REVIEW | doi:10.20944/preprints202003.0064.v1
Subject: Life Sciences, Virology Keywords: advocacy coalition; policy; antiretroviral therapy; emergence; South Africa
Online: 4 March 2020 (10:59:44 CET)
South Africa possesses the largest anti-retroviral therapy (ART) program in the world but the path to this record was dramatic. There is scarce literature employing a comprehensive framework to explain this ART policy change and inform current policy making processes. This paper applies the Advocacy Coalition Framework (ACF) to analyse the interactions among diverse actors, institutions and networks that were associated with the ART policy change in South Africa. Post-apartheid, HIV/AIDS and AIDS-related mortality were serious public health problems. At the time, the discernible coalitions in the AIDS policy subsystem were the prescience coalition and AIDS dissidents. In view of the availability of compelling scientific evidence on the pathogenesis of HIV/AIDS, the clinical usefulness of ART, the availability of funding for national ART roll-out, strong global advocacy to reduce the cost of ART, all of these in an era when access to adequate HIV care was increasingly considered a human right, the environment to establish an appropriate ART policy for the country was conducive. However, AIDS dissidents dominated the policy agenda via their control over key institutions, the use of various dimensions of power, biasing evidence to inform policy, and promoting the activities of strong interest groups that were not in support of ART. National ART roll-out ultimately emerged as a political priority as a result of external shocks (on the ART policy subsystem) which disfavoured the dominant coalition. Failure to supplement this application of the ACF with key pubic policy concepts such as power dimensions, evidence use in policy, governance and emergence of global health networks would have led to suboptimal appraisal of the ART policy change and misinformation of current policy making processes.
ARTICLE | doi:10.20944/preprints201811.0575.v1
Subject: Medicine & Pharmacology, Other Keywords: antiretroviral treatment; residual HIV replication; episomal DNA; proviral DNA; antibody quantitation; LPS
Online: 26 November 2018 (08:32:26 CET)
Background: The presence of HIV residual replication markers was investigated among distinct subgroups of individuals on antiretroviral treatment (ART). Methods: One hundred sixteen patients were distributed into 5 treatment groups: first-line suppressive ART with a non-nucleoside analog reverse-transcriptase inhibitor (NNRTI) (n = 26), first-line suppressive ART with boosted protease inhibitors (PI-r) (n = 25), suppressive salvage therapy using PI-r (n = 27), suppressive salvage therapy with PI-r and raltegravir (n = 22) and virologic failure (n = 16). Episomal and total DNA quantitation was evaluated. HIV antibody and LPS quantitation was performed. Results: Episomal DNA was positive in 26% to 38% of individuals under suppressive ART, and it was higher among ART virologic failure group (p = 0.04). HIV proviral load was higher among patients with detectable episomal DNA (p = 0.01). Individuals receiving initial PI-r treatment presented lower HIV antibody (p = 0.027) and LPS (p = 0.029) levels than individuals receiving NNRTI. There was a negative correlation between episomal DNA quantitation and the duration of suppressive ART (p = 0.04), CD4+ T-cell count (p = 0.08), and CD8+ T-cell count (p = 0.07). Conclusions: Residual HIV replication has been inferred among individuals under suppressive ART according to episomal DNA detection. Residual replication may decrease with longer periods of suppressive ART and higher levels of CD4+ and CD8+ T cells. The relationship between episomal DNA and total DNA suggests there is a replenishment of the proviral reservoir. Lower antibody and LPS levels among patients with initial PI-r ART suggest these regimens may more effectively suppress HIV, more effectively decreasing HIV antigenic component.
REVIEW | doi:10.20944/preprints202206.0296.v1
Subject: Medicine & Pharmacology, Psychiatry & Mental Health Studies Keywords: new materialism; assemblage; storyboarding; HIV; adherence; antiretroviral therapy; young people; perinatal infection; qualitative evidence synthesis; biopsychosocial
Online: 21 June 2022 (10:54:56 CEST)
Young people living with perinatal infections of Human Immunodeficiency Virus (YLPHIV) face a chronic disease, with treatment including adherence to life-long antiretroviral treatment (ART). The aim of this QES was to explore adherence to ART for YLPHIV as an assemblage within the framework of the BPS model with a new materialist perspective. We searched up to November 2021 and followed the ENTREQ and Cochrane guidelines for QES. All screening, data extraction and critical appraisal was done in duplicate. We analysed and interpreted the findings innovatively, by creating images of meaning, a storyboard, and storylines. We then reported the findings in a narrative first person story. We included 47 studies and identified 9 storylines. We found that treatment adherence has less to do with humans’ preferences, motivations, needs and dispositions, and more to do with how bodies, viruses, things, ideas, institutions, environments, social processes, and social structures assemble. This QES highlights that adherence to ART for YLPHIV is a multisensorial experience in a multi agentic world. Future research into rethinking the linear and casual inferences we are accustomed too in evidence-based health care is needed if we are to adopt multidisciplinary approaches to address pressing issues such as adherence to ART.
ARTICLE | doi:10.20944/preprints202211.0496.v1
Subject: Medicine & Pharmacology, General Medical Research Keywords: hypertension, comorbidity, HIV, antiretroviral treatment, treatment outcomes
Online: 28 November 2022 (06:04:48 CET)
Globally, non-communicable diseases like hypertension are on the rise, existing concurrently with the human immunodeficiency virus (HIV) in populations, especially those in low- to middle-income countries. The introduction of antiretroviral treatment (ART) for people living with HIV was welcomed with great enthu-siasm across populations. A cross-sectional study of 100 purposively selected adult participants on an-tiretroviral treatment living in the OR Tambo district was conducted to determine factors associated with treatment outcomes among patients living with HIV and hypertension comorbidity. The data was analyzed using the Statistical Package for Social Sciences, with a p-value of 0.05 considered significant. A total of 86% of the female population, with a mean age of 39.76, was studied. Participants with improved viral load and CD4 cell count after initiation of ART increased from 63% to 68% and 74% to 90%, respectively whilst viral load suppression increased from 45.1% to 90.2%. Hypertension post-ART initiation increased from 9% to 34%, exacerbated by smoking (12%), alcohol (14%), vegetable consumption (39%), skipping breakfast (50%), sugar use (62%), and vigorous physical activity (12%). The onset of hypertension was linked to the start of ART, and risky behaviors influenced treatment outcomes. Primordial prevention, like strong health promotion inter-ventions for risk factors, is needed to improve life expectancy.
REVIEW | doi:10.20944/preprints202108.0420.v1
Subject: Medicine & Pharmacology, Oncology & Oncogenics Keywords: Hodgkin lymphoma, HIV,; antiretroviral therapy; prognosis; etiopathogenesis
Online: 20 August 2021 (14:08:47 CEST)
Despite widespread use of combined antiretroviral therapy (cART) and increased life expectancy in people living with HIV (PLWH), HIV-related lymphomas (HRL) remain a leading cause of cancer morbidity and mortality for PLWH, even in patients optimally treated with cART. While incidence of aggressive forms of non-Hodgkin lymphoma decreased after cART advent, incidence of Hodgkin lymphoma (HL) has increased among PLWH in recent decades. The coinfection of Epstein Barr virus plays a crucial role in the pathogenesis of HL in the HIV setting. Currently, PLWH with HRL, including HL, are treated similarly to HIV-negative patients and, importantly, the prognosis of HL in PLWH is approaching to that of the general population. In this regard, effective chem-otherapy is strongly recommended since it has been shown to improve survival rates in all lymphoma subtypes, including HL. As a consequence, interdisciplinary collaboration between HIV specialists and hemato-oncologists for the management of potential drug-drug interactions and overlapping toxicities between antiretroviral and antineoplastic drugs is crucial for the op-timal treatment of PLWH with HL. In this article the authors review and update the epidemio-logical, clinical and biological aspects of HL presenting in PLWH with special emphasis in the improvement on prognosis and the factors that have contributed to it.
Subject: Medicine & Pharmacology, Allergology Keywords: Hodgkin lymphoma, HIV; antiretroviral therapy; prognosis; etiopathogenesis
Online: 2 June 2021 (11:53:29 CEST)
Despite widespread use of combined antiretroviral therapy (ART) and increased life expectancy in people living with HIV (PLWH), HIV-related lymphomas (HRL) remain a leading cause of cancer morbidity and mortality for PLWH, even in patients optimally treated with ART. While incidence of aggressive forms of non-Hodgkin lymphoma decreased after ART advent, incidence of Hodgkin lymphoma (HL) has increased among PLWH in recent decades. The coinfection of Epstein Barr virus plays a crucial role in the pathogenesis of HL in the HIV setting. Currently, PLWH with HRL, including HL, are treated similarly to HIV-negative patients and, importantly, the prognosis of HL in PLWH is approaching to that of the general population. In this regard, effective chemotherapy is strongly recommended since it has been shown to improve survival rates in all lymphoma subtypes, including HL. As a consequence, interdisciplinary collaboration between HIV specialists and hemato-oncologists for the management of potential drug-drug interactions and overlapping toxicities between antiretroviral and antineoplastic drugs is crucial for the optimal treatment of PLWH with HL. In this article the authors review and update the epidemiological, clinical and biological aspects of HL presenting in PLWH with special emphasis in the improvement on prognosis and the factors that have contributed to it.
REVIEW | doi:10.20944/preprints202005.0314.v1
Subject: Medicine & Pharmacology, Other Keywords: antiretroviral therapy; differentiated service delivery; retention; suppression; Africa; systematic review
Online: 19 May 2020 (09:53:46 CEST)
Introduction: Differentiated service delivery (DSD) models for antiretroviral treatment (ART) for HIV are being scaled up in the expectation that they will improve the quality and efficiency of treatment delivery and reduce costs while maintaining at least equivalent clinical outcomes. Even this minimum requirement of equivalent clinical outcomes is poorly documented for most models and settings, however. We reviewed the recent literature on DSD models to describe what is known about clinical outcomes. Methods: We conducted a rapid systematic review of peer-reviewed publications in PubMed, Embase, and the Web of Science and major international conference abstracts that reported outcomes of DSD models for the provision of ART in sub-Saharan Africa from January 1, 2016 to September 12, 2019. Sources reporting standard clinical HIV treatment metrics, primarily retention in care and viral load suppression, were reviewed and categorized by DSD model and source quality assessed. Results and Discussion: Twenty-nine papers and abstracts describing 37 DSD models and reporting 52 discrete outcomes met search inclusion criteria. Of the 37 models, 7 (19%) were facility-based individual models, 12 (32%) out-of-facility based individual models, 5 (14%) client-led groups, and 13 (35%) healthcare worker-led groups. Retention was reported for 73% of the models and viral suppression for 57%. Where a comparison with conventional care was provided, retention in most DSD models was within 5% of that for conventional care; where no comparison was provided, retention generally exceeded 80%. For viral suppression, all those with a comparison to conventional care reported a small increase in suppression in the DSD model; reported suppression exceeded 90% in 11/21 models. Analysis was limited by the extensive heterogeneity of study designs, outcomes, models, and populations. Most sources did not provide comparisons with conventional care, and metrics for assessing outcomes varied widely and were in many cases poorly defined. Conclusion: Existing evidence on the clinical outcomes of DSD models for HIV treatment in sub-Saharan Africa is limited in both quantity and quality but suggests that retention in care and viral suppression are roughly equivalent to those in conventional models of care.
ARTICLE | doi:10.20944/preprints202104.0292.v1
Subject: Mathematics & Computer Science, Algebra & Number Theory Keywords: Multi-scale model; system of differential equations; HIV propagation; complex network; basic reproduction number; antiretroviral therapy; prevalence.
Online: 12 April 2021 (12:35:52 CEST)
A multiscale mathematical model is proposed seeking to study the propagation dynamics of the Human Immunodeficiency Virus (HIV) in a group of young people between 15 and 24 years of age, through sexual contact without protection, considering the use of antiretroviral therapy (ART) and therapeutic failure. The model consists in a scale-free complex network that follows a power law, coupled with the immunological dynamics of each individual, that is, it considers the infection by the virus in the immune system of each HIV carrier, through a system of non-linear differential equations that govern the infection’s behavior in the immune system. Propagation of the virus in the network is modelled by taking into account information from the immunological status of each person. The study found that for a population to have high HIV prevalence, it is not necessary at the beginning of the simulation time for the virus to propagate rapidly. In addition, the study proves that with a higher number of sexual partners, there will be greater prevalence of HIV in the population and that the use of ART helps to control the propagation of the infection in the population. As an interesting result, it was also found that there is a higher number of HIV carriers who abandon ART than those who have access to it.
REVIEW | doi:10.20944/preprints202012.0536.v1
Subject: Life Sciences, Biochemistry Keywords: immune reconstitution inflammatory syndrome (IRIS); AIDS/HIV; antiretroviral therapy (ART); cryptococcal meningitis (CM); blood biomarkers; cerebrospinal fluid biomarkers.
Online: 21 December 2020 (15:51:21 CET)
Immune reconstitution inflammatory syndrome (IRIS) presents as an exaggerated immune reaction that occurs during dysregulated immune restoration in immunocompromised patients in late-stage HIV infection who commenced antiretroviral treatments. Virtually, any opportunistic pathogen can provoke this type of immune restoration disorders. In this review, we focus on recent development in the identification of risk factors for Cryptococcal IRIS and on advancements in our understanding of C-IRIS immunopathogenesis. We overview new findings in blood and cerebrospinal fluid which can potentially be useful in the diagnosis of cryptococcal meningitis IRIS. We assess the utility of these biomarkers to identify putative host-based targets, which may justify a clinical need for improvement in monitoring a patient’s laboratory results and adjusting treatment modalities in AIDS patients co-infected with Cryptococcus.