The CRISPR-Cas9 induced CCR5 Δ32 mutation as a potent gene therapy methodology for resistance to HIV-1 variant: a review.

Human Immunodeficiency Virus (HIV) has continuously been the greatest epidemic for humanity over a period spanning almost five decades. With no specific cure or treatment available to date despite extensive research, the C-C Chemokine Receptor 5, Delta 32 (CCR5 Δ32) allele genetic point mutation plays an imperative role in the prevention of acquired immunodeficiency syndrome (AIDS). This comprehensive study aims to review the induction of the homozygous recessive deletion genotype using the Clustered Regularly Interspaced Short Palindromic Repeats, Cas 9 Enzyme (CRISPR-Cas9), and hematopoietic stem cell transplantation under positive selection pressure for active immunity in seropositive patients' populations as the phenotype. A methodology is proposed to trigger a significant increase in the expression of Delta 32 beneficial mutant alleles within controlled modern healthcare facilities utilizing totipotent stem cells through somatic gene therapy. It acts upon two dysfunctional CCR5 genes, translating mutant G protein-coupled co-receptors, whose primary function is similar to that of C-X-C Motif Chemokine receptor 4 (CXCR4), by blocking the entry of viral RNA into the CD4+ T helper lymphocytes, halting infection and seizing viral life cycle. This modification is endemic in Northern Europe, where it naturally pertains to the Caucasian descent population samples in the form of polymorphism, p (X=0.01), where X is the probability of frequency of complete immunity against HIV-1 in population samples. The epigenetics of the single nucleotide polymorphism (SNP) are analyzed as they play a significant role in immunity distribution. Furthermore, a comparative analysis within the ethical boundaries of CRISPR-Cas9 is conducted to discuss the practical aspects and challenges of the presented methodologies and treatment alternatives. Additionally, the study assembles all available data and summarizes preexisting research while providing a promising solution to this ethical dilemma. Finally, a methodology is devised to answer the question of whether the variant-specific epidemic of AIDS caused by HIV-1 can be cured via artificially inducing immunity by CRISPR-Cas9.

Impact of exercise training and diet therapy on the physical fitness, quality of life, and immune response of people living with HIV/AIDS: a randomized controlled trial.

BACKGROUND: Exercise and dietary nutrition are considered crucial in human immunodeficiency virus (HIV)/ acquired immunodeficiency syndrome (AIDS) treatment protocols and people living with HIV/AIDS (PLWHA) rehabilitation care. However, there is no well-studied research evaluating the effects of combined interventions on the fitness and immune systems of PLWHA. Therefore, this study aimed to analyze the effects of exercise and dietary intervention on physical fitness, quality of life and immune response in PLWHA. METHODS: This was an experimental study, with a sample of 25 male PLWHA divided into two groups: the intervention group (IG: 12 participants) and the control group (CG: 13 participants). All participants have not had any exercise habits and nutritional supplements in the past six months. The participants in the IG completed 45 min of exercise (60-80% HRmax) 4 times per week for 4 weeks. The exercise was in the form of brisk walking or running. They were also given a nutritional dietary supplement 3 times a day for 4 weeks. The 13 individuals in the CG continued their normal daily life (physical activity and diet). The following parameters were evaluated before and after the intervention: body composition, physical fitness, immune response, quality of life (QoL), stress, dietary behavior, dietary habits, exercise motivation, and physical self-efficacy. RESULTS: The significant changes were observed in burnout of stress variables and physical efficiency index (PEI) of physical fitness in the IG (p =.023). Moreover, in the saliva samples, sal-T levels significantly increased only after the intervention in the IG (p =.012). Additionally, regarding the analysis of the interaction (group × time), there was a significant improvement in the reaction speed (p =.001) and grip strength (left: p =.002, right: p =.030) and a significant difference in physical satisfaction in QoL (p =.001), stress burnout (p =.043), self-confidence in physical efficacy (p =.045), external display (p =.008), and fulfillment (p =.047) in exercise motivation. Moreover, the significant effect of the intervention on emotional eating in dietary behavior was shown in the comparison of the IG before and after intervention (p =.001) and in the comparison of the IG group with the CG after the experiment (p =.013). However, there was no significant effect of time or interaction between the condition and time on body composition. CONCLUSIONS: In conclusion, exercise training and diet therapy caused changes in physical fitness and Sal-T levels, which had positive effects on the health promotion of PLWHA.

Prevalence and treatment of HIV/AIDS in Pakistani population: A retrospective study.

HIV/AIDS epidemic poses an emerging threat around the world. An estimated 0.1% of people aged 15 to 49 years have been infected with HIV/AIDS in Pakistan during the last few years. This research study aims to analyse the prevalence and treatment/management of HIV/AIDS among the Pakistani population aged 15 to 45 years from 1990 to 2020 and this research data was collected during the year 2021. The analysis was done by using E-views software. Descriptive statistical analysis, correlation coefficient, unit root analysis, and linear regression analysis were used. Results indicated that there is low awareness regarding AIDS in the population and there is a significant link between prevalence and population increase, i.e. with the increase in population the prevalence of AIDS also increases. Findings are discussed in terms of implications for prevention and education of HIV/AIDS in Pakistan's population.

Abandono de la terapia antirretroviral entre adolescentes y jóvenes con VIH/SIDA durante el COVID-19: un estudio de casos y controles / Antiretroviral therapy abandonment among adolescents and young people with HIV/AIDS during COVID-19: A case-control study / Abandono da terapia antirretroviral entre adolescentes e jovens com HIV/aids durante a COVID-19: estudo caso-controle

Objetivo: identificar los factores asociados al abandono de la terapia antirretroviral entre adolescentes y jóvenes que vivían con VIH/sida durante la pandemia de COVID-19. Método: estudio de casos y controles realizado entre 2020 y 2021 en Maringá, Paraná. Los casos fueron: adolescentes y jóvenes (10 a 24 años) diagnosticados con VIH/sida y que abandonaron el tratamiento, mientras que el grupo de controles fue compuesto por personas con características sociodemográficas semejantes, diagnosticadas con VIH/sida, sin historia de abandono del tratamiento. El emparejamiento de casos y controles se hizo por conveniencia, con cuatro controles por cada caso. El instrumento de investigación presentó variables sociodemográficas y clínicas, entre otras y la asociación con el abandono del tratamiento se analizó por regresión logística. Resultados: se incluyeron 27 casos y 109 controles en el estudio (proporción 1/4). La variable asociada con mayor probabilidad de abandono fue la edad próxima a 22,8 años (ORaj:1,47; IC 95%:1,07-2,13; p=0,024). El uso esporádico del preservativo (ORaj:0,22; IC 95%:0,07-0,59; p=0,003) y padecer una infección oportunista (OR:0,31; IC 95%:0,10-0,90; p=0,030) fueron factores protectores. Conclusión: la edad próxima a los 23 años en la última visita se asoció al abandono de la terapia antirretroviral. La presencia de infección oportunista y el uso de preservativos son factores determinantes para la continuidad del tratamiento durante el COVID-19.

Objective: to identify the factors associated with antiretroviral therapy abandonment among adolescents and young people living with HIV/AIDS during the COVID-19 pandemic. Method: a case-control study carried out between 2020 and 2021 in Maringá, Paraná. The cases corresponded to the following: adolescents and young people (aged from 10 to 24 years old) diagnosed with HIV/AIDS and who abandoned treatment, while the Control Group consisted of people with similar sociodemographic characteristics, diagnosed with HIV/AIDS and with no history of treatment abandonment. Pairing of the cases and controls was by convenience, with four controls for each case. The research instrument presented sociodemographic variables, clinical characteristics and others, whose association with treatment abandonment was analyzed by means of logistic regression. Results: a total of 27 cases and 109 controls were included in the study (1/4 ratio). The variable associated with an increased chance of abandonment was age close to 22.8 years old (ORadj: 1.47; 95% CI: 1.07-2.13; p=0.024). Sporadic condom use (ORadj: 0.22; 95% CI: 0.07-0.59; p=0.003) and having an opportunistic infection (OR: 0.31; 95% CI: 0.10-0.90; p=0.030) were protective factors. Conclusion: age close to 23 years old at the last consultation was associated with antiretroviral therapy abandonment. The presence of opportunistic infections and condom use are determining factors for treatment continuity during COVID-19.

Objetivo: identificar os fatores associados ao abandono da terapia antirretroviral entre adolescentes e jovens vivendo com HIV/aids durante a pandemia de COVID-19. Método: estudo caso-controle realizado entre 2020 e 2021 em Maringá, Paraná. Os casos foram: adolescentes e jovens (10 a 24 anos) diagnosticados com HIV/aids e que abandonaram o tratamento, enquanto o grupo dos controles foi composto por pessoas com características sociodemográficas semelhantes, diagnosticadas com HIV/aids, sem histórico de abandono de tratamento. O pareamento dos casos e controles foi por meio de conveniência, sendo quatro controles para cada caso. O instrumento de pesquisa apresentou variáveis sociodemográficas, características clínicas e outras, cuja associação com o abandono do tratamento foi analisada por meio de regressão logística. Resultados: 27 casos e 109 controles foram incluídos no estudo (proporção 1/4). A variável associada à maior chance de abandono foi idade próxima de 22,8 anos (ORaj.:1,47; IC95%:1,07-2,13; p=0,024). O uso esporádico de preservativo (ORaj:0,22; IC95%:0,07-0,59; p=0,003) e ter infecção oportunista (OR:0,31; IC95%:0,10-0,90; p=0,030) foram fatores de proteção. Conclusão: idade próxima a 23 anos na última consulta foi associada ao abandono da terapia antirretroviral. A presença de infecção oportunista e o uso de preservativo são fatores determinantes para continuidade do tratamento durante a COVID-19.

Inclusion of nutritional counseling and mental health services in HIV/AIDS management: A paradigm shift.

Human immunodeficiency virus (HIV) infection is a public health challenge that can degenerate into acquired immunodeficiency syndrome (AIDS) if not properly managed. HIV infection shortens life expectancy to about 5 to 10 years compared to noninfected individuals. People living with HIV/AIDS (PLWHA) are prone to several health challenges as a result of a deranged immune system culminating in high morbidity and mortality. Depression is a common feature of PLWHA. Depression heightens the emergence of opportunistic infections in HIV-infected individuals, accelerates the progression to AIDS, and increased suicidal tendencies, morbidity, and mortality. Food insecurity with its resultant undernutrition contributes to HIV/AIDS-related deaths. Undernourished PLWHA are more prone to opportunistic infections due to poor immunity. Interestingly, proper diet intake can boost immunity, slow the progression of AIDS and opportunistic infections, enhance body weight, and retard depression tendencies. Undernutrition can also be ameliorated by incorporating nutritional counseling and oral nutrient supplementation in routine HIV/AIDS checkups. Therefore, to increase HIV/AIDS management outcomes, the integration of nutrition counseling, dietary supplements, and mental health services should be embraced. Thus, HIV/AIDS care centers should amplify these services. In this article, we isolated relevant studies from various databases, illuminated the interwoven relationship between HIV/AIDS, depression, and undernutrition, and also reemphasized the need for adequate nutritional intervention in the battle against HIV/AIDS. Thus, this study provides a reawakening call to focus on incorporating nutritional guides and mental health care in HIV/AIDS management protocols.

How Do People Living With HIV (PLHIV) and AIDS Feel About the Quality of Care They Received Amid the COVID-19 Pandemic in Lagos, Nigeria?

Background: This study aimed to assess the perception of quality of care among people living with HIV (PLHIV) in Lagos, Nigeria, and identify factors influencing their perceptions. Methodology: The study was a descriptive cross-sectional survey conducted between December 2020 and March 2021 among 578 PLHIVs drawn from various healthcare facilities in Lagos where HIV care and treatment services were provided. Data were collected through pretested questionnaires and analyzed using Stata SE 12. Results: About 83% of the respondents had a good attitude toward their HIV medication, and 95.5% had a good perception of the quality of care they received. PLHIVs with higher education, skilled or professional occupations and higher monthly income had a significantly higher perception of quality of care compared to others (P < .05). Conclusion: The PLHIV in Lagos had a positive attitude toward their medication and a good perception of the quality of care they received during the COVID-19 pandemic. All stakeholders' efforts should be sustained for continuous quality improvement in HIV care in Lagos.

PEPFAR at 20-Looking Back and Looking Ahead.

This Viewpoint looks at PEPFAR (the United States President's Emergency Plan for AIDS Relief) from its inception to today, including successes and goals for the future to help care for people worldwide living with HIV.

The impact of the COVID-19 pandemic on the provision of HIV/AIDS-related services in Iran: a qualitative study.

BACKGROUND: Providing services to people living with HIV (PLWH) faced many challenges during the COVID-19 pandemic. This study aimed to examine the impact of the COVID-19 pandemic on providing HIV/AIDS-related services in Iran. METHODS: In this qualitative study, the participants were included by purposive sampling between November 2021 and February 2022. Virtually focused group discussion (FGD) meetings were conducted with the first group including policymakers, service providers, and researchers (n = 17), and the interviews were conducted telephonic and face-to-face using a semi-structured guide with the second group including people who received services (n = 38). Data were analyzed by content analysis using the inductive method in MAXQDA 10 software. RESULTS: Six categories were obtained, including mostly affected services, ways of the effect of COVID-19, healthcare systems reaction, effects on social inequality, opportunities created by the pandemic, and suggestions for the future. In addition, people who received services believed the COVID-19 pandemic has affected their life in several ways, including getting COVID-19, mental and emotional problems during the pandemic, financial problems, changes in the care plan, and changes in high-risk behaviors. CONCLUSION: Considering the level of community involvement with the issue of COVID-19 and the shock caused by the pandemic, as mentioned by the world health organization, it is necessary to improve health systems' resilience for better preparedness for similar conditions.

Disciplined appetites: Reimagining food and nutrition programs for people living with HIV and AIDS.

AIMS: Medical nutrition therapy is recommended for people living with HIV/AIDS to improve health and wellness; however, there is a lack of food and nutrition programs for people living with HIV/AIDS in Nova Scotia, Canada. The aim of this study was to explore the beliefs, values, and experiences of people living with HIV/AIDS in relation to food and nutrition programs. METHODS: A critical social theory lens with two disciplinary contexts: critical health geography and critical dietetics guided this research. Semi-structured interviews were conducted with 12 people living with HIV/AIDS and analysed for themes. RESULTS: The three main themes were identified: (1) intersections of social determinants of health, wellness, and food security; (2) discursive shaping of food and nutrition in relation to HIV; and (3) the dynamic nature of HIV care. CONCLUSIONS: Participants offered recommendations on how food and nutrition programs might be reimagined to be more accessible, inclusive, and effective for people living with HIV/AIDS.

Executive summary of the consensus document on the shared care of patients with HIV infection between primary and hospital care / Resumen ejecutivo del documento de consenso sobre el manejo compartido del paciente con infección por VIH entre Atención Primaria y Hospitalaria

The current reality of the diagnosis and treatment of HIV infection justifies a multidisciplinary and coordinated approach between Primary Care and Hospital Care, contemplating bidirectionality and communication between the two care settings. The consensus document, coordinated by the AIDS Study Group of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC-GeSIDA) and the Spanish Society of Family and Community Medicine (semFYC), was born out of this need. Here, the recommendations of the four sections that comprise it are summarized: the first deals with aspects of prevention and diagnosis of HIV infection; the second contemplates the clinical care of people living with HIV; the third deals with social factors, including legal and confidentiality issues, quality of life, and the role of NGOs; finally, the fourth block addresses bidirectional and shared training/teaching and research.(AU)

La realidad actual del diagnóstico y tratamiento de la infección por VIH justifica un abordaje multidisciplinar y coordinado entre atención primaria y atención hospitalaria, contemplando la bidireccionalidad y la comunicación entre los dos escenarios asistenciales. El presente documento de consenso, coordinado entre el Grupo de Estudio del Sida de la Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC-GeSIDA) y la Sociedad Española de Medicina de Familia y Comunitaria (semFYC), nace de esta necesidad. Aquí se resumen las recomendaciones de los cuatro bloques que lo componen: el primero trata aspectos de prevención y diagnóstico de la infección por el VIH; en el segundo se contempla la atención y el manejo clínico de las personas que viven con VIH; el tercero trata aspectos sociales, incluyendo temas legales y de confidencialidad, la calidad de vida y el papel de las ONG; por último, el cuarto bloque aborda la formación/docencia y la investigación bidireccional y compartida.(A)

Modelling Botswana's HIV/AIDS response and treatment policy changes: Insights from a cascade of mathematical models.

The management of HIV/AIDS has evolved ever since advent of the disease in the past three decades. Many countries have had to revise their policies as new information on the virus, and its transmission dynamics emerged. In this paper, we track the changes in Botswana's HIV/AIDS response and treatment policies using a piece-wise system of differential equations. The policy changes are easily tracked in three epochs. Models for each era are formulated from a "grand model" that can be linked to all the epochs. The grand model's steady states are determined and analysed in terms of the model reproduction number, $ R_{0}. $ The model exhibits a backward bifurcation, where a stable disease-free equilibrium coexists with a stable endemic equilibrium when $ R_{0} < 1. $ The stability of the models for the other epochs can be derived from that of the grand model by setting some parameters to zero. The models are fitted to HIV/AIDS prevalence data from Botswana for the past three decades. The changes in the populations in each compartment are tracked as the response to the disease and treatment policy changed over time. Finally, projections are made to determine the possible trajectory of HIV/AIDS in Botswana. The implications of the policy changes are easily seen, and a discussion on how these changes impacted the epidemic are articulated. The results presented have crucial impact on how policy changes affected and continue to influence the trajectory of the HIV/AIDS epidemic in Botswana.

A CRISPR-Cas Cure for HIV/AIDS.

Human immunodeficiency virus (HIV) infections and HIV-induced acquired immunodeficiency syndrome (AIDS) continue to represent a global health burden. There is currently no effective vaccine, nor any cure, for HIV infections; existing antiretroviral therapy can suppress viral replication, but only as long as antiviral drugs are taken. HIV infects cells of the host immune system, and it can establish a long-lived viral reservoir, which can be targeted and edited through gene therapy. Gene editing platforms based on the clustered regularly interspaced palindromic repeat-Cas system (CRISPR-Cas) have been recognized as promising tools in the development of gene therapies for HIV infections. In this review, we evaluate the current landscape of CRISPR-Cas-based therapies against HIV, with an emphasis on the infection biology of the virus as well as the activity of host restriction factors. We discuss the potential of a combined CRISPR-Cas approach that targets host and viral genes to activate antiviral host factors and inhibit viral replication simultaneously. Lastly, we focus on the challenges and potential solutions of CRISPR-Cas gene editing approaches in achieving an HIV cure.

Advancements in Cell-Based Therapies for HIV Cure.

The treatment of human immunodeficiency virus (HIV-1) has evolved since the establishment of combination antiretroviral therapy (ART) in the 1990s, providing HIV-infected individuals with approaches that suppress viral replication, prevent acquired immunodeficiency syndrome (AIDS) throughout their lifetime with continuous therapy, and halt HIV transmission. However, despite the success of these regimens, the global HIV epidemic persists, prompting a comprehensive exploration of potential strategies for an HIV cure. Here, we offer a consolidated overview of cell-based therapies for HIV-1, focusing on CAR-T cell approaches, gene editing, and immune modulation. Persistent challenges, including CAR-T cell susceptibility to HIV infection, stability, and viral reservoir control, underscore the need for continued research. This review synthesizes current knowledge, highlighting the potential of cellular therapies to address persistent challenges in the pursuit of an HIV cure.

Response of Care Services for Patients with HIV/AIDS during a Pandemic: Perspectives of Health Staff in Bolivia.

The COVID-19 pandemic has caused an unprecedented crisis striking health services, generating risks of setbacks in health care and affecting the most vulnerable populations such as HIV patients. This study aims to explore the impact of the COVID-19 pandemic on the operational management of health services for people living with HIV/AIDS in Cochabamba, Bolivia. We applied a qualitative approach using semi-structured in-depth interviews with ten key health professionals who care for patients with HIV/AIDS in Cochabamba, Bolivia. Interviews were transcribed verbatim and uploaded to Atlas.ti software for analysis. We used an ethnographic approach within the interpretive paradigm to carry out the thematic analysis, considering the "Determinants of health systems resilience framework" of five dimensions developed by the World Health Organization. Even though the provision of services in public care services was not interrupted during the COVID-19 pandemic, health service delivery was severely affected. Digital technology could be used to compensate in urban areas. Regarding the distribution of medications, adaptative strategies to reduce patient complications were implemented. Unfortunately, the complementary tests availability was limited. The COVID-19 pandemic had a significant impact on HIV/AIDS patient care services in Cochabamba, with repercussions for HIV treatment access and virologic suppression.

Milestone house: The story of a hospice for people with HIV/AIDS.

The HIV/AIDS epidemic of the early 1980s has been extensively documented, with all its epidemiological, scientific and medical impacts. Cultural implications for many sectors of society have been profound and long-lasting. Some areas merit reflection for their ingenuity in the face of a crisis and the effect they have had on clinical practice. This report gives an account of a venture into the unknown territory of palliative care. Described here is a group of young people and their families propelled into a nightmarish condition. Those involved were outlawed and stigmatised, suffering from a disease leading to their inevitable death. By association with this group, carers and medical staff were left to interpret unhelpful guidelines and to venture into unknown therapeutic territory, sometimes beyond the margins of conventional practice.

The effects of traditional healing on HIV and AIDS management: An ethnographic study.

BACKGROUND: This article presents the effects of traditional healing on the management of human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) in the Vhembe district, South Africa. The Vhembe district is one of the rural districts in Limpopo Province, South Africa, in which traditional healers are used as the first point of consultation for most ailments, regardless of their causes. METHODS: This ethnographic study was based on Leininger's theory of culture care diversity and universality. It was carried out in selected villages in the Vhembe district. Observation and interviews with 15 purposively selected key informants, who are traditional healers, were used to collect data. Interviews were tape-recorded and field notes were also taken. The data were analysed using the ethnographic content analysis method. RESULTS: The results suggest that traditional healing has both negative and positive effects on HIV and AIDS management. The positive effects are the effective treatment of some opportunistic infections, such as diarrhoea, skin lesions and childhood diseases. Negative effects, however, include incisions to let the 'dirty blood flow out' and inducing of vomiting and diarrhoea, which may lead to anaemia, dehydration and electrolyte imbalances. Some traditional healers are of the view that HIV does not exist and that people either have an ancestral calling or are bewitched. Even though their claims have not been scientifically proven, some traditional healers stated that they can heal HIV and AIDS. CONCLUSION: The research brings insight as to whether Vhavenda traditional healing has a favourable or unfavourable impact on HIV and AIDS management. Using Leininger's steps for adaptation for culture care diversity and universality will help with re-Africanisation of HIV management. The researcher recommend the modification of practices with a high risk of HIV infection to reduce this risk, whilst also supporting the continuation of beneficial practices that reduce HIV mortality, such as diarrhoea management.

The Effect of Routine Management Combined with Case Management Model on Social Support, Self-Efficacy, Self-Management Ability, and Psychological Flexibility of AIDS Patients.

Objective: To explore the influence of conventional management combined with case management on social support and self-efficacy of AIDS patients. Methods: The clinical case data of 120 AIDS patients who were treated and nursed in our hospital from June 2019 to June 2021 were selected as the research objects and were divided into the control group and the observation group according to the digital table method, with 60 cases each. The control group implements routine management, and the observation group implements case-based nursing management on this basis and compares the effects of self-efficacy, self-management ability, nursing ability, social support, and psychological flexibility of the two groups of patients. Results: Before the intervention, the quality of life scores of the two groups was not statistically significant (P > 0.05). After the intervention, the physical function score, pain management score, and symptom response score of the observation group were significantly higher than those of the control group, and statistics showed that the difference was statistically significant (P < 0.05). Before the intervention, the self-management ability of the two groups of patients was not statistically significant (P > 0.05). After the intervention, the observation group's symptom management, emotional cognition management, social support and assistance, daily life management, disease knowledge management, and treatment compliance management were significantly higher than those of the control group. Statistics show that this difference is statistically significant (P < 0.05). Before the intervention, there was no significant difference in the nursing ability and psychological flexibility between the two groups of patients (P > 0.05). After the intervention, the observation group's health knowledge level, self-care skills, self-care responsibility, self-concept, and mental flexibility (resilience, strength, optimism) indicators were higher than the control group, while the depression mood disorder score was significantly lower than the control group; statistics showed that this difference was statistically significant (P < 0.05). Conclusion: Routine management combined with case-based nursing management can effectively improve the self-management ability and psychological flexibility of AIDS patients, improve patient care ability and self-efficacy, and provide certain reference value for effective management of AIDS patients.

The Role of RNA Modification in HIV-1 Infection.

RNA plays an important role in biology, and more than 170 RNA modifications have been identified so far. Post-transcriptional modification of RNA in cells plays a crucial role in the regulation of its stability, transport, processing, and gene expression. So far, the research on RNA modification and the exact role of its enzymes is becoming more and more comprehensive. Human immunodeficiency virus 1 (HIV-1) is an RNA virus and the causative agent of acquired immunodeficiency syndrome (AIDS), which is one of the most devastating viral pandemics in history. More and more studies have shown that HIV has RNA modifications and regulation of its gene expression during infection and replication. This review focuses on several RNA modifications and their regulatory roles as well as the roles that different RNA modifications play during HIV-1 infection, in order to find new approaches for the development of anti-HIV-1 therapeutics.

Navigating the healthcare system in Nairobi City County: perspectives and experiences in the utilization of oral healthcare by caregivers of children with HIV/AIDS.

BACKGROUND: The healthcare system in any republic can cause inequalities in health outcomes if they do not take into account the needs of deprived populations. Children with HIV/AIDS are known to have a high vulnerability to oral diseases; yet, they continue to face limitations in the utilization of oral healthcare. While other determinants of healthcare utilization may co-exist, possible gaps in the oral healthcare system can collectively affect a vulnerable group disproportionately in the utilization of oral healthcare. OBJECTIVE: To explore qualitatively, the perspectives, experiences and attributions of a cohort of caregivers of children with HIV/AIDS and their Health Care Providers (HCPs), on the utilization of oral healthcare within the structure of the oral healthcare system in Nairobi City County (NCC). DESIGN: A cross-sectional explorative mixed methods study design of two hundred and twenty one (221) female caregivers of children with HIV/AIDS and their HCPs using a survey, Focus Group Discussions (FGDs) and In-depth Interviews (IDIs). The study setting was the HIV-Care Facilities (HIV-CCFs) at three large hospitals in NCC. RESULTS: Caregivers mainly utilized independent 'nearby' private dental clinics for oral healthcare services, attributing their selection to cheaper user-fees, proximal service location, and recommendations from social networks. Wait time, opening and closing hours, health workers' attitudes and inferred opportunity costs were perceived as important quality issues in the utilization of oral healthcare. CONCLUSION: The oral healthcare system in NCC does not support the utilization of oral healthcare within the context of providing comprehensive healthcare for children with HIV/AIDS. Absence of 'in-house' oral health services at the HIV- CCFs is viewed as a defining structural barrier.