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1.
BMC Infect Dis ; 21(1): 731, 2021 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-34340689

RESUMO

BACKGROUND: Children living with human immunodeficiency virus (HIV) infection require lifelong effective antiretroviral therapy (ART). The goal of ART in HIV-infected persons is sustained viral suppression. There is limited information on virological non-suppression or failure and its associated factors in children in resource limited countries, particularly Ghana. METHODS: A cross-sectional study of 250 children aged 8 months to 15 years who had been on ART for at least 6 months attending the Paediatric HIV clinic at Korle Bu Teaching hospital in Ghana was performed. Socio-demographic, clinical, laboratory and ART Adherence related data were collected using questionnaires as well as medical records review. Blood samples were obtained for viral load and CD4+ count determination. Viral load levels > 1000 copies/ml on ART was considered virological non-suppression. Logistic regression was used to identify factors associated with virological non-suppression. RESULTS: The mean (±SD) age of the study participants was 11.4 ± 2.4 years and the proportion of males was 53.2%. Of the 250 study participants, 96 (38.4%) had virological non-suppression. After adjustment for significant variables, the factors associated with non-suppressed viral load were female gender (AOR 2.51 [95% CI 1.04-6.07], p = 0.041), having a previous history of treatment of tuberculosis (AOR 4.95 [95% CI 1.58-15.5], p = 0.006), severe CD4 immune suppression status at study recruitment (AOR 24.93 [95% CI 4.92-126.31], p < 0.001) and being on a nevirapine (NVP) based regimen (AOR 7.93 [95% CI 1.58-1.15], p = 0.005). CONCLUSION: The prevelance of virological non-suppression was high. Virological non-suppression was associated with a previous history of TB treatment, female gender, severe CD4 immune suppression status at study recruitment and being on a NVP based regimen. Early initiation of ART and phasing out NVP-based regimen might improve viral load suppression in children. In addition, children with a history of TB may need focused measures to maximize virological suppression.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Adolescente , Contagem de Linfócito CD4 , Criança , Pré-Escolar , Estudos Transversais , Feminino , Gana , HIV/isolamento & purificação , Infecções por HIV/complicações , Infecções por HIV/virologia , Humanos , Lactente , Modelos Logísticos , Masculino , Nevirapina/uso terapêutico , Fatores de Risco , Fatores Sexuais , Falha de Tratamento , Tuberculose/complicações , Carga Viral
2.
Transfusion ; 61(8): 2392-2400, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34224581

RESUMO

BACKGROUND: Undisclosed antiretroviral drug (ARV) use among blood donors who tested HIV antibody positive, but RNA negative, was previously described by our group. Undisclosed ARV use represents a risk to blood transfusion safety. We assessed the prevalence of and associations with undisclosed ARV use among HIV-positive donors who donated during 2017. STUDY DESIGN AND METHODS: South African National Blood Service (SANBS) blood donors are screened by self-administered questionnaire, semi-structured interview, and individual donation nucleic acid amplification testing for HIV. Stored samples from HIV-positive donations were tested for ARV and characterized as recent/longstanding using lag avidity testing. RESULTS: Of the 1462 HIV-positive donations in 2017, 1250 had plasma availability for testing of which 122 (9.8%) tested positive for ARV. Undisclosed ARV use did not differ by gender (p = .205) or ethnicity (p = .505) but did differ by age category (p < .0001), donor (p < .0001), clinic type (p = .012), home province (p = .01), and recency (p < .0001). Multivariable logistic regression found older age (adjusted odds ratio [aOR] 3.73, 95% confidence interval [CI] 1.98-7.04 for donors >40 compared with those <21), first-time donation (aOR 5.24; 95% CI 2.48-11.11), and donation in a high HIV-prevalence province (aOR 9.10; 95% CI 2.70-30.72) compared with Northern Rural provinces to be independently associated with undisclosed ARV use. DISCUSSION: Almost 1 in 10 HIV-positive blood donors neglected to disclose their HIV status and ARV use. Demographic characteristics of donors with undisclosed ARV use differed from those noted in other study. Underlying motivations for nondisclosure among blood donors remain unclear and may differ from those in other populations with significant undisclosed ARV use.


Assuntos
Doadores de Sangue , Segurança do Sangue , Infecções por HIV/diagnóstico , Adulto , Estudos Transversais , Seleção do Doador , Feminino , HIV/isolamento & purificação , Infecções por HIV/epidemiologia , Teste de HIV , Humanos , Masculino , Técnicas de Amplificação de Ácido Nucleico , África do Sul/epidemiologia , Adulto Jovem
3.
Medicine (Baltimore) ; 100(25): e26285, 2021 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-34160393

RESUMO

ABSTRACT: The aim of this study was to identify viral exposure (VE) measures and their relationship to mortality risk among persons with HIV.Prospective multicenter observational study to compare VE formulae.Eligible participants initiated first combination antiretroviral therapy (cART) between March 1, 1995 and June 30, 2015. We included 1645 participants followed for ≥6 months after starting first cART, with cART prescribed ≥75% of time, who underwent ≥2 plasma viral load (VL) and ≥1 CD4+ T-lymphocyte cell (CD4) measurement during observation. We evaluated all-cause mortality from 6 months after cART initiation until June 30, 2016. VE was quantified using 2 time-updated variables: viremia copy-years and percent of person-years (%PY) spent >200 or 50 copies/mL. Cox models were fit to estimate associations between VE and mortality.Participants contributed 10,453 person years [py], with median 14 VLs per patient. Median %PY >200 or >50 were 10% (interquartile range: 1%-47%) and 26% (interquartile range: 6%-72%), respectively. There were 115 deaths, for an overall mortality rate of 1.19 per 100 person years. In univariate models, each measure of VE was significantly associated with mortality risk, as were older age, public insurance, injection drug use HIV risk history, and lower pre-cART CD4. Based on model fit, most recent viral load and %PY >200 copies/mL provided the best combination of VE factors to predict mortality, although all VE combinations evaluated performed well.The combination of most recent VL and %PY >200 copies/mL best predicted mortality, although all evaluated VE measures performed well.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Linfócitos T CD4-Positivos , Infecções por HIV/mortalidade , HIV/isolamento & purificação , Carga Viral , Adulto , Contagem de Linfócito CD4 , Progressão da Doença , Quimioterapia Combinada , Feminino , Infecções por HIV/sangue , Infecções por HIV/tratamento farmacológico , Infecções por HIV/virologia , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais/estatística & dados numéricos , Estudos Prospectivos , Estados Unidos/epidemiologia
4.
Int J Cancer ; 149(8): 1536-1543, 2021 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-34124779

RESUMO

Non-Hodgkin lymphomas (NHL) are underestimated causes of cancer in West Africa where chronic viral hepatitis and HIV are endemic. While the association with HIV infection has already been characterized, limited information is available on the association between chronic viral hepatitis and NHL in sub-Saharan Africa. A case-control study was conducted in referral hospitals of Abidjan (Cote d'Ivoire) and Dakar (Senegal). Cases of NHL were matched with controls on age, gender and participating site. The diagnosis of NHL relied on local pathological examination completed with immunohistochemistry. HIV, HBV and HCV serology tests were systematically performed. A conditional logistic regression model estimated the associations by the Odds Ratio (OR) with their 95% confidence interval (CI). A total of 117 NHL cases (Abidjan n = 97, Dakar n = 20) and their 234 matched controls were enrolled. Cases were predominantly men (68.4%) and had a median age of 50 years (IQR 37-57). While Diffuse Large B-cell lymphoma were the most reported morphological type (n = 35) among mature B-cell NHL, the proportion mature T-cell NHL (30%) was high. The prevalence figures of HBV, HCV and HIV infection were 12.8%, 7.7% and 14.5%, respectively among cases of NHL. In multivariate analysis, HBV, HCV and HIV were independently associated with NHL with OR of 2.23 (CI 1.05-4.75), 4.82 (CI 1.52-15.29) and 3.32 (CI 1.54-7.16), respectively. Chronic viral hepatitis B and C were significantly associated with NHL in West Africa. Timely preventive measures against HBV infection and access to curative anti-HCV treatment might prevent a significant number of NHL.


Assuntos
Infecções por HIV/complicações , HIV/isolamento & purificação , Vírus da Hepatite B/isolamento & purificação , Hepatite B Crônica/complicações , Linfoma não Hodgkin/epidemiologia , Adulto , África Ocidental/epidemiologia , Estudos de Casos e Controles , Feminino , Seguimentos , Infecções por HIV/virologia , Hepatite B Crônica/virologia , Humanos , Linfoma não Hodgkin/virologia , Masculino , Pessoa de Meia-Idade , Prognóstico
5.
Int J Cancer ; 149(8): 1564-1575, 2021 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-34164807

RESUMO

In 2020, the World Health Organisation (WHO) published a strategy to eliminate cervical cancer as a public health concern. In South Africa, despite having a national screening policy in place since 2000, diagnosed cervical cancer incidence has shown no signs of decline. We extend a previously developed individual-based model for human immunodeficiency virus (HIV) and human papillomavirus (HPV) infection to include progression to cervical cancer. The model accounts for future reductions in HIV incidence and prevalence and includes a detailed cervical cancer screening algorithm, based on individual-level data from the public health sector. We estimate the impact of the current prevention programme and alternative screening scenarios on cervical cancer incidence. The South African screening programme prevented 8600 (95%CI 4700-12 300) cervical cancer cases between 2000 and 2019. At current levels of prevention (status quo vaccination, screening, and treatment), age-standardised cervical cancer incidence will reduce from 49.4 per 100 000 women (95%CI 36.6-67.2) in 2020, to 12.0 per 100 000 women (95%CI 8.0-17.2) in 2120. Reaching WHO's prevention targets by 2030 could help South Africa reach elimination (at the 10/100 000 threshold) by 2077 (94% probability of elimination by 2120). Using new screening technologies could reduce incidence to 4.7 per 100 000 women (95%CI 2.8-6.7) in 2120 (44% probability of elimination at the 4/100 000 threshold). HPV vaccination and decreasing HIV prevalence will substantially reduce cervical cancer incidence in the long term, but improvements to South Africa's current screening strategy will be required to prevent cases in the short term. Switching to new screening technologies will have the greatest impact.


Assuntos
Alphapapillomavirus/efeitos dos fármacos , Infecções por HIV/prevenção & controle , HIV/efeitos dos fármacos , Modelos Estatísticos , Infecções por Papillomavirus/prevenção & controle , Neoplasias do Colo do Útero/epidemiologia , Vacinas contra a AIDS/administração & dosagem , Adulto , Idoso , Alphapapillomavirus/isolamento & purificação , Detecção Precoce de Câncer/métodos , Feminino , Seguimentos , HIV/isolamento & purificação , Infecções por HIV/complicações , Infecções por HIV/virologia , Humanos , Incidência , Pessoa de Meia-Idade , Infecções por Papillomavirus/complicações , Infecções por Papillomavirus/virologia , Vacinas contra Papillomavirus/administração & dosagem , Prognóstico , África do Sul/epidemiologia , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/virologia , Adulto Jovem
6.
BMC Infect Dis ; 21(1): 618, 2021 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-34187374

RESUMO

BACKGROUND: Nutrition is a crucial factor that can impact morbidity and mortality in older people living with HIV (PLWH). Studies on nutritional risk and nutritional status in all age groups in PLWH have been conducted. However, few studies have focused on nutritional risk in older PLWH. This study aimed to describe the nutritional risk and nutritional status in older PLWH, and explore factors associated with nutritional risk and undernutrition status. METHODS: We conducted a cross-sectional study. We recruited participants aged 50 years or older from the Third People's Hospital of Shenzhen from January 2016 to May 2019. Nutritional risk and nutritional status were evaluated by the Nutritional Risk Screening 2002 (NRS 2002) tool, body mass index (BMI), albumin level, and prealbumin level on the first day of admission. Logistic regression models were used to identify the factors associated with undernutrition based on the BMI, albumin, and prealbumin criteria. RESULTS: A total of 196 older PLWH were included in the analysis. We found that 36% of hospitalized older PLWH had nutritional risk, and 12-56% of them had undernutrition based on the BMI, albumin, and prealbumin criteria. An increased nutritional risk score was associated with older age (ß = 0.265 CI [0.021, 0.096], P = 0.002), a higher viral load (ß = - 0.186 CI [- 0.620, - 0.037], P = 0.028), a lower BMI (ß = - 0.287 CI [- 0.217, - 0.058], P = 0.001), and a lower albumin level (ß = - 0.324 CI [- 8.896, - 1.230], P = 0.010). The CD4 count was associated with the prevalence of undernutrition based on the albumin criterion (OR = 15.637 CI [2.742, 89.178], P = 0.002). CONCLUSION: Our study indicated that nutritional screening, assessment, and management should be routinely performed in hospitalized older PLWH. HIV-specific measures should be used to assess nutritional risk, and albumin, BMI, and other assessments should be used in combination to identify undernutrition in older PLWH.


Assuntos
Infecções por HIV/epidemiologia , HIV/isolamento & purificação , Hospitalização , Desnutrição/epidemiologia , Estado Nutricional , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Contagem de Linfócito CD4 , China/epidemiologia , Comorbidade , Estudos Transversais , Testes Diagnósticos de Rotina/métodos , Feminino , Infecções por HIV/sangue , Infecções por HIV/virologia , Humanos , Modelos Logísticos , Masculino , Desnutrição/sangue , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Avaliação Nutricional , Prevalência , Fatores de Risco , Albumina Sérica Humana/análise , Carga Viral
7.
J Steroid Biochem Mol Biol ; 211: 105905, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33962013

RESUMO

HIV infection affects 36.9 million people globally, and vitamin D deficiency is a global public health concern for HIV patients. Approximately 70 %-80 % of HIV-infected patients have vitamin D deficiency. The deficiency is associated with many pathologies such as immune disorders, infectious diseases, chronic inflammation, oral diseases, as well as the fast progression of HIV. The causes of vitamin D deficiency in HIV infections include HIV itself, traditional factors such as less sun exposure, mal-absorption, hypercholesterolemia, seasonal variation, poor nutrition as well as some HAART drugs like efavirenz. Vitamin D has an immunomodulatory, anti-inflammatory, and anti-proliferative function. In the oral cavity, it plays a significant role in preventing oral infections such as periodontal and gum diseases, dental caries, and oral candidiasis. The consequences of vitamin D deficiency are bone resorption, increased productions of pro-inflammatory cytokines, T-lymphocytes, increased T-helper-1 functions, and decreased T-helper-2 functions. Consequently, this leads to increased infections, chronic inflammation, and the occurrence of oral diseases such as oral candidiasis, periodontal and gum diseases, and dental caries. The majority of these oral diseases are encountered in HIV patients. Vitamin D deficiency is significantly found in HIV patients. There is a lack of studies that directly link vitamin D to most oral diseases in HIV patients; however, the role of vitamin D in immunoregulation, prevention of oral diseases, and HIV infection is substantiated.


Assuntos
Infecções por HIV/epidemiologia , HIV/isolamento & purificação , Saúde Bucal/normas , Deficiência de Vitamina D/complicações , Vitamina D/administração & dosagem , Infecções por HIV/tratamento farmacológico , Infecções por HIV/virologia , Humanos
8.
PLoS One ; 16(4): e0249517, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33831067

RESUMO

To analyze the results of HIV screening and the HIV-positive rate based on different HIV detection strategies in Zhejiang Province, China. Data were downloaded from the AIDS Prevention and Control Information System on May 1, 2019. HIV screening, prevalence, and incidence data were analyzed from 2008 to 2018. The incidence of HIV was calculated from the results of BED testing. SPSS software (ver. 19.0) was used for the analysis. The number of people screened for HIV increased by 229.7% from 2008 to 2018, while the incidence of HIV increased from 1.14‱ (2010) to 1.67‱ (2018), peak by 2015 (2.28‱). The proportion of people screened for HIV in medical institutions increased from 62.0% in 2008 to 67.1% in 2018, while of all positive tests, 47.9% were conducted at medical institutions in 2008, which increased to 63.2% in 2018. VCT and STD clinic attendees, who had only 4.5% of all those undergoing HIV tests, accounted for 23.7% of all HIV positive in 2018. The rate of HIV-positive people and incidence of HIV both increased in Zhejiang Province between 2008 and 2015. The most effective strategy for detecting HIV new cases is screening visitors to VCT and STD clinics.


Assuntos
Infecções por HIV/diagnóstico , HIV/isolamento & purificação , Programas de Rastreamento/métodos , Instituições de Assistência Ambulatorial , China/epidemiologia , Infecções por HIV/epidemiologia , Infecções por HIV/virologia , Humanos , Fatores de Tempo
9.
Viruses ; 13(4)2021 03 30.
Artigo em Inglês | MEDLINE | ID: mdl-33808053

RESUMO

Molecular cluster detection analyzes HIV sequences to identify rapid HIV transmission and inform public health responses. We describe changes in the capability to detect molecular clusters and in geographic variation in transmission dynamics. We examined the reporting completeness of HIV-1 polymerase sequences in quarterly National HIV Surveillance System datasets from December 2015 to December 2019. Priority clusters were identified quarterly. To understand populations recently affected by rapid transmission, we described the transmission risk and race/ethnicity of people in clusters first detected in 2018-2019. During December 2015 to December 2019, national sequence completeness increased from 26% to 45%. Of the 1212 people in the 136 clusters first detected in 2018-2019, 69% were men who have sex with men (MSM) and 11% were people who inject drugs (PWID). State-by-state analysis showed substantial variation in transmission risk and racial/ethnic groups in clusters of rapid transmission. HIV sequence reporting has increased nationwide. Molecular cluster analysis identifies rapid transmission in varied populations and identifies emerging patterns of rapid transmission in specific population groups, such as PWID, who, in 2015-2016, comprised only 1% of people in such molecular clusters. These data can guide efforts to focus, tailor, and scale up prevention and care services for these populations.


Assuntos
Hotspot de Doença , Infecções por HIV/etnologia , Infecções por HIV/transmissão , HIV/genética , Monitoramento Epidemiológico , Geografia , HIV/enzimologia , HIV/isolamento & purificação , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Humanos , Masculino , Saúde Pública/métodos , Análise de Sequência de DNA , Minorias Sexuais e de Gênero/estatística & dados numéricos , Estados Unidos/epidemiologia
10.
Nucleic Acids Res ; 49(12): e70, 2021 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-33849057

RESUMO

Technical challenges remain in the sequencing of RNA viruses due to their high intra-host diversity. This bottleneck is particularly pronounced when interrogating long-range co-evolved genetic interactions given the read-length limitations of next-generation sequencing platforms. This has hampered the direct observation of these genetic interactions that code for protein-protein interfaces with relevance in both drug and vaccine development. Here we overcome these technical limitations by developing a nanopore-based long-range viral sequencing pipeline that yields accurate single molecule sequences of circulating virions from clinical samples. We demonstrate its utility in observing the evolution of individual HIV Gag-Pol genomes in response to antiviral pressure. Our pipeline, called Multi-read Hairpin Mediated Error-correction Reaction (MrHAMER), yields >1000s of viral genomes per sample at 99.9% accuracy, maintains the original proportion of sequenced virions present in a complex mixture, and allows the detection of rare viral genomes with their associated mutations present at <1% frequency. This method facilitates scalable investigation of genetic correlates of resistance to both antiviral therapy and immune pressure and enables the identification of novel host-viral and viral-viral interfaces that can be modulated for therapeutic benefit.


Assuntos
HIV/genética , Sequenciamento por Nanoporos/métodos , DNA Complementar , Farmacorresistência Viral/genética , Evolução Molecular , Proteínas de Fusão gag-pol/genética , Genoma Viral , HIV/isolamento & purificação , Infecções por HIV/tratamento farmacológico , Infecções por HIV/virologia , Humanos , Mutação , Reação em Cadeia da Polimerase Via Transcriptase Reversa/métodos
12.
Anal Bioanal Chem ; 413(11): 2923-2931, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33712918

RESUMO

Detection of blood-borne pathogens such as hepatitis C virus (HCV), hepatitis B virus (HBV) and human immunodeficiency virus (HIV) is essential to ensure the safety of blood transfusion. However, traditional PCR-based pathogen nucleic acid detection methods require relatively high experimental facilities and are difficult to apply in areas with limited resources. In this study, a self-driven microfluidic chip was designed to carry out multiplex detection of HBV, HCV and HIV by using loop-mediated isothermal amplification (LAMP). Benefitting from the air permeability of the polydimethylsiloxane material, the chip could accomplish sample loading within 12 min driven by the pressure difference between the reaction chambers and vacuum chambers in the chip without using pumps or any injection devices. Multiplex detection is achieved by presetting LAMP primers specific to different targets in different reaction chambers. Calcein was used as an indicator to indicate the positive amplification reaction, and the result can be recorded by a smartphone camera. After 50 min of isothermal amplification at 63 °C, 2 copies/µL of HBV, HCV and HIV target nucleic acids could be detected. The results of HBV detection of 20 clinical plasma samples by using the chip are consistent with that of the qPCR-based kit, indicating that the LAMP-based self-driven chip has the clinical application potential for blood-borne pathogen detection, especially in resource-limited areas.


Assuntos
Patógenos Transmitidos pelo Sangue/isolamento & purificação , Dispositivos Lab-On-A-Chip , Técnicas de Diagnóstico Molecular/métodos , Técnicas de Amplificação de Ácido Nucleico/métodos , HIV/isolamento & purificação , Hepacivirus/isolamento & purificação , Vírus da Hepatite B/isolamento & purificação , Limite de Detecção , Técnicas Analíticas Microfluídicas/instrumentação
13.
PLoS One ; 16(2): e0246717, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33596216

RESUMO

OBJECTIVES: We examined key gender, interpersonal and community dynamics influencing PrEP acceptability among adolescent girls and young women (AGYW) and their male partners. METHODS: We administered 12 in-depth interviews (IDI) to partnered, or married AGYW aged 15-24 years living without HIV, and 16 IDIs to male partners living without HIV aged 18 or older, partnered or married to an AGYW in Tanzania. Card sorting, a participatory qualitative method for facilitating systematic discussion, was used to identify attitudes, values, and desires that would influence PrEP acceptability. RESULTS: Relationship distrust, partner communication about HIV risk, and need to control HIV risk were highly influential considerations for PrEP use. AGYW and male partners both wanted to discuss PrEP use amidst relationship distrust, while most male partners encouraged AGYW PrEP use for shared protective benefit. Anticipated stigma of being perceived as a person living with HIV, as a result of PrEP use, was a deterrent for both AGYW and male partners while AGYW also feared additional stigma of being considered sexually promiscuous. CONCLUSIONS: Couples counseling for PrEP uptake and adherence might be a well-placed strategy for couples who are living without HIV to educate one another about the relationship benefits of using PrEP, thereby increasing its acceptance and adherence, addressing unequal power dynamics, and reducing associated relationship distrust. Community awareness and education about PrEP can help curb persistent PrEP stigma, including intersectional stigma.


Assuntos
Infecções por HIV/prevenção & controle , Infecções por HIV/psicologia , Profilaxia Pré-Exposição/métodos , Estigma Social , Adulto , Fármacos Anti-HIV/uso terapêutico , Aconselhamento , Feminino , HIV/isolamento & purificação , Infecções por HIV/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Relações Interpessoais , Masculino , Profilaxia Pré-Exposição/tendências , Comportamento Sexual , Parceiros Sexuais , Tanzânia/epidemiologia , Adulto Jovem
14.
PLoS One ; 16(2): e0243167, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33544717

RESUMO

BACKGROUND: Additional progress towards HIV epidemic control requires understanding who remains at risk of HIV infection in the context of high uptake of universal testing and treatment (UTT). We sought to characterize seroconverters and risk factors in the SEARCH UTT trial (NCT01864603), which achieved high uptake of universal HIV testing and ART coverage in 32 communities of adults (≥15 years) in rural Uganda and Kenya. METHODS: In a pooled cohort of 117,114 individuals with baseline HIV negative test results, we described those who seroconverted within 3 years, calculated gender-specific HIV incidence rates, evaluated adjusted risk ratios (aRR) for seroconversion using multivariable targeted maximum likelihood estimation, and assessed potential infection sources based on self-report. RESULTS: Of 704 seroconverters, 63% were women. Young (15-24 years) men comprised a larger proportion of seroconverters in Western Uganda (18%) than Eastern Uganda (6%) or Kenya (10%). After adjustment for other risk factors, men who were mobile [≥1 month of prior year living outside community] (aRR:1.68; 95%CI:1.09,2.60) or who HIV tested at home vs. health fair (aRR:2.44; 95%CI:1.89,3.23) were more likely to seroconvert. Women who were aged ≤24 years (aRR:1.91; 95%CI:1.27,2.90), mobile (aRR:1.49; 95%CI:1.04,2.11), or reported a prior HIV test (aRR:1.34; 95%CI:1.06,1.70), or alcohol use (aRR:2.07; 95%CI:1.34,3.22) were more likely to seroconvert. Among survey responders (N = 607, 86%), suspected infection source was more likely for women than men to be ≥10 years older (28% versus 8%) or a spouse (51% vs. 31%) and less likely to be transactional sex (10% versus 16%). CONCLUSION: In the context of universal testing and treatment, additional strategies tailored to regional variability are needed to address HIV infection risks of young women, alcohol users, mobile populations, and those engaged in transactional sex to further reduce HIV incidence rates.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Teste de HIV , Adolescente , Adulto , Feminino , HIV/isolamento & purificação , Infecções por HIV/diagnóstico , Teste de HIV/métodos , Humanos , Incidência , Quênia/epidemiologia , Masculino , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Fatores de Risco , População Rural , Fatores Sexuais , Uganda/epidemiologia , Adulto Jovem
15.
PLoS One ; 16(2): e0243274, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33621231

RESUMO

BACKGROUND: People living with human immunodeficiency virus (PLWH) are at risk of developing pulmonary hypertension (PH) and right ventricular (RV) dysfunction, but understanding of the relationship of RV function to afterload (RV-PA coupling) is limited. We evaluated the clinical and hemodynamic characteristics of human immunodeficiency virus (HIV)-associated PH. METHODS: We performed a retrospective review of patients with a diagnosis of HIV undergoing right heart catheterization (RHC) from 2000-2016 in a tertiary care center. Inclusion criteria were diagnosis of HIV, age ≥ 18 years and availability of RHC data. PH was classified as either pulmonary arterial hypertension (PAH; mean pulmonary arterial pressure [mPAP] ≥ 25mmHg with pulmonary artery wedge pressure [PAWP] ≤ 15mmHg) or pulmonary venous hypertension (PVH; mPAP ≥ 25mmHg with PAWP > 15). We collected demographics, CD4 cell count, HIV viral load, RHC and echocardiographic data. The single beat method was used to calculate RV-PA coupling from RHC. RESULTS: Sixty-two PLWH with a clinical likelihood for PH underwent RHC. Thirty-two (52%) met PH criteria (15 with PAH, 17 with PVH). Average time from diagnosis of HIV to diagnosis of PH was 11 years. Eleven of 15 individuals with PAH were on antiretroviral therapy (ART) while all 17 patients with PVH were on ART. Compared to PLWH without PH, those with PH had an increased likelihood of having a detectable HIV viral load and lower CD4 cell counts. PLWH with PAH or PVH had increased RV afterload with normal RV contractility, and preserved RV-PA coupling. CONCLUSION: PLWH with PH (PAH or PVH) were more likely to have a detectable HIV viral load and lower CD4 count at the time of RHC. PLWH with PAH or PVH had increased RV afterload, normal RV contractility, with preserved RV-PA coupling suggestive of an early onset, mild, and compensated form of PH. These results should be confirmed in larger studies.


Assuntos
Infecções por HIV/complicações , Hipertensão Pulmonar/etiologia , Disfunção Ventricular Direita/etiologia , Adulto , Cateterismo Cardíaco , Feminino , HIV/isolamento & purificação , Infecções por HIV/diagnóstico , Infecções por HIV/fisiopatologia , Infecções por HIV/virologia , Humanos , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/fisiopatologia , Hipertensão Pulmonar/virologia , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Contração Miocárdica , Hipertensão Arterial Pulmonar/diagnóstico , Hipertensão Arterial Pulmonar/etiologia , Hipertensão Arterial Pulmonar/fisiopatologia , Hipertensão Arterial Pulmonar/virologia , Estudos Retrospectivos , Disfunção Ventricular Direita/diagnóstico , Disfunção Ventricular Direita/fisiopatologia , Disfunção Ventricular Direita/virologia , Carga Viral
16.
Sci Rep ; 11(1): 696, 2021 01 12.
Artigo em Inglês | MEDLINE | ID: mdl-33436856

RESUMO

The surgical treatment and transcatheter arterial chemoembolization (TACE) rate of human immunodeficiency virus (HIV)-infected hepatocellular carcinoma (HCC) patients is relatively low in West China. For various reasons, most patients do not receive timely surgical treatment. Upon transfer to an infectious disease centralized hospital, they were already classified in the Barcelona Clinic Liver Cancer (BCLC)-B stage. A total of 2249 BCLC-B HCC patients were analyzed. The eligible population was divided into three groups for analysis of survival and prognostic factors; These were 21 HIV infected (HIV+) HCC patients treated with TACE (TACE+), 1293 non-HIV-infected (HIV-) HCC patients treated with TACE, and 150 HIV- HCC patients who only receive medication (TACE-) as a second control group. After 1:2 matching, 1- and 2-year survival of HIV+ TACE+ and HIV- TACE+ groups was 64.3% and 76.5% (P = 0.453) and 45.5% vs. 50.0% (P = 0.790) respectively. We also compared one and two-year survival between HIV+ TACE+ and HIV- TACE-. One-year overall survival was 64.3% vs. 45.7% (P = 0.097) and 2-year survival was 45.5% vs. 7.1% (P = 0.004). Multivariate analysis showed that the most important prognostic factors for survival were serum alpha-fetoprotein (AFP) and Child-Pugh score and tumor size, while HIV status had no significant effect on prognosis statistically. CD4 levels below 200 may increase the risk of opportunistic infection after surgery, but after anti-infection and systematic supportive therapy, it has no effect on survival. HIV+ patients should have the same treatment opportunities as HIV- patients. If the patient's immune status permits, we suggest that early TACE treatment should be administered to BCLC-B HCC patients, regardless of HIV infection.


Assuntos
Carcinoma Hepatocelular/mortalidade , Quimioembolização Terapêutica/mortalidade , Infecções por HIV/complicações , HIV/isolamento & purificação , Neoplasias Hepáticas/mortalidade , Carcinoma Hepatocelular/etiologia , Carcinoma Hepatocelular/patologia , Carcinoma Hepatocelular/terapia , Estudos de Casos e Controles , Feminino , Infecções por HIV/virologia , Humanos , Neoplasias Hepáticas/etiologia , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/terapia , Masculino , Pessoa de Meia-Idade , Taxa de Sobrevida , Resultado do Tratamento
17.
PLoS One ; 16(1): e0244543, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33507898

RESUMO

After an epidemic outbreak, the infection persists in a community long enough to engulf the entire susceptible population. Local extinction of the disease could be possible if the susceptible population gets depleted. In large communities, the tendency of eventual damp down of recurrent epidemics is balanced by random variability. But, in small communities, the infection would die out when the number of susceptible falls below a certain threshold. Critical community size (CCS) is considered to be the mentioned threshold, at which the infection is as likely as not to die out after a major epidemic for small communities unless reintroduced from outside. The determination of CCS could aid in devising systematic control strategies to eradicate the infectious disease from small communities. In this article, we have come up with a simplified computation based approach to deduce the CCS of HIV disease dynamics. We consider a deterministic HIV model proposed by Silva and Torres, and following Nåsell, introduce stochasticity in the model through time-varying population sizes of different compartments. Besides, Metcalf's group observed that the relative risk of extinction of some infections on islands is almost double that in the mainlands i.e. infections cease to exist at a significantly higher rate in islands compared to the mainlands. They attributed this phenomenon to the greater recolonization in the mainlands. Interestingly, the application of our method on demographic facts and figures of countries in the AIDS belt of Africa led us to expect that existing control measures and isolated locations would assist in temporary eradication of HIV infection much faster. For example, our method suggests that through systematic control strategies, after 7.36 years HIV epidemics will temporarily be eradicated from different communes of island nation Madagascar, where the population size falls below its CCS value, unless the disease is reintroduced from outside.


Assuntos
Síndrome de Imunodeficiência Adquirida/epidemiologia , Infecções por HIV/epidemiologia , África/epidemiologia , Surtos de Doenças , Epidemias , HIV/isolamento & purificação , Humanos , Madagáscar/epidemiologia , Modelos Estatísticos , Densidade Demográfica , Fatores de Risco , Processos Estocásticos
18.
BMC Infect Dis ; 21(1): 48, 2021 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-33430783

RESUMO

BACKGROUND: In Morocco, of the estimated 29,000 people living with HIV in 2011, only 20% were aware of their HIV status. More than half of diagnoses were at the AIDS stage. We assumed that people who were unaware of their infection had contacts with the healthcare system for HIV indicators that might prompt the healthcare provider to offer a test. The aim was to assess missed opportunities for HIV testing in patients newly diagnosed with HIV who accessed care in Morocco. METHODS: A cross-sectional study was conducted in 2012-2013 in six Moroccan HIV centers. Participants were aged ≥18, and had sought care within 6 months after their HIV diagnosis. A standardized questionnaire administered during a face-to-face interview collected the patient's characteristics at HIV diagnosis, HIV testing and medical history. Contacts with care and the occurrence of clinical conditions were assessed during the 3 years prior to HIV diagnosis. Over this period, we assessed whether healthcare providers had offered HIV testing to patients with HIV-related clinical or behavioral conditions. RESULTS: We enrolled 650 newly HIV-diagnosed patients (median age: 35, women: 55%, heterosexuals: 81%, diagnosed with AIDS or CD4 < 200 cells/mm3: 63%). During the 3 years prior to the HIV diagnosis, 71% (n = 463) of participants had ≥1 contact with the healthcare system. Of 323 people with HIV-related clinical conditions, 22% did not seek care for them and 9% sought care and were offered an HIV test by a healthcare provider. The remaining 69% were not offered a test and were considered as missed opportunities for HIV testing. Of men who have sex with men, 83% did not address their sexual behavior with their healthcare provider, 11% were not offered HIV testing, while 6% were offered HIV testing after reporting their sexual behavior to their provider. CONCLUSIONS: Among people who actually sought care during the period of probable infection, many opportunities for HIV testing, based on at-risk behaviors or clinical signs, were missed. This highlights the need to improve the recognition of HIV clinical indicators by physicians, further expand community-based HIV testing by lay providers, and implement self-testing to increase accessibility and privacy.


Assuntos
Síndrome de Imunodeficiência Adquirida/diagnóstico , Síndrome de Imunodeficiência Adquirida/epidemiologia , Teste de HIV , HIV/isolamento & purificação , Programas de Rastreamento , Adulto , Estudos Transversais , Feminino , Heterossexualidade , Homossexualidade Masculina , Humanos , Masculino , Marrocos/epidemiologia , Prevalência , Assunção de Riscos , Comportamento Sexual , Minorias Sexuais e de Gênero , Inquéritos e Questionários
19.
BMC Infect Dis ; 21(1): 51, 2021 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-33430786

RESUMO

BACKGROUND: Multidrug-resistant tuberculosis (MDR-TB) in HIV infected individuals is a serious threat to global efforts to combat tuberculosis. Inconsistent findings on the association between HIV infection and MDR-TB were present in many studies. We aimed to review existing data on the relationship between HIV infection and MDR-TB systematically to assess the contribution of HIV on MDR-TB worldwide. We also investigated the patterns of MDR-TB by age, country-wise income, study designs, and global regions. METHODS: We utilized PubMed, Google Scholar, and ScienceDirect databases to select eligible studies for meta-analysis that were published between January 12,010, and July 30, 2020. The random-effects model was used to obtain the pooled odds ratio of the crude association between HIV and MDR-TB with a 95% confidence interval. We investigated the potential publication-bias by checking funnel plot asymmetry and using the Egger's test. Moreover, we assessed the heterogeneity using the I2 statistic. Sensitivity analysis was performed based on sample size and adjustment factors. The protocol was registered with PROSPERO-CRD42019132752. RESULTS: We identified 1603 studies through a database search, and after subsequent eliminations we selected 54 studies including 430,534 TB patients. The pooled odds of MDR-TB was 1.42 times higher in HIV-positive patients than HIV-negative patients (OR=1.42,CI=1.17-1.71, I2=75.8%). Subgroup analysis revealed that the estimated pooled odds for South-East Asian countries was 1.86, which is the highest in WHO regions (OR=1.86,CI=1.30-2.67, I2=0.00%), followed by Europe and Africa. The effect estimate was found to be higher for primary MDR-TB (OR=2.76,CI=1.70-4.46, I2=0.00%). There was also a trend towards increased odds of MDR-TB for HIV patients older than 40 years (OR=1.56,CI=1.17-2.06). The association was found to be significant in high-burden TB countries (OR=1.75, CI=1.39-2.19) and in high-income countries (OR=1.55, CI=1.06-2.27). CONCLUSION: Such findings indicate that HIV infection raises the risk of MDR-TB, and after contrasting it with the results of the earlier pooled study, it appeared to be an upward risk trend. Moreover, we found that the risk is the highest in the South-East Asian region. A balanced allocation of resources is needed to halt both primary and secondary MDR-TB, particularly in HIV infected people with 40 years of age and older.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/complicações , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , HIV/isolamento & purificação , Mycobacterium tuberculosis/isolamento & purificação , Tuberculose Resistente a Múltiplos Medicamentos/complicações , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Adulto , África/epidemiologia , Antituberculosos/uso terapêutico , Ásia Sudeste/epidemiologia , Europa (Continente)/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Risco , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico
20.
BMC Infect Dis ; 21(1): 61, 2021 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-33435863

RESUMO

BACKGROUND: To effectively reduce vertical HIV transmission requires a reduction of HIV prevalence and incidence among pregnant women and a full understanding of its epidemiology. The study aimed to determine the prevalence of HIV among women attending antenatal care and further determine spousal support during antenatal care attendance in rural areas in Eastern Cape province, South Africa. METHODS: A Cross-sectional study of women attending antenatal care in four Primary Care facilities was conducted using an interviewer-administered questionnaire which collected information on socio-demographic characteristics and medical history. Binomial logistic regression analyses were used to determine factors associated with HIV and to estimate the prevalence ratio (PR). The 95% confidence interval (95%CI) is used for precision of estimates; p≤0.05 for statistical significance. RESULTS: A total of 343 participants were included in the final analysis. The antenatal HIV prevalence was 38.2% (95%CI: 33.2-43.9). For 75% of the women, the HIV diagnosis was made 141 days before the date of the interview (median=77 days, interquartile range=42-141 days). Participants between the age of 30 to 39 years were 50% more likely to be HIV positive compared to those who were between the age of 20 to 29, these differences were statistically significant (PR=1.5; p-value=0.001). Furthermore, self-employed women were 30% less likely to be HIV positive when compared to unemployed participants, this was also statistically significant (PR=0.7; p-value< 0.0001). CONCLUSION: Despite a 100% antenatal HIV testing rate, the antenatal HIV prevalence remains high in this population, coupled with no spousal attendance in antenatal care. It is important to move beyond awareness about the HIV status to actionable strategies of reducing the HIV incident cases. It is therefore important to remain vigilant and monitor mother-to-child transmission that could be associated with this increased prevalence.


Assuntos
Infecções por HIV/epidemiologia , HIV/isolamento & purificação , Pobreza , Complicações Infecciosas na Gravidez/epidemiologia , Cuidado Pré-Natal , Atenção Primária à Saúde , Serviços de Saúde Rural , Adolescente , Adulto , Estudos Transversais , Feminino , Infecções por HIV/virologia , Humanos , Incidência , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Gravidez , Complicações Infecciosas na Gravidez/virologia , Prevalência , Testes Sorológicos , África do Sul/epidemiologia , Adulto Jovem
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