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Cells Dec 2023The treatment of human immunodeficiency virus (HIV-1) has evolved since the establishment of combination antiretroviral therapy (ART) in the 1990s, providing... (Review)
Review
The treatment of human immunodeficiency virus (HIV-1) has evolved since the establishment of combination antiretroviral therapy (ART) in the 1990s, providing HIV-infected individuals with approaches that suppress viral replication, prevent acquired immunodeficiency syndrome (AIDS) throughout their lifetime with continuous therapy, and halt HIV transmission. However, despite the success of these regimens, the global HIV epidemic persists, prompting a comprehensive exploration of potential strategies for an HIV cure. Here, we offer a consolidated overview of cell-based therapies for HIV-1, focusing on CAR-T cell approaches, gene editing, and immune modulation. Persistent challenges, including CAR-T cell susceptibility to HIV infection, stability, and viral reservoir control, underscore the need for continued research. This review synthesizes current knowledge, highlighting the potential of cellular therapies to address persistent challenges in the pursuit of an HIV cure.
Topics: Humans; HIV Infections; HIV; Acquired Immunodeficiency Syndrome; Antiretroviral Therapy, Highly Active; Cell- and Tissue-Based Therapy
PubMed: 38201268
DOI: 10.3390/cells13010064 -
American Journal of Physiology. Lung... Dec 2021
Topics: Acquired Immunodeficiency Syndrome; COVID-19; HIV Infections; Humans; Pandemics
PubMed: 34786993
DOI: 10.1152/ajplung.00463.2021 -
Public Health Nursing (Boston, Mass.) Sep 2022In Canada, HIV diagnoses continue unabated, with many of these cases being identified at a late stage of infection. While current public health surveillance data does... (Review)
Review
OBJECTIVES
In Canada, HIV diagnoses continue unabated, with many of these cases being identified at a late stage of infection. While current public health surveillance data does not capture timing of diagnoses, locally, we identified a number of patients concurrently diagnosed with AIDS and HIV.
DESIGN
To understand the key characteristics, presenting symptoms, and risk factors associated with an AIDS diagnosis, we undertook a prospective chart review of HIV and AIDS diagnoses in Ottawa, Canada.
SAMPLE
Sixty seven charts of persons diagnosed with HIV and AIDS between 2015 and 2021 were reviewed.
MEASUREMENTS
Data were analyzed using descriptive statistics.
RESULTS
Results show some inconsistencies regarding HIV risk factors identified in published literature compared to those for persons diagnosed with AIDS in this study. Namely, patients in this review were more likely to be male, Black (from HIV-endemic regions), and heterosexual, and were diagnosed at critical stage in infection (total average CD4+ count of 92.9 cells/mm ) with 44.8% of patients concurrently diagnosed with one or more AIDS-related opportunistic infections.
CONCLUSIONS
The findings can be applied to strengthen HIV screening efforts in primary care settings, particularly among patients who present with persistent symptoms or illnesses related to chronic HIV infection. Additional considerations should be made for public health nurses to provide counseling and linkage to HIV testing/prevention services for patients at the time of an STI or Tuberculosis diagnosis and to increase AIDS-specific data collection.
Topics: AIDS-Related Opportunistic Infections; Acquired Immunodeficiency Syndrome; CD4 Lymphocyte Count; Female; HIV Infections; Humans; Male; Prospective Studies
PubMed: 35305282
DOI: 10.1111/phn.13065 -
BMC Health Services Research Dec 2022Thailand has achieved global acclaim for its response to HIV/AIDS. However, the success of some of the country's most well-known initiatives was by no means a foregone... (Review)
Review
BACKGROUND
Thailand has achieved global acclaim for its response to HIV/AIDS. However, the success of some of the country's most well-known initiatives was by no means a foregone conclusion. Policy entrepreneurs on the periphery of power had to achieve buy-in from stakeholders in state and society to scale and mainstream their ideas. This paper offers a comparative and historical understanding the process by which three of the country's most well-known initiatives came into being: a civil society campaign to promote condom usage; a Ministry of Public Health program that aimed to prevent the spread of Human Immunodeficiency Virus (HIV) by targeting high-risk populations (the 100% condom program); and a universal Prevention of Mother-To-Child Transmission (PMTCT) program.
METHODS
The research relied on existing literature and interviews with high-ranking ministerial officials, representatives from international and non-governmental organizations, professors, and philanthropic organizations, in addition to a review of the existing literature. Taking a comparative and historical approach that is common within political science and sociology, we analysed the in-depth qualitative interviews in relation to the literatures and used an inductive cross-case analysis aimed to draw out critical features that the initiatives shared in common.
RESULTS
Common factors in HIV/AIDS prevention that cut across the three key cases include policy entrepreneurs who championed the programs, successful demonstration projects that produced a credible evidence base for policy adoption, and a diverse set of institutional partners that played critical roles in helping to mainstream their initiatives into national HIV/AIDS policy and scale programs nationally. The findings from this comparative research project have implications not only for the building of understanding related to one single project, but for broader theoretical understanding related to the mainstreaming of health policy from peripheral spaces of power.
CONCLUSIONS
This analysis draws out the role that demonstration projects played in building a credible evidence base for policy adoption and the role that a diverse set of institutional partners played in elevating the profile of policy entrepreneurs' ideas and helping to scale them nationally as state policy. Success was contingent on entrepreneurs first identifying and then taking advantage of different political opportunities that arose during each of the historical periods. Over time, these initiatives have evolved from vertical programs into an integrated program, in parallel with the evolution of the HIV/AIDS landscape at the global level.
Topics: Female; Humans; HIV; Acquired Immunodeficiency Syndrome; Infectious Disease Transmission, Vertical; Thailand; Health Policy
PubMed: 36474252
DOI: 10.1186/s12913-022-08786-6 -
The Lancet. Oncology Jun 2021Non-AIDS-defining cancers are a growing source of morbidity for people with HIV globally. Although people living with HIV have a disproportionately increased risk of... (Review)
Review
Non-AIDS-defining cancers are a growing source of morbidity for people with HIV globally. Although people living with HIV have a disproportionately increased risk of developing virally mediated cancers, cancer burden for common non-AIDS-defining cancers that are not virally associated and are linked to ageing, such as prostate cancer, is becoming higher than for virally mediated cancers. Ageing, behavioural, and HIV-specific factors drive the incidence and affect the outcomes of non-AIDS-defining cancers, presenting different challenges for addressing global morbidity and mortality from non-AIDS-defining cancer. Although large population-based studies have shown that people living with HIV with non-AIDS-defining cancers have poorer cancer outcomes than do people without HIV, current guidelines emphasise that people living with HIV with non-AIDS-defining cancers should receive standard, guideline-based treatment, and infectious disease and oncology providers should work closely to address potential drug interactions between antiretroviral therapy and antineoplastic treatment. Most trials target preventive measures focusing on non-AIDS-defining cancers. However, treatment trials for the optimal management of people living with HIV and non-AIDS-defining cancer, including interventions such as immunotherapies, are needed to improve non-AIDS-defining cancer outcomes.
Topics: Acquired Immunodeficiency Syndrome; Antiretroviral Therapy, Highly Active; HIV; HIV Infections; Humans; Immunotherapy; Neoplasms; Risk Factors; Sarcoma, Kaposi; Treatment Outcome
PubMed: 34087151
DOI: 10.1016/S1470-2045(21)00137-6 -
AIDS (London, England) Jun 2023
Topics: Humans; Acquired Immunodeficiency Syndrome; China; HIV Infections; United Nations
PubMed: 37139655
DOI: 10.1097/QAD.0000000000003571 -
Journal of Medicine and Life Sep 2023The problem of human immunodeficiency virus (HIV) /acquired immunodeficiency syndrome (AIDS) is increasingly complex, including not only health-related concerns problems...
The problem of human immunodeficiency virus (HIV) /acquired immunodeficiency syndrome (AIDS) is increasingly complex, including not only health-related concerns problems but also rampant stigma and discrimination, further exacerbating the health and social conditions of the affected individuals. This study aimed to examine the triggers of stigma and discrimination among individuals with HIV/AIDS in Wakatobi, Southeast Sulawesi. We employed a quasi-qualitative design with a case study approach involving data reduction, presentation, and drawing conclusions. Triggers of stigma and discrimination experienced by individuals living with HIV/AIDS encompassed a range of factors. Stigma was rooted in various causes, including fear, perceptions of unattractiveness, anxiety, associations with the disease, and lack of confidentiality. Discrimination, on the other hand, was caused by disappointment, feelings of insecurity, diminished self-esteem, and factors like competition and exploitation. The forms of stigma for people living with HIV/AIDS were public stigma, self-stigma, verbal discrimination, and avoidance. Meanwhile, the impact of stigma and discrimination on individuals living with HIV and AIDS is substantial. They encounter difficulties in finding help, restoring their lives, and discrimination. Stigmatizing attitudes and discriminatory acts of people living with HIV/AIDS worsen the quality of life of people living with HIV/AIDS, which can potentially cause new infections. Therefore, the government should undertake extensive educational initiatives regarding HIV and AIDS. By enhancing public knowledge and awareness, society can work towards eradicating stigma and discrimination from social interactions.
Topics: Humans; Acquired Immunodeficiency Syndrome; HIV Infections; HIV; Incidence; Quality of Life
PubMed: 38107709
DOI: 10.25122/jml-2023-0171 -
AIDS (London, England) Jul 2019: Tremendous biomedical advancements in HIV prevention and treatment have led to aspirational efforts to end the HIV epidemic. However, this goal will not be achieved... (Review)
Review
: Tremendous biomedical advancements in HIV prevention and treatment have led to aspirational efforts to end the HIV epidemic. However, this goal will not be achieved without addressing the significant mental health and substance use problems among people living with HIV (PLWH) and people vulnerable to acquiring HIV. These problems exacerbate the many social and economic barriers to accessing adequate and sustained healthcare, and are among the most challenging barriers to achieving the end of the HIV epidemic. Rates of mental health problems are higher among both people vulnerable to acquiring HIV and PLWH, compared with the general population. Mental health impairments increase risk for HIV acquisition and for negative health outcomes among PLWH at each step in the HIV care continuum. We have the necessary screening tools and efficacious treatments to treat mental health problems among people living with and at risk for HIV. However, we need to prioritize mental health treatment with appropriate resources to address the current mental health screening and treatment gaps. Integration of mental health screening and care into all HIV testing and treatment settings would not only strengthen HIV prevention and care outcomes, but it would additionally improve global access to mental healthcare.
Topics: Acquired Immunodeficiency Syndrome; Disease Management; Humans; Mental Disorders; Mental Health Services
PubMed: 30950883
DOI: 10.1097/QAD.0000000000002227 -
The Journal of Clinical Investigation Jun 2020The critical role of suppressive myeloid cells in immune regulation has come to the forefront in cancer research, with myeloid-derived suppressor cells (MDSCs) as a main... (Review)
Review
The critical role of suppressive myeloid cells in immune regulation has come to the forefront in cancer research, with myeloid-derived suppressor cells (MDSCs) as a main oncology immunotherapeutic target. Recent improvement and standardization of criteria classifying tumor-induced MDSCs have led to unified descriptions and also promoted MDSC research in tuberculosis (TB) and AIDS. Despite convincing evidence on the induction of MDSCs by pathogen-derived molecules and inflammatory mediators in TB and AIDS, very little attention has been given to their therapeutic modulation or roles in vaccination in these diseases. Clinical manifestations in TB are consequences of complex host-pathogen interactions and are substantially affected by HIV infection. Here we summarize the current understanding and knowledge gaps regarding the role of MDSCs in HIV and Mycobacterium tuberculosis (co)infections. We discuss key scientific priorities to enable application of this knowledge to the development of novel strategies to improve vaccine efficacy and/or implementation of enhanced treatment approaches. Building on recent findings and potential for cross-fertilization between oncology and infection biology, we highlight current challenges and untapped opportunities for translating new advances in MDSC research into clinical applications for TB and AIDS.
Topics: Acquired Immunodeficiency Syndrome; HIV-1; Humans; Mycobacterium tuberculosis; Myeloid-Derived Suppressor Cells; Tuberculosis
PubMed: 32420917
DOI: 10.1172/JCI136288 -
AIDS (London, England) Jun 2022People with severe mental illness are 10 times more likely to have HIV/ AIDS than the general population, yet little is known about the characteristics and frequency of...
OBJECTIVES
People with severe mental illness are 10 times more likely to have HIV/ AIDS than the general population, yet little is known about the characteristics and frequency of recognition of pre-existing HIV/AIDS diagnoses among inpatients with severe mental illness. This study examines documentation rates of pre-existing HIV/ AIDS among inpatients within psychiatric hospitals in New York State.
DESIGN
Retrospective cohort study to examine recognition of pre-existing HIV/AIDS among psychiatric inpatients.
METHODS
Patient-level Medicaid claims records were linked with hospital and regional data for people admitted to psychiatric inpatient units in New York State. Presence of HIV/AIDS diagnoses prior to psychiatric hospitalization was coded for each inpatient (n = 14 602). Adjusted odds ratios of undocumented HIV/AIDS diagnoses at the time of discharge were calculated using logistic regression analyses.
RESULTS
About 5.1% (741/14 602) of unique psychiatric inpatients had pre-existing HIV/AIDS diagnoses. Of these inpatients, 58.3% (432/741) were not coded as having HIV/AIDS upon discharge. Higher rates of missed detection were associated with younger age, non-Hispanic white race/ethnicity, shorter length of stay, more distal coding of an HIV/AIDS diagnosis, and fewer HIV/AIDS-related Medicaid claims in the past year. Hospitals with higher readmission rates also had higher rates of undetected HIV/AIDS diagnoses.
CONCLUSION
Over half of inpatients previously diagnosed with HIV/AIDS did not have their HIV-positive status noted upon discharge from psychiatric hospitalization. This finding underscores how frequently clinically significant medical comorbidities fail to be incorporated into psychiatric treatment and treatment planning. Inpatient clinicians are missing important opportunities to optimize HIV/AIDS treatment and reduce morbidity and mortality.
Topics: Acquired Immunodeficiency Syndrome; HIV Infections; Hospitalization; Humans; Inpatients; Mental Disorders; Retrospective Studies
PubMed: 35142705
DOI: 10.1097/QAD.0000000000003190