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Decentralising and integrating HIV services in community-based health systems: a qualitative study of perceptions at macro, meso and micro levels of the health system 28588995 2018 11 13 2059-7908 2 1 2017 BMJ global health BMJ Glob Health Decentralising and integrating HIV services in community-based health systems: a qualitative study of perceptions at macro, meso and micro levels of the health system. e000107 10.1136/bmjgh-2016-000107 HIV services at the community level in Kenya (...) are currently delivered largely through vertical programmes. The funding for these programmes is declining at the same time as the tasks of delivering HIV services are being shifted to the community. While integrating HIV into existing community health services creates a platform for increasing coverage, normalising HIV and making services more sustainable in high-prevalence settings, little is known about the feasibility of moving to a more integrated approach or about how acceptable such a move would
Latent human cytomegalovirus enhances HIV-1 infection in CD34+ progenitor cells 29296946 2018 11 13 2473-9529 1 5 2017 Jan 24 Blood advances Blood Adv Latent human cytomegalovirus enhances HIV-1 infection in CD34 + progenitor cells. 306-318 10.1182/bloodadvances.2016000638 Individuals who have been preinfected by human cytomegalovirus (HCMV) are more prone to AIDS disease progression after subsequent HIV-1 infection but the underlying mechanism remains elusive. HCMV is a ubiquitous DNA virus (...) that commonly establishes lifelong latent infection in CD34 + progenitor cells, where latency-specific HCMV genes may modulate host restriction to HIV-1 infection. To test this hypothesis, we studied progenitor cells that are known to resist replicative HIV-1 infection because of the intrinsic expression of host restriction factors. Interestingly, in primary CD34 + cells undergoing latent HCMV infection, an enhanced level of HIV-1 proviral DNA and replication was observed as measured by digital polymerase
Breast Cancer and HIV in Sub-Saharan Africa: A Complex Relationship 30241185 2018 12 07 2378-9506 4 2018 Sep Journal of global oncology J Glob Oncol Breast Cancer and HIV in Sub-Saharan Africa: A Complex Relationship. 1-11 10.1200/JGO.2016.006585 The number and lifespan of individuals living with HIV have increased significantly with the scale-up of antiretroviral therapy. Furthermore, the incidence of breast cancer in women with HIV is growing, especially in sub-Saharan Africa (SSA). However (...) , the association between HIV infection and breast cancer is not well understood. A literature search was performed to identify articles published in journals pertaining to breast cancer and HIV, with an emphasis on SSA. Selected US-based studies were also identified for comparison. Among the 56 studies reviewed, the largest study examined 314 patients with breast cancer and HIV in the United States. There is no consensus on whether HIV infection acts as a pro-oncogenic or antioncogenic factor in breast cancer
Vaccination of HIV-infected pregnant women: implications for protection of their young infants 28883971 2018 11 13 2055-0936 3 2017 Tropical diseases, travel medicine and vaccines Trop Dis Travel Med Vaccines Vaccination of HIV-infected pregnant women: implications for protection of their young infants. 1 10.1186/s40794-016-0044-7 The prevention of mother to child transmission of HIV has resulted in reduced burden of pediatric HIV-infection, but the prevalence of maternal HIV infection remains (...) high in sub-Saharan African countries. HIV-exposed-uninfected infants have an increased risk of morbidity and mortality due to infectious diseases than HIV-unexposed infants, particularly during the first six months of life, which in part might be due to lower levels of pathogen-specific protective antibodies acquired transplacentally from their mothers. This could be mitigated by vaccinating pregnant women to boost antibody levels; although vaccine responses among HIV-infected pregnant women might
Hormonal contraceptive eligibility for women at high risk of HIV WHO IRIS: Hormonal contraceptive eligibility for women at high risk of HIV: guidance statement: recommendations concerning the use of hormonal contraceptive methods by women at high risk of HIV Browse Related links Files in This Item: File Description Size Format 2.57 MB Adobe PDF 3.24 MB Adobe PDF Title: Hormonal contraceptive eligibility for women at high risk of HIV: guidance statement: recommendations concerning the use (...) of hormonal contraceptive methods by women at high risk of HIV Authors: Issue Date: 2017 Publisher: World Health Organization Place of publication: Geneva Language: English Portuguese Description: 20 p. Subject: Context: methods Gov't Doc #: WHO/RHR/17.04 URI: Other Language Versions: License: CC BY-NC-SA 3.0 IGO License URL: Appears in Collections: Items in WHO IRIS are protected by copyright, with all rights reserved, unless otherwise indicated. |
Consolidated guideline on sexual and reproductive health and rights of women living with HIV: executive summary WHO IRIS: Consolidated guideline on sexual and reproductive health and rights of women living with HIV: executive summary Browse Related links Files in This Item: File Description Size Format 537.57 kB Adobe PDF Title: Consolidated guideline on sexual and reproductive health and rights of women living with HIV: executive summary Authors: Issue Date: 2017 Publisher: World Health
Consolidated guideline on sexual and reproductive health and rights of women living with HIV WHO IRIS: Consolidated guideline on sexual and reproductive health and rights of women living with HIV Browse Related links Files in This Item: File Description Size Format 1.7 MB Adobe PDF Title: Consolidated guideline on sexual and reproductive health and rights of women living with HIV Authors: Issue Date: 2017 Publisher: World Health Organization Place of publication: Geneva Language: English
WHO Working Group on HIV incidence assays: estimating HIV incidence using HIV case surveillance: meeting report, Glion, Switzerland, 10–11 December 2015 WHO IRIS: WHO Working Group on HIV incidence assays: estimating HIV incidence using HIV case surveillance: meeting report, Glion, Switzerland, 10–11 December 2015 Browse Related links Files in This Item: File Description Size Format 607.73 kB Adobe PDF Title: WHO Working Group on HIV incidence assays: estimating HIV incidence using HIV case (...) surveillance: meeting report, Glion, Switzerland, 10–11 December 2015 Authors: Issue Date: 2017 Publisher: World Health Organization Place of publication: Geneva Language: English Description: 28 p. Subject: Context: epidemiology Gov't Doc #: WHO/HIV/2017.03 URI: License: CC BY-NC-SA 3.0 IGO License URL: Appears in Collections: Items in WHO IRIS are protected by copyright, with all rights reserved, unless otherwise indicated. |
Foundation for Innovative New Diagnostics, WHO Working Group on HIV incidence assays: meeting report, Boston, MA, USA, 20–26 February 2016 WHO IRIS: Foundation for Innovative New Diagnostics, WHO Working Group on HIV incidence assays: meeting report, Boston, MA, USA, 20–26 February 2016 Browse Related links Files in This Item: File Description Size Format 647.85 kB Adobe PDF Title: Foundation for Innovative New Diagnostics, WHO Working Group on HIV incidence assays: meeting report, Boston, MA (...) , USA, 20–26 February 2016 Authors: Issue Date: 2017 Publisher: World Health Organization Place of publication: Geneva Language: English Description: 38 p. Subject: Context: epidemiology Gov't Doc #: WHO/HIV/2017.04 URI: License: CC BY-NC-SA 3.0 IGO License URL: Appears in Collections: Items in WHO IRIS are protected by copyright, with all rights reserved, unless otherwise indicated. |
Sex work, drug use, HIV infection, and spread of sexually transmitted infections in Moscow, Russian Federation. Rates of HIV-1 infection are growing rapidly, and the epidemic of sexually transmitted infections is continuing at an alarming rate, in the Russian Federation. We did a cross-sectional study of sexually transmitted infections, HIV infection, and drug use in street youth at a juvenile detention facility, adults at homeless detention centres, and women and men at a remand centre (...) in Moscow. 160 (79%) women at the remand centre were sex workers. 91 (51%) homeless women had syphilis. At least one bacterial sexually transmitted infection was present in 97 (58%) female juvenile detainees, 120 (64%) women at the remand centre, and 133 (75%) homeless women. HIV seroprevalence was high in women at the remand centre (n=7 [4%]), adolescent male detainees (5 [3%]), and homeless women (4 [2%]). In view of the interaction between sexually transmitted infections and HIV infection, these
Antituberculosis drug resistance and anonymous HIV surveillance in tuberculosis patients in Botswana, 2002. Two surveys undertaken in Botswana in the 1990s have recorded low rates of antituberculosis drug resistance, despite a three-fold rise in tuberculosis since 1989. We undertook a third survey to determine both trends since 1995 and HIV prevalence in tuberculosis patients in Botswana. Sputum specimens were obtained from patients nationwide in 2002 who also underwent anonymous, rapid HIV (...) testing by use of Oraquick. Of 2200 sputum smear-positive patients and 219 previously treated patients with suspected recurrent tuberculosis, 1457 (60%) were infected with HIV. Resistance to at least one drug in new patients rose from 16 (3.7%) isolates in 1995 to 123 (10.4%; p<0.0001) in 2002. Interventions for tuberculosis control are urgently needed in Botswana to prevent further emergence of drug resistance.
Depletion of latent HIV-1 infection in vivo: a proof-of-concept study. BACKGROUND: Persistent infection in resting CD4+ T cells prevents eradication of HIV-1. Since the chromatin remodeling enzyme histone deacetylase 1 (HDAC1) maintains latency of integrated HIV, we tested the ability of the HDAC inhibitor valproic acid to deplete persistent, latent infection in resting CD4+ T cells. PROCEDURES: We did a proof-of-concept study in four volunteers infected with HIV and on highly-active (...) antiretroviral therapy (HAART). After intensifying the effect of HAART with subcutaneous enfuvirtide 90 mug twice daily for 4-6 weeks to prevent the spread of HIV, we added oral valproic acid 500-750 mg twice daily to their treatment regimen for 3 months. We quantified latent infection of resting CD4+ T cells before and after augmented treatment by limiting-dilution culture of resting CD4+ T cells after ex-vivo activation. FINDINGS: The frequency of resting cell infection was stable before addition
Diagnosis of sputum-scarce HIV-associated pulmonary tuberculosis in Lima, Peru. Sputum induction, bronchoalveolar lavage, or gastric aspiration are often needed to produce adequate diagnostic respiratory samples from people with HIV in whom tuberculosis is suspected. Since these procedures are rarely appropriate in less-developed countries, we compared the performances of a simple string test and the gold-standard sputum induction. 160 HIV-positive adults under investigation for tuberculosis (...) , and 52 asymptomatic HIV-positive control patients underwent the string test followed by sputum induction. The string test detected tuberculosis in 14 patients in whom this disease was suspected; sputum induction detected only eight of them (McNemar's test, p=0.03). These preliminary data suggest that the string test is safe and effective for retrieval of useful clinical specimens for diagnosis of pulmonary tuberculosis, and is at least as sensitive as sputum induction.
HIV prevalence and trends in sub-Saharan Africa: no decline and large subregional differences. BACKGROUND: Expansion of HIV surveillance systems in sub-Saharan Africa is leading to downward adjustments to the size of the AIDS epidemic. However, only analysis of surveillance data from the same populations over time can provide insight into trends of HIV prevalence. We have used data from the same antenatal clinics to document recent empirical trends. METHODS: We collated data from antenatal (...) clinics on HIV prevalence between 1997 and 2003. Data were obtained from 140?000 pregnant women attending more than 300 antenatal clinics in 22 countries in sub-Saharan Africa. Additionally, long-term trend data are available for 57 urban areas and provinces. FINDINGS: Median HIV prevalence in 148 antenatal clinic sites in southern Africa increased from 21.3% (IQR 11.5-28.2%) in 1997/98 to 23.8% (15.6-29.2%) in 2002. At more than half the sites (58%) an increase of at least one-tenth was noted
Predictors of trend in CD4-positive T-cell count and mortality among HIV-1-infected individuals with virological failure to all three antiretroviral-drug classes. BACKGROUND: Treatment strategies for patients in whom HIV replication is not suppressed after exposure to several drug classes remain unclear. We aimed to assess the inter-relations between viral load, CD4-cell count, and clinical outcome in patients who had experienced three-class virological failure. METHODS: We undertook (...) collaborative joint analysis of 13 HIV cohorts from Europe, North America, and Australia, involving patients who had had three-class virological failure (viral load >1000 copies per mL for >4 months). Regression analyses were used to quantify the associations between CD4-cell-count slope, HIV-1 RNA concentration, treatment information, and demographic characteristics. Predictors of death were analysed by Cox's proportional-hazards models. FINDINGS: 2488 patients were included. 2118 (85%) had started
Pancreatic toxic effects associated with co-administration of didanosine and tenofovir in HIV-infected adults. The rise in didanosine concentrations in plasma when given with tenofovir raises concern for a high risk of toxic effects. Recommendations to reduce didanosine dose have been issued, but only for adults weighing more than 60 kg. We reviewed cases of pancreatitis in patients receiving didanosine plus tenofovir, didanosine alone, and tenofovir alone to assess the incidence of and risk
HIV/AIDS in Asia. HIV (ie, HIV-1) epidemics in Asia show great diversity, both in severity and timing. But epidemics in Asia are far from over and several countries including China, Indonesia, and Vietnam have growing epidemics. Several factors affect the rate and magnitude of growth of HIV prevalence, but two of the most important are the size of the sex worker population and the frequency with which commercial sex occurs. In view of the present state of knowledge, even countries with low (...) prevalence of infection might still have epidemics affecting a small percentage of the population. Once HIV infection has become established, growing needs for care and treatment are unavoidable and even the so-called prevention-successful countries of Thailand and Cambodia are seeing burgeoning care needs. The manifestations of HIV disease in the region are discussed with the aim of identifying key issues in medical management and care of HIV/AIDS. In particular, issues relevant to developing
The changing face of the HIV epidemic in western Europe: what are the implications for public health policies? In this review, we describe changes in dynamics of HIV transmission and shifts in affected populations in western Europe using HIV/AIDS surveillance data and published and unpublished reports. Despite substantial reductions in HIV-related morbidity and mortality since the introduction of highly active antiretroviral treatment, HIV continues to pose a major public health problem (...) in western Europe. More than half a million people are living with an infection that remains incurable and requires costly lifelong treatment; many people remain unaware of their infection, and thousands of new infections continue to occur every year. Migrants from countries with a high prevalence of HIV/AIDS, notably sub-Saharan Africa, bear a disproportionate and increasing share of HIV throughout western Europe and, in most countries, account for the majority of heterosexually acquired HIV infections
Mortality of infected and uninfected infants born to HIV-infected mothers in Africa: a pooled analysis. BACKGROUND: HIV contributes substantially to child mortality, but factors underlying these deaths are inadequately described. With individual data from seven randomised mother-to-child transmission (MTCT) intervention trials, we estimate mortality in African children born to HIV-infected mothers and analyse selected risk factors. METHODS: Early HIV infection was defined as a positive HIV-PCR (...) test before 4 weeks of age; and late infection by a negative PCR test at or after 4 weeks of age, followed by a positive test. Mortality rate was expressed per 1000 child-years. We investigated the effect of maternal health, infant HIV infection, feeding practices, and age at acquisition of infection on mortality assessed with Cox proportional hazards models, and allowed for random effects for trials grouped geographically. FINDINGS: 378 (11%) of 3468 children died. By age 1 year, an estimated 35.2
Effect of co-trimoxazole prophylaxis on morbidity, mortality, CD4-cell count, and viral load in HIV infection in rural Uganda. BACKGROUND: Prophylaxis with co-trimoxazole (trimethoprim-sulphamethoxazole) is recommended for people with HIV infection or AIDS but is rarely used in Africa. We assessed the effect of such prophylaxis on morbidity, mortality, CD4-cell count, and viral load among people with HIV infection living in rural Uganda, an area with high rates of bacterial resistance to co (...) -trimoxazole. METHODS: Between April, 2001, and March, 2003, we enrolled, and followed up with weekly home visits, 509 individuals with HIV-1 infection and their 1522 HIV-negative household members. After 5 months of follow-up, HIV-positive participants were offered daily co-trimoxazole prophylaxis (800 mg trimethoprim, 160 mg sulphamethoxazole) and followed up for a further 1.5 years. We assessed rates of malaria, diarrhoea, hospital admission, and death. FINDINGS: Co-trimoxazole was well tolerated