(95% CI 1.98-68.24) and sickle cell disease, OR 4.68 (95% CI 1.11-19.70). This study found a protective effect of oral contraceptive use for stroke OR 0.27 95% CI 0.08-0.87. There was no association between stroke and hypertension, diabetes, and hyperlipidemia. CONCLUSION: Among young adults with stroke, ischemic stroke predominated over hemorrhagic stroke. Risk factors for stroke were HIV infection, elevated waist to hip ratio and sickle cell disease.


Asunto(s)
Anemia de Células Falciformes , Infecciones por VIH , Accidente Cerebrovascular Hemorrágico , Accidente Cerebrovascular Isquémico , Accidente Cerebrovascular , Adolescente , Adulto , Anemia de Células Falciformes/complicaciones , Estudios de Casos y Controles , Femenino , Infecciones por VIH/complicaciones , Humanos , Persona de Mediana Edad , Factores de Riesgo , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/etiología , Adulto Joven
5.
PLoS One ; 17(9): e0274614, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-36126067

RESUMEN

INTRODUCTION: The scale-up of access to antiretroviral therapy has transformed HIV from an acute, terminal disease to a manageable chronic illness. Yet, sustaining high levels of antiretroviral therapy adherence remain a challenge, especially in the sub-Saharan Africa region which is disproportionately affected by HIV. This protocol proposes a scoping review to explore literature reporting on the antiretroviral therapy adherence levels among people who experience substance abuse and violence (SAVA) syndemics, as well as mood disorders such as anxiety and depression among people living with HIV in sub-Saharan Africa. METHODS AND ANALYSIS: This proposed scoping review will follow Arksey and O'Malley's methodological framework for conducting scoping reviews as refined by Levac et al. The review will follow the Joanna Briggs Institute's manual for conducting scoping reviews. Literature searches will be conducted using six databases: Academic search complete; APA PsycArticles; CINAHL; MEDLINE; SocINDEX and Web of science. Title screening will see the "Participant, Concept, Context" framework applied to identify relevant literature and will not include the appraisal of search results. Data charting will follow an adapted version of Trico and colleagues' PRISMA-ScR and results will be mapped descriptively and in tabular format. Furthermore, results will be discussed within the syndemics model of health, and summarised as a biosocial conceptual model. ETHICS AND DISSEMINATION: The study will make use of secondary data that are readily available to the public and will not require ethical approval. We intend to publish our results in a peer-reviewed journal and disseminate our findings at relevant conferences and seminars.


Asunto(s)
Infecciones por VIH , Sindémico , Ansiedad/epidemiología , Depresión/epidemiología , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Humanos , Grupos de Población , Literatura de Revisión como Asunto , Revisiones Sistemáticas como Asunto , Violencia
6.
NPJ Syst Biol Appl ; 8(1): 35, 2022 Sep 21.
Artículo en Inglés | MEDLINE | ID: mdl-36131068

RESUMEN

Atherosclerosis (AS)-associated cardiovascular disease is an important cause of mortality in an aging population of people living with HIV (PLWH). This elevated risk has been attributed to viral infection, anti-retroviral therapy, chronic inflammation, and lifestyle factors. However, the rates at which PLWH develop AS vary even after controlling for length of infection, treatment duration, and for lifestyle factors. To investigate the molecular signaling underlying this variation, we sequenced 9368 peripheral blood mononuclear cells (PBMCs) from eight PLWH, four of whom have atherosclerosis (AS+). Additionally, a publicly available dataset of PBMCs from persons before and after HIV infection was used to investigate the effect of acute HIV infection. To characterize dysregulation of pathways rather than just measuring enrichment, we developed the single-cell Boolean Omics Network Invariant Time Analysis (scBONITA) algorithm. scBONITA infers executable dynamic pathway models and performs a perturbation analysis to identify high impact genes. These dynamic models are used for pathway analysis and to map sequenced cells to characteristic signaling states (attractor analysis). scBONITA revealed that lipid signaling regulates cell migration into the vascular endothelium in AS+ PLWH. Pathways implicated included AGE-RAGE and PI3K-AKT signaling in CD8+ T cells, and glucagon and cAMP signaling pathways in monocytes. Attractor analysis with scBONITA facilitated the pathway-based characterization of cellular states in CD8+ T cells and monocytes. In this manner, we identify critical cell-type specific molecular mechanisms underlying HIV-associated atherosclerosis using a novel computational method.


Asunto(s)
Aterosclerosis , Infecciones por VIH , Anciano , Aterosclerosis/complicaciones , Aterosclerosis/genética , Aterosclerosis/metabolismo , Glucagón , Infecciones por VIH/complicaciones , Humanos , Leucocitos Mononucleares/metabolismo , Lípidos , Fosfatidilinositol 3-Quinasas/metabolismo , Proteínas Proto-Oncogénicas c-akt/metabolismo , Transducción de Señal
7.
Antivir Ther ; 27(4): 13596535221119932, 2022 08.
Artículo en Inglés | MEDLINE | ID: mdl-36062614

RESUMEN

We report a case of an infant with HIV receiving raltegravir granules for oral suspension and rifampicin-based TB prophylaxis. Raltegravir trough levels remained subtherapeutic and viral load increased during concurrent rifampicin therapy despite using double-dosed raltegravir. Even after rifampicin therapy, a higher dose was needed. This highlights the importance of therapeutic drug monitoring and dose adjustments of raltegravir in infants with rifampicin as comedication.


Asunto(s)
Fármacos Anti-VIH , Infecciones por VIH , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Humanos , Lactante , Raltegravir Potásico/uso terapéutico , Rifampin/uso terapéutico , Carga Viral
8.
Antivir Ther ; 27(5): 13596535221126828, 2022 10.
Artículo en Inglés | MEDLINE | ID: mdl-36112852

RESUMEN

Epstein-Barr virus-associated smooth muscle tumor (EBV-SMT) is a rare mesenchymal tumor which occurs in immunocompromised patients. The immune status is an important factor in the treatment of EBV-SMTs, but the efficacy of antiretroviral therapy (ART) is not elucidated in acquired immune deficiency syndrome (AIDS) related EBV-SMTs. Here, we report the first successful case of a 29-year-old man with hepatic AIDS related EBV-SMT treated with ART solely. Positron emission tomography scan was useful for the evaluation of disease status. Recent advances in ART that enables to restore patient's immune status rapidly may change the treatment strategy in AIDS related EBV-SMT.


Asunto(s)
Síndrome de Inmunodeficiencia Adquirida , Infecciones por Virus de Epstein-Barr , Infecciones por VIH , Tumor de Músculo Liso , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Adulto , Infecciones por Virus de Epstein-Barr/complicaciones , Infecciones por Virus de Epstein-Barr/tratamiento farmacológico , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Herpesvirus Humano 4 , Humanos , Masculino , Tumor de Músculo Liso/tratamiento farmacológico , Tumor de Músculo Liso/patología
9.
AIDS Res Ther ; 19(1): 43, 2022 Sep 19.
Artículo en Inglés | MEDLINE | ID: mdl-36123679

RESUMEN

BACKGROUND: People with HIV (PWH) commonly have elevated cholesterol and triglycerides levels that have been linked to medications. However, healthy behaviors including lifestyle changes can lower high cholesterol (CHOL) or high triglycerides (TG), thereby reducing individual risk for cardiovascular diseases. This study aimed to determine the prevalence and risk factors associated with high CHOL or TG among PWH in Texas. METHODS: Cross-sectional data of 981 PWH from the 2015-2017 Texas and Houston Medical Monitoring Projects were examined. High CHOL or TG was identified by medical chart diagnosis, CHOL or TG medication use, or most recent fasting lab ≥ 200 mg/dl (total CHOL) or ≥ 150 mg/dl (TG). High CHOL or TG associations with sociodemographic and clinical characteristics were assessed using Rao-Scott chi-square tests. Prevalence of high CHOL or TG development was calculated using multivariable logistic regression model. RESULTS: High CHOL or TG prevalence was 41% with participants being mostly male (73%), ≥ 40 years (68%), with overweight (31%) or obesity (28%), and virally suppressed (62%). Compared with PWH < 40 years of age, PWH in their 40s, 50s, and ≥ 60s were 57%, 64%, and 62% more likely to have high CHOL or TG, respectively. Participants with overweight and obesity were 41% and 30% more likely to have high CHOL or TG than those with normal weight (BMI: 18.5- < 25), respectively. CONCLUSION: Since high CHOL and TG are modifiable CVD risk factors, increased education and lifestyle modification interventions are warranted to prevent the development of high CHOL or TG among PWH.


Asunto(s)
Enfermedades Cardiovasculares , Infecciones por VIH , Hipercolesterolemia , Enfermedades Cardiovasculares/etiología , Colesterol , Estudios Transversales , Femenino , Infecciones por VIH/complicaciones , Infecciones por VIH/epidemiología , Humanos , Hipercolesterolemia/complicaciones , Masculino , Obesidad/complicaciones , Obesidad/epidemiología , Sobrepeso/complicaciones , Sobrepeso/epidemiología , Prevalencia , Factores de Riesgo , Texas/epidemiología , Triglicéridos
10.
Medicine (Baltimore) ; 101(36): e30182, 2022 Sep 09.
Artículo en Inglés | MEDLINE | ID: mdl-36086717

RESUMEN

Double-negative T (DNT) cells are a T-cell subset with a CD4-CD8- phenotype. They represent 1% to 5% of circulating lymphocytes, but an increase in this proportion can be found during lymphoproliferative and autoimmune diseases. This increase has also been reported in persons with HIV (PWH). The aim of this work was to better describe the proportion of DNT cell subset in PWH. We retrospectively collected 984 samples from PWH referred for lymphocyte immunophenotyping over a 7.5-year period. Quantification of DNT cells was performed by flow cytometry. DNT cell proportion was calculated by subtracting the CD4+ and CD8+ subsets proportions from the total of T cells. A total of 984 blood samples from PWH were collected. Mean CD4 T-cell count was decreased in such patients while DNT cell frequency was increased with a mean of 6.7%. More than half of the patients had a DNT cell proportion >5%. Patients with DNT cell proportion over 5% exhibited significantly reduced CD3+ and CD4+ T-cell counts, while CD8+ T-cell count was unchanged compared to patients with normal DNT cell rates. Interestingly, DNT cell percentage was negatively correlated with CD4 and CD3 T-cell counts in all included patients. Moreover, the DNT cell proportion was significantly increased in subjects with CD4+ T cells <200/mm3 compared to those with CD4+ T cells >200/mm3. Interestingly, DNT cell proportions were significantly higher in patients with high viral load compared with those presenting undetectable viral load. HIV infection is associated with an increase in DNT cell proportion. This increase is more frequent as the CD4 count is decreased and the viral load is increased. DNT cell subset should not be omitted when interpreting immunophenotyping in PWH as it appears to be associated with disease progression in patients under antiretroviral therapy.


Asunto(s)
Infecciones por VIH , Recuento de Linfocito CD4 , Infecciones por VIH/complicaciones , Humanos , Recuento de Linfocitos , Estudios Retrospectivos , Carga Viral
11.
J Acquir Immune Defic Syndr ; 91(S1): S8-S15, 2022 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-36094509

RESUMEN

BACKGROUND: We aimed to examine the evolution of blood lipids and compare the risk of dyslipidemia between antiretroviral-naive people living with HIV who received tenofovir disoproxil fumarate (TDF), lamivudine (3TC), and efavirenz (EFV) (TDF + 3TC + EFV) and those who received coformulated elvitegravir, cobicistat, emtricitabine, and tenofovir alafenamide (E/C/F/TAF). METHODS: We retrospectively reviewed the medical records of 2343 antiretroviral-naive people living with HIV who initiated TDF + 3TC + EFV or E/C/F/TAF. A propensity score matching method was used to compare longitudinal changes of blood lipids between the 2 groups. RESULTS: By using 1:3 matching ratio, we included 253 and 91 matched patients in TDF + 3TC + EFV group and E/C/F/TAF group, respectively. The levels of total cholesterol, triglyceride, low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol were higher in E/C/F/TAF group than those in TDF + 3TC + EFV group at 3, 6, 9, and 12 months (Wilcoxon test, all Ps < 0.05), except for high-density lipoprotein cholesterol at 9 and 12 months. The cumulative rates of hypercholesterolemia, hypertriglyceridemia, and high LDL-C in PLWH with normal lipid levels in E/C/F/TAF group were higher than those in TDF + 3TC + EFV group (hypercholesterolemia, 59.7% vs 21.5%, P < 0.001; hypertriglyceridemia, 69.5% vs 46.3%, P < 00.001; and high LDL-C, 41.5% vs 14.2%, P < 0.001). Multivariate analysis showed treatment with E/C/F/TAF was associated with a significantly higher risk of hypercholesterolemia [adjusted hazard ratio (HR), 4.12; 95% confidence interval (CI): 2.65 to 6.41], hypertriglyceridemia (adjusted HR, 1.69; 95% CI: 1.18 to 2.43), and high LDL-C (adjusted HR, 4.60; 95% CI: 2.66 to 7.97). CONCLUSIONS: We concluded that treatment with E/C/F/TAF resulted in higher risks of dyslipidemia compared with TDF + 3TC + EFV.


Asunto(s)
Fármacos Anti-VIH , Infecciones por VIH , VIH-1 , Hipercolesterolemia , Hipertrigliceridemia , Adenina/uso terapéutico , Alanina , Alquinos , Fármacos Anti-VIH/efectos adversos , Antirretrovirales/uso terapéutico , Benzoxazinas , LDL-Colesterol , Cobicistat/uso terapéutico , Ciclopropanos , Emtricitabina/uso terapéutico , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Humanos , Hipercolesterolemia/tratamiento farmacológico , Hipertrigliceridemia/tratamiento farmacológico , Lamivudine/efectos adversos , Lipoproteínas HDL , Quinolonas , Estudios Retrospectivos , Tenofovir/efectos adversos , Tenofovir/análogos & derivados
12.
J Acquir Immune Defic Syndr ; 91(S1): S20-S26, 2022 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-36094511

RESUMEN

BACKGROUND: Few large investigations have evaluated the association of cerebrospinal fluid/plasma (CSF/plasma) discordance with opportunistic neurological infections. We aimed to determine risk factors for CSF/plasma discordance to further assess whether CSF/plasma discordance is associated with antiretroviral therapy (ART) and opportunistic neurological infections. METHODS: A retrospective study was conducted based on HIV RNA viral load and associated risk factors in plasma and CSF samples from 491 HIV-infected patients. HIV RNA levels higher in CSF compared with plasma was defined as CSF/plasma discordance. RESULTS: In this study, the rate of CSF/plasma discordance was 18.3%. We observed that headache, cryptococcal antigen, CSF cell count, Treponema pallidum particle assay positivity, and ART use were significantly associated with CSF/plasma discordance in the multivariate logistic regression model. The CSF RNA/plasma RNA ratio was significantly higher in HIV-infected patients with neurological infections than in HIV-infected cases without neurological infections (P < 0.001). CSF/plasma discordance was significantly different between HIV-infected patients without central nervous system (CNS) infection and those with CNS infection, tuberculous meningitis, cryptococcal meningitis, and neurosyphilis (P < 0.05). CONCLUSIONS: ART and CNS inflammation may influence CSF/plasma discordance.


Asunto(s)
Infecciones por VIH , VIH-1 , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , VIH-1/genética , Humanos , ARN Viral , Estudios Retrospectivos , Factores de Riesgo , Carga Viral
13.
Klin Lab Diagn ; 67(9): 544-549, 2022 Sep 12.
Artículo en Inglés | MEDLINE | ID: mdl-36099465

RESUMEN

In recent tuberculosis years is the main cause of morbidity and death among patients with HIV infection. Modern diagnostics of tuberculosis includes mass screening of the population: digital fluorography from the age of 15 and immunodiagnostics in children and adolescents. Detection of mycobacterium tuberculosis by microscopy occurs in forms of tuberculosis with the decay of lung tissue. Such patients represent a high epidemic risk. To improve the verification of diagnosis in the practice of a phthisiologist, molecular genetic methods for the search for mycobacteria are increasingly used, based on the identification of specific fragments of the DNA chain in the diagnostic material. The most widely used method is the polymerase chain reaction (PCR), which is based on directed DNA amplification. The latest innovation is fully automated systems using cartridge technology GeneXpert. The advantages of GeneXpert are high sensitivity, speed (result in 2 hours), real-time PCR detection, exclusion of sample contamination. The technique of cartridge technology is constantly being improved, various cartridges are used on its platform, which not only detect M. tuberculosis, but also determine the sensitivity to anti-tuberculosis drugs - rifampicin (MTB / RIF cartridge) or several anti-TB drugs (MTB / XDR). Cartridges have been developed that are able to detect Mycobacterium tuberculosis (MBT) at an even lower concentration in the test material - MTB / RIF (Ultra). GeneXpert technology can be used to diagnose extrapulmonary tuberculosis by examining various biological materials, which are more effective in detecting tuberculosis in children and adolescents, in HIV-positive individuals.


Asunto(s)
Infecciones por VIH , Mycobacterium tuberculosis , Tuberculosis , Adolescente , Niño , Infecciones por VIH/complicaciones , Humanos , Biología Molecular , Mycobacterium tuberculosis/genética , Reacción en Cadena en Tiempo Real de la Polimerasa , Rifampin/farmacología , Rifampin/uso terapéutico , Sensibilidad y Especificidad , Tuberculosis/diagnóstico , Tuberculosis/genética , Tuberculosis/microbiología
14.
AIDS Patient Care STDS ; 36(9): 336-342, 2022 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-36099481

RESUMEN

The prevalence of HIV-associated neurocognitive impairment persists despite highly effective antiretroviral therapy (ART). In this study we explore the role of internalized stigma, acceptance of negative societal characterizations, and perceptions about people living with HIV (PLWH) on neurocognitive functioning (executive function, learning, memory, attention/working memory, psychomotor speed, fluency, motor skills) in a national cohort of women living with HIV (WLWH) in the United States. We utilized observational data from a multicenter study of WLWH who are mostly African American living in low-resource settings. Neurocognitive function was measured using an eight-test battery. A multiple linear regression model was constructed to investigate the relationship between internalized stigma and overall neurocognitive functioning (mean of all neurocognitive domain standardized T-scores), adjusting for age, education, race, previous neuropsychological battery scores, illicit drug use, viral load, and years on ART. Our analysis revealed that internalized HIV-related stigma is significantly associated with worse performance on individual domain tests and overall neurocognitive performance (B = 0.27, t = 2.50, p = 0.01). This suggests HIV-related internalized stigma may be negatively associated with neurocognitive functioning for WLWH. This finding highlights a specific psychosocial factor associated with poor neurocognitive function that may be targeted to better promote the health of PLWH. Future research on the longitudinal relationship between these variables and the effects of other stigma dimensions on poor neurocognitive function would provide further insights into the pathways explaining the relationship between internalized stigma and neurocognition.


Asunto(s)
Infecciones por VIH , Afroamericanos , Femenino , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/psicología , Humanos , Estigma Social , Estados Unidos/epidemiología , Carga Viral
15.
Arq Gastroenterol ; 59(3): 390-393, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-36102437

RESUMEN

BACKGROUND: The emergence of potent combined highly active antiretroviral therapy (ART) in 1996 changed the natural history of HIV infection, with a significant reduction in mortality due to opportunistic infections but increased morbidity due to chronic cardiovascular, hepatic, and renal diseases. In May 2016, a reference center for liver transplantation in the Northeast of Brazil performed the first liver transplantations (LT) in HIV patients, with five others until 2021. METHODS: The criteria for selection of LT were good adherence and absence of resistance to ART, HIV viral load maximum suppression, T-CD4+ lymphocyte count of more than 100 cells/mm3, and absence of opportunistic infections in the last 6 months. RESULTS: Six liver transplants were performed between May 2016 and May 2021, five men, with a mean age of 53.2 years, and one was a diabetic patient. All patients had access to grafts with short cold ischemia with a mean time of 5 hours and 39 minutes. The 4-month survival rate was 100%, with a range time of follow-up of 4-63 months (mean time of 31 months). The mean pre-transplant T-CD4+ lymphocyte count was 436 cells/mm3. The mean length of hospital stay after transplantation was 16.8 days. One patient presented precocious vena cava thrombosis; another had stenosis of cavocaval anastomosis leading to refractory ascites, renal failure and post-transplant graft dysfunction, and another presented stenosis of choledochal anastomosis. Immunosuppression and prophylaxis were used according to standard protocols, and there were no differences in the profile of infections or rejection after liver transplantation. CONCLUSION: This case series documents good survival and usual transplant procedures for confirmed HIV cases.


Asunto(s)
Infecciones por VIH , Trasplante de Hígado , Infecciones Oportunistas , Brasil , Constricción Patológica , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana Edad
16.
Front Immunol ; 13: 891201, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-36090970

RESUMEN

Background: Tuberculosis (TB) is the leading infectious cause of mortality worldwide. In the last years, resistant strains of the etiological agent, Mycobacterium tuberculosis, have emerged, thus demanding more triage tests to identify active pulmonary TB (PTB) patients and to evaluate their disease severity. Therefore, acute-phase reaction serum tests are required for monitoring TB patients, among WHO symptom screening recommendations. C-reactive protein (CRP) is a non-specific inflammatory biomarker that has been recently proposed for TB screening and can be quantitatively analyzed through cost-effective point-of-care assays. A previous meta-analysis found CRP to be highly sensitive and moderately specific for active PTB with confirmed HIV infection. Methods: We performed a meta-analysis update of diagnostic tests, pooling sensitivities, and specificities in order to assess the accuracy of CRP as a potential test for the screening of HIV-associated PTB in outpatients. We searched MEDLINE, Web of Science, and SCOPUS for eligible articles before 19 October 2021. Results: We identified 13 eligible studies with HIV-positive patients with PTB. At a CRP threshold of 10 mg/L, CRP pooled sensitivity was 87% (76%-93%) and pooled specificity was 67% (49%-81%), with an area under the curve (AUC) of 0.858. Using a CRP threshold of 8 mg/L, pooled sensitivity was 82% (72%-89%) and pooled specificity was 82% (67%-92%), with an AUC of 0.879. We found that CRP has a high sensitivity in the screening of PTB in HIV-positive outpatients, consistent with findings reported previously. Conclusions: Regardless of pooled specificity, better results were found using the CRP threshold of 8 mg/L as a test screening of PTB, meeting the need of further approaching specific TB diagnostic methods and reducing resource consumption.


Asunto(s)
Infecciones por VIH , Mycobacterium tuberculosis , Tuberculosis Ganglionar , Tuberculosis Pulmonar , Proteína C-Reactiva/análisis , Infecciones por VIH/complicaciones , Humanos , Tuberculosis Ganglionar/complicaciones
17.
J Acquir Immune Defic Syndr ; 91(2): 162-167, 2022 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-36094482

RESUMEN

INTRODUCTION: Bone loss and cognitive impairment are common in women living with HIV (WLWH) and are exacerbated by menopause. Bone-derived undercarboxylated osteocalcin (ucOCN) and sclerostin appear to influence cognition. The current study investigated whether the circulating levels of these 2 proteins are associated with cognition in midlife WLWH and demographically similar HIV seronegative women. METHODS: Plasma samples from women enrolled in a musculoskeletal substudy within the Women's Interagency HIV Study were used to measure ucOCN and sclerostin. A neuropsychological (NP) test battery assessing executive function, processing speed, attention/working memory, learning, memory, verbal fluency, and motor function was administered within 6 months of musculoskeletal enrollment and every 2 years after (1-4 follow-up visits per participant). A series of generalized estimating equations were conducted to examine the association between biomarkers and NP performance at the initial assessment and over time in the total sample and in WLWH only. Primary predictors included biomarkers, time, and biomarker by time interactions. If the interaction terms were not significant, models were re-run without interactions. RESULTS: Neither biomarker predicted changes in NP performance over time in the total sample or in WLWH. ucOCN was positively associated with executive function in the total sample and in WLWH and with motor skills in WLWH. ucOCN was negatively associated with attention/working memory in the total sample. There were no significant associations between sclerostin and NP performance. CONCLUSION: The current study suggests an association between bone-derived ucOCN and cognition in women with and without HIV infection.


Asunto(s)
Infecciones por VIH , Biomarcadores , Cognición , Femenino , Infecciones por VIH/complicaciones , Infecciones por VIH/psicología , Humanos , Pruebas Neuropsicológicas , Osteocalcina
18.
J Acquir Immune Defic Syndr ; 91(2): 168-174, 2022 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-36094483

RESUMEN

BACKGROUND: Older (older than 50 years) persons living with HIV (PWH) are at elevated risk for falls. We explored how well our algorithm for predicting falls in a general population of middle-aged Veterans (age 45-65 years) worked among older PWH who use antiretroviral therapy (ART) and whether model fit improved with inclusion of specific ART classes. METHODS: This analysis included 304,951 six-month person-intervals over a 15-year period (2001-2015) contributed by 26,373 older PWH from the Veterans Aging Cohort Study who were taking ART. Serious falls (those falls warranting a visit to a health care provider) were identified by external cause of injury codes and a machine-learning algorithm applied to radiology reports. Potential predictors included a fall within the past 12 months, demographics, body mass index, Veterans Aging Cohort Study Index 2.0 score, substance use, and measures of multimorbidity and polypharmacy. We assessed discrimination and calibration from application of the original coefficients (model derived from middle-aged Veterans) to older PWH and then reassessed by refitting the model using multivariable logistic regression with generalized estimating equations. We also explored whether model performance improved with indicators of ART classes. RESULTS: With application of the original coefficients, discrimination was good (C-statistic 0.725; 95% CI: 0.719 to 0.730) but calibration was poor. After refitting the model, both discrimination (C-statistic 0.732; 95% CI: 0.727 to 0.734) and calibration were good. Including ART classes did not improve model performance. CONCLUSIONS: After refitting their coefficients, the same variables predicted risk of serious falls among older PWH nearly and they had among middle-aged Veterans.


Asunto(s)
Infecciones por VIH , Accidentes por Caídas , Anciano , Anciano de 80 o más Años , Envejecimiento , Estudios de Cohortes , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Humanos , Persona de Mediana Edad , Polifarmacia
20.
J Int Assoc Provid AIDS Care ; 21: 23259582221124826, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-36083172

RESUMEN

A retrospective study of 2764 patients was conducted at an HIV clinic in Nigeria to evaluate retention in care in patients treated for TB. At 6 and 12 months after commencement of TB treatment, 1842(66.6%) and 1624(58.8%) participants remained in care. Of the 922 and 1140 not in care at 6 and 12 months, 814(88.3%) and 1006(88.2%) respectively were lost to follow-up (LTFU). VL < 1000copies/ml was associated with higher odds of retention in care at 6 and 12 months (OR = 2.351 and 2.393) than VL > 1000 copies/ml. HAART use was associated with high likelihood of being in care at 12 months (OR = 3.980). CD4 counts of 200-350 and >350 cells/mm3 were associated with increased odds of remaining in care at 12 months compared with CD4 < 200 cells/mm3 (p = 0.005 and p = 0.001). Targeted interventions such as early HAART and close follow-up for high risk groups are likely to improve retention in care.


Asunto(s)
Infecciones por VIH , Retención en el Cuidado , Tuberculosis , Recuento de Linfocito CD4 , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Humanos , Nigeria/epidemiología , Estudios Retrospectivos , Tuberculosis/complicaciones , Tuberculosis/tratamiento farmacológico , Tuberculosis/epidemiología
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