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The article is devoted to the global problems of modern medicine - HIV infection and the COVID-19 pandemic. The review of the literature highlights current ideas about the pathogenesis and course of COVID-19 in patients with HIV infection, and also touches upon the problems of concomitant pathology and mental health of patients with HIV in the setting of the COVID-19 pandemic. It has been shown that HIV-positive patients are a risk group for the severe course of COVID-19, in particular, individuals with severe immunodeficiency (CD4+ T lymphocytes 200 cells/l) due to the development of synergetic lung damage by SARS-CoV-2 and secondary infectious agents such as cytomegalovirus and Pneumocystis carinii. It has been proven that one of the targets of the SARS-CoV-2 virus is CD4+ T cells, which in COVID-19 leads to a more rapid progression of immunodeficiency in patients with HIV infection and, thus, significantly increases the risk of secondary diseases and death. Particular attention should be paid to middle-aged and elderly people living with HIV, who, compared with HIV-negative patients, are more likely to have concomitant pathology - arterial hypertension, cardiomyopathy and diabetes mellitus, which are the risk factors for severe COVID-19. The results of studies on the effect of antiretroviral drugs on the course of COVID-19 showed that HIV-infected patients receiving tenofovir + emtricitabine have a lower risk of severe COVID-19 and associated hospitalization than patients receiving other HIV treatment regimens. Clinical and preclinical data support the potential use of tenofovir in the treatment of novel coronavirus infection.
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Introduction:Coronavirus disease 2019 (COVID-19) has become a pandemic with 1771514 cases identified in the world and 70029 cases in Iran until April 12, 2020. The co-prescription of psychotropics with COVID-19 medication is not uncommon. Healthcare providers should be familiar with many Potential Drug-Drug Interactions (DDIs) between COVID-19 therapeutic agents and psychotropic drugs based on cytochrome P450 metabolism. This review comprehensively summarizes the current literature on DDIs between antiretroviral drugs and chloroquine/hydroxychloroquine, and psychotropics, including antidepressants, antipsychotics, mood stabilizers, and anxiolytics.Methods:Medical databases, including Google Scholar, PubMed, Web of Science, and Scopus were searched to identify studies in English with keywords related to psychiatric disorders, medications used in the treatment of psychiatric disorders and COVID-19 medications.Results:There is a great potential for DDIs between psychiatric and COVID-19 medications ranging from interactions that are not clinically apparent (minor) to those that produce life-threatening adverse drug reactions, or loss of treatment efficacy. The majority of interactions are pharmacokinetic interactions via the cytochrome P450 enzyme system.Conclusion:DDIs are a major concern in the comorbidity of psychiatric disorders and COVID-19 infection resulting in the alteration of expected therapeutic outcomes. The risk of toxicity or lack of efficacy may occur due to a higher or lower plasma concentration of medications. However, psychiatric medication can be safely used in combination with COVID-19 pharmacotherapy with either a wise selection of medication with the least possibility of interaction or careful patient monitoring and management.
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In this paper, we explore the strategies utilized by civil society organizations to improve access to medicines during the HIV/AIDS and COVID-19 health crises. In particular, we seek to illuminate why some of the successful approaches for increasing access to antiretrovirals for HIV/AIDS in the early 2000s failed in creating equitable global access to COVID-19 vaccines. While civil society has historically mobilized human rights to facilitate greater access to essential medicines, we argue that earlier strategies were not always sustainable and that civil society is now mobilizing human rights in radically different ways than previously. Instead of focusing chiefly on securing an intellectual property waiver to the TRIPS Agreement, civil society organizations are now challenging vaccine injustice, rejecting the "charity discourse" that fuels Global South dependency on Global North actors in favor of scaling up manufacture in low- and middle-income countries, and moving to embed the right to access medicines in a new World Health Organization pandemic treaty with civil society organization participation and meaningful representation from low- and middle-income countries. Such approaches, we contend, will lead to more sustainable solutions in order to avert further health care disasters, like those seen with two distinct but related struggles-the fights for equitable access to essential medicines for HIV/AIDS and for COVID-19.
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The logistical management of an injectable therapy for the treatment of HIV can be expensive, time consuming, frustrating and riddled with barriers. In this Commentary, we describe our experiences to date with acquiring, storing, handling, administering and billing for long-acting cabotegravir and rilpivirine through four scenarios, each of which have presented their own unique obstacles and learning curves. At the time of writing, we have successfully transitioned four patients from the CUSTOMIZE trial to long-acting cabotegravir and rilpivirine. In doing so, we encountered a variety of barriers to acquiring, handling and administering the medication for both insured and uninsured patients; it is expensive, on a limited number of insurance formularies, and often requires a prior authorization from the provider. Cold-chain handling of the injectable therapy, along with individual patient characteristics, present barriers to management and administration of this therapy. Whilst a seemingly very attractive option for the treatment of HIV-1 infection in adults, long-acting cabotegravir and rilpivirine present a variety of challenges to pharmacists, providers and clinic staff on how to obtain it for and administer it to the patient. We plan to continue documenting our experiences, progress and successes, or lack thereof, in order to fine-tune our process and share with others.
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The infections by viruses are a great threat to our immunity but an array of powerful vaccines have successfully protected mankind from the attack of many of them. HIV is a tough enemy of the human body as it eludes the immune system by various mechanisms. It attacks immune cells causing a disease that gradually progresses to AIDS in some infections. Despite the success of ART, which has converted its infection into a manageable chronic condition, it is a major global health problem as 37.7 million people worldwide are HIV infected. ART is a lifelong treatment where a variety of drug options are designed to replace its resistant forms. Vaccines can protect from the stigmatized disease of HIV and control it in the absence of ART. In stark contrast with the speed with which the Covid-19 vaccines were developed in two years of the pandemic, an effective vaccine for HIV is still a challenge after decades of ongoing research. Coincidentally, both HIV and SARS-CoV-2 are pandemic causing mRNA viruses, which have spilled from animal sources. They mutate and attach to their host cells with their surface spikes. The paper is a review of the status of the HIV/AIDS pandemic, the unique challenges of the complex structure of the virus for the development of vaccines and a hope from the novel game-changing mRNA vaccine. After the recent success of the mRNA vaccine for Covid-19, it may become a promising tool to defeat HIV also by providing RNA-based HIV immunogens to trigger the body's immune response.
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In 2020, 75% of all locally acquired HIV diagnoses will be among gay, bisexual, and other males who have sex with men, indicating that they will continue to be the group in New Zealand most at risk for contracting the virus. Since the peak in 2016 (n=97), the number of MSM reported to have contracted HIV in New Zealand has been declining, with the number in 2020 (n=49) being the lowest since 2011. This is probably because pre-exposure prophylaxis (PrEP) and more testing choices are being pushed and made available to this group as combination preventive treatments. Less transmission as a result of COVID-19 physical distancing measures and more restricted testing access will also have contributed to the drop in 2020. It will be crucial to keep an eye on these figures to see if the lower trend persists, as well as to keep up the preventative efforts of routine HIV testing and linking to care and treatment, investigating potential sexually transmitted diseases. In New Zealand in 2020, little over half (54%) of people with heterosexually acquired HIV had a CD4 count at the time of diagnosis that was less than 350 cells/mm3, which was a sign of a delayed diagnosis of their HIV. In addition, six of the 14 patients who received an AIDS diagnosis in 2020 were heterosexually acquired;four of them also received an HIV diagnosis at the same time. Therefore, even if there do not seem to be any obvious risk factors, doctors should test for HIV in patients with similar clinical symptoms. Through antenatal screening in 2020, three women who had recently been diagnosed with HIV were given the opportunity to choose their own medication and care, lowering the chance of mother-to-child transmission. The significance of the antenatal HIV screening program in preventing vertical and secondary transmission is further highlighted by this.
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Background: We investigated the global threat of co-infection of severe acute respiratory coronavirus 2 (SARS-CoV-2) to patients living with another prevalent viral infection HIV. We have analyzed symptom status, treatment, and outcome of co-infected individuals.
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As we move towards HIV epidemic control in Cameroon, we strive to limit the number of new infections by maintaining on-treatment PWHIV. The emergence of the Covid-19 pandemic may cause interruptions in HIV treatment and slow progression. COVID-19 control measures have caused;the lockdown of businesses, some health services, and imposed work from home, with intimate partners and more people spending longer hours together at home. As a consequence, there is an increased risk of gender-based violence (GBV). GBV can affect adherence to treatment in PWHIV and prevent them from accessing health services. The main objective of the study was to determine the effect of Covid-19 and GBV on the uptake of HIV services by assessing interruptions in treatment. Using a structured questionnaire, demographic data, Information on COVID-19 and intimate partner violence were obtained from 339 participants between 15 and 60 years old, taking HIV treatment at the Touboro district hospital. We used the Antiretroviral treatment register of the health facility to extract data on the frequency and duration of interruption in treatment. The Prevalence of intimate partner violence was high in our study participants, although interruption in treatment was only significant in respondents who reported verbal abuse. A strong association was observed between Covid 19 and interruption in treatment. There was equally an association between Covid-19 and an increase in intimate IPV. Other Socio-demographic variables found to affect interruption in treatment were level of Education of the partner, Age difference with intimate partner greater than 10 years, and early years on antiretroviral therapy. According to the study, Both Gender-based violence (IPV) and Covid-19 affect interruption in antiretroviral treatment.
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Coronavirus disease 2019 (COVID-19) and AIDS (acquired immunodeficiency syndrome, AIDS) both belong to Class B infectious diseases, and their pathogens are novel coronavirus (severe acute respiratory syndrome coronavirus 2, SARS-CoV-2) and human immunodeficiency virus (HIV). Although HIV infection is not a risk factor for COVID-19, recent clinical studies have shown that compared with HIV-negative COVID-19 patients, HIV-positive COVID-19 patients have a longer clinical course, especially with higher CD4 + T lymphocyte counts. Patients on low or no antiretroviral therapy (ART) were more severely ill. Therefore, this paper will compare the differences between the two viruses in terms of etiology and infection pathogenesis, and describe the immunological and virological characteristics of HIV-positive COVID-19 patients, which will be helpful for SARS-CoV-2 and HIV infection. have a clearer understanding.
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BACKGROUND: Afghanistan adopted a "test and treat" strategy for all people living with HIV (PLWH) in 2016. In this study, we presented demographic and clinical characteristics of all people diagnosed between 2013 and 2019 and evaluated progress towards 90-90-90 UNAIDS targets and identified program gaps among PLWH in Afghanistan diagnosed in 2018. METHODS: We used clinical, behavioral, and demographic data from national HIV surveillance for 1394 patients diagnosed from 2013 through 2019. We also tracked 184 patients diagnosed with HIV in 2018 over 15 months to assess their enrollment in care, antiretroviral therapy (ART) initiation, retention on ART, and viral suppression. RESULTS: Of 1394 patients diagnosed from 2013 through 2019, 76.0% were male, 73.7% were older than 24 years, and 33.4% acquired HIV through heterosexual sex. Of the 184 patients diagnosed in 2018, 94.6% were enrolled in care, 88.6% received ART, 84.2% were retained on ART for at least 12 months, and 33.7% received a viral load test. Of those with a viral load test, 74.2% were virally suppressed. Patients who were 35-44 years old (52.0%, p-value .001), acquired HIV through unsafe injection (62.5%, p-value .413), were co-infected with hepatitis C virus (HCV) (60.0%, p-value .449), and with CD4 > 500 at diagnosis (64.7%, p-value .294) were less likely to be virally suppressed 12 months after diagnosis. CONCLUSION: Nearly 95% of people diagnosed with HIV in Afghanistan in 2018 were linked to care and nearly 90% were on ART. Viral testing and viral suppression remain low with notable disparities for middle-aged patients, and possibly for those who injected drugs. Addressing barriers to HIV programs in Afghanistan, particularly for people who inject drugs (PWID), are urgently needed to reach the 90-90-90 global targets. Surveillance data on the number of people with undiagnosed HIV is needed to assess the first 90 target.
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HIV Infections , Adult , Afghanistan/epidemiology , Continuity of Patient Care , HIV Infections/diagnosis , HIV Infections/drug therapy , HIV Infections/epidemiology , Heterosexuality , Humans , Male , Middle Aged , Viral LoadABSTRACT
INTRODUCTION: In December 2019, dolutegravir-based treatment was recommended as first-line antiretroviral therapy (ART) in South Africa. Dolutegravir has clinically significant interactions with several commonly used drugs, such as rifampicin, metformin and cation-containing medicines. National guidelines detail these interactions and how to manage them. While previous international studies have shown low healthcare worker knowledge of drug-drug interactions, there is a paucity of information on antiretroviral interaction knowledge in the South African setting, where much ART is nurse-led. The study aimed to determine this knowledge and to describe which variables were associated with gaps in knowledge. METHODS: An anonymous online survey of healthcare workers in the field of HIV was conducted in August/September 2020. The survey was designed, tested and piloted, and included sections on demographics, guideline access and training, interaction knowledge, counselling and the effect of COVID-19. Dissemination was via e-mail and social media (convenience sampling). Descriptive and inferential analysis was done using proportions and the 95% confidence interval to determine relationships between independent and dependent variables. Research ethics approval was obtained from the University of Cape Town's Human Research Ethics Committee (HREC Ref: 357/2020). RESULTS AND DISCUSSION: In total, 1950 survey responses were included in the analysis - 47.1% nurses, 35.8% doctors and 8.9% pharmacists. When asked whether they were aware that dolutegravir has interactions, 70% said yes, 13.9% said no and 16.1% did not answer. Knowledge of specific interactions and the dosing changes needed was low with a wide range between different drugs: 79.7% knew to double the dolutegravir dose with rifampicin, but with calcium, 5.1% picked both correct dosing options and 33.7% picked one of the two correct options. Access to guidelines and training were positively associated with drug interaction knowledge. CONCLUSIONS: There are gaps in the awareness and knowledge of dolutegravir interactions and how to adjust dosing among South African healthcare workers.
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COVID-19 , HIV Infections , Cross-Sectional Studies , Drug Interactions , HIV Infections/drug therapy , Health Knowledge, Attitudes, Practice , Health Personnel , Heterocyclic Compounds, 3-Ring , Humans , Oxazines , Piperazines , Pyridones , SARS-CoV-2 , South AfricaABSTRACT
More than a decade ago, the preventive effect of antiretroviral treatment against HIV (TasP) was scientifically demonstrated: an HIV-positive person under treatment with an undetectable viral load cannot transmit the virus. This article aims to assess the level of knowledge about TasP among men who have sex with men (MSM), to describe the men's characteristics according to their declared HIV status and to identify the factors associated with their knowledge. The data source is the survey Rapport au Sexe (ERAS) 2021: a cross-sectional, anonymous, voluntary and self-administered online survey. Among the 14,706 respondents included in the analysis, who were residing in France and had engaged in sexual intercourse with a man at least once in their lifetime, 60.5% were aware of TasP, 92.4% among HIV-positive MSM and 58.2% among HIV-negative MSM or those who did not know their HIV status. Logistic regressions show that, to different extents depending on the respondent's HIV status, a low level of education, a financial situation perceived as difficult, a low level of health literacy and not defining oneself as homosexual were factors associated with less knowledge. Conversely, living in an urban area, frequenting the gay community, or attending HIV care services were positively associated to TasP knowledge. The continuation of public awareness campaigns around TasP is essential, whether administered through associations, the gay community, via health initiatives or the mass media, in order to improve knowledge about HIV and reduce HIV-related stigma.
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Introduction: The end of the 2000s was marked by an important turning point in HIV management: HIV-positive people on effective antiretroviral treatment whose viral load is biologically undetectable no longer transmit the virus. These advances are at the origin of the research's initial question: what remains of the social stigma associated with HIV? Does the achievement or the prospect of achieving an undetectable viral load allow for the disappearance of the subjective experiences of shame and/or stigmatization described up to now in sociological studies and more broadly in public health data? Materials and methods: This article presents the main results of a thesis on the sociological analysis of gay men's experiences of being HIV-positive. A qualitative longitudinal study conducted during the first two years following the medical diagnosis combines repeated biographical interviews (n=35) with these men and multi-sited observations within the different spaces they frequent and cross (department of infectious and tropical diseases, associations related to HIV-AIDS and/or LGBT, spaces of sociability, private spheres of friendship, family and couple).
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Introduction - Transgender people are highly vulnerable to HIV infection and other STIs, due to behavioral, economic, or social factors. This work aims to describe HIV diagnoses in this population. Materials-methods - The data come from HIV mandatory reporting. We analysed HIV diagnoses in transgender people between 2012 and 2020. Two categories have been described, new diagnoses (people not knowing their HIV status before diagnosis), and first diagnoses in France for people already diagnosed in another country. Results - From 2012 to 2020, 253 new HIV diagnoses in transgender people were reported, i.e. 0.7% of diagnoses. After adjustment for underreporting and missing data, this number was estimated at 418 (95% CI [367-469]). Most of these people were trans women (87%), with a median age of 31 (38.5 for men). Trans women were more often born abroad (83%, mainly in South America) than trans men (52%). The probable mode of contamination was mainly sexual (98%). The most common reason for performing serology was recent exposure to HIV (33%), and 15% of diagnoses were made following a positive rapid diagnostic orientation test. One in five trans people were diagnosed with advanced infection (AIDS or <200 CD4 cells), and 37% of trans people were co-infected with another STI. Between 2012 and 2020, 115 first diagnoses in France in transgender people knowing their HIV status were reported. These diagnoses concern almost exclusively women (99%). After correction, their number is estimated at 169 (95% CI [137-201]) people. Discussion-conclusion - Transgender people newly diagnosed are mainly born abroad and sexually infected. They are often coinfected with a bacterial STI, highlighting their high level of sexual exposure and calls for a strengthening of diversified prevention in this population, including PrEP. New diagnoses at an advanced stage of infection are more common in foreign-born transgender people diagnosed several years after arrival in France, which is an argument to support HIV screening in this population. As well as new HIV diagnoses, the first diagnoses in France of people already diagnosed in another country, are an important issue in terms of setting up HIV medical care, whether for initiation or continued antiretroviral therapy.
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This special issue contains 58 articles that discuss COVID-19 in relation to other diseases. Topics include dengue fever, tuberculosis, Guillain-Barre syndrome, antiretroviral shortage amidst the pandemic, measles, reinfection by 2 genetically distinct SARS-CoV-2 viruses, Lassa fever, molecular biology of SARS-CoV-2 proteins, dermatological manifestation of COVID-19, immunosuppressive therapy in COVID-19-positive patients, rapid antigen tests for detection of COVID-19, among others.
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World AIDS Day, which falls on 1 December every year, serves as an annual reminder of the global HIV and AIDS epidemic, with this year marking 40 years since the first reported cases of HIV-related illnesses and deaths. The most recent worldwide report of the UN Joint Programme on HIV/AIDS (UNAIDS) estimated that 37.7 million people were living with HIV at the end of 2020. Around 27.5 million people were accessing antiretroviral therapy, up from 6.4 million in 2009. Approximately 1.5 million people were newly infected with HIV in 2020 and there were around 680,000 AIDS-related deaths worldwide last year. People living with HIV can experience more severe outcomes and have higher comorbidities from COVID-19 than people not living with HIV. In mid-2021, many people living with HIV, particularly in sub-Saharan Africa, did not have access to COVID-19 vaccines.
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COVID-19, a disease induced by SARS-CoV-2, became a worldwide pandemic while SARS, a disease induced by a closely related virus, SARS-CoV, was successfully contained. This is because COVID-19, unlike SARS, can be spread by people who do not display any symptoms of disease, either because they are in the early stages of the infection or because their infection remains clinically silent. This research article traces the complex history of the diagnosis of symptom-free (or asymptomatic) carriers of pathogens, a term inseparably linked to the rise of the laboratory diagnosis of pathogens. Only such a diagnosis can reveal that an apparently healthy individual harbours dangerous bacteria, parasites, or viruses. The article begins with the iconic story of 'Typhoid Mary', a New York cook found to be an asymptomatic carrier of typhoid fever microbes. It then discusses divergent approaches to the treatment of symptom-free carriers of hookworm and controversies around the screening of HIV carriers, especially before the development of anti-retroviral treatments. It concludes with a presentation of the debates on the role of asymptomatic carriers in the spread of COVID-19 and of the differences between the approaches of countries seeking to eliminate this disease, a goal that itself entails tracing and isolation of all asymptomatic carriers of coronavirus, and those trying to contain it, an approach that tolerates the presence of a limited number of 'invisible' virus carriers.
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COVID-19/epidemiology , HIV Infections/drug therapy , Infertility, Female/etiology , Papillomavirus Infections/prevention & control , Papillomavirus Vaccines/adverse effects , Syphilis/diagnosis , Syphilis/psychology , Alphapapillomavirus/genetics , Alphapapillomavirus/immunology , Anti-HIV Agents/therapeutic use , Biomedical Research , COVID-19/psychology , Female , HIV Infections/epidemiology , Humans , Male , Papillomavirus Vaccines/administration & dosage , Point-of-Care Testing , Sexual Behavior , Sexual and Gender Minorities/psychology , Sexual and Gender Minorities/statistics & numerical data , VaccinationABSTRACT
INTRODUCTION: The extreme health and economic problems in the world due to the SARS-CoV-2 infection have led to an urgent need to identify potential drug targets for treating coronavirus disease 2019 (COVID-19). The present state-of-the-art tool-based screening was targeted to identify drug targets among clinically approved drugs by uncovering SARS-CoV-2 helicase inhibitors through molecular docking analysis. MATERIAL AND METHODS: Helicase is a vital viral replication enzyme, which unwinds nucleic acids and separates the double-stranded nucleic acids into single-stranded nucleic acids. Hence, the SARS-CoV-2 helicase protein 3D structure was predicted, validated, and used to screen the druggable targets among clinically approved drugs such as protease inhibitor, nucleoside reverse transcriptase inhibitor, and non-nucleoside reverse transcriptase inhibitors, used to treat HIV infection using molecular docking analysis. RESULTS: Interaction with SARS-CoV-2 helicase, approved drugs, vapreotide (affinity: -12.88; S score: -9.84 kcal/mol), and atazanavir (affinity: -11.28; S score: -9.32 kcal/mol), approved drugs for treating AIDS-related diarrhoea and HIV infection, respectively, are observed with significantly low binding affinity and MOE score or binding free energy. The functional binding pockets of the clinically approved drugs on SARS-CoV-2 helicase protein molecule suggest that vapreotide and atazanavir may interrupt the activities of the SARS-CoV-2 helicase. CONCLUSIONS: The study suggests that vapreotide may be a choice of drug for wet lab studies to inhibit the infection of SARS-CoV-2.