Vulnerability of the Brazilian LGBT population in HIV treatment

INTRODUCTION

Human immunodeficiency virus (HIV) infection affects the lesbian, gay, bisexual, transvestite, and transsexual (LGBT) population. We aimed to identify the indidual vulnerability profile of the LGBT population ling with H/acquired immunodeficiency syndrome (AIDS) and correlate it with the treatment situation.

METHODOLOGY

This cross-sectional study included 510 LGBT people living with HIV (PLHIV)/AIDS who attended the Complex of Chronic Communicable Diseases of the municipality of São José do Rio Preto, São Paulo, Brazil, between 2008 and 2015.

RESULTS

There was a predominance of indiduals who were white (70.2%), male (98.4%), single (87.1%), aged 25-44 years (70.0%), educated up to high school (47.7%), economically acte (91.2%), under treatment (80.8%), having CD4 > 350 cells/mm3 (77.1%), and having undetectable viral load (53.3%). HIV transmission was mainly sexual (97.0%) and most people used drugs (76.5%). There was a weak correlation between the variables 'in treatment' and acte occupation (r = 0.148, p = 0.001), single marital status (r = 0.128, p = 0.004), white race/colour (r = 0.117, p = 0.008), high school education (r = 0.111, p = 0.012), sexual transmission (r = 0.222, p = 0.000), drug use (r = 0.087, p = 0.049), and CD4 > 350 cells/mm3 (r = 0.118, p = 0.008); and strong correlation between the variables 'in treatment' and undetectable viral load (r = -0.937, p = 0.113).

CONCLUSIONS

The characteristics of the indidual vulnerability of LGBT people involve, among other aspects, issues of gender and social exclusion, a situation that is part of the daily life of PLHIV/AIDS in many scenarios and territories. This can be alleviated with a network of social and health support and effecte and efficient, protecte, attitudinal, and behavioural public policies.

Assessing the Vulnerability and Risks of Adolescent Girls and Young Women in East and Southern Africa: A Preliminary Review of the Tools in Use

The sexual and reproductive health (SRH) needs of adolescent girls and young women (AGYW) aged 10–24 years remain a cause for concern in the countries of East and Southern Africa (ESA). High rates of adolescent pregnancy and HIV prevalence prevail, and prevention programmes are challenged to identify those at greatest risk. This review aimed to identify tools being used in ESA countries that support the recording of factors that make AGYW vulnerable to SRH risks and document their use. A mixed-methods approach was used to find available English language tools that had been designed to assess the vulnerability of AGYW SRH risks including literature reviews and key informant interviews with thirty-five stakeholders. Twenty-two tools were identified, and experiences of their use obtained through the interviews. All but one tool focused on HIV prevention, and most aimed at establishing eligibility for programmes, though not aligned with programme type. Analyses of the content of seventeen tools showed information collection related to behavioral, biological, and structural risk factors of HIV and other aspects of AGYWs’ lives. There was considerable diversity in the ways in which these questions were framed. Aspects of the processes involved in undertaking the risk and vulnerability assessments are presented.

Sleep state misperception: is there a CNS structural source?

Introduction

We describe a case of sleep state misperception in a patient with a neurotoxoplasmosis lesion in the left nucleocapsular region.

Case report

A 40-year-old female patient presented relating sleeplessness over the past 2 years, concurrent with progressive headaches, dizziness and motor and sensory deficits in the right upper and lower limbs. She had a history of AIDS, on irregular antiretroviral therapy and neurotoxoplasmosis. A polysomnography confirmed the hypothesis of sleep state misperception, and magnetic resonance imaging revealed a residual lesion in the left nucleocapsular region.

Conclusion

Different models consider that the sleep state misperception could be correlated to structural abnormalities of the central nervous system. A recent study showed that the medial prefrontal cortex had a lower activation in patients with unrefreshing sleep due to chronic fatigue syndrome. This case report highlights the possibility of sleep state misperception having - at least partially - an anatomical substrate in the left nucleocapsular region.

Liver function test abnormalities in a longitudinal cohort of Thai individuals treated since acute HIV infection

INTRODUCTION

Liver disease is a common cause of non-AIDS morbidity and mortality in people living with HIV (PLHIV), but the prevalence and significance of liver function test (LFT) abnormalities in early HIV infection is unknown. This study aimed to characterize LFTs in a large cohort of participants with acute HIV infection initiating immediate antiretroviral therapy (ART) and examine the association between LFTs and biomarkers of HIV infection and inflammation.

METHODS

We measured LFTs at the time of HIV diagnosis and at 4, 12, 24 and 48 weeks after ART initiation in 426 Thai individuals with acute HIV infection from 2009 to 2018. A subset of individuals had data available at 96 and 144 weeks. We excluded individuals with concomitant viral hepatitis. Alanine aminotransferase (ALT) was the primary outcome of interest; values greater than 1.25 times the upper limit of normal were considered elevated. Analyses utilized descriptive statistics, non-parametric tests and multivariate logistic regression.

RESULTS

Sixty-six of the 426 individuals (15.5%) had abnormal baseline ALT levels; the majority (43/66, 65.5%) had Grade 1 elevations. Elevated baseline ALT correlated with Fiebig stages III to V (p = 0.001) and baseline HIV RNA >6 log₁₀ copies/mL (p = 0.012). Baseline elevations resolved by 48 weeks on ART in 59 of the 66 individuals (89%). ALT elevations at 24 and 48 weeks correlated with Fiebig stages I to II at diagnosis (p < 0.001), baseline plasma HIV RNA levels <6 log₁₀ copies/mL (p < 0.001), abnormal baseline ALT (p < 0.001), baseline CD4 >350 cells/μL (p = 0.03) and older age (p = 0.03). Individuals initiating efavirenz-based regimens were more likely to have elevated ALT levels at 48 weeks compared with those on non-efavirenz-based regimens (p = 0.003).

CONCLUSIONS

One in six people with acute HIV infection have elevated LFTs. Clinical outcomes with ART started in acute HIV are generally good, with resolution of ALT elevations within 48 weeks on ART in most cases. These results suggest a multifactorial model for hepatic injury involving a combination of HIV-associated and ART-associated processes, which may change over time.

Learning from combination HIV prevention programmes to face COVID-19 emerging pandemic

Before a vaccine against SARS-CoV-2 became available, several measures to control COVID-19 pandemic are necessary. Analogously, in the absence of an available vaccine, Combination HIV Prevention Programmes have consolidated a large experience of biomedical, behavioral and structural interventions suitable for several epidemiological settings. Adaptation of such experiences can organize mid-term and long-term responses to face COVID-19.

Prevalence of hearing loss and tinnitus in a group of adults with Human Immunodeficiency Virus

Background

The Human Immunodeficiency Virus (HIV) has become a global pandemic. With the improvement of antiretroviral (ARV) treatment regimens, life-expectancy of HIV-positive individuals has increased. HIV literature suggests that head and neck manifestations may be the first indication of supressed immunity. Therefore, research regarding the effects of HIV and new treatment regimens on auditory function remains a priority.

Objectives

To describe the audiological characteristics and determine the prevalence of hearing loss and tinnitus in a group of HIV-positive individuals on ARV treatment residing in a rural province.

Methods

The study employed a cross-sectional descriptive research design. Participants were recruited from the clinic and pharmacy waiting areas of a medical centre in a rural area of Limpopo province, South Africa. Two participant groups, an HIV-positive group (N₁ = 60) and an HIV-negative group (N₂ = 32) were included in the study. The test battery comprised a comprehensive case history and a routine audiological test battery, which included otoscopy, tympanometry and pure tone audiometry (250 Hz to 8000 Hz).

Results

No statistically significant difference was found regarding the prevalence of hearing loss in the two participant groups (p = 0.709). However, the prevalence of tinnitus was significantly higher in the HIV-positive group (p = 0.05).

Conclusion

The insignificant difference in the audiological test battery results found between the two participant groups may be due to improved ARV treatment regimens and management strategies employed at the medical centre. However, the increased prevalence of tinnitus in the HIV-positive group may also be attributed to the ARV regimen and/or the result of subtle damage to the auditory system, which was not identified by the current audiological test battery. More insight may be obtained about the effects of HIV on hearing by employing a longitudinal research design and inclusion of a more ototoxicity sensitive test battery.

CD4 Cell Counts, Lipid Profile, and Oral Manifestations in HIV-Infected and AIDS Patients

Objectives

The present study aimed to evaluate CD4 cell counts, lipid profile, and oral manifestations in human immunodeficiency virus (HIV)-infected and acquired immune deficiency syndrome (AIDS) patients and their correlation with seronegative controls.

Materials and Methods

In this cross-sectional, hospital-based study, there were three groups of subjects: group A consisting of 500 healthy patients (controls), group B composed of 500 HIV-infected patients, and group C comprised of 500 AIDS patients based on their CD4 cell counts. CD4 cell counts were assessed using the CyFlow counter. Lipid profile was evaluated with the Erba EM 360 analyzer.

Results

The results were statistically significant for CD4 cell counts (P<0.001). The levels of total cholesterol (TC) and low-density lipoproteins (LDLs) were significantly decreased while triglycerides (TGs) and very-low-density lipoproteins (VLDLs) were significantly increased in AIDS patients compared to the controls and HIV-infected patients. Various results were obtained regarding oral manifestations with different levels of significance.

Conclusion

CD4 cell counts, TC, LDLs, TGs, and VLDLs were significantly changed in HIV-infected and AIDS patients compared to the controls.

Impact of an HIV-trained clinical pharmacist intervention on error rates of antiretroviral and opportunistic infection medications in the inpatient setting

Background:

Based on a retrospective study performed at our institution, 38% of inpatients living with human immunodeficiency virus (HIV) were found to have a medication error involving their anti-retroviral (ARV) and/or opportunistic infection (OI) prophylaxis medications.

Objective:

To determine the impact of a dedicated HIV-trained clinical pharmacist on the ARV and OI prophylaxis medication error rates at our institution.

Methods:

A prospective quality improvement project was conducted over a six month period to assess the impact of a dedicated HIV-trained clinical pharmacist on the ARV and OI prophylaxis medication error rates. IRB approval received.

Results:

There were 144 patients included in this analysis, who experienced a combined 76 medication errors. Compared to historical control study conducted at our institution, the percent of patients who experienced a medication error remained stable (38% vs. 39%, respectively) and the error rate per patient was similar (1.44 vs. 1.36, p=NS). The percent of medication errors that were corrected prior to discharge increased from 24% to 70% and the median time to error correction decreased from 42 hours to 11.5 hours (p<0.0001).

Conclusions:

Errors relating to ARV or OI prophylaxis medications remain frequent in inpatient people living with HIV/AIDS. After multiple interventions were implemented, ARV and OI prophylaxis medication errors were corrected faster and with greater frequency prior to discharge, however, similar rates of errors for patients existed. Dedicated HIV clinicians with adequate training and credentialing are necessary to manage this specialized disease state and to reduce the overall number of medication errors associated with HIV/AIDS.

Neurocognitive SuperAging in Older Adults Living With HIV: Demographic, Neuromedical and Everyday Functioning Correlates

OBJECTIVES

Studies of neurocognitively elite older adults, termed SuperAgers, have identified clinical predictors and neurobiological indicators of resilience against age-related neurocognitive decline. Despite rising rates of older persons living with HIV (PLWH), SuperAging (SA) in PLWH remains undefined. We aimed to establish neuropsychological criteria for SA in PLWH and examined clinically relevant correlates of SA.

METHODS

734 PLWH and 123 HIV-uninfected participants between 50 and 64 years of age underwent neuropsychological and neuromedical evaluations. SA was defined as demographically corrected (i.e., sex, race/ethnicity, education) global neurocognitive performance within normal range for 25-year-olds. Remaining participants were labeled cognitively normal (CN) or impaired (CI) based on actual age. Chi-square and analysis of variance tests examined HIV group differences on neurocognitive status and demographics. Within PLWH, neurocognitive status differences were tested on HIV disease characteristics, medical comorbidities, and everyday functioning. Multinomial logistic regression explored independent predictors of neurocognitive status.

RESULTS

Neurocognitive status rates and demographic characteristics differed between PLWH (SA=17%; CN=38%; CI=45%) and HIV-uninfected participants (SA=35%; CN=55%; CI=11%). In PLWH, neurocognitive groups were comparable on demographic and HIV disease characteristics. Younger age, higher verbal IQ, absence of diabetes, fewer depressive symptoms, and lifetime cannabis use disorder increased likelihood of SA. SA reported increased independence in everyday functioning, employment, and health-related quality of life than non-SA.

CONCLUSIONS

Despite combined neurological risk of aging and HIV, youthful neurocognitive performance is possible for older PLWH. SA relates to improved real-world functioning and may be better explained by cognitive reserve and maintenance of cardiometabolic and mental health than HIV disease severity. Future research investigating biomarker and lifestyle (e.g., physical activity) correlates of SA may help identify modifiable neuroprotective factors against HIV-related neurobiological aging. (JINS, 2019, 25, 507-519).

In Trump, HIV/AIDS Groups Find an Ally Who's Tough To Love

Adjusting their vision so it looks past the messenger and focuses on President Trump's stated goal to end AIDS by 2030 isn't easy for HIV/AIDS advocates. But they aren't being entirely dismissive, either. They have some faith in, and working relationships with, federal government health officials who will oversee implementation of the plan.

To Be Continued:The Search for a Cure for HIV

Effective treatment has helped curb the epidemic, but practical cures have been elusive. Now being tested: a "sterilizing cure" that eradicates HIV from the body, and a "functional cure" that effectively reduces the viral load so it cannot be transmitted or progress to AIDS.

Progressive multifocal leukoencephalopathy: a challenging diagnosis established at autopsy

Progressive multifocal leukoencephalopathy (PML) is a feared entity that occurs most frequently in conditions of extreme immunodeficiency. The diagnosis is often made long after the onset of symptoms due to the physicians’ unfamiliarity, and the unavailability of diagnostic tests in some medical centers. Although the incidence of PML is decreasing among HIV patients with the advent of highly active antiretroviral therapy (HAART), in Brazil this entity is the fourth highest neurological complication among these patients. The authors present the case of a middle-aged man who tested positive for HIV concomitantly with the presentation of hyposensitivity in the face and the right side of the body, accompanied by mild weakness in the left upper limb. The clinical features worsened rapidly within a couple of weeks. The diagnostic work-up pointed to the working diagnosis of PML after brain magnetic resonance imaging; however, the detection of the John Cunningham virus (JCV) in the cerebral spinal fluid was negative. HAART was started but the patient died after 7 weeks of hospitalization. The autopsy revealed extensive multifocal patchy areas of demyelination in the white matter where the microscopy depicted demyelination, oligodendrocytes alterations, bizarre atypical astrocytes, and perivascular lymphocytic infiltration. The immunohistochemistry was positive for anti-SV40, and the polymerase chain reaction of the brain paraffin-embedded tissue was positive for JCV. The authors highlight the challenges for diagnosing PML, as well as the devastating outcome of PML among HIV patients.

Prevalence trend and risk factors for anemia among patients with human immunodeficiency virus infection receiving antiretroviral therapy in rural China

OBJECTIVE

To estimate the prevalence trend and risk factors for anemia in patients with human immunodeficiency virus (HIV) infection receiving antiretroviral therapy (ART) in rural China.

METHODS

We conducted cross-sectional studies among the same population in 2010, 2012, and 2014, based on data from standard medical record registers. Factors associated with anemia were evaluated using a logistic regression model.

RESULTS

The number of patients with HIV infection included in each cross-sectional study was 1456 in 2010, 1531 in 2012, and 1567 in 2014, and the prevalence of anemia was 44.3%, 34.7%, and 27.6%, respectively. The prevalence of anemia was lower in female patients in 2010 [odds ratio (OR) 0.68; 95% confidence interval (CI) 0.55-0.85]; however, there was no difference by sex in 2012 (OR 0.90; 95% CI 0.72-1.11) and 2014 (OR 1.05; 95% CI 0.84-1.32). Patients with a higher level of education had a lower risk of anemia in 2014 (OR 0.72; 95% CI 0.56-0.92), but there was no difference in 2010 (OR 1.00; 95% CI 0.79-1.25) and 2012 (OR 0.99; 95% CI 0.79-1.24). Patients who had received a longer duration of ART had a higher risk of anemia in 2014 (OR 1.74; 95% CI 1.15-2.64), but there was no difference in 2010 and 2012 (P > 0.05). Patients receiving Traditional Chinese Medicine (TCM) therapy had a lower risk of anemia.

CONCLUSION

The prevalence of anemia among patients with HIV infection receiving ART decreased between 2010 and 2014 in Henan Province but was still higher than the prevalence in the general population of China. TCM therapy can potentially decrease the risk of anemia among patients with HIV infection.

[Evaluation of Chiapas’ HIV/AIDS information system of epidemiological surveillance]

BACKGROUND

The functionality and performance of a health information system should be evaluated from the perspective of those who develop its processes. Considering the above, this study evaluated the performance of the HIV/AIDS Epidemiological Surveillance System (SIVE VIH/SIDA, according to its initials in Spanish) in Chiapas, Mexico.

METHODS

Qualitative study on the performance, structure and dynamics of SIVE VIH/SIDA, based on interviews with the personnel participating in this surveillance system, using the Updated Guidelines for the Evaluation of Public Health Surveillance Systems. The analysis was performed through the cyclic interactive method of content analysis, from which the evaluation indices were constructed.

RESULTS

A total of 32 interviews were conducted. The structure was described as well defined, at the expense of organizational dimensions, procedures and material resources. The dynamics of information, from the perspective of the collection, processing and use of information, was rated as regular. The performance of the SIVE HIV/AIDS in Chiapas was regular at the expense of these attributes of the information system: simplicity, flexibility, quality of data, acceptability, sensitivity, representativeness, timeliness and stability.

CONCLUSIONS

In order to improve the performance of SIVE VIH/SIDA, it is necessary to strengthen the human resources and use of information dimensions, so that it can be an instrument for action.

Association Between Health-Related Quality of Life and Physical Functioning in Antiretroviral-Naive HIV-Infected Patients

Background:

Poor functional status can significantly affect Health-Related Quality of Life (HRQoL) of HIV patients. However, there is scarce information on the functional profile of such patients before starting antiretroviral therapy (ART).

Objective:

To estimate the association between health-related quality of life and physical functioning in Antiretroviral-Naive HIV-infected patients.

Methods:

We conducted a cross-sectional study with HIV-infected patients older than 18 years, and naïve to antiretroviral therapy. The patients were evaluated for functional profile by pulmonary function (forced vital capacity, forced expiratory volume at one second, and Tiffeneau index), handgrip strength, and six-minute walk test in a cross-sectional study. HRQoL was evaluated by the 36-Item Short-Form Health Survey and its Physical (PCS) and Mental (MCS) Component Summaries. Multiple linear regression analyses were used to evaluate the association of predictor variables with PCS and MCS scores.

Results:

We found lower HRQoL among females patients, with far below average impairment of mental health component. Both male and female patients presented lower 6MWD function test values. Patients with dynapenia were older than patients without it, presented lower PCS mean score, lower family income, poor 6 MWD function test, lower FVC, and lower FEV1 t. Multivariable logistic regression analyses showed that Grip Strength, age and family income were predictor variables for Physical component of HRQoL. Female gender and smoking habit were predictive for the mental component of HRQoL.

Conclusion:

HRQoL in HIV, drug-naïve patients is predicted by level of dynapenia, smoking, income and gender. Therefore, lifestyle changes and active exercising can help to improve HRQoL in such patients.

Association of Urinary Biomarkers of Kidney Injury with Estimated GFR Decline in HIV-Infected Individuals following Tenofovir Disoproxil Fumarate Initiation

BACKGROUND AND OBJECTIVES

Tenofovir disoproxil fumarate (tenofovir) is associated with elevated concentrations of biomarkers of kidney damage and dysfunction in individuals with HIV. The relationship of these kidney biomarkers with longitudinal kidney function decline is unknown.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

We evaluated associations of 14 urinary biomarkers of kidney injury with changes in eGFR among 198 men and women with HIV who initiated tenofovir between 2009 and 2015 in the Multicenter AIDS Cohort Study and Women's Interagency HIV Study. Urinary biomarkers included albumin-to-creatinine ratio, α-1-microglobulin, β-2-microglobulin, cystatin C, kidney injury molecule-1 (KIM-1), IL-18, neutrophil gelatinase-associated lipocalin (NGAL), clusterin, osteopontin, uromodulin, monocyte chemoattractant protein-1, EGF, trefoil factor 3, and chitinase 3-like protein 1. We used multivariable linear mixed-effect models controlling for demographics, traditional kidney disease risk factors, and HIV-related risk factors to evaluate associations of baseline biomarkers with first-year changes in eGFR, and associations of year 1 and first-year change in biomarkers with changes in eGFR from year 1 to year 3. We used the least absolute shrinkage and selection operator method to identify a parsimonious set of biomarkers jointly associated with changes in eGFR.

RESULTS

Median eGFR before tenofovir initiation was 103 (interquartile range, 88-116) ml/min per 1.73 m2. During the first year of tenofovir use, eGFR decreased on average by 9.2 (95% confidence interval, 6.5 to 11.9) ml/min per 1.73 m2 and was stable afterward (decrease of 0.62; 95% confidence interval, -0.85 to 2.1 ml/min per 1.73 m2 per year). After multivariable adjustment, higher baseline β-2-microglobulin, KIM-1, and clusterin were associated with larger first-year eGFR declines, whereas higher baseline uromodulin was associated with a smaller eGFR decline. First-year increase in urinary cystatin C and higher year 1 IL-18 were associated with larger annual eGFR declines from year 1 to year 3. The parsimonious models identified higher pre-tenofovir clusterin and KIM-1, lower pre-tenofovir uromodulin, and higher year 1 IL-18 as jointly associated with larger eGFR declines.

CONCLUSIONS

Urinary biomarkers of kidney injury measured before and after tenofovir initiation are associated with subsequent changes in eGFR in individuals with HIV.

PODCAST

This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2018_08_28_CJASNPodcast_18_9_S.mp3.

Fatal disseminated cytomegalovirus infection with necrotizing oophoritis in a patient with acquired immunodeficiency syndrome

Disseminated human cytomegalovirus (CMV) disease occurs mainly as a congenital infection and among immunocompromised hosts. Patients with acquired immunodeficiency syndrome (AIDS) are at increased risk for CMV infection, and the most prevalent clinical manifestation is retinitis, followed by colitis, esophagitis, pneumonitis, and encephalitis. CMV oophoritis is poorly described in the literature with some cases reported in patients with hematological or solid malignancies, bone marrow or solid organ transplantation, immunosuppressive therapy, and advanced AIDS cases. We report the case of a 61-year-old woman with a recent diagnosis of AIDS, which was associated with a wasting syndrome. The patient presented with abdominal pain, headache, cutaneous vesicular lesions on the abdomen, anemia, lymphopenia, and hyponatremia; she died suddenly on the fourth day of hospitalization. The autopsy was performed and demonstrated disseminated CMV infection with hemorrhagic encephalitis as the immediate cause of death. Additionally, pneumonitis, extensive adrenalitis, ulcerated enteritis, focal hepatitis, and necrotizing oophoritis were found.

[Life Experiences of Uninfected Women Living with HIV-Infected Husbands: A Phenomenological Study]

PURPOSE

This study aimed to understand the meaning and essence of the life experiences of uninfected women living with HIV-infected husbands.

METHODS

This qualitative study adopted van Manen's hermeneutic phenomenological method. Study participants were 8 females whose husband had been diagnosed with HIV for longer than 6 months, who had known about their husband's infection for more than 6 months, who were in a legal or common-law marriage and were living with their husbands at the time of interview for this study, and whose HIV antibody test results were negative. Data were collected from in-depth individual interviews with the participants from May to August 2016, and from related idiomatic expressions, literature, artwork, and phenomenological references.

RESULTS

The following essential themes were identified regarding the life experiences of uninfected women living with HIV-infected husbands: 'experiencing an abrupt change that came out of the blue and caused confusion', 'accepting one's fate and making desperate efforts to maintain one's family', 'dealing with a heavy burden alone', 'experiencing the harsh reality and fearful future', and 'finding consolation in the ordeal'.

CONCLUSION

This study provided a holistic and in-depth understanding of the meaning and essence of the life experiences of uninfected women living with HIV-infected husbands. Thus, this study recognizes these unnoticed women as new nursing subjects. Further, the present findings can be used as important basic data for the development of nursing interventions and national policy guidelines for uninfected women living with HIV-infected husbands.

Epidemiological and Clinical Characteristics of HIV Infected Patients at a Tertiary Care Hospital in Oman

Objectives

In 2015, the Joint United Nations Program on HIV/AIDS (UNAIDS) set a target that 90% of all people living with HIV will know their HIV status, 90% of those diagnosed will receive antiretroviral therapy, and 90% of those receiving antiretroviral therapy will have viral suppression by 2020. We sought to elucidate the epidemiological and clinical characteristics of HIV infected patients at the Infectious Diseases Clinic at Royal Hospital, Oman, with a focus on the UNAIDS 90-90-90 achieved rates.

Methods

We conducted a retrospective analysis of the medical records of 326 HIV infected patients from 1989 to 2016. Data collected included demographics, Word Health Organization (WHO) staging, laboratory analyses, and treatment outcomes.

Results

The overall mean age of the cohort was 36.0±15.0 years, and 60.4% (n = 197) were males. The majority of patients acquired HIV through heterosexual transmission (58.9%; n = 192). At the time of the first clinic visit, 26.1% (n = 85) of patients had WHO stage 4 HIV infection. The rates of HIV/HBV and HIV/HCV coinfections were 2.7% and 5.8%, respectively. The baseline CD4+ cells count was < 200 cells/mm³ in 38.0% (n = 124) of patients, 201-500 cells/mm³ in 30.1% (n = 99) of patients, and > 500 cells/mm³ in 27.0% (n = 88) of patients. The baseline HIV RNA titer was greater than 1000 copies/mL³ in 74.5% (n = 243) of the cohort. A total of 96.3% (n = 314) of patients received antiretroviral therapy, most commonly non-nucleoside reverse transcriptase inhibitor-based regimens. HIV genotype resistance testing was performed in 165 patients (50.6%) either at baseline in treatment naïve patients or following treatment failure. Among the 326 patients included, 22 patients (6.7%) died, and 29 patients (8.9%) were lost to follow-up.

Conclusions

Regarding the UNAIDs 90-90-90 target, over a quarter of the patients presented late with WHO stage 4 HIV disease, 96.3% of cohort patients received antiretroviral treatment, and 71.5% achieved virological suppression.

The diagnosis of multiple opportunistic infections in advanced stage AIDS: when Ockham's Razor doesn't cut it

In the advanced stage of AIDS, the diagnosis of the opportunistic infections may be challenging due to the high risk of performing invasive diagnostic methods in a patient with a critical clinical condition, as well as the correct interpretation of the results of microbiological exams. One of the challenges for the diagnosis and treatment of the opportunistic infections is that they may occur concomitantly in the same patient and they may mimic each other, leading to a high discrepancy between clinical and autopsy diagnoses. We describe the case of a 52-year-old man who was hospitalized because of weight loss, anemia, cough, and hepatosplenomegaly. During the investigation, the diagnosis of AIDS was made, and the patient developed respiratory failure and died on the fourth day of hospitalization. At autopsy, disseminated non-tuberculosis mycobacteriosis was found, affecting mainly the organs of the reticuloendothelial system. Also, severe and diffuse pneumonia caused by multiple agents (Pneumocystis jirovecii , Histoplasma capsulatum, suppurative bacterial infection, non-tuberculosis mycobacteria, and cytomegalovirus) was seen in a morphological pattern that could be called "collision pneumonia." The lesson from this case, revealed by the autopsy, is that in advanced AIDS, patients often have multiple opportunistic infections, so the principle of Ockham's razor-that a single diagnosis is most likely the best diagnosis-fails in this clinical context.

Social welfare related to AIDS in Brazil: factors associated with social assistance and social security, 2004 - 2016

OBJECTIVE

To describe the occurrence of social welfare benefits related to AIDS in Brazil and to compare the characteristics of the beneficiaries of social assistance and social security in 2004 - 2016.

METHODS

This was an observational, analytical study based on secondary data obtained from the Ministry of Social Security of Brazil. Sociodemographic and epidemiologic characteristics of the beneficiaries of AIDS-related social assistance and social security were analyzed.

RESULTS

From 2004 - 2016, a total of 99 369 benefits were granted, the majority of which were sick pay (64%), followed by social assistance benefits (26.5%) and disability retirement (8.1%). At the time that benefits were initiated, 51% of the individuals were unemployed. Those living in urban areas, females, the young, the elderly, and residents of the North and Northeast received more social assistance benefits. Duration of social assistance benefits (average 4 589 days) was greater than that of social security benefits (302 days). Survival among women (578 months) was greater than among men (311 months).

CONCLUSIONS

In Brazil, the profile of social welfare beneficiaries living with AIDS reveals their social vulnerability. Controlling AIDS should be a priority on public agendas, aiming to minimize the disease's social and economic impact, especially on public health, social security, and social assistance.

Who is Saying What on Twitter: An Analysis of Messages with References to HIV and HIV Risk Behavior

This research aimed to determine the nature of social media discussions about HIV. With the goal of conducting a descriptive analysis, we collected almost 1,000 tweets posted February to September 2015. The sample of tweets included keywords related to HIV or behavioral risk factors (e.g., sex, drug use) and was coded for content (e.g., HIV), behavior change strategies, and message source. Seven percent of tweets concerned HIV/AIDS, which were often referred to as jokes or insults. The majority of tweets coded as behavior change attempts involved attitude change strategies. The majority of the tweets (80%) came from private users (vs. organizations). Different types of sources employed different types of behavior change strategies: For instance, private users, compared to experts or organizations, included more strategies to decrease detrimental attitudes (29% versus 6%, p < .001), and also more strategies to counter myths and misinformation (6% versus 1%, p = .008). In summary, tweets related to HIV/AIDS and associated risk factors frequently use the terms in jokes and insults, come largely from private users, and entail attitudinal and informational strategies. Online health campaigns with clear calls to action and corrections of misinformation may make important contributions to social media conversations about HIV/AIDS.

HIV Universal Vaccine

BACKGROUND

For many deadly viruses, there are no preventive and / or therapeutic vaccines approved by health authorities World-wide (e.g., HIV, Ebola, Dengue, and many others). Although, for some viruses, prophylactic vaccines are very effective (e.g., HBV, and many others).In this realm, we design, manufacture, test, and streamline into the clinics novel viral universal vaccines (VUV). VUV have such unique features, that medical vaccination or natural infection induced immunity against some viruses (e.g., HBV) upon the VUV's administration to the infected with other, different viruses patients, is redirected against these other, newly infecting viruses (e.g., HIV).

SPECIFIC AIM

The specific aim of this work was biomolecular engineering of the HIV universal vaccine comprising the two main functional domains: CD4 or anti-gp120 - as the HIV tagging domain and HBsAg - as the immune response eliciting domain, so that upon its administration the HBV medical immunization or natural infection induced immunity would be redirected, accelerated, and amplified to fight the HIV infection.

HEALTHY DONORS AND PATIENTS

Per the Institutional Review Board approval and in compliance with the Declaration of Helsinki, all healthy donors and patients were presented with the Patients' Bill of Rights and provided Patient Informed Consent. All the procedures were pursued by the licensed medical doctors.

METHODS & RESULTS

We have biomolecularly engineered HIV universal vaccine (HIVUV) comprising human CD4 or anti-gp120 and HBsAg of HBV. By immunoblotting and magnetic activated molecular sorting, we have demonstrated high specificity of this vaccine in binding HIV. By flow cytometry and nuclear magnetic resonance, we have demonstrated high efficacy of these vaccines to engage HBV immunized patients' immune system against HIV. Administration of HIVUV to blood or lymph of the HIV+ patients resulted in rapid reduction of the HIV viremia down to undetectable. It also resulted in protection of populations of CD4+ cells against HIV caused decline.

CONCLUSIONS

We have demonstrated the proof of concept for high efficacy of VUV, specifically HIVUV, in annihilating HIV. Nevertheless, the same compositions, processes, and methods, for persons skilled in biotechnology, pharmacogenomics, and molecular medicine, are adaptable for other deadly viral infections, which we vigorously pursue.