Antiretroviral therapy improves neurocognitive impairment in people living with HIV? A meta-analysis

Objectives:Although effective antiretroviral therapy(ART)has been used for more than two decades,HIV-associated neurocognitive disorder remains prevalent.Thus,whether ART can improve neurocognitive impairment is controversial.This review aims to explore the effects of ART on cognitive impairment in people living with HIV(PLWH).Methods:A systematic literature search was conducted in eight databases(PubMed,Embase,Web of Science,Cochrane Library,CNKI,VIP,China Biology Medicine disc,and WanFang)to identify studies that compare cognitive function between study groups who are administered and not administered ART.We searched for articles published up to April 2019.Article evaluation and data extraction were independently conducted by two reviewers.Results:Sixteen articles(6,694 participants)-14 cross-sectional studies and 2 cohort studies—were included in this meta-analysis.The cross-sectional studies demonstrated that ART group did not perform better than the non-ART group(OR=1.16;95%CI,1.03-1.30).However,the cohort studies reported a significant improvement in cognitive function at three months(OR=4.01;95%CI,2.35-6.85)and six months(OR=9.24;95%CI,1.71-49.96)after ART initiation compared with the baseline data.No significant cognitive improvement was found in participants younger than 55 years old,but the two crosssectional studies showed that ART may improve cognitive function in PLWH under 65 years old with poor physical condition and immune status.Conclusions:ART could improve cognitive function in PLWH with poor physical condition and immune status,but it does not considerably improve cognition in the entire PLWH population.

The relationship between acceptance of illness and quality of life among men who have sex with men living with human immunodeficiency virus:A cross-sectional study

Objectives To explore the relationship between acceptance of illness and quality of life(QOL),and factors associated with acceptance of illness among men who have sex with men(MSM)living with human immunodeficiency virus(HIV).Methods Three hundred and one MSM were recruited from an HIV clinic between August and December 2018.The battery of measurements consisted of the Acceptance of Illness Scale,World Health Organization Quality of Life Questionnaire for HIV brief version,HIV Cognitive Appraisal Scale and a self-designed questionnaire used to collect general information.Pearson correlation test was used to examine the relationship between acceptance of illness and QOL.Univariate and multivariate ordinal logistic regression analyses were used to examine whether the general data(demographic and HIV-related clinical data)and HIV cognitive appraisal were associated with acceptance of illness levels.Results Descriptive analysis showed the acceptance level among MSM living with HIV was moderate(Mean=26.29,SD=5.28).Those with a better acceptance of illness had a better QOL(r=0.69,P<0.01).In the multivariate ordinal logistic regression model,education level,threat appraisals(OR:1.09;95%CI[1.06–1.13]),and controllability appraisals(OR:0.82;95%CI[0.71–0.94])were significantly associated with acceptance of illness.Conclusions Results showed acceptance level was moderate and had a positive correlation with QOL.High level of education,low threat appraisals and high controllability appraisals were related to high illness acceptance.This finding highlights the importance of focusing on HIV-infected MSM with low education and on their perceptions of threat and controllability about HIV-related issues when designing interventions to promote illness acceptance in this vulnerable population.

Efficacy and Safety of Tenofovir and Lamivudine in Combination with Efavirenz in Patients Co-infected with Human Immunodeficiency Virus and Hepatitis B Virus in China

Background： The prevalence of hepatitis B virus （HBV） infection is high among individuals infected with human immunodeficiency virus （HIV） in China.Both HIV and HBV can be treated with tenofovir disoproxil fumarate （TDF） and lamivudine （3TC）, so we evaluated the safety and efficacy of combination antiretroviral therapy （ART） that included TDF, 3TC, and efavirenz （EFV） among ART-naive individuals who were co-infected with HIV and HBV.Methods： One hundred HIV/HBV co-infected ARV-naive individuals were started on the regimen ofTDF, 3TC, and EFV, and the levels of plasma HBV DNA, HIV RNA, and biochemical evaluation related to the function of liver and kidney were analyzed.Results： Concerning efficacy, this study found that by week 48, the vast majority co-infected participants receiving this ART regimen had undetectable HBV DNA levels （71%） and/or HIV RNA levels （90%）.Concerning safety, this study found that the median estimated glomerular filtration rate of participants decreased from baseline （109 ml＆#183;min-1＆#183; 1.73 m-2） to week 12 （104 ml＆#183;min-1＆#183; 1.73 m-2） but was almost back to baseline at week 48 （1 1 1 ml＆#183;min-1＆#183; 1.73 m-2）.Conclusion： This combination ART regimen is safe and effective for patients with HIV/HBV co-infection.Trial Registration： ClinicalTrials.gov, NCT01751555;https：//clinicaltrials.gov/ct2/show/NCT01751555.