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1.
Cien Saude Colet ; 26(7): 2653-2662, 2021 Jul.
Artigo em Português, Inglês | MEDLINE | ID: mdl-34231678

RESUMO

This study analyzes how experiences of HIV-related stigma are expressed among HIV-positive young people transitioning to an adult clinic, the health service, the family, the affective-sexual interactions, and their relationship with inequalities and social hierarchies. This research included 31 young people (median age 21) transitioning to an adult clinic (G1) and 12 young people (median age 30) who had already made this transition (G2), both monitored at a health service in Rio de Janeiro. Seventy percent of the 43 young people were women and 65% were infected by mother-to-child transmission. Young people answered questionnaires and participated in focus groups on AIDS stigma and transition to adulthood. Most reported discrimination associated with HIV stigma in daily life and health care. G1 young people showed more significant concern about the consequences of HIV disclosure and difficulties with treatment. The G2 accounts suggest that establishing marital relationships, including HIV-negative partners and children, linked to treatment access allowed resignifying the fear of stigmatization. The findings aim to guide the training and action of professionals involved in the prevention and care of young people living with HIV.


Assuntos
Infecções por HIV , Transmissão Vertical de Doenças Infecciosas , Adolescente , Adulto , Brasil , Feminino , Infecções por HIV/epidemiologia , Hospitais Públicos , Humanos , Estigma Social , Adulto Jovem
2.
Cien Saude Colet ; 26(6): 2183-2194, 2021 Jun.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-34231730

RESUMO

A scoping literature review to identify the multilevel HIV serosorting related elements was developed. Articles from EBSCO, PubMed, PsyNET and Science Direct with serosort* or serosorting at the tittle or abstract, written in English or Spanish were included. No restriction in type of population or design were applied. 239 records were retrieved after duplicates removed, but 181 references were extracted for full-text review. Individual level: HIV knowledge, serostatus, risk perceptions, abilities to disclose and for condom use negotiation, motivations, use of drugs, stigma, attitudes toward condom use, and perceptions/beliefs about the HIV and related treatments, HIV infection rates/testing and behavioral factors. Interpersonal level: social networks, abilities (sexual behavior negotiation, and communication). Community level: stigma, social norms, access to HIV related services. Structural level: political context, HIV related funding and public policies. HIV Serosorting is not solely an interpersonal behavior it involves multilevel elements that must be acknowledged by professionals and stakeholders.


Assuntos
Infecções por HIV , Preservativos , Infecções por HIV/epidemiologia , Seleção por Sorologia para HIV , Homossexualidade Masculina , Humanos , Masculino , Sexo Seguro , Comportamento Sexual , Parceiros Sexuais
3.
Artigo em Inglês | MEDLINE | ID: mdl-34205036

RESUMO

The study sought to determine the impact of COVID-19 on HIV/AIDS programming in the Kibera informal settlement and COVID-19 hotspot counties during the first wave of the pandemic. The study was conducted in two phases. The first phase entailed the analysis of HIV care and treatment secondary data (2018-2020) from the Kenya Health Information System. In the second phase, a prospective cohort study was conducted among people living with HIV in the Kibera informal settlement. A total of 176 participants aged 18 years and above accessing HIV services at selected healthcare facilities in Kibera were randomly sampled from facility electronic medical records and followed up for three months. Socio-demographics and contact details were abstracted from the records and telephone interviews were conducted with consenting participants. Results from the retrospective review of HIV program data indicated a 56% (p < 0.000, 95% CI: 31.3%-62.8%) reduction in uptake of HIV services. Clients starting antiretroviral therapy (ART) reduced significantly by 48% (p < 0.001, 95% CI: 35.4%-77%) in hotspot counties. However, pre-exposure prophylaxis uptake increased significantly by 24% (p < 0.019, 95% CI: 4%-49%). In Kibera, 14% reported missing medications at the onset of the COVID-19 pandemic because of lack of food (38%) and government measures (11%), which affected ART access; 11% did not access health facilities due to fear of contracting COVID-19, government regulations and lack of personal protective equipment. Socioeconomic factors, food insecurity and government measures affected uptake of HIV/AIDS services; hence, the need for scaling up measures to increase access to HIV/AIDS services during the onset of pandemics.


Assuntos
COVID-19 , Infecções por HIV , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Quênia/epidemiologia , Pandemias , Estudos Prospectivos , Estudos Retrospectivos , SARS-CoV-2
4.
BMC Health Serv Res ; 21(1): 647, 2021 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-34217285

RESUMO

BACKGROUND: PLWH are living longer as a result of advancement and adherence to antiretroviral therapy. As the life expectancy of PLWH increases, they are at increased risk of hypertension and diabetes. HIV chronic co-morbidities pose a serious public health concern as they are linked to increased use and need of health services, decreased overall quality of life and increased mortality. While research shows that integrated care approaches applied within primary care settings can significantly reduce hospital admissions and mortality levels among patients with comorbidities, the primary care system in South Africa continues to be challenged with issues about the delivery of quality care. METHODS: This study applied a phenomenological qualitative research design. IDIs were conducted with 24 HCPs and adults living with the comorbidity of HIV and either hypertension or diabetes across two provinces in South Africa. The objective of the research was to understand the challenges faced by HCPs and patients in health facilities where the ICDM model is implemented. The health facilities were purposively sampled. However, the HCPs were recruited through snowballing and the patients through reviewing the facilities' clinic records for participants who met the study criteria. All participants provided informed consent. The data was collected between March and May 2020. The findings were analysed inductively using thematic content analysis. RESULTS: The challenges experienced included lack of staff capacity, unclear guidelines on the delivery of integrated care for patients with HIV chronic comorbidities, pill burden, non-disclosure, financial burden, poor knowledge of treatments, relocation of patients and access to treatment. Lack of support and integrated chronic programmes including minimal information regarding the management of HIV chronic comorbidities were other concerns. CONCLUSION: The outcomes of the ICDM model need to be strengthened and scaled up to meet the unique health needs and challenges of people living with HIV and other chronic conditions. Strengthening these outcomes includes providing capacity building and training on the delivery of chronic care treatment under the ICDM model, assisted self-management to improve patient responsibility of chronic disease management and strengthening activities for comorbidity health promotion.


Assuntos
Diabetes Mellitus , Infecções por HIV , Hipertensão , Adulto , Instituições de Assistência Ambulatorial , Comorbidade , Infecções por HIV/epidemiologia , Pessoal de Saúde , Humanos , Pesquisa Qualitativa , Qualidade de Vida , África do Sul
5.
Artigo em Inglês | MEDLINE | ID: mdl-34203191

RESUMO

BACKGROUND: Many countries around the world are currently threatened by the COVID-19 pandemic, and nurses are facing increasing responsibilities and work demands related to infection control. To establish a developmental strategy for infection control, it is important to analyze, understand, or visualize the accumulated data gathered from research in the field of nursing. METHODS: A total of 4854 articles published between 1978 and 2017 were retrieved from the Web of Science. Abstracts from these articles were extracted, and network analysis was conducted using the semantic network module. RESULTS: 'wound', 'injury', 'breast', "dressing", 'temperature', 'drainage', 'diabetes', 'abscess', and 'cleaning' were identified as the keywords with high values of degree centrality, betweenness centrality, and closeness centrality; hence, they were determined to be influential in the network. The major topics were 'PLWH' (people living with HIV), 'pregnancy', and 'STI' (sexually transmitted infection). CONCLUSIONS: Diverse infection research has been conducted on the topics of blood-borne infections, sexually transmitted infections, respiratory infections, urinary tract infections, and bacterial infections. STIs (including HIV), pregnancy, and bacterial infections have been the focus of particularly intense research by nursing researchers. More research on viral infections, urinary tract infections, immune topic, and hospital-acquired infections will be needed.


Assuntos
COVID-19 , Infecções por HIV , Pesquisa em Enfermagem , Doenças Sexualmente Transmissíveis , Feminino , Infecções por HIV/epidemiologia , Humanos , Pandemias , Gravidez , SARS-CoV-2 , Web Semântica , Doenças Sexualmente Transmissíveis/epidemiologia
6.
J Acquir Immune Defic Syndr ; 87(5): 1167-1172, 2021 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-34229329

RESUMO

BACKGROUND: Data on clinical characteristics and outcomes of people living with HIV (PLWH) hospitalized with coronavirus disease 2019 (COVID-19) who develop acute kidney injury (AKI) are limited. SETTING: Large tertiary health care system in the Bronx, NY. METHODS: We performed a retrospective cohort study of 83 PLWH and 4151 patients without HIV hospitalized with COVID-19 from March 10, 2020, to May 11, 2020. We compared the clinical characteristics and outcomes associated with AKI by HIV serostatus and evaluated HIV-related factors for AKI among PLWH. AKI was defined and staged using Kidney Disease Improving Global Outcomes criteria. RESULTS: The incidence of AKI in hospitalized patients with COVID-19 did not differ significantly by HIV serostatus (54.2% in PLWH vs 49.5% in patients without HIV, P = 0.6). Despite a higher incidence of stage 3 AKI (28.9% vs 17.1% P = 0.05) in PLWH compared with those without HIV, there was no significant difference in the need for renal replacement therapy (22.2% vs 13.4% P = 0.12), renal recovery (76.9% vs 82.5% P = 0.61), or dependence on renal replacement therapy (7.7% vs 3.8% P = 0.27). CD4 T-cell count, HIV-1 RNA viral suppression, and antiretroviral therapy use were not associated with AKI. AKI was associated with increased need for invasive ventilation and in-hospital death, but HIV was not an independent risk factor of in-hospital death after AKI [adjusted hazard ratio 1.01 (95% CI: 0.59 to 1.72), P = 0.98]. CONCLUSIONS: HIV-related factors were not associated with increased risk of AKI in PLWH hospitalized with COVID-19. PLWH hospitalized with COVID-19 had more stage 3 AKI, but outcomes after AKI were similar to those without HIV.


Assuntos
Injúria Renal Aguda/tratamento farmacológico , COVID-19/complicações , Infecções por HIV/tratamento farmacológico , Injúria Renal Aguda/complicações , Injúria Renal Aguda/epidemiologia , Idoso , Antirreumáticos/uso terapêutico , COVID-19/epidemiologia , Feminino , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Mortalidade Hospitalar , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , SARS-CoV-2
7.
Rev Soc Bras Med Trop ; 54: e00762021, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34231771

RESUMO

INTRODUCTION: Leptospirosis and brucellosis cause immunosuppression that worsens the clinical condition of people living with HIV/AIDS (PLWHA). We investigated the serological profile and risk factors of PLWHA. METHODS: Serum samples (n=238) were researched for Brucella spp. antibodies using Rose Bengal and tube agglutination tests and Leptospira spp. antibodies using the microscopic agglutination test. RESULTS: All samples were negative for Brucella spp. For leptospirosis, four samples (1.69%) were positive, and Andamana was the prevalent serovar. CONCLUSIONS: Low or no detection of these zoonoses does not reduce their importance in PLWHA. Vigilant, educational, and preventive measures should be adopted.


Assuntos
Brucelose , Infecções por HIV , Leptospira , Leptospirose , Testes de Aglutinação , Animais , Anticorpos Antibacterianos , Brasil/epidemiologia , Brucelose/complicações , Brucelose/epidemiologia , HIV , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Hospitais , Humanos , Leptospirose/complicações , Leptospirose/epidemiologia , Encaminhamento e Consulta , Fatores de Risco
8.
J Med Case Rep ; 15(1): 341, 2021 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-34243803

RESUMO

INTRODUCTION: Since its debut recognition in 1981, human immunodeficiency virus/acquired immunodeficiency syndrome has affected over 77 million people and has resulted in premature cessation of 35.4 million lives worldwide. Commonly, human immunodeficiency virus is transmitted by sexual contact across mucosal surfaces, by sharing of injecting equipment, through contaminated blood transfusions, and by maternal-infant exposure. Nevertheless, accidental transmission incidences involving family members are rare but possible. CASE PRESENTATION: A 78-year-old woman of African descent from Mtwara Region south of Tanzania was referred to us for further evaluation and treatment. She is 30 years postmenopausal and has a 35-year history of hypertension. Her last attendance to our institute was 11 months prior the index visit and she tested negative for human immunodeficiency virus. She came with complaints of weight loss, recurrent fevers, and cough. Her hematological tests revealed leukopenia with lymphocytosis, together with a normocytic normochromic anemia. Enzyme-linked immunosorbent assay for human immunodeficiency virus was positive, and she had a CD4 count of 177 cells/µL. We went back to history taking to identify the potential source of infection. We were informed that for the past 6 months, the 78-year-old lady has been living with her unwell 24-year-old granddaughter who has been divorced. The granddaughter had a history of recurrent fevers, significant weight loss, and a suppurative skin condition. As a way to show love and care, the old lady was puncturing the suppurative lesions with bare hands; then she would suck them to clear away the discharge. We requested to see the young lady, and she tested positive for human immunodeficiency virus. Both were started on tenofovir/lamivudine/dolutegravir combination plus cotrimoxazole 960 mg. The family was in total disarray following these findings. The patient was discharged through infectious diseases department and died of Pneumocystis jirovecii pneumonia 12 weeks later. CONCLUSIONS: Certain sociocultural norms that are believed to express love, care, and togetherness in developing rural communities, particularly Sub-Saharan Africa, have a potential of spreading human immunodeficiency virus, thus warranting prompt transformation.


Assuntos
Avós , Infecções por HIV , Adulto , Idoso , Contagem de Linfócito CD4 , Feminino , HIV , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Humanos , Tanzânia , Adulto Jovem
9.
Artigo em Inglês | MEDLINE | ID: covidwho-1259474

RESUMO

The study sought to determine the impact of COVID-19 on HIV/AIDS programming in the Kibera informal settlement and COVID-19 hotspot counties during the first wave of the pandemic. The study was conducted in two phases. The first phase entailed the analysis of HIV care and treatment secondary data (2018-2020) from the Kenya Health Information System. In the second phase, a prospective cohort study was conducted among people living with HIV in the Kibera informal settlement. A total of 176 participants aged 18 years and above accessing HIV services at selected healthcare facilities in Kibera were randomly sampled from facility electronic medical records and followed up for three months. Socio-demographics and contact details were abstracted from the records and telephone interviews were conducted with consenting participants. Results from the retrospective review of HIV program data indicated a 56% (p < 0.000, 95% CI: 31.3%-62.8%) reduction in uptake of HIV services. Clients starting antiretroviral therapy (ART) reduced significantly by 48% (p < 0.001, 95% CI: 35.4%-77%) in hotspot counties. However, pre-exposure prophylaxis uptake increased significantly by 24% (p < 0.019, 95% CI: 4%-49%). In Kibera, 14% reported missing medications at the onset of the COVID-19 pandemic because of lack of food (38%) and government measures (11%), which affected ART access; 11% did not access health facilities due to fear of contracting COVID-19, government regulations and lack of personal protective equipment. Socioeconomic factors, food insecurity and government measures affected uptake of HIV/AIDS services; hence, the need for scaling up measures to increase access to HIV/AIDS services during the onset of pandemics.


Assuntos
COVID-19 , Infecções por HIV , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Quênia/epidemiologia , Pandemias , Estudos Prospectivos , Estudos Retrospectivos , SARS-CoV-2
10.
Blood Adv ; 5(13): 2701-2706, 2021 07 13.
Artigo em Inglês | MEDLINE | ID: mdl-34196676

RESUMO

Betibeglogene autotemcel (beti-cel) gene therapy (GT) for patients with transfusion-dependent ß-thalassemia uses autologous CD34+ cells transduced with BB305 lentiviral vector (LVV), which encodes a modified ß-globin gene. BB305 LVV also contains select HIV sequences for viral packaging, reverse transcription, and integration. This case report describes a patient successfully treated with beti-cel in a phase 1/2 study (HGB-204; #NCT01745120) and subsequently diagnosed with wild-type (WT) HIV infection. From 3.5 to 21 months postinfusion, the patient stopped chronic red blood cell transfusions; total hemoglobin (Hb) and GT-derived HbAT87Q levels were 6.6 to 9.5 and 2.8 to 3.8 g/dL, respectively. At 21 months postinfusion, the patient resumed transfusions for anemia that coincided with an HIV-1 infection diagnosis. Quantitative polymerase chain reaction assays detected no replication-competent lentivirus. Next-generation sequencing confirmed WT HIV sequences. Six months after starting antiretroviral therapy, total Hb and HbAT87Q levels recovered to 8.6 and 3.6 g/dL, respectively, and 3.5 years postinfusion, 13.4 months had elapsed since the patient's last transfusion. To our knowledge, this is the first report of WT HIV infection in an LVV-based GT recipient and demonstrates persistent long-term hematopoiesis after treatment with beti-cel and the ability to differentiate between WT HIV and BB305-derived sequences.


Assuntos
Infecções por HIV , Talassemia beta , Terapia Genética , Vetores Genéticos/genética , Infecções por HIV/complicações , Infecções por HIV/terapia , Humanos , Lentivirus/genética , Talassemia beta/genética , Talassemia beta/terapia
11.
MMWR Morb Mortal Wkly Rep ; 70(26): 942-946, 2021 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-34197361

RESUMO

Male circumcision is an important preventive strategy that confers lifelong partial protection (approximately 60% reduced risk) against heterosexually acquired HIV infection among males (1). In Mozambique, the prevalence of male circumcision was 51% when the voluntary medical male circumcision (VMMC) program began in 2009. The Mozambique Ministry of Health set a goal of 80% circumcision prevalence among males aged 10-49 years by 2019 (2). CDC analyzed data from five cross-sectional surveys of the Chókwè Health and Demographic Surveillance System (CHDSS) to evaluate progress toward the goal and guide ongoing needs for VMMC in Mozambique. During 2014-2019, circumcision prevalence among males aged 15-59 years increased 42%, from 50.1% to 73.5% (adjusted prevalence ratio [aPR] = 1.42). By 2019, circumcision prevalence among males aged 15-24 years was 90.2%, exceeding the national goal (2). However, circumcision prevalence among males in older age groups remained below 80%; prevalence was 62.7%, 54.5%, and 55.7% among males aged 25-34, 35-44, and 45-59 years, respectively. A multifaceted strategy addressing concerns about the safety of the procedure, cultural norms, and competing priorities that lead to lack of time could help overcome barriers to circumcision among males aged ≥25 years.


Assuntos
Circuncisão Masculina/estatística & dados numéricos , Infecções por HIV/prevenção & controle , Programas Voluntários , Adolescente , Adulto , Infecções por HIV/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Moçambique/epidemiologia , Prevalência , Avaliação de Programas e Projetos de Saúde , Adulto Jovem
12.
BMC Infect Dis ; 21(1): 657, 2021 Jul 07.
Artigo em Inglês | MEDLINE | ID: mdl-34233630

RESUMO

BACKGROUND: HIV-positive patients are increasingly being affected by non-communicable diseases such as coronary artery disease (CAD). Data from high-income countries (HICs) indicate that HIV-positive patients have different risk-factor profiles for acute coronary syndrome (ACS) as well as different cardiac manifestations of this syndrome compared to HIV-negative patients. There is limited data from Sub-Saharan Africa (SSA), and particularly from South Africa with the biggest HIV epidemic in the world. The objective of this study was to determine the 12-month period prevalence of HIV in patients with ACS and to compare the risk-factor profile, ACS presentation and management between HIV-positive and HIV-negative adults. METHODS: We included all patients hospitalised with ACS from 01 January to 31 December 2018 in a tertiary hospital, Tygerberg Hospital, in Cape Town, South Africa. The HIV-status of all patients was determined using routine clinical records. We performed multiple conditional logistic regression on HIV-positive and HIV-negative patients (1:3 ratio) to compare the risk factor profile, ACS presentation and management between the groups. RESULTS: Among 889 patients, 30 (3.4%) were HIV-positive (95% confidence interval (CI): 2.3-4.8). HIV-positive patients were younger, more frequently men, and had a lower prevalence of medical comorbidities and a family history of CAD. They were more likely to present with ST-elevation myocardial infarction (STEMI) [odd's ratio (OR) (95% CI): 3.12 (1.2-8.4)], and have single-vessel disease [OR (95% CI): 3.03 (1.2-8.0)]. Angiographic and echocardiographic data, as well as management, did not differ between the groups. Among HIV-positive patients, 17 (65%) were virally suppressed (HIV viral load < 200 copies/mL) with a median CD4+ count of 271 cells/mm3. The majority (20, 67%) of HIV-positive patients were receiving antiretroviral therapy at the time of the ACS. CONCLUSIONS: We found an HIV-prevalence of 3.4% (95% CI 2.3-4.8) in adults with ACS in a high endemic HIV region. HIV-positive patients were younger and more likely to present with STEMIs and single-vessel disease, but had fewer CAD risk factors, suggesting additional mechanisms for the development of ACS.


Assuntos
Síndrome Coronariana Aguda/epidemiologia , Doença da Artéria Coronariana/epidemiologia , Infecções por HIV/epidemiologia , Síndrome Coronariana Aguda/terapia , Adulto , Idoso , Comorbidade , Estudos Transversais , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Fatores de Risco , África do Sul/epidemiologia
13.
BMC Infect Dis ; 21(1): 659, 2021 Jul 07.
Artigo em Inglês | MEDLINE | ID: mdl-34233631

RESUMO

BACKGROUND: Pneumocystis pneumonia (PCP) severely menaces modern chemotherapy and immunosuppression. Detailed description of the epidemiology of Pneumocystis jirovecii today is needed to identify candidates for PCP-prophylaxis. METHODS: We performed a 12-year retrospective study of patients with P. jirovecii detected by polymerase chain reaction in Central Norway. In total, 297 patients were included. Comprehensive biological, clinical and epidemiological data were abstracted from patients' medical records. Regional incidence rates and testing trends were also assessed. RESULTS: From 2007 to 2017 we found a 3.3-fold increase in testing for P. jirovecii accompanied by a 1.8-fold increase in positive results. Simultaneously, regional incidence rates doubled from 5.0 cases per 100,000 person years to 10.8. A majority of the study population had predisposing conditions other than human immunodeficiency virus (HIV). Hematological (36.0%) and solid cancers (25.3%) dominated. Preceding corticosteroids were a common denominator for 72.1%. Most patients (74.4%) presented with at least two cardinal symptoms; cough, dyspnea or fever. Main clinical findings were hypoxia, cytopenias and radiological features consistent with PCP. A total of 88 (29.6%) patients required intensive care and 121 (40.7%) suffered at least one complication. In-hospital mortality was 21.5%. Three patients (1.0%) had received prophylaxis. CONCLUSIONS: P. jirovecii is re-emerging; likely due to increasing immunosuppressants use. This opportunistic pathogen threatens the life of heterogenous non-HIV immunosuppressed populations currently at growth. Corticosteroids seem to be a major risk factor. A strategy to increase prophylaxis is called for.


Assuntos
Hospedeiro Imunocomprometido , Imunossupressores/administração & dosagem , Pneumocystis carinii/isolamento & purificação , Pneumonia por Pneumocystis/diagnóstico , Pneumonia por Pneumocystis/mortalidade , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Idoso , Feminino , Infecções por HIV/epidemiologia , Neoplasias Hematológicas/epidemiologia , Mortalidade Hospitalar , Humanos , Imunossupressores/uso terapêutico , Incidência , Masculino , Pessoa de Meia-Idade , Noruega/epidemiologia , Pneumocystis carinii/genética , Pneumonia por Pneumocystis/microbiologia , Reação em Cadeia da Polimerase , Estudos Retrospectivos , Fatores de Risco
14.
BMC Infect Dis ; 21(1): 655, 2021 Jul 07.
Artigo em Inglês | MEDLINE | ID: mdl-34233649

RESUMO

BACKGROUND: Macrophages, besides resting latently infected CD4+ T cells, constitute the predominant stable, major non-T cell HIV reservoirs. Therefore, it is essential to eliminate both latently infected CD4+ T cells and tissue macrophages to completely eradicate HIV in patients. Until now, most of the research focus is directed towards eliminating latently infected CD4+ T cells. However, few approaches have been directed at killing of HIV-infected macrophages either in vitro or in vivo. HIV infection dysregulates the expression of many host genes essential for the survival of infected cells. We postulated that exploiting this alteration may yield novel targets for the selective killing of infected macrophages. METHODS: We applied a pooled shRNA-based genome-wide approach by employing a lentivirus-based library of shRNAs to screen novel gene targets whose inhibition should selectively induce apoptosis in HIV-infected macrophages. Primary human MDMs were infected with HIV-eGFP and HIV-HSA viruses. Infected MDMs were transfected with siRNAs specific for the promising genes followed by analysis of apoptosis by flow cytometry using labelled Annexin-V in HIV-infected, HIV-exposed but uninfected bystander MDMs and uninfected MDMs. The results were analyzed using student's t-test from at least four independent experiments. RESULTS: We validated 28 top hits in two independent HIV infection models. This culminated in the identification of four target genes, Cox7a2, Znf484, Cstf2t, and Cdk2, whose loss-of-function induced apoptosis preferentially in HIV-infected macrophages. Silencing these single genes killed significantly higher number of HIV-HSA-infected MDMs compared to the HIV-HSA-exposed, uninfected bystander macrophages, indicating the specificity in the killing of HIV-infected macrophages. The mechanism governing Cox7a2-mediated apoptosis of HIV-infected macrophages revealed that targeting respiratory chain complex II and IV genes also selectively induced apoptosis of HIV-infected macrophages possibly through enhanced ROS production. CONCLUSIONS: We have identified above-mentioned novel genes and specifically the respiratory chain complex II and IV genes whose silencing may cause selective elimination of HIV-infected macrophages and eventually the HIV-macrophage reservoirs. The results highlight the potential of the identified genes as targets for eliminating HIV-infected macrophages in physiological environment as part of an HIV cure strategy.


Assuntos
Apoptose/genética , Proteínas de Fluorescência Verde , Infecções por HIV , Macrófagos , RNA Interferente Pequeno , Linfócitos T CD4-Positivos/virologia , Estudo de Associação Genômica Ampla , Infecções por HIV/genética , Infecções por HIV/virologia , HIV-1/fisiologia , Humanos , Linfócitos T
15.
Front Cell Infect Microbiol ; 11: 701913, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34262882

RESUMO

Increasing attention has been directed to Talaromyces marneffei (T. marneffei) infection in HIV-negative patients due to its high mortality rate. However, nonspecific symptoms and biological characteristics similar to those of other common pathogenic fungi complicate the rapid and accurate diagnosis of T. marneffei infection. Sphingolipids (SPLs) are bioactive lipids involved in the regulation of various physiological and pathological processes and have been identified as serum biomarkers for several diseases. This study employed a sphingolipidomic approach established in our previous work to explore the use of serum SPLs in the diagnosis of HIV-negative patients with T. marneffei infection. Additional clinical cohorts of patients infected with other microorganisms were also recruited. We found that sphinganine (Sa) (d16:0) exhibited obvious depletion after infection; moreover, its level in patients with T. marneffei infection was significantly lower than that in patients infected with other microorganisms. Therefore, Sa (d16:0) was considered a specific diagnostic biomarker for T. marneffei infection, and 302.71 nM was selected as the optimal cutoff value with a diagnostic sensitivity of 87.5% and specificity of 100%. These results suggested that determination of serum Sa (d16:0) levels can be used as a new alternative tool for the rapid diagnosis of T. marneffei infection in HIV-negative patients.


Assuntos
Infecções por HIV , Talaromyces , Adulto , Infecções por HIV/complicações , Infecções por HIV/diagnóstico , Humanos , Micoses , Esfingolipídeos
16.
Artigo em Inglês | MEDLINE | ID: covidwho-1295818

RESUMO

BACKGROUND: Many countries around the world are currently threatened by the COVID-19 pandemic, and nurses are facing increasing responsibilities and work demands related to infection control. To establish a developmental strategy for infection control, it is important to analyze, understand, or visualize the accumulated data gathered from research in the field of nursing. METHODS: A total of 4854 articles published between 1978 and 2017 were retrieved from the Web of Science. Abstracts from these articles were extracted, and network analysis was conducted using the semantic network module. RESULTS: 'wound', 'injury', 'breast', "dressing", 'temperature', 'drainage', 'diabetes', 'abscess', and 'cleaning' were identified as the keywords with high values of degree centrality, betweenness centrality, and closeness centrality; hence, they were determined to be influential in the network. The major topics were 'PLWH' (people living with HIV), 'pregnancy', and 'STI' (sexually transmitted infection). CONCLUSIONS: Diverse infection research has been conducted on the topics of blood-borne infections, sexually transmitted infections, respiratory infections, urinary tract infections, and bacterial infections. STIs (including HIV), pregnancy, and bacterial infections have been the focus of particularly intense research by nursing researchers. More research on viral infections, urinary tract infections, immune topic, and hospital-acquired infections will be needed.


Assuntos
COVID-19 , Infecções por HIV , Pesquisa em Enfermagem , Doenças Sexualmente Transmissíveis , Feminino , Infecções por HIV/epidemiologia , Humanos , Pandemias , Gravidez , SARS-CoV-2 , Web Semântica , Doenças Sexualmente Transmissíveis/epidemiologia
17.
Viruses ; 13(7)2021 06 29.
Artigo em Inglês | MEDLINE | ID: mdl-34209711

RESUMO

In stark contrast to the rapid development of vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), an effective human immunodeficiency virus (HIV) vaccine is still lacking. Furthermore, despite virologic suppression and CD4 T-cell count normalization with antiretroviral therapy (ART), people living with HIV (PLWH) still exhibit increased morbidity and mortality compared to the general population. Such differences in health outcomes are related to higher risk behaviors, but also to HIV-related immune activation and viral coinfections. Among these coinfections, cytomegalovirus (CMV) latent infection is a well-known inducer of long-term immune dysregulation. Cytomegalovirus contributes to the persistent immune activation in PLWH receiving ART by directly skewing immune response toward itself, and by increasing immune activation through modification of the gut microbiota and microbial translocation. In addition, through induction of immunosenescence, CMV has been associated with a decreased response to infections and vaccines. This review provides a comprehensive overview of the influence of CMV on the immune system, the mechanisms underlying a reduced response to vaccines, and discuss new therapeutic advances targeting CMV that could be used to improve vaccine response in PLWH.


Assuntos
Coinfecção/virologia , Infecções por Citomegalovirus/virologia , Citomegalovirus/imunologia , Infecções por HIV/virologia , Vacinas/imunologia , Animais , Fármacos Anti-HIV/uso terapêutico , Ensaios Clínicos como Assunto , Citomegalovirus/patogenicidade , Infecções por Citomegalovirus/tratamento farmacológico , Infecções por Citomegalovirus/imunologia , Trato Gastrointestinal/imunologia , Trato Gastrointestinal/patologia , Trato Gastrointestinal/virologia , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Infecções por HIV/imunologia , Humanos , Imunossenescência , Inflamação , Infecção Latente/imunologia , Infecção Latente/virologia , Camundongos , Vacinas/administração & dosagem
18.
Reprod Health ; 18(1): 148, 2021 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-34246286

RESUMO

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


Assuntos
Comunicação , Infecções por HIV/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Terapia Antirretroviral de Alta Atividade , Criança , Países Desenvolvidos , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Pesquisa Qualitativa
19.
BMC Health Serv Res ; 21(1): 685, 2021 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-34247604

RESUMO

BACKGROUND: In sub-Saharan Africa, there is increasing mortality and morbidity of adolescents due to poor linkage, retention in HIV care and adherence to antiretroviral therapy (ART). This is a result of limited adolescent-centred service delivery interventions. This cost-effectiveness and feasibility study were piggybacked on a cluster-randomized trial that assessed the impact of an adolescent-centred service delivery intervention. The service delivery intervention examined the impact of an incentive scheme consisting of conditional economic incentives and motivational interviewing on the health outcomes of adolescents living with HIV in Nigeria. METHOD: A cost-effectiveness analysis from the healthcare provider's perspective was performed to assess the cost per additional patient achieving undetected viral load through the proposed intervention. The cost-effectiveness of the incentive scheme over routine care was estimated using the incremental cost-effectiveness ratio (ICER), expressed as cost/patient who achieved an undetectable viral load. We performed a univariate sensitivity analysis to examine the effect of key parameters on the ICER. An in-depth interview was conducted on the healthcare personnel in the intervention arm to explore the feasibility of implementing the service delivery intervention in HIV treatment hospitals in Nigeria. RESULT: The ICER of the Incentive Scheme intervention compared to routine care was US$1419 per additional patient with undetectable viral load. Going by the cost-effectiveness threshold of US$1137 per quality-adjusted life-years suggested by Woods et al., 2016, the intervention was not cost-effective. The sensitivity test showed that the intervention will be cost-effective if the frequency of CD4 count and viral load tests are reduced from quarterly to triannually. Healthcare professionals reported that patients' acceptance of the intervention was very high. CONCLUSION: The conditional economic incentives and motivational interviewing was not cost-effective, but can become cost-effective if the frequency of HIV quality of life indicator tests are performed 1-3 times per annum. Patients' acceptance of the intervention was very high. However, healthcare professionals believed that sustaining the intervention may be difficult unless factors such as government commitment and healthcare provider diligence are duly addressed. TRIAL REGISTRATION: This trial is registered in the WHO International Clinical Trials Registry through the WHO International Registry Network ( PACTR201806003040425 ).


Assuntos
Fármacos Anti-HIV , Infecções por HIV , Entrevista Motivacional , Adolescente , Fármacos Anti-HIV/uso terapêutico , Análise Custo-Benefício , Estudos de Viabilidade , Infecções por HIV/tratamento farmacológico , Humanos , Motivação , Nigéria , Avaliação de Resultados em Cuidados de Saúde , Qualidade de Vida
20.
Georgian Med News ; (314): 56-63, 2021 May.
Artigo em Russo | MEDLINE | ID: mdl-34248028

RESUMO

Oral manifestations of HIV infection are diverse and not still not completely studied. HIV-associated diseases can occur as the first symptoms of infection, these are characterized by high frequency, clinical polymorphism and pronounced course. Periodontal aspects are also neglected in the literature. No papers on the condition of different areas of the oral mucosa, tongue and periodontium where they were studied simultaneously and according to various criteria have been found in the available literature. The objective of the research is to evaluate the condition of periodontium and the oral mucosa in different parts of the oral cavity in HIV-positive patients. Total number of the HIV-positive patients observed was 90, among them 81 males and 9 females between the age range of 24-62. An average age of the patients was 45.2±8.34, with male patients prevailing (p<0.001). HIV infection was diagnosed by Western-blot reaction. Clinical examination as well as probing and determination of the pocket depth by means of the periodontal probe was carried out to assess the health status of the oral cavity. Periodontal indices were also determined. It has been found that immunocompromised condition due to HIV infection contributes to the oral mucosa lesions. Namely, coated tongue was observed in 100% of cases, the oral mucosa relief impairment was seen in 75.6% of cases, lip cracks of different location and bright red color of the mucous membrane were observed in 73.3% and 82.2%, respectively (р<0.001). Examination of the tongue revealed the symptoms which were not found in the control group, such as tongue coating - in 100% (90 patients observed), epithelial desquamation foci - in 54.4% (49) (p<0.001). Inflammatory diseases of periodontium, particularly catarrhal and hypertrophic gingivitis and periodontitis of moderate severity were also revealed.


Assuntos
Gengivite , Infecções por HIV , Periodontite , Feminino , Gengivite/complicações , Gengivite/epidemiologia , Infecções por HIV/complicações , Humanos , Masculino , Saúde Bucal , Periodonto
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