Frequency: Quarterly E- ISSN: 2320-852X P- ISSN: Awaited Abstracted/ Indexed in: Ulrich's International Periodical Directory, Google Scholar, SCIRUS, getCITED, EBSCO Information Services
Quarterly published in print and online "Inventi Impact: Preventive & Social Medicine (Formerly Inventi Impact: AIDS)" publishes high quality unpublished as well as high impact pre-published research and reviews catering to the needs of researchers and professionals. This journal focuses on all the aspects related to HIV/AIDS that help in better understanding of disease and improve the quality of patient care. Articles from following areas are given special emphasis, diagnosis, epidemiology, prevention, treatment, virology & immunology of HIV/AIDS, opportunistic infections and pathogenicity.
The Integrated Bio-Behavioural Surveillance Survey of 2022–2023 among key populations report from Zanzibar has been released. The prevalence of HIV is estimated to be 21.1%, 11.4%, and 9.3% among Female Sex Workers, Men who have Sex with Men, and People Who Injected Drugs, respectively. This has prompted a closer examination of the factors contributing to this trend, with a particular focus on the low coverage of Pre-Exposure Prophylaxis in these key populations. The current prevalence reported in December 2023 signals a critical turning point that necessitates a reevaluation of the barriers and facilitators of Pre Exposure Prophylaxis intervention to combat the epidemic. It is imperative to acknowledge the severity of the situation and take decisive action to prevent further spread of the virus in the Isles....
Since May 2022, a global outbreak of human Mpox has rapidly spread in non-endemic countries. We report a case of a 34-year-old man admitted to hospital for a six-day history of fever associated with vesiculo-pustular rash involving the face, limbs, trunk and perianal region, lymphadenopathy and severe proctitis and pharyngitis. He was HIV-positive and virologically suppressed by stable antiretroviral therapy. On admission, Mpox virus-specific RT-PCR was positive from multiple samples. Additionally, blood cultures yielded Streptococcus pyogenes, prompting a 14-day-course of penicillin G and clindamycin. Due to the worsening of proctitis along with right ocular mucosa involvement, tecovirimat treatment was started with a rapid improvement in both skin and mucosal involvement. The patient was discharged after 21 days of hospitalization and the complete clinical resolution occurred 38 days after symptom onset. This is a case of Mpox with extensive multi-mucosal (ocular, pharyngeal and rectal) and cutaneous extension and S. pyogenes bacteraemia probably related to bacterial translocation from the skin or oral cavity that was eased by Mpox lesions/inflammation. The HIVinfection, although well controlled by antiretroviral therapy, could have played a role in the severe course of Mpox, suggesting the importance of a prompt antiviral treatment in HIV-positive patients....
Background Immune reconstitution inflammatory syndrome (IRIS) associated with syphilis has rarely been described in HIV-infected patients. Diagnosis can be challenging because it is not always possible to discern it from a recent infection or a worsening of an undiagnosed one. Case presentation An HIV-positive 42-year-old man with a poor compliance history of antiretroviral therapy presented at our unit and complained of ocular symptoms. Ocular syphilis diagnosis was posed after initial misdiagnosing with cytomegalovirus infection, and antiretroviral therapy compliance improved after switching to a bictegravirbased regimen. Despite intravenous (IV) penicillin, we observed an initial worsening with the appearance of new skin lesions, and IRIS syphilis was suspected. In the literature, 14 cases of IRIS syphilis are described, all regarding male patients. Seven were HIV naïve to therapy, and 7 HIV-experienced with poor therapy compliance. Basal syphilis serology was negative in ten, with subsequent seroconversion after the development of IRIS. IRIS-syphilis development was observed after a median time of 28 days from ART initiation; 10 cases were considered "unmasking-IRIS" and 4 "paradoxical-IRIS". Skin and ocular involvement were the most often reported. In most cases, it was not necessary to use a systemic steroid. A good outcome was reported in 12. Conclusions Syphilis should be considered in differential diagnosis with other diseases associated with IRIS. A negative syphilis serology before beginning antiretroviral therapy could convey the impression that syphilis has been ruled out. Whereas a high index of suspicion should be maintained when symptoms suggestive of syphilis, such as ocular and skin manifestations, are noticed after therapy has begun....
Background: South Africa implements variations of second generation suveilance\nsurveys to monitor human immunodeficiency virus (HIV) epidemic.\nObjective : This paper compares HIV estimates from two design variations:\ntake all approach and sub-sampling approach to ascertain if any changes in\nHIV epidemic are due to methodological changes or inherent evolution of the\nepidemic. Methods : A multi-stage stratified cluster sample of 1000 census\nenumerator areas was implemented with 15 households systematically sampled\nwithin each census enumerator area. In each household, every member\nwas invited to participate (take all approach). To compare to the previous\nsurvey designs, a sub-sampling approach of at most four people from each\nhousehold was implemented by randomly sampling one person from each\nage group: <2 years, 2 - 14 years, 15 to 24 years and 25 years and above. Results\n: HIV estimates were comparable with no systematic pattern. Prevalence\nestimates were slightly higher 12.2% [11.4% - 13.1%] in the take all compared\nto 11.6% [10.6% - 12.6%] in the sub-sampling approach. Estimates from\nsub-sampling approach were more variable. The design effects in the take all..................
A number of antiviral agents used against Human Immunodeficiency Virus (HIV) infection and hepatitis B virus\n(HBV) mono or co-infection have been associated with real nephrotoxicity (including tenofovir disoproxil fumarate\n(TDF), atazanavir, indinavir and lopinavir) or apparent changes in renal function (e.g. cobicistat, ritonavir, rilpivirine\nand dolutegravir). Patients with HIV are at higher risk of acute and chronic renal dysfunction, so baseline assessment\nand ongoing monitoring of renal function is an important part of routine management of patients with HIV.\nGiven the paucity of evidence in this area, we sought to establish a consensus view on how routine monitoring\ncould be performed in Australian patients on ART regimens, especially those involving TDF. A group of\nnephrologists and prescribers (an HIV physician and a hepatologist) were assembled by Gilead to discuss practical\nand reasonable renal management strategies for patients particularly those on TDF-based combination regimens\n(in the case of those with HIV-infection) or on TDF-monotherapy (in the case of HBV-mono infection). The group\nconsidered which investigations should be performed as part of routine practice, their frequency, and when\nspecialist renal referral is warranted. The algorithm presented suggests testing for serum creatinine along with\nplasma phosphate and an assessment of urinary protein (rather than albumin) and glucose.\nHere we advocate baseline tests of renal function at initiation of therapy. If creatinine excretion inhibitors (e.g.\ncobicistat or rilpivirine) are used as part of the ART regimen, we suggest creatinine is rechecked at 4 weeks and this\nvalue used as the new baseline. Repeat testing is suggested at 3-monthly intervals for a year and then at least yearly\nthereafter if no abnormalities are detected. In patients with abnormal baseline results, renal function assessment\nshould be performed at least 6 monthly. In HBV mono-infected patients advocate that a similar testing protocol\nmay be logical....
Background\nThree national HIV household surveys were conducted in South Africa, in 2002, 2005 and 2008. A novelty of the 2008 survey was the addition of serological testing to ascertain antiretroviral treatment (ART) use.\n\nMethods and Principal Findings\nWe used a validated mathematical method to estimate the rate of new HIV infections (HIV incidence) in South Africa using nationally representative HIV prevalence data collected in 2002, 2005 and 2008. The observed HIV prevalence levels in 2008 were adjusted for the effect of antiretroviral treatment on survival. The estimated ââ?¬Å?excessââ?¬Â HIV prevalence due to ART in 2008 was highest among women 25 years and older and among men 30 years and older. In the period 2002ââ?¬â??2005, the HIV incidence rate among men and women aged 15ââ?¬â??49 years was estimated to be 2.0 new infections each year per 100 susceptible individuals (/100pyar) (uncertainty range: 1.2ââ?¬â??3.0/100pyar). The highest incidence rate was among 15ââ?¬â??24 year-old women, at 5.5/100pyar (4.5ââ?¬â??6.5). In the period 2005ââ?¬â??2008, incidence among men and women aged 15ââ?¬â??49 was estimated to be 1.3/100 (0.6ââ?¬â??2.5/100pyar), although the change from 2002ââ?¬â??2005 was not statistically significant. However, the incidence rate among young women aged 15ââ?¬â??24 declined by 60% in the same period, to 2.2/100pyar, and this change was statistically significant. There is evidence from the surveys of significant increases in condom use and awareness of HIV status, especially among youth.\n\nConclusions\nOur analysis demonstrates how serial measures of HIV prevalence obtained in population-based surveys can be used to estimate national HIV incidence rates. We also show the need to determine the impact of ART on observed HIV prevalence levels. The estimation of HIV incidence and ART exposure is crucial to disentangle the concurrent impact of prevention and treatment programs on HIV prevalence....
This case report describes an HIV-positive patient with recurrent tuberculosis in Uganda. After several failed courses\r\nof treatment, the patient was diagnosed with multi-drug resistant tuberculosis (MDR-TB). As adequate in-patient\r\nfacilities were unavailable, we advised the patient to remain at home, and he received treatment at home via his\r\nfamily and a community nurse. The patient had a successful clearance of tuberculosis. This strategy of home-based\r\ncare represents an important opportunity for treatment of patients in East Africa, where human resource\r\nconstraints and inadequate hospital facilities exist for complex patients at high risk of infection to others....
Background: Despite progress in the development of combined antiretroviral therapies (cART), HIV infection\r\nremains a significant challenge for human health. Current problems of cART include multi-drug-resistant virus\r\nvariants, long-term toxicity and enormous treatment costs. Therefore, the identification of novel effective drugs is\r\nurgently needed.\r\nMethods: We developed a straightforward screening approach for simultaneously evaluating the sensitivity of\r\nmultiple HIV gag-pol mutants to antiviral drugs in one assay. Our technique is based on multi-colour lentiviral\r\nself-inactivating (SIN) LeGO vector technology.\r\nResults: We demonstrated the successful use of this approach for screening compounds against up to four HIV\r\ngag-pol variants (wild-type and three mutants) simultaneously. Importantly, the technique was adapted to Biosafety\r\nLevel 1 conditions by utilising ecotropic pseudotypes. This allowed upscaling to a large-scale screening protocol\r\nexploited by pharmaceutical companies in a successful proof-of-concept experiment.\r\nConclusions: The technology developed here facilitates fast screening for anti-HIV activity of individual agents from\r\nlarge compound libraries. Although drugs targeting gag-pol variants were used here, our approach permits\r\nscreening compounds that target several different, key cellular and viral functions of the HIV life-cycle. The modular\r\nprinciple of the method also allows the easy exchange of various mutations in HIV sequences. In conclusion, the\r\nmethodology presented here provides a valuable new approach for the identification of novel anti-HIV drugs....
Background HIV prevention knowledge levels are low in sub-Saharan Africa. In our efficacy study, the Mzake ndi Mzake (Friend-to-Friend; hereafter Mzake) 6-session peer group intervention, delivered by health workers, improved HIV prevention knowledge and other outcomes in Malawi. To expand HIV prevention approaches, this implementation study tested whether the intervention remained effective when implemented by trained community volunteers. HIV prevention knowledge findings are presented. Methods Using a stepped wedge design, three communities implemented the Mzake program sequentially in randomly assigned order. Repeated surveys assessed outcomes, and participants served as controls until they completed the program. At Time 2, Community 1 became the intervention group, and at Time 3, Communities 1 and 2 were the intervention group. HIV prevention knowledge, the primary outcome, was assessed through two indicators: UNAIDS comprehensive knowledge (UNAIDS Knowledge), defined as correctly answering five HIV prevention questions (Yes/ No), and a 9-item HIV/PMTCT Knowledge Index (number correct). Multivariate generalized estimating equation logistic regression (UNAIDS Knowledge) and mixed-effects regression models (HIV/PMTCT Knowledge Index) were used to assess knowledge controlling for five sociodemographic factors. Results In bivariate analyses of UNAIDS Knowledge, more persons answered correctly in the intervention group than the control group at Time 2 (56.8% vs. 47.9%, p < 0.01), but the difference was not significant at Time 3. In logistic regression, there was a significant linear increase in the proportion who correctly answered all questions in the control group, but the increase was significantly higher in the intervention group (log-odds estimate = 0.17, SE = 0.06, p-value < 0.01). The HIV/PMTCT Knowledge Index scores increased over time for both groups, but in the intervention group the increase was significantly higher than the control group (0.11 at Time 2; 0.21 at Time 3). In youth and adult subsamples analyses, the intervention was highly effective in increasing knowledge for youth, but not for adults. Conclusion This implementation study showed that Mzake was effective in increasing HIV prevention knowledge when delivered by community members. Community approaches offer an important strategy to increase HIV prevention in rural communities without burdening healthcare systems. Trial registration ClinicalTrials.gov NCT02765659. Registered 06/05/2016...
Background: Chemokines can block viral entry by interfering with HIV co-receptors and are recognised mediators\r\nof atherosclerosis development. A number of experimental drugs that inhibit HIV entry arrest the development of\r\natherosclerosis in animal models. We hypothesised that the expression of chemokine receptors in circulating\r\nleukocytes is associated with the rate of atherosclerosis progression in HIV-infected patients.\r\nMethods: The increase in intima-media thickness during a 2-year follow-up was used to classify HIV-infected\r\npatients (n = 178) as progressors (n = 142) or non-progressors (n = 36) with respect to atherosclerosis. Logistic\r\nregression was used to assess variables associated with atherosclerosis progression. Mutations in the CCR5?32,\r\nCCR2 64I, and CX3CR1 (T280M and V249I) co-receptors as well as the levels of CCR5, CXCR4, CX3CR1, and CCR2\r\nmRNA expression in circulating leukocytes were analysed as independent variables.\r\nResults: Among the baseline variables, only genetic variants explained the dichotomous outcome. The expression\r\nof CCR2 and CXCR4 did not discriminate between progressors and non-progressors. Conversely, CCR5 and CX3CR1\r\nexpression was higher in not only progressors but also patients with detectable viral load. The logistic regression,\r\nhowever, demonstrated a significant role for CCR5 expression as a predictor of atherosclerosis progression\r\n(B = 2.1, OR = 8.1, p = 0.04) and a negligible effect for CXC3R1 and CCR2 expression.\r\nConclusions: Available CCR5 antagonists should be investigated for their potential to delay the course of\r\natherosclerosis in HIV-infected patients....
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