Current HIV Research - Volume 21, Issue 1, 2023

Background: Pre-exposure prophylaxis (PrEP) has recently been introduced in Mexico. Still, there are no data exploring the frequency and related factors of willingness to recommend it among non-physician health providers (Non-PHP). Objective: Compare awareness, knowledge, attitudes, and willingness to recommend PrEP and combined HIV prevention among Mexican non-PHP. Methods: We conducted an online survey assessing data on sociodemographics, awareness, knowledge, and willingness to recommend PrEP. We performed a descriptive and comparative analysis between those willing and unwilling to recommend PrEP. Results: The final sample was 142 participants, and most were willing to recommend PrEP (79.6%). This group reported higher confidence in evaluating PrEP eligibility (90.1%, p<.01), identified that populations at increased risk of HIV would benefit the most from PrEP (p≤.05), and considered the lack of professionals to prescribe PrEP as a barrier (60.7%, p<.01), and were more likely to recommend post-exposure prophylaxis (95.6%, p<.01) compared to those not willing to recommend PrEP. On the other hand, more non-PHP unwilling to recommend PrEP considered that behavioral interventions should be prioritized over PrEP (89.3%, p<.05), PrEP should not be provided in public services (43.3%, p<.001), and the demand of PrEP users would be low to maintain PrEP as a public policy (34.5%, p<.05). Conclusion: A high proportion of Mexican non-PHP is willing to recommend PrEP. Still, it is necessary to increase their PrEP knowledge, including improving their prejudices and beliefs, so they can identify and refer potential PrEP users based on their risk of getting HIV.

Objective: It has been reported that carnitine deficiency is observed in various viral infections and in the follow-up of the prognosis of some diseases. In this cross-sectional study, we aimed to determine how carnitine ester derivatives change in HIV-positive patients. Materials and Methods: In this study, 25 HIV-infected patients who applied to Harran University Faculty of Medicine Education Research and Practice Hospital Infectious Diseases and Clinical Microbiology Outpatient Clinic and who did not receive any antiretroviral treatment, as well as 25 healthy volunteers were included in the study. Carnitine ester levels in serum samples were measured by Liquid Chromatography-Mass Spectrometry/Mass Spectrometry (LC-MS/MS) method (Shimadzu North America, Columbia, MD, USA). Results: While suberoylcarnitine (C8DC), myristoleylcarnitine (C14:1), tetradecadienoylcarnitine (C14:2), palmitoleylcarnitine (C16:1), and linoleylcarnitine (C18:2) levels in HIV(+) patients were quite low compared to the control group, tiglylcarnitine (C5:1) levels were high (p ≤ 0.05). In addition, C5:1 and C14:2 index parameters according to VIP score, and C5:1 and C14:1/C16 index parameters according to ROC analysis were determined as markers with high potential to distinguish HIV(+) patients from healthy volunteers. Conclusion: This study showed that levels of acylcarnitine derivatives might be altered in HIV(+) patients, and the results obtained may contribute to a better understanding of carnitine metabolism.

Background: Periodontitis (PDT) has gained attention in the literature with the increase in life expectancy of people living with HIV on combined antiretroviral therapy (cART). Thus, the search for inflammatory biomarkers could be useful to understand the pathophysiology of chronic oral diseases in the cART era. Objective: The aim of this study was to evaluate the impact of non-surgical periodontal therapy (NSPT) on clinical parameters of PDT, Candida spp. count and expression of lactoferrin (LF) and histatin (HST) in saliva and gingival crevicular fluid (GCF) of HIV-infected patients. Methods: Bleeding index (BI), probing depth (PD), clinical attachment level (CAL), colonyforming units (CFUs) of Candida spp, and LF and HST levels were measured in saliva and GCF of both groups at three different times: baseline (before treatment), and 30 and 90 days after the NSPT. Clinical, mycological and immunoenzymatic analyses were also performed. Results: Twenty-two HIV-infected patients and 25 non-HIV-infected patients with PDT participated in the study. NSPT was effective in improving periodontal clinical parameters, including ≤ 4 sites with PD ≤ 5mm and BI ≤ 10%. Significant change in oral Candida spp. count occurred neither between the two groups nor after NSPT. And the salivary and GCF levels of LF and HST were not influenced by the NSPT; by contrast, except for salivary LF, HST and LF were shown to exhibit significantly higher levels in HIV-infected than in non-HIV-infected patients. Conclusion: NSPT was effective in improving periodontal disease parameters in HIV-infected patients, but did not affect LF and HST expression in saliva and GCF of HIV-infected patients.

Objective: To evaluate the epidemiological profile and clinical findings of newly diagnosed HIV-infected patients in terms of changing trends over 16 years. Methods: A total of 748 patients (mean ± SD age: 34 ± 11.6 years, 88.9% were males) newly diagnosed with HIV/AIDS at a tertiary care hospital located in Istanbul province between 2002 and 2017 were included in this retrospective study. Data on sociodemographic characteristics, potential routes of transmission, the reason for HIV testing, time from diagnosis to treatment onset, and the HIV RNA values and CD4⁺ T cell count (at diagnosis and treatment onset) were recorded in each patient and compared between the diagnoses made within the 2002-2009 (n = 141) vs. 2010-2017 (n = 607) periods. Results: When compared to HIV diagnoses within the 2002-2009 period, the diagnoses made within the 2010-2017 period were associated with a significantly higher percentage of males (78.7 vs. 91.3%, p < 0.001), 18-29 years age group (23.6% vs. 35.5%, p = 0.029), singles (34.0 vs. 49.6%, p = 0.004), university graduates (9.9 vs. 23.4%, p < 0.001) and students (0.7 vs. 8.2%, p < 0.001) along with an increased likelihood of voluntary testing (6.4 vs. 15.2%, p = 0.048) and a lower percentage of heterosexual individuals (63.8 vs. 47.0%, p < 0.001). Sexual contact (88.0%) was the leading transmission route, and the presence of complaints (44.3%) was the leading reason for HIV testing. Overall, the time from diagnosis to treatment onset was a median 1 month (range, 1 to 97 months), and the median HIV RNA level at the time of diagnosis was 208065 copies/mL with no significant difference between study periods. The diagnoses within the 2010-2017 vs. 2002-2009 period were associated with significantly higher median (min-max) CD4⁺ T cell counts (378(0-2522) vs. 319(4-1270) cells/mm³, p < 0.001) and a lower percentage of patients with CD4⁺ T cell count < 200 cells/mm³ (22.1 vs. 39.0%, p = 0.002) at the time of diagnosis. Conclusion: In conclusion, our findings on the epidemiological profile and clinical characteristics of newly diagnosed HIV patients over 16 years (2002-2017) in a tertiary care center in Turkey revealed a considerable increase in the number of new diagnoses, an improved earlier diagnosis and a change in epidemiologic profile over the years with increased likelihood of disease to be more commonly diagnosed among males, 18-29 years age group and MSM.

Background: Acquired immune deficiency syndrome and fracture are all serious hazards to human health that create a widespread alarm. Biomarkers that are closely linked to HIVRNA and fracture are unknown. Methods: 48 cases with HIV and fracture and 112 normal cases were recruited. Blood neutrophil count (NEU), white blood cell count (WBC), PAK1 and HIVRNA were measured. Pearson's chisquared test was used to evaluate the association between HIVRNA with fracture and NEU, WBC, PAK1. BP neural network model was constructed to analyze the predictive power of the combined effects of NEU, WBC, PAK1 for HIV RNA with fracture. Results: There exist strong correlations between PAK1, NEU, WBC and HIVRNA with fracture. The neural network model was successfully constructed. The overall determination coefficients of the training sample, validation sample, and test sample were 0.7235, 0.4795, 0.6188, 0.6792, respectively, indicating that the fitting effect between training sample and overall was good. Statistical determination coefficient of the goodness of fit R² ≈ 0.82, it can be considered that degree of fit between the estimate and corresponding actual data is good. Conclusion: HIVRNA with fracture could be predicted using a neural network model based on NEU, WBC, PAK1. The neural network model is an innovative algorithm for forecasting HIVRNA levels with fracture.

Background: Acquired Immune Deficiency Syndrome (AIDS) remains a nationwide health problem in China; there were a reported 1,045,000 people living with Human immunodeficiency virus (HIV)/AIDS by the end of October 2020, and the proportion of individuals aged 50 years and older living with HIV has also increased from 8% to 24% over the past two decades. Methods: A cross-sectional study and an 1:2 matched case-control study were conducted from July to August 2016, in Wuxi city, eastern China. A total of 1,000 men aged 50 years and older completed a face-to-face interview regarding their AIDS-related knowledge and attitudes, as well as risk behaviors. Results: Prevalence was 0.1% for HIV and 2% for syphilis. The awareness rate of AIDS-related knowledge among elderly men was 48.9% (range 40.7%-63.9%). The 1158;‰2 matched case-control study indicated that only the AIDS-related attitudes were different between the two groups (χ²=8.726, P=0.013), the conditional logistic regression analysis indicated that scores of AIDS health knowledge were the only significant prognostic factor for the infection (HR=0.754 (0.569- 0.999), P=0.049). Conclusion: It was crucial to prevent HIV/AIDS and syphilis infections by improving the awareness of AIDS-related knowledge and changing related attitudes among the elderly. Further research aimed at identifying how these factors impact their sexual decision-making can shed valuable insight into further prevention program in this population.

Objective: Improving health-related quality of life (HRQOL) in people living with HIV (PLWH) is one of the critical goals of HIV prevention and control in the following decades, and perceived social support (PSS) has always exhibited a positive influence on patients' HRQOL. This study aims to describe the gap in social support in improving HRQOL between symptomatic and asymptomatic PLWH. Methods: By analysing secondary data from an online survey, a multicenter, descriptive and crosssectional study was conducted. The correlation trend and differences between PSS and HRQOL among asymptomatic and symptomatic PLWH were determined. Results: Information from 493 PLWH with ART medication was finally analyzed: 34.89% asymptomatic PLWH and 65.11% symptomatic PLWH. There were significant differences observed between the two groups in terms of family income (χ² = 9.782, P = 0.021), HIV-positive duration (χ² = 19.541, P < 0.001), stage of disease (χ² = 9.617, P = 0.008), and comorbidities (χ² = 26.119, P < 0.001). The mean score of HRQOL of PLWH for the whole domain of the questionnaire was 86.56 (SD = 15.95). In six domains of QOL and PSS, the asymptomatic group had better conditions than the symptomatic group. There was a linear association between PSS and HRQOL, not only in the symptomatic group but also asymptomatic population, after adjusting for potential confounding factors. When the level of PSS was between 60 and 80, the HRQOL of the symptomatic group was similar to that of the asymptomatic group. While the score of PSS exceeded 80, the HRQOL of the symptomatic group was less sensitive to the changes in PSS. The social and environmental status of HRQOL in PLWH was most strongly correlated with their PSS. Conclusion: The value of PSS on the HRQOL in PLWH is confirmed, especially for asymptomatic subjects. Healthcare providers need a complete understanding of the gap in social support between the asymptomatic and symptomatic populations. The comprehensive strategies, including symptom management, active treatment, and social support, should be more efficient for improving the overall health of symptomatic PLWH.

Objective: HIV patients are prone to infection and difficult to treat, which mainly manifests itself in decreased CD4⁺ T cells in the body. Therefore, the predictive value of lymphocyte count and hemoglobin for CD4⁺ levels in HIV patients was discussed in the prospective study. Methods: 125 HIV patients (aged >18 or < 80 years) were recruited. Pearson chi-square test was used to explore the correlation between CD4⁺ content and blood-related parameters in HIV patients. Univariate and multivariate logistic regression analyses were used to calculate ORs for each variable. In addition, receiver ROC curves were constructed to assess each factor's accuracy and sensitivity in diagnosing CD4⁺. Results: Lymphocyte count and hemoglobin were significantly correlated with CD4⁺. In terms of multivariate logistic regression level, there was a significant correlation between lymphocyte count (OR = 3.170, 95% CI: 1.442-6.969, P = 0.004), hemoglobin (OR = 2.545, 95% CI: 1.148- 5.646, P = 0.022) and CD4⁺content in HIV patients. Based on the neural network model, the level of lymphocyte and hemoglobin might be the predictive indexes of CD4⁺ level. We find the high-risk warning indicator of CD4⁺ level: 3 < lymphocyte (10⁹/L) < 3.6, and 150 < hemoglobin (g/L) < 200. Conclusion: Better predictive value of lymphocyte count and hemoglobin for CD4⁺ level of HIV patients.

Background: It has been more than 17 years since the introduction of free ART in India. At this point, it would be prudent to look at the factors associated with the survival of persons living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) (PLHA) who are already enrolled in the ART program. Methods: PLHAs enrolled from antiretroviral therapy (ART) centers located in three different cities in India – Delhi, Pune and Kolkata, and were followed up at six monthly intervals monitoring the WHO stage, CD4 counts, complete blood counts, and liver and kidney function tests, for a duration of three years. Results and Discussion: The incidence of mortality among HIV/AIDS patients on ART was 5.0 per 1000 patient-years (21/1410, 1.4%). Age at initiation of ART, being above 35 years, was the only significant predictor of mortality (log-rank p = 0.018). Multivariable analysis showed a significant association of an unfavourable outcome (defined as mortality or development of opportunistic infection during follow-up) with male gender (adjusted odds ratio (AOR) = 5.26, p = <0.01) and being unmarried at ART initiation (AOR = 1.39, p = 0.005). Conclusion: The survival of PLHA with good adherence to ART is independent of the WHO stage or CD4 counts at the initiation of ART. Initiation of ART after 35 years of age was a significant predictor of mortality.