The development of antiretroviral drugs (ARVs) was a great milestone in the management of HIV infection. ARVs suppress viral activity in the host cell, thus minimizing injury to the cells and prolonging life. However, an effective treatment has remained elusive for four decades due to the successful immune evasion mechanisms of the virus. A thorough understanding of the molecular interaction of HIV with the host cell is essential in the development of both preventive and curative therapies for HIV infection. This review highlights several inherent mechanisms of HIV that promote its survival and propagation, such as the targeting of CD4⁺ lymphocytes, the downregulation of MHC class I and II, antigenic variation and an envelope complex that minimizes antibody access, and how they collaboratively render the immune system unable to mount an effective response.

Background: An increase in the prevalence of HIV drug resistance (HIVDR) has been reported in recent years, especially in persons on non-nucleoside reverse transcriptase inhibitors (NNRTIs) due to their low genetic barrier to mutations. However, there is a paucity of epidemiological data quantifying HIVDR in the era of new drugs like dolutegravir (DTG) in sub-Saharan Africa. We, therefore, sought to determine the prevalence and correlates of viral load (VL) suppression in adult people with HIV (PWH) on a fixed-dose combination of tenofovir disoproxil fumarate/lamivudine/dolutegravir (TLD) or tenofovir alafenamide/emtricitabine/dolutegravir (TAFED) and describe patterns of mutations in individuals failing treatment.Methods: We conducted a cross-sectional study among 384 adults living with HIV aged ≥15 years between 5^thJune 2023 and 10^thAugust 2023. Demographic, laboratory and clinical data were collected from electronic health records using a data collection form. Viral load suppression was defined as plasma HIV-1 RNA VL of <1000 copies/ml after being on ART for ≥ 6 months. SPSS version 22 to analyze the data. Descriptive statistics and logistic regression were the statistical methods used.Results: The median (interquartile range (IQR)) age was 22 (IQR 18, 38) years, and 66.1% (n = 254) were females. VL suppression was 90.4% (n = 347); (95% confidence interval (CI) 87.6%-93.6%) after switching to TLD/TAFED. Among the virally suppressed, the majority (67.1%, n = 233) were female. Those who missed ≥2 doses in the last 30 days prior to the most recent review were less likely to attain viral suppression compared to those who did not miss any dose (adjusted odds ratio (AOR) 0.047; 95% CI 0.016–0.136; p<0.001). Four participants had resistance mutations to lamivudine and tenofovir. The most common NRTI mutations were M184MV and K65R while K101E was the most common NNRTI mutation.Conclusion: Our findings show that viral suppression was high after switching to TLD/TAFED; but lower than the last 95% target of the UNAIDS. Adherence to antiretroviral therapy was a significant correlate of VL suppression. We, therefore, recommend prompt switching of PWH to TLD/TAFED regimen and close monitoring to enhance adherence to therapy.

Background: Preeclampsia (PE) is a significant obstetric complication associated with adverse maternal and fetal outcomes. Zambia, like several Sub-Saharan African nations, experiences a high prevalence of pregnancy-related hypertension, with PE being a major contributor to maternal and foetal mortality. This study aimed to identify the factors associated with the development of PE. Methods: We conducted a cross-sectional study at Livingstone University Teaching Hospital in Zambia (LUTH). PE was defined as new-onset hypertension with systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg occurring after 20 weeks of gestation, accompanied by proteinuria with dipstick reading of 1 + . Data from patients’ most recent hospital visits was collected by trained research assistants using medical record abstraction. A total of 1018 participants were included. Demographic, clinical, and haematological parameters were analysed. We conducted both descriptive and inferential analyses using Stata version 17. Univariable and multivariable logistic regression were employed to investigate factors associated with PE. Results: The median age of participants was 27 years (IQR: 21–33). The prevalence of PE was 12.2% (n = 124). Among the 17.7% (n = 172) of participants who were employed, 19.1% (n = 33) had PE. Factors positively associated with PE included increasing age (Adjusted Odds Ratio [AOR]: 1.07, 95% Confidence Interval [CI]: 1.02–1.12, p = 0.002), a previous history of PE (AOR: 30.8, 95% CI: 8.7–108.6, p < 0.001), and a family history of PE (AOR: 9.97, 95% CI: 2.53–39.27, p = 0.001). Conversely, a unit (week) increase in gestational age was negatively associated with PE (AOR: 0.89, 95% CI: 0.83–0.97, p = 0.007). Conclusion: This study identifies maternal age, family history, and prior obstetric history as key associated factors for PE, emphasizing the need for targeted screening and early intervention. Enhanced prenatal care, including routine risk assessments, patient education, and regular monitoring through blood pressure checks, urine protein testing, and fetal growth assessments, is cardinal for early detection and effective management of high-risk individuals.

Background: Hypertension is a risk factor for cardiovascular events. Inflammation plays an important role in the development of essential hypertension. Studies assessing the association between complete blood count-based inflammatory scores (CBCIS) and hypertension are scarce. Therefore, this study aimed to determine the relationship between CBCIS and hypertension among individuals with and without human immunodeficiency virus (HIV). Method: This was a cross-sectional study among 344 participants at Serenje District Hospital and Serenje Urban Clinic. We used structured questionnaires to collect sociodemographic, clinical and laboratory characteristics. CBCIS included lymphocyte-monocyte ratio (LMR), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), derived neutrophil-lymphocyte ratio (d-NLR), and differential white blood cells. The primary outcome variable was hypertension defined as systolic and diastolic blood pressure higher than or equal to 140/90 mmHg. Logistic regression was used to estimate the association between hypertension and CBCIS in statistical package for social science (SPSS) version 22.0. Results: The participants had a median age of 32 years (interquartile range (IQR) 24–42) and 65.1% (n = 224) were female. The prevalence of hypertension was 10.5% (n = 36). Among those with hypertension, 55.6% (n = 20) were female and 44.4% (n = 16) were male. The CBCIS significantly associated with hypertension in people living with HIV (PLWH) was PLR (adjusted odds ratio (AOR) 0.98; 95% confidence interval (CI) 0.97–0.99, p = 0.01) while in people without HIV, AMC (AOR 15.40 95%CI 3.75–63.26), ANC (AOR 1.88 95%CI 1.05–3.36), WBC (AOR 0.52 95%CI 0.31–0.87) and PLR (AOR 0.98 95%CI 0.97–0.99) were the factors associated with hypertension. Compared to people without HIV, only WBC, ANC, NLR, and d-NLR were good predictors of hypertension among PLWH. Conclusion: Our study indicates a notable HIV-status driven association between CBCIS and hypertension, suggesting the use of CBICS as potential biomarkers for hypertension risk with substantial implications for early detection and preventive measures.

Background Malaria is the predominant driver of morbidity and mortality in Zambia, particularly among children under the age of 5. This disease ranks first in both outpatient and inpatient records, highlighting its prevalent impact on public health. Malaria has such an adverse socioeconomic impact that it significantly exacerbates poverty and underdevelopment. Therefore, this study aimed to investigate the prevalence of malaria and related factors in children under five years of age in the Chiengi and Puta Districts. Methods A descriptive cross-sectional survey was carried out in the Chiengi and Puta districts, which are malaria endemic areas. Using a pretested structured questionnaire, every head of a randomly selected household male or female present from July 1, 2022 – July 30, 2022 was interviewed about ownership of an insecticide-treated mosquito net (ITN), actual usage, coverage of indoor residual spraying, sociodemographic factors, and the presence of malaria parasites in the underfive population, which was determined using a malaria rapid diagnostic test (mRDT). Results A total of 318 participants were recruited from the Puta Rural Health Centre and Chiengi District Hospital. The children’s overall mean standard deviation (SD) age was 2.35 (1.53) years, 50.3% were female (160/318), and 49.7% were male (158/318). The prevalence of malaria was 59.1% (188/318), with the Puta Rural Health Centre accounting for 61.3% and the Chiengi District Hospital accounting for 48.1%. Among the 56% of households that recorded possession and usage of the ITN, the prevalence of malaria was 4.3%. Conclusions The use of insecticide-treated nets was found to be the most dominant risk factor for malaria infection. Enhancing accessibility to comprehensive malaria interventions is essential for disrupting transmission at the community level, particularly when targeting at-risk age groups. Thus, it is crucial to raise awareness within the community regarding the proper utilization of insecticide-treated bed nets (ITNs).

Schizophrenia frequently involves comorbid substance use, exacerbating symptoms and reducing treatment efficacy yet no prior studies have examined this comorbidity locally. This study determined the prevalence and factors associated with illicit substance use among adults with schizophrenia at the Livingstone University Teaching Hospital (LUTH). A hospital-based single center cross-sectional study was conducted at LUTH from January to June 2023. A sample of 303 adults with schizophrenia were recruited via systematic random sampling. Data were collected from existing medical records which included documentation from structured interviews with validated tools (Alcohol, Smoking, and Substance Involvement Screening Test [ASSIST], Positive and Negative Syndrome Scale [PANSS]) conducted as part of routine clinical care. Sociodemographic, clinical, and substance use variables were analyzed using chi-square tests and multivariate logistic regression to identify factors associated with illicit substance use. The prevalence of illicit substance use was 31.1% (94/303). Alcohol use (AOR = 6.08, 95% CI: 3.14–11.78, p < 0.0001) and tobacco smoking (AOR = 4.80, 95% CI: 2.44–9.46, p < 0.0001) were strongly associated with illicit substance use. Factors associated with lower odds of illicit substance use included female sex (AOR = 0.27, 95% CI: 0.12–0.60, p = 0.001), marriage (AOR = 0.39, 95% CI: 0.19–0.79, p = 0.008), having both parents deceased (AOR = 0.29, 95% CI: 0.11–0.75, p = 0.011), and higher education (AOR = 0.44, 95% CI: 0.24–0.81, p = 0.009). Increased hospitalizations were associated with illicit substance use (AOR = 1.29, 95% CI: 1.01–1.65, p = 0.038). Integrated screening, gender-specific interventions, and socioeconomic support related to illicit substance use are urgently needed in Zambia’s resource-constrained setting.