AIDS Research and Treatment最新文献

Background: Second-generation HIV-1 integrase strand transfer inhibitors (INSTIs)-bictegravir (BIC), cabotegravir (CAB), and dolutegravir (DTG)-are leading components of highly potent antiretroviral therapy, and CAB is also used for long-acting chemoprevention. Rapid detection of clinically relevant INSTI concentrations could support point-of-care assessment and real-time clinical decision-making. We developed a lateral flow assay (LFA) that detects BIC, CAB, and DTG in whole blood and plasma and evaluated its performance against predefined concentration thresholds and high-performance liquid chromatography-tandem mass spectrometry (LC-MS/MS).

Methods: A single LFA cassette design was developed using a monoclonal antibody to distinguish BIC, CAB, and DTG concentrations below trough, at minimal-to-moderate trough, and at ideal concentrations. LFA results were read visually at 20 min and were compared with LC-MS/MS-quantified INSTI concentrations for 124 clinical plasma specimens.

Results: For 24 plasma samples from US participants receiving treatment involving one of the three INSTIs, the LFA interpretations matched all LC-MS/MS results except for one DTG specimen, which was interpreted by LFA as 1.0-1.6 μg/mL but measured 2.1 μg/mL by LC-MS/MS. Among 100 plasma remnants from routine national surveillance in Eswatini, the LFA correctly interpreted DTG concentrations in 95 specimens. Four specimens had DTG LC-MS/MS concentrations slightly above the LFA-determined range, differing by ≤ 0.1 μg/mL, and one specimen measured at 1.20 μg/mL by LC-MS/MS was interpreted as ≥ 1.6 μg/mL by LFA. In total, 6 of 124 specimens (4.8%) had LFA-interpreted INSTI concentrations that varied slightly from the LC-MS/MS results, with no statistically significant difference in overall performance by Wilcoxon signed-rank test (W = 8.00, p = 0.94, one-tailed).

Conclusions: The LFA design successfully provided clinically useful interpretations of BIC, CAB, and DTG concentrations with minor discrepancies in < 5% of samples. Importantly, all low-concentration samples of < 1 μg/mL were correctly interpreted by LFA. The assay shows promise as a point-of-care tool for assessing clinically relevant INSTI concentrations.

Background: Depression is common among older adults living with HIV (OLHIV) and is associated with poor antiretroviral adherence and higher viral load. Despite the importance of addressing psychological health issues in older people living with HIV, there is a paucity of tailored depression interventions for low-resource settings. Although the stepped-care task-sharing (SCT) intervention model is effective for depression in low-resource settings, it has not been applied to this population. This study examined preimplementation requirements for piloting a SCT model for depression among OLHIV in a government-funded clinic in Southwest Nigeria.

Methods: We conducted a qualitative preimplementation study, guided by the Consolidated Framework for Implementation Research (CFIR), to assess the contextual fit and feasibility of integrating a SCT intervention for depression into routine HIV services. In-depth interviews were conducted with healthcare providers and older adults with HIV at the Infectious Disease Institute, Ibadan, Nigeria. Data were analyzed using rapid qualitative methods to identify CFIR-informed barriers, facilitators, and adaptation needs to guide intervention refinement prior to pilot testing.

Results: Twenty-two interviews were conducted with healthcare providers (n = 11) and OLHIV (n = 11), each lasting 30-45 min. Findings indicated that the SCT intervention was perceived as feasible, supported by staff willingness and existing clinic structures that could be leveraged during pilot testing. Key barriers to implementation included high workload, limited provider training, stigma, discontinuity of care, and financial constraints. Facilitators included organizational readiness and high acceptability among service users.

Conclusion: The SCT model is perceived as acceptable and potentially feasible for integrating depression care into HIV services for OLHIV. However, it requires adaptation into existing workflows, provider capacity, and patient follow-up routines. Findings provide insights to refine the intervention processes in preparation for pilot testing and integration of psychological healthcare into HIV services.

Background: People living with HIV (PLWHA) may experience increased vulnerability to SARS-CoV-2 infection and severe COVID-19 due to immune dysregulation, comorbidities, and treatment adherence challenges. Kenya has over 1.4 million PLWHA. However, only a few have been reported with severe COVID-19, suggesting potential protective roles of antiretroviral therapy (ART), management of comorbidities, and COVID-19 vaccination.

Methods: This study was conducted across high HIV-prevalence regions in Kenya (Nakuru, Malindi/Mariakani, and Kisumu). A cross-sectional survey evaluates clinical characteristics and self-reported COVID-19 vaccination outcomes among 303 PLWHA. Quantitative data were collected through structured questionnaires and clinical records. Associations between ART, immune markers (CD4/CD8 counts; viral load), COVID-19 vaccination, and SARS-CoV-2 infection and severity were tested using Chi-square and Fisher's exact tests.

Results: An analysis of 303 participants (70.6% female, median age 40) revealed an 86.5% COVID-19 vaccination rate and 94.1% ART adherence. Only 9.2% reported prior SARS-CoV-2 infection, mostly mild, potentially indicating underreporting or asymptomatic cases. Interestingly, missing ART doses were significantly associated with contracting SARS-CoV-2 (p = 0.03). Furthermore, all participants reporting or demonstrating SARS-CoV-2 infection were vaccinated, compared to 85.1% of uninfected participants (p = 0.014). Due to incomplete health records, data for CD4 counts were available for only 7.6% of participants (n = 23), limiting conclusions regarding immune dysregulation.

Conclusion: Low COVID-19 rates were observed. All cases occurred in vaccinated participants, likely reflecting health-seeking bias rather than vaccine failure. Missing ART doses were significantly associated with infection. Optimal risk mitigation requires integrated strategies prioritizing both high vaccine coverage and strict ART adherence.

Introduction: Sustained adherence to antiretroviral therapy (ART) is critical for managing HIV, yet side effects and food insecurity present significant barriers in resource-limited settings. While the role of formal support is recognized, the use of indigenous knowledge and food-based coping mechanisms remains an underdocumented facet of self-management. This study explored how individuals in Ghana utilize local foods and cultural knowledge to manage ART side effects and support adherence.

Methods: A qualitative descriptive study was conducted at the Cape Coast Teaching Hospital. Through semistructured in-depth interviews (n = 20) and one focus group discussion (n = 5) with adults on ART for at least 6 months, we collected rich, experiential data. Participants were purposively sampled, and data collection continued until thematic saturation was achieved. Thematic analysis was employed to identify patterns and themes related to food-based coping strategies.

Results: Analysis revealed that participants strategically employed indigenous knowledge, using specific local foods as active agents to manage side effects. Ginger tea was used to combat nausea, while avocado and groundnuts served as a protective stomach buffer. The timing of medication was often deliberately aligned with meals, with participants delaying doses if food was unavailable to avoid distress. These practices were deeply pragmatic, relying on affordable staples like gari (cassava flour) and yams, and were seamlessly integrated into daily routines. While these strategies demonstrated significant patient agency and resilience, they were also born from necessity, often representing suboptimal adaptations to food insecurity and poverty.

Conclusion: Indigenous knowledge provides a crucial, culturally resonant toolkit for managing ART side effects and facilitating adherence. Healthcare systems should move beyond generic instructions to formally recognize, validate, and integrate these patient-derived strategies into adherence counseling and peer support, fostering a more holistic and effective model of HIV care that bridges biomedical and indigenous knowledge systems.

People living with HIV (PLHIV) are at increased risk of liver and kidney dysfunction due to chronic HIV infection, long-term antiretroviral therapy (ART), and persistent immune activation. However, age-related differences in organ function and treatment outcomes remain insufficiently characterized in African settings. This study aimed to assess age-related differences in liver and renal function among PLHIV in Ghana to identify patterns of organ dysfunction across different age groups. This multicenter cross-sectional study included 558 PLHIV aged 10-76 years receiving ART, of whom 96.4% were on dolutegravir-based regimens. Renal function was assessed using serum urea, creatinine, urea-to-creatinine ratio, and estimated glomerular filtration rate (eGFR). Liver function was assessed using AST/ALT ratios, hepatotoxicity grading, and fibrosis indices (APRI, FIB-4), while virologic outcomes were assessed using HIV viral load measurements. A composite renal-hepatic-virologic abnormality score was developed based on reduced kidney function (eGFR < 60 mL/min/1.73 m²), elevated AST/ALT ratio (> 1), and unsuppressed viral load (≥ 1000 copies/mL). Data were analyzed using STATA, with p < 0.05 considered statistically significant. Renal, hepatic, and virologic parameters showed significant variation across age groups. Older participants, particularly those aged ≥ 60 years, had lower mean eGFR values (60.32 ± 17.17 mL/min/1.73 m²; p < 0.001), while adolescents aged 13-19 years had the highest frequency of virological failure (22.22%; p < 0.001). The composite renal-hepatic-virologic abnormality score differed significantly across age groups (p < 0.001), with adolescents aged 13-19 years having higher odds of a greater abnormality score compared with children aged ≤ 12 years (aOR = 3.15, 95% CI: 1.23-8.08; p = 0.017). In conclusion, age-related differences were observed in renal, hepatic, and virologic abnormalities among PLHIV in Ghana. These findings support the need for age-tailored biochemical monitoring and further longitudinal studies to clarify temporal relationships between aging and organ function in PLHIV.

Until now, human immunodeficiency virus type 1 infection monitoring is based on plasma viral load and cluster of differentiation (CD)4-positive cells from thymus (CD4+ T cells) count. However, it is increasingly accepted that this biological monitoring should be strengthened with other markers that would reinforce the management. Therefore, we addressed this task by assessing the risk associated with therapeutic failure/success linked to the dynamic of immunological parameters in people living with HIV-1 (PLHIV-1) and on antiretroviral therapy (ART) in order to identify their prognostic values. Ninety enrolled PLHIV-1 were classified according to their therapeutic status. Twenty healthy persons were also recruited as a control group. Serum cytokine levels and immune cell frequencies were determined, and the risk of therapeutic failure associated with immunological parameters was assessed. We observed low frequencies of CD4+ T, natural killer (NK), natural killer T (NKT) cells, classical monocytes, nonclassical monocytes, granulocytes, and high frequency of CD8+ T cells in all PLHIV-1 groups in treatment failure under dolutegravir (DTG) and efavirenz (EFV) regimens compared to control participants. Moreover, interferon-gamma (IFN-γ) levels decreased in PLHIV-1 with therapeutic success under the DTG regimen, while interleukin-4 (IL-4) increased in treatment success under the EFV regimen. Proinflammatory tumor necrosis factor-alpha (TNF-α), IL-6, and IL-7 significantly increased in therapeutic failure groups under both regimens. IL-5 concentrations increased in all PLHIV-1, while IL-13 levels did not change. Logistic regression analysis revealed a positive correlation between the risk of treatment failure and proinflammatory cytokines IFN-γ, TNF-α, IL-6, IL-7, eosinophils, and CD8+ T cells in PLHIV-1 under EFV and DTG regimes. In contrast, the risk of therapeutic failure decreased with increasing numbers of CD4+ T cells, neutrophils, and the anti-inflammatory IL-4 in PLHIV-1 treated with the same antiretroviral molecules. Collectively, these results indicated that pro- and anti-inflammatory cytokines and immune cells could serve as prognostic factors for monitoring HIV-1 disease progression and response to ART. However, further studies with a larger sample size would be needed to confirm our data.

Background: Dyslipidemia is a common metabolic complication among people living with HIV and a major contributor to cardiovascular morbidity and mortality. However, it remains insufficiently characterized in Ethiopia, particularly in contemporary urban ART settings.

Methods: We conducted a facility-based cross-sectional study among 398 patients selected by systematic random sampling from November 1 to December 31, 2025. Data were collected using a structured data collection tool, entered into KoboToolbox, and analyzed in SPSS Version 27. Bivariable and multivariable logistic regression analyses were used to identify factors associated with dyslipidemia. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated, and p < 0.05 was considered statistically significant.

Results: The median age of participants was 50 years (IQR: 42-56), and 66.8% (n = 266) were female. The median duration since HIV diagnosis was 19 years (IQR: 15-20). Predominant regimens included TDF+3TC+ DTG (72.8%). The prevalence of dyslipidemia was 65.3% (95% CI: 60.5-70.1), with elevated triglycerides (37.2%), total cholesterol (34.7%), high LDL-C (34.2%), and low HDL-C (28.1%). On multivariable analysis, dyslipidemia was significantly associated with history of ART change (AOR 2.62, 95% CI: 1.13-6.04), hypertension (AOR 2.45, 95% CI: 1.28-4.69), overweight (AOR 3.56, 95% CI: 1.44-8.81), obesity (AOR 5.15, 95% CI: 1.16-22.82), and sedentary and moderate physical activity (AOR 9.46, 95% CI: 2.46-36.32 and AOR 3.80, 95% CI: 1.77-8.18, respectively).

Conclusion: Dyslipidemia was prevalent among approximately two in three HIV-positive patients receiving long-term ART at two tertiary hospitals in Addis Ababa, Ethiopia. These findings highlight the need for routine lipid monitoring and integrated cardiovascular risk management within HIV care settings in similar urban, tertiary-care contexts.

Objective: To analyze the clinical characteristics of patients with acute immunodeficiency syndrome (AIDS) combined with Talaromyces marneffei (TM) infection of the central nervous system (CNS), thereby improving awareness toward early diagnosis and treatment.

Methods: The clinical data of eight patients with AIDS who were treated for CNS TM infection in the Guiyang Public Health Treatment Center from May 2021 to November 2022 were retrospectively analyzed.

Results: The median age of the patients was 43.50 (range: 35.00-58.00) years, and all eight were male. TM infection was confirmed via metagenomic next-generation sequencing (mNGS) in three cases, positive cerebrospinal fluid (CSF) cultures of TM in four cases, and both in one case. CSF and blood cultures were both positive for one patient, whereas multiple blood cultures were negative for the other seven. The number of nucleated cells and the protein level in the CSF were elevated in five and six patients, respectively, and the CSF levels of glucose and chloride were low in four patients each. Seven patients had intracranial lesions upon head imaging, and all eight were discharged from the hospital with improvement after antifungal treatment. The median CD4+ T-cell count was 58.50/μL (range: 39.00-73.00/μL), indicating severe immunosuppression.

Conclusion: The clinical characteristics and CSF-related examinations of patients with AIDS combined with CNS TM infection are not distinct, complicating diagnosis and increasing the likelihood of misdiagnosis. Early diagnosis and systemic antifungal therapy can improve patients' prognosis.

[This corrects the article DOI: 10.1155/arat/6901278.].

Background: Advanced HIV disease (AHD) remains a major contributor to HIV-related morbidity and mortality. While HIV screening strategies in Brazil emphasize populations traditionally considered at high risk, a significant number of individuals without previous HIV infection present with AHD despite lacking recognized risk profiles. This study aimed to define the sociodemographic and behavioral characteristics of patients presenting with advanced HIV at diagnosis, with the goal of identifying gaps in current HIV screening efforts.

Methods: We conducted a retrospective cohort study of patients hospitalized in the infectious diseases ward of a tertiary referral hospital between January 2015 and December 2024. We included individuals previously unaware of their HIV status who met World Health Organization (WHO) criteria for AHD, defined as CD4 count < 200 cells/mm³ and/or a WHO Clinical Stage 3 or 4 condition. Sociodemographic characteristics, behavioral risk factors, and clinical data were abstracted from medical records and standardized epidemiologic intake forms. Descriptive analyses compared characteristics across sexuality and gender groups.

Results: Among 1615 unique patients hospitalized with AHD, 407 (25%) were newly diagnosed with HIV during hospitalization. The median CD4 count at diagnosis was 53 cells/mm³ (IQR 27-110), reflecting profound immunosuppression. Most patients identified as heterosexual men (49%), while only 10% identified as sexual or gender minorities. Fewer than one-quarter (24%) had psychosocial risk factors commonly emphasized in HIV screening strategies. Heterosexual men were predominantly employed, married or partnered, and had children, while women and sexual and gender minority patients were older and younger, respectively, and reported fewer risk factors. Injection drug use history and homelessness were rare across all groups.

Conclusions: AHD at first diagnosis was not concentrated within traditionally recognized high-risk populations. The diversity of patients presenting with AHD at first diagnosis suggests that reliance solely on traditional risk-based screening strategies may be insufficient to ensure timely detection. Expanded routine, opt-out HIV testing across healthcare settings, as well as indicator-based testing, self-testing, and pharmacy-based testing may help reduce missed opportunities for diagnosis and prevent severe immunosuppression.