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Sickness absence after carpal tunnel release: a systematic review of the literature.

BACKGROUND: Clinical and laboratory monitoring of patients on antiretroviral therapy is an integral part of HIV care and determines whether … nitoring was also assessed using visual analogue scales. RESULTS: Of 93 participants randomised to dolutegravir plus emtricitabine and 94 individuals to combination antiretroviral therapy (median nadir CD4 count, 246 cells/mm3; median age, 48 years; female, 17%),patient-centred monitoring generated no substantial reductions or increases in total costs (US$ -4 …

Prevalence of detectable viral load and its associated factors among adult patients receiving ART in Choma District, Zambia.

BACKGROUND: Africa accounts for two-thirds of the global HIV infection and a disproportionate burden is in sub-Saharan Africa. In 2017, the … .25, 7.76; p = 0.014), Missing taking medication (OR 8.28; 95%CI 2.59, 26.40; p < 0.001) and taking dolutegravir-based regimen with zidovudine/lamivudine backbone (OR 17.80 95% CI 2.29 - 132.31; p = 0.005). CONCLUSION: Detectable VL and virological failure were prevalent among adults receiving ART for ≥ 12 months and were significantly associated with sociode …

Monitoring of virological response and acquired HIV-1 drug resistance among patients initiating antiretroviral therapy in the Centre Region of Cameroon.

INTRODUCTION: despite the success of antiretroviral therapy (ART), the emergence of HIV drug resistance (HIVDR) remains a major threat in su … ue to the wide use of NNRTI-based ART. Viral susceptibility to INSTIs supports a possible switch to dolutegravir-based ART for optimal response.

Plasma Viral Load of 200 Copies/mL is a Suitable Threshold to Define Viral Suppression and HIV Drug Resistance Testing in Low- and Middle-Income Countries: Evidence From a Facility-Based Study in Cameroon.

INTRODUCTION: In low-and-middle-income-countries (LMIC), viral suppression is defined as plasma viral load (PVL) below 1000 copies/mL (low-level viremia [LLV]) and threshold for HIV drug resistance (HIVDR) testing. However, there is evidence that drug resistance mutations (DRMs) may emerge at LLV, thus compromising antiretroviral treatment (ART) response. We evaluated sequencing success rates (SSR) at LLV, described HIVDR profiles and adequacy with potential efficacy of tenofovir-lamivudine-dolutegravir (TLD). METHODS: A cross-sectional study was conducted among individuals with LLV at the Ch…

Durability of single tablet regimen for patients with HIV infection in Southern Taiwan: data from a real-world setting.

BACKGROUND: A single-tablet regimen (STR) has been associated with better drug adherence. However, the durability of different STRs was unkn … mtricitabine/Rilpivirine/Tenofovir Disoproxil Fumarate (FTC/RPV/TDF) and 24.2% (24/99) for Abacavir/Dolutegravir/Lamivudine (ABC/DTG/3TC) (p=0.16). Fifty-six patients (25%) discontinued their STRs owing to toxicity/intolerance. When compared to EFV/FTC/TDF, treatment with FTC/RPV/TDF (aHR 8.39, CI 1.98-35.58, p = 0.004) and ABC/DTG/3TC (aHR 8.40, CI 2.39-29.54 …

Mechanistic Analysis of the Broad Antiretroviral Resistance Conferred by HIV-1 Envelope Glycoprotein Mutations.

Despite the effectiveness of antiretroviral (ARV) therapy, virological failure can occur in some HIV-1-infected patients in the absence of mutations in drug target genes. We previously reported that, in vitro, the lab-adapted HIV-1 NL4-3 strain can acquire resistance to the integrase inhibitor dolutegravir (DTG) by acquiring mutations in the envelope glycoprotein (Env) that enhance viral cell-cell transmission. In this study, we investigated whether Env-mediated drug resistance extends to ARVs other than DTG and whether it occurs in other HIV-1 isolates. We demonstrate that Env mutations can r…

Therapeutic Approaches for HTLV-1-Associated Myelopathy/Tropical Spastic Paraparesis: Current and Emerging Strategies.

Human T-cell leukemia virus-1 (HTLV-1)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is a chronic inflammatory disease of the spinal cord induced by immunological activation due to high HTLV-1 proviral load in the peripheral blood. HAM/TSP is representative of HTLV-1-related inflammatory diseases, and its main neurological symptoms-namely, motor dysfunction of the lower extremities through spastic paraparesis with urinary disturbance-are progressive and lead to deterioration in the quality of life of patients once these dysfunctions develop. Therefore, novel and safe therapeutic

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… Very recently, the efficacy of another integrase inhibitor, dolutegravir, was also reported in a phase II controlled trial [ 16 ]. This trial was an open-label randomized trial of dolutegravir at 50 mg daily versus oral vitamin C at 500 mg daily for 48 weeks in HAM/TSP patients. … The administration of dolutegravir, but not vitamin C, induced a significant improvement in neurologic function, including lower extremity spasticity, sensory function, and nocturia. …

The cyclical cascade of HIV care: Temporal care engagement trends within a population-wide cohort.

BACKGROUND: The traditional HIV treatment cascade aims to visualise the journey of each person living with HIV from diagnosis, through initi … nt was also common, overall treatment coverage had increased slowly over 5 years. The transition to dolutegravir-based regimens was dramatic with good virological outcomes for those in care, notwithstanding a clearly discernible impact of the Coronavirus Disease 2019 (COVID-19) pandemic on viral load (VL) testing. People currently engaged and disengaged in car …

Virological Failure And HIV-1 Drug Resistance in Indian Adults and Adolescents on Protease Inhibitor Based Second-line Antiretroviral Therapy: A Five-year Follow-up Study.

INTRODUCTION: In the changing HIV treatment landscape, the focus shifts to persons living with HIV (PLH) experiencing virological non-suppression on second-line antiretroviral therapy (ART). This includes understanding viral genetic profiles, antiretroviral susceptibility, and the effectiveness of protease inhibitors (PIs) amid evolving dolutegravir-based regimen recommendations. METHODS: In this retrospective study, PLH with first-line ART failure transitioned to second-line ART (dual NRTI + ritonavir-boosted PI) between September 2015 and October 2018. Eligible patients were ≥ 13 years old,…

De-simplifying single-tablet antiretroviral treatments: uptake, risks and cost savings.

OBJECTIVES: As more HIV-positive individuals receive antiretroviral therapy (ART), payers are seeking options for covering these increased and sustained drug costs. Strategic use of available generic antiretroviral (ARV) formulations may be feasible. De-simplifying a single-tablet co-formulation (STF) into two or more tablets using both brand and generic drugs has been proposed. We determine if voluntary de-simplification of one STF could be utilized as a cost-saving strategy. We report on the challenges, uptake, outcomes and cost savings of this initiative. METHODS: Patients stable on the mo

Temporal trends and clinical outcomes of antiretroviral therapy initiation and regimens in treatment-naive people with HIV: A real-world study at a tertiary specialist hospital in Beijing, China.

BACKGROUND: The WHO and international treatment guidelines recommend rapid initiation of antiretroviral therapy (ART) for all treatment-naiv … l suppression factors showed both bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) and dolutegravir/lamivudine (DTG/3TC) were non-inferior to EFV+3TC+TDF (odds ratio [OR] = 1.34, 95% confidence interval [CI]: 0.75 - 2.39, P = 0.318; OR = 1.92, 95% CI: 0.54 - 6.80, P = 0.311, respectively). Moreover, BIC/FTC/TAF and DTG/3TC were associated with a l …

Association between mental disorders with detectable viral load and poor adherence to antiretroviral therapy among adolescents infected with Human Immunodeficiency Virus on follow-up at Chantal Biya Foundation, Cameroon.

INTRODUCTION: Perinatally HIV-Infected Adolescents (HIVIA) are more likely to have mental health problems than their uninfected peers. In re … ving both parents alive (aOR (95 %CI): 0.4 (0.2-0.9); p = 0.031) or receiving ART with efavirenz or dolutegravir (aOR (95 %CI): 0.5 (0.2-0.9); p = 0.047) was strongly associated with a lower likelihood of having a detectable VL. Moreover, detectable viral load was slightly less frequent in adolescents whose household was equipped with a television (p = 0.084) …

Cardiometabolic health in people with HIV: expert consensus review.

ObjectivesTo develop consensus data statements and clinical recommendations to provide guidance for improving cardiometabolic health outcomes in people with HIV based on the knowledge and experience of an international panel of experts.MethodsA targeted literature review including 281 conference presentations, peer-reviewed articles, and background references on cardiometabolic health in adults with HIV published between January 2016 and April 2022 was conducted and used to develop draft consensus data statements. Using a modified Delphi method, an international panel of 16 experts convened in

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… Greater weight gain in treatment-naive persons starting dolutegravir-based antiretroviral therapy. Clin Infect Dis 2020; 70: 1267–74. 10.1093/cid/ciz407 22. Ruderman SA, Crane HM, Nance RMet al. … Weight gain among treatment-naïve persons with HIV receiving dolutegravir in Kenya. J Acquir Immune Defic Syndr 2022; 91: 490–6. 10.1097/QAI.0000000000003087 27. Martínez-Sanz J, Blanco J-R, Muriel Aet al. …

A decentralized point of service triple prevention and treatment model for hepatitis B, C and HIV in people who inject drugs in South Africa.

BACKGROUND: The burden of viral hepatitis and HIV in sub-Saharan Africa is substantial with an estimated 64.7 million living with hepatitis … were HBsAg positive and HIV negative. If HIV positive or HIV-HBV co-infected, tenofovir/lamivudine/dolutegravir combination as ART was commenced. In those with confirmed HCV-viraemia, 12-weeks of sofosbuvir and daclatasvir as HCV DAA therapy were initiated in those with HCV mono-infection, or with HIV and/or HBV co-infection, if stable on treatment. RESULTS: …

Evaluation of archived drug resistance mutations in HIV-1 DNA among vertically infected adolescents under antiretroviral treatment in Cameroon: Findings during the COVID-19 pandemic.

BACKGROUND: With the success of antiretroviral therapy (ART), children born with HIV are more likely to reach adolescence. However, frequent … leoside reverse transcriptase inhibitor (NNRTI)-based first-line ART (of whom 19/31 transitioned to dolutegravir-based ART in 2020) and 24/55 (43.6%) were on second-line ART. Forty-two out of 60 (70.0%) ALHIV were non-viraemic; 43/60 (71.6%) were successfully sequenced. Overall the ADRM rate was 62.7% (27/43), with 69.2% (9/13) viraemic and 60.0% (18/30) non-v …

A systematic review of evidence on weight change following initiation of long-acting cabotegravir for the prevention or treatment of HIV.

BACKGROUND: Weight gain is an increasingly recognized concern among people receiving antiretroviral therapy (ART) and may increase the risk of non-communicable diseases. Integrase inhibitors (INSTIs) such as dolutegravir (DTG) have been associated with weight gain, but the metabolic effects of long-acting cabotegravir (CAB-LA), another INSTI, for HIV treatment and prevention remain incompletely characterized. We conducted a systematic review to synthesize evidence on weight and body mass index (BMI) changes associated with CAB-LA-based regimens across ART and pre-exposure prophylaxis (PrEP) tr…

Spectrum and immunovirological determinants of tumours among people living with HIV in Uganda: A retrospective cross sectional study from a specialised HIV centre, 2017-2026.

BACKGROUND: Sub-Saharan Africa carries a disproportionate burden of HIV-associated malignancies. The contemporary tumour spectrum in the dolutegravir (DTG) era remains incompletely characterised in East African routine HIV-care settings. The immunovirological context at the time of cancer or benign tumor diagnosis is similarly under-described. We sought to describe the spectrum, malignant fraction, and immunovirological correlates of neoplasms diagnosed at a specialised HIV centre in Kampala, Uganda. METHODS: We conducted a retrospective, cross-sectional analysis of 219 tumour records identif…

Progressive disseminated histoplasmosis with concomitant disseminated nontuberculous mycobacterial infection in a patient with AIDS from a nonendemic region (California).

BACKGROUND: Opportunistic infections, while well studied in the AIDS population, continue to have variable and surprising presentations. Here, we present a case of disseminated histoplasmosis with disseminated nontuberculous mycobacterial infection in a 50 year old man with long standing AIDS living in a non-endemic area. CASE PRESENTATION: Patient presented with a constellation of symptoms, and imaging of the chest showed a pulmonary mass with cavitation, multiple nodules, and ground glass opacities. Further investigations revealed granulomatous lung nodules and fungemia consistent with Hist

Integrase inhibitors in late pregnancy and rapid HIV viral load reduction.

BACKGROUND: Minimizing time to HIV viral suppression is critical in pregnancy. Integrase strand transfer inhibitors (INSTIs), like raltegravir, are known to rapidly suppress plasma HIV RNA in nonpregnant adults. There are limited data in pregnant women. OBJECTIVE: We describe time to clinically relevant reduction in HIV RNA in pregnant women using INSTI-containing and non-INSTI-containing antiretroviral therapy (ART) options. STUDY DESIGN: We conducted a retrospective cohort study of pregnant HIV-infected women in the United States from 2009 through 2015. We included women who initiated ART,

Extensive brain masses and cavitary lung lesions associated with toxoplasmosis and acquired immunodeficiency syndrome.

Toxoplasmosis is an important cause of enhancing brain lesions in patients with acquired immunodeficiency syndrome (AIDS), and it is typically associated with low CD4-lymphocyte counts. Extensive toxoplasma encephalitis when the CD4-lymphocyte count is above 100 cells/µl is unusual. Cavitary lung lesions are also not typically associated with toxoplasmosis. Here, we present a case of toxoplasmosis associated with extensive brain masses and cavitary lung lesions, both of which improved with directed toxoplasmosis therapy, in an AIDS patient with a CD4 cell count of 120 cells/µl.