Summary of Guidelines for Managing Histoplasmosis among People Living with HIV

Histoplasmosis is a frequent fungal opportunistic infection in people living with HIV (PLHIV), associated every year to a total of 5% to 15% of AIDS-related deaths among this population. In 2020, the first global guidelines for diagnosing and managing disseminated histoplasmosis among PLHIV was published. This document recommends (1) detection of circulating Histoplasma antigens as the recommended laboratory assay to diagnose histoplasmosis among PLHIV; (2) the use of liposomal amphotericin for induction therapy in severe or moderately severe disease, followed by a maintenance therapy with itraconazole for 12 months; a shorter maintenance therapy could be considered if the patient is clinically stable and if immune status has improved; (3) antiretroviral therapy initiation as soon as possible among patients with histoplasmosis without involvement of central nervous system; and (4) that for the treatment of co-infection with histoplasmosis and tuberculosis (TB), treatment of TB should be initiated according to the World Health Organization treatment guidelines. Appropriate health education of providers, supportive supervision, and policy guidance for the care of PLHIV are required.

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Two diseases, same person: moving toward a combined HIV and tuberculosis continuum of care

International Journal of STD & AIDS ◽

10.1177/0956462418761930 ◽

2018 ◽

Vol 29 (9) ◽

pp. 873-883 ◽

Cited By ~ 1

Author(s):

Reuben Granich ◽

Somya Gupta

Keyword(s):

Public Health ◽

Disease Control ◽

Treatment Success ◽

World Health ◽

People Living With Hiv ◽

Global Public Health ◽

Tb Treatment ◽

Immunodeficiency Virus ◽

Health Organization ◽

Living With Hiv

The human immunodeficiency virus (HIV) and Mycobacterium tuberculosis syndemic remains a global public health threat. Separate HIV and tuberculosis (TB) global targets have been set; however, success will depend on achieving combined disease control objectives and care continua. The objective of this study was to review available policy, budgets, and data to reconceptualize TB and HIV disease control objectives by combining HIV and TB care continua. For 22 World Health Organization (WHO) TB and TB/HIV priority countries, we used 2015 data from the HIV90–90–90watch website, UNAIDS AIDSinfo, and WHO 2016 and 2017 Global TB Reports. Global resources available in TB and HIV/TB activities for 2003–2017 were collected from publicly available sources. In 22 high-burden countries, people living with HIV on antiretroviral therapy ranged from 9 to 70%; viral suppression was 38–63%. TB treatment success ranged from 71 to 94% with 14 (81% HIV/TB burden) countries above 80% TB treatment success. From 2003 to 2017, reported global international and domestic resources for HIV-associated TB and TB averaged $2.85 billion per year; the total for 2003–2017 was 43 billion dollars. Reviewing combined HIV and TB targets demonstrate disease control progress and challenges. Using an integrated HIV and TB continuum supports HIV and TB disease control efforts focused on improving both individual and public health.

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Pulmonary tuberculosis screening in anti-retroviral treated adults living with HIV in Kenya

BMC Infectious Diseases ◽

10.1186/s12879-021-05916-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jill K. Gersh ◽

Ruanne V. Barnabas ◽

Daniel Matemo ◽

John Kinuthia ◽

Zachary Feldman ◽

...

Keyword(s):

Pulmonary Tuberculosis ◽

Preventive Therapy ◽

World Health ◽

People Living With Hiv ◽

Tuberculosis Screening ◽

Hiv Positive Adults ◽

Health Organization ◽

A Prospective Study ◽

Living With Hiv ◽

Tuberculosis Prevalence

Abstract Background People living with HIV (PLHIV) who reside in high tuberculosis burden settings remain at risk for tuberculosis disease despite treatment with anti-retroviral therapy and isoniazid preventive therapy (IPT). The performance of the World Health Organization (WHO) symptom screen for tuberculosis in PLHIV receiving anti-retroviral therapy is sub-optimal and alternative screening strategies are needed. Methods We enrolled HIV-positive adults into a prospective study in western Kenya. Individuals who were IPT-naïve or had completed IPT > 6 months prior to enrollment were eligible. We evaluated tuberculosis prevalence overall and by IPT status. We assessed the accuracy of the WHO symptom screen, GeneXpert MTB/RIF (Xpert), and candidate biomarkers including C-reactive protein (CRP), hemoglobin, erythrocyte sedimentation rate (ESR), and monocyte-to-lymphocyte ratio for identifying pulmonary tuberculosis. Some participants were evaluated at 6 months post-enrollment for tuberculosis. Results The study included 383 PLHIV, of whom > 99% were on antiretrovirals and 88% had received IPT, completed a median of 1.1 years (IQR 0.8–1.55) prior to enrollment. The prevalence of pulmonary tuberculosis at enrollment was 1.3% (n = 5, 95% CI 0.4–3.0%): 4.3% (0.5–14.5%) among IPT-naïve and 0.9% (0.2–2.6%) among IPT-treated participants. The sensitivity of the WHO symptom screen was 0% (0–52%) and specificity 87% (83–90%). Xpert and candidate biomarkers had poor to moderate sensitivity; the most accurate biomarker was CRP ≥ 3.3 mg/L (sensitivity 80% (28–100) and specificity 72% (67–77)). Six months after enrollment, the incidence rate of pulmonary tuberculosis following IPT completion was 0.84 per 100 person-years (95% CI, 0.31–2.23). Conclusions In Kenyan PLHIV treated with IPT, tuberculosis prevalence was low at a median of 1.4 years after IPT completion. WHO symptoms screening, Xpert, and candidate biomarkers were insensitive for identifying pulmonary tuberculosis in antiretroviral-treated PLHIV.

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Tuberculosis: Development of New Drugs and Treatment Regimens

Jurnal Respirasi ◽

10.20473/jr.v7-i.1.2021.36-45 ◽

2021 ◽

Vol 7 (1) ◽

pp. 36

Author(s):

Soedarsono Soedarsono

Keyword(s):

Treatment Guidelines ◽

New Drugs ◽

World Health ◽

Health Crisis ◽

Treatment Regimens ◽

Tb Treatment ◽

Repurposed Drugs ◽

Latent Tb Infection ◽

Health Organization ◽

Who Guideline

Tuberculosis (TB) still becomes a public health crisis. Drug-resistant TB (DR-TB) becomes a concern as the increasing DR-TB cases in countries with high TB burden. The 2017 World Health Organization (WHO) guideline recommended a combination of TB treatment consisting of 2 months of intensive phase with isoniazid (H), rifampisin (R), pyrazinamid (Z), and ethambutol (E), followed by 4 months of continuation phase with HR daily. WHO has updated DR-TB treatment guidelines several times. In 2016, WHO recommended shorter regimen and individual regimen based on certain conditions. The most updated 2020 WHO guideline recommended the short regimen consisting of all oral drugs as well as changes in the grouping of medicines used in DR-TB regimens in longer/individual regimens. Bedaquiline, delamanid, pretomanid, and sutezolid are new drugs which have been studied for their uses as anti-TB drugs (ATD). Bedaquilin and delamanid, which have passed phase 3 trials, have been approved and recommended by WHO for DR-TB treatment. Repurposed drugs have been used for DR-TB treatment during the time of evaluation of drugs list and regimens for DR-TB treatment. Fluoroquinolones, clofazimine, linezolid, carbapenem, amoxicillin/clavulanic acid are repurposed drugs. TB and DR-TB management will be updated at any time, based on the latest findings in studies, to evaluate and improve the effectiveness of current treatments. Prevention of active TB disease by the treatment of latent TB infection (LTBI) is also a critical component of the end TB strategy by WHO. Therefore, the development of new drugs for the LTBI treatment is also needed.

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Repurposing of Chloroquine and Its Derivative, Hydroxychloroquine for COVID-19: Implications for People Living with HIV in Africa

10.20944/preprints202004.0395.v1 ◽

2020 ◽

Author(s):

Chiagoziem Otuechere

Keyword(s):

Immune System ◽

Antiviral Agents ◽

World Health ◽

People Living With Hiv ◽

Short Term ◽

Confounding Variables ◽

Immunodeficiency Virus ◽

Proven Efficacy ◽

Health Organization ◽

Living With Hiv

The coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2, has been declared by the World Health Organization (WHO) as a pandemic. Unfortunately, finding a vaccine or developing drugs from the scratch is a time-consuming luxury given the widespread and high fatality rates of the virus. In the short term, repurposing of drugs already in use seem to be the most rational step to quickly and effectively curb the virus. Several antiviral agents had been proposed as possible remedies, but the 4-aminoquinolines, Chloroquine (CHQ) and hydroxychloroquine (HCHQ) appear to be generating more interest. They are generic, cheaply available and have proven efficacy against malaria parasites in Africa. The human immunodeficiency virus (HIV), on the other hand, targets the immune system thereby reducing the patient’s ability to fight infections. Sadly, 68% of the global HIV burden occur in Africa. It is therefore anticipated that incidence of severe forms of COVID-19 could occur in Africa because of associated endemic conditions that compromise the immune system. With CHQ and HCHQ being considered for clinical use against COVID-19, there is a need to highlight their potential merits and confounding variables in the subgroup of patients with or without HIV.

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Kondisi Psikologi, Sosial, dan Spiritual pada Orang dengan HIV/AIDS Selama Pengobatan Antiretroviral di Komisi Penanggulangan AIDS Kota Bogor Tahun 2019

Jurnal Integrasi Kesehatan & Sains ◽

10.29313/jiks.v2i2.5601 ◽

2020 ◽

Vol 2 (2) ◽

Author(s):

Ervan Meidan Ariatama ◽

Titik Respati ◽

Eka Nurhayati

Keyword(s):

Aids Prevention ◽

World Health ◽

People Living With Hiv ◽

Cross Sectional ◽

World Health Organization Quality ◽

Organization Quality ◽

Health Organization ◽

Living With Hiv ◽

Hiv Aids

Penyakit HIV/AIDS selain mengakibatkan dampak kesehatan dapat juga mengakibatkan dampak negatif terhadap psikologi, sosial, dan spiritual pada kualitas hidup orang dengan HIV/AIDS (ODHA). Antiretroviral (ARV) merupakan obat penghambat proses replikasi HIV yang merupakan solusi untuk meningkatkan kualitas hidup dan harapan hidup penderita. Tujuan penelitian ini adalah menggambarkan kondisi psikologi, sosial, dan spiritual ODHA selama menjalani pengobatan ARV di Komisi Penanggulangan AIDS (KPA) Kota Bogor periode bulan Agustus–September 2019. Penelitian ini dilakukan menggunakan metode observasi analitik dengan pendekatan cross sectional. Data diambil menggunakan kuesioner World Health Organization Quality of Life-HIV Instrument (WHOQOL-HIV Instrument) yang terdiri atas 120 pertanyaan dan terbagi menjadi 6 domain (psikologi, sosial, spiritual, fisik, lingkungan hidup, dan tingkat kebebasan). Pada penelitian ini hanya diambil 3 domain, yaitu psikologi, sosial, dan spiritual dengan jumlah pertanyaan 52 butir yang dibagikan kepada 80 responden dan dilaksanakan selama bulan Agustus sampai bulan September 2019. Teknik pengambilan sampel menggunakan non-probability sampling jenis consecutive sampling berdasar atas rumus besar estimasi proporsi dengan presisi absolut. Hasil menunjukkan mayoritas kondisi psikologi, sosial, dan spiritual ODHA selama pengobatan antiretroviral di KPA Kota Bogor tahun 2019 dalam kondisi baik dengan persentase kondisi psikologi 96%, sosial 99%, dan spiritual 70%. Simpulan penelitian ini adalah kondisi psikologi, sosial, dan spiritual pada ODHA di Komisi Penanggulangan AIDS Kota Bogor tahun 2019 mayoritas dalam kondisi baik, walaupun kondisi spiritual ODHA masih terdapat hasil kurang baik. PSYCHOLOGICAL, SOCIAL, AND SPIRITUAL CONDITIONS IN PEOPLE LIVING WITH HIV/AIDS DURING ANTIRETROVIRAL TREATMENT AT THE AIDS PREVENTION COMMISSION AT BOGOR CITY IN 2019Apart from having an impact on health, HIV/AIDS can also have a negative psychological, social, and spiritual impact on people living with HIV/AIDS (PLWHA). Antiretroviral (ARV) as drugs that inhibits the process of replication of HIV, which is a solution to improve the quality of life and life expectancy of patients. The purpose of this study was to describe the psychological, social, and spiritual conditions of PLWHA during ARV treatment at the AIDS Prevention Commission in Bogor City in August to September 2019. The study was a cross-sectional study. The research material consisted of primary data taken using the World Health Organization-Quality Instrument HIV questionnaire (WHOQOL-HIV Instrument) consisting of 120 questions and divided into six domains (psychological, social, spiritual, physical, environment, degree of freedom). However, in this study, only three domains studied, which are psychological, social, and spiritual, with 52 questions and then distributed to 80 respondents and carried out from August to September. The sampling technique uses non-probability sampling type consecutive sampling based on large formula of proportion estimation with absolute precision. Results showed the psychological, social, and spiritual condition of PLWHA during antiretroviral treatment at the Bogor City AIDS Commission in 2019 shows a good condition. The majority of good psychological, social, and spiritual domain experienced by 96%, 99%, and 70% of respondents, respectively. The conclusion of this research is the psychological, social, and spiritual conditions of PLWHA in the Bogor AIDS prevention commission in 2019 in the good conditions, even though there was a spiritual condition of ODHA that was still not good.

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Self-Reported Disability in Persons With HIV-Related Neuropathy Is Mediated by Pain Interference and Depression

Physical Therapy ◽

10.1093/ptj/pzaa161 ◽

2020 ◽

Vol 100 (12) ◽

pp. 2174-2185

Author(s):

David M Kietrys ◽

James Scott Parrott ◽

Mary Lou Galantino ◽

Tracy Davis ◽

Todd Levin ◽

...

Keyword(s):

Peripheral Neuropathy ◽

Pain Interference ◽

World Health ◽

Depression Symptoms ◽

People Living With Hiv ◽

Disability Assessment ◽

Painful Neuropathy ◽

Health Organization ◽

Living With Hiv ◽

The Relationship

Abstract Objective The purpose of this study was to compare disability in people with HIV and peripheral neuropathy with those without neuropathy and explore how neuropathy and other relevant factors are associated with disability. Methods In this cross-sectional study, participants completed the Brief pain inventory, Beck Depression Inventory II, World Health Organization Disability Assessment Schedule (WHODAS 2.0), and a health and demographic questionnaire. Additional data were extracted from the medical record. A raw score of ≥1 on the Subjective Peripheral Neuropathy Screen questions about lower extremity numbness or paresthesia was used to identify peripheral neuropathy. Predictors of disability (as determined by association with World Health Organization Disability Assessment Schedule 2.0 scores) were evaluated bivariately and in a multivariable model. Path modeling was used to identify a parsimonious model to elucidate the mediated effects of peripheral neuropathy on disability. Results Participants with peripheral neuropathy had more depression symptoms, more pain (severity and interference), and higher disability scores compared with participants without neuropathy. The relationship between neuropathy and disability was mediated by pain interference and depression (standardized root mean residual = .056). Conclusion In this sample of people with HIV, those with lower extremity peripheral neuropathy reported more severe disability, worse pain, and more depression symptoms than those without neuropathy. The relationship between peripheral neuropathy and disability may be mediated though pain interference and depression. Impact Distal sensory polyneuropathy is a common comorbidity experienced by people living with HIV and frequently causes pain. This study can help providers direct care toward lessening disability experienced among people with HIV and peripheral neuropathy by targeting interventions for treatment of pain and depression. Lay Summary People living with HIV may experience disabling painful neuropathy. Treatment for pain and depression may help reduce the disability associated with painful neuropathy.

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Rolling out Xpert MTB/RIF® for tuberculosis detection in HIV-positive populations: An opportunity for systems strengthening

African Journal of Laboratory Medicine ◽

10.4102/ajlm.v6i2.460 ◽

2017 ◽

Vol 6 (2) ◽

Cited By ~ 6

Author(s):

Ishani Pathmanathan ◽

Anand Date ◽

William L. Coggin ◽

John Nkengasong ◽

Amy S. Piatek ◽

...

Keyword(s):

Scale Up ◽

World Health ◽

People Living With Hiv ◽

Successful Implementation ◽

High Expectations ◽

Resource Limited ◽

Health Organization ◽

Living With Hiv ◽

And Control ◽

Monitoring Treatment

Background: To eliminate preventable deaths, disease and suffering due to tuberculosis ,improved diagnostic capacity is critical. The Cepheid Xpert MTB/RIF® assay is recommended by the World Health Organization as the initial diagnostic test for people with suspected HIV associatedtuberculosis. However, despite high expectations, its scale-up in real-world settings has faced challenges, often due to the systems that support it.Opportunities for System Strengthening: In this commentary, we discuss needs and opportunities for systems strengthening to support widespread scale-up of Xpert MTB/RIF as they relate to each step within the tuberculosis diagnostic cascade, from finding presumptive patients, to collecting, transporting and testing sputum specimens, to reporting and receiving results, to initiating and monitoring treatment and, ultimately, to ensuring successful and timely treatment and cure. Investments in evidence-based interventions at each step along the cascade and within the system as a whole will augment not only the utility of Xpert MTB/RIF, but also the successful implementation of future diagnostic tests.Conclusion: Xpert MTB/RIF will only improve patient outcomes if optimally implemented within the context of strong tuberculosis programmes and systems. Roll-out of this technology to people living with HIV and others in resource-limited settings offers the opportunity to leverage current tuberculosis and HIV laboratory, diagnostic and programmatic investments, while also addressing challenges and strengthening coordination between laboratory systems, laboratory-programme interfaces, and tuberculosis-HIV programme interfaces. If successful, the benefits of this tool could extend beyond progress toward global End TB Strategy goals, to improve system-wide capacity for global disease detection and control.

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Internet-based HIV self-testing program to increase HIV testing uptake for men who have sex with men in Brazil (Preprint)

10.2196/preprints.14145 ◽

2019 ◽

Author(s):

Raquel Brandini De Boni ◽

Valdilea Gonçalves Veloso ◽

Nilo M Fernandes ◽

Flavia Lessa ◽

Renato Girade Correa ◽

...

Keyword(s):

Scale Up ◽

Integrated System ◽

World Health ◽

People Living With Hiv ◽

System P ◽

Self Testing ◽

Testing Uptake ◽

Sex With Men ◽

Health Organization ◽

Living With Hiv

BACKGROUND Approximately 30% of people living with HIV worldwide are estimated to be unaware of their infection. HIV self-testing (HIVST) is a strategy recommended by the World Health Organization which increases access to and uptake of testing among key populations who are at high risk for HIV infection. OBJECTIVE To describe the development and feasibility of a free, anonymous, Internet-based HIV self-testing (HIVST) strategy designed for men who have sex with men (MSM) in Curitiba, Brazil (E-testing). METHODS The project was developed under the scope of the “A Hora é Agora” (Time is now) program. Individuals aiming to request an HIVST package (2 tests each) answered an anonymous 5-minute questionnaire regarding inclusion criteria and sexual risk behavior. Eligible individuals could receive one package every 6 months for free. Website analytics, response to online questionnaires, packages distribution, and return of test results were monitored via a platform-integrated system. RESULTS Between February 2015 and January 2016, the website documented 17,786 unique visitors with 3,218 provided complete answers to the online questionnaires. Most individuals self-reported being white (77%), young (median age was 25 years, interquartile range 22-31), educated (87.3% complete secondary education or more), and had previously tested for HIV (62.5%). Overall, 2,526 HIVST packages were delivered; of those, 542 (21.4%) reported a result online or by mail (23 reactive and 11 invalid). During the study period, 37 individuals reporting to have used E-testing visited the pre-specified health facility for confirmatory testing (30 positive; 7 negative). CONCLUSIONS E-testing proved highly feasible and acceptable in this study, thus supporting scale-up to additional MSM population centers in Brazil.

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Factors associated with undernourishment among people 20 years old or over with HIV/AIDS, attending public health services in the São Paulo municipality, Brazil

Cadernos de Saúde Pública ◽

10.1590/0102-311x00174513 ◽

2014 ◽

Vol 30 (12) ◽

pp. 2578-2586 ◽

Cited By ~ 1

Author(s):

Katia Cristina Bassichetto ◽

Denise Pimentel Bergamaschi ◽

Vania Regina Salles Garcia ◽

Maria Amélia de Sousa Mascena Veras

Keyword(s):

Nutritional Status ◽

Health Department ◽

Nutritional Risk ◽

World Health ◽

People Living With Hiv ◽

Public Health Services ◽

Health Organization ◽

Living With Hiv ◽

Municipal Health ◽

Hiv Aids

The study evaluated the nutritional status of 629 people living with HIV/AIDS attended at 12 specialized services of São Paulo's Municipal Health Department, Brazil. Data were obtained from medical records and through interviews during nutritional consultation. We used the classification criteria established by World Health Organization to assess malnourished individuals, a BMI < 18.5kg/m2. The prevalence of malnutrition in people with AIDS is 3.12 times that observed among people with HIV, and among people with co-infection it is 3.41 times that obtained among people without co-infection. This indicates how these conditions can harm the maintenance of the nutritional status, and shows that they demand a comprehensive understanding of the mechanisms involved in this phenomenon, as well as the development of strategies to improve the health care of individuals at nutritional risk.

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Cardiovascular Risk Factors and Cardiovascular Risk in People Living with HIV: Comparison of Four Cardiovascular Risk Prediction Algorithms

Global Journal of Medical Research ◽

10.34257/ljmhrvol20is5pg57 ◽

2020 ◽

pp. 57-71

Author(s):

Abdou Razak Moukaila ◽

Edem Komi Mossi ◽

Nouroudine Amadou ◽

Komi Dzidzonu Nemi ◽

Mouhaman-Inouwa Kpelafia ◽

...

Keyword(s):

Cardiovascular Risk ◽

Pearson Correlation ◽

Cross Sectional Study ◽

University Hospital ◽

World Health ◽

People Living With Hiv ◽

Cross Sectional ◽

Health Organization ◽

Hiv Drugs ◽

Living With Hiv

Introduction: The objective of our study was to evaluate, in a population of Togolese People Living With HIV (PLWHIV), the agreement between three scores derived from the general population namely the Framingham score, the Systematic Coronary Risk Evaluation (SCORE), the evaluation of the cardiovascular risk (CVR) according to the World Health Organization (WHO) and the CVR evaluation equation derived from the Data collection on Adverse effects of anti-HIV Drugs (D.A.D). Methods: We conducted a descriptive and analytical cross-sectional study including 212 HIV-infected patients recruited from the day hospital of the Infectious Diseases Department of the Sylvanus Olympio University Hospital. The level of agreement between the different scores was estimated using the Pearson correlation test and the Cohen Kappa coefficient.

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