Tropical Medicine and Infectious Disease

IntroductionTuberculosis (TB) is one of the main causes of morbidity and mortality worldwide, especially in people living with HIV (PLHIV). TB preventive treatment (TPT) reduces the incidence and mortality of TB in PLHIV. As of March 2021, in Mozambique, only 40% (182,512/460,080) of those eligible had received a full course of TPT. The aim of this study is to describe the variation in TPT provision and the TB incidence in PLHIV in Mozambique from April 2021 to March 2023. MethodologyWe analyzed provincial reports with monthly and semi-annual aggregated data of TPT and TB Monitoring, Evaluation, and Report (MER) indicators of 591 Health Facilities supported by The U.S. Presidential Emergency Plan for Aids Relief (PEPFAR) at the national level. The analyses included the four following indicators: TPT eligibility, TPT completion, TPT coverage, and TB disease incidence rate. TPT data were analyzed using a MS Excel 365 database. Data were collected periodically and analyzed using tables and graphs with variation lines. ResultsTPT eligibility decreased by 75%, from 687,711 in April 2021 to 170,011 in March 2024. TPT coverage increased from 42% (489,905/1,177,616) in April 2021 to 89% (1,405,139/1,575,150) in March 2024. TPT completion rate also increased by 8%, from 81% (120,692/148,507) to 89% (104,690/117,764). TPT coverage increased by 47%, from 41% (489.905/1.177.616) in April 2021 to 89% (1.405.139/1.575.150) in March 2024. TB disease incidence rate among PLHIV decreased by 0,15%, from 0.65% (7,801/1,208,559) to 0.5% (7,974/1,592,102). ConclusionIn 3 years, Mozambique drastically increased the number of PLHIV who had received TPT, with almost 90% TPT coverage achieved among PLHIV through a system-wide multidisciplinary approach.

PurposeThe aim of the study was to evaluate the features of clinic and diagnosis of comorbidity of pulmonary tuberculosis, coronavirus (CVP), pneumocystis (PCP) and pneumococcal (PCcP) pneumonia in patients in the late stages of HIV infection with immunodeficiency (ID). Materials and methodsThe prospective study included 120 newly diagnosed patients with disseminated pulmonary tuberculosis with isolation of Mycobacterium tuberculosis and IVB stage of HIV infection in the progression phase and in the absence of antiretroviral therapy aged 29-53 years, who were randomized into the main 1A and 2A groups and the 1B and 2B groups of comparison. The 1A group included 29 patients with comorbidity of disseminated pulmonary tuberculosis, coronavirus and pneumocystis pneumonia, in 2A - 31 patients with comorbidity of disseminated pulmonary tuberculosis, CVP and PCcP, while the 1B and 2B groups included 29 and 31 similar patients, but without CVP. PCR for SARS-CoV-2 RNA was used in naso- and oropharyngeal swabs, in sputum or in endotracheal aspirate to diagnose CVP. For the detection of Pneumocystis jirovecii, the causative agent of PCP, a microscopic examination of diagnostic material from the respiratory tract was carried out with staining according to Romanowsky-Giemsa and according to Grocott-Gomori, while for detection of Streptococcus pneumoniae, the causative agent of pneumococcal pneumonia, the diagnostic material was sown on special nutrient media, with the determination of drug resistance of the obtained culture to broad-spectrum antibiotics. Statistical data processing was carried out using Microsoft Office Excel 2019 with calculation of mean value of the indicator in the group, standard error and confidence interval. ResultsThe comorbidity of disseminated pulmonary tuberculosis, CVP, PCP and PCcP in patients in the late stages of HIV infection in the phase of progression and in the absence of antiretroviral therapy were characterized by severe immunodeficiency, generalization of tuberculosis with multiple extrapulmonary lesions and severe pneumonia. This determines the similarity of clinical manifestations and respiratory symptoms as well as also makes it difficult to visualize computed tomographic changes consisting of complex of simultaneous combination of four pathological syndromes: dissemination, pleural pathology, increased pulmonary pattern and adenopathy. Simultaneous overlap of several pathologies with the same type of clinical manifestations and computed tomographic changes requires a complex etiological diagnosis of the specific diseases to prescribe timely complex treatment and reduce mortality among that severe contingent of patients. ConclusionPatients with disseminated pulmonary tuberculosis and HIV infection represent a high-risk group for COVID-19 infection and development of CVP (and in in cases of severe immunodeficiency - PCP and PCcP) - they should be regularly subjected to preventive examinations for timely detection of COVID-19, CVP, PCP and PCcP and for purpose of their emergency hospitalization and timely treatment.

BackgroundEarly infant diagnosis (EID) for HIV-exposed infants is essential due to high mortality during the first months of their lives. In Conakry (Guinea) timely EID is difficult as traffic congestion prevents the rapid transport of blood samples to the central laboratory. We investigated the cost-effectiveness of transporting EID blood samples by unmanned aerial vehicles (UAV), also known as drones. Methods and FindingsWe conducted a cost-effectiveness comparative analysis between EID blood samples transportation by UAV compared to motorcycle using Monte Carlo simulations. Incremental cost-effectiveness ratio (ICER) per life-year gained was computed with local annual GDP per capita (US$1,194) set as the threshold. Simulation models included parameters such as consultation timing (e.g. time of arrival), motorcycle and UAV characteristics, weather and traffic conditions. Sensitivity analyses were conducted. Over a 5-year program and 778 HIV-exposed infants seen in consultation on average every year, the UAV transport strategy was able to save 49.6 life-years [90% PI: -1.3 -100.5]. The UAV strategy costs an additional of $12.4 [10.2 -14.6] per infant tested compared to the motorcycle one. With an ICER of $979 per life-year gained, the UAV transportation strategy was below the cost-effectiveness threshold. The ICER is primarily sensitive to weather-related downtime, UAV loss risk, number of HIV-infected infants and travel time saved by UAV. ConclusionThe transportation of EID blood samples by UAVs in Conakry was found to be cost effective in that context. EID blood samples transportation by UAV could be a cost-effective strategy in other countries with traffic congestion and low rate of EID. What is already known on this topic O_LIThe cost-effectiveness of Unmanned aerial vehicles--UAV (drones) transportation for blood products remains limited in the Global South. C_LIO_LIWe aimed to investigate the cost-effectiveness of urgent blood sample transportation for early HIV infant diagnosis (EID) by UAV compared to motorcycle in the region of Conakry, Guinea. C_LI What this study adds O_LIWe found that UAV transportation for EID was faster, saved more lives than motorcycles and was cost-effective (Incremental cost-effectiveness ratio: US$979 per life-year gained) C_LIO_LIThe effectiveness of the drone strategy was primarily sensitive to weather-related downtime, UAV loss risk, number of HIV-infected infants and travel time saved by UAV. C_LI How this study might affect research, practice or policy O_LIOur study suggests that the transportation of EID blood could be cost-effective in the Conakry region. Other low-or middle-income cities experiencing important traffic congestion with low EID could benefit from this strategy. C_LI

BackgroundWomen living with HIV face a higher risk of developing cervical cancer compared to those without HIV. However, comprehensive cervical cancer screening programs for this population are still lacking in Indonesia. This has resulted in many cases of late-stage cervical cancer being diagnosed, especially in Bali, which has experienced an increase in cases of HIV and cervical cancer. This study aimed to determine the prevalence of and risk factors for cervical cytological abnormalities in women living with HIV in Bali and to explore their relationship with high-risk HPV (HR-HPV) types. MethodsThis is a cross-sectional study with eligible participants recruited from outpatient HIV clinics in Bali. Between July to December 2023, participants were interviewed to collect demographic and historical medical information, followed by physical examination including collection of cervical swabs and blood samples. Pap smear sampling and swab collection using ThinPrep for cytology. HPV DNA was then identified by PCR and genotyped for HR-HPV 16,18,31,33,35,39,45,51,52,56,58,59,66,68. Blood samples were analyzed for CD4 and CD8 cell counts. ResultsA total of 245 women with HIV at median age of 38 years old (24-50 years) and with median time of ARV therapy of 7 years (0-18 years) were enrolled. Only 239 participants were included in the analysis for their valid initial results. Overall, 26 (10.87%) of samples showed abnormal cytology including 6 (2.5%) ASC-H, 9 (3.8%) ASC-US, 4 (1.7%) H-SIL and 7 (2.9%) L-SIL. Of the 58 (24%) that tested positive for HPV DNA, 18 (31%) samples had abnormal cytology. HPV 18 was the most common genotype detected (n=16 or 28%). Bivariate analysis revealed a significant association between positive HPV DNA and abnormal cytology, with those testing HPV-positive having seven times higher risk of ASC-US or greater (PR=7.022;95%CI=3.223-15.295). Multivariate regression identified having HPV 18 infection as an independent risk factor for abnormal cytology (ExpB=9.029;p=0.007), and a history of Pap smear screening associated with reduced risk of HR-HPV infection (ExpB=0.358;p=0.013). ConclusionIn our study, 10.87% of women living with HIV had abnormal cytology and 24% had positive HPV DNA tests. HPV 18 was associated with a greater risk of abnormal cytology compared to other high-risk HPV strains, but our sample size was small. History of pap smear was also shown to decrease the risk of HR-HPV infection. The results underscore the need for increased vaccination of younger women and screening of all women living with HIV in Indonesia in order to improve their cervical health outcomes.

BackgroundIntestinal parasitic infections remain a significant health concern for individuals living with HIV/AIDS, particularly in resource-limited settings such as Ethiopia. Due to compromised immune function, HIV-infected patients are highly susceptible to secondary infections, including parasitic diseases, which can exacerbate their health conditions. Understanding the prevalence and distribution of these infections is crucial for improving patient care and intervention strategies. MethodA retrospective cross-sectional study was conducted to assess the prevalence of intestinal parasites among HIV-infected patients attending Hossana Health Center over the past five years. The study utilized a convenience sampling method, including data from all patients recorded in the facilitys logbook. The completeness of patient records was verified before data extraction. Chi-square tests were performed using R programming software to examine associations between demographic variables and parasitic infections. A p-value of less than 0.05 was considered statistically significant, and results were presented in frequency tables for clarity. ResultsThe analysis revealed an overall prevalence of intestinal parasitic infections at 31.93% among HIV-infected patients. The most frequently identified parasites included Ascaris lumbricoides (42.47%), Entamoeba histolytica (27.82%), and Giardia lamblia (9.20%). Other detected parasites included Trichuris trichiura (5.86%) and Taenia species (5.02%), which were the least prevalent. A statistically significant association was observed between age groups and parasitic infection rates (p < 0.001), suggesting that age-related factors--such as environmental exposure, behavioral patterns, and differences in immune function--may contribute to the likelihood of infection. ConclusionThe findings highlight the persistent burden of intestinal parasitic infections among HIV-infected individuals and reinforce the importance of age-specific intervention strategies. Efforts should focus on improving sanitation, hygiene, and targeted health education programs to mitigate the impact of these infections in vulnerable populations.

Long-distance truck drivers (LDTDs) endure a disproportionately high burden of HIV in various global settings. However, unlike other most at-risk populations, the global burden of HIV among LDTDs has not been documented so far. The result has been poor allocation and distribution of the limited HIV preventive resources for LDTDs in most parts of the world. Thus, a systematic review and meta-analysis were conducted to assess the global burden of HIV among LDTDs. A comprehensive electronic search was conducted in PubMed, ProQuest Central, PubMed Central, CINAHL, and Global Index Medicus to identify relevant information published in English on HIV prevalence among LDTDs from 1989 to the 16th of May 2023. A random-effects meta-analysis was conducted to establish the burden of HIV at global and regional levels. The Joanna Briggs Institute (JBI) and Newcastle-Ottawa Scale (NOS) tools were used to assess the quality of the included studies. Of the 1787 articles identified, 43 were included. Most of the included studies were conducted in sub-Saharan Africa (44.19%, n=19), and Asia and the Pacific (37.21%, n=16). The pooled prevalence of HIV was 3.82%. The burden of HIV was highest in sub-Saharan Africa at 14.34%, followed by Asia and the Pacific at 2.14%, and lastly Western, Central Europe and North America at 0.17%. The overall heterogeneity score was (I2 = 98.2%, p < 0.001). The global burden of HIV among LDTDs is 3.82%, six times higher than that of the general population globally. Compared to other regions, the burden of HIV is highest in sub-Saharan Africa at 14.34%, where its estimated to be 3% in the general population. Thus, LDTDs endure a disproportionately high burden of HIV compared to other populations. Consequently, more LDTD-centred HIV research and surveillance is needed at national and regional levels to institute tailored preventive policies and interventions. PROSPERO NumberCRD42023429390

IntroductionHuman immunodeficiency virus (HIV) infection is a known risk factor for abnormal cervical cytology and cervical cancer. The aim of this study was to investigate cervical cytological abnormalities and its relation with CD4 (T4 Lymphocyte) count among HIV seropositive women. MethodsWe conducted a study on 58 HIV positive women referred to Ahvaz Counseling Center for Behavioral Disease, southwest of Iran between 2016 and 2017. Pap smear was performed for all participants from the cervix and endocervix. Patients characteristics including age, duration of disease, treatment with anti-retroviral treatment (ART), marital status, number of children, and contraception method were also recorded. Cervical cytological abnormalities reported as Bethesda system (TBS). A regular blood sample was taken from all the patients to evaluate the CD4 cells counts. Logistic regression models were used to obtain OR of presences of cytological abnormalities related to CD4 counts, controlling for important factors. ResultsOut of 58 patients only 5 were not under ART. We demonstrated that 29.3 % of patients had squamous cell abnormalities and these abnormalities, was more prevalent among 30-40 years old patients (70.6%). The prevalence of ASC-US (Atypical Squamous Cells of Undetermined Significance), LSIL (Low-Grade Squamous Intraepithelial Lesions) and HSIL (High-Grade Squamous Intraepithelial Lesions) were 19.0%, 3.4%, and 6.9% respectively. Overall 9 patients need to repeat Pap smear test. Presence of cervical cytological abnormalities was not associated with the CD4 count, even after adjusting for the variable such age, duration of disease and ART. ConclusionWe found a high prevalence of ASC-US in HIV-infected women which was independent of age, duration of diseases and history of ART. Though cervical cancer screening in this population might have a substantial public health benefit. Summary box- More than 70% of cervical cancers incidences associated with Genital HPV infections - Prevalent of Squamous cell abnormalities among HIV-infected women was about sex time more than general population - We demonstrated that squamous cell abnormalities are more prevalent in middle age women (30 to 40 years) - The high prevalence of Squamous cell abnormalities in HIV-infected women warrants the need for regular Pap smear screening

BackgroundAn outbreak of novel coronavirus (SARS- CoV-2) was observed on December 2019 in Wuhan, China which led to a global pandemic declared in March 2020. As a consequence, it imposed delirious consequences in patients with underlying co - morbid conditions that make them immunocompromised. The purpose of this paper is to provide an in - depth review of influence of COVID - 19 in patients with underlying HIV in terms of mortality and hospitalization. Authors also aim to provide a thorough risk analysis of hospitalization, ICU admission and mortality of PLWH and COVID-19. The secondary objective was to analyze the CD4+ count variations and outcome of COVID - 19 and to correlate if ART provided a protective role. Authors also aim to provide an evaluation of typical clinical presentation of COVID-19 in PLWH. ART is found to show activity against SARS-CoV-2 in vitro, and there is some similarity in the structure of HIV-1 gp41 and S2 proteins of SARS-CoV since they both belong to +ssRNA type. MethodsWe conducted a literature review using search engines namely, Cochrane, PubMed and Google Scholar. The following keywords were targeted: "COVID-19," "SARS-CoV-2," and "HIV." We included case reports, case series, and cohort (retrospective and prospective) studies. We excluded clinical trials and review articles. We came across 23 articles that met the inclusion criteria. PRISMA guidelines were followed for study acquisition (Fig. 9). O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=176 SRC="FIGDIR/small/21260967v1_fig9.gif" ALT="Figure 9"> View larger version (20K): org.highwire.dtl.DTLVardef@1df3963org.highwire.dtl.DTLVardef@30c4c8org.highwire.dtl.DTLVardef@1c729a4org.highwire.dtl.DTLVardef@7f0543_HPS_FORMAT_FIGEXP M_FIG O_FLOATNOFig.9C_FLOATNO PRISMA guidelines for study acquisition C_FIG ResultsFrom the 23 studies, we found a total of 651 PLWH with confirmed COVID-19 (549, 91, and 11 in cohorts, case series, and case reports, respectively). The overall risk of hospital admission from pooled data of the 23 reviewed articles was 69.13% (450/651), ICU admission was 12.90% (84/651) in total infected patients, and 18.67% (84/450) among hospitalized patients. The overall case fatality rate from the 23 reviewed articles was 11.21 (73/651).A weak positive correlation was found between CD4+ counts and hospital admissions in case series and case reports, while the weak negative correlation was found in cohorts. For mortality, there was a negative weak association in the cohorts and in case series, while a weak positive was seen in case reports (Fig.7). We assessed the presenting symptoms of PLWH with COVID-19, and our review demonstrated this group does not greatly differ from the rest of the population, as their common presenting symptoms were cough, fever, and SOB. O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=93 SRC="FIGDIR/small/21260967v1_fig7.gif" ALT="Figure 7"> View larger version (37K): org.highwire.dtl.DTLVardef@132a333org.highwire.dtl.DTLVardef@1788387org.highwire.dtl.DTLVardef@10335a5org.highwire.dtl.DTLVardef@1b70c29_HPS_FORMAT_FIGEXP M_FIG O_FLOATNOFig.7C_FLOATNO Results: As scoping review of HIV and COVID-19 C_FIG ConclusionOur results indicated that there was a high rate of hospitalization, ICU admission, and mortality among patients living with HIV and COVID-19. PLWH needs to be noted as a high-risk group for COVID-19 complications and severity. We recommend that PLWH be closely monitored by their physicians and strictly adhere to antiretroviral therapy and standard universal COVID-19 precautions.

PurposeTo study the features of the diagnosis, course and outcomes of comorbidity of tuberculosis (TB), opportunistic respiratory infections (ORI) and COVID-19 in patients with advanced HIV infection with immunodeficiency (ID). Materials and methodsThe prospective two-year follow-up study included 58 patients aged 26-56 years who were randomized into 2 groups. The 1st group included 29 patients with TB, ORI and COVID-19 comorbidity, of 4B stage of HIV infection in the progression phase and in the absence of ART. Group 2 - 29 patients selected according to the "copy-pair" principle, identical to patients of Group 1, but without COVID-19. ResultsThe comorbidity of TB, ORI, and COVID-19 in patients with advanced HIV infection is characterized by marked immunodeficiency and generalization of tuberculosis with multiple extrapulmonary manifestations and high levels (more than 70%) of MDR and BDR. Significant improvement in patients of the 1st and 2nd groups was established in 24.1% and 20.7% of cases, progression in 31.0% and 41.4%, respectively, death in 41.3% and 37.9%. Progression and death were associated with lack of treatment adherence, drug dependence, severe generalized TB and ORI progression. ConclusionPatients with TB, ORI and COVID comorbidity in the late stages of HIV infection with ID represent a high risk group for severe disease and death, due to, among other things, social maladjustment and lack of adherence to examination and treatment, active examination of such patients. It is required to establish an etiological diagnosis necessary for their emergency hospitalization in a specialized infectious diseases hospital for adequate comprehensive treatment.

Back groundHIV/AIDS remained among the common public health problems worldwide. Despite the extensive delivery of ART and improved coverage of the service access, still, man-made problems like war have negatively influenced the utilization of antiretroviral treatment services. The war in Tigray Region in the northern Ethiopia broke out in November 2020 and thereby has brought about an extreme damage on most of the infrastructure in Tigray, including the health institutions. The purpose of this study is, therefore, to assess and report the trend of HIV service provision across the war affected rural health facilities in Tigray. MethodsThe study was conducted in 33 rural health facilities during the active war in Tigray. A facility based retrospective cross-sectional study design was conducted among health facilities from July 03 to August 05, 2021. ResultA total of 33 health facilities from 25 rural districts were included in the HIV service delivery assessment. A total of 3274 and 3298 HIV patients were seen during pre-war period in September and October 2020, respectively. The number of follow-up patients during the war period in January remained to be only 847(25%) which is significantly reduced with a P value<0.001. A similar trend was observed during the subsequent months until May. The trend of follow-up patients on ART significantly declined from 1940 in September (pre-war) to 331(16.6%) in May (during the war). This study also revealed a 95.5% reduction of laboratory service provision to HIV/AIDS patients during the war in January and with similar trends thereafter (P<0.001). ConclusionThe war has led to a significant decline of HIV service provision in the rural health facilities and most part of the region during the first eight months of active war in Tigray.

AimTo study features of social status, clinical pattern and diagnosis in cases of comorbidity of respiratory tuberculosis and viral pneumonia caused by Herpesvirus Simplex of type 1, Human Cytomegalovirus and SARS-CoV-2 in patients with late-stage HIV infection with immunodeficiency. Materials and methodsThe prospective study included 25 patients with comorbid condition of respiratory tuberculosis with Mycobacterium tuberculosis in excreta, herpesvirus and coronavirus pneumonia, and 21 patients with respiratory tuberculosis as well as cytomegalovirus and coronavirus pneumonia (1a and 2a main groups) and, respectively, 25 and 21 similar patients, but without coronavirus pneumonia (1b and 2b comparison group) in the late stages of HIV infection with immunodeficiency. For the etiological diagnosis of herpesvirus- and cytomegalovirus pneumonia, the PCR test was used for recognition of DNA of Herpesvirus Simplex of type 1 and Human Cytomegalovirus in the diagnostic material of respiratory tract and for the etiological diagnosis of coronavirus pneumonia, the PCR for recognition of RNA was used to reveal SARS-CoV-2. Statistical analysis of the data was performed by the use of the Microsoft Office Excel 2019 software for calculation of group mean, standard error of mean and confidence interval. ResultsThe comorbidity of respiratory tuberculosis, herpes-, cytomegalo- and coronavirus pneumonia in patients with late-stage HIV infection in the phase of progression and in the absence of ART was characterized by severe immunodeficiency and generalization of tuberculosis with multiple extrapulmonary lesions. The results displayed similarity of clinical manifestations and visualization of changes in CT-picture in cases of comorbidity the diseases which hampers their recognition due to simultaneous combination of several pathologies with similar clinical manifestations that requires a complex etiological diagnosis of the specific diseases to prescribe a timely comprehensive treatment and reduce lethality in this severe contingent of patients. ConclusionPatients with respiratory tuberculosis and HIV infection registered in the office of tuberculosis care for HIV-infected individuals in the antituberculosis dispensary represent a group of high risk from COVID-19 infection and CVP disease, and, in cases of combination with severe immunodeficiency, HVP and CMVP, the patients should be regularly subjected to preventive studies for timely detection of COVID-19 for the purpose of their emergency isolation and treatment.

BackgroundHIV-2 prevalence is poorly understood outside its West African epicenter, contributing to gaps in global epidemiolocal understanding. Cases have been identified in countries like India, Europe, and the Americas, largely due to migration and travel. With a clinical presentation marked by lower viremia and reduced transmission risk, HIV-2 progresses to AIDS more gradually than HIV-1. However, it can still lead to significant health issues. The overlap in diagnostic profiles for HIV-1 and HIV-2 often results in the under-recognition of the latter in areas where HIV-1 is dominant. This under-detection poses challenges in eradicating the epidemic, as current testing protocols may not adequately differentiate between the two strains. In Uganda, we recently transitioned to the Roche Cobas 8800/6800 using the Cobas(R) HIV-1/HIV-2 Qualitative nucleic acid test, for the early infant diagnosis of HIV. The platform has the ability to differentiate between HIV-1 and HIV-2 to detect presence of HIV-2 in DBS, Serum, Plasma and whole blood samples. This represents a pivotal shift toward refining early infant diagnosis and underscores the need for nuanced surveillance to address the distinct epidemiology of HIV-2. MethodTwenty-four thousand six hundred and nineteen (24,619) Dry blood spots (DBS) collected from infants under 18 months old, all born to mothers living with HIV AIDs in Uganda were tested according to the Uganda consolidated guidelines for HIV prevention and treatment. These were tested for routine early infant diagnosis (EID) at the centralized reference lab as per the Uganda national HIV consolidated guideline. Testing was performed using the Cobas(R) HIV-1/HIV-2 Qualitative nucleic acid test for use on the Cobas(R) 5800/6800/8800 Systems. This advanced testing method not only detects HIV but also differentiates between HIV-1 and HIV-2, which is crucial for accurate diagnosis and treatment. Its a reliable test, with a specificity confirmed to be 100% (95% confidence limit: [&ge;] 99.5%) and it is both FDA approved and WHO Pre-qualified. ResultsOf the 24,619 DBS tested between May and November 2023, 466 were confirmed positive (1.9%). Four (4) of the 466 (0.9%) were confirmed HIV-2. These 4 are from Kampala (1), Kagadi (1), Namutumba (1), and Oyam (1) districts. The HIV-2 positive samples had higher CT values (39.2, 40.33, 40.35, 44.62) compared to the average less than 30 for the HIV-1 positive samples and are representative of the 95th percentile. The significance of the CT (cycle threshold) values obtained for HIV-2 positive samples is crucial for understanding the viral load and transmission risk. Compared to HIV-1, HIV-2 is generally associated with lower viral loads, as indicated by higher CT values in PCR testing. This lower viral load is a key factor in the reduced transmissibility of HIV-2 compared to HIV-1. In the context of mother-to-child transmission, the CT values can provide insights into the risk of transmission from mother to infant. Typically, a higher CT value (indicating a lower viral load) would suggest a lower risk of MTCT for HIV-2. This distinction is important for tailoring prevention and treatment strategies specifically for HIV-2, considering its unique virological characteristics compared to HIV-1. DiscussionThis study marks a pioneering report on the possible transmission of HIV-2 from mother to child in Uganda, with 4 cases identified between May to November 2023. The HIV-2 positive samples exhibited high CT values, indicative of low viral load that is characteristic for HIV-2. Further investigations are ongoing to gather more details about the HIV-2 positive infants and to perform alternative tests to rule put non-specificity.

BackgroundLeishmania infantum is an opportunistic parasitic infection. An immunocompromised state increases the risk of converting asymptomatic infection to symptomatic visceral leishmaniasis (VL), which has a [~]5% fatality rate even with treatment. HIV coinfection increases the risk of death from VL. MethodsA cross-sectional study was performed between 2014 and 2016 to determine the prevalence of L. infantum infection in HIV positive subjects residing in the state of Rio Grande do Norte, Brazil (n=1,372) and of these a subgroup of subjects were followed longitudinally. Subsequent incident cases of VL were ascertained from a public health database through 2018. A subgroup (n=69) of the cross-sectional study subjects was chosen to assess immune status (T cell activation, senescence, exhaustion) and outcome. The data were compared between asymptomatic HIV+/L. infantum+ (HIV/Leish), symptomatic visceral leishmaniasis (VL), recovered VL, DTH+ (Delayed-Type Hypersensitivity response - Leishmanin skin test), AIDS/VL, HIV+ only (HIV+), and Non-HIV/Non L. infantum infection (control subjects). ResultsThe cross-sectional study showed 24.2% of HIV+ subjects had positive anti-IgG Leishmania antibodies. After 3 years, 2.4% (8 of 333) of these HIV/Leish coinfected subjects developed AIDS/VL, whereas 1.05% (11 of 1,039) of HIV subjects with negative leishmania serology developed AIDS/VL. Poor adherence to antiretroviral therapy (p=0.0008) or prior opportunistic infections (p=0.0007) was associated with development of AIDS/VL. CD4+ (p=0.29) and CD8+ (p=0.38) T cells counts or viral load (p=0.34) were similar between asymptomatic HIV/Leish and HIV subjects. However, activated CD8+CD38+HLA-DR+ T cells were higher in asymptomatic HIV/Leish than HIV group. Likewise, senescent (CD57+) or exhausted (PD1+) CD8+ T cells were higher in asymptomatic HIV/Leish than in AIDS/VL or HIV groups. ConclusionAlthough asymptomatic HIV/Leish subjects had normal and similar CD4+ and CD8+ T cells counts, their CD8+T cells had increased activation, senescence, and exhaustion, which could contribute to risk of developing VL. Author SummaryThe frequency of asymptomatic HIV/Leishmania infantum (HIV/Leish) infection and the immunological status of subjects with HIV+ residing in the state of Rio Grande do Norte, Brazil, between 2014 and 2016 were studied. A high frequency of asymptomatic HIV/Leishmania infantum infection (HIV subjects with positive anti-IgG Leishmania antibodies) was found. Asymptomatic HIV/Leish subjects had CD8 T cells with higher markers of activation, senescence and exhaustion than the other groups (HIV-alone, symptomatic VL, Recovered VL, DTH+, AIDS/VL and Controls subjects). Poor adherence to antiretroviral therapy or history of previous opportunistic infection was associated with AIDS/VL. Asymptomatic HIV/Leish had high relative risk of developing AIDS/VL. Thus, subjects with HIV residing in endemic areas for VL should be assessed for their L. infantum infection status and advised to closely adhere to ART.

BackgroundThere is an increased risk of human papillomavirus (HPV)-associated infections and malignancies among people living with HIV (PLHIV). However, there is limited literature exploring the intersection of HPV, HIV, and oral health in Tanzania and across sub-Saharan Africa. We reviewed the existing literature on the intersection of HIV, HPV, and oral health in Tanzania. MethodsThis was a scoping review with the search of key words representing HIV, HPV, oral health, and Tanzania. Since there were no studies that explored the intersection of HIV, HPV, and oral health in Tanzania, the search extended to include studies with the intersection between oral health and either HIV or HPV in Tanzania. Findings44 studies were eligible for analysis. Only one of them explored the relationship between HPV and oral health, where 4 (6%) of adolescent schoolgirls were detected with HPV-DNA and the paper hinted at the possibility of HPV autoinoculation. There were no articles linking HPV vaccination and oral health. The remaining 43 (98%) studies explored the relationship between HIV and oral health. There has been an increase in oral manifestations in PLHIV in the last two decades, and highly active antiretroviral therapy has been protective against oropharyngeal candidiasis but had no significance on head and neck cancer. Single-dose fluconazole and 35% herbal antifungals were identified to be effective in treating oral candidiasis. No recent studies explored the different facets of dental care among PLHIV. InterpretationThere are no studies exploring the intersection of HIV, HPV, and oral health in Tanzania. Future studies are needed to determine the burden and barriers of HPV-associated oral manifestations among PLHIV in Tanzania and across Sub-Saharan Africa.

IntroductionData quality improvements have aimed to align national reporting systems for Ministry of Health (MISAU) and PEPFAR. For example, in 2019 the patient Master Card improved systematic data collection process and sites were selected for intensified support including data quality activities (AJUDA). This study aims to compare reported data between MISAU and PEPAFR to understand data alignment trends. MethodsThe annual number of PLHIV on ART, newly initiating ART and HIV status in first ANC visit as reported by MISAU and PEPFAR were compared for 2017-2023. The absolute difference was calculated as MISAU-reported number minus PEPFAR-reported number; proportional absolute difference as the absolute difference over the MISAU-reported number and assessed the slope of the difference over time. ResultsDuring 2017-2023, median absolute difference for PLHIV on ART was 104,940 (range = 154,901 [2018] to 1,598 [2020]), and median proportional difference was 5.0% (range = 0.1% [2020] to 12.8% [2018]), with a trend towards improved concordance. A similar trend was found in positive HIV status at first ANC (10.4% [2017] to 0.0% [2023]), as well as with newly initiated on ART (2.7% [2017] to 0.3% [2023]). ConclusionIn the three indicators analyzed, there were improvements in data alignment between the years of 2017 and 2023, with increased alignment in different years and for different reasons. Continued improvements will support programming and increase certainty for tracking progress toward the UNAIDS 95-95-95 goals to end HIV.

BackgroundUganda has a heavy double burden of tuberculosis (TB) and currently ranks among the seven highest TB affected countries globally. World Health Organization (WHO) recommends isoniazid preventive therapy (IPT) for the treatment of latent TB. However, the adherence to IPT in military settings has not been well documented in Uganda. MethodsWe conducted a cross-sectional study among 300 HIV-positive clients on antiretroviral therapy (ART) at Bombo Military Hospital in Uganda. Clients were cumulatively recruited to a threshold sample. Data were entered and analysed using Epidata client v4.6.0.6 and Stata 14.0. ResultsOf the 300 clients the prevalence of IPT was 94.7% CI (92.1-97.2); adherence to IPT was associated with being: aged [&ge;] 50 years prevalence ratio (PR) of 1.061 and a confidence interval (CI) of 95% (1.01-1.12); married [PR: 1.438, CI: 95% (1.12-1.84)]; having social support [PR: 1.498, CI: 95% (1.17-1.92)] and the role this played in IPT adherence among married participants [PR: 0.817, CI: 95% (0.72-0.93)] are factors that were found to be significant. ConclusionThere is need for Bombo medical facility in Uganda to emphasis on strategies to improve access, retention and adherence to ART and IPT for young adults. Secondly, advocating for social support and behavioural interventions have been identified as requirement for improving IPT adherence among HIV positive soldiers. There is need for more research on the role that social support plays to reduce social stigma associated with HIV-positive patients. The findings for this Uganda study suggest that there is need to increase adherence to IPT for married participants living with HIV and this model could also be adopted in other resource constrained and low middle income countries.

IntroductionAlthough traditional male circumcision (TMC) is still practiced in a number of countries, and its healing process may have a high risk of HIV and other STIs transmission, there have been no published systematic reviews on TMC, HIV risk, and impacts on circumcised men and their families. The aim of this study is to synthesise evidence of how TMC practices contribute to HIV transmission among males and the impacts of HIV on themselves and their families. MethodsThe systematic search started with an initial search following the PICO (Population, Intervention, Comparison and Outcomes) framework. A systematic review was conducted to find literature using databases including PubMed, CINHAL, SCOPUS, ProQuest, Cochrane, and Medline. The search was limited to the English language, and with no year limit in order to capture as many articles as possible about circumcision, traditional male circumcision, HIV, and impact on men and their families. Critical appraisal tools developed by the Joanna Briggs Institute (JBI) for study design were used to assess the methodological quality of included studies. ResultA total of 18 studies were included: 11 were qualitative studies, 5 were quantitative studies, and 2 were mixed-method studies. All the studies included were conducted in areas where traditional male circumcision was performed (17 in Africa and 1 in Papua New Guinea). The findings of the review were categorized into themes namely TMC as a cultural practice, consequences of not being traditionally circumcised on men and their families, and TMC-related risk of HIV transmission. The review showed that TMC and HIV risk could bring significant and negative challenges for men and their families. ConclusionThe findings indicated the need for targeted health intervention programs and efforts to address psychological and social challenges in communities practicing TMC. Prospero Number RegistrationCRD42022357788.

HIV/AIDS continues to be a global public health problem. Studies of the incidence and prevalence of HIV and other sexually transmitted infections (STIs) that may contribute to or aggravate its acquisition remain an effective means of prevention. In recent years, terrorist groups have established themselves in the northern regions of Cameroon. This insecurity has led to a large influx of refugees with no information about their HIV and STI status. Given this above mentioned situation, this study aimed to assess the incidence and prevalence of HIV and STI and their associated risk factors in order to adjust strategies to monitor the epidemic. A cohort of 684 consenting participants from the North and Far North were enrolled in the study in 2021 and followed up in 2022 to measure the incidence and prevalence of HIV and to assess some associated risk factors. Each participant was administered a pretested questionnaire to collect sociodemographic variables and risk behaviors. Anti-HIV Ab, HBsAg (Hepatitis B Surface Antigen), TPHA (Treponema Pallidum Hemagglutination Assay) tests were performed. The data were compiled using EPI Info 7.5.2 for epidemiological analyses. The association between co-infections of HIV, Hepatitis, and syphilis and HIV incidence was evaluated using the Chi-2 test. The HIV incidence and overall prevalence were 1.63% (163/10,000 population) and 3.8%, respectively. The HIV incidence increased from 0.27% in 2017 (DHS) to 1.63% in the North and Far North regions as found in our study. The incidences of syphilis and hepatitis B were 1.03% and 4.56%, respectively. Factors associated with HIV acquisition included religion (Muslims being more infected, P<0.03), unprotected sex with a new partner (P<0.007), having a sex worker as a partner (P<0.0001), and co-infection with syphilis and hepatitis B (P<0.05). The findings also link increased HIV incidence to insecurity and population displacement. In HIV prevention strategies, it is important to consider the security and political stability context as well as HIV-associated infections such as hepatitis B and syphilis.

BackgroundTuberculosis (TB) and Human Immuno Deficiency Virus (HIV) co-infection represents a complex pathogenic scenario with synergistic effect and leads to about 300,000 HIV-associated TB deaths in the world in 2017. Despite this burden of death, time to death and its predictors among TB-HIV co-infected patient was not adequately studied; and the existing evidences are inconsistent. Therefore, this study was aimed to determine time to death and identify its predictors among adult TB/HIV co-infected patients. MethodRetrospective cohort study was conducted by reviewing registers of randomly selected 364 TB/HIV co-infected patients enrolled in health care from July 2, 2007 up to July 1, 2017 at Mizan Tepi University Teaching Hospital. The hospital was located in Bench Maji Zone, South West Ethiopia. Data were collected from March 1 through 31, 2018, entered to Epi data 3.1 and exported to SPSS version 21. Each patient was followed from date of TB treatment initiation till death, loss to follow up and treatment completed. On the other hand, events other than death were considered as censored. After checking the proportional hazard model assumption, Cox-regression was used to identify the predictors. In bivariable analyses, P-value[&le;]0.25 was used to identify candidate variables for multivariable analysis. The 95% CI of hazard ratio (HR) with respective P-value <0.05 was used to declare significance in the final model. ResultAll the 364 patients were followed for 1,654 person months. There were 83 (22.8%) deaths and most 38 (45.8%) were occurring within the first two months of anti-TB treatment initiation. The overall incidence rate and median survival time were 5.02 per 100 person months (95% CI: 4.05, 6.22) and 10 months respectively. Statistically significant better survival was observed among patients: with CD4 [&ge;] 200 cells/mm3 (P<0.001), who had a history of cotrimoxazole preventive therapy (CPT) use (P<0.001), who disclose their HIV status (P<0.001) and with working functional status (P<0.001). Not using CPT (adjusted hazard ratio [AHR] =1.72; P=0.023), bedridden functional status (AHR=2.55; P=0.007), not disclosing HIV status (AHR=4.03; P<0.001) and CD4 < 200 cells/mm3 (AHR=6.05; P<0.001) were predictors of time to death among TB/HIV co-infected patients. ConclusionThe median survival time was 10 months and poor survival was associated with low CD4 count, not using CPT, not disclosing HIV status and having bedridden functional status. Close monitoring of bedridden and low CD4 count patients, prompt CPT initiation and encouraging HIV status disclosure are recommended.

Data on people living with human immunodeficiency virus (PLWH) in the current SARS-CoV-2 pandemic is still scarce. This case series of 33 PLWH patients with COVID-19 reveals symptoms and outcome in this special population. Three out of 32 patients with documented outcome died (9%). However, 91% of the patients recovered and 76% have been classified as mild cases, indicating that there is no excess morbidity and mortality among PLWH with symptomatic COVID-19. All patients were on antiretroviral treatment, of them 22 on tenofovir-containing regimen, and 4 on the protease inhibitor darunavir.