COVID-19 outcomes in HIV patients: A review

Design, and synthesis of 2,4-thiazolidinedione substituted 1,3,5-triazine derivatives as anti-HIV agent via inhibition of reverse transcriptase along with anti-SARS CoV-2, antibacterial and antibiofilm activity

The present study demonstrated the design and synthesis of novel 1,2,4-thiazolidinedione substituted 1,3,5-triazine derivatives as putative inhibitors against various infective diseases. The title analogues were synthesized in a multi-step process, and their structures were verified through elemental analysis and a variety of spectral analyses (FT-IR, 1H NMR, 13C NMR, mass). Compounds 12a was identified as prospective lead compound against HIV-1 based on their high CDdocker interaction energy and stability among the developed derivatives, according to molecular docking and MD simulation experiments with HIV-1 RT. Compound 12a was found effective against HIV-1 in a cell-based experiment, preventing the virus from replicating in CEM-GFP cells infected with 0.5 MOI of HIV-1 NL4-1. In the RNA-dependent DNA polymerase (RDDP) activity of the HIV-1 RT enzyme using a cell free based RT assay, compound 12a showed a therapeutic index of 113 and an EC50 of 125.1 nM. All of the compounds inhibited SARS-CoV-2 replication in the VeroE6-GFP cell line to varying degrees; compound 10e, 12e, 12a, 12b, and 12c, in particular, showed considerable inhibitory activity. The compounds exhibited stronger antibacterial action against Gram-negative than Gram-positive bacteria in an antimicrobial assay, and a SAR analysis revealed that tri-substituted 1,3,5-triazine derivatives exhibited greater inhibitory activity than di-substituted ones. Additionally, 12d and 12e were found to be the most effective inhibitors of P. aeruginosa biofilms when tested against this bacterium. The most active inhibitors, 12a and 12e, were also tested for thermodynamic solubility at pH 7.4 via miniaturized shake-flask method. Here, their solubility was found to be significantly influenced by the presence of hydroxyl group and morpholine. In conclusion, our research demonstrated the significant inhibitory activity of 1,2,4-thiazolidinedione substituted 1,3,5-triazine derivatives against HIV, SARS-CoV-2, and bacterial microorganisms.

A cross-sectional, retrospective study analyzing the impact of COVID-19 on surgical mortality in Johannesburg, South Africa

Background

Various comorbidities are known to exacerbate the risk of surgical mortality with COVID-19 infection. The effect of HIV infection on surgical mortality in the context of COVID-19 has also not been investigated. The aim of our study was to investigate the influence of HIV status on mortality in surgical patients admitted during the COVID-19 pandemic in Johannesburg, South Africa.

Material and methods

We reviewed records of patients who were admitted and underwent surgery during the COVID-19 pandemic and died. Data regarding perioperative COVID-19 infection, risk factors, comorbidities, mortality preventability, and contributing factors were extracted. Logistic regression was used to analyze comorbidities associated with COVID-19 infection among surgical mortalities.

Results

A total of 404 records of mortalities were found and 25% (82/404) tested positive for COVID-19. 40% Of the mortalities were either potentially preventable or preventable. Comorbidities in patients who were COVID-19-positive surgical mortalities compared to their negative counterparts included smoking in 35% versus 4%, chronic obstructive pulmonary disease (COPD) in 20% versus 3%, and diabetes mellitus in 23% versus 13%, respectively. The odds of being COVID-19 positive in surgical mortalities with hypertension, smoking, and COPD were 1.96 times [OR = 1.96, 95% CI (1.06, 3.59)], 7.78 times [OR = 7.78, 95% CI (3.45, 18.35)], and 3.09 times [OR = 3.09, 95% CI (1.08, 8.95)], respectively. 55% of COVID-19-positive patients who died were HIV positive compared to 31% among the COVID-19-negative group. 26% of HIV-positive patients were on anti-retroviral treatment (ART). 22% of HIV-/COVID-19-coinfected surgical mortalities were not on antiretroviral treatment compared to 9% in the HIV-positive and COVID-19-negative groups. The odds of COVID-19 infection in surgical mortalities who were HIV positive and not on ART was 3.10 [95% CI (1.55, 6.11)].

Conclusion

The rate of COVID-19 infection was higher in HIV-positive patients who died, especially if they were not on ART. Smoking, COPD, and hypertension imparted the largest risk on COVID-19 infection in cases of surgical mortality. These comorbidities likely superimpose the pathological effects of COVID-19 infection, worsening surgical prognosis.

Depression, anxiety, and stress among HIV-positive pregnant women during the COVID-19 pandemic: a hospital-based cross-sectional study in India

BACKGROUND

The COVID-19 pandemic has caused an unparalleled increase in psychological distress among everyone and everywhere. Perinatal depression, anxiety, and stress (DAS) are more prominent among HIV-positive pregnant women and are associated with poor maternal and neonatal outcomes. Therefore, this study aimed to assess the prevalence and explore the factors associated with DAS among HIV-positive pregnant women in India.

METHODS

A multicentric, cross-sectional, analytical study was conducted among all HIV-positive pregnant women, aged more than 18 years, taking antiretroviral therapy, and attending antenatal care visits at two hospitals that are offering HIV care services in Anantapur District, Andhra Pradesh, India. Women who were unable to communicate were mentally ill, and refused to give consent were excluded. The study was conducted for a period of eighteen months from April 2020 to September 2021. A validated and interview-based data collection form was used to capture sociodemographic, obstetric profiles, clinical and support-related profiles, and COVID-19 stressors among study participants. The DASS-21 scale was used to assess depression, anxiety, and stress among study participants. Univariable and multivariable Poisson regression analyses were used to identify factors associated with DAS among study participants.

RESULTS

The prevalence of depression, anxiety, and stress among HIV-positive pregnant women was found to be 50.3% (95% CI 23.6-76.4), 56.2% (95% CI 28.3-80.3), and 42.2% (95% CI 18.5-69.9), respectively. A multivariate Poisson regression analysis showed that participants living in a rural area (adj. PR 1.43,1.08-1.91), primigravidae (adj. PR 1.37, 1.09-1.72), less number of ANC visits (adj. PR 1.41, 1.12-1.76), identified HIV during pregnancy (adj. PR 1.42, 1.13-1.77), non-disclosure of HIV status with one's partner (adj. PR 1.43, 1.11-1.83), no partner support (adj. PR 1.84, 1.31-2.59), and having a negative HIV status sexual partner (adj. PR 1.35, 1.02-1.79) were all significantly associated with depression. Factors such as lack of partner support (adj. PR 1.48, 1.09-1.99) and known HIV status during pregnancy (adj. PR 1.24, 1.01-1.52) were significantly associated with anxiety. Participants who had less ANC visits (adj. PR 1.50, 1.12-2.02), non-disclosure of HIV status with partner (adj. PR 1.47, 1.08-2.02), known HIV status during pregnancy (adj. PR 1.62, 1.23-2.15), negative HIV status of sexual partner (adj. PR 1.44, 1.02-2.02), and no partner's support (adj. PR 1.85, 1.25-2.74) were significantly associated with stress.

CONCLUSION

The study concludes that about one-third of the HIV-positive pregnant women reported anxiety, and more than half of the women were feeling stressed and depressed during COVID-19. Factors such as residence and primigravidae were linked with antenatal depression. Whereas variables like ANC visits, knowing HIV status during pregnancy, non-disclosure of HIV status, no partner's support, and sexual partner HIV negative status were associated with depression and stress. The anxiety symptoms are very high among women who are HIV positive during pregnancy, and not having a partner's support. Demographic, clinical, and support-related determinants and COVID-19 stressors of DAS provide insights for interventions to reduce the burden of mental health problems among HIV-positive pregnant women.

Investigating the follow-up discontinuation among people living with HIV in North Shoa Zone, Oromia, Ethiopia

Introduction

Follow-up discontinuation among people living with HIV can increase mortality and HIV spread within communities. This study investigates the impact of the COVID-19 on follow-up discontinuation among people living with HIV in Ethiopia.

Methods

This longitudinal study used retrospective document review to compare follow-up status of people living with HIV during the COVID-19 pandemic with their status from 2017 to 2019. Data from selected health facilities were collected using a checklist, entered and cleaned in Excel, and analyzed in Stata. Descriptive statistics were presented in tables and line graphs. Incidence risk (IR) and incidence rate ratios (IRR) were calculated.

Results

Between 2017 and 2021, a total of 7,447 people living with HIV were registered to begin ART at selected health facilities. Annual retention rates were consistent from 2017 to 2019, ranging from 0.941 to 0.949. During the COVID-19 pandemic, they dropped to 0.837 in 2020 and 0.840 in 2021. Retention rates were significantly correlated with loss to follow-up (r: -0.959, p ≤ 0.001), death (r: -0.968, p ≤ 0.001), and transfer-out (r: -0.979, p ≤ 0.001). Moreover, the incidence of loss to follow-up (IRR: 3.00, 95%CI: 2.71-3.33, p ≤ 0.001), death (IRR: 3.61, 95%CI: 3.13-4.16, p ≤ 0.001), poor adherence (IRR: 2.27, 95%CI: 2.14-2.40, p ≤ 0.001), and severe malnutrition (IRR: 2.32, 95%CI: 2.18-2.47, p ≤ 0.001) significantly increased during the COVID-19.

Conclusion

The study found that COVID-19 healthcare disruptions increased follow-up loss among people living with HIV and heightening the disease burden in Ethiopia.

Fear of COVID and Physical Health Among People Living with HIV in China: Mediation Effects of HIV Stigma, Social Support, and Substance Use

The COVID-19 pandemic has uniquely impacted people living with HIV (PLWH) worldwide. The negative impacts on PLWH's mental health from fear of COVID-19 are labeled as "a double stress." The association between fear of COVID-19 and HIV (internalized) stigma has been found among PLWH. Studies that explore the relationships between fear of COVID-19 and physical health outcomes are few, especially among PLWH. In this study, we explored the relationship between fear of COVID-19 and physical health among PLWH and the mediated effects of HIV stigma, social support, and substance use. A cross-sectional online survey of PLWH (n = 201) from November 2021 to May 2022 was carried out in Shanghai, China. The data on socio-demographics, fear of COVID-19, physical health, HIV-related perceived stigma, social support, and substance use were gathered and analyzed by structure equation modeling (SEM). In SEM analysis, fear of COVID-19 showed a significant and indirect effect on physical health (β=-0.085) which was primarily mediated by HIV stigma. In SEM analysis, the final model had a good fit. Fear of COVID-19 showed a significant effect on HIV stigma (β = 0.223) with the majority being direct effects (β = 0.262) and a small indirect effect via substance use (β=-0.039). Furthermore, HIV stigma showed a significant effect on physical health (β=-0.382), the majority of which was direct (β=-0.340), and a small indirect effect via social support (β=-0.042). This is one of the first studies to explore how fear of contracting COVID-19 can affect PLWH's coping behaviors (e.g., using substances and obtaining social support) used to combat HIV stigma as well as to achieve better physical health in China.

No effects of nirmatrelvir/ritonavir on darunavir plasma trough concentrations: a case report

COVID-19 may be associated with worst outcomes in people living with HIV compared with HIV-negative patients. Nirmatrelvir/ritonavir can be safely co-administered with all the HIV antiretroviral drugs, without considering dose adjustment. However, no studies have formally investigated the effect of a double booster (ritonavir plus cobicistat) regimen on darunavir concentrations. We presented a case describing the lack of effects of adding nirmatrelvir/ritonavir on darunavir plasma trough concentrations in a patient with HIV already on treatment with a booster-based antiretroviral regimen. We believe this could be a reassuring message for physicians, allowing them to prevent unnecessary denial of COVID-19 treatment or inappropriate discontinuation of co-medications in patients with HIV.

Uncovering the forgotten story of the impact of Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome on economic growth in Ghana: A gender analysis

Aside from being a health issue, Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) has an economic impact on Africa and Ghana in particular. Despite this, fewer empirical studies have examined the effect of the disease on economic growth from a gender point of view. This study aims to investigate the impact of the HIV/AIDS epidemic on economic growth in Ghana. The paper uses time series data spanning 1990-2018 to estimate the impact of HIV/AIDS from a gender perspective. The Cobb-Douglas aggregate function and the Granger Causality test were used to examine the determinant of growth and the direction of causality, respectively. The study's finding shows a unidirectional feedback causality running from HIV/AIDS to economic growth. Controlling for varieties of factors, the study found that HIV/AIDS has a negative significant impact on economic growth in both the short and long-run periods in Ghana. From the gender perspective, the impact of HIV/AIDS on growth was higher in the case of males when compared to females.

Impact of COVID-19 on HIV services and anticipated benefits of vaccination in restoring HIV services in Ethiopia: A qualitative assessment

Background

HIV services were inevitably disrupted and affected due to COVID-19. There are many challenges in implementing appropriate HIV services, particularly in the provision of health care and the link between people living with HIV/AIDS and retention in care. The study investigated the impact of COVID-19 on HIV services and the anticipated benefit of the COVID-19 vaccination on HIV service restoration in North Shewa, Oromia, Ethiopia.

Methods

A qualitative descriptive study approach was used to explore how healthcare delivery evolved during the outbreak of COVID-19 in Ethiopia. Sixteen antiretroviral therapy (ART) clinics were selected from 13 districts and one administrative town in Ethiopia. From them, 32 ART providers were purposively selected based on their experience in ART provision. Data were collected from June to July 2021 using in-depth interviews. A thematic analysis approach was used to analyze the data, based on themes and subthemes emerging from the data. ATLAS.ti software was used for coding.

Results

Healthcare for people living with HIV was interrupted due to the COVID-19 pandemic. Medical appointments, HIV testing and counseling services, opportunistic infection treatment, medicine supply, and routine viral load and CD₄ T-cell count tests were interrupted. Due to a shortage of healthcare staff, outreach testing services and home index testing were discontinued and HIV testing was limited only to hospitals and health centers. This has substantially affected accessibility to HIV testing and reduced the quality of HIV service delivery. Telehealth and less frequent visits to health facilities were used as alternative ways of delivering HIV services. The COVID-19 vaccination campaign is expected to restore healthcare services. Vaccination may also increase the confidence of healthcare providers by changing their attitudes toward COVID-19.

Conclusions

The COVID-19 pandemic has substantially impacted HIV services and reduced the quality of HIV care in Ethiopia. Health facilities could not provide routine HIV services as they prioritize the fight against COVID-19, leading to an increase in service discontinuation and poor adherence.