Mental health and implications for antiretroviral adherence in a multiethnic Asian cohort

ObjectivesResearch suggests a high prevalence of depression and anxiety in people living with HIV, resulting in negative health outcomes and poorer help-seeking behaviours when undetected. Subsequent disease progression and non-adherence to treatment constitute a significant barrier to HIV treatment. This paper aims to identify the risk factors for the development of psychological distress and non-adherence to antiretroviral medication in people living with HIV.MethodsAn HIV outpatient clinical service screened for anxiety and depressive symptoms. As part of a retrospective analysis of the cohort, independent sample t-test and χ2 test were conducted to examine differences between symptomatic and asymptomatic patients in demographic variables such as mode of transmission and disclosure to family; clinical indicators such as psychiatric history and history of alcohol and substance use; and outcome variables such as current psychological distress and non-adherence. Binary logistic regression was conducted to determine predictors of psychological distress and non-adherence.ResultsAfter adjusting for age, no history of alcohol use and psychiatric history were found to be significant risk factors for psychological distress during the programme. Older patients were less likely to be symptomatic during the programme. After adjusting for age, having received intervention and psychiatric history, significant risk factors for non-adherence to antiretroviral medication were mode of transmission, history of smoking and being symptomatic during the programme.ConclusionSignificant psychological distress occurring early in HIV care predicts future non-adherence to antiretroviral treatment, highlighting the importance of early detection and intervention for psychological distress in people living with HIV. Mental health interventions should be intercalated with treatment adherence interventions to improve HIV treatment outcomes.

HIV Pre-Exposure Prophylaxis (PrEP) purchase patterns and STI occurrence among Israeli men: A cohort analysis

Background HIV Pre-exposure prophylaxis (PrEP) is the regular use of antiretroviral medication by people who are not infected with HIV to prevent seroconversion. Israel approved PrEP for continuous use in 2017, and Israeli Health Maintenance Organizations (HMO) offered PrEP with a copayment to eligible members. Methodology This retrospective cohort study included all people who were dispensed PrEP between September 2017 to June 2019 in the second largest HMO in Israel. Statistical analysis, including Kaplan Meier, was conducted to evaluate user PrEP purchase, adherence to medical follow-up, and clinical outcomes. Results In total, a cohort of 757 PrEP users were followed for 657.8 person-years. All but one user were male; median age was 35 years. At baseline, 0.8% had gonorrhea and 1.5% had chlamydia infections and 4.4% had recent syphilis infection. Continuous use of PrEP (without interruption/discontinuation) was observed in 29.9%, while 39.9% interrupted and 30.3% discontinued use. Median time to first interruption/discontinuation was 4.0 months. At 6–12 months after initiation, 79.8% of users had a documented HIV test, 77.3% a Chlamydia-Gonorrhea panel, and 78.9% a creatinine test. There was one new case of HIV among the cohort, five months after PrEP discontinuation. Estimated first-year infection rates were 5.0%, 8.6% and 6.8% for gonorrhea, chlamydia and first-time syphilis, respectively. Conclusions This study shows heterogeneous PrEP purchase patterns and required medical follow-up, and an increase in STIs among consistent PrEP users. Improving adherence to recommended medical follow-up during PrEP use is essential in PrEP’s integration into Israel’s national HIV prevention strategy.

Assessment of Biomarkers in Patients Co-Infected with HIV/HBV Attending the Antiretroviral Clinic in a Tertiary Institution

Aim: The level of some biomarkers such as the Lipid profiles and some liver enzymes were checked for in patients who were found to be co infected with HIV/HBV Study Design: The study was conducted among patients infected with the Human Immunodeficiency Virus attending the antiretroviral clinic at the Braith Waite memorial hospital, Port Harcourt, Rivers State. The samples and relevant data were gotten between the months of January and March 2019, using a structured questionnaire Methodology: The Samples were collected from patients infected with HIV attending the Braith Waite memorial hospital on antiretroviral medication. A total number of 98 samples were collected and analyzed for the presence of HBV IgM core antibody using the ELISA method. The statistical analysis was done using a Stata version 16 and the student T-test was used to determine the P value. A total of 98 samples were collected, 66(67.3%) were females and 32(32.6%) of them were males. Of the 98 samples, 5 (5.1%) of them were positive to HIV/HBV co infection of which 3(3.1%) were females and 2(2%) were males. The age range for those co infected was between 29 – 34 years old. The lipid profile and liver enzymes for the positive samples were analyzed. The result showed an increase in the level of LDL, HDL and triglyceride. The analysis for the liver enzymes showed an increase in the level of AST and ALP while the ALT and GGT remained within the healthy range. The increase in the level of most of the biomarkers, showed that the patients co infected with HIV/HBV were at risk of heart and kidney diseases since they are already immunocompromised. From this result, it shows that patients who are HIV positive should undergo HBV test regularly. Those who are positive should have their biomarkers monitored and put under medication early.

The Association Between Mental Health of HIV Patients and Antiretroviral Medication Adherence

Background: Various factors, like mental disorders, may affect the desire for medication and adherence in HIV/AIDS patients. Objectives: The present study aimed to determine levels of neurotic disorders and associations of disorders level and HAART medication adherence in HIV/AIDS patients. Patients and Methods: Finally, 150 patients of Behavioral Disease Counseling Center of Shiraz were selected by a convenience method and were evaluated by Symptom Checklist-25 (SCL-25) and Medication Adherence Questionnaire (MAQ). Results: Seventy-eight percent of patients had normal mental health status. Also, 83% had very good medication adherence. Female gender, single or divorced, and working in temporary and low-income jobs were associated with decreased mental health status. Higher age and education were associated with increased adherence. Anxiety was the most common and effective disorder. Decreased mental health' status was shown to reduce drug adherence. Conclusions: Treatment of mental disorders, particularly anxiety, can be one of the most effective ways to increase drug compliance in HIV/AIDS patients.

Development of reverse phase high-performance liquid chromatographic method for the estimation of HIV non-nucleoside reverse transcriptase inhibitor drug efavirenz in the rat brain

Background The brain is the potential viral reservoir, and estimating the antiviral drug concentration in the brain is a hurdle to the researchers as very few animal models are available for this study. The objective of the study was to develop and validate the RP-HPLC method for the estimation of antiviral drug efavirenz (EFV) in the brain of healthy Wistar rats. EFV was the first-line antiretroviral medication. The optimized HPLC condition used for the analysis had the mobile phase methanol to water (9:1) ratio. The flow rate was set at 0.8 mL/min, while the detection wavelength was 248 nm. Results The retention time was found to be 5.7 min, and the % RSD was found within the limit. Recovery was found to be nearly 78%. The validation results were found to be within the limit range; hence, the obtained method was accurate, specific, rapid, and repeatable for estimation of EFV in the brain. Conclusion This method for estimation of EFV in the rat brain can be applicable for pharmacokinetic and toxicology study of EFV in the brain after administration of EFV to rats. Graphical abstract .

Attendance of psychosocial teen clubs and self-reported antiretroviral medication adherence: a cross section study of adolescents with perinatal HIV in the Kingdom of Lesotho

<abstract><sec> <title>Background</title> <p>To address the problem of poor adherence among adolescents with perinatal HIV (PHIV), all clinics in Lesotho offer adolescent-friendly services and psychosocial support to improve their overall health outcomes and adherence. As a result, most adolescents with PHIV attend Teen Clubs as part of the package of youth-friendly HIV services. This study set out to determine whether attending Teen Clubs facilitates treatment adherence among adolescents with PHIV.</p> </sec><sec> <title>Methods</title> <p>In this cross-sectional study, data were collected from 130 adolescents aged 10–19 years who were aware of their HIV status and had attended three or more Teen Club sessions in selected clinics in rural district in Lesotho. Adherence was measured through self-report of last pills missed, based on the 7-days recall of pills taken. Descriptive statistics were used to analyse the data.</p> </sec><sec> <title>Results</title> <p>The median age of adolescents was 15 years, 56% were female, 37.7% were orphans, 41% were being cared for by their grandparents, 6.9% were living with siblings with no adult figure, and two were living on their own. The majority (93%) reported optimal adherence, 92% had not missed a clinic appointment in the past 30 days, and 74.4% knew that if they skipped doses, the viral load would increase and they would get sick. Over half (56%) had been reminded by their caregivers to take their medication and 96% talked to their caregivers regularly about their medication.</p> </sec><sec> <title>Conclusion</title> <p>A supportive environment provided through the Teen Clubs and in the home were the main facilitators for adherence. Strategies to improve adherence among adolescents should consider the importance of the involvement of caregivers in the adolescents' visits to their clinic.</p> </sec></abstract>