Risultati per: Linee guida su HIV, epatite e malattie sessualmente trasmissibili.

Il 30% più veloci per chi ne soffre

Objective
To investigate the associations between mental health literacy (MHL), self-disclosure and psychological distress among HIV-positive young and middle-aged men who have sex with men (MSM). We hypothesised that self-disclosure would mediate the relationship between MHL and psychological distress.

Design
A cross-sectional study.

Setting
Participants were recruited from the outpatient clinic of the Department of Infection at a tertiary hospital in Nanjing, Jiangsu province, China.

Participants
A total of 209 HIV-positive young and middle-aged MSM.

Outcome measures
Using convenient sampling method, the study selected 209 HIV-positive young and middle-aged MSM from a tertiary hospital in Nanjing, China, from November 2023 to January 2024. The data were collected using a general information questionnaire, the Multicomponent Mental Health Literacy, the Kessler Psychological Distress Scale and the Distress Disclosure Index. Descriptive statistics, Pearson correlation analysis and mediation analysis were conducted in the study.

Results
The mean MHL score among HIV-positive young and middle-aged MSM was 11.90 (SD=5.09). Their mean score for self-disclosure was 31.97 (SD=6.87) and for psychological distress was 25.43 (SD=8.16). The bivariate correlation analysis showed that self-disclosure was positively correlated with MHL (r=0.264, p

Introduction
Stand-alone HIV clinics in sub-Saharan Africa (SSA) have effectively expanded antiretroviral therapy since the 2000s, transforming HIV from a deadly infection into a chronic condition. However, over the past decade, there has been a significant rise in the prevalence of non-communicable diseases (NCDs) globally and in SSA. People living with HIV are at higher risk for some NCDs, including hypertension, diabetes and different cancers. The region’s current healthcare infrastructure is not equipped to address this growing burden. Integrating health services for HIV and NCDs (ie, combining services for HIV with services for hypertension, diabetes, depression and mental health, substance use disorder or cancer) could be one strategy for responding to these challenges. In this scoping review, we aim to identify randomised controlled trials on HIV-NCD integration, assess implemented integration models and measured outcomes and highlight evidence gaps.

Methods and analysis
This scoping review will follow the Arksey and O’Malley (2005) methodological framework. Reporting will be guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist. We will conduct a systematic search of the databases OVID Medline, Embase, Web of Science, Global, Africa Index Medicus, including terms related to HIV, NCDs and healthcare integration. Included trials must have been conducted within SSA and have been published in English or French after 1 January 2010. We will not select based on sample size or number of clusters. Both the title and abstract screening and full-text screening will be done in Covidence by at least two reviewers working independently. Data extraction will focus on key variables, including study design, geographical location, integration intervention, measured outcomes and reported findings.

Ethics and dissemination
This scoping review aims to generate new insights from publicly available research. Therefore, ethical approval is not required. Study findings will be shared through discussion with policymakers, implementation science researchers and healthcare providers. The results of this study are intended to be published in a peer-reviewed journal.

Trial registration
This protocol has been registered with Center for Open Science OSF Registry (DOI: 10.17605/OSF.IO/RGQSN). The search was conducted on 25 March 2024 and updated on 21 October 2024. The review is expected to be completed by March 2025.

Objectives
People living with HIV (PLWH) were previously shown to have a higher prevalence of non-calcified coronary plaque with discrepant results for coronary stenosis and any plaque prevalence. This systematic review and meta-analysis summarise and estimate pooled effect sizes for observational studies among PLWH using comprehensive coronary CT angiography (CTA).

Design
Preferred Reporting Items for Systematic Review and Meta-analysis reporting guidelines were used.

Data sources
PubMed, Embase, Web of Science, CINAHL, Cochrane Clinical Trials and EBM were searched from inception to 23 February 2024.

Eligibility criteria
We included studies evaluating coronary atherosclerosis in adult PLWH with controls and CTA results for plaque prevalence, extent, severity and high-degree stenosis.

Data extraction and synthesis
Two independent reviewers used standardised methods to screen for relevance by title, abstract and full-text review. Two unblinded independent reviewers manually extracted data and rated study quality using the Newcastle-Ottawa Scale. Meta-analysis was conducted using random effects models. A sensitivity analysis was performed with a fixed effects model. Publication bias was assessed by visual inspection of funnel plots and formal testing by Egger’s and Begg’s tests. Segment scores were evaluated using the difference of medians.

Results
PLWH showed a significantly higher prevalence of non-calcified plaque (34% (95% CI: 15% to 53%)) compared with controls (22% (95% CI: 6% to 38%)) with an OR of 1.61 (1.13–2.30, p=0.009). There was no significant difference in partially calcified plaque prevalence (OR=1.20, 0.96–1.49), stenosis prevalence (OR=1.34, 0.92–1.96) and median difference in Segment Involvement Score (SIS; 0.39, –0.01 to 0.79) in PLWH compared with controls who have a non-significant difference in calcified plaque (OR=0.80, 0.61–1.04). The prevalence of any plaque (OR=1.22, 0.93–1.61) and difference in median Segment Stenosis Score (–0.12, –0.60 to 0.35) did not differ between groups.

Conclusion
This study demonstrates a greater prevalence of non-calcified plaque in PLWH than controls. Additional research is needed to assess quantitative CTA measurements. Increased power may reveal a difference in the prevalence of high-degree stenosis and median SIS score in PWLH, while controls may have a greater prevalence of calcified plaque.

Introduction
Heavy alcohol use has the potential to derail progress towards UNAIDS 95-95-95 targets for countries in sub-Saharan Africa (SSA). Within couples, alcohol use is closely linked with factors such as intimate partner violence and economic insecurity and can result in poor adherence to antiretroviral therapy (ART) and HIV clinical outcomes. We hypothesise that a combined economic and relationship intervention for couples that builds on the prior success of standalone economic and relationship-strengthening interventions will be efficacious for improving HIV clinical outcomes and reducing alcohol use. The synergy of these interventions has not been assessed in SSA—specifically among people living with HIV who drink alcohol. To test this hypothesis, we will test Mlambe, an economic and relationship-strengthening intervention, found to be feasible and acceptable in a pilot study in Malawi. We will conduct a full-scale, randomised controlled trial (RCT) to evaluate the efficacy and cost-effectiveness of Mlambe.

Methods and analysis
We will enrol 250 adult married couples having at least one partner living with HIV and reporting heavy alcohol use. There will be two arms: Mlambe or an enhanced usual care control arm. Couples in the Mlambe arm will receive incentivised matched savings accounts and monthly sessions on financial literacy, relationship skills, and alcohol reduction education and counselling. Participants will be assessed at baseline, 11 months, 15 months and 20 months to examine effects on heavy alcohol use, HIV viral suppression, ART adherence and couple relationship dynamics. Study hypotheses will be tested using multilevel regression models, considering time points and treatment arms. Programmatic costs will be ascertained throughout the study and incremental cost-effectiveness ratios will be computed for each arm.

Ethics and dissemination
The RCT has been approved by the University of California, San Francisco (UCSF) (Human Research Protection Program; Protocol Number 23-40642), and the study has been approved by the National Health Sciences Research Committee (NHSRC; Protocol Number 24/05/4431) in Malawi. Adverse events and remedial actions will be reported to authorities both in Malawi and at UCSF. Results will be disseminated to study participants, local health officials and HIV policy makers and through presentations at conferences and publications in peer-reviewed journals.

Trial registration number
ClinicalTrials.gov Protocol Registration; NCT06367348 registered on 19 April 2024; https://register.clinicaltrials.gov/. Protocol Version 1.0: 22 October 2024.

Purpose
The NCDzz study is a prospective cohort of people living with and without HIV attending primary care clinics in Zambia and Zimbabwe and was established in 2019 to understand the intersection between noncommunicable diseases (NCDs) and HIV in Southern Africa. Here, we describe the study design and population and evaluate their ideal cardiovascular health (ICVH) using the Life’s Simple 7 (LS7) score according to the American Heart Association.

Participants
Antiretroviral therapy-naïve people living with HIV (PLWH) and people living without HIV (PLWOH) 30 years or older were recruited from three primary care clinics in Lusaka and Harare, and underwent comprehensive clinical, laboratory and behavioural assessments. All study measurements are repeated during yearly follow-up visits. PLWOH were recruited from the same neighbourhoods and had similar socioeconomic conditions as PLWH.

Findings to date
Between August 2019 and March 2023, we included 1100 adults, of whom 618 (56%) were females and 539 (49%) were PLWH. The median age at enrolment was 39 years (IQR 34–46 years). Among 1013 participants (92%) with complete data, the median LS7 score was 11/14 (IQR 10–12). Overall, 60% of participants met the criteria of ICVH metrics (5–7 ideal components) and among individual components of the LS7, more females had poor body mass index (BMI) than males, regardless of HIV status (27% vs 3%, p

Sip, ‘il focus deve spostarsi dal peso alla salute’

Circulation, Ahead of Print. BACKGROUND:Although combination antiretroviral therapy has increased life expectancy in people living with HIV, it has led to a marked increase in the prevalence of hypertension, the cause of which is unknown. Despite combination antiretroviral therapy, HIV-derived proteins remain expressed and produced by CD4+T lymphocytes in people living with HIV. However, their contribution to HIV-associated hypertension and impaired endothelium-dependent relaxation remains ill defined.METHODS:Here, we tested the hypothesis that CD4+T cells expressing viral proteins contribute to endothelial dysfunction and hypertension using the Tg26 mouse model of HIV that expresses 7 of the 9 HIV proteins under the long terminal repeat promoter. We used male and female mice, bone marrow transplantation (BMT), adoptive transfer of CD4+T cells, and aorta specimen discarded from people living with HIV.RESULTS:We reported that intact Tg26 mice and mice receiving BMT (Tg26→WT) or CD4+T cells from Tg26 mice display impaired endothelium-dependent relaxation and hypertension. Conversely, BMT from WT mice into Tg26 mice, inhibition of T cell activation, and CD4+T cell depletion restored endothelial function and blood pressure in Tg26 mice. Cytokine profiling revealed that Tg26 mice, Tg26→WT, and Tg26 CD4+T cells consistently exhibit high interleukin 1α (IL-1α) levels with no significant increase in other cytokines, whereas BMT from WT mice into Tg26 mice reduced IL-1α levels. IL-1α neutralization reduced blood pressure and restored endothelial function in Tg26 mice. To investigate the role of CD4+T cells and IL-1α in endothelial dysfunction, we developed an aorta-immune cell coculture system. Exposure of WT aortas to Tg26 CD4+T cells impaired endothelium-dependent relaxation, which was blocked by IL-1α–neutralizing antibody. While investigating the mechanisms of endothelial dysfunction, we reported that Tg26 mice, Tg26→WT aorta exhibit high NADPH oxidase (NOX) 1 expression. IL-1α exposure increased NOX1 in human microvascular endothelial cells, and NOX1 blockade restored endothelial function in Tg26 and Tg26→WT arteries, whereas NOX1 deficiency protected against Tg26 BMT-induced impaired endothelium-dependent relaxation and hypertension. Aortas from people living with HIV exhibit high NOX1 levels, and exposure of human aorta to Tg26 T cells increased NOX1 expression.CONCLUSIONS:We provide the first evidence that CD4+T cells expressing HIV viral proteins induced hypertension through IL-1α–mediated increases in vascular NOX1, which impairs endothelial function in males and females.

Lenacapavir, a twice yearly injection, may be a promising alternative to the current standard of care for HIV prevention, according to the results of a randomized clinical trial published in the New England Journal of Medicine.

This case report describes a man in his 60s with hypertension, deep vein thrombosis, and a recent diagnosis of HIV presented with low CD4 cell count after starting antiretroviral therapy with tenofovir alafenamide-emtricitabine-bictegravir.

Stroke, Volume 56, Issue Suppl_1, Page AWP320-AWP320, February 1, 2025. Background:The intersection of HIV and stroke presents a significant public health concern, with stroke-related mortality in HIV patients influenced by various demographic factors such as race and gender. This study aims to elucidate the trends in stroke-related mortality among HIV patients in the US over two decades, stratified by race and gender.Methods:Data from the CDC-WONDER database was analyzed from 1999 to 2020 to assess stroke-related mortality rates among HIV patients. Age-adjusted mortality rates were calculated, and trends were analyzed using Joinpoint regression to identify changes in mortality patterns over time. The analysis was stratified by race (Black or African American, White) and gender (male, female).Results:Stroke-related mortality among HIV patients showed a significant initial decline from 1999 to 2001 with an Annual Percent Change (APC) of -21.57% (p

This Viewpoint discusses the need to recommit to the fight against HIV/AIDS to reach the United Nation’s 2030 goal of ending the epidemic as a public health threat.

This randomized clinical trial compares the seroprotection response achieved with a 2-dose and a 3-dose hepatitis B vaccine with a cytosine phosphoguanine adjuvant vs a conventional 3-dose hepatitis B vaccine with an aluminum hydroxide adjuvant in people with HIV and prior nonresponse to hepatitis B vaccine.