OBJECTIVE: The COVID-19 pandemic posed unprecedented challenges to global healthcare, particularly affecting respiratory systems and impacting individuals with pre-existing conditions, including those with HIV.
METHODS: HIV\'s impact on clinical outcomes was assessed in four Statistical Population, synchronized with control groups. The study also explored the influence of SARS-CoV-2 and COVID-19 treatments. Ultimately, a comparison was drawn between patients with and without HIV.
RESULTS: In the first Statistical Population of COVID-19 patients with HIV, predominantly African-American men with risk factors such as obesity, hypertension, and diabetes were present. Diagnostic results showed no significant differences between the two groups. In the second Statistical Population, half of the patients were asymptomatic, with diagnoses mostly based on clinical symptoms; 6 individuals developed severe respiratory illness. In the third Statistical Population, 81 % of patients were treated at home, and all hospitalized patients had CD4+ lymphocyte counts above 350 cells/mm³. Most patients improved, with fatalities attributed to comorbid conditions. In the fourth Statistical Population, HIV patients were less likely to benefit from antimicrobial drugs, and mortality was higher, though synchronized analysis did not reveal significant differences.
CONCLUSIONS: HIV patients are more susceptible to COVID-19, but the direct impact is less significant than other factors. Additional factors contribute to increased risk, while early improvement, accurate diagnosis, and intensive care reduce fatalities.

BACKGROUND: Mother-to-child transmission is the primary cause of HIV cases among children. Antiretroviral therapy (ART) plays a critical role in preventing mother-to-child transmission and reducing HIV progression, morbidity, and mortality among mothers. However, after more than two decades of ART during pregnancy, the comparative effectiveness and safety of ART medications during pregnancy are unclear, and existing evidence is contradictory. This study aimed to assess the effectiveness and safety of different ART regimens among pregnant women living with HIV at preconception or during pregnancy.
METHODS: We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Web of Science. We included randomized trials that enrolled pregnant women living with HIV and randomized them to receive ART for at least four weeks. Pairs of reviewers independently completed screening for eligible studies, extracted data, and assessed the risk of bias using the Cochrane risk of bias tool. Our outcomes of interest included low birth weight, stillbirth, preterm birth, mother-to-child transmission of HIV, neonatal death, and congenital anomalies. Network meta-analysis was performed using a random-effects frequentist model, and the certainty of evidence was evaluated using the GRADE approach.
RESULTS: We found 14 eligible randomized trials enrolling 9,561 pregnant women. The median duration of ART uptake ranged from 6.0 to 17.4 weeks. No treatment was statistically better than a placebo in reducing the rate of neonatal mortality, stillbirth, congenital defects, preterm birth, or low birth weight deliveries. Compared to placebo, zidovudine (ZDV)/lamivudine (3TC) and ZDV monotherapy likely reduce mother-to-child transmission (odds ratio (OR): 0.13; 95% CI: 0.05 to 0.31, high-certainty; and OR: 0.50; 95% CI: 0.33 to 0.74, moderate-certainty). Moderate-certainty evidence suggested that ZDV/3TC was associated with decreased odds of stillbirth (OR: 0.47; 95% CI: 0.09 to 2.60).
CONCLUSIONS: Our analysis provides high- to moderate-certainty evidence that ZDV/3TC and ZDV are more effective in reducing the odds of mother-to-child transmission, with ZDV/3TC also demonstrating decreased odds of stillbirth. Notably, our findings suggest an elevated odds of stillbirth and preterm birth associated with all other ART regimens.

OBJECTIVE: This article aimed to analyze upper endoscopic findings in the HIV patient population to elucidate the upper-gastrointestinal complications related to HIV infection. Gastrointestinal (GI) disorders in individuals living with HIV/AIDS exhibit diverse and often nonspecific manifestations, imposing substantial morbidity and mortality burdens. Endoscopic evaluation with biopsies is essential in the diagnosis and management of these conditions. Delayed treatment due to undetected GI abnormalities during endoscopic examinations can lead to poorer health outcomes.
METHODS: This systematic review has determined the findings of upper-GI endoscopy of HIV-infected patients. Online databases of PubMed, Web of Science, Jisc Library Hub Discover, and Library of Congress have been searched using relevant keyword combinations. We have retrieved all the pertinent papers and reports published in English and screened them against inclusion/exclusion criteria for data extraction in two steps. First, titles/abstracts have been evaluated and then full-text screening has been performed by independent researchers. This study has adhered to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) checklist.
RESULTS: In this review, 24 articles have been included in the final analysis. The study has focused on the characteristics of participants and the findings of endoscopic evaluations. The participants of the study have been HIV-positive patients, and the majority of them have undergone endoscopy due to gastrointestinal symptoms. The biopsy regions primarily targeted have been observed to be the esophagus, stomach, and duodenum. The most common result of the biopsy specimens has been chronic active gastritis.
CONCLUSIONS: To improve clinical practice, this systematic review sought to provide an up-to-date reference for upper gastrointestinal endoscopic findings of HIV-infected persons. Our results are in line with earlier research showing how effective endoscopy is for determining a precise diagnosis and directing care. The majority of HIV patients with gastrointestinal symptoms have been found to have opportunistic infections and persistent active gastritis as well as mucosal abnormalities of the upper gastrointestinal tract. Studies have shown that endoscopic and histological assessment can aid in the early detection and management of issues involving the upper gastrointestinal tract.

UNASSIGNED: Antiretroviral Treatment (ART) has great importance in reducing viral load. Though a global effort was made to suppress viral load, the level of viral load suppression among ART patients is still high in Ethiopia.
UNASSIGNED: This study aims to assess the magnitude and contributing factors for viral load suppression among patients attending ART clinics in Ethiopia.
UNASSIGNED: The articles were searched using different databases using the guideline of reporting systematic review and meta-analysis (PRISMA). A random effect model was used to ascertain the pooled prevalence of viral load suppression in Ethiopia using STATA 14 software.
UNASSIGNED: The pooled prevalence of suppressed viral load was 75.25% (95% CI: 68.61-81.89). Having good adherence (OR: 2.71, 95% CI 2.27, 3.15), baseline CD4 count (OR: 1.74, 95% CI 1.53, 1.96), and being female (OR: 1.41, 95% CI 1.04, 1.79) were determinants of pooled estimates of suppressed viral load.
UNASSIGNED: The pooled prevalence of suppressed viral load was 75% which is lower than the targeted level by the sustainable development goal (SDG) 2020, which was 90%. Therefore, the stakeholders should be focused on the existing strategies to decrease viral load among ART patients. They should work to adhere to patients for ART treatment.

The article presents an overview of clinical recommendations for currant antiretroviral therapy. Currently, the current preferred first-line antiretroviral therapy regimens are combinations of 2 or 3 antiretroviral drugs (ARVs) in one tablet with a frequency of administration 1 time per day and, as a rule, include drugs of the 2nd generation (integrase inhibitors or non-nucleoside reverse transcriptase inhibitors). These schemes have high efficiency and a good genetic barrier in the development of HIV resistance mutations. HIV protease inhibitors are used as alternative regimens. Schemes with the least number and spectrum of side effects, no effect on metabolic processes and minimal drug interactions have advantages. Switching patients to injectable therapy regimens with a frequency of administration of drugs once every 2 months can significantly improve the quality of life of patients and, accordingly, adherence to their treatment. The development and introduction of new classes of ARVs into clinical practice ensures the suppression of HIV replication in most patients with HIV strains resistant to drugs of the main groups of ARVs (nucleoside/nucleotide reverse transcriptase.
В статье представлен обзор клинических рекомендаций по современной антиретровирусной терапии. В настоящее время современные предпочтительные схемы антиретровирусной терапии 1-й линии представляют собой комбинации 2 или 3 антиретровирусных препаратов (АРВП) в одной таблетке с кратностью приема 1 раз в сутки и, как правило, включают препараты II поколения (ингибиторы интегразы или ненуклеозидные ингибиторы обратной транскриптазы). Эти схемы обладают высокой эффективностью и хорошим генетическим барьером при развитии мутаций резистентности ВИЧ. Ингибиторы протеазы ВИЧ используют в качестве альтернативных режимов. Преимущества имеют схемы с наименьшим количеством и спектром побочных эффектов, отсутствием влияния на метаболические процессы и минимальными лекарственными взаимодействиями. Переключение пациентов на инъекционные режимы терапии с кратностью введения препаратов 1 раз в 2 месяца позволяет существенно повысить качество жизни пациентов и, соответственно, приверженность их лечению. Разработка и внедрение в клиническую практику АРВП новых классов обеспечивает подавление репликации ВИЧ у большинства пациентов, имеющих штаммы ВИЧ, устойчивые к препаратам основных групп АРВП (нуклеозидные ингибиторы обратной транскриптазы, ненуклеозидные ингибиторы обратной транскриптазы, ингибиторы протеазы, ингибиторы интегразы).

Weil\'s disease, an icterohemorrhagic infection, is the most severe and fatal form of leptospirosis and is characterized by jaundice, renal dysfunction, and hemorrhagic predisposition. Weil\'s disease with HIV infection has rarely been reported. A 68-year-old male with HIV infection presented to our hospital with fever and dyspnea that progressed to severe hemoptysis and systemic multiple organ failure, necessitating a tracheal intubation ventilator. A diagnosis of Weil\'s disease was made after Leptospira interrogans was identified via metagenomic next-generation sequencing (mNGS) in bronchoalveolar lavage fluid (BALF). After immediately receiving supportive therapy and targeted antimicrobial agents, the patient achieved complete recovery upon discharge. The co-infection of HIV infection and leptospirosis resulting in systemic multi-organ failure is rare, but awareness should be raised of the differential diagnosis. mNGS can help identify pathogens and facilitate the use of targeted and efficacious antimicrobial therapy in unusual clinical environments.

UNASSIGNED: Evidence for efficacy of single, high-dose liposomal amphotericin B (LAmB) in HIV-associated cryptococcal meningitis and histoplasmosis is growing. No systematic review has examined the safety of this regimen across multiple studies.
UNASSIGNED: We systematically searched Medline, Scopus, and the Cochrane Library from inception to April 2023 for studies reporting grade 3 and 4 adverse events (AEs) with single high-dose LAmB vs traditional amphotericin regimens for HIV-associated fungal infections.
UNASSIGNED: Three trials (n = 946) were included. Compared with traditional regimens, single high-dose LAmB was associated with equivalent risk of grade 3 and 4 AEs (risk ratio [RR], 0.75; 95% CI, 0.53-1.06) and lower overall risk of grade 4 AEs (RR, 0.68; 95% CI, 0.55-0.86), grade 4 renal (RR, 0.43; 95% CI, 0.20-0.94) and grade 4 hematological AEs (RR, 0.46; 95% CI, 0.32-0.65).
UNASSIGNED: Single, high-dose LAmB is associated with a lower risk of life-threatening AEs compared with other World Health Organization-endorsed amphotericin B-based regimens in invasive HIV-related fungal infection.

As people age, geriatric syndromes characterized by frailty significantly impact both clinical practice and public health. Aging weakens people\'s immune functions, leading to chronic low-grade inflammation that ultimately contributes to the development of frailty. Effectively managing geriatric syndromes and frailty can help alleviate the economic burden of an aging population. This review delves into the intricate relationship among aging, infection-induced inflammation, chronic inflammation, and frailty. In addition, it analyzes various approaches and interventions to address frailty, such as smart rehabilitation programs and stem-cell treatments, offering promising solutions in this new era. Given the importance of this topic, further research into the mechanisms of frailty is crucial. Equally essential is the devising of relevant measures to delay its onset and the formulation of comprehensive clinical, research, and public health strategies to enhance the quality of life for elderly individuals.

Universal recommendation for antiretroviral drugs and their effectiveness has put forward the challenge of assuring a chronic and continued care approach to PLHIV (People Living with HIV), pressured by aging and multimorbidity. Integrated approaches are emerging which are more responsive to that reality. Studying those approaches, and their relation to the what of delivery arrangements and the how of implementation processes, may support future strategies to attain more effective organizational responses.
We reviewed empirical studies on either HIV, multimorbidity, or both. The studies were published between 2011 and 2020, describing integrated approaches, their design, implementation, and evaluation strategy. Quantitative, qualitative, or mixed methods were included. Electronic databases reviewed cover PubMed, SCOPUS, and Web of Science. A narrative analysis was conducted on each study, and data extraction was accomplished according to the Effective Practice and Organisation of Care taxonomy of health systems interventions.
A total of 30 studies, reporting 22 different interventions, were analysed. In general, interventions were grounded and guided by models and frameworks, and focused on specific subpopulations, or priority groups at increased risk of poorer outcomes. Interventions mixed multiple integrated components. Delivery arrangements targeted more frequently clinical integration (n = 13), and care in proximity, community or online-telephone based (n = 15). Interventions reported investments in the role of users, through self-management support (n = 16), and in coordination, through multidisciplinary teams (n = 9) and continuity of care (n = 8). Implementation strategies targeted educational and training activities (n = 12), and less often, mechanisms of iterative improvement (n = 3). At the level of organizational design and governance, interventions mobilised users and communities through representation, at boards and committees, and through consultancy, along different phases of the design process (n = 11).
The data advance important lessons and considerations to take steps forward from disease-focused care to integrated care at two critical levels: design and implementation. Multidisciplinary work, continuity of care, and meaningful engagement of users seem crucial to attain care that is comprehensive and more proximal, within or cross organizations, or sectors. Promising practices are advanced at the level of design, implementation, and evaluation, that set integration as a continued process of improvement and value professionals and users\' knowledge as assets along those phases.
PROSPERO number CRD42020194117.

UNASSIGNED: The effect of human immunodeficiency virus (HIV) on precancerous cervical lesion is not consistent across studies. Besides to the variability in the presence of a significant association between HIV and precancerous cervical lesion, the reported strengths are inconsistent among studies that report a significant association. Therefore, we sought to determine the impact of HIV on women\'s risk of precancerous cervical lesion by conducting a systematic review and meta-analysis of case-control studies in Ethiopia.
UNASSIGNED: Relevant articles were systematically searched on African Journals Online, Cochrane Library, Science Direct, Google Scholar, and PubMed from January 1, 2023, to February 20, 2023. After critical appraisal, pertinent data were extracted into an Excel spreadsheet and then exported to STATA 14 for further statistical analysis. The pooled effect size was estimated using the random-effect model. The Egger\'s regression test and I 2 statistics were employed to assess publication bias and heterogeneity among included studies, respectively.
UNASSIGNED: Ten case-control studies with a total of 3035 participants (992 cases and 2043 controls) were involved in this meta-analysis. According to our analysis, HIV-infected women were 2.86 times more likely to develop precancerous cervical lesion as compared with their counterparts (odds ratio: 2.86, 95% confidence interval: 1.79, 4.58).
UNASSIGNED: We found that HIV-infected women have a higher risk of precancerous cervical lesion. Thus, targeted screening programs should be considered to reduce the burden of cervical cancer among HIV-infected women in Ethiopia.