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AIDS Reviews 2024This study was performed to reveal the risk factors associated with mortality in people living with HIV (PLHIV) who were diagnosed with COVID-19. Studies reporting... (Meta-Analysis)
Meta-Analysis
This study was performed to reveal the risk factors associated with mortality in people living with HIV (PLHIV) who were diagnosed with COVID-19. Studies reporting deaths among PLHIV and infected with SARS-CoV-2 were investigated. After protocol setup and registration, the extracted sources were categorized and assessed for quality. This study examined ten articles with a total of 46,136 patients. Patients aged ≥ 60 years (hazard ratio [HR] = 2.22; 95% CI: 1.617, 3.050; p < 0.001), male (HR = 1.668; 95% CI: 1.179, 2.361; p = 0.004), and people with diabetes (risk ratio [RR] = 3.34; 95% CI: 1.45, 7.68; p = 0.005) were at higher risk of death. Adherence to antiretroviral therapy (ART) reduced mortality risk (RR = 0.90; 95% CI: 0.83, 0.98; p = 0.02). Patients in the survival groups showed a statistically significant lower mean of C-reactive protein (mean difference = 114.08; 95% -74.05, 154.10; p < 0.001). Deceased patients showed higher mean levels of interleukin-6 (IL-6). Chronic respiratory disorders, hypertension, oxygen requirement, admission to an intensive care unit, D-dimer levels, and HIV viral load < 50 copies RNA/mL before admission did not show statistically significant differences between the deceased and survival groups. ART therapy reduced mortality risk (RR = 0.90; 95% 0.83, 0.98; p = 0.02). Identifying PLHIV at higher mortality risk could improve the outcomes of COVID-19 by stratifying these patients to the most effective treatment in a timely fashion.
Topics: Humans; Male; COVID-19; HIV Infections; SARS-CoV-2; Risk Factors; Treatment Outcome
PubMed: 38530743
DOI: 10.24875/AIDSRev.23000017 -
PloS One 2024The epidemiology of Human Immunodeficiency Virus (HIV)-associated pneumocystosis (HAP) is poorly described on a worldwide scale. We searched related databases between... (Meta-Analysis)
Meta-Analysis
The epidemiology of Human Immunodeficiency Virus (HIV)-associated pneumocystosis (HAP) is poorly described on a worldwide scale. We searched related databases between January 2000 and December 2022 for studies reporting HAP. Meta-analysis was performed using StatsDirect (version 2.7.9) and STATA (version 17) according to the random-effects model for DerSimonian and Laird method and metan and metaprop commands, respectively. Twenty-nine studies with 38554 HIV-positive, 79893 HIV-negative, and 4044 HAP populations were included. The pooled prevalence of HAP was 35.4% (95% CI 23.8 to 47.9). In contrast, the pooled prevalence of PCP among HIV-negative patients was 10.16% (95% CI 2 to 25.3). HIV-positive patients are almost 12 times more susceptible to PCP than the HIV-negative population (OR: 11.710; 95% CI: 5.420 to 25.297). The mortality among HAP patients was 52% higher than non-PCP patients (OR 1.522; 95% CI 0.959 to 2.416). HIV-positive men had a 7% higher chance rate for PCP than women (OR 1.073; 95% CI 0.674 to 1.706). Prophylactic (OR: 6.191; 95% CI: 0.945 to 40.545) and antiretroviral therapy (OR 3.356; 95% CI 0.785 to 14.349) were used in HAP patients six and three times more than HIV-positive PCP-negatives, respectively. The control and management strategies should revise and updated by health policy-makers on a worldwide scale. Finally, for better management and understanding of the epidemiology and characteristics of this coinfection, designing further studies is recommended.
Topics: Male; Humans; Female; HIV; Pneumonia, Pneumocystis; Prevalence; HIV Infections; HIV Seropositivity
PubMed: 38526997
DOI: 10.1371/journal.pone.0297619 -
Future Microbiology 2024To determine the prevalence of ocular toxoplasmosis among people living with HIV through a systematic review and meta-analysis. A literature search was conducted,... (Meta-Analysis)
Meta-Analysis Review
To determine the prevalence of ocular toxoplasmosis among people living with HIV through a systematic review and meta-analysis. A literature search was conducted, estimating pooled prevalence and performing quality assessment, outlier, influential and meta-regression analyses. Twenty-nine studies were included in the analysis, revealing that the rate of ocular toxoplasmosis among people living with HIV was 0.37% (95% CI: 0.2-0.6). Substantial heterogeneity was observed among the studies. Despite analyzing continuous variables, including year of publication, proportion of males, mean age and proportion of patients receiving antiretroviral therapy, no statistically significant associations were found. This study provides an overview of the prevalence of ocular toxoplasmosis in people living with HIV, emphasizing the need for further research to uncover factors contributing to its development.
Topics: Humans; HIV Infections; Prevalence; Toxoplasmosis, Ocular; Male; Female; Toxoplasma
PubMed: 38507297
DOI: 10.2217/fmb-2023-0215 -
AIDS Care Mar 2024We investigated the effects of exercise training on bone mineral density (BMD) in people living with Human Immunodeficiency Virus (PLHIV). Pubmed, Scopus, Cochrane...
We investigated the effects of exercise training on bone mineral density (BMD) in people living with Human Immunodeficiency Virus (PLHIV). Pubmed, Scopus, Cochrane Library, and ScienceDirect databases were searched for trials investigating exercise training-induced changes in BMD of PLHIV at baseline . post-intervention assessed by dual-energy X-ray absorptiometry (DXA). Hedge effect sizes (ES) were calculated incorporating fixed effects for BMD variation assumptions. Disaggregated comparisons were performed for trials with more than one intervention or BMD site assessment. Seven trials included 210 PLHIV and 35 non-HIV-infected controls. Methodological quality evaluated using the Physiotherapy Evidence Database (PEDro) scale ranged from poor to moderate. Interventions applied isolated resistance, combined aerobic and resistance, and multimodal exercise protocols performed 3 d/wk for 12-to 104 week. One controlled and another uncontrolled trial presented significant effects, reporting improvements at the femoral neck and total (ES 2.14 and 0.49, respectively). Magnitude of those specific ES influenced the overall effect (controlled and uncontrolled trials), which was small but significant (= 12, ES 0.277, 95% confidence interval 0.120-0.434). Resistance training may promote favorable adaptations in BMD of PLHIV, particularly in femur. Future research should elucidate the optimal dose-response relationship and physiological mechanisms underlying exercise-induced adaptations on the BMD of PLHIV.
PubMed: 38502603
DOI: 10.1080/09540121.2024.2331213 -
Journal of the International AIDS... Mar 2024Disengagement from antiretroviral therapy (ART) care is an important reason why people living with HIV do not achieve viral load suppression become unwell.
INTRODUCTION
Disengagement from antiretroviral therapy (ART) care is an important reason why people living with HIV do not achieve viral load suppression become unwell.
METHODS
We searched two databases and conference abstracts from January 2015 to December 2022 for studies which reported reasons for disengagement from ART care. We included quantitative (mainly surveys) and qualitative (in-depth interviews or focus groups) studies conducted after "treat all" or "Option B+" policy adoption. We used an inductive approach to categorize reasons: we report how often reasons were reported in studies and developed a conceptual framework for reasons.
RESULTS
We identified 21 studies which reported reasons for disengaging from ART care in the "Treat All" era, mostly in African countries: six studies in the general population of persons living with HIV, nine in pregnant or postpartum women and six in selected populations (one each in people who use drugs, isolated indigenous communities, men, women, adolescents and men who have sex with men). Reasons reported were: side effects or other antiretroviral tablet issues (15 studies); lack of perceived benefit of ART (13 studies); psychological, mental health or drug use (13 studies); concerns about stigma or confidentiality (14 studies); lack of social or family support (12 studies); socio-economic reasons (16 studies); health facility-related reasons (11 studies); and acute proximal events such as unexpected mobility (12 studies). The most common reasons for disengagement were unexpected events, socio-economic reasons, ART side effects or lack of perceived benefit of ART. Conceptually, studies described underlying vulnerability factors (individual, interpersonal, structural and healthcare) but that often unexpected proximal events (e.g. unanticipated mobility) acted as the trigger for disengagement to occur.
DISCUSSION
People disengage from ART care for individual, interpersonal, structural and healthcare reasons, and these reasons overlap and interact with each other. While HIV programmes cannot predict and address all events that may lead to disengagement, an approach that recognizes that such shocks will happen could help.
CONCLUSIONS
Health services should focus on ways to encourage clients to engage with care by making ART services welcoming, person-centred and more flexible alongside offering adherence interventions, such as counselling and peer support.
Topics: Adolescent; Female; Humans; Male; Pregnancy; Anti-Retroviral Agents; Developing Countries; HIV Infections; Sexual and Gender Minorities; Medication Adherence; Patient Dropouts
PubMed: 38494657
DOI: 10.1002/jia2.26230 -
Frontiers in Medicine 2024Integrase strand transfer inhibitor (INSTI) dolutegravir (DTG)-based antiretroviral therapy (ART) is recommended by World Health Organisation as preferred first-line...
BACKGROUND
Integrase strand transfer inhibitor (INSTI) dolutegravir (DTG)-based antiretroviral therapy (ART) is recommended by World Health Organisation as preferred first-line regimen in pregnant women living with human immunodeficiency virus (HIV) (WLHIV). Non-nucleoside reverse transfer inhibitor (NNRTI)-based ART and protease inhibitor (PI)-based ART are designated as alternative regimens. The impact of different ART regimens on perinatal outcomes is uncertain. We aimed to assess the comparative risk of adverse perinatal outcomes in WLHIV receiving different classes of ART.
MATERIALS AND METHODS
A systematic literature review was conducted by searching PubMed, CINAHL, Global Health, and EMBASE for studies published between Jan 1, 1980, and July 14, 2023. We included studies reporting on the association of pregnant WLHIV receiving different classes of ART with 11 perinatal outcomes: preterm birth (PTB), very PTB, spontaneous PTB, low birthweight (LBW), very LBW, term LBW, preterm LBW, small for gestational age (SGA), very SGA (VSGA), stillbirth, and neonatal death. Pairwise random-effects meta-analyses compared the risk of each adverse perinatal outcome among WLHIV receiving INSTI-ART, NNRTI-ART, PI-ART, and nucleoside reverse transfer inhibitor (NRTI)-based ART, and compared specific "third drugs" from different ART classes. Subgroup and sensitivity analyses were conducted based on country income status and study quality.
RESULTS
Thirty cohort studies published in 2006-2022, including 222,312 pregnant women, met the eligibility criteria. Random-effects meta-analyses found no evidence that INSTI-ART is associated with adverse perinatal outcomes compared to NNRTI-ART and PI-ART. We found that PI-ART is associated with a significantly increased risk of SGA (RR 1.28, 95% confidence interval (95% CI) [1.09, 1.51], = 0.003) and VSGA (RR 1.41, 95% CI [1.08, 1.83], = 0.011), compared to NNRTI-ART. Specifically, lopinavir/ritonavir (LPV/r) was associated with an increased risk of SGA (RR 1.40, 95% CI [1.18, 1.65], = 0.003) and VSGA (RR 1.84, 95% CI [1.37, 2.45], = 0.002), compared to efavirenz, but not compared to nevirapine. We found no evidence that any class of ART or specific "third drug" was associated with an increased risk of PTB.
CONCLUSION
Our findings support the recommendation of INSTI-ART as first-line ART regimen for use in pregnant WLHIV. However, the increased risks of SGA and VGSA associated with PI-ART, compared to NNRTI-ART, may impact choice of second- and third-line ART regimens in pregnancy.: https://www.crd.york.ac.uk/prospero/, identifier CRD42021248987.
PubMed: 38476445
DOI: 10.3389/fmed.2024.1323813 -
The Pan African Medical Journal 2023in 2015, the World Health Organization recommended early antiretroviral therapy (ART) initiation after HIV diagnosis. Mixed results on the effect of same-day ART... (Meta-Analysis)
Meta-Analysis
Same-day ART initiation, loss to follow-up and viral load suppression among people living with HIV in low- and middle-income countries: systematic review and meta-analysis.
INTRODUCTION
in 2015, the World Health Organization recommended early antiretroviral therapy (ART) initiation after HIV diagnosis. Mixed results on the effect of same-day ART initiation (SDI) over non-same-day ART initiation (NSDI) on loss to follow-up (LTFU) and viral load suppression (VLS) necessitate further evaluation.
METHODS
this was a systematic review and meta-analysis of people living with HIV in low- and middle-income countries (LMICs). Multiple databases were searched from January 2016 to December 2022. VLS was defined as HIV RNA <1,000 or <400 cells/ml, depending on the study. Forest plots were used to present the pooled prevalence and 95% confidence intervals (CIs). Heterogeneity was tested by an I statistic and a p-value of <0.05 indicated its presence. Analyses were performed in STATA.
RESULTS
sixteen studies (5 clinical trials, 10 cohorts, and 1 cross-sectional) were included in the final analysis. Nine studies with 157,633 people living with HIV were analyzed for LTFU and the pooled prevalence of LTFU was 22.0% (95%CI; 18.5-25.7). The pooled prevalence of VLS was 72.7% (95%CI; 65.4-79.5%). The I statistic had a Q value of 200.62 (p<0.001) and 44.63 (p<0.001) for pooled prevalence of LTFU and VLS, respectively. Overall, compared to those who received NSDI, SDI had a significantly increased risk of LTFU (risk difference (RD)=0.04; 95%CI: 0.01-0.07). Although observational studies showed an increased risk of LTFU among SDI compared to NSDI (RD=0.05, 95%CI: 0.02-0.08), clinical trials did not. There was no statistically significant difference in VLS comparing those who received SDI vs NSDI (RD= 0.02, 95%CI: -0.03 - 0.07).
CONCLUSION
nearly two in ten people living with HIV in LMICs who initiated ART were LTFU. SDI was associated with increased risk of LTFU. Efforts to prevent LTFU among those who receive SDI are critical to maximize its potential benefits.
Topics: Humans; Anti-HIV Agents; Cross-Sectional Studies; Developing Countries; HIV Infections; Lost to Follow-Up; Viral Load
PubMed: 38405092
DOI: 10.11604/pamj.2023.46.92.40848 -
Viruses Feb 2024There are an increasing number of articles focused on the prevalence and clinical impact of pretreatment HIV drug resistance (PDR) detected by Sanger sequencing (SGS).... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
There are an increasing number of articles focused on the prevalence and clinical impact of pretreatment HIV drug resistance (PDR) detected by Sanger sequencing (SGS). PDR may contribute to the increased likelihood of virologic failure and the emergence of new resistance mutations. As SGS is gradually replaced by next-generation sequencing (NGS), it is necessary to assess the levels of PDR using NGS in ART-naïve patients systematically. NGS can detect the viral variants (low-abundance drug-resistant HIV-1 variants (LA-DRVs)) of virus quasi-species at levels below 20% that SGS may fail to detect. NGS has the potential to optimize current HIV drug resistance surveillance methods and inform future research directions. As the NGS technique has high sensitivity, it is highly likely that the level of pretreatment resistance would be underestimated using conventional techniques.
METHODS
For the systematic review and meta-analysis, we searched for original studies published in PubMed, Web of Science, Scopus, and Embase before 30 March 2023 that focused exclusively on the application of NGS in the detection of HIV drug resistance. Pooled prevalence estimates were calculated using a random effects model using the 'meta' package in R (version 4.2.3). We described drug resistance detected at five thresholds (>1%, 2%, 5%, 10%, and 20% of virus quasi-species). Chi-squared tests were used to analyze differences between the overall prevalence of PDR reported by SGS and NGS.
RESULTS
A total of 39 eligible studies were selected. The studies included a total of 15,242 ART-naïve individuals living with HIV. The prevalence of PDR was inversely correlated with the mutation detection threshold. The overall prevalence of PDR was 29.74% at the 1% threshold, 22.43% at the 2% threshold, 15.47% at the 5% threshold, 12.95% at the 10% threshold, and 11.08% at the 20% threshold. The prevalence of PDR to INSTIs was 1.22% (95%CI: 0.58-2.57), which is the lowest among the values for all antiretroviral drugs. The prevalence of LA-DRVs was 9.45%. At the 2% and 20% detection threshold, the prevalence of PDR was 22.43% and 11.08%, respectively. Resistance to PIs and INSTIs increased 5.52-fold and 7.08-fold, respectively, in those with a PDR threshold of 2% compared with those with PDR at 20%. However, resistance to NRTIs and NNRTIs increased 2.50-fold and 2.37-fold, respectively. There was a significant difference between the 2% and 5% threshold for detecting HIV drug resistance. There was no statistically significant difference between the results reported by SGS and NGS when using the 20% threshold for reporting resistance mutations.
CONCLUSION
In this study, we found that next-generation sequencing facilitates a more sensitive detection of HIV-1 drug resistance than SGS. The high prevalence of PDR emphasizes the importance of baseline resistance and assessing the threshold for optimal clinical detection using NGS.
Topics: Humans; HIV-1; Anti-HIV Agents; HIV Infections; Genotype; Drug Resistance, Viral; HIV Seropositivity; High-Throughput Nucleotide Sequencing; Prevalence; Mutation
PubMed: 38400015
DOI: 10.3390/v16020239 -
AIDS Patient Care and STDs Feb 2024Globally, 38.4 million people are affected by the human immunodeficiency virus (HIV) pandemic, and more than 2.5 million new HIV infections occur yearly. HIV... (Meta-Analysis)
Meta-Analysis
Globally, 38.4 million people are affected by the human immunodeficiency virus (HIV) pandemic, and more than 2.5 million new HIV infections occur yearly. HIV pre-exposure prophylaxis (PrEP) has been widely recognized as a potential way to prevent new infections among risk population. There is a paucity of abridged evidence on the level and barriers to PrEP service uptake in sub-Saharan Africa (SSA). Therefore, we conducted a systematic review to synthesize existing evidence on PrEP uptake in SSA. Relevant studies were searched from major databases (PubMed and PsychInfo) and direct Google Scholar. Data were extracted and recorded using a pilot-tested template. Methodological rigor, heterogeneity and publication bias of studies were assessed to minimize the inclusion of erroneous findings. A random effect model was used for the meta-analysis followed by narrative metasynthesis. The protocol of this systematic review has been by registered PROSPERO (ID: CRD42022308855). A total of 1830 studies were retrieved, and 30 studies met inclusion criteria of the systematic review. People who heard about PrEP ranged from 23% to 98%. The pooled prevalence of willingness to use PrEP was 64.2% (95% confidence interval: 55.5-72.0). Fear of side effect, stigma, nonreceptive attitude, cost of pills, low awareness about PrEP, perceived reason about the effectiveness of PrEP, and lack of friendly services were the common barriers to PrEP uptake in Africa. In conclusion, comprehensive knowledge and willingness to use PrEP were low in SSA. The barriers to low PrEP service uptake are avoidable through comprehensive awareness creation and availing essential services to key population in Africa. Expanding educational messages to key population using friendly approaches and more accessible platforms, engaging stakeholders, and integrating PrEP service with routine health care are important to foster HIV prevention and control in the future.
Topics: Humans; HIV Infections; HIV; Anti-HIV Agents; Pre-Exposure Prophylaxis; Africa South of the Sahara
PubMed: 38381951
DOI: 10.1089/apc.2023.0117 -
PloS One 2024Many children and adolescents living with HIV have ended up as orphans. Due to HIV taking away their parents leaves them deprived of their most important social network... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Many children and adolescents living with HIV have ended up as orphans. Due to HIV taking away their parents leaves them deprived of their most important social network and support, which predisposes them to poor adherence to antiretroviral therapy (ART). Various studies have shown poor adherence to ART among orphaned children and adolescents. This systematic review and meta-analysis, therefore, aims to determine the level of ART adherence among orphaned children and adolescents living with HIV/AIDS.
METHODS
This PROSPERO registered review (CRD42022352867) included studies from PubMed, Google Scholar, Scopus, Web of Science, Africa Journal Online, and selected HIV/AIDS journals from data inception to June 01, 2022. We included articles published in all languages that report the prevalence of adherence to ART among children and adolescent orphans (single parent orphans and/or double orphans) living with HIV/AIDS. We excluded qualitative studies, case studies, opinion papers, and letters to editors. We used the random-effect model to calculate the pooled prevalence of ART adherence based on the highest prevalence provided by the various methods in a particular study. We used the Joanna Briggs Institute Appraisal tool for the prevalence study to evaluate for risk of bias in the included studies. The Egger's test was used to assess small study effects.
RESULTS
Out of 1087 publications identified from the various databases, six met the selection criteria. The included six studies had a total 2013 orphans living with HIV/AIDS. The pooled prevalence of ART adherence was 78∙0% (95% Confidence Interval: 67.4-87.7; I2 = 82.92%, p<0∙001) and ranged between 7∙6% and >95%, using one of the following methods: pill count, caregiver's self-report, clinical attendance, and nevirapine plasma levels (above three μg/mL). The factors associated with adherence were pill burden, caregiver involvement, stunting, and caregiver relationship.
LIMITATION
There was a high level of heterogeneity in the finding.
CONCLUSION
Approximately four fifth of orphan children and adolescents living with HIV/AIDS adhere to ART. Strategies to improve adherence among this group should be prioritized, especially among the double orphaned children and adolescents.
Topics: Child; Humans; Adolescent; Acquired Immunodeficiency Syndrome; Anti-HIV Agents; Child, Orphaned; HIV Infections; Anti-Retroviral Agents; Medication Adherence
PubMed: 38381726
DOI: 10.1371/journal.pone.0295227