Special Issue:
Challenges and Opportunities in HIV
Abstract
Background: Peer navigation is an evidence-based model for engaging and retaining women living with HIV in medical care. Participants of an adapted Lotus peer navigation group intervention were hypothesized to have more self-perceived HIV self-care and advocacy behaviors following their participation than non-Lotus participants at an agency serving cisgender women and their families affected by HIV in San Diego, California.
Methods: The peer navigation intervention, Lotus, was adapted to include new modules on substance use, human trafficking, and intimate partner violence and piloted to compare its overall effects with a comparison group (2018-2019). Ninety-five cisgender women living with HIV (WLWH) completed posttest surveys measuring their perceived changes in peer advocacy and self-advocacy following their participation in a pilot of an adapted Lotus. Participants of the four-session Lotus group intervention (n=34) were compared to non-Lotus participants who engaged in other types of group activities at the agency (n=61). The Lotus group participants included a cohort of cisgender women > 50 years old, English and Spanish speaking women, and a mixed age and race/ethnicity group. All clients of Christie’s Place, an organization for women living with HIV in San Diego, were eligible if they were not actively using illicit substances substances in the past year. Cross-sectional bivariate analyses were run to determine differences between intervention and comparison groups. The groups were not randomized.
Results: Among 95 participants, 17% were White, 14% Black/African American, 44% Hispanic/Latino, and 25% Other/Mixed race/ethnicity with median age 51 years (IQR: 45-60). Eleven Latina, 9 White, 6 Black/African American, and 8 Other/Mixed individuals participated in Lotus. In bivariate analyses, Lotus WLWH living with HIV at posttest took their HIV medications correctly (p=0.040) and attended their healthcare/other service appointments as advised/scheduled 3 times more often than non-Lotus WLWH (p=0.014). They advocated for themselves within medical and social service settings 6 times more often (p<0.001) and talked openly with their doctor 4 times more often (p=0.028). They were also twice as likely to talk more often with their partner about safer sex (p=0.022) and PrEP (p=0.037) and a peer about safer sex (p=0.001). They were 3 times more likely to help a peer understand how HIV medications can improve their health (p=0.001). Medical records showed all Lotus intervention participants as virally suppressed one year after their participation.
Conclusions: Participants of an HIV peer navigation intervention experienced significant changes in self-reported self-advocacy outcomes. Peer navigation training interventions remain critical for medication adherence and self-advocacy among cisgender WLWH.
Moses Katbi
Office of HIV/AIDS & TB, United States Agency for International Development, Nigeria
Tyra Fom
Institutional Capacity Strengthening (ICS) programme, Tony Blair Institute for Global Change, West Africa
Adefisayo Adedoyin
USAID MELSA project, Social Impact, Nigeria
Kent Klindera
United States Agency for International Development, Washington, USA
Olugbenga Stephen Asaolu
Office of HIV/AIDS & TB, United States Agency for International Development, Nigeria
Doreen Magaji
Office of HIV/AIDS & TB, United States Agency for International Development, Nigeria
Angela Agweye
Office of HIV/AIDS & TB, United States Agency for International Development, Nigeria
Iyiola Faturiyele
United States Agency for International Development, Washington DC, USA
Abstract
Background: Pre-exposure prophylaxis (PrEP) is recommended for people at substantial risk of acquiring HIV to prevent new infections. The Nigeria PEPFAR program through USAID funded the implementation of PrEP for Key Population (KP) groups including Men Who Have Sex with Men (MSM), People who inject drugs (PWIDS), and Female sex Workers (FSW) in July 2020. We assessed the number of new infections averted and the financial resources saved because of this intervention.
Methodology: HIV-negative clients from the key population community in North- East Nigeria eligible for PrEP were enrolled over a 7-month period (July 2020 – February 2021). Eligibility criteria used include being at substantial risk for HIV infection based on a screening test administered. The person-month was calculated by using the duration the participants were retained on PrEP. The incidence 15.4/100 person-years of HIV among MSM at high risk of HIV infection in the TRUST study conducted in Nigeria was used to calculate the expected positive cases if PrEP was not provided for those enrolled using the formula (15.4/100 * X) where X is number of person-years. We compared the expected positive to the actual positive seen among KPs while on PrEP within the study period. The cost-effectiveness of being on PrEP was calculated by multiplying the standard cost per HIV infection averted ($13, 267 per HIV infection averted) by the No of HIV averted.
Results: We enrolled a total of 1,197 eligible HIV-negative KPs within the study period (189 were retained for seven months, 407 for four months, 585 for 3 months, and 18 for 1 month). A total of 4722 person-months (394 person-years) were accumulated over the period of the study. Using the incidence of 15.4/100 person-years, the expected positive cases if PrEP was not provided was 61 (15.4/100 *394). With the use PrEP, no client seroconverted to be HIV positive. This means that within the 7-month period, 61 HIV infections were averted. At the cost of $13,267 per HIV infection averted for PrEP, the project saved $809,287 for averting 61 HIV infections in seven months of using PrEP among HIV-negative KPs involved in high-risk behaviors.
Conclusion: This study shows that PrEP is effective in averting new infections among key population groups. Placing high-risk groups such as KPs on PrEP is cost-effective due to the money saved from new infections averted. Increased funding for proven and innovative strategies on PrEP enrolment, retention, and adherence of eligible clients should be expanded for KPs.
Ali Zare Dehnavi
Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine and Science, Rochester, USA; Research Center for Antibiotic Stewardship and Antimicrobial Resistance, Infectious diseases department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
Seyed Ali Dehghan Manshadi
Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
Seyed Ahmad Seyed Alinaghi
Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
Behnam Amini
Research Center for Antibiotic Stewardship and Antimicrobial Resistance, Infectious diseases department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
Fatemeh Rashidi
Research Center for Antibiotic Stewardship and Antimicrobial Resistance, Infectious diseases department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
Masoumeh Farrokh Ashtiani
Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
Hoda khoshnevis
Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
Adel Tabrizi Tochaee
Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
Mohammadreza Salehi
Research Center for Antibiotic Stewardship and Antimicrobial Resistance, Infectious diseases department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
Cristina Mussini
University of Modena and Reggio Emilia, Modena, Italy
Abstract
There is limited information about COVID-19 vaccines in people living with HIV (PLWH). We aimed to compare the immunogenicity and effectiveness of the Sinopharm BIBP COVID-19 inactivated vaccine between PLWH and non-HIV individuals in the Omicron era. We evaluated the production of receptor-binding domain (RBD), spike, SARS-CoV-2 IgG, and neutralizing antibodies in both PLWH (case) and individuals without HIV (control) groups three months after they received the second dose of the vaccine. All participants were also followed during three months after the second dose for the COVID-19 infection and its outcomes (hospital admission, need to intensive care unit, and mortality). A total of 250 individuals comprising 150 PLWH and 100 people without HIV were recruited. The mean age was 42.2 years. The infection rate was significantly higher in non-HIV individuals than in PLWH (63% vs. 21.3%, p < 0.001). The hospitalization rate in the PLWH group was significantly hig1her than that in the non-HIV group (5.3% vs. 1%, p = 0.009). There were no significant differences in the mean levels of Spike antibody (84.4 ± 34.4 vs. 95 ± 109.5 RU/mL), RBD antibody (65.6 ± 42 vs. 69 ± 42.3 RU/mL), and SARS-CoV-2 IgG (2.9 ± 2.5 vs. 3 ± 2.3 Index) between the groups. The mean value of neutralizing antibodies was significantly higher in non-HIV individuals (34 ± 23.3 vs. 26.2 ± 20 µg/mL, p = 0.005). The Sinopharm BIBP COVID-19 inactivated vaccine can be as immunogenic in PLWH as in non-HIV individuals. This vaccine is likely more effective in preventing Omicron-associated hospitalization in non-HIV individuals.
Okoro Olihe N, PhD, MPH
University of Minnesota, College of Pharmacy, Duluth 1110 Kirby Drive | Duluth MN 55812
Shanasha Whitson O, MA, MBA, LSW
Executive Director/CEO, Community Partnership Collaborative 2.0
Nambangi Melissa N, MA
Executive Director/CEO, Minnesota African Women’s Association
Ballay-Swaray Vivian K, PsyD, LP
CEO/Psychologist/Consultant, VEEMAH Integrated Wellness & Consulting Services, LLC
Rotich Veronica C, BA
Executive Director/CEO, African Women & Youth Resource Center
Boumi Ama E, MSc
Executive Director/CEO, Empowerment Consulting Services
Gobina Elizabeth N
Volunteer, Minnesota African Women’s Association
Abstract
Background: Incidence rates of HIV are higher among African-born immigrants than in the general US population. In Minnesota, African-born immigrant women accounted for 40% of all adult females (as assigned by birth) living with HIV and 39% of new diagnosis in 2021, while constituting only 2% of the female population. Findings from a preliminary study point to gender-specific, sociocultural factors as drivers of HIV in this population. Key among these is the lack of sexual and reproductive health knowledge, consequent to cultural norms that regard sex-related discussions as taboo, making African women particularly vulnerable to HIV infection. Conventional HIV prevention programming has not been effective as these approaches lack cultural congruence. In the absence of culturally responsive strategies, AB women are likely to remain at significant risk of HIV.
Program Description: This report is a description of the process and key elements employed in developing a curriculum for culturally-responsive, community-based sexual and reproductive health education for HIV prevention among African-born women. The Curriculum Design Team (CDT) of five (5) AB immigrant women adapted and augmented the Becoming A Responsible Teenager (BART) curriculum and developed a culturally congruent theoretical framework to guide programming. Feedback on the curriculum and programming was sought from community members through focus groups with African-born men and women, respectively.
Recommendations: Feedback from community-engaged efforts included alignment with cultural norms and values regarding the roles and influence of women; ensuring cultural appropriateness of content and delivery; racial-concordance of facilitators and participants; and use of informal social group setting as critical elements to facilitate engagement of African-born women in the proposed approach to HIV prevention in this population.
Amos Milanzi
University of Zimbabwe
Naomi Netsayi Wekwete
University of Zimbabwe
Abstract
Objective: The objective of the study was to investigate the Sexual and Reproductive Health (SRH) issues among Adolescents Living with HIV (ALHIV) in Gweru rural district in Zimbabwe.
Design: A cross sectional mixed method research design was used with qualitative and quantitative methods.
Setting: The study was conducted in Gweru rural district community.
Subjects: A total of 112 questionnaires were administered to ALHIV, four focus group discussions (FGDs) were conducted with ALHIV in Gweru rural district, and six key informant interviews with key informants were held at district and national levels.
Results: All respondents were not in relationships, while 94 percent lacked general understanding of relationships. All respondents reported that they were not sexually active, although 62 percent intend to have sex in future. Seventy-eight percent lacked comprehensive knowledge of HIV transmission. Respondents were aware of few modern contraception methods namely female condoms (39 percent), male condoms (37 percent) and the pill (25 percent). Adolescents Living with HIV (ALHIV) mainly access HIV related services in Gweru rural district. There is limited access to SRH services besides HIV treatment as 41 percent of ALHIV reported talking to a health service provider about SRH issues such as sexuality, family planning, condoms, sexually transmitted infections, pregnancy and childbearing.
Conclusion: The key SRH issues facing ALHIV include lack of comprehensive knowledge on SRH issues, such as sexuality, relationships, prevention of HIV re-infection, pregnancy and childbearing and family planning. There is also limited access to SRH services. Adolescents living with HIV in Gweru rural district face barriers to accessing SRH services at policy, programmatic, community, family and individual levels.
Carl GA Jacob, PhD, Auxiliary Professor
School of Nursing, Nursing History Research Unit, Faculty of Health Sciences, University of Ottawa, 200 Lees Avenue, Room 313, Ottawa, Ontario, Canada K1N 6N5
Daniel Lagacé-Roy, PhD, Full Professor
Department of Military Leadership and Psychology, Royal Military College of Canada, PO Box 17000, Station Forces, Kingston, Ontario, Canada K7K 7B4
Abstract
The HIV/AIDS pandemic was a major crisis at the end of the 20th century. A defining moment in the history of health-related infections. It led to the transformation of its proponents, as well as their medical practice. This paper is an addendum to a research paper previously published in SAGE Open in 2019. The previously published paper used data from a study conducted by Jacob, in 2012. The data was gathered using semi-structured interviews with six Canadian gay physicians from different Canadian HIV/AIDS treatment centres. The study aimed to answer the following research question: What are the lived journeys of gay physicians while attempting to treat, care for, and cure/heal their HIV/AIDS patients during the pandemic, from 1981 to 2009? The results deduced from a qualitative and interpretive data analysis, as well as a literature review for the published research paper, suggest that through reflection on their experiences during the HIV/AIDS pandemic, they transformed their personal and professional identities, and rethought their relationship with their patients, as well as their professional, pharmaceutical, and community networks. The addendum, using unpublished information from the study and additional information from a literature review of material published by other proponents after the publication of the paper, aims to substantiate the testimonies of six Canadian gay physicians who fought against the HIV/AIDS pandemic and who advocated for their HIV/AIDS patients. In fact, these results are evidence of an untold and valuable period in medical history. For some, it will serve as a reminder. For others, it will be novel and even foreign. It was a time marked by a major crisis that mobilized gay physicians who were personally and professionally affected by their HIV/AIDS patients, and who were forever transformed by their response to the pandemic.
Nishan Gantayat Alok Gangaramany
Final Mile Consulting – New York, NY 10007
Ram Prasad
Final Mile Consulting – New York, NY 10007
Rosemary Pierce-Messick
Final Mile Consulting – New York, NY 10007
Rujuta Kumbhojkar
Final Mile Consulting – New York, NY 10007
Abstract
Background: Despite a declining trend in Human immunodeficiency virus (HIV) prevalence across sub-Saharan Africa, specific vulnerable groups continue to be disproportionately impacted (29.9% for sex workers, 12.9% for gay men having sex with men (MSM) vs 5.9% for adults). In the face of this challenge, it is critical to tailor demand creation for prevention, in particular self-care, for maximum impact and cost-efficiency. This study seeks to provide a behavioral understanding towards HIV prevention that shape the efficacy of prevention strategies among priority populations (female sex workers, MSM and adolescent girls and young women) in southern and eastern Africa.
Methods: This study involved a literature review of 110 articles, focusing on HIV prevention in priority populations, behavioral interventions, and policy priorities from governments and funders. Additionally, insights were gained from 11 in-depth interviews and a workshop with 10 experts at the AIDS Impact 2023 conference. Participants included behavioral researchers and program leaders from Global Fund, United States Agency for International Development (USAID), U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), Bill and Melinda Gates Foundation, FHI360, Population Services International and Genesis Analytics. A user-centric behavioral framework was devised to identify actionable drivers and barriers in HIV prevention during the consultation exercise.
Results: The study highlights the importance of shared and effective self-care in enhancing HIV prevention, particularly in vulnerable groups. The behavioral framework integrates the decision-making contexts and the health ecosystem layers to inform research and demand strategy. Key findings include: (1) effective self-care is not the same as continuous use of Pre-exposure prophylaxis and therefore, programs and policies need to measure them differently; (2) users exercise choice through a combination of prevention products and focus on a few may be sub-optimal, and (3) perceived risk is transient and hence risk-based messaging lacks sustained relevance.
Conclusion: Effective self-care strategies extend beyond overcoming access and availability issues. Examining the underlying factors causing the barriers is essential. The behavioral framework presented here suggests that: (a) Self-care is a shared responsibility between the user and healthcare system and (b) demand creation should be de-medicalised, away from products and towards meeting the needs and preferences of users.
Deborah Konopnicki, MD, PhD
Infectious Diseases Department, Centre Hospitalier Universitaire (CHU) Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
Victoria De Wit, MD
Infectious Diseases Department, Centre Hospitalier Universitaire (CHU) Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
Marc Delforge
Infectious Diseases Department, Centre Hospitalier Universitaire (CHU) Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
Guy-Bernard Cadière, MD, PhD
Department of Gastrointestinal Surgery, Centre Hospitalier Universitaire (CHU) Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
Stephane De Wit, MD, PhD
Infectious Diseases Department, Centre Hospitalier Universitaire (CHU) Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
Abstract
Objectives: Obesity and related comorbidities are increasing among people living with HIV (PLWH). This study compared the evolution of severe obesity and related comorbidities in PLWH with (cases) or without (controls) bariatric surgery (BS).
Methods: Monocentric retrospective comparison of PLWH with severe obesity (body mass index (BMI) ≥40 kg/m2 or BMI ≥ 35 together with ≥ 1 comorbidity (diabetes, dyslipidemia, arterial hypertension, sleep apnea, cardiovascular events)) between cases at baseline, 1, 2, 5 and 10 years after BS or as controls matched (1:3) on age, gender, ethnicity and severe obesity criteria.
Results: Between 2006 and 2019, we included 27 cases and 73 controls: 84% female, median age 43 years, 78% originated from sub-Saharan Africa; median time with HIVRNA <50 cp/ml 6 years in both groups. BMI decreased from 41 (baseline) to 29 kg/m2 at 2 years after BS (p=0.002) while controls remained at 37 kg/m2 both at baseline and 2 years. At 5 and 10 years, BMI was ≤31 in cases while controls remained ≥ 35 kg/m2. Comorbidities favorable evolution at 2 years occurred in 50% of cases versus 12.5% in controls for diabetes, 44% versus 0 (p=0.006) for hypertension and 90% versus 0 (p<0.0001) for sleep apnea. Post-operative complications rate was 11% and HIV infection remained under control after BS.
Conclusion: Bariatric surgery is a safe and efficient treatment of severe obesity and its related comorbidities among patients with well-controlled HIV at short, middle and long terms with no impact on control of HIV disease.
Stephen A. Klotz
University of Arizona College of Medicine, Department of Medicine, Division of Infectious Diseases, Tucson, AZ, USA.
Nafees Ahmad
University of Arizona College of Medicine, Department of Immunobiology, Tucson, AZ, USA.
Abstract
The world is now well into the third decade of use of effective anti-retroviral therapy (ART) that provides sustained control of HIV-1 viremia (viral loads <200 copies of HIV RNA/microliter). With few exceptions, control of HIV in individual patients is predictable and long lasting. Only a short time ago, the prevailing opinion was that HIV infection ‘physiologically aged’ an individual by ten years or more compared to uninfected subjects and could lead to premature frailty.1-4 Whereas these findings may have accurately characterized the untreated HIV-infected individual, they do not apply to those on ART. We discuss these concepts and show why they have not held up to scrutiny since clinical and cellular evidence contradict these statements. Theories about aging in HIV-positive patients arose in the early 2000’s5 about the time we began to study the course of HIV infection in our clinics, measuring frailty as well as obtaining and preserving blood samples from HIV- and healthy, age-matched control patients that allowed us to study cellular aging and immunity as well as the molecular features of HIV genes in viral quasispecies suppressed by ART.
Shirley Lecher
International Laboratory Branch, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
David Bressler
International Laboratory Branch, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
Monte Martin
International Laboratory Branch, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
Abstract
Introduction: Waste generated from HIV viral load testing and SARS CoV-2 for diagnosis of COVID-19 contains potentially hazardous guanidinium thiocyanate. Guanidinium thiocyanate may be toxic to humans and if not properly disposed of can pollute waters and harm aquatic life. Sub-Saharan African countries are particularly challenged by limited resources to suitably manage waste generated at health care facilities and laboratories. There is a need to identify waste management challenges and develop strategies to mitigate this type of laboratory testing waste in resource limited countries.
Methods: HIV viral load data used for this analysis were standardized monitoring evaluation and reporting Presidents Emergency Plan for AIDS Relief datasets for Malawi, Mozambique, South Africa, and Zimbabwe. COVID-19 data was obtained from the Johns Hopkins Coronavirus Resource Center.
Discussion: Inadequate management of HIV viral load and COVID-19 guanidinium thiocyanate waste due to lack of policy, guidelines and appropriate procedures for containment, poses a significant public health threat to the environment. Recognizing this gap, the United States Centers for Disease Control and Prevention has decided to provide technical expertise, raise awareness, and work with other international partners to disseminate knowledge and find solutions for the Presidents Emergency Plan for AIDS Relief supported countries in sub-Saharan Africa. The World Health Organization guidelines on safe management of waste from healthcare activities were proposed as a starting point to develop country specific guidelines.
Conclusions: The United States Centers for Disease Control and Prevention, in collaboration with other international partners, is diligently working to provide technical assistance to countries for training and development of mitigation strategies to appropriately manage guanidinium thiocyanate containing waste. Waste management is a growing problem as molecular testing for HIV, COVID-19, and other emerging diseases increase.
Inês Rego de Figueiredo
Unidade de Transplantes, Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central
Miguel Martins
Serviço de Medicina 2.3, Hospital Santo António dos Capuchos, Centro Hospitalar Universitário Lisboa Central
Carolina Midões
Serviço de Medicina 1.4, Hospital de São José, Centro Hospitalar Universitário Lisboa Central
Joana Branco Ferrão
Serviço de Medicina Intensiva, Hospital Professor Doutor Fernando da Fonseca
Abstract
Opportunistic infections affect patients with immunocompromised status and are caused by common microorganisms with more severe presentations, or atypical organisms that do not cause disease in the immunocompetent. The type of infection varies with the type of immune dysfunction.
Patients with cell-mediated immune dysfunction tend to be infected with a range of viral infections, intracellular bacteria, and fungi. This contrasts to patients with defects in humoral immunity, where infections with encapsulated bacteria, and enteric organisms such Giardia lamblia and enteroviruses predominate. Patients with phagocytic defects are especially prone to infections with Gram-negative bacteria and fungi, whilst those with complement disorders are prone to recurrent infections with encapsulated bacteria. In contrast to patients with primary immunodeficiencies, which usually present with only one defect of the above, acquired immunodeficiencies present with a variety of those, and clinical presentations are diversified.
The epidemic of HIV and AIDS shed some light into infections that were before extremely rare, by making them frequent, but with the advent of anti-retroviral therapy their clinical presentation has shifted. Also, the emergence of novel immunotherapies for cancer and autoimmune diseases, allied with an increase in organ transplant has increased the pool of immunosuppressed patients without HIV, which present differently regarding opportunist infections.
Rapid and specific microbiologic diagnosis is essential. Newer microbiologic assays have improved the diagnosis and management of opportunistic infections.
Our aim was to revise and summarize the most frequent opportunist infections, and how their presentation and course compares in different immunosuppressed diseases (HIV and non-HIV).
Olugbenga Asaolu, PhD
Babcock University, Ilishan Remo, Ogun State, Nigeria
Gbadegesin O Alawode, MPH
Association for Reproductive and Family Health, Lagos, Nigeria.
Saratu Ajike, PhD
Babcock University, Ilishan Remo, Ogun State, Nigeria
Ololade O Ogunsanmi, PhD
Babcock University, Ilishan Remo, Ogun State, Nigeria
Mustapha S Bello, MD, MPH
Formerly of University of Leeds, Leeds, UK.
John O Ibitoye, PhD
Catholic Relief Services, Abuja, Nigeria
Adebusola Oyeyemi, PhD
Babcock University, Ilishan Remo, Ogun State, Nigeria
Adeniyi Adeniran, MD, PhD
Babcock University, Ilishan Remo, Ogun State, Nigeria
Chisom L Emeka, PhD
Babcock University, Ilishan Remo, Ogun State, Nigeria
Oluwagbemiga Obembe, MPH
Texila American University, Georgetown, Guyana
Olubunmi Ojelade, PhD
Babcock University, Ilishan Remo, Ogun State, Nigeria
Olutayo Asaolu, MBA
Babcock University, Ilishan Remo, Ogun State, Nigeria
Adaeze Ugwu, MD, MPH
Liverpool John Moores University, Liverpool, UK
Christopher Obanubi, MD, MHE, MDS, MPPA
Bayero University Kano, Kano State, Nigeria
Abdulmalik Abubakar, MPH
Liverpool John Moores University, Liverpool, UK
Adekemi Asaolu, MBA
University of Ibadan School of Business, University of Ibadan, Oyo State, Nigeria
Olubayode Asaolu, MSc
University of Ilorin, Kwara State, Nigeria
Nannim Nalda, MPH
Staffordshire University, Stoke-on-Trent, UK
Adebayo O. Amao, MPH
Lagos State, University College of Medicine, Lagos State, Nigeria
Oladimeji Folorunso-Ako, PhD
Babcock University, Ilishan Remo, Ogun State, Nigeria
Ishaq K. Salako, MD, MPH
Babcock University, Ilishan-Remo, Ogun State, Nigeria
Catherine Agbede, PhD
Babcock University, Ilishan-Remo, Ogun State, Nigeria
Catherine Agbede, PhD
Babcock University, Ilishan Remo, Ogun State, Nigeria
Abstract
Medication adherence and antiretroviral therapy retention are required for successful durable, virologic suppression and treatment outcomes among youths. The use of peer-led health education in increasing medication adherence and antiretroviral therapy retention has been advocated. Therefore, this study investigated the effect of peer education on medication adherence and antiretroviral-therapy retention practices among Youth Living with HIV in Niger state, Nigeria. The study was a quasi-experimental design in two selected hospitals. One hospital was assigned to a one-hour peer-led health education session for six weeks, and the 2nd served as the control group. Data were collected at baseline, immediate post-intervention, and at the sixth-week follow-up. Data were analyzed using descriptive and inferential statistics at a 0.05 level of significance.
Majority of respondents practice Islam and are within the ages of 20-24 years (control: 100%, 89%; intervention: 83%, 73%), from the Hausa Ethnic group (control: 62%; intervention: 56%). Majority of respondents in the control group have Islamic education (50%) and Secondary education (50%), while the majority of those in the intervention group have primary education (35%), secondary (29%), tertiary (19%) and Islamic (17%) respectively. Medication adherence and ART retention was higher in the intervention group (27%, 16%) compared with the control (17%, 9%). A significant association between knowledge and perception due to peer education on medication adherence was found (24%, 80%) in the intervention group and (11%, 36%) in the control group. Subsequently, the 6th week follow-up sustained findings from the intervention period on medication adherence and ART retention (27%, 16%) in the intervention group compared with control group (17%, 9%). Similarly, knowledge and perception follow-up post intervention was sustained (24%, 80%) in the intervention group and (11%, 36%) in the control group.
Interventions leveraging peer-led health education enhanced HIV medication adherence and antiretroviral therapy retention practices among youths. Thus, we recommend scale-up of the structured peer-led curriculum and integration into the health systems to improve health outcomes among HIV positive youths, achieve epidemic control and accelerate progress for the UNAIDS 95:95:95 goals.
Ajitava Dutta
Department of Neuromedicine, Bangur Institute of Neurosciences, Institute of Post Graduate Medical Education and Research & SSKM Hospital, Kolkata, West Bengal, India
Ritwik Ghosh
Department of General Medicine, Burdwan Medical College and Hospital, Burdwan, West Bengal, India
Alak Pandit
Department of Neuromedicine, Bangur Institute of Neurosciences, Institute of Post Graduate Medical Education and Research & SSKM Hospital, Kolkata, West Bengal, India
Adrija Ray
Department of General Medicine, RG Kar Medical College, and Hospital, Kolkata, West Bengal, India
Dwaipayan Bhattacharya
Department of Neuromedicine, Bangur Institute of Neurosciences, Institute of Post Graduate Medical Education and Research & SSKM Hospital, Kolkata, West Bengal, India
Arkaprava Chakraborty
Department of Neuromedicine, Bangur Institute of Neurosciences, Institute of Post Graduate Medical Education and Research & SSKM Hospital, Kolkata, West Bengal, India
Uddalok Chakraborty
Department of Neuromedicine, Bangur Institute of Neurosciences, Institute of Post Graduate Medical Education and Research & SSKM Hospital, Kolkata, West Bengal, India
Souvik Dubey
Department of Neuromedicine, Bangur Institute of Neurosciences, Institute of Post Graduate Medical Education and Research & SSKM Hospital, Kolkata, West Bengal, India
Julián Benito-León
Department of Neurology, University Hospital “12 de Octubre”, Madrid, Spain; Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain; Department of Medicine, Complutense University, Madrid, Spain
Abstract
Background: Cerebral venous thrombosis (CVT) following either human immunodeficiency virus (HIV) infection or hepatitis B virus (HBV) infection is a very rare condition. Moreover, it has never been reported as the presenting manifestation of HIV and HBV co-infection, even more so when the patient had a normal CD4 count and no demonstrable opportunistic infections. We aimed to report the first case of an adult Indian male, an intravenous drug abuser who developed CVT as the presenting manifestation of HIV-HBV co-infection.
Methods: Patient data were obtained from medical records from the Bangur Institute of Neurosciences, Institute of Post Graduate Medical Education and Research & SSKM Hospital, Kolkata, West Bengal, India.
Results: A 25-year-old male with a history of intravenous drug abuse and a normal CD4 count developed CVT as the presenting manifestation of HIV-HBV co-infection. His CD4 count was normal, and he had no demonstrable opportunistic infections. He had an uneventful recovery of the condition (CVT) following the institution of conventional anticoagulation therapy alongside anti-retroviral therapy.
Conclusion: Whether illicit drug abuse or HIV/HBV infection itself or all in combination led to this thrombotic event cannot be precisely established. Notwithstanding, we recommend serologic testing for HIV and HBV in patients suffering from CVT with high-risk behavior.
Hellen Pollyanna Mantelo Cecilio
Universidade Federal de Mato Grosso do Sul. Três Lagoas, Mato Grosso do Sul, Brasil
Themis Apostolidis
Aix-Marseille Université. Marselha, França
Tadeu Lessa da Costa
Universidade Federal do Rio de Janeiro. Macaé, Rio de Janeiro, Brasil
Rodrigo Leite Hipólito
Universidade Federal Fluminense. Niterói, Rio de Janeiro, Brasil
Daniela Sousa Oliveira
Universidade do Estado da Bahia. Guanambi, Bahia, Brasil
Juliana Pereira Domingues
Universidade do Estado do Rio de Janeiro. Rio de Janeiro, Rio de Janeiro, Brasil
Renata Lacerda Marques Stefaisk
Universidade do Estado do Rio de Janeiro. Rio de Janeiro, Rio de Janeiro, Brasil
Yndira Ita Machado
Universidade do Estado do Rio de Janeiro. Rio de Janeiro, Rio de Janeiro, Brasil
Antonio Marcos Tosoli Gomes
Sergio Correa Marques
Universidade do Estado do Rio de Janeiro. Rio de Janeiro, Rio de Janeiro, Brasil
Abstract
Background: Time perspective can be an important variable for the understanding the quality of life of people living with HIV/AIDS.
Aims: The objective was to examine the relation between quality of life and time perspective among persons living with HIV receiving care from public health services in Brazil.
Methods: Data were collected at four public health services in Brazil. Hierarchical regression analyses were then performed for each of six quality of life domains.
Results: The subscales associated with high quality of life in physical and level of independence domains were low past-negative and high future orientation; psychological and environmental domains were low past-negative, high past-positive and high future orientations; social relations domain were high past-positive and high future orientations; and spirituality, religion and personal beliefs domain was low past-negative orientation.
Conclusion: The hypothesis that time constructs have implications for the experience of the disease and for evaluation of quality of life was proven determined by positive orientations like future and past-positive and past-negative orientation.
Abstract
Asian American Pacific Islanders (AAPI) are the fastest growing ethnic group in the United States. Despite such growth, AAPI face considerable challenges to HIV prevention, treatment, testing and care. The development of multilevel and multi-strategy approaches to education, prevention, and treatment requires an understanding of personal and cultural barriers, as well as implementation of culturally sensitive and specific measures. The purpose of this article is to highlight barriers to HIV-related prevention, treatment, and care for AAPI and provide practical, application-based suggestions which may facilitate greater inclusion of AAPI in the continuum of HIV care.
HLA-genotype-based Predictive Diagnosis of T-cell Responses to SARS-CoV-2 Infection Powered by Machine Learning
Robert G. Lisziewicz
VERDI Solutions; Vienna, Austria
Felipe Oviedo
Microsoft AI for Good Research Laboratory; Redmond, USA
Andras G. Szasz
VERDI Solutions; Vienna, Austria
Juan L. Ferres
Microsoft AI for Good Research Laboratory; Redmond, USA
Franco Lori
VERDI Solutions; Vienna, Austria/ Research Institute for Genetic and Human Therapy; Milano, Italy
Julianna Lisziewicz
VERDI Solutions, GMBH
Abstract
Background: The COVID-19 pandemic has necessitated the development of efficient diagnostic tools to predict T-cell responses, which are crucial for viral clearance and protection against reinfection. Current diagnostic tests lack the ability to predict the epitope repertoire of an individual that induces T-cell responses.
Methods: We developed VERDI, a new machine learning-based diagnostic tool that leverages the sequence data of all the six HLA class I alleles of an individual to rank all putative epitopes based on their potential to induce T-cell responses. VERDI was trained on a comprehensive clinical dataset of 920 SARS-CoV-2 epitopes and validated using an independent dataset collected for the FDA-approved T-detect COVID test. We compared VERDI’s performance with existing HLA-allele-based models through statistical analyses.
Results: Our findings reveal that VERDI’s top-ranked epitopes accurately represent the individual’s epitope repertoire that participates in T-cell responses. VERDI outperformed current models, improving T-cell response prediction recall by threefold and precision by eightfold. It exhibited exceptional diagnostic accuracy, precision, and recall in predicting the potency of the top 20 epitopes. Despite experimental limitations that allow testing of only 1% of putative epitopes, VERDI accurately predicted 30% of these, implying a potentially higher accuracy if broader testing were feasible. Notably, the mean potency of the top-ranked epitopes predicted by VERDI, which reflects the strength of an individual’s SARS-CoV-2-specific T-cell responses, exhibited a Gaussian distribution.
Conclusions: VERDI is the first diagnostic tool that uses the complete HLA genotype data to predict the breadth and strength of an individual’s T-cell responses to SARS-CoV-2 infection. Its ability to accurately identify the potency of epitopes involved in individual T-cell responses and its superior performance compared to the state-of-the-art make it a new resource for personalized vaccine design and disease management.
Amanda M. Healan
Division of Infectious Diseases and HIV Medicine, Case Western Reserve University, Cleveland, OH, USA
John Mcleod Griffiss
ClinicalRM, Hinckley, OH, and Dept. of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA
Mary Ann O’Riordan
Department of Pediatrics, Case Western Reserve University, Cleveland, OH, USA
Wesley A. Gray
Department of Pediatrics, University of Toledo College of Medicine, Toledo, OH, USA
Robert A. Salata
Division of Infectious Diseases and HIV Medicine, Case Western Reserve University, Cleveland, OH, USA
Jeffrey L. Blumerd
Deceased
Abstract
Bedaquiline (BDQ), a diarylquinoline mycobacterial ATP synthase inhibitor approved in the United States for drug-resistant tuberculosis, is metabolized by CYP3A4, an hepatic enzyme strongly induced by rifampin (RIF), an essential part of drug-sensitive tuberculosis treatment. BDQ is used more broadly in some other countries and has been evaluated for treatment of non-tuberculosis mycobacterial infections, often in combination with rifabutin (RBT). We examined the pharmacokinetic interactions of BDQ plus either RIF or RBT in 33 healthy volunteers. Subjects were randomly assigned to receive two single 400 mg doses of BDQ, given 29 days apart, and either RBT 300 mg or RIF 600 mg, given daily from day 20 to 41 after the first dose of BDQ. Blood samples were collected prior to dosing and at multiple subsequent time points to measure plasma drug concentrations, including those of the rifamycin primary metabolites. BDQ treatment had little effect on the disposition of RIF but resulted in a dramatic shortening of the half-life of RBT and decreased exposure to it. When the drugs were administered together (Day 29) the peak rifamycin concentrations and peak rifamycin metabolite concentrations were reduced significantly (p <0.001). This appeared to result from reduced absorption and raises a concern that doses of BDQ and the rifamycins, particularly RBT should be staggered when the two drugs are given on the same day. The optimum time between dosing should be determined.
Kiran Kumar Kompella, Dr
MD MED, FNB INFECTIOUS DISEASES
Someshwar Gaikwad, Dr
MD MED
Anuj Singhal, Prof
MD , FRCP
Vishal Mangal, Dr
MD MED
Arun Kumar Yadav, Dr
MD in Community Medicine
Saurav Kumar Chauhan, Dr
MBBS graduate
Abstract
Background: Tuberculosis (TB) still remains an important public health problem in India. After completion of treatment, we hardly know that what happened to these cases once they are declared as cured and released in community. Hence the study was conducted to find out the outcomes and factors associated with them.
Material and methods: It was a longitudinal observational study. Patients were followed up for up to one year after completion of the treatment for weight gain, and adverse side effects.
Results: In our study 91 % of the cases were cured, 1.7 % were treatment failure and 2.18 % died. All the cases of recurrent TB were cured. HIV and TB co-infection was found in 15.7 % cases. 85% of patients tolerated the anti-tubercular therapy (ATT) well. The incidence of extra pulmonary TB was 19.2 %. Out of 229 cases 16 failed to gain weight at the end of therapy. The gain in weight was statistically significant (p value <0.001). The adverse outcome was seen in 20 cases.
Conclusion: In our study, 91 % of the cases including 100% of recurrent Tb cases were cured because of newer RNTCP program. The incidence of extra pulmonary TB was higher than the national average. The majority (85%) of patients tolerated the anti-tubercular therapy (ATT) well. Out of 229 cases, only 16 patients failed to gain weight at the end of therapy. The gain in weight was significant predictor of good outcome in treating tuberculosis. The factors like weight gain, age, sex, place of stay or comorbidities were not associated as predictors of poor outcome. However, presence of co-morbidity like HIV and Diabetes may be associated with poor outcome but a higher sample size may be required to confirm it.
Abstract
Preexposure prophylaxis is a powerful biomedical intervention for prevention of human immunodeficiency virus. However, its implementation has been slow and uneven in the United States. Research into innovative agents, formulations and implementation, for preexposure prophylaxis, is ongoing, and a number of new and improved methods of delivery have been developed. However, the delivery of preexposure prophylaxis primarily by nurses, has not received much attention. We overview the global evidence and programs for nurse-led preexposure prophylaxis, and propose this as a feasible and promising implementation strategy for the United States.
Ilham Zaidi
Advisor, International Society for Chronic Illnesses/ MPH Scholar, The Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
Jagadeeswari Vardha
MSC student, University of Glasgow, Scotland, United Kingdom
Abdul khayum
Medical Officer, Dept of Respiratory medicine, JSSMC, Mysuru, India
Sahifa Anjum
MPH Scholar, The Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
Shikhar Chaudhary
MPH Scholar, The Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
Aditi Bakshi
WHO- TDR scholar, IIHMR University, Jaipur, India
Jasmeen Kaur Gill
MPH Scholar, Indian Institute of Public Health Delhi, India
Jaiprakash Gurav
Advisor, International Society for Chronic Illnesses/ Scholar, Department of Medicine Armed Forces Medical College, Pune
Abstract
Tuberculosis (TB) along with pulmonary co-infections in patients became a grave concern to public health complicating the disease diagnosis, treatment, and prognosis. It became a challenge to healthcare professionals urging to develop new diagnostic tools and treatment regimens. This paper reviews the complex interplay and management strategies for Tuberculosis patients with co-infections. It encompasses antimicrobial therapy tailored to particular pathogens, including their susceptibility profiles to antibiotics, and understanding the potential implications of drug interactions with anti- Tuberculosis medications. In cases of co-infection between Tuberculosis and Human Immuno-Deficiency Virus (HIV), a particular focus is placed on the significance of synergistic methods and treatment duration.
Moreover, immunomodulatory drugs, immunotherapies, cellular treatments, adjunct therapies, and immunomodulatory agents that are customised to the patient’s immunological status and co-infecting pathogens emerge as a crucial component. Mitigating the transmission of pulmonary co-infections requires the implementation of infection control measures in both healthcare settings and communities. A strong barrier against the spread of tuberculosis and related illnesses is formed by administrative, engineering, and personal protective measures combined with screening, education, isolation, and contact tracking.
Prospective approaches underscore the necessity for enhanced diagnostic instruments, promoting cutting-edge technologies including molecular diagnostics, immunological tests, radiological imaging, biosensors, and point-of-care diagnostics. Comprehensive management is emphasised through multidisciplinary care comprising pulmonologists, infectious disease experts, microbiologists, and immunologists. Priorities for research include combination medications, new therapeutic approaches, personalised medicine, and developing diagnostic techniques to improve knowledge of and treatments for pulmonary co-infections.
Phillip Huang Chen
Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
Steven-Huy Han
Pfleger Liver Institute, UCLA Medical Center, Los Angeles, CA; Greater Los Angeles VA Healthcare System, Los Angeles, CA
Abstract
Hepatitis B (HBV) in special populations within this article is considered as acute on chronic liver failure due to HBV, coinfection with Hepatitis C (HCV), Hepatitis D (HDV), or Human Immunodeficiency Virus (HIV), and HBV infection in patients who are in immunosuppressive states due to specific therapies and liver transplant recipients. Patients within these special populations are at higher risk of liver-related complications such as fibrosis, accelerated cirrhosis, acute on chronic liver failure, and/or development of hepatocellular carcinoma (HCC). Given their respective complex pathophysiology, specific treatment approaches are required for each population. With the introduction of effective antiviral HBV therapies over the past decade and the respective treatment options for the special population diseases, patient outcomes have seen improvement. With the advent of HCV direct antivirals, treatment of HBV-HCV coinfection has been more successful and consistently shown high rates of sustained virologic response. Treatment of HBV-HDV coinfection remains primarily as interferon-based, though new promising therapies have shown greater improvement in viral suppression. HBV-HIV coinfection has also shown promising results given overlapping mechanisms for treatment and specific regimens should be chosen to decrease risk of resistance. HBV reactivation in patients undergoing immunosuppressive therapies have been reported and guidelines recommend close monitoring and in certain cases, HBV antiviral therapy prophylaxis. With the effective HBV therapies, the perception of HBV as a contraindication for liver transplant has been diminishing and prolonged graft survival with effective antiviral therapies have shown promising outcomes.
Jesús Sánchez
Department of Sociobehavioral and Administrative Pharmacy, College of Pharmacy, Nova Southeastern University
Jodi-Ann Hibbert
Department of Sociobehavioral and Administrative Pharmacy, College of Pharmacy, Nova Southeastern University
Abstract
Background: Latino and Latina migrant workers constitute a vast amount of the agricultural workforce within the United States. A few studies indicate that a significant segment of the Latino migrant worker population in the United States is at high risk for alcohol abuse and related high-risk behaviors. Information about the prevalence of alcohol use and abuse and its association with high-risk sexual behaviors is needed to design effective prevention strategies in this underserved population.
Aims: To assess the association between alcohol use and high-risk sexual behaviors in this population.
Methods: Cross-sectional data was obtained from March 2018 through December 2019 as part of a study entitled “Project Salud: HIV Prevention among Latino Migrant Workers in Florida.” Study participants were recruited from neighborhoods and migrant camps in the Immokalee area in Central Florida by means of a stratified network-based (snowball) sampling design. Of the 782 screened participants, 671 (86%) met eligibility criteria and consented to participate in the study. Participants were grouped based on ‘‘no alcohol use” “alcohol use” and ‘‘binge drinking.”
Results: More than one-third (36.2%) of the sample reported no alcohol use during the last 30 days prior to the interview. The rest of study participants reported alcohol use (28.5%) and binge drinking (35.3%). Binge drinking was more common among male participants compared to their female counterparts (41.6% vs 29.6%). Among Latino migrant workers, rates of high-risk sexual behaviors in the last 30 days were generally high and did not vary as a function of alcohol use. Among Latina migrant workers, rates of vaginal sex were high for all study participants, but this behavior did not vary as a function of alcohol use. However, binge drinking was found to be significantly associated with increase rates of anal sex and multiple sex partners.
Conclusion: High-risk sexual behaviors are prevalent in the Latino migrant worker community. Among Latina migrant workers, these behaviors significantly increase among those who engage in binge drinking. Further research on the intersection of alcohol use and high-risk behaviors in the Latino migrant worker community, especially among Latina migrant workers, is necessary to develop and implement appropriate interventions.
Katerini Philippou
Department of Nursing, School of Health Sciences, Cyprus University of Technology, 15, Vragadinou Str, 3041 Limassol, Cyprus
Martha Kyriakou
European University Cyprus, Nicosia, Cyprus, 6 Diogenis Str., 2404 Engomi, Nicosia-Cyprus
Nicos Middleton
Department of Nursing, School of Health Sciences, Cyprus University of Technology, 15, Vragadinou Str, 3041 Limassol, Cyprus
Andreas Charalambous
Department of Nursing, School of Health Sciences, Cyprus University of Technology, 15, Vragadinou Str, 3041 Limassol, Cyprus
Vasilios Raftopoulos
Department of HIV & STDs, Hellenic National Public Health Organization, 3-5 Agrafon str Athens, 15123, Greece, Email: Department of Nursing, School of Health Sciences, Cyprus University of Technology, 15, Vragadinou Str, 3041 Limassol, Cyprus
Marianna Constantinou
Department of Nursing, School of Health Sciences, Cyprus University of Technology, 15, Vragadinou Str, 3041 Limassol, Cyprus
Ekaterini Lambrinou
Department of Nursing, School of Health Sciences, Cyprus University of Technology, 15, Vragadinou Str, 3041 Limassol, Cyprus
Abstract
A comorbidity like diabetes mellitus (DM) complicates heart failure (HF) self-care management and adherence to the therapy and results poorer clinical outcomes. This study aims to examine the various factors influencing adherence to the therapy of patients with HF and DM. A systematic literature search was established in the electronic data basis PubMed, Cochrane Library and Cumulative Index to Nursing and Allied Health Literature (CINAHL) using inclusion and exclusion criteria. The search yielded eight articles. The introduction of empowerment models in the management of patients with HF and DM made patients more involved in their self-care management and their self-monitoring behavior and adherence were increased. Patients with HF and DM during their hospitalization, were less likely to receive smoking cessation counseling and blood pressure control and experienced longer length of stay. Patients with HF preserved ejection fraction (HFpEF) and DM were less likely to receive an angiotensin convertive enzyme (ACE) inhibitor or angiotensin receptor or beta-blockers and had worse blood pressure (BP) control compared with patients with reduced ejection fraction (HFrEF) and DM. Effective self-care management of patients with HF and DM seems to depend on the type and the severity of comorbid conditions and the availability of effective therapies. Adequate support to patients with HF and DM from health professionals (HPs) is important, in order to establish self-management and adherence to the therapy.
Laurens Holmes, Jr
Global Epigenomic Research Analytics, Wilmington, DE 19802
Kerti Deepika
Global Epigenomic Research Analytics, Wilmington, DE 19802; 2 Fellow of Translational Health Disparities Science (FTHDS), Wilmington, DE 19803, USA
Janille Williams
Global Epigenomic Research Analytics, Wilmington, DE 19802; Fellow of Translational Health Disparities Science (FTHDS), Wilmington, DE 19803, USA
Benjamin Ogundele
Global Health Services Initiatives Inc, Arlington, TX, 76014; 2 Fellow of Translational Health Disparities Science (FTHDS), Wilmington, DE 19803, USA
Glen Philipcien
Emergency Department, Victoria Hospital, Castries, St. Lucia
Michael Enwere
Global Epigenomic Research Analytics, Wilmington, DE 19802; Fellow of Translational Health Disparities Science (FTHDS), Wilmington, DE 19803, USA; Public Health Department, Walden University, Minneapolis, MN 55401, USA
Shikha Jain
MVJ Medical College, Hoskote, Karnataka, India
Naresh Dasari
Medicine and Long-term Care Associates, Cranston, RI 02920
Ram Sanjiv Alur
Marion Veterans Affairs Medical Center, IL
Ramesh Adhikari
Franciscan Health, Lafayette, IN 47909
Gbadebo Ogungbade
Global Health Services Initiatives Incorporated, Arlington, TX 76014 USA
Abstract
Purpose: Viral infections had been historically observed in chronic disease development and complications including although not limited to hepatitis C, influenza A, cytomegalovirus (CMV), Epstein bar virus (EBV), HIV and herpes simplex. Epidemiologic data had implicated CMV, herpes simplex and hepatitis C in type II diabetes (T2D). With the observed increased incidence T2D in COVID-19 among children and adults, this review aimed to examine scientific literature on immune and endocrine systems dysregulation in T2D and pancreatic neoplasm.
Materials & Method: A qualitative systematic review (QSR) was utilized in assessing the immune system deregulation and endocrine system involvement in chronic disease development such as T2D. The PubMed was the main search engine in studies identification with several search terms such as “SARS-CoV-2 and T2D”, “COVID-19 and T2D”, SARS-CoV-2 and insulin resistant”, etc.
Results: Viral pathogens such as CMV, influenza A, and herpes simplex and hepatitis C infections have been implicated in decreased insulin sensitivity (IS) and increased insulin resistant (IR). Similarly, these pathogenic microbes increased the T2D incidence and complications. SARS-CoV-2 a COVID-19 causative pathogen had been observed in increased risk and incidence of T2D among children and adults. While data are not currently available on the precise mechanistic process, SARS-CoV-2 viral infection in T2D incidence may be explained by excess pro-inflammatory cytokines elaboration (cytokine storm) resulting in increased IR and decreased IS, leading to glucose intolerance and T2D. Further COVID-19 may increase pancreatic neoplasm in populations with increased incidence of COVID-19, due to pancreatic beta cells and insulin receptors dysregulation and cellular dysfunctionality as abnormal cellular proliferation.
Conclusions/Recommendation: SARS-CoV-2 a causative pathogen in COVID-19 morbidity is associated with increased incidence of T2D, which is explained in part by immune and endocrine system integration dysregulation, resulting in cytokine storm, decreased IS and increased IR, implying glucose intolerance and T2D. Additionally this pathogenic microbe may result in increasing incidence of pancreatic neoplasm, a malignant neoplasm with the worst prognosis and excess mortality due to late stage at diagnosis and marginalized biomarkers of susceptibility and morbidity.
