Factors affecting viral suppression or rebound in people living with HIV and receiving antiretroviral therapy in Ghana

IntroductionRegular viral load (VL) testing for people living with HIV (PLWH) is key to attaining the Joint United Nations Program on HIV/AIDS (UNAIDS) Fast-Track 95–95-95 target to end the HIV epidemic by 2030. However, VL testing remains sporadic in routine HIV care in the majority of resource-limited settings, including Ghana, except when provided through research initiatives. In this study, we measured VL among PLWH in Ghana at regular intervals and investigated factors affecting viral suppression (VS) and rebound.MethodsWe analyzed data from a hospital-based cohort enrolled in our HIV cure research. Participants were recruited from three hospitals in the Greater Accra region of Ghana. Demographic characteristics were obtained from participants’ folders, while CD4+ T cell counts and VLs were measured from blood samples collected at baseline, 6 months, and 18 months.ResultsThe study participants were predominantly women (68%) with a median age of 45 years (IQR: 21–76 years). A total of 52% of participants had been on antiretroviral therapy (ART) for more than 6 years, and 74% were following dolutegravir-based regimens. At baseline, 74% of participants had a VL of <50 copies/mL, which increased to 88% at 18 months, with 80% having a CD4+ T cell count of >350 cells/μl. Age group [<40 vs. > 40 years] (OR 2.35, 95% CI; 1.21–4.58, p = 0.012), CD4+ T cell count [>350 vs. < 350 cells/μl] (OR 4.35, 95% CI; 2.32–8.18, p < 0.001), and ART regimen [NVP based vs. DTG based] (OR 7.00, 95% CI; 1.15–42.57, p = 0.034) were associated with VS of <50 copies/mL. The overall viral rebound rate was estimated at 13.61 per 1,000 person-months (95% CI 10.52–17.74), with decreasing rates over time. Lower educational levels (up to Junior High School) were significantly associated with viral rebound (p = 0.011).ConclusionA key feature of our study was measuring VL at three time points over 2 years, which may explain the high VS levels observed. Viral rebound was linked to low education levels, highlighting the need for targeted education for PLWH with junior high school (JHS) education or less. Regular VL monitoring and the implementation of measures to prevent viral rebound, particularly among PLWH with lower education levels, will help Ghana move closer to attaining the third “95” of the UNAIDS 95–95-95 target by 2030

The Role of HIF-1 Alpha in Immune Regulation During Atopic Dermatitis

Atopic dermatitis (AD), commonly known as eczema, affects roughly 20% of the global population and 10% of Americans, most of them children. Characterized by chronic itching, inflammation, and skin irritation, AD causes emotional distress, social challenges, and sleep deprivation. Current treatments—such as corticosteroids, antihistamines, and costly biologics—only manage symptoms without addressing the root cause. Araba Abaidoo-Myles’s research investigates the immune mechanisms underlying AD, focusing on the role of a key regulatory protein, HIF-1α (hypoxia-inducible factor 1-alpha). This protein acts as a molecular switch that influences immune cell behavior and inflammation. Using mouse models, her team found that activating HIF-1α through topical treatment with the drug roxadustat significantly reduced AD severity. These findings suggest that targeting HIF-1α could offer a promising path toward curative therapies, moving beyond symptom relief to address the underlying immune dysregulation driving atopic dermatitis

The impact of COVID-19 on HIV care: a comprehensive analysis of patient and healthcare providers experiences at the largest HIV treatment center in Ghana

Abstract Background We sought to determine how the COVID-19 pandemic affected care delivery for HIV patients in Ghana. Methods Guided by the Consolidated Framework for Implementation Research (CFIR), we performed a cross-sectional study between May and July 2021 among 40 people living with HIV and 19 healthcare providers caring for HIV patients. In-depth interviews and focus group discussions were done with HIV patients, doctors, nurses, pharmacists, laboratory scientists, data scientists, administrators, and counselors to ascertain barriers and facilitators to HIV care during the pandemic. We asked for their input on removing barriers to care during this and future pandemics. Data was analyzed thematically with the help of the qualitative software MAXQDA. Results Pre-pandemic practices, such as using cards for appointments and making phone calls to patients, and intra-pandemic measures, such as re-arranging the clinic setup for patient safety, contributed to clinic attendance. However, the fear of infection, transportation costs, and fear of stigma impeded clinic attendance. Patients spent less time in the clinic because stable patients received medication refills without seeing the doctor. This meant many patients with chronic diseases like hypertension, diabetes, and hyperlipidemia did not get the necessary physician review during the pandemic's peak. Due to pervasive stigma, patients were cautious about home delivery of medications and telemedicine solutions. Conclusion While solutions like telemedicine and home visits may work for primary care or other chronic conditions during pandemics, stigma makes these interventions unattractive options for many HIV patients

High prevalence of co-infections with latent tuberculosis, syphilis and hepatitis B and C among people with HIV in Ghana: a call for integrating screening into routine care

Abstract Background People with HIV (PWH) are at risk of co-infections, such as latent tuberculosis (LTBI), hepatitis B (HBV), hepatitis C (HCV), and syphilis; hence, routine screening is critical. However, evaluation of routine screening is not being fully implemented in Ghana. This study assessed the prevalence of these co-infections among PWH in Accra, Ghana. Methods The HIV Cure Research Infrastructure Study (H-CRIS) followed 390 PWH from three HIV treatment centres in Accra. A cross-sectional study was conducted within this cohort, and participants were screened for LTBI, hepatitis B, hepatitis C, and syphilis using standardized assays. LTBI was detected using the QuantiFERON-TB Gold Plus assay. Syphilis testing included treponemal and non-treponemal assays. HBV and HCV were tested using rapid test kits. Data was collected on demographics, viral load, CD4 count, ART regimen, and therapy duration. Descriptive statistics used frequency and proportion, while inferential analysis employed chi-square tests, t-tests, and odds ratios (OR) to assess associations. Results Among 390 participants, median age: 45 years (IQR: 39–52 years), 69% (269/390) were virologically suppressed, and 80% (312/390) had CD4 counts above 350 cells/µL. The prevalence of co-infections was 12% (48/390) for HBV, 10.8% (42/390) for LTBI, 12.5% (40/320) for syphilis, and 1% (4/390) for HCV, with 2% (8/390) having more than two co-infections. LTBI was associated with age (> 60 years; OR = 3.5) and years of HIV diagnosis (> 10 years; OR = 2.2). Conclusion The significant burden of co-infections among PWH in Ghana highlights the urgent need to integrate routine screening into HIV care