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Sample records for hiv patients studied

  1. Upper Gastrointestinal Symptoms Predictive of Candida Esophagitis and Erosive Esophagitis in HIV and Non-HIV Patients: An Endoscopy-Based Cross-Sectional Study of 6011 Patients.

    PubMed

    Takahashi, Yuta; Nagata, Naoyoshi; Shimbo, Takuro; Nishijima, Takeshi; Watanabe, Koji; Aoki, Tomonori; Sekine, Katsunori; Okubo, Hidetaka; Watanabe, Kazuhiro; Sakurai, Toshiyuki; Yokoi, Chizu; Mimori, Akio; Oka, Shinichi; Uemura, Naomi; Akiyama, Junichi

    2015-11-01

    esophagitis in both patient groups. The internal consistency test using Cronbach's α revealed that the 9 symptom scores were reliable in both HIV (α, 0.86) and non-HIV-infected patients (α, 0.85).This large-scale endoscopy-based study showed that HIV-infected patients have greater GI symptom scores compared with non-HIV-infected patients even after excluding GI-organic diseases. None of the upper GI symptoms predict candida esophagitis in HIV-infected patients, but dysphagia and odynophagia predict candida esophagitis in non-HIV-infected patients. Heartburn and acid regurgitation predict erosive esophagitis in both patient groups.

  2. Knowledge about HIV prevention and transmission among recently diagnosed tuberculosis patients: a cross sectional study

    PubMed Central

    2013-01-01

    Background Patients with Tuberculosis (TB) are a vulnerable group for acquiring HIV infection. Therefore, countries with a concentrated HIV epidemic and high prevalence of TB should provide adequate information about HIV prevention to TB patients. Methods We conducted a cross-sectional study to evaluate the level of knowledge on HIV prevention and transmission among newly diagnosed TB patients in Lima, Peru. The survey evaluated knowledge about HIV infection and prevention and was administered before HIV counseling and blood sampling for HIV testing were performed. Results A total of 171 TB patients were enrolled; mean age was 31.1 years, 101 (59%) were male. The overall mean level of knowledge of HIV was 59%; but the specific mean level of knowledge on HIV transmission and prevention was only 33.3% and 41.5%, respectively. Age and level of education correlated with overall level of knowledge in the multivariate model (P-value: 0.02 and <0.001 respectively). Conclusions The study shows inadequate levels of knowledge about HIV transmission and prevention among newly-diagnosed TB patients in this setting, and underscores the need for implementing educational interventions in this population. PMID:24373517

  3. HIV/AIDS patients' medical and psychosocial needs in the era of HAART: a cross-sectional study among HIV/AIDS patients receiving HAART in Yunnan, China.

    PubMed

    Wen, Yi; Shi, Yun; Jiang, Chengqin; Detels, Roger; Wu, Di

    2013-01-01

    Since the launch of China's Free Antiretroviral Therapy (ART) Program in 2002, more than 100,000 HIV/AIDS patients have been treated with highly actively antiretroviral therapy (HAART). However, the current evaluation system for this program mainly focused on its medical outcomes. This study aims to evaluate the medical and psychosocial needs of HIV/AIDS patients after initiating HAART. A cross-sectional study was conducted among 499 HIV/AIDS patients who were currently being treated with HAART in three designated hospitals in Luxi City, Yunnan Province. A questionnaire was used to collect information about participants' demographic characteristics, perceived HIV-related stigma, physician-patient relationship, quality of life, family functioning, etc. Patients' medical records in the National HIV Information System were linked with their questionnaire by their ART identification number. Patients on HAART who were infected with HIV through injection drug use and were current smokers typically had poorer physical health than other participants on HAART. Better financial status and better physician-patient relationship were associated with both physical and psychological well-being. Family awareness of the patient's HIV status was negatively associated with the patient's psychological well-being. Higher levels of perceived HIV-related stigma were associated with poorer psychological health and poorer family functioning. This study emphasizes the importance of assuring a caring environment in China's AIDS treatment program and re-enforces the need to combat the stigma encountered with health providers and the public.

  4. Comparative study on the microbiological features of angular cheilitis in HIV seropositive and HIV seronegative patients from South India

    PubMed Central

    Krishnan, P Anitha; Kannan, Ranganathan

    2013-01-01

    Objective: This study was designed to compare the microbiological features of angular cheilitis (AC) in human immunodeficiency virus (HIV) seropositive and HIV seronegative individuals, in a group of south Indians. Materials and Methods: Swabs from oral commissures of 46 patients were obtained and inoculated on to Sabouraud's dextrose agar (SDA) supplemented with chloramphenicol, blood agar (BA) and MacConkey's agar (MCA) plates and cultured. α-hemolytic Streptococci, Staphylococcus albus, Staphylococcus aureus, Candida species, Klebsiella species and Pseudomonas species were cultured. Candidal colonies were further speciated by the conventional biotyping technique. Results: In AC of HIV seropositive patients Candida albicans and Staphylococcus aureus were more prevalent than that in HIV seronegative patients. Incidentally in patients with CD4 cell count less than 200 there was an increase in the incidence of Candidal and Staphylococcus aureus colonization when compared to patients with CD4 cell count higher than 200. Conclusion: The present study suggests a definite difference in the microbial flora of AC in HIV seropositive patients than that of HIV seronegative population. PMID:24574650

  5. Adequacy of Mental Health Services for HIV-Positive Patients with Depression: Ontario HIV Treatment Network Cohort Study

    PubMed Central

    Choi, Stephanie K. Y.; Boyle, Eleanor; Cairney, John; Gardner, Sandra; Collins, Evan J.; Bacon, Jean; Rourke, Sean B.

    2016-01-01

    Background Major depression can profoundly impact clinical and quality-of-life outcomes of people living with HIV, and this disease is underdiagnosed and undertreated in many HIV-positive individuals. Here, we describe the prevalence of publicly funded primary and secondary mental health service use and antidepressant use, as well as mental health care for depression in accordance with existing Canadian guidelines for HIV-positive patients with depression in Ontario, Canada. Methods We conducted a prospective cohort study linking data from the Ontario HIV Treatment Network Cohort Study with administrative health databases in the province of Ontario, Canada. Current depression was assessed using the Center for Epidemiologic Depression Scale or the Kessler Psychological Distress Scale. Multivariable regressions were used to characterize prevalence outcomes. Results Of 990 HIV-positive patients with depression, 493 (50%) patients used mental health services; 182 (18%) used primary services (general practitioners); 176 (18%) used secondary services (psychiatrists); and 135 (14%) used both. Antidepressants were used by 407 (39%) patients. Patients who identified as gay, lesbian, or bisexual, as having low income or educational attainment, or as non-native English speakers or immigrants to Canada were less likely to obtain care. Of 493 patients using mental health services, 250 (51%) received mental health care for depression in accordance with existing Canadian guidelines. Conclusions Our results showed gaps in delivering publicly funded mental health services to depressed HIV-positive patients and identified unequal access to these services, particularly among vulnerable groups. More effective mental health policies and better access to mental health services are required to address HIV-positive patient needs and reduce depression’s impact on their lives. PMID:27280751

  6. Sexual abstinence in patients with HIV infection: a 2-year follow-up study.

    PubMed

    Jordan, W C

    1991-12-01

    Thirty-five human immunodeficiency virus (HIV)-positive patients were followed over a 2-year period. All agreed to abstain from sexual intercourse. This group had a low level of recurring infections. A comparison study of sexually active HIV males is underway.

  7. [Prevalence of HIV infection in dialysis patients: results of a national multicenter study].

    PubMed

    Poignet, J L; Desassis, J F; Chanton, N; Litchinko, M B; Zins, B; Kolko, A; Patte, R; Sobel, A

    1999-01-01

    In order to determine the prevalence of HIV infection in french patients with end-stage renal disease (ESRD) on maintenance dialysis therapy, questionnaire forms were mailed out in february 1997 to the heads of the 260 dialysis facilities. We documented number of patients on maintenance dialysis therapy (hemo and peritoneal dialysis) and for HIV infected dialysis patients: age, gender, cause and duration of ESRD, known duration of HIV infection, risk factors for HIV infection, HBV and/or HCV infection, presence of clinical acquired immunodeficiency syndrome (AIDS), total CD4 count and treatment with antiretroviral agents. Questionnaire forms were returned from 98% of the dialysis facilities. As of february 1997 some 22,707 patients with ESRD were treated by renal replacement therapy, 19,947 by hemodialysis (HD) and 2760 by peritoneal dialysis (PD). 82 patients with ESRD and HIV infection were reported corresponding to 0.36% prevalence rate of all patients undergoing dialysis at the time specified. The 82 study subjects with ESRD and HIV infection received hemodialysis (79 patients) or peritoneal dialysis (3 patients) in 42 facilities. Forty seven patients were treated in Paris and suburbs and 9 in our own center. All 82 patients comprised 63% men and 47% women which included patients coming from Africa (37%), Caribbean and Oceania (28%), Europe (35%) of a mean age of 41.8 years. Modes of transmission were homobisexuals 15%, heterosexuals 31%, intravenous drug abusers 17%, blood transfusion 17% and unknown 20%. The mean duration of HIV infection was 96 months (range 12-168 months) and the mean duration of ESRD was 58 months (range 1-235 months). HIV associated nephropathy was established in 31%. AIDS was diagnosed in 25 patients. Seventy one percent of the patients were receiving an antiretroviral drug (tritherapy in 25% of cases). In conclusion HIV prevalence rate among French dialysis patients is low and focused in Paris and oversea. Sexual transmission is the

  8. Echocardiographic findings and abnormalities in HIV-infected patients: results from a large, prospective, multicenter HIV-heart study

    PubMed Central

    Reinsch, Nico; Kahlert, Philipp; Esser, Stefan; Sundermeyer, Andreas; Neuhaus, Katrin; Brockmeyer, Norbert; Potthoff, Anja; Erbel, Raimund; Buck, Thomas; Neumann, Till

    2011-01-01

    Aims: The aim of the current study was to assess cardiac structure and function as well as cardiac abnormalities in a large patient-population based multicenter study of HIV-infected subjects. Materials and methods: We enrolled 803 HIV-positive adults (83.4% men, mean age: 44.2 ± 10.3 yrs) in this prospective, cross-sectional cohort study. The study protocol included a standardized documentation of patient history, medical treatment and clinical examination. All subjects underwent a standardized transthoracic echocardiographic examination protocol including Doppler and tissue Doppler imaging. Results: Echocardiographic measurements revealed a structural dilatation of the left ventricle in 10.1% of all HIV-infected subjects. Interventricular septum and posterior wall thickness were increased in 18.0% and 11.1%, respectively, with elevated muscle mass in 14.3% male and 19.4% female patients. Of all participants 13.5% exhibited a pathologic contraction characteristic of one or more myocardial segments. Prevalence of systolic and diastolic dysfunction was 34.3% and 48.0%, respectively. However, severe forms of ventricular dysfunction were rare. Conclusions: In conclusion our results demonstrate the relevance of echocardiography in this patient-population in the era of antiretroviral therapy. Above all, left ventricular wall thickness and function should be controlled regularly in HIV-infected subjects. (ClinicalTrials.gov number, NCT01119729). PMID:22254197

  9. Is HIV Painful? An Epidemiologic Study of the Prevalence and Risk Factors for Pain in HIV-Infected Patients

    PubMed Central

    Lawson, Edwina; Sabin, Caroline; Perry, Nicky; Richardson, Daniel; Gilleece, Yvonne; Churchill, Duncan; Dean, Gill; Williams, Debbie; Fisher, Martin; Walker-Bone, Karen

    2016-01-01

    Objectives To evaluate the prevalence, impact and risk factors for pain among a cohort of HIV-infected adults treated with combination anti-retroviral therapy (cART) if indicated according to current guidelines. Methods This was a cross-sectional epidemiological observational study. All patients attending one HIV-outpatient centre in the UK in a 10-month period were eligible. Patients completed a validated questionnaire enquiring about demographics, HIV factors and symptoms of pain. Results Of 1050 eligible participants, 859 (82%) completed a questionnaire. The 1-month period prevalence of pain lasting > 1 day was 62.8% amongst whom 63% reported current pain. The prevalence of pain at most anatomical sites was broadly similar to that observed in population studies using the same questionnaires except that we found considerably higher rates of foot/ankle pain. The median duration of pain was 3 years (range 0-51 years) and the median pain score was 5.0 on an 11-point visual analogue score. Over 40% of people in pain had consulted their primary care physician and > 20% were taking analgesics daily. Independent risk factors for current pain were older age (p=0.001), time since diagnosis of HIV infection (p=0.001) and receipt of a protease inhibitor-based regimen (p=0.04). Discussion Pain, and notably foot/ankle pain, is common among adults living with prevalent HIV and is associated with substantial morbidity and healthcare utilisation. PMID:25329144

  10. Study of blood groups in HIV seropositive patients.

    PubMed

    Sayal, S K; Das, A L; Nema, S K

    1996-01-01

    Blood groups in 104 cases of HIV infection and 300 normal persons were determined. A relatively increased incidence of HIV infection was observed in persons with blood group O and relativey lower incidence in blood group B. Incidence of HIV infection was also low in Rh negative subjects. These results suggest a possible relationship between the incidence of blood group and the natural defence mechanism against HIV infection.

  11. HIV associated hypocalcaemia among diarrheic patients in northwest Ethiopia: a cross sectional study

    PubMed Central

    2014-01-01

    Background Hypocalcaemia, defined by serum calcium level less than 8.5 mg/dl, could be caused by human immunodeficiency virus (HIV) and diarrheal diseases. In Ethiopia, while morbidities from diarrheal diseases and HIV are serious health problems, studies assessing the interactions amongst of the three do not exist. Therefore, the present study was undertaken to investigate the level of calcium among diarrheic patients with and without HIV co-infection. Methods Consecutive diarrheic patients attending Gondar University Hospital in Ethiopia were enrolled and screened for HIV, intestinal parasites, Shigella and Salmonella. Concentration of calcium in serum was determined using an inductively coupled plasma mass spectrometer. Results A total of 206 diarrheic patients were included in the study (109 = HIV positive, 97 = HIV negative). Intestinal parasites and Shigella species were detected in 32.2% and 8.5% of the patients, respectively. The serum calcium levels in the patients who were found positive for Shigella species or intestinal parasites was not significantly different by the presence or absence of HIV co-infection. HIV infected diarrheic patients had significantly lower mean serum calcium levels (7.82 ± 1.23 mg/dl) than those negative for HIV (8.38 ± 1.97) (P = 0.015). The age groups 25–35 and greater than 45 years showed significantly lower mean serum calcium levels (7.77 ± 1.55 mg/dl) in comparison to the other age groups (7.84 ± 1.41 mg/dl, P = 0.009). On the other hand, females presented with significantly lower mean serum calcium levels (7.79 ± 1.60 mg/dl, P = 0.044) than males (8.26 ± 1.65 mg/dl). Conclusion There is high prevalence of hypocalcaemia among diarrheic patients in northwest Ethiopia. And HIV stood out to be a major risk factor for development of hypocalcaemia among the diarrheic patients in northwest Ethiopia. Further studies are required to substantiate and characterize the

  12. Does HIV status influence the outcome of patients admitted to a surgical intensive care unit? A prospective double blind study.

    PubMed Central

    Bhagwanjee, S.; Muckart, D. J.; Jeena, P. M.; Moodley, P.

    1997-01-01

    OBJECTIVES: (a) To assess the impact of HIV status (HIV negative, HIV positive, AIDS) on the outcome of patients admitted to intensive care units for diseases unrelated to HIV; (b) to decide whether a positive test result for HIV should be a criterion for excluding patients from intensive care for diseases unrelated to HIV. DESIGN: A prospective double blind study of all admissions over six months. HIV status was determined in all patients by enzyme linked immunosorbent assay (ELISA), immunofluorescence assay, western blotting, and flow cytometry. The ethics committee considered the clinical implications of the study important enough to waive patients' right to informed consent. Staff and patients were blinded to HIV results. On discharge patients could be advised of their HIV status if they wished. SETTING: A 16 bed surgical intensive care unit. SUBJECTS: All 267 men and 135 women admitted to the unit during the study period. INTERVENTIONS: None. MAIN OUTCOME MEASURES: APACHE II score (acute physiological, age, and chronic health evaluation), organ failure, septic shock, durations of intensive care unit and hospital stay, and intensive care unit and hospital mortality. RESULTS: No patient had AIDS. 52 patients were tested positive for HIV and 350 patients were tested negative. The two groups were similar in sex distribution but differed significantly in age, incidence of organ failure (37 (71%) v 171 (49%) patients), and incidence of septic shock (20 (38%) v 54 (15%)). After adjustment for age there were no differences in intensive care unit or hospital mortality or in the durations of stay in the intensive care unit or hospital. CONCLUSIONS: Morbidity was higher in HIV positive patients but there was no difference in mortality. In this patient population a positive HIV test result should not be a criterion for excluding a patient from intensive care. PMID:9133887

  13. Urine-Based Nested PCR for the Diagnosis of Mycobacterium tuberculosis: A Comparative Study Between HIV-Positive and HIV-Negative Patients

    PubMed Central

    Jamshidi Makiani, Mahin; Davoodian, Parivash; Baghershiroodi, Mahnaz; Nejatizadeh, Abdol Azim; Fakkhar, Farideh; Zangeneh, Mehrangiz; Jahangiri, Nadia

    2016-01-01

    Background While tuberculosis (TB) can be diagnosed by microscopy and culture, the sensitivity of Ziehl-Neelsen staining is variable and culture results require 4 - 8 weeks to be determined. Polymerase chain reaction (PCR) and its modifications, including nested PCR, might be promising methods for the rapid diagnosis of TB. Objectives This study aimed to evaluate the performance of nested PCR on urine samples of human immunodeficiency virus (HIV)-positive and -negative patients with different manifestations of clinical TB. Methods In a prospective study, three early-morning urine samples from 100 patients with pulmonary TB (PTB) or extrapulmonary TB (EPTB) were evaluated using a molecular target with insertion element IS6110, specific to the Mycobacterium tuberculosis genome, and nested PCR was performed. The results were analyzed with SPSS version 22. Results A total of 100 patients, including 74 (74%) with PTB and 26 (26%) with EPTB, were enrolled. Positive smears were seen in 38 patients (38%). Lymph nodes were the most commonly involved organ in 14 of the 26 (53.8%) EPTB patients (13.5%). Seven (23.1%) of the EPTB patients were HIV-positive. Urine PCR was positive in only 28 patients (28%). Seven HIV-positive patients with PTB showed positive urine PCR results. Moreover, PCR results were positive in only one of the seven HIV-positive subjects with EPTB. Positive PCR results were found in 20 of the 73 HIV-negative patients (27.4%) and in 8 of the 27 HIV-positive patients (29.6%). Therefore, there was no significant difference between the HIV-negative and HIV-positive patients for urine PCR (sensitivity 29.6%, specificity 72.6%; positive and negative predictive values 28% and 72%, respectively; P = 0.138). Conclusions Nested PCR showed the same sensitivity in HIV-positive and HIV-negative patients. It can be applied as a rapid technique for the diagnosis of TB. PMID:27800137

  14. A study of financial incentives to reduce plasma HIV RNA among patients in care.

    PubMed

    Farber, Steven; Tate, Janet; Frank, Cyndi; Ardito, David; Kozal, Michael; Justice, Amy C; Scott Braithwaite, R

    2013-09-01

    The role of financial incentives in HIV care is not well studied. We conducted a single-site study of monetary incentives for viral load suppression, using each patient as his own control. The incentive size ($100/quarter) was designed to be cost-neutral, offsetting estimated downstream costs averted through reduced HIV transmission. Feasibility outcomes were clinic workflow, patient acceptability, and patient comprehension. Although the study was not powered for effectiveness, we also analyzed viral load suppression. Of 80 eligible patients, 77 consented, and 69 had 12 month follow-up. Feasibility outcomes showed minimal impact on patient workflow, near-unanimous patient acceptability, and satisfactory patient comprehension. Among individuals with detectable viral loads pre-intervention, the proportion of undetectable viral load tests increased from 57 to 69 % before versus after the intervention. It is feasible to use financial incentives to reward ART adherence, and to specify the incentive by requiring cost-neutrality and targeting biological outcomes.

  15. Liver Retransplantation in Patients With HIV-1 Infection: An International Multicenter Cohort Study.

    PubMed

    Agüero, F; Rimola, A; Stock, P; Grossi, P; Rockstroh, J K; Agarwal, K; Garzoni, C; Barcan, L A; Maltez, F; Manzardo, C; Mari, M; Ragni, M V; Anadol, E; Di Benedetto, F; Nishida, S; Gastaca, M; Miró, J M

    2016-02-01

    Liver retransplantation is performed in HIV-infected patients, although its outcome is not well known. In an international cohort study (eight countries), 37 (6%; 32 coinfected with hepatitis C virus [HCV] and five with hepatitis B virus [HBV]) of 600 HIV-infected patients who had undergone liver transplant were retransplanted. The main indications for retransplantation were vascular complications (35%), primary graft nonfunction (22%), rejection (19%), and HCV recurrence (13%). Overall, 19 patients (51%) died after retransplantation. Survival at 1, 3, and 5 years was 56%, 51%, and 51%, respectively. Among patients with HCV coinfection, HCV RNA replication status at retransplantation was the only significant prognostic factor. Patients with undetectable versus detectable HCV RNA had a survival probability of 80% versus 39% at 1 year and 80% versus 30% at 3 and 5 years (p = 0.025). Recurrence of hepatitis C was the main cause of death in the latter. Patients with HBV coinfection had survival of 80% at 1, 3, and 5 years after retransplantation. HIV infection was adequately controlled with antiretroviral therapy. In conclusion, liver retransplantation is an acceptable option for HIV-infected patients with HBV or HCV coinfection but undetectable HCV RNA. Retransplantation in patients with HCV replication should be reassessed prospectively in the era of new direct antiviral agents. PMID:26415077

  16. A Study to Evaluate Lipid Profile in Treatment Naïve HIV Positive Patients.

    PubMed

    Devanath, Anitha; Ray, Somdattaa; Kumar, Ravi; Prarthana, B S

    2014-01-01

    HIV infection is associated with lipid abnormalities in treatment naïve patients. CD4 count is used for monitoring the HIV infection. Primary objective was to evaluate and correlate lipid profile and CD4 counts in HIV infection. Secondary objective was to evaluate the feasibility of using Lipid profile to monitor the HIV infected treatment naïve patients instead of CD4 counts. 112 patients were selected based on a criteria from ART center in tertiary care center. CD4 counts were assessed and Lipid profile was evaluated enzymatically. A correlation study was done between the lipid profile and the CD4 count and clinical stages of infection. Cholesterol showed no significant correlation in any stage. HDL-C showed significant correlation (p < 0.05) with stage 2 and 4 disease. LDL-C showed no significant correlation in any stage. TGL showed significant correlation (p < 0.05) at stage 4 disease. Hence, HDL-C and TGL can be used as indicators of lipid status and for infection progression in treatment naive HIV patients, while Cholesterol and LDL-C has no role to play.

  17. Study of Natural Cytotoxicity Receptors in Patients with HIV/AIDS and Cancer: A Cross-Sectional Study

    PubMed Central

    Terra Junior, Orlando Nascimento; Maldonado, Gabriel de Carvalho; Alfradique, Guilherme Rohem; Lisboa, Vinicius da Cunha; Arnóbio, Adriano; de Lima, Dirce Bonfim; Diamond, Hilda Rachel; de Souza, Maria Helena Faria Ornellas

    2016-01-01

    The NCR receptors play a fundamental role in the cytotoxicity mediated by NK cells against tumor cells. In the current study, we investigated possible HIV/AIDS-related changes in the expression of the NCR receptors comparing healthy donors, HIV/AIDS patients, and HIV/AIDS patients with cancer (HIV/AIDSWC). The NCRs were quantified in NK cells (NKdim and NKbright) and T lymphocytes from peripheral blood samples by flow cytometry. We found a significant decrease in the frequency of NK cells expressing NKp46 in HIV/AIDS group (p = 0.0012). There was a decrease in the frequency of NK cells expressing NKp46 in the HIV/AIDSWC group; however, this was not statistically significant. We found a significant decrease in the frequency of NK cells expressing NKp30 in the HIV/AIDS group (p = 0.0144). There was a decrease in the frequency of NK cells expressing NKp30 and in the HIV/AIDSWC group, but this was not statistically significant. There were no changes in the distribution of NK cells and their subtypes in both groups. PMID:27382604

  18. Study of Natural Cytotoxicity Receptors in Patients with HIV/AIDS and Cancer: A Cross-Sectional Study.

    PubMed

    Terra Junior, Orlando Nascimento; Maldonado, Gabriel de Carvalho; Alfradique, Guilherme Rohem; Lisboa, Vinicius da Cunha; Arnóbio, Adriano; de Lima, Dirce Bonfim; Diamond, Hilda Rachel; de Souza, Maria Helena Faria Ornellas

    2016-01-01

    The NCR receptors play a fundamental role in the cytotoxicity mediated by NK cells against tumor cells. In the current study, we investigated possible HIV/AIDS-related changes in the expression of the NCR receptors comparing healthy donors, HIV/AIDS patients, and HIV/AIDS patients with cancer (HIV/AIDSWC). The NCRs were quantified in NK cells (NK(dim) and NK(bright)) and T lymphocytes from peripheral blood samples by flow cytometry. We found a significant decrease in the frequency of NK cells expressing NKp46 in HIV/AIDS group (p = 0.0012). There was a decrease in the frequency of NK cells expressing NKp46 in the HIV/AIDSWC group; however, this was not statistically significant. We found a significant decrease in the frequency of NK cells expressing NKp30 in the HIV/AIDS group (p = 0.0144). There was a decrease in the frequency of NK cells expressing NKp30 and in the HIV/AIDSWC group, but this was not statistically significant. There were no changes in the distribution of NK cells and their subtypes in both groups. PMID:27382604

  19. Complex care needs of patients with late-stage HIV disease: A retrospective study

    PubMed Central

    Halman, Mark; Carusone, Soo Chan; Stranks, Sarah; Schaefer-McDaniel, Nicole; Stewart, Ann

    2013-01-01

    This retrospective chart review provides a profile of an emerging population of vulnerable HIV patients with complex comorbidities. Data were abstracted from all 87 patients admitted in 2008 to Casey House, a community-based hospital dedicated to supportive and palliative care for persons with HIV in Toronto, Canada. We describe patient characteristics, including medical and psychiatric conditions, and use a Venn diagram and case study to illustrate the frequency and reality of co-occurring conditions that contribute to the complexity of patients’ health and health care needs. The mean age at admission was 48.9 years (SD = 10.5). Eighty percent were male. Patients experienced a mean of 5.8 medical comorbidities (SD = 2.3) and 1.9 psychiatric disorders (lifetime axis I diagnoses). Forty-one patients (47%) experienced cognitive impairment including HIV-associated dementia. Patients were on a mean of 11.8 (SD = 5.3) medications at admission; 74% were on antiretroviral medications with 55% reporting full adherence. Current alcohol and drug use was common with 54% reporting active use at admission. Our Venn diagram illustrates the breadth of complexity in the clients with 9% of clients living in unstable housing with three or more medical comorbidites and two or more psychiatric diagnoses. Comprehensive HIV program planning should include interventions that can flexibly adapt to meet the multidimensional and complex needs of this segment of patients. Researchers, policymakers and clinicians need to have greater awareness of overlapping medical, psychiatric and psychosocial comorbidities. Inclusion of the needs of these most vulnerable patients in the development of evidence based guidelines is an important step for effectively treating, preventing and planning for the future of HIV/AIDS care.

  20. Risk of coronary heart disease among HIV-infected patients: a multicenter study in Brazil.

    PubMed

    Fuchs, Sandra C; Alencastro, Paulo R; Ikeda, Maria Letícia R; Barcellos, Nêmora T; Wolff, Fernando H; Brandão, Ajácio B M; Ximenes, Ricardo A A; Miranda-Filho, Demócrito de B; Lacerda, Heloísa Ramos; de Albuquerque, Maria de Fátima P M; Montarroyos, Ulisses Ramos; Nery, Max W; Turchi, Marilia D

    2013-01-01

    Cardiovascular disease has emerged as a crescent problem among HIV-infected population. This study aimed to determine the 10-year risk of coronary heart disease using the Framingham risk score among HIV-infected patients from three regions of Brazil. This is a pooled analysis of three cohort studies, which enrolled 3,829 individuals, 59% were men, 66% had white skin color, and mean age 39.0 ± 9.9 years. Comparisons among regions showed that there were marked differences in demographic, socioeconomic, clinical, and HIV-related characteristics. Prevalence of Framingham score ≥10 was 4.5% in the Southern, 4.2% in the Midwest, and 3.9% in the Northeast of Brazil. The Framingham score ≥10 was similar between regions for males, patients aged ≥60 years, with obesity, central obesity, hypertension, and diabetes mellitus. Women were three times more likely to have coronary heart disease in 10 years than men. Hypertension and diabetes increased more than four times the risk of coronary heart disease, followed by central obesity, obesity, and prehypertension. The use of antiretroviral agents and time since HIV diagnosis were not risk factors for coronary artery disease in 10 years. In conclusion, hypertension and diabetes are the strongest independent predictors of 10-year risk of coronary heart disease among HIV-infected population.

  1. Retained in HIV Care But Not on Antiretroviral Treatment: A Qualitative Patient-Provider Dyadic Study

    PubMed Central

    Christopoulos, Katerina A.; Olender, Susan; Lopez, Andrea M.; Lekas, Helen-Maria; Jaiswal, Jessica; Mellman, Will; Geng, Elvin; Koester, Kimberly A.

    2015-01-01

    Background Patients retained in HIV care but not on antiretroviral therapy (ART) represent an important part of the HIV care cascade in the United States. Even in an era of more tolerable and efficacious ART, decision making in regards to ART offer and uptake remains complex and calls for exploration of both patient and provider perspectives. We sought to understand reasons for lack of ART usage in patients meeting the Health Resources Services Administration definition of retention as well as what motivated HIV primary care appointment attendance in the absence of ART. Methods and Findings We conducted a qualitative study consisting of 70 in-depth interviews with ART-naïve and ART-experienced patients off ART and their primary care providers in two urban safety-net HIV clinics in San Francisco and New York. Twenty patients and their providers were interviewed separately at baseline, and 15 dyads were interviewed again after at least 3 mo and another clinic visit in order to understand any ART use in the interim. We applied dyadic analysis to our data. Nearly all patients were willing to consider ART, and 40% of the sample went on ART, citing education on newer antiretroviral drugs, acceptance of HIV diagnosis, social support, and increased confidence in their ability to adhere as facilitators. However, the strength of the provider recommendation of ART played an important role. Many patients had internalized messages from providers that their health was too good to warrant ART. In addition, providers, while demonstrating patient-centered care through sensitivity to patients experiencing psychosocial instability, frequently muted the offer of ART, at times unintentionally. In the absence of ART, lab monitoring, provider relationships, access to social services, opiate pain medications, and acute symptoms motivated care. The main limitations of this study were that treatment as prevention was not explored in depth and that participants were recruited from academic

  2. Dengue infections in HIV patients.

    PubMed

    Siong, Wong Chia; Ching, Tan Huey; Jong, Go Chi; Pang, Chan Siew; Vernon, Lee Jian Ming; Sin, Leo Yee

    2008-03-01

    A retrospective review of hospital admission records was conducted on patients who were admitted to the Communicable Disease Center (CDC)/Tan Tock Seng Hospital, Singapore from 1 January 2004 to 31 December 2005. There were 5 HIV patients who were admitted with dengue infection during the study period. Their symptoms were generally mild and recovery was uneventful. None of the patients developed dengue hemorrhagic fever or dengue shock syndrome. The symptoms and signs of dengue infection in HIV patients are nonspecific. It is important for healthcare workers to maintain a high index of suspicion in order to make the diagnosis. Interactions between pathogenesis pathways or with antiviral treatments may have contributed to the apparently less severe dengue infections in HIV patients. This observation needs to be explored further.

  3. Assessing Implicit Cognition Among Patients Lost to Follow-up for HIV Care: A Preliminary Study

    PubMed Central

    Houston, Eric; Lyons, Thomas; Wolfe, Brenda; Rolfsen, Norma; Williams, Maryanne; Rucker, Monique; Glick, Nancy

    2016-01-01

    Objective: While a growing body of research indicates that implicit cognitive processes play an important role in a range of health behaviors, the assessment of these impulsive, associative mental processes among patients living with HIV has received little attention. This preliminary study explored how multidimensional scaling (MDS) could be used to assess implicit cognitive processes among patients lost to follow-up for HIV care and develop interventions to improve their engagement. Method: The sample consisted of 33 patients who were identified as lost to follow up for HIV care at two urban hospitals. Participants were randomly assigned to either the MDS assessment program or control group. All participants underwent measures designed to gauge behavioral change intentions and treatment motivation. Assessment group participants were interviewed to determine their reactions to the assessment program. Results: The MDS assessment program identified cognitive processes and their relationship to treatment-related behaviors among assessment group participants. Assessment group participants reported significantly greater behavior change intentions than those in the control group (p =.02; Cohen’s d = 0.84). Conclusion: MDS shows promise as a tool to identify implicit cognitive processes related to treatment-related behaviors. Assessments based on MDS could serve as the basis for patient-centered clinical interventions designed to improve treatment adherence and HIV care engagement in general. PMID:27347274

  4. Correlation between HIV viral load and aminotransferases as liver damage markers in HIV infected naive patients: a concordance cross-sectional study

    PubMed Central

    Mata-Marín, José Antonio; Gaytán-Martínez, Jesús; Grados-Chavarría, Bernardo Horacio; Fuentes-Allen, José Luis; Arroyo-Anduiza, Carla Ileana; Alfaro-Mejía, Alfredo

    2009-01-01

    Abnormalities in liver function tests could be produced exclusively by direct inflammation in hepatocytes, caused by the human immunodeficiency virus (HIV). Mechanisms by which HIV causes hepatic damage are still unknown. Our aim was to determine the correlation between HIV viral load, and serum levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) as markers of hepatic damage in HIV naive infected patients. We performed a concordance cross-sectional study. Patients with antiviral treatment experience, hepatotoxic drugs use or co-infection were excluded. We used a Pearson's correlation coefficient to calculate the correlation between aminotransferases serum levels with HIV viral load. We enrolled 59 patients, 50 men and 9 women seen from 2006 to 2008. The mean (± SD) age of our subjects was 34.24 ± 9.5, AST 37.73 ± 29.94 IU/mL, ALT 43.34 ± 42.41 IU/mL, HIV viral load 199,243 ± 292,905 copies/mL, and CD4+ cells count 361 ± 289 cells/mm3. There was a moderately strong, positive correlation between AST serum levels and HIV viral load (r = 0.439, P < 0.001); and a weak correlation between ALT serum levels and HIV viral load (r = 0.276, P = 0.034); after adjusting the confounders in lineal regression model the correlation remained significant. Our results suggest that there is an association between HIV viral load and aminotransferases as markers of hepatic damage; we should improved recognition, diagnosis and potential therapy of hepatic damage in HIV infected patients. PMID:19878552

  5. Biomarkers and Bacterial Pneumonia Risk in Patients with Treated HIV Infection: A Case-Control Study

    PubMed Central

    Bjerk, Sonja M.; Baker, Jason V.; Emery, Sean; Neuhaus, Jacqueline; Angus, Brian; Gordin, Fred M.; Pett, Sarah L.; Stephan, Christoph; Kunisaki, Ken M.

    2013-01-01

    Background Despite advances in HIV treatment, bacterial pneumonia continues to cause considerable morbidity and mortality in patients with HIV infection. Studies of biomarker associations with bacterial pneumonia risk in treated HIV-infected patients do not currently exist. Methods We performed a nested, matched, case-control study among participants randomized to continuous combination antiretroviral therapy (cART) in the Strategies for Management of Antiretroviral Therapy trial. Patients who developed bacterial pneumonia (cases) and patients without bacterial pneumonia (controls) were matched 1∶1 on clinical center, smoking status, age, and baseline cART use. Baseline levels of Club Cell Secretory Protein 16 (CC16), Surfactant Protein D (SP-D), C-reactive protein (hsCRP), interleukin-6 (IL-6), and d-dimer were compared between cases and controls. Results Cases (n = 72) and controls (n = 72) were 25.7% female, 51.4% black, 65.3% current smokers, 9.7% diabetic, 36.1% co-infected with Hepatitis B/C, and 75.0% were on cART at baseline. Median (IQR) age was 45 (41, 51) years with CD4+ count of 553 (436, 690) cells/mm3. Baseline CC16 and SP-D were similar between cases and controls, but hsCRP was significantly higher in cases than controls (2.94 µg/mL in cases vs. 1.93 µg/mL in controls; p = 0.02). IL-6 and d-dimer levels were also higher in cases compared to controls, though differences were not statistically significant (p-value 0.06 and 0.10, respectively). Conclusions In patients with cART-treated HIV infection, higher levels of systemic inflammatory markers were associated with increased bacterial pneumonia risk, while two pulmonary-specific inflammatory biomarkers, CC16 and SP-D, were not associated with bacterial pneumonia risk. PMID:23457535

  6. Subtypes of depressive symptoms and inflammatory biomarkers: An exploratory study on a sample of HIV-positive patients.

    PubMed

    Norcini Pala, A; Steca, P; Bagrodia, R; Helpman, L; Colangeli, V; Viale, P; Wainberg, M L

    2016-08-01

    Depressive symptoms cause major impairment and may accelerate HIV progression despite the use of antiretroviral medication. The somatic symptoms criteria for HIV infection and depression partially overlap, which can make differential diagnosis challenging. Because of chronic inflammation caused by HIV infection, HIV-positive patients may develop somatic and affective-cognitive symptoms of depression. Inflammation-related depression is primarily characterized with severe somatic symptoms such as fatigue and sleep disturbance. This study sought to explore the patterns of somatic and cognitive-affective depressive symptoms that characterize HIV-positive patients. Our specific aims were (1) to identify subtypes of depressive symptoms in a sample of HIV-positive patients; and (2) to test the subtypes' difference on inflammatory and HIV disease progression biomarkers. HIV-positive men and women (N=102) with and without depressive symptoms were randomly selected from an Italian HIV clinic. Depressive symptoms (PHQ-9), viral load (VL), CD4+, Il-6, TNF-α, and monocytes were assessed. The three subtypes formed using Latent Class Analysis (LCA) identified patients with (1) severe cognitive-affective and somatic depressive symptoms; (2) severe/moderate somatic symptoms; and (3) absent or low depressive symptoms. The subtype with severe/moderate somatic symptoms was characterized with elevated levels of Il-6 and monocytes. No difference on HIV progression biomarkers was found. The subtypes of depressive symptoms might help differentiating depressive symptoms from HIV- and inflammatory-related somatic symptoms. When present, cognitive-affective and/or somatic symptoms cause significant impairment to patients' lives and thus warrant further assessment and treatment.

  7. Etiological study of lymphadenopathy in HIV-infected patients in a tertiary care hospital

    PubMed Central

    Nag, Dipanwita; Dey, Sumedha; Nandi, Ayandip; Bandyopadhyay, Ranjana; Roychowdhury, Debjani; Roy, Raja

    2016-01-01

    Introduction: Human immunodeficiency virus (HIV) infection has become a global pandemic. Persistent generalized lymphadenopathy (PGL) is very common manifestation of HIV infection. Moreover, different opportunistic infections such as tuberculosis (TB) and malignancies may present with lymphadenopathy. Mycobacterium avium complex (MAC) infection is most common with cluster of differentiation (CD)4+ count ≤50 cells/μL. Fine-needle aspiration cytology (FNAC) offers a simple and effective modality for obtaining a representative sample of the material from lymph nodes, permitting cytological evaluation and other investigations. Aims and Objectives: The aim of this study is to find out the different etiologies of lymphadenopathy in HIV-infected patients and to establish a possible correlation with CD4+ count. Materials and Methods: A total of 100 HIV-infected patients having significant (>1 cm) extrainguinal lymphadenopathy were studied in 1 year at the Department of Pathology by FNAC and the stains used were Leishman–Giemsa, Ziehl–Neelsen (ZN), Papanicoloau, and Gram stains. For tubercular culture, Löwenstein–Jensen (LJ) medium was used. CD4+count was done by flow cytometer. Result: The present study revealed four types of cytomorphological variants in lymphadenopathy cases by FNAC, which include: Reactive hyperplasia and caseation necrosis; caseation necrosis and ill-formed granuloma; well-formed granuloma without any necrosis; and non-Hodgkin lymphoma (NHL). The highest acid-fast bacilli (AFB) positivity was among the patients showing caseation necrosis. Tubercular culture in LJ media turned out as a more sensitive method for diagnosis than routine ZN staining. The 2 cases that showed well-formed epithelioid granuloma without any necrosis turned out to be histoplasmosis and cryptococcosis, respectively. In this study, we found 2 cases of NHL. The study also revealed that caseation necrosis and AFB positivity along with opportunistic infections increases with

  8. A Study of Parasitic and Bacterial Pathogens Associated with Diarrhea in HIV-Positive Patients

    PubMed Central

    Kongre, Vaishali; Kumar, Varun; Bharadwaj, Renu

    2016-01-01

    Introduction Diarrhea is a common complication of acquired immune deficiency syndrome (AIDS), occurring in almost 90% of AIDS patients in developing countries like India. The present study was aimed to determine the prevalence and microbiological profile of pathogens associated with diarrhea in human immunodeficiency virus (HIV) positive patients and their relation to CD4 counts. Materials and methods Forty-five successive HIV-positive patients, 27 with diarrhea (study group) and 18 without diarrhea (control group), were included in the three-month study. The HIV infection was confirmed by three different antibody detection tests. The stool samples were collected on two consecutive days and were examined for parasites by microscopy using wet mount and modified Ziehl-Neelsen stain. They were examined for bacteria by Gram stain and conventional Ziehl-Neelsen stain and were inoculated on appropriate culture media. The isolates were identified by standard biochemical tests, followed by antibiotic susceptibility testing using the Kirby-Bauer disc diffusion method. Results  Twenty-four pathogens were detected in diarrheal HIV-positive patients, including 14 parasites (58.33%), seven bacteria (29.17%), and three fungi (12.50%). Isospora sp. was the most common parasite (25.9%) followed by Cryptosporidium sp. (14.8%). Other parasites included Cyclospora sp., Strongyloides stercoralis, and Entamoeba histolytica (3.7% each).​ Escherichia coli (18.5%) was the most common bacterial isolate, of which, 80% were Enterotoxigenic E. coli (ETEC) while 20% were Enteropathogenic E. coli (EPEC). Other isolates included Shigella flexneri and Mycobacterium tuberculosis (3.7% each). The isolates were sensitive to furazolidone (94.11%), chloramphenicol (76.47%), and gentamicin (52.94%). The isolates from diarrheal patients showed resistance to norfloxacin (5.88% vs. 50%, p<0.05) as compared to those from non-diarrheal patients. The diarrheal HIV-positive patients

  9. High Feasibility of Empiric HIV Treatment for Patients With Suspected Acute HIV in an Emergency Department.

    PubMed

    Jacobson, Kathleen R; Arora, Sanjay; Walsh, Kristin B; Lora, Meredith; Merjavy, Stephen; Livermore, Shanna; Menchine, Michael

    2016-07-01

    Earlier intervention in acute HIV infection limits HIV reservoirs and may decrease HIV transmission. We developed criteria for empiric antiretroviral therapy (ART) in an emergency department (ED) routine HIV screening program. We assessed the feasibility and willingness of patients with suspected acute HIV infection in the ED to begin ART. A suspected acute HIV infection was defined as a positive HIV antigen antibody combination immunoassay with pending HIV-antibody differentiation test results and HIV RNA viral load. During the study period, there were 16 confirmed cases of acute HIV infection: 11 met our criteria for empiric ART and agreed to treatment, 10 were prescribed ART, and 1 left the ED against medical advice without a prescription for ART. Eight patients completed at least one follow-up visit. Empiric HIV treatment in an ED is feasible, well received by patients, and offers a unique entry point into the HIV care continuum. PMID:27028498

  10. Prevalence of metabolic syndrome among HIV-infected patients in Ghana: A cross-sectional study

    PubMed Central

    Obirikorang, Christian; Quaye, Lawrence; Osei-Yeboah, James; Odame, Enoch Anto; Asare, Isaac

    2016-01-01

    Background: Prevalence of metabolic syndrome (MetS) in HIV-infected patients is very limited in the Ghanaian setting and may vary across the globe by the different study populations and criteria used. Aim: We investigated the prevalence of MetS among HIV-infected patients receiving highly active antiretroviral therapy (HAART) at the St. Dominic Hospital, Akwatia, Ghana. Patients and Methods: This cross-sectional study recruited 433 HIV-infected patients (294 on HAART and 139 HAART-naïve) from the period of February 2013 to December 2013. Information on the demographic, clinical, anthropometric characteristics were obtained and lipid profile for each patient was assessed. MetS was assessed based on the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III), World Health Organization (WHO) and International Diabetes Federation (IDF) criteria. Results: The prevalence of MetS was 24.5% according to WHO criteria, 48.3% by NCEP-ATP III criteria, and 42.3% by IDF criteria. In general, participants on HAART were significantly associated with higher prevalence of MetS compared to those without HAART (P < 0.05) irrespective of the criteria used. Prevalence of clustering components of MetS was significantly higher among those on HAART when risk scores of 2 and above were used compared with those not on HAART (P < 0.05). Conclusion: HAART recipient developed MetS as indicated by dyslipidemia, high blood pressure, and abnormal body fat. It is incumbent on health giver to incorporate MetS assessment as a part of treatment and management plan in patients receiving HAART. PMID:27226681

  11. Clinical outcomes in breast cancer patients with HIV/AIDS: a retrospective study.

    PubMed

    Gomez, Alexandra; Montero, Alberto J; Hurley, Judith

    2015-02-01

    The purpose of the study is to describe what is the presentation of breast cancer in women with HIV, their tolerance to therapy, the most common complications of treatment and their outcomes. Retrospective chart review of patients with HIV diagnosed with breast cancer between January 1, 1989 and December 31, 2013 at the University of Miami/Jackson Memorial Hospital (UM/JMH) 47 females and 1 male were included in the analysis. The median age of diagnosis was 46 years (IQR 41-52) and 64% of the women were premenopausal. Median CD4(+) count was 330 cells/µL (IQR 131-589 cells/µL). 41% had AIDS at time of diagnosis. 94% of patients presented with locoregional disease and 6% with late stage breast cancer. 52% had ER(+) tumors. 6% had HER-2/neu tumor expression and 21 % had triple negative disease. The 5 year PFS was 50% (95% CI 34-64%), the 5 year OS was 44% (95% CI 29-58%), and the Breast cancer-specific survival was 57% (95% CI 40-70%). Death was attributed to breast cancer in 22 patients, AIDS progression in 6 patients, other medical condition in 1, and for 4, the cause was unknown. Serious adverse events were documented in 46% of patients treated with chemotherapy. Targeted therapy was well tolerated. Patients with HIV/AIDS and breast cancer pose a major challenge for oncologists. Surgery, radiation, and endocrine therapy are well tolerated. Standard dose chemotherapy can have life-threatening side effects which can be managed with growth factor support and antimicrobial prophylaxis. All cancer therapy can be given while continuing with antiviral therapy at full dose.

  12. Statin Use Is Associated With Incident Diabetes Mellitus Among Patients in the HIV Outpatient Study

    PubMed Central

    Lichtenstein, Kenneth A.; Hart, Rachel L. D.; Wood, Kathleen C.; Bozzette, Samuel; Buchacz, Kate; Brooks, John T.

    2015-01-01

    Introduction Statin therapy is effective in the prevention of cardiovascular disease in the general population but has been shown to modestly increase the risk for incident diabetes mellitus (DM). Methods We analyzed incident DM in HIV Outpatient Study (HOPS) participants followed at 8 HIV clinic sites during 2002–2011, comparing rates among those who initiated statin therapy during that period with those who did not. Using Cox proportional hazards models, we examined the association between cumulative years of statin exposure and the risk of developing DM, after controlling for age, sex, race/ethnicity, antiretroviral history, prevalent hepatitis C, body mass index, and cumulative exposure to protease inhibitor therapy. We also adjusted for propensity scores to account for residual confounding by indication. Results Of 4692 patients analyzed, 590 (12.6%) initiated statin therapy and 355 (7.2%) developed DM. Incident DM was independently associated with statin therapy (adjusted hazard ratio, 1.14 per year of statin use), as well as older age, Hispanic/Latino ethnicity, non-Hispanic/Latino black race, antiretroviral-naive status, prevalent hepatitis C, and body mass index ≥30 kg/m2 (P < 0.05 for all). The association of statin use with incident DM was similar in the model adjusted for propensity score. Conclusions Statin use was associated with a modestly increased risk of incident DM in an HIV-infected population, similar to existing data for the general population. HIV-infected patients should be monitored for glucose intolerance, but statins should not be withheld if clinically indicated for cardiovascular disease risk reduction. PMID:26181706

  13. HIV/AIDS and the risk of deep vein thrombosis: a study of 45 patients with lower extremity involvement.

    PubMed

    Saber, A A; Aboolian, A; LaRaja, R D; Baron, H; Hanna, K

    2001-07-01

    Many aspects of acquired immunodeficiency syndrome (AIDS) have been described in detail in the literature. However, there have been very few articles on the phenomenon of deep vein thrombosis (DVT) in the lower extremities of human immunodeficiency virus (HIV)/AIDS patients. The objective of this communication is to record the incidence of DVT in HIV/AIDS patients and the risks for development of embolic events and to emphasize the need for prevention and for the vigorous treatment of this complication. We conducted a retrospective review of HIV/AIDS-infected patients with DVT admitted to Mount Sinai School of Medicine/Cabrini Hospital in New York during the last 5 years. Analysis includes demographic data; risk factors for HIV/AIDS infection; associated medical problems; recent surgery; and laboratory findings including CD4 counts, platelet counts, prothrombin times, partial thromboplastin times, and plasma albumin levels; and image studies. From January 1995 to January 2000 4752 HIV/AIDS-infected patients were admitted. Of those admitted to the hospital 45 (0.95%) were found to have DVT. There were 36 males and nine females (mean age 43 years). Of the 45 patients 38 had infectious complications and 13 developed a malignancy. The distribution of the thromboses were the femoral vein in 23 patients, the popliteal vein in 20 patients, and the iliofemoral system in 2 patients. Twelve patients had recurrent DVT and three patients developed a pulmonary embolism. HIV/AIDS infection is a considerable risk for development of DVT in the lower extremity. Statistically DVT in HIV/AIDS is approximately 10 times greater than in the general population. Emphasis upon prevention and vigorous treatment of DVT is recommended.

  14. Study of T Cell subsets and IL-7 protein expression in HIV-1-infected patients after 7 years HAART

    PubMed Central

    2011-01-01

    Objective To study the changes in T cell subsets and IL-7 in HIV-1-infected patients after seven years of highly active antiretroviral therapy (HAART). Methods Seventy-five individuals were included in this study (25 with effective HAART, 18 with ineffective HAART, 17 untreated HIV+ patients, and 15 volunteers in the HIV negative control group). The counts of CD4+, CD8+, CD8/CD38+, and CD8/HLADR+ T cells as well as the IL-7 protein expression was measured at 5 time points during a period of seven years in patients starting HAART (baseline) and in the HIV negative control group. The expression of CD127 on CD3+ T cells was measured by flow cytometry at a single time point (after 7 years) in patients with HAART and was compared with untreated HIV+ patients and the HIV negative control group. Results At baseline CD4+ T cell counts of HIV-1-infected patients were lower than that in the control group (p < 0.01), whereas the CD8+, CD8/HLADR+ and CD8/CD38+ T cell counts were higher than those in the control group (p <0.01). After seven years of effective HAART, the CD4+ T cell counts had increased and the CD8+ T cell count had decreased, although not to the normal levels (p < 0.05). Both the CD8/HLADR+ and CD8/CD38+ T cell counts had gradually approached those of the control group (p > 0.05). In the ineffective HAART group, the CD8/CD38+ T cell count had not decreased significantly, and CD8/HLADR+ T cell count gradually decreased. Before treatment, IL-7 serum levels of patients were significantly higher than that in the control group (p < 0.01). After seven years of effective HAART, IL-7 levels had gradually decreased, but were still higher than in the control group (p < 0.01). The CD127 expression on CD3+ CD8+ T cells in effective HAART patients was higher than in untreated HIV+ patients (p < 0.05), but was lower than that in the control group (p < 0.05). CD127 expression on CD3+ CD4+ T cells was not significantly different among the control group, untreated HIV+ patients

  15. Use of electronic personal health record systems to encourage HIV screening: an exploratory study of patient and provider perspectives

    PubMed Central

    2011-01-01

    Background When detected, HIV can be effectively treated with antiretroviral therapy. Nevertheless in the U.S. approximately 25% of those who are HIV-infected do not know it. Much remains unknown about how to increase HIV testing rates. New Internet outreach methods have the potential to increase disease awareness and screening among patients, especially as electronic personal health records (PHRs) become more widely available. In the US Department of Veterans' Affairs medical care system, 900,000 veterans have indicated an interest in receiving electronic health-related communications through the PHR. Therefore we sought to evaluate the optimal circumstances and conditions for outreach about HIV screening. In an exploratory, qualitative research study we examined patient and provider perceptions of Internet-based outreach to increase HIV screening among veterans who use the Veterans Health Administration (VHA) health care system. Findings We conducted two rounds of focus groups with veterans and healthcare providers at VHA medical centers. The study's first phase elicited general perceptions of an electronic outreach program to increase screening for HIV, diabetes, and high cholesterol. Using phase 1 results, outreach message texts were drafted and then presented to participants in the second phase. Analysis followed modified grounded theory. Patients and providers indicated that electronic outreach through a PHR would provide useful information and would motivate patients to be screened for HIV. Patients believed that electronic information would be more convenient and understandable than information provided verbally. Patients saw little difference between messages about HIV versus about diabetes and cholesterol. Providers, however, felt patients would disapprove of HIV-related messages due to stigma. Providers expected increased workload from the electronic outreach, and thus suggested adding primary care resources and devising methods to smooth the flow of

  16. A cross-sectional study of HIV-seropositive patients with varying degrees of proteinuria in South Africa.

    PubMed

    Han, T M; Naicker, S; Ramdial, P K; Assounga, A G

    2006-06-01

    Human immunodeficiency virus (HIV)-associated nephropathy (HIVAN) is the most common finding on renal biopsy in HIV-infected black patients and is also the commonest cause of end-stage renal disease in these patients. Early detection of HIVAN may be beneficial in evaluating early treatment. This study examined the pattern of renal diseases in HIV-infected South Africans and also attempted to diagnose HIVAN at an early stage. In this single-center cross-sectional study, 615 HIV-infected patients were screened for proteinuria. Thirty patients with varying degrees of proteinuria underwent renal biopsy. Patients with diabetes mellitus, uncontrolled hypertension, known causes of chronic kidney disease, and serum creatinine above 250 mumol/l were excluded. Patients in this study were not on antiretroviral therapy. HIVAN was found in 25 (83%) patients. Six of them (24%) had microalbuminuria. Altogether, seven patients with persistent microalbuminuria were biopsied and six (86%) showed HIVAN. Other biopsy findings included membranoproliferative nephropathy in two (7%) and interstitial nephritis in three (10%). Four patients with HIVAN had associated membranous nephropathy. HIVAN is the commonest biopsy finding among our study patients with HIV infection who present with varying degrees of proteinuria. Microalbuminuria is a manifestation of HIVAN in our study patients. Therefore, microalbuminuria may be an early marker of HIVAN, and screening for its presence may be beneficial. Renal biopsy may be considered in seropositive patients who present with persistent microalbuminuria, especially with low CD4 counts irrespective of good renal function. This will allow diagnosis and treatment of HIVAN at an early stage and may prevent further disease progression. PMID:16672914

  17. A Comparison of Methods for Analyzing Viral Load Data in Studies of HIV Patients.

    PubMed

    Rose, Charles E; Gardner, Lytt; Craw, Jason; Girde, Sonali; Wawrzyniak, Andrew J; Drainoni, Mari-Lynn; Davila, Jessica; DeHovitz, Jack; Keruly, Jeanne C; Westfall, Andrew O; Marks, Gary

    2015-01-01

    HIV RNA viral load (VL) is a pivotal outcome variable in studies of HIV infected persons. We propose and investigate two frameworks for analyzing VL: (1) a single-measure VL (SMVL) per participant and (2) repeated measures of VL (RMVL) per participant. We compared these frameworks using a cohort of 720 HIV patients in care (4,679 post-enrollment VL measurements). The SMVL framework analyzes a single VL per participant, generally captured within a "window" of time. We analyzed three SMVL methods where the VL binary outcome is defined as suppressed or not suppressed. The omit-participant method uses a 8-month "window" (-6/+2 months) around month 24 to select the participant's VL closest to month 24 and removes participants from the analysis without a VL in the "window". The set-to-failure method expands on the omit-participant method by including participants without a VL within the "window" and analyzes them as not suppressed. The closest-VL method analyzes each participant's VL measurement closest to month 24. We investigated two RMVL methods: (1) repeat-binary classifies each VL measurement as suppressed or not suppressed and estimates the proportion of participants suppressed at month 24, and (2) repeat-continuous analyzes VL as a continuous variable to estimate the change in VL across time, and geometric mean (GM) VL and proportion of participants virally suppressed at month 24. Results indicated the RMVL methods have more precision than the SMVL methods, as evidenced by narrower confidence intervals for estimates of proportion suppressed and risk ratios (RR) comparing demographic strata. The repeat-continuous method had the most precision and provides more information than other considered methods. We generally recommend using the RMVL framework when there are repeated VL measurements per participant because it utilizes all available VL data, provides additional information, has more statistical power, and avoids the subjectivity of defining a "window." PMID

  18. Kaposi Sarcoma among HIV Infected Patients in Lagos University Teaching Hospital, Nigeria: A 14-Year Retrospective Clinicopathological Study

    PubMed Central

    Akinde, Olakanmi; Adeyemo, Titilope; Omoseebi, Oladipo; Ikeri, Nzechukwu; Okonkwo, Ikechukwu; Afolayan, Olatunji

    2016-01-01

    Background. Despite the increased incidence of Kaposi sarcoma (KS) resulting from the Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) pandemic, there is still significant underreporting of KS in this environment. Objectives. This study was aimed at determining the incidence and clinicopathologic patterns of KS among HIV infected patients in Lagos University Teaching Hospital (LUTH), Nigeria, over a 14-year period: January 2000 to December 2013. Methodology. The materials for this study included patients' hospital clinical files, duplicate copies of histopathologic reports, and tissue blocks and corresponding archival slides in the Anatomic and Molecular Pathology Department and the HIV/AIDS unit of the Department of Haematology. Results. Within the study period, 182 cases of KS were diagnosed, accounting for 1.2% of all patients managed for HIV/AIDS and 2.99% of solid malignant tumours. The male-to-female ratio and modal age group were 1 : 1.3 and 5th decade, respectively. Most cases (90%) had purely mucocutaneous involvement with the lower limb being the commonest site (65.8%). The majority of lesions were plaques (65.8%). Vascular formation was the predominant histologic type seen (43.5%). Conclusion. KS in Lagos followed the same epidemiologic trend as other centers in Nigeria, with an increasing incidence in this era of HIV/AIDS. PMID:27034839

  19. Ocular manifestation of HIV/AIDS and correlation with CD4+ cells count among adult HIV/AIDS patients in Jimma town, Ethiopia: a cross sectional study

    PubMed Central

    2013-01-01

    Background HIV/AIDS is one of twenty first century’s challenges to human being with protean manifestation affecting nearly all organs of our body. It is causing high morbidity and mortality especially in sub-Saharan Africa with numerous ocular complications and blindness. The purpose of this study was to determine the patterns of ocular manifestations of HIV/AIDS and their correlation with CD4+Tcells count. Methods A cross-sectional study was done on 348 HIV-positive patients presented to Anti-Retroviral Therapy clinics. Data were collected using face-to-face interview, clinical examination and laboratory investigation, and analyzed using SPSS version 13 software. Statistical association test was done and p<0.05 was considered significant. Other statistical tests like student t-test and logistic regression were also done. Results Of 348 patients, 175 were on antiretroviral therapy and 173 were not on therapy. The mean duration of therapy was 27 months. The overall prevalence of ocular manifestations was 25.3%. The commonest ocular manifestation was keratoconjunctivitis sicca (11.3%) followed by blepharitis (3.2%), molluscum contagiosum (2.6%), conjunctival squamous cell carcinoma (2.3%), conjunctival microvasculopathy (2.3%), cranial nerve palsies (2%), herpes zoster ophthalmicus (HZO) (1.2%), and HIV retinopathy (0.6%). HIV retinopathy and conjunctival microvasculopathy were common in patient with CD4+ count of <200 cells/μl while HZO and molluscum contagiosum were common in patients with CD4+ count of 200–499 cells/μl. Prevalence of ocular manifestation was higher among patients on HAART (32.6%) than those patients not on HAART (17.9%) (p<0.05). There was statistically significant association between ocular manifestation and sex, CD4+Tcells count, and age (p<0.05). CD4+ count, <200 cells/μl and age >35 years were independent risk factors for ocular manifestations. Conclusion The study showed that the prevalence of ocular manifestation of HIV/AIDS is

  20. Reliability and validity of mobile teledermatology in HIV positive patients in Botswana: a pilot study

    PubMed Central

    Azfar, Rahat S; Lee, Robert A.; Castelo-Soccio, Leslie; Greenberg, Martin S.; Bilker, Warren B; Gelfand, Joel M; Kovarik, Carrie L

    2014-01-01

    Importance Mobile teledermatology may increase access to care. Objective To determine if mobile teledermatology in HIV positive patients in Gaborone, Botswana was reliable and produced valid consultations in comparison to face-to-face dermatology consultations. Design Cross-sectional study Setting Outpatient clinics and public inpatient settings in Botswana. Participants 76 HIV positive patients aged 18 years and up with a skin or mucosal complaint that had not been previously evaluated by a dermatologist. Main Outcome(s) and Measure(s) We calculated Cohen's kappa coefficient for diagnosis, diagnostic category and management for test-retest reliability and for inter-rater reliability. We also calculated sensitivity and specificity for each diagnosis. Results Cohen's kappa for test-retest reliability ranged from 0.47 (95% CI 0.35-0.59) to 0.78 (95% CI 0.67-0.88) for the primary diagnosis, 0.29 (95% CI 0.18-0.42) to 0.73 (95% CI 0.61-0.84) for diagnostic category, and 0.17 (95% CI -0.01-0.36) to 0.54 (95% CI 0.38-0.70) for management. Cohen's kappa for inter-rater reliability ranged from 0.41 (95% CI 0.31-0.52) to 0.51 (95% CI 0.41-0.61) for the primary diagnosis, from 0.22 (95% CI 0.14-0.31) to 0.43 (95% CI 0.34-0.53) for the diagnostic category for the primary diagnosis and from 0.08 (95% CI 0.02-0.15) to 0.12 (95% CI 0.01-0.23) for management. Sensitivity and specificity for the top ten diagnoses ranged from 0 to 0.88 and from 0.84 to 1 respectively. Conclusions and Relevance Our results suggest that while the use of mobile teledermatology technology in HIV-positive patients in Botswana has significant potential for improving access to care, additional work is needed to improve reliability and validity of this technology on a larger scale in this population. PMID:24622778

  1. Perceptions of quality of life among Ugandan patients living with HIV: a qualitative study

    PubMed Central

    2014-01-01

    Background Ugandans have endured the HIV epidemic for three decades. Now, with the availability of antiretroviral therapy (ART) and early diagnosis, those living with HIV can live longer and can enjoy the same life expectancy as the rest of the Ugandan population. This emerging trend necessitates the assessment of quality of life, alongside other patient outcomes, of those undergoing therapy, alongside other patient outcomes. While major strides have been made in developing measures of quality of life in the developed world, there remains a paucity of evidence from resource-limited settings. This challenge is further complicated by the contentious definition of quality of life, which is highly subjective and varies between individuals. In this paper, we aim to identify the determinants of quality of life for people living with HIV in a Ugandan context to contribute to the chronic care model for persons living with HIV/AIDS. Methods Twenty HIV-positive participants took part in in-depth interviews at an urban clinic, with follow-ups at three and six months. Ten patients were on ART and ten not on ART. All interviews were transcribed and translated for analysis. Data were analysed manually using the framework approach to content analysis. Results Individuals reported on four aspects of quality of life: liveability of the environment, utility of life, life ability of a person and appreciation of life. Respondents described multiple expectations and expressed hope for their future. However, many still suffered from stigma, fears of disclosure and poverty, which negatively affected their quality of life. Conclusions Individuals living with HIV receiving treatment or in care experienced an improved quality of life in this setting, although the situation for many remains precarious. PMID:24721338

  2. Prevalence and impact of body physical changes in HIV patients treated with highly active antiretroviral therapy: results from a study on patient and physician perceptions.

    PubMed

    Cabrero, Esther; Griffa, Laura; Burgos, Angel

    2010-01-01

    Patients infected with HIV treated with highly active antiretroviral therapy (HAART) frequently develop body physical changes (BPC) that have an important psychosocial burden. The purpose of this study was to determine the prevalence of BPC observed by HIV-infected patients and their attending physicians and to assess the impact BPC had on daily life. In this epidemiologic multicenter study, patients with HIV infection and their treating physicians filled out parallel questionnaires about their perceptions of specific BPC and their impact on daily activities. A total of 965 patient-physician questionnaires were collected across 98 health centers. Patient's mean age was 43.7 +/- 8.5 years and 72.6% were men. Adjusted prevalence of perceived BPC by patients and physicians was 55.1% (95% confidence interval [CI]: 52.0-58.1) and 55.2% (95% CI: 52.1-58.2), respectively (p = 1.000). Overall patient-physician agreement concerning perception of BPC was 83% (p < 0.0005). The most common BPC was lipoatrophy, described by 46.8% (95% CI: 43.7-49.8) of patients and 49.4% (95% CI: 46.3-52.5) of physicians (p = 0.033) followed by lipohypertrophy. No gender differences were observed in the global prevalence of BPC (p = 0.649). However, significantly more women reported lipoatrophy of the lower limbs (p = 0.009) and buttocks (p = 0.007), as well as lipohypertrophy (p = 0.007), than men; 58.2% (95% CI: 54.0-62.4) patients noted that BPC negatively affected their daily activities. This study reflects the high prevalence of patient and physician-perceived BPC in the HIV population, and the adverse impact on daily life. Physicians should be aware of the psychosocial consequences of BPC in HIV patients in order to improve patient well-being.

  3. Anolunula in Fingernails among Patients Infected with HIV.

    PubMed

    Gahalaut, Pratik; Mishra, Nitin; Chauhan, Sandhya; Ali, Mir Mubashir; Rastogi, Madhur Kant; Thakur, Richa

    2014-01-01

    Lunula is the white, half-moon shaped area seen in proximal ends of some nails. Though a few studies have described the nail changes that can occur in association with HIV infection, none of these paid much attention to lunula. Aims and Objectives. To study the lunula in fingernails among HIV infected patients. Materials and Methods. An observational, cross-sectional study to record presence of lunula in 168 HIV-positive patients and compare it with age and sex matched 168 healthy HIV-negative control. Anolunula (absence of lunula) in HIV-positive patients was correlated with CD4 counts, stages of HIV infection, time since patient was diagnosed as HIV-positive, and status of antiretroviral therapy. Results. Anolunula was present in significantly more fingernails in HIV-positive patients compared to HIV-negative controls. There was a highly significant difference for total anolunula (anolunula in all fingernails) in study and control group. Incidence of total anolunula was directly proportional to the stage of HIV infection, increasing progressively as the HIV infection advances from stage 1 to stage 4. Conclusion. Absence of lunula is related to not only HIV infection per se but also the stages of HIV infection.

  4. Cohort Profile: The Bissau HIV Cohort-a cohort of HIV-1, HIV-2 and co-infected patients.

    PubMed

    Jespersen, Sanne; Hønge, Bo Langhoff; Oliveira, Inés; Medina, Candida; da Silva Té, David; Correira, Faustino Gomes; Erikstrup, Christian; Laursen, Alex Lund; Østergaard, Lars; Wejse, Christian

    2015-06-01

    The West African country Guinea-Bissau is home to the world's highest prevalence of HIV-2, and its HIV-1 prevalence is rising. Other chronic viral infections like human T-lymphotropic virus type 1 (HTLV-1) and hepatitis B virus are common as well. The Bissau HIV Cohort was started in 2007 to gain new insights into the overall effect of introducing antiretroviral treatment in a treatment-naïve population with concomitant infection with three retroviruses (HIV-1, HIV-2 and HTLV-1) and tuberculosis. The cohort includes patients from the HIV clinic at Hospital Nacional Simão Mendes, the main hospital in Bissau, the capital of the country. From July 2007 to June 2013, 3762 HIV-infected patients (69% HIV-1, 18% HIV-2, 11% HIV-1/2 and 2% HIV type unknown) were included in the world's largest single-centre HIV-2 cohort. Demographic and clinical data are collected at baseline and every 6 months, together with CD4 cell count and routine biochemistry analyses. Plasma and cells are stored in a biobank in Denmark. The Bissau HIV Cohort is administered by the Bissau HIV Cohort study group. Potential collaborators are invited to contact the chair of the cohort study group, Christian Wejse, e-mail: [wejse@dadlnet.dk].

  5. A Retrospective Cohort Study of Lesion Distribution of HIV-1 Infection Patients With Cryptococcal Meningoencephalitis on MRI

    PubMed Central

    Xia, Shuang; Li, Xueqin; Shi, Yanbin; Liu, Jinxin; Zhang, Mengjie; Gu, Tenghui; Pan, Shinong; Song, Liucun; Xu, Jinsheng; Sun, Yan; Zhao, Qingxia; Lu, Zhiyan; Lu, Puxuan; Li, Hongjun

    2016-01-01

    Abstract The objective of this paper is to correlate the MRI distribution of cryptococcal meningoencephalitis in HIV-1 infection patients with CD4 T cell count and immune reconstitution effect. A large retrospective cohort study of HIV patients from multi-HIV centers in China was studied to demonstrate the MRI distribution of cryptococcal meningoencephalitis and its correlation with the different immune status. The consecutive clinical and neuroimaging data of 55 HIV-1-infected patients with cryptococcal meningoencephalitis collected at multi-HIV centers in China during the years of 2011 to 2014 was retrospectively analyzed. The enrolled patients were divided into 2 groups based on the distribution of lesions. One group of patients had their lesions at the central brain (group 1, n = 34) and the other group of patients had their lesions at the superficial brain (group 2, n = 21). We explored their MRI characterization of brain. In addition, we also compared their CD4 T cell counts and immune reconstitution effects between the 2 groups based on the imaging findings. No statistical difference was found in terms of age and gender between the 2 groups. The medians of CD4 T cell counts were 11.67 cells/mm3 (3.00–52.00 cells/mm3) in group 1 and 42.00 cells/mm3 (10.00–252.00 cells/mm3) in group 2. Statistical difference of CD4 T cell count was found between the 2 groups (P = 0.023). Thirteen patients in group 1 (13/34) and 12 patients in group 2 (12/21) received highly active antiretroviral treatment (HAART). Patients of group 2 received HAART therapy more frequently than patients of group 1 (P = 0.021). Central and superficial brain lesions detected by MR imaging in HIV-1-infected patients with cryptococcal meningoencephalitis are in correlation with the host immunity and HAART therapy. PMID:26871791

  6. Endocrine function in 98 HIV-infected patients: a prospective study.

    PubMed

    Raffi, F; Brisseau, J M; Planchon, B; Rémi, J P; Barrier, J H; Grolleau, J Y

    1991-06-01

    Endocrine function was prospectively evaluated in 98 patients (73 men and 25 women) infected by HIV in various stages of illness: Centers for Disease Control groups II (19), III (20), IVA and IVC2 (27), IVC1 and IVD (32). Testing included baseline and post-stimulation evaluation of gonadal, thyroidal, and adrenal axes. Although adrenal function was within normal values in most cases, with no differences between patient groups, nine out of 98 patients had either a low baseline or post-stimulation serum cortisol, cytomegalovirus adrenalitis being suspected in two cases. Mineralocorticoid response was normal in all individuals. The main abnormalities were sick euthyroid syndrome with low tri-idothyronine and/or thyroxine in 16% of patients and hypotestosteronemia in 29% of men with AIDS. These abnormalities, related to a functional deficiency of the hypothalamic-pituitary axis, were highly correlated with the degree of illness, i.e. weight loss and low CD4+ cell count. It was concluded that endocrine dysfunction in HIV-infected patients is rarely of clinical significance, that it is related more to cachexia and advanced disease than to HIV or opportunistic infections, and that it could serve as a prognostic marker.

  7. Barriers and facilitators to antiretroviral medication adherence among patients with HIV in Chennai, India: a qualitative study.

    PubMed

    Kumarasamy, N; Safren, Steven A; Raminani, Sudha R; Pickard, Robert; James, Romola; Krishnan, A K Sri; Solomon, Suniti; Mayer, Kenneth H

    2005-08-01

    Antiretroviral therapy (ART) for HIV is increasingly being introduced and utilized in diverse areas of the world. However, little research exists on adherence to ART in different cultural settings, particularly in developing countries such as India. This formative qualitative study examined barriers and facilitators of ART adherence among 60 (49 men, 11 women; 33 taking ART, 27 not currently taking ART) patients receiving HIV primary care at YRG CARE, a nongovernmental organization, in Chennai, India. The average participant reported becoming HIV infected through heterosexual transmission, was between 31 and 40 years old, had over ninth class standard education, was married, and generally had access to medical care; however, we obtained some qualitative data from various other risk categories. Trained ethnographers at the study site conducted in-depth interviews in the local language. These interviews were analyzed for content and ethnographic data. Almost all of the participants discussed the cost of ART as a barrier, with many reporting extended drug holidays, turning to family and/or friends, or taking drastic measures (i.e., selling family jewels, property) for financial assistance. Other barriers centered on privacy and stigma issues, such as disclosure of HIV inhibiting pill-taking and social support. Frequently discussed facilitators of adherence included perceived benefits of ART and proper adherence, perceptions about the consequences of nonadherence, and social support, if available. These data highlight the importance of reducing the cost of antiretroviral medications, involving family members in HIV care, and addressing privacy issues and stigma in counseling interventions in this setting.

  8. Understanding how adherence goals promote adherence behaviours: a repeated measure observational study with HIV seropositive patients

    PubMed Central

    2012-01-01

    Background The extent to which patients follow treatments as prescribed is pivotal to treatment success. An exceptionally high level (> 95%) of HIV medication adherence is required to suppress viral replication and protect the immune system and a similarly high level (> 80%) of adherence has also been suggested in order to benefit from prescribed exercise programmes. However, in clinical practice, adherence to both often falls below the desirable level. This project aims to investigate a wide range of psychological and personality factors that may lead to adherence/non-adherence to medical treatment and exercise programmes. Methods HIV positive patients who are referred to the physiotherapist-led 10-week exercise programme as part of the standard care are continuously recruited. Data on social cognitive variables (attitude, intention, subjective norms, self-efficacy, and outcome beliefs) about the goal and specific behaviours, selected personality factors, perceived quality of life, physical activity, self-reported adherence and physical assessment are collected at baseline, at the end of the exercise programme and again 3 months later. The project incorporates objective measures of both exercise (attendance log and improvement in physical measures such as improved fitness level, weight loss, improved circumferential anthropometric measures) and medication adherence (verified by non-invasive hair analysis). Discussion The novelty of this project comes from two key aspects, complemented with objective information on exercise and medication adherence. The project assesses beliefs about both the underlying goal such as following prescribed treatment; and about the specific behaviours such as undertaking the exercise or taking the medication, using both implicit and explicit assessments of patients’ beliefs and attitudes. We predict that i) the way people think about the underlying goal of their treatments explains medication and exercise behaviours over and above

  9. The Importance of the Family: A Longitudinal Study of the Predictors of Depression in HIV Patients in South Africa.

    PubMed

    Wouters, Edwin; Masquillier, Caroline; le Roux Booysen, Frederik

    2016-08-01

    As a chronic illness, HIV/AIDS requires life-long treatment adherence and retention-and thus sufficient attention to the psychosocial dimensions of chronic disease care in order to produce favourable antiretroviral treatment (ART) outcomes in a sustainable manner. Given the high prevalence of depression in chronic HIV patients, there is a clear need for further research into the determinants of depression in this population. In order to comprehensively study the predictors of depressive symptoms in HIV patients on ART, the socio-ecological theory postulates to not only incorporate the dominant individual-level and the more recent community-level approaches, but also incorporate the intermediate, but crucial family-level approach. The present study aims to extend the current literature by simultaneously investigating the impact of a wide range individual-level, family-level and community-level determinants of depression in a sample of 435 patients enrolled in the Free State Province of South Africa public-sector ART program. Structural equation modeling is used to explore the relationships between both latent and manifest variables at two time points. Besides a number of individual-level correlates-namely education, internalized and external stigma, and avoidant and seeking social support coping styles-of depressive symptoms in HIV patients on ART, the study also revealed the important role of family functioning in predicting depression. While family attachment emerged as the only factor to continuously and negatively impact depression at both time points, the second dimension of family functioning, changeability, was the only factor to produce a negative cross-lagged effect on depression. The immediate and long-term impact of family functioning on depression draws attention to the role of family dynamics in the mental health of people living with HIV/AIDS. In addition to individual-level and community-based factors, future research activities should also

  10. Patterns and trends in mortality among HIV-infected and HIV-uninfected patients in a major Internal Medicine Unit in Yaoundé, Cameroon: a retrospective cohort study

    PubMed Central

    Mbuagbaw, Josephine; Jingi, Ahmadou M; Kaze, Arnaud D; Nansseu, Jobert Richie N; Bigna, Jean Joel R; Wawo Yonta, Edvine; Ngu Blackett, Kathleen

    2016-01-01

    Objective To describe the trends in mortality and the spectrum of disease in HIV-infected and -uninfected inpatients in a population in Yaoundé. Design A retrospective study. Setting Internal Medicine Unit, University Hospital Centre, Yaoundé, Cameroon. Participants All deaths registered between January 2000 and May 2007 in the unit. Main outcomes measures Sociodemographic characteristics, clinical features and results of all investigations done, cause of death. Results During the study period, 362 deaths were registered, consisting of 281 (77.6%) in HIV-infected patients, 54.4% of which were women. HIV-infected patients were younger (mean age: 40.2 (SD: 11.6) vs. 55.5 (SD: 18.3) years, p < 0.001) and economically active (60.3% vs. 24.4%, p < 0.001). Most HIV-infected patients (77.6%) were classified as WHO stage IV, with the rest being WHO stage III. Most HIV-infected patients (87.8%) had evidence of profound immunosuppression (CD4 < 200 cells/mm3). The mortality trend appeared to be declining with appropriate interventions. The most frequent causes of death in HIV-infected patients were pleural/pulmonary tuberculosis (34.2%), undefined meningoencephalitis (20.3%), other pneumonias (18.2%), toxoplasmosis (16.4%), cryptococcal meningitis (14.2%) and Kaposi sarcoma (15.7%). HIV-uninfected patients died mostly as a result of chronic diseases including liver diseases (17.3%), kidney failure (13.6%), congestive heart failure (11.1%) and stroke (9.9%). Conclusion There was a declining mortality due to HIV with appropriate interventions such as subsidised tests for HIV-infected patients, increased availability of HAART and other medications for prevention and treatment of opportunistic infections. The spectrum of HIV disease was wide and preventable. PMID:27688899

  11. Patterns and trends in mortality among HIV-infected and HIV-uninfected patients in a major Internal Medicine Unit in Yaoundé, Cameroon: a retrospective cohort study

    PubMed Central

    Mbuagbaw, Josephine; Jingi, Ahmadou M; Kaze, Arnaud D; Nansseu, Jobert Richie N; Bigna, Jean Joel R; Wawo Yonta, Edvine; Ngu Blackett, Kathleen

    2016-01-01

    Objective To describe the trends in mortality and the spectrum of disease in HIV-infected and -uninfected inpatients in a population in Yaoundé. Design A retrospective study. Setting Internal Medicine Unit, University Hospital Centre, Yaoundé, Cameroon. Participants All deaths registered between January 2000 and May 2007 in the unit. Main outcomes measures Sociodemographic characteristics, clinical features and results of all investigations done, cause of death. Results During the study period, 362 deaths were registered, consisting of 281 (77.6%) in HIV-infected patients, 54.4% of which were women. HIV-infected patients were younger (mean age: 40.2 (SD: 11.6) vs. 55.5 (SD: 18.3) years, p < 0.001) and economically active (60.3% vs. 24.4%, p < 0.001). Most HIV-infected patients (77.6%) were classified as WHO stage IV, with the rest being WHO stage III. Most HIV-infected patients (87.8%) had evidence of profound immunosuppression (CD4 < 200 cells/mm3). The mortality trend appeared to be declining with appropriate interventions. The most frequent causes of death in HIV-infected patients were pleural/pulmonary tuberculosis (34.2%), undefined meningoencephalitis (20.3%), other pneumonias (18.2%), toxoplasmosis (16.4%), cryptococcal meningitis (14.2%) and Kaposi sarcoma (15.7%). HIV-uninfected patients died mostly as a result of chronic diseases including liver diseases (17.3%), kidney failure (13.6%), congestive heart failure (11.1%) and stroke (9.9%). Conclusion There was a declining mortality due to HIV with appropriate interventions such as subsidised tests for HIV-infected patients, increased availability of HAART and other medications for prevention and treatment of opportunistic infections. The spectrum of HIV disease was wide and preventable.

  12. Alterations in the Fecal Microbiota of Patients with HIV-1 Infection: An Observational Study in A Chinese Population

    PubMed Central

    Ling, Zongxin; Jin, Changzhong; Xie, Tiansheng; Cheng, Yiwen; Li, Lanjuan; Wu, Nanping

    2016-01-01

    The available evidence suggests that alterations in gut microbiota may be tightly linked to the increase in microbial translocation and systemic inflammation in patients with human immunodeficiency virus 1 (HIV-1) infection. We profiled the fecal microbiota as a proxy of gut microbiota by parallel barcoded 454-pyrosequencing in 67 HIV-1-infected patients (32 receiving highly active antiretroviral therapy [HAART] and 35 HAART naïve) and 16 healthy controls from a Chinese population. We showed that α-diversity indices did not differ significantly between the healthy control and HIV-1-infected patients. The ratio of Firmicutes/Bacteroidetes increased significantly in HIV-1-infected patients. Several key bacterial phylotypes, including Prevotella, were prevalent in HIV-1-infected patients; whereas Phascolarctobacterium, Clostridium XIVb, Dialister and Megamonas were significantly correlated with systemic inflammatory cytokines. After short-term, effective HAART, the viral loads of HIV-1 were reduced; however, the diversity and composition of the fecal microbiota were not completely restored. and the dysbiosis remained among HIV-1-infected subjects undergoing HAART. Our detailed analysis demonstrated that dysbiosis of fecal microbiota might play an active role in HIV-1 infection. Thus, new insights may be provided into therapeutics that target the microbiota to attenuate the progression of HIV disease and to reduce the risk of gut-linked disease in HIV-1-infected patients. PMID:27477587

  13. Early diagnosis and retention in care of HIV-infected patients through rapid salivary testing: a test-and-treat fast track pilot study.

    PubMed

    Parisi, Maria Rita; Soldini, Laura; Negri, Silvia; Vidoni, Gian Marino; Gianotti, Nicola; Nozza, Silvia; Schlusnus, Karin; Dorigatti, Fernanda; Lazzarin, Adriano

    2016-01-01

    Aim of this study was to evaluate the efficacy and the retention-in-care of individuals diagnosed during six years of salivary HIV testing (EASY-test project). Among those linked-to-care at the Infectious Diseases Department of San Raffaele Hospital (Milan, Italy), the proportion of patients engaged, retained in care and virologically suppressed after the antiretroviral treatment was 96%, 100% and 95.2%, respectively. Results from our study suggest that salivary HIV testing may help bring to light cases of HIV infection otherwise undiagnosed, and thus favour a more rapid and wider reduction of the HIV infection burden at the population level.

  14. Early diagnosis and retention in care of HIV-infected patients through rapid salivary testing: a test-and-treat fast track pilot study.

    PubMed

    Parisi, Maria Rita; Soldini, Laura; Negri, Silvia; Vidoni, Gian Marino; Gianotti, Nicola; Nozza, Silvia; Schlusnus, Karin; Dorigatti, Fernanda; Lazzarin, Adriano

    2016-01-01

    Aim of this study was to evaluate the efficacy and the retention-in-care of individuals diagnosed during six years of salivary HIV testing (EASY-test project). Among those linked-to-care at the Infectious Diseases Department of San Raffaele Hospital (Milan, Italy), the proportion of patients engaged, retained in care and virologically suppressed after the antiretroviral treatment was 96%, 100% and 95.2%, respectively. Results from our study suggest that salivary HIV testing may help bring to light cases of HIV infection otherwise undiagnosed, and thus favour a more rapid and wider reduction of the HIV infection burden at the population level. PMID:26922986

  15. HIV antiviral drug resistance: patient comprehension.

    PubMed

    Racey, C Sarai; Zhang, Wendy; Brandson, Eirikka K; Fernandes, Kimberly A; Tzemis, Despina; Harrigan, P Richard; Montaner, Julio S G; Barrios, Rolando; Toy, Junine; Hogg, Robert S

    2010-07-01

    A patient's understanding and use of healthcare information can affect their decisions regarding treatment. Better patient understanding about HIV resistance may improve adherence to therapy, decrease population viral load and extend the use of first-line HIV therapies. We examined knowledge of developing HIV resistance and explored treatment outcomes in a cohort of HIV+ persons on highly active antiretroviral therapy (HAART). The longitudinal investigations into supportive and ancillary health services (LISA) cohort is a prospective study of HIV+ persons on HAART. A comprehensive interviewer-administrated survey collected socio-demographic variables. Drug resistance knowledge was determined using a three-part definition. Clinical markers were collected through linkage with the Drug Treatment Program (DTP) at the British Columbia Centre for Excellence in HIV/AIDS. Categorical variables were compared using Fisher's Exact Test and continuous variables using the Wilcoxon rank-sum test. Proportional odds logistic regression was performed for the adjusted multivariable analysis. Of 457 LISA participants, less than 4% completely defined HIV resistance and 20% reported that they had not discussed resistance with their physician. Overall, 61% of the cohort is >or=95% adherent based on prescription refills. Owing to small numbers pooling was preformed for analyses. The model showed that being younger (OR=0.97, 95% CI: 0.95-0.99), having greater than high school education (OR=1.64, 95% CI: 1.07-2.51), discussing medication with physicians (OR=3.67, 95% CI: 1.76-7.64), having high provider trust (OR=1.02, 95% CI: 1.01-1.03), and receiving one-to-one counseling by a pharmacist (OR=2.14, 95% CI: 1.41-3.24) are predictive of a complete or partial definition of HIV resistance. The probability of completely defining HIV resistance increased from 15.8 to 63.9% if respondents had discussed HIV medication with both a physician and a pharmacist. Although the understanding of HIV

  16. Normal Myocardial Flow Reserve in HIV-Infected Patients on Stable Antiretroviral Therapy: A Cross-Sectional Study Using Rubidium-82 PET/CT.

    PubMed

    Knudsen, Andreas; Christensen, Thomas E; Ghotbi, Adam Ali; Hasbak, Philip; Lebech, Anne-Mette; Kjær, Andreas; Ripa, Rasmus Sejersten

    2015-10-01

    Studies have found HIV-infected patients to be at increased risk of myocardial infarction, which may be caused by coronary microvascular dysfunction. For the first time among HIV-infected patients, we assessed the myocardial flow reserve (MFR) by Rubidium-82 (82Rb) positron emission tomography (PET), which can quantify the coronary microvascular function. MFR has proved highly predictive of future coronary artery disease and cardiovascular events in the general population.In a prospective cross-sectional study, HIV-infected patients all receiving antiretroviral therapy (ART) with full viral suppression and HIV-uninfected controls were scanned using 82Rb PET/computed tomography at rest and adenosine-induced stress, thereby obtaining the MFR (stress flow/rest flow), stratified into low ≤1.5, borderline >1.5 to 2.0, or normal >2.0.Fifty-six HIV-infected patients and 25 controls were included. The HIV-infected patients had a mean age of 53 years (range 37-68 years) with 23% active smokers. The controls had a mean age of 52 years (range 36-68 years) and 26% active smokers. In the HIV-infected group 73% had a normal MFR, 17% borderline, and 10% low values of MFR. Among controls these values were 71%, 19%, and 10%, respectively (P = 0.99). However, the HIV-infected group had lower values of stress myocardial blood flow (MBF) (2.63 ± 0.09 mL/g/min vs 2.99 ± 0.14 mL/g/min; P = 0.03). We found no evidence of decreased MFR as assessed by 82Rb PET among HIV-infected patients on stable ART with full viral suppression compared with HIV-uninfected controls. We did notice a decreased MBF during stress. PMID:26512605

  17. A Study of Compliance to Antiretroviral Therapy among HIV Infected Patients at a Tertiary Care Hospital in North Karnataka

    PubMed Central

    Hasabi, Ishwar Siddappa; Kachapur, Chandrashekar; Kaulgud, Ram Suresh

    2016-01-01

    Introduction Compliance to Antiretroviral Therapy (ART) is a primary determinant of treatment success of HIV-AIDS. Many studies have shown inadequate compliance to ART in the Indian population. Aim To assess the compliance to ART among HIV infected patients, to explore the factors affecting compliance and impact of compliance on CD4 count. Materials and Methods A cross-sectional study was conducted with 200 adult patients attending ART center, KIMS, Hubli. The patients were randomly selected and compliance to ART over preceding 3 months was assessed. Reasons for non- compliance were assessed among those with inadequate compliance. Results Mean age of the study population was 40.07±9.99 years. The sex ratio was 1.02:1 (M:F). Majority of patients were in WHO stage 1 with treatment, with CD4 count above 500/μl. Pulmonary tuberculosis was the most common opportunistic infection. Most of the patients were on long term ART, more than 5 years {81 (40.5%)}. Most of the patients were on ZLN regimen {97 (48.5%)}. Compliance over the preceding 3 months was 94.84± 14.93% for ART and 88.97±23.75% for opportunistic infection prophylaxis. There was no significant difference in compliance in relation to age group, sex, educational status, residence, religion, habits, HIV status of spouse or child, the regimen of ART and frequency of dosing. The compliance was better among those on long term treatment, i.e., those on treatment for more than 5 years compared to those who started ART in last 1 year (p=0.06). The most common reasons given by patients for non-compliance were going away from home, busy with other work and simply forgot. Better compliance was associated with higher CD4 count. Conclusion Compliance to ART was inadequate in the studied population, which is a major obstacle to success of ART. PMID:27437267

  18. The Effect of Spirulina platensis versus Soybean on Insulin Resistance in HIV-Infected Patients: A Randomized Pilot Study

    PubMed Central

    Marcel, Azabji-Kenfack; Ekali, Loni G.; Eugene, Sobngwi; Arnold, Onana E.; Sandrine, Edie D.; von der Weid, Denis; Gbaguidi, Emmanuel; Ngogang, Jeanne; Mbanya, Jean C.

    2011-01-01

    HIV-infected patients develop abnormalities of glucose metabolism due to the virus and antiretroviral drugs. Spirulina and soybean are nutritional supplements that are cheap, accessible in our community and affect glucose metabolism. We carried out a randomized study to assess the effect of Spirulina platensis versus soybean as a food supplement on HIV/HAART-associated insulin resistance (IR) in 33 insulin-resistant HIV-infected patients. The study lasted for two months at the National Obesity Centre of Cameroon. Insulin resistance was measured using the short insulin tolerance test. Physical activity and diet did not change over the study duration. On-treatment analysis was used to analyze data. The Mann-Whitney U test, the Students T test and the Chi square test were used as appropriate. Curve gradients were analyzed using ANCOVA. Seventeen subjects were randomized to spirulina and 16 to soybean. Each received 19 g of supplement daily. The follow up rate was 65% vs. 100% for spirulina and soybean groups, respectively, and both groups were comparable at baseline. After eight weeks, insulin sensitivity (IS) increased by 224.7% vs. 60% in the spirulina and soybean groups respectively (p < 0.001). One hundred per cent vs. 69% of subjects on spirulina versus soybean, respectively, improved their IS (p = 0.049) with a 1.45 (1.05–2.02) chance of improving insulin sensitivity on spirulina. This pilot study suggests that insulin sensitivity in HIV patients improves more when spirulina rather than soybean is used as a nutritional supplement. Trial registration: ClinicalTrials.gov identifier NCT01141777. PMID:22254118

  19. Symptomatic Patients without Epidemiological Indicators of HIV Have a High Risk of Missed Diagnosis: A Multi-Centre Cross Sectional Study

    PubMed Central

    Svedhem, Veronica; Marrone, Gaetano; Andersson, Örjan; Azimi, Farshad; Blaxhult, Anders; Sönnerborg, Anders

    2016-01-01

    Objectives One quarter of HIV-1 positive individuals in Sweden present for care with HIV or AIDS associated conditions without an HIV test (missed presentations) and 16% report neglect of such symptoms. The objective of this study was to identify risk factors for these missed opportunities of HIV-1 diagnosis. Methods A national study, recruiting 409 newly diagnosed HIV-1 infected adults over a 2.5-year period, was performed. Logistic regression models tested the relationship between missed presentation and patient’s neglect versus socio-demographic and behavioural risk factors. Additionally the initiator of the HIV test was assessed. Results The odds for a missed presentation was lower for migrants (from East Europe, Asia, and Pacific (East): OR 0.4 (0.2–0.8); Sub-Saharan Africa (SSA): 0.3 (0.2–0.6); other: 0.5 (0.2–1.0)), compared to patients born in Sweden, just as symptoms neglected by the patient (East (0.3 (0.1–1.0); SSA (0.4 (0.2–0.8)). The latter was also lower for men who have sex with men (0.5 (0.2–1.0)), compared to patients infected heterosexually. Patients infected in the East, with present/previous substance use or a previous negative HIV test were more likely to take the initiative to test on their own, whereas those >50 years and with a previously missed presentation had significantly reduced odds, p<0.05. Conclusions Individuals without epidemiological indicators of HIV are more likely to have a history of missed presentations, to neglect symptoms and are less prone to take an initiative to test for HIV themselves. It is important to further implement testing to include all patients with symptoms and conditions indicative of HIV. PMID:27603207

  20. Evaluation of patient care cascade for HIV-positive patients diagnosed in La Romana, Dominican Republic in 2011: a retrospective cohort study.

    PubMed

    Bowman, Alex S; Lerebours, Leonel; Amesty, Silvia; de la Rosa, Milagros; Gil, Elizabeth; Halpern, Mina; Nicholas, Stephen; Lamb, Matthew R

    2016-04-01

    The Caribbean has the highest adult HIV prevalence in the world after sub-Saharan Africa (2011). One sub-population in the Dominican Republic is the migratory Batey community primarily comprised of Haitian immigrants with limited access to healthcare and HIV prevalence rates of between 3.0% and 9.0%, compared to 0.7% nationally. This retrospective cohort study describes the cumulative retention from diagnosis to virological suppression for newly-diagnosed HIV-infected adults presenting to the Clínica de Familia and its Batey programme in La Romana, during 2011. Of the patients diagnosed with HIV, 65% entered into care, 59% completed immunologic testing, 53% were eligible for antiretroviral therapy (ART) initiation, 36% initiated ART within three months of eligibility and 27% were retained in care. Seventeen per cent of those retained on ART with a 12-month viral load measure had undetectable viral load. Attrition primarily occurred before ART initiation. The Batey programme had a first step lost-to-follow-up of 88% compared to 20% at the clinic (p < 0.001). This retrospective study details the continuum of care and indicates where structural changes must occur to increase continuity between steps. The manuscript results are important to help implement programmes to enhance engagement and retention in HIV primary care.

  1. Anaemia and Iron Homeostasis in a Cohort of HIV-Infected Patients: A Cross-Sectional Study in Ghana

    PubMed Central

    Obirikorang, Christian; Issahaku, Razak Gyesi; Osakunor, Derick Nii Mensah; Osei-Yeboah, James

    2016-01-01

    Aim. We determined the prevalence of anaemia and evaluated markers of iron homeostasis in a cohort of HIV patients. Methods. A comparative cross-sectional study on 319 participants was carried out at the Tamale Teaching Hospital from July 2013 to December 2013, 219 patients on HAART (designated On-HAART) and 100 HAART-naive patients. Data gathered include sociodemography, clinical history, and selected laboratory assays. Results. Prevalence of anaemia was 23.8%. On-HAART participants had higher CD4/CD3 lymphocyte counts, Hb, HCT/PCV, MCV, MCH, iron, ferritin, and TSAT (P < 0.05). Hb, iron, ferritin, and TSAT decreased from grade 1 to grade 3 anaemia and CD4/CD3 lymphocyte count was lowest in grade 3 anaemia (P < 0.05). Iron (P = 0.0072) decreased with disease severity whilst transferrin (P = 0.0143) and TIBC (P = 0.0143) increased with disease severity. Seventy-six (23.8%) participants fulfilled the criteria for anaemia, 86 (26.9%) for iron deficiency, 41 (12.8%) for iron deficiency anaemia, and 17 (5.3%) for iron overload. The frequency of anaemia was higher amongst participants not on HAART (OR 2.6 for grade 1 anaemia; OR 3.0 for grade 3 anaemia). Conclusion. In this study population, HIV-associated anaemia is common and is related to HAART status and disease progression. HIV itself is the most important cause of anaemia and treatment of HIV should be a priority compared to iron supplementation. PMID:27092270

  2. Impact of HIV Status on Treatment Outcome of Tuberculosis Patients Registered at Arsi Negele Health Center, Southern Ethiopia: A Six Year Retrospective Study

    PubMed Central

    Gebremariam, Gebreslassie; Asmamaw, Getachew; Hussen, Muktar; Hailemariam, Mengistu Z.; Asegu, Demissie; Astatkie, Ayalew; Amsalu, Anteneh G.

    2016-01-01

    Background Despite implementation of different strategies, the burden and mortality of human immunodeficiency virus (HIV)-associated tuberculosis (TB) remains a challenge in Ethiopia. The aim of this study was to assess the impact of HIV status on treatment outcome of tuberculosis patients registered at Arsi Negele Health Center, Southern Ethiopia. Methods A six-year retrospective data (from September 2008 to August 2014) of tuberculosis patients (n = 1649) registered at the directly observed therapy short-course (DOTS) clinic of Arsi Negele Health Center was reviewed. Treatment outcome and tuberculosis type were categorized according to the national tuberculosis control program guideline. Data were entered and analyzed using SPSS version 20. Multinomial logistic regression analysis was used to examine the effect of HIV status separately on default/failure and death in relation to those who were successfully treated. Odds ratios with 95% confidence intervals were used to check the presence and strength of association between TB treatment outcome and HIV status and other independent variables. Results Out of the 1649 TB patients, 94.7% (1562) have been tested for HIV of whom 156(10%) were HIV co-infected. The mean (standard deviation) age of the patients was 28.5(15.5) years. The majority were new TB cases (96.7%), male (53.7%), urban (54.7%), and had smear negative pulmonary TB (44.1%). Overall, the treatment success rate of TB patients with or without HIV was 87.3%. Using cure/completion as reference, patients without known HIV status had significantly higher odds of default /failure [aOR, 4.26; 95%CI, 1.684–10.775] and transfer-out [aOR, 2.92; 95%CI, 1.545–5.521] whereas those who tested positive for HIV had a significantly higher odds of death [aOR, 6.72; 95%CI, 3.704–12.202] and transfer-out [aOR, 2.02; 95%CI, 1.111–3.680]. Conclusion Overall, treatment outcome and HIV testing coverage for TB patients is promising to reach the WHO target in the study

  3. Lack of awareness of treatment failure among HIV-1-infected patients in Guinea-Bissau – a retrospective cohort study

    PubMed Central

    Jespersen, Sanne; Hønge, Bo Langhoff; Medina, Candida; da Silva Té, David; Correira, Faustino Gomes; Laursen, Alex Lund; Erikstrup, Christian; Østergaard, Lars; Wejse, Christian

    2015-01-01

    Introduction With more people receiving antiretroviral treatment (ART), the need to detect treatment failure and switch to second-line ART has also increased. We assessed CD4 cell counts (as a marker of treatment failure), determined the rate of switching to second-line treatment and evaluated mortality related to treatment failure among HIV-infected patients in Guinea-Bissau. Methods In this retrospective cohort study, adult patients infected with HIV-1 receiving ≥6 months of ART at an HIV clinic in Bissau were included from June 2005 to July 2014 and followed until January 2015. Treatment failure was defined as 1) a fall in CD4 count to baseline (or below) or 2) CD4 levels persistently below 100 cells/µL after ≥6 months of ART. Cox hazard models, with time since six months of ART as the time-varying coefficient, were used to estimate the hazard ratio for death and loss to follow-up. Results We assessed 1,591 HIV-1-infected patients for immunological treatment failure. Treatment failure could not be determined in 594 patients (37.3%) because of missing CD4 cell counts. Among the remaining 997 patients, 393 (39.4%) experienced failure. Only 39 patients (9.9%) with failure were switched from first- to second-line ART. The overall switching rate was 3.1 per 100 person-years. Mortality rate was higher in patients with than without treatment failure, with adjusted hazard rate ratios (HRRs) 10.0 (95% CI: 0.9–107.8), 7.6 (95% CI: 1.6–35.5) and 3.1 (95% CI: 1.5–6.3) in the first, second and following years, respectively. During the first year of follow-up, patients experiencing treatment failure had a higher risk of being lost to follow-up than patients not experiencing treatment failure (adjusted HRR 4.4; 95% CI: 1.7–11.8). Conclusions We found a high rate of treatment failure, an alarmingly high number of patients for whom treatment failure could not be assessed, and a low rate of switching to a second-line therapy. These factors could lead to an increased

  4. Patient Reported Delays in Seeking Treatment for Tuberculosis among Adult and Pediatric TB Patients and TB Patients Co-Infected with HIV in Lima, Peru: A Qualitative Study

    PubMed Central

    Paz-Soldan, Valerie A.; Alban, Rebecca E.; Dimos Jones, Christy; Powell, Amy R.; Oberhelman, Richard A.

    2014-01-01

    Introduction: Tuberculosis (TB) remains a significant public health challenge worldwide, and particularly in Peru with one of the highest incidence rates in Latin America. TB patient behavior has a direct influence on whether a patient will receive timely diagnosis and successful treatment of their illness. Objectives: The objective was to understand the complex factors that can impact TB patient health seeking behavior. Methods: In-depth interviews were conducted with adult and parents of pediatric patients receiving TB treatment (n = 43), within that group a sub-group was also co-infected with HIV (n = 11). Results: Almost all of the study participants recognized delays in seeking either their child’s or their own diagnosis of their TB symptoms. The principal reasons for treatment-seeking delays were lack of knowledge and confusion of TB symptoms, fear and embarrassment of receiving a TB diagnosis, and a patient tendency to self-medicate prior to seeking formal medical attention. Conclusion: Health promotion activities that target patient delays have the potential to improve individual patient outcomes and mitigate the spread of TB at a community level. PMID:25566523

  5. Differential clinical outcome of dengue infection among patients with and without HIV infection: a matched case-control study.

    PubMed

    Pang, Junxiong; Thein, Tun-Linn; Lye, David C; Leo, Yee-Sin

    2015-06-01

    Clinical characteristics and outcome among dengue patients with and without human immunodeficiency virus (HIV) infection remain elusive. A total of 10 dengue virus (DENV)-HIV Chinese patients were compared with 40 Chinese dengue patients without HIV, who were matched for age, gender, type of care received, methods, and year of dengue diagnosis from 2005 to 2008. Univariate and multivariate conditional logistics regression were applied. DENV-HIV patients were significantly associated with the World Health Organization (WHO) 2009 severe dengue (conditional odds ratio [COR] = 5.72; 95% confidence interval [CI] = 1.01-32.64) but not with the WHO 1997 dengue hemorrhagic fever/dengue shock syndrome (COR = 0.40; 95% CI = 0.09-1.71). This is mainly due to severe plasma leakage and the lack of hemorrhagic manifestations. Hospitalization duration was longer for DENV-HIV patients (10.5 days; interquartile range [IQR] = 5.5-26.3 days) compared with dengue patients (5 days; IQR = 4-6 days). There were no significant differences in presentation of clinical warning signs and symptoms at admission and during hospitalization, except for rash (adjusted COR [ACOR] = 0.06; 95% CI = 0.03-0.92). DENV-HIV patients were associated with higher pulse rate (ACOR = 1.13; 95% CI = 1.02-1.25), eosinophils proportion (ACOR = 3.07; 95% CI = 1.12-8.41) and lower hematocrit level (ACOR = 0.79; 95% CI = 0.64-0.98) compared with dengue patients. Even though DENV-HIV patients may present similarly to dengue patients, they may be more likely to have severe dengue outcome. Hence, close monitoring of DENV-HIV patients is highly recommended as part of dengue clinical care and management.

  6. Lung cancer in HIV-infected patients

    PubMed Central

    Palacios, R; Lebrón, J; Guerrero-León, M; Del Arco, A; Colmenero, J; Márquez, M; Santos, J

    2012-01-01

    Purpose Several studies have shown that HIV patients are at higher risk of lung cancer. Our aim is to analyse the prevalence and features of lung cancer in HIV-infected patients. Methods The clinical charts of 4,721 HIV-infected patients seen in three hospitals of southeast Spain (study period 1992–2012) were reviewed, and all patients with a lung cancer were analysed. Results There were 61 lung cancers, giving a prevalence of 1.2%. There was a predominance of men (82.0%), and smokers (96.6%; mean pack-years 35.2), with a median age of 48.0 (41.7–52.9) years, and their distribution according to risk group for HIV was: intravenous drug use 58.3%, homosexual 20.0%, and heterosexual 16.7%. Thirty-four (56.7%) patients were Aids cases, and 29 (47.5%) had prior pulmonar events: tuberculosis 16, bacterial pneumonia 9, and P. jiroveci pneumonia 4. The median nadir CD4 count was 149/mm3 (42–232), the median CD4 count at the time of diagnosis of the lung cancer was 237/mm3 (85–397), and 66.1%<350/mm3. 66.7% were on ART, and 70% of them had undetectable HIV viral load. The most common histological types of lung cancer were adenocarcinoma and epidermoid, with 24 (40.0%) and 23 (38.3%) cases, respectively. There were 49 (80.3%) cases with advanced stages (III and IV) at diagnosis. The distribution of treatments was: only palliative 23 (39.7%), chemotherapy 14 (24.1%), surgery and chemotherapy 8 (13.8%), radiotherapy 7 (12.1%), surgery 4 (6.9%), and other combined treatments 2 (3.4%). Forty-six (76.7%) patients died, with a median survival time of 3 months. The Kaplan-Meier survival rate at 6 months was 42.7% (at 12 months 28.5%). Conclusions The prevalence of lung cancer in this cohort of HIV-patients is high. People affected are mainly men, smokers, with transmission of HIV by intravenous drug use, and around half of them with prior opportunistic pulmonary events. Most patients had low nadir CD4 count, and were immunosuppressed at the time of diagnosis. Adenocarcinoma

  7. Hospital treatment of HIV patients.

    PubMed

    Ola, Samuel Olawale

    2006-12-01

    Treatment of patients with HIV/AIDS in Nigeria has progressed from the stage of inactivity, unconcern, abandonment and neglect to the present stage of holistic care involving treatment of the infection with Highly Active Anti Retroviral Agents, complications of the disease and side effects of antiretroviral therapy as well as that of human behavioural responses towards the disease with hope and promising outcome. The goal of the treatment is to prolong the patient's life while maintaining the best possible quality of health and life. It is now a continuum of care between the hospital and the different sectors of the community. Hospital treatment of patients with HIV-AIDS is complex and yet a simple task if there is healthy interaction of the patients and health care providers in a milieu of well equipped hospital setting with available treatment facilities for proper management of diseases. Similarly, for the care to achieve its goal, it requires a joint participation of the community and the commitment of the government not only on curtailment of the reservoir of HIV infection by antiretroviral therapy but total eradication of diseases, poverty and ignorance in all its entirety. PMID:18050774

  8. Cryptoccocal meningitis in Yaoundé (Cameroon) HIV infected patients: Diagnosis, frequency and Cryptococcus neoformans isolates susceptibility study to fluconazole.

    PubMed

    Kammalac Ngouana, T; Dongtsa, J; Kouanfack, C; Tonfack, C; Fomena, S; Mallié, M; Delaporte, E; Boyom, F-Fekam; Bertout, S

    2015-03-01

    Cryptococcal meningitis is a mycosis encountered especially in patients with Acquired Immunodeficiency Syndrome and is fatal in the absence of treatment. Information on epidemiology, diagnosis and susceptibility profile to antifungal drugs, are scarce in Cameroon. Authors evaluated the diagnosis possibilities of the cryptococcal meningitis in Cameroon, and studied the antifungal susceptibility of isolated strains to fluconazole, used as first line treatment of the disease in Cameroon. Between December 2009 and July 2011, 146 cerebrospinal fluids obtained from HIV patients with suspicion of meningitis were analysed. The diagnosis procedure involved macroscopic and cyto-chemical analysis, India ink test, culture on Sabouraud chloramphenicol medium and antigen latex agglutination test. Antifungal susceptibility testing of isolated strains to fluconazole was done by the E-test(®) method. The diagnosis of cryptococcal meningitis gave 28.08% positive cases. Among these patients, 80% were at stages III and IV and 20% at stage I of the HIV infection, according to the WHO previous classification. Cyto-chemical analysis showed current findings in the case of cryptococcal meningitis. India ink test and latex agglutination test exhibited very high sensitivity and specificity (>94%). Fluconazole antifungal susceptibility testing gave MICs lower than 32μg/mL to 92.7% of isolated strains and MICs greater than this value to 7.3% of isolates. These results showed that cryptococcal meningitis remains a real problem among HIV infected patients in Yaoundé. The emergence of fluconazole reduced susceptibility strains is worrying. Nevertheless, efficacy of rapid detection tests is interesting because this will help in rapid diagnosis and treatment of patients.

  9. Ocular lesions in 1,000 consecutive HIV-positive patients in India: a long-term study

    PubMed Central

    2013-01-01

    Background Ocular lesions in patients on highly active antiretroviral therapy (HAART) have shown changes in disease prevalence and pattern. Although they have been described in the Western population, there are not many such studies in the HAART era from India. This study aims to present the clinical profile, systemic correlation, and visual outcome in HIV-positive patients in relation to HAART in comparison with pre-HAART Indian studies and current Western data. Ocular findings and systemic correlation in 1,000 consecutive patients with HIV seen at a tertiary eye care center were analyzed. This study uses a prospective observational case series design. Results Age range of the patients was 1.5 to 75 years. Ocular lesions were seen in 68.5% of the patients (cytomegalovirus (CMV) retinitis was the commonest). The commonest systemic disease was pulmonary TB. Mean interval between HIV diagnosis and onset of ocular lesions was 2.43 years. CD4 counts range from 2 to 1,110 cells/mm3. Immune recovery uveitis (IRU) was seen in 17.4%. Interval between HAART initiation and IRU was 4 months to 2.5 years. Recurrence of ocular infection was seen in 2.53% (post-HAART) and > 20% (pre-HAART). Overall visual outcome showed improvement in about 14.3% and was maintained in 71.6% of the patients. Conclusions CMV retinitis is the commonest ocular opportunistic infection in India, even in the HAART era. Newer manifestations of known diseases and newer ocular lesions are being seen. In contrast to Western studies, in our patients on HAART, ocular lesions do not always behave as in immunocompetent individuals. Ocular TB needs to be kept in mind in India, as well as other neuro-ophthalmic manifestations related to cryptococci, especially in gravely ill patients. Occurrence and frequency of various ocular opportunistic infections in developing nations such as India have significant variations from those reported in Western literature and need to be managed accordingly. PMID:23514612

  10. Clinicopathologic Features of Colorectal Carcinoma in HIV-Positive Patients

    PubMed Central

    Sigel, Carlie; Cavalcanti, Marcela S.; Daniel, Tanisha; Vakiani, Efsevia; Shia, Jinru; Sigel, Keith

    2016-01-01

    Background Emerging evidence suggests differences in colo-rectal cancer in HIV-infected patients (HIV+) compared with HIV− patients. Microsatellite instability (MSI), occurring in a subset of colorectal cancer, is present at a higher rate in certain cancers in HIV+ patients. Colorectal cancer with MSI share some characteristics with those reported for HIV+ colorectal cancer. On this premise, we studied clinical and pathologic features of HIV+ colorectal cancer and evaluated for MSI using matched HIV− colorectal cancer controls. Methods Two nested, matched cohorts were identified from a hospital-based cohort of colorectal cancer patients. HIV+ colo-rectal cancers were identified and random control patients were matched for selected characteristics. Mismatch repair protein (MMR) IHC was performed as the detection method for MSI. Variables were compared between cases and controls using fixed-effects logit modeling to account for matching. Results We included 184 colorectal cancer samples (38 HIV+, 146 HIV− control). Median patient age at colorectal cancer onset was 55. When compared with HIV− colorectal cancer, HIV+patients were more likely to have smoked (P = 0.001), have right-sided colorectal cancer (37% vs. 14%; P = 0.003), and tumor-infiltrating lymphocytes (TIL) above 50/10 high-power fields (21% vs. 7%). There was no difference in MMR protein expression (P = 0.6). HIV+ colorectal cancer patients had reduced overall survival (P = 0.02) but no difference in progression-free survival. Conclusions HIV+ patients developed colorectal cancer at a lower median age than population estimates, had a higher frequency of right-sided disease, and increased TILs, suggesting potential biologic differences compared with uninfected patients. Impact Clinicopathologic differences in colorectal cancer of HIV+ persons may have implications for tumor pathogenesis. PMID:27197294

  11. Upper Gastrointestinal Symptoms Predictive of Candida Esophagitis and Erosive Esophagitis in HIV and Non-HIV Patients

    PubMed Central

    Takahashi, Yuta; Nagata, Naoyoshi; Shimbo, Takuro; Nishijima, Takeshi; Watanabe, Koji; Aoki, Tomonori; Sekine, Katsunori; Okubo, Hidetaka; Watanabe, Kazuhiro; Sakurai, Toshiyuki; Yokoi, Chizu; Mimori, Akio; Oka, Shinichi; Uemura, Naomi; Akiyama, Junichi

    2015-01-01

    .05) associated with erosive esophagitis in both patient groups. The internal consistency test using Cronbach's α revealed that the 9 symptom scores were reliable in both HIV (α, 0.86) and non-HIV-infected patients (α, 0.85). This large-scale endoscopy-based study showed that HIV-infected patients have greater GI symptom scores compared with non-HIV-infected patients even after excluding GI-organic diseases. None of the upper GI symptoms predict candida esophagitis in HIV-infected patients, but dysphagia and odynophagia predict candida esophagitis in non-HIV-infected patients. Heartburn and acid regurgitation predict erosive esophagitis in both patient groups. PMID:26632738

  12. A Descriptive Analysis of HIV Prevalence, HIV Service Uptake, and HIV-Related Risk Behaviour among Patients Attending a Mental Health Clinic in Rural Malawi

    PubMed Central

    Lommerse, Kinke; Stewart, Robert C.; Chilimba, Queen; van den Akker, Thomas; Lund, Crick

    2013-01-01

    Background Human immunodeficiency virus (HIV) and mental illness are interlinked health problems; mental illness may pose a risk for contracting HIV and HIV-positive individuals are at higher risk of mental illness. However, in countries with high HIV prevalence, the main focus of HIV-related health programmes is usually on prevention and treatment of somatic complications of HIV, and mental illness is not given high priority. We examined HIV prevalence, uptake of HIV services, and HIV-related risk behaviour among people attending a mental health clinic in rural Malawi. Methodology Semi-structured interviews were performed with patients capable to consent (94%), and with those accompanied by a capable caregiver who consented. HIV counselling and testing was offered to participants. Findings Among 174 participants, we collected 162 HIV test results (91%). HIV prevalence was 14.8%. Women were three times as likely to be HIV-positive compared to men. Two-thirds of participants reported having been tested for HIV prior to this study. The uptake of HIV-services among HIV-positive patients was low: 35% did not use recommended prophylactic therapy and 44% of patients not receiving antiretroviral treatment (ART) had never been assessed for ART eligibility. The reported rate of sexual activity was 61%, and 9% of sexually active participants had multiple partners. Inconsistent condom use with stable (89%) and occasional (79%) sexual partners, and absence of knowledge of the HIV status of those partners (53%, 63%) indicate high levels of sexual risk behaviour. Conclusions HIV-prevalence among persons attending the clinic, particularly men, was lower than among the general population in a population survey. The rate of HIV testing was high, but there was low uptake of preventive measures and ART. This illustrates that HIV-positive individuals with mental illness or epilepsy constitute a vulnerable population. HIV programmes should include those with neuropsychiatric illness

  13. Patient-adapted, specific activation of HIV-1 by customized TAL effectors (TALEs), a proof of principle study.

    PubMed

    Geissler, Rene; Hauber, Ilona; Funk, Nancy; Richter, Annekatrin; Behrens, Martina; Renner, Ivonne; Chemnitz, Jan; Hofmann-Sieber, Helga; Baum, Heidi; van Lunzen, Jan; Boch, Jens; Hauber, Joachim; Behrens, Sven-Erik

    2015-12-01

    The major obstacle to cure infections with human immunodeficiency virus (HIV-1) is integrated proviral genomes, which are not eliminated by antiretroviral therapies (ART). Treatment approaches with latency-reversing agents (LRAs) aim at inducing provirus expression to tag latently-infected cells for clearance through viral cytopathic effects or cytotoxic T cell (CTL) responses. However, the currently tested LRAs reveal evident drawbacks as gene expression is globally induced and viral outgrowth is insecure. Here, we present transcription activator-like effector (TALE) proteins as potent tools to activate HIV-1 specifically. The large variety of circulating HIV-1 strains and, accordingly, integrated proviruses was addressed by the programmable DNA-specificity of TALEs. Using customized engineered TALEs, a substantial transcription activation and viral outgrowth was achieved with cells obtained from different HIV-1 patients. Our data suggest that TALEs may be useful tools in future strategies aimed at removing HIV-1 reservoirs. PMID:26474371

  14. Deterrents to HIV-patient initiation of antiretroviral therapy in urban Lusaka, Zambia: a qualitative study.

    PubMed

    Musheke, Maurice; Bond, Virginia; Merten, Sonja

    2013-04-01

    Some people living with HIV (PLHIV) refuse to initiate antiretroviral therapy (ART) despite availability. Between March 2010 and September 2011, using a social ecological framework, we investigated barriers to ART initiation in Lusaka, Zambia. In-depth interviews were conducted with PLHIV who were offered treatment but declined (n=37), ART staff (n=5), faith healers (n=5), herbal medicine providers (n=5), and home-based care providers (n=5). One focus group discussion with lay HIV counselors and observations in the community and at an ART clinic were conducted. Interviews were audio-recorded, transcribed, and translated, coded using Atlas ti, and analyzed using latent content analysis. Lack of self-efficacy, negative perceptions of medication, desire for normalcy, and fear of treatment-induced physical body changes, all modulated by feeling healthy, undermined treatment initiation. Social relationships generated and perpetuated these health and treatment beliefs. Long waiting times at ART clinics, concerns about long-term availability of treatment, and taking strong medication amidst livelihood insecurity also dissuaded PLHIV from initiating treatment. PLHIV opted for herbal remedies and faith healing as alternatives to ART, with the former being regarded as effective as ART, while the latter contributed to restoring normalcy through the promise of being healed. Barriers to treatment initiation were not mutually exclusive. Some coalesced to undermine treatment initiation. Ensuring patients initiate ART requires interventions at different levels, addressing, in particular, people's health and treatment beliefs, changing perceptions about effectiveness of herbal remedies and faith healing, improving ART delivery to attenuate social and economic costs and allaying concerns about future non-availability of treatment. PMID:23530573

  15. The effects of mindfulness-based stress reduction (MBSR) program in Iranian HIV/AIDS patients: a pilot study.

    PubMed

    Jam, Sara; Imani, Amir Hossein; Foroughi, Maryam; SeyedAlinaghi, SeyedAhmad; Koochak, Hamid Emadi; Mohraz, Minoo

    2010-01-01

    Psychological or behavioral interventions that attenuate the effects of stress may be useful in promoting immunocompetence and delaying HIV disease progression and CD4 count level. Mindfulness-Based Stress Reduction (MBSR) is a behavioral intervention that has as its foundation the practice of insight-oriented (or mindfulness) meditation. In this study, we examined the effects of MBSR upon psychological, physical status and CD4 count of HIV/AIDS infected patients registered at the Positive Club of Imam Khomeini Hospital in 2007. Using a pilot study, we evaluated the effectiveness of a psychological intervention (8-week) that was based on training in mindfulness at the Positive Club of Imam Khomeini Hospital in 2007. Eight 2-hour sessions weekly and a day-long retreat were planned for a group of 10 participants with HIV. We investigated the long-term effects of this approach on psychological and physical status of patients by SCL-90-R and MSCL questionnaires and CD4 count after MBSR and in 3, 6, 9 and 12-month follow-ups. We studied six HIV positive patients. The mean age was 35 +/- 7.7 yrs. There was no significant difference in MSCL scores after MBSR and in 3, 6, 9 and 12 months compared to those before MBSR (P>0.05). There was a significant difference in SCL-90-R score after MBSR compared with before (P=0.05). Nevertheless, in 3, 6, 9 and 12 months no significant differences were seen in SCL-90-R scores relative to those before MBSR (P>0.05). The means of CD4 count, before and after MBSR, and in 3, 6, 9 and 12 months were 549 +/- 173.6, 640.2 +/- 189.4, 655.3 +/- 183.4, 638 +/- 167.4, 619.3 +/- 163.2, and 595.2 +/- 165.6, respectively. There was a significant difference in CD4 counts in comparison with those before MBSR (P<0.05). In our study, MBSR had positive effects on psychological status and CD4 count. However, more studies with large sample size are necessary.

  16. Opportunistic diseases in HIV-infected patients in Gabon following the administration of highly active antiretroviral therapy: a retrospective study.

    PubMed

    Okome-Nkoumou, Madeleine; Guiyedi, Vincent; Ondounda, Magloire; Efire, Nora; Clevenbergh, Philippe; Dibo, Mireille; Dzeing-Ella, Arnaud

    2014-02-01

    Opportunistic diseases cause substantial morbidity and mortality to human immunodeficiency virus (HIV)-infected patients. Highly active antiretroviral therapy (HAART) leading to immune reconstitution is the most effective treatment of preventing opportunistic diseases. This retrospective study established an epidemiologic profile of opportunistic diseases 10 years after the introduction of HAART. The HIV antiretroviral therapy-naive patients matching inclusion criteria were included. The primary outcome was the prevalence of opportunistic diseases. From January 1, 2002 to September 30, 2010, 654 opportunistic diseases were identified in 458 patients. Pulmonary tuberculosis, herpes zoster, cerebral toxoplasmosis, oral candidiasis, and severe pneumonia accounted for 22.05%, 15.94%, 14.19%, 14.19%, and 9.39%, respectively. Cryptococcal meningitis and pneumocystosis accounted for 0.44% and 0.21%, respectively. The prevalence of opportunistic diseases in Gabon remains high. New guidelines emphasize the importance of initiating antiretroviral therapy early to reconstitute the immune system, and reduce disease risk, and treat the primary opportunistic infection of pulmonary tuberculosis.

  17. HIV-2 Genetic Evolution in Patients with Advanced Disease Is Faster than That in Matched HIV-1 Patients▿ †

    PubMed Central

    Skar, Helena; Borrego, Pedro; Wallstrom, Timothy C.; Mild, Mattias; Marcelino, José Maria; Barroso, Helena; Taveira, Nuno; Leitner, Thomas; Albert, Jan

    2010-01-01

    The objective of this study was to estimate and compare the evolutionary rates of HIV-2 and HIV-1. Two HIV-2 data sets from patients with advanced disease were compared to matched HIV-1 data sets. The estimated mean evolutionary rate of HIV-2 was significantly higher than the estimated rate of HIV-1, both in the gp125 and in the V3 region of the env gene. In addition, the rate of synonymous substitutions in gp125 was significantly higher for HIV-2 than for HIV-1, possibly indicating a shorter generation time or higher mutation rate of HIV-2. Thus, the lower virulence of HIV-2 does not appear to translate into a lower rate of evolution. PMID:20463072

  18. HIV-infected mental health patients: characteristics and comparison with HIV-infected patients from the general population and non-infected mental health patients

    PubMed Central

    2013-01-01

    Objectives HIV-infected patients are at increased risk of developing mental health symptoms, which negatively influence the treatment of the HIV-infection. Mental health problems in HIV-infected patients may affect public health. Psychopathology, including depression and substance abuse, can increase hazardous sexual behaviour and, with it, the chance of spreading HIV. Therefore, it is important to develop an optimal treatment plan for HIV-infected patients with mental health problems. The majority of HIV-infected patients in the Netherlands (almost 60%) are homosexual men. The main objectives of this study were to describe the clinical and demographic characteristics of patients with HIV who seek treatment for their mental health symptoms in the Netherlands. Secondly, we tested whether HIV infected and non-infected homosexual patients with a lifetime depressive disorder differed on several mental health symptoms. Methods We compared a cohort of 196 patients who visited the outpatient clinic for HIV and Mental Health with HIV-infected patients in the general population in Amsterdam (ATHENA-study) and with non-HIV infected mental health patients (NESDA-study). DSM-IV diagnoses were determined, and several self-report questionnaires were used to assess mental health symptoms. Results Depressive disorders were the most commonly occurring diagnoses in the cohort and frequent drug use was common. HIV-infected homosexual men with a depressive disorder showed no difference in depressive symptoms or sleep disturbance, compared with non-infected depressive men. However, HIV-positive patients did express more symptoms like fear, anger and guilt. Although they showed significantly more suicidal ideation, suicide attempts were not more prevalent among HIV-infected patients. Finally, the HIV-infected depressive patients displayed a considerably higher level of drug use than the HIV-negative group. Conclusion Habitual drug use is a risk factor for spreading HIV. It is also more

  19. Intimacy versus isolation: a qualitative study of sexual practices among sexually active HIV-infected patients in HIV care in Brazil, Thailand, and Zambia.

    PubMed

    Closson, Elizabeth F; Mimiaga, Matthew J; Sherman, Susan G; Tangmunkongvorakul, Arunrat; Friedman, Ruth K; Limbada, Mohammed; Moore, Ayana T; Srithanaviboonchai, Kriengkrai; Alves, Carla A; Roberts, Sarah; Oldenburg, Catherine E; Elharrar, Vanessa; Mayer, Kenneth H; Safren, Steven A

    2015-01-01

    The success of global treatment as prevention (TasP) efforts for individuals living with HIV/AIDS (PLWHA) is dependent on successful implementation, and therefore the appropriate contribution of social and behavioral science to these efforts. Understanding the psychosocial context of condomless sex among PLWHA could shed light on effective points of intervention. HPTN 063 was an observational mixed-methods study of sexually active, in-care PLWHA in Thailand, Zambia, and Brazil as a foundation for integrating secondary HIV prevention into HIV treatment. From 2010-2012, 80 qualitative interviews were conducted with PLWHA receiving HIV care and reported recent sexual risk. Thirty men who have sex with women (MSW) and 30 women who have sex with men (WSM) participated in equal numbers across the sites. Thailand and Brazil also enrolled 20 biologically-born men who have sex with men (MSM). Part of the interview focused on the impact of HIV on sexual practices and relationships. Interviews were recorded, transcribed, translated into English and examined using qualitative descriptive analysis. The mean age was 25 (SD = 3.2). There were numerous similarities in experiences and attitudes between MSM, MSW and WSM across the three settings. Participants had a high degree of HIV transmission risk awareness and practiced some protective sexual behaviors such as reduced sexual activity, increased use of condoms, and external ejaculation. Themes related to risk behavior can be categorized according to struggles for intimacy and fears of isolation, including: fear of infecting a sex partner, guilt about sex, sexual communication difficulty, HIV-stigma, and worry about sexual partnerships. Emphasizing sexual health, intimacy and protective practices as components of nonjudgmental sex-positive secondary HIV prevention interventions is recommended. For in-care PLWHA, this approach has the potential to support TasP. The overlap of themes across groups and countries indicates that

  20. Intimacy versus Isolation: A Qualitative Study of Sexual Practices among Sexually Active HIV-Infected Patients in HIV Care in Brazil, Thailand, and Zambia

    PubMed Central

    Closson, Elizabeth F.; Mimiaga, Matthew J.; Sherman, Susan G.; Tangmunkongvorakul, Arunrat; Friedman, Ruth K.; Limbada, Mohammed; Moore, Ayana T.; Srithanaviboonchai, Kriengkrai; Alves, Carla A.; Roberts, Sarah; Oldenburg, Catherine E.; Elharrar, Vanessa; Mayer, Kenneth H.; Safren, Steven A.

    2015-01-01

    The success of global treatment as prevention (TasP) efforts for individuals living with HIV/AIDS (PLWHA) is dependent on successful implementation, and therefore the appropriate contribution of social and behavioral science to these efforts. Understanding the psychosocial context of condomless sex among PLWHA could shed light on effective points of intervention. HPTN 063 was an observational mixed-methods study of sexually active, in-care PLWHA in Thailand, Zambia, and Brazil as a foundation for integrating secondary HIV prevention into HIV treatment. From 2010–2012, 80 qualitative interviews were conducted with PLWHA receiving HIV care and reported recent sexual risk. Thirty men who have sex with women (MSW) and 30 women who have sex with men (WSM) participated in equal numbers across the sites. Thailand and Brazil also enrolled 20 biologically-born men who have sex with men (MSM). Part of the interview focused on the impact of HIV on sexual practices and relationships. Interviews were recorded, transcribed, translated into English and examined using qualitative descriptive analysis. The mean age was 25 (SD = 3.2). There were numerous similarities in experiences and attitudes between MSM, MSW and WSM across the three settings. Participants had a high degree of HIV transmission risk awareness and practiced some protective sexual behaviors such as reduced sexual activity, increased use of condoms, and external ejaculation. Themes related to risk behavior can be categorized according to struggles for intimacy and fears of isolation, including: fear of infecting a sex partner, guilt about sex, sexual communication difficulty, HIV-stigma, and worry about sexual partnerships. Emphasizing sexual health, intimacy and protective practices as components of nonjudgmental sex-positive secondary HIV prevention interventions is recommended. For in-care PLWHA, this approach has the potential to support TasP. The overlap of themes across groups and countries indicates that

  1. Profile of the HIV epidemic in Cape Verde: molecular epidemiology and drug resistance mutations among HIV-1 and HIV-2 infected patients from distinct islands of the archipelago.

    PubMed

    de Pina-Araujo, Isabel Inês M; Guimarães, Monick L; Bello, Gonzalo; Vicente, Ana Carolina P; Morgado, Mariza G

    2014-01-01

    HIV-1 and HIV-2 have been detected in Cape Verde since 1987, but little is known regarding the genetic diversity of these viruses in this archipelago, located near the West African coast. In this study, we characterized the molecular epidemiology of HIV-1 and HIV-2 and described the occurrence of drug resistance mutations (DRM) among antiretroviral therapy naïve (ARTn) patients and patients under treatment (ARTexp) from different Cape Verde islands. Blood samples, socio-demographic and clinical-laboratory data were obtained from 221 HIV-positive individuals during 2010-2011. Phylogenetic and bootscan analyses of the pol region (1300 bp) were performed for viral subtyping. HIV-1 and HIV-2 DRM were evaluated for ARTn and ARTexp patients using the Stanford HIV Database and HIV-GRADE e.V. Algorithm Homepage, respectively. Among the 221 patients (169 [76.5%] HIV-1, 43 [19.5%] HIV-2 and 9 [4.1%] HIV-1/HIV-2 co-infections), 67% were female. The median ages were 34 (IQR = 1-75) and 47 (IQR = 12-84) for HIV-1 and HIV-2, respectively. HIV-1 infections were due to subtypes G (36.6%), CRF02_AG (30.6%), F1 (9.7%), URFs (10.4%), B (5.2%), CRF05_DF (3.0%), C (2.2%), CRF06_cpx (0.7%), CRF25_cpx (0.7%) and CRF49_cpx (0.7%), whereas all HIV-2 infections belonged to group A. Transmitted DRM (TDRM) was observed in 3.4% (2/58) of ARTn HIV-1-infected patients (1.7% NRTI, 1.7% NNRTI), but not among those with HIV-2. Among ARTexp patients, DRM was observed in 47.8% (33/69) of HIV-1 (37.7% NRTI, 37.7% NNRTI, 7.4% PI, 33.3% for two classes) and 17.6% (3/17) of HIV-2-infections (17.6% NRTI, 11.8% PI, 11.8% both). This study indicates that Cape Verde has a complex and unique HIV-1 molecular epidemiological scenario dominated by HIV-1 subtypes G, CRF02_AG and F1 and HIV-2 subtype A. The occurrence of TDRM and the relatively high level of DRM among treated patients are of concern. Continuous monitoring of patients on ART, including genotyping, are public policies to be implemented.

  2. Profile of the HIV Epidemic in Cape Verde: Molecular Epidemiology and Drug Resistance Mutations among HIV-1 and HIV-2 Infected Patients from Distinct Islands of the Archipelago

    PubMed Central

    de Pina-Araujo, Isabel Inês M.; Guimarães, Monick L.; Bello, Gonzalo; Vicente, Ana Carolina P.; Morgado, Mariza G.

    2014-01-01

    HIV-1 and HIV-2 have been detected in Cape Verde since 1987, but little is known regarding the genetic diversity of these viruses in this archipelago, located near the West African coast. In this study, we characterized the molecular epidemiology of HIV-1 and HIV-2 and described the occurrence of drug resistance mutations (DRM) among antiretroviral therapy naïve (ARTn) patients and patients under treatment (ARTexp) from different Cape Verde islands. Blood samples, socio-demographic and clinical-laboratory data were obtained from 221 HIV-positive individuals during 2010–2011. Phylogenetic and bootscan analyses of the pol region (1300 bp) were performed for viral subtyping. HIV-1 and HIV-2 DRM were evaluated for ARTn and ARTexp patients using the Stanford HIV Database and HIV-GRADE e.V. Algorithm Homepage, respectively. Among the 221 patients (169 [76.5%] HIV-1, 43 [19.5%] HIV-2 and 9 [4.1%] HIV-1/HIV-2 co-infections), 67% were female. The median ages were 34 (IQR = 1–75) and 47 (IQR = 12–84) for HIV-1 and HIV-2, respectively. HIV-1 infections were due to subtypes G (36.6%), CRF02_AG (30.6%), F1 (9.7%), URFs (10.4%), B (5.2%), CRF05_DF (3.0%), C (2.2%), CRF06_cpx (0.7%), CRF25_cpx (0.7%) and CRF49_cpx (0.7%), whereas all HIV-2 infections belonged to group A. Transmitted DRM (TDRM) was observed in 3.4% (2/58) of ARTn HIV-1-infected patients (1.7% NRTI, 1.7% NNRTI), but not among those with HIV-2. Among ARTexp patients, DRM was observed in 47.8% (33/69) of HIV-1 (37.7% NRTI, 37.7% NNRTI, 7.4% PI, 33.3% for two classes) and 17.6% (3/17) of HIV-2-infections (17.6% NRTI, 11.8% PI, 11.8% both). This study indicates that Cape Verde has a complex and unique HIV-1 molecular epidemiological scenario dominated by HIV-1 subtypes G, CRF02_AG and F1 and HIV-2 subtype A. The occurrence of TDRM and the relatively high level of DRM among treated patients are of concern. Continuous monitoring of patients on ART, including genotyping, are public policies to be

  3. Profile of the HIV epidemic in Cape Verde: molecular epidemiology and drug resistance mutations among HIV-1 and HIV-2 infected patients from distinct islands of the archipelago.

    PubMed

    de Pina-Araujo, Isabel Inês M; Guimarães, Monick L; Bello, Gonzalo; Vicente, Ana Carolina P; Morgado, Mariza G

    2014-01-01

    HIV-1 and HIV-2 have been detected in Cape Verde since 1987, but little is known regarding the genetic diversity of these viruses in this archipelago, located near the West African coast. In this study, we characterized the molecular epidemiology of HIV-1 and HIV-2 and described the occurrence of drug resistance mutations (DRM) among antiretroviral therapy naïve (ARTn) patients and patients under treatment (ARTexp) from different Cape Verde islands. Blood samples, socio-demographic and clinical-laboratory data were obtained from 221 HIV-positive individuals during 2010-2011. Phylogenetic and bootscan analyses of the pol region (1300 bp) were performed for viral subtyping. HIV-1 and HIV-2 DRM were evaluated for ARTn and ARTexp patients using the Stanford HIV Database and HIV-GRADE e.V. Algorithm Homepage, respectively. Among the 221 patients (169 [76.5%] HIV-1, 43 [19.5%] HIV-2 and 9 [4.1%] HIV-1/HIV-2 co-infections), 67% were female. The median ages were 34 (IQR = 1-75) and 47 (IQR = 12-84) for HIV-1 and HIV-2, respectively. HIV-1 infections were due to subtypes G (36.6%), CRF02_AG (30.6%), F1 (9.7%), URFs (10.4%), B (5.2%), CRF05_DF (3.0%), C (2.2%), CRF06_cpx (0.7%), CRF25_cpx (0.7%) and CRF49_cpx (0.7%), whereas all HIV-2 infections belonged to group A. Transmitted DRM (TDRM) was observed in 3.4% (2/58) of ARTn HIV-1-infected patients (1.7% NRTI, 1.7% NNRTI), but not among those with HIV-2. Among ARTexp patients, DRM was observed in 47.8% (33/69) of HIV-1 (37.7% NRTI, 37.7% NNRTI, 7.4% PI, 33.3% for two classes) and 17.6% (3/17) of HIV-2-infections (17.6% NRTI, 11.8% PI, 11.8% both). This study indicates that Cape Verde has a complex and unique HIV-1 molecular epidemiological scenario dominated by HIV-1 subtypes G, CRF02_AG and F1 and HIV-2 subtype A. The occurrence of TDRM and the relatively high level of DRM among treated patients are of concern. Continuous monitoring of patients on ART, including genotyping, are public policies to be implemented

  4. Herbal product use in non-HIV and HIV-positive Hispanic patients.

    PubMed Central

    Rivera, José O.; González-Stuart, Armando; Ortiz, Melchor; Rodríguez, José C.; Anaya, Jaime P.; Meza, Armando

    2005-01-01

    PURPOSE: The primary endpoint of this study was to determine the prevalence of herbal product use by a sample of Mexican-American patients in the El Paso, TX region. Even though medicinal plants are popularly assumed to be a safe and natural alternative to conventional medications, some herbal products may pose a potential health risk to the consumer. Currently, there are few studies related to herbal use by Mexican Americans and none in HIV patients living on the U.S./México border. METHODS: A prospective observational study was conducted in hospitals and clinics throughout the El Paso region area. A semistructured interview was conducted by trained bilingual interviewers. A 45-item bilingual questionnaire was used to collect the information. RESULTS: A total of 439 non-HIV patients as well as 35 patients afflicted with HIV participated in the study. Seventy-nine percent (347/439) of non-HIV and 71% (25/35) of HIV patients reported using herbal products. The percentages of herbal use among the two groups did not show any statistically significant differences (p=0.29), and both groups reflected that herbal products are commonly used. CONCLUSIONS: The use of herbal products was very common among non-HIV (79%) and HIV-positive (71%) Mexican-Americans patients in the El Paso region. PMID:16396061

  5. [Incidence and etiology of psychotic disorders in HIV infected patients].

    PubMed

    Niederecker, M; Naber, D; Riedel, R; Perro, C; Goebel, F D

    1995-05-01

    There are numerous case reports on psychoses in AIDS patients and, although more seldom, also in HIV-positive patients in early stages of infection; however, systematic investigations on the frequency, e.g., relevant for the indication of an HIV test in psychiatric patients, are missing. For this study, 1046 HIV-positive patients were examined regarding psychoses. A total of 301 patients (28.8%) were HIV-positive but asymptomatic, and 380 patients (36.2%) had the lymphadenopathy syndrome. One hundred thirty-two patients (12.6%) suffered from an AIDS-related complex and 233 patients (22.3%) from AIDS. Of these 1046 patients, only 9 (0.9%) suffered from psychoses. One patient with a paranoid-hallucinatory syndrome was asymptomatic; one in the lymphadenopathy syndrome was manic. The other 7 patients were all in late stages of the infection. A causal relationship between HIV infection and psychosis and probable in only 3 patients. These data do not indicate a markedly elevated prevalence of psychosis in HIV-positive or AIDS patients.

  6. [Incidence and etiology of psychotic disorders in HIV infected patients].

    PubMed

    Niederecker, M; Naber, D; Riedel, R; Perro, C; Goebel, F D

    1995-05-01

    There are numerous case reports on psychoses in AIDS patients and, although more seldom, also in HIV-positive patients in early stages of infection; however, systematic investigations on the frequency, e.g., relevant for the indication of an HIV test in psychiatric patients, are missing. For this study, 1046 HIV-positive patients were examined regarding psychoses. A total of 301 patients (28.8%) were HIV-positive but asymptomatic, and 380 patients (36.2%) had the lymphadenopathy syndrome. One hundred thirty-two patients (12.6%) suffered from an AIDS-related complex and 233 patients (22.3%) from AIDS. Of these 1046 patients, only 9 (0.9%) suffered from psychoses. One patient with a paranoid-hallucinatory syndrome was asymptomatic; one in the lymphadenopathy syndrome was manic. The other 7 patients were all in late stages of the infection. A causal relationship between HIV infection and psychosis and probable in only 3 patients. These data do not indicate a markedly elevated prevalence of psychosis in HIV-positive or AIDS patients. PMID:7609818

  7. Stem Cell Transplant Can Help HIV Patients Battling Lymphoma

    MedlinePlus

    ... page: https://medlineplus.gov/news/fullstory_159395.html Stem Cell Transplant Can Help HIV Patients Battling Lymphoma: Study ... for lymphoma, and a new study concludes that stem cell transplant should be standard treatment in these cases. ...

  8. Use, perceptions, and acceptability of a ready-to-use supplementary food among adult HIV patients initiating antiretroviral treatment: a qualitative study in Ethiopia

    PubMed Central

    Olsen, Mette Frahm; Tesfaye, Markos; Kaestel, Pernille; Friis, Henrik; Holm, Lotte

    2013-01-01

    Objectives Ready-to-use supplementary foods (RUSF) are used increasingly in human immunodeficiency virus (HIV) programs, but little is known about how it is used and viewed by patients. We used qualitative methods to explore the use, perceptions, and acceptability of RUSF among adult HIV patients in Jimma, Ethiopia. Methods The study obtained data from direct observations and 24 in-depth interviews with HIV patients receiving RUSF. Results Participants were generally very motivated to take RUSF and viewed it as beneficial. RUSF was described as a means to fill a nutritional gap, to “rebuild the body,” and protect it from harmful effects of antiretroviral treatment (ART). Many experienced nausea and vomiting when starting the supplement. This caused some to stop supplementation, but the majority adapted to RUSF. The supplement was eaten separately from meal situations and only had a little influence on household food practices. RUSF was described as food with “medicinal qualities,” which meant that many social and religious conventions related to food did not apply to it. The main concerns about RUSF related to the risk of HIV disclosure and its social consequences. Conclusion HIV patients view RUSF in a context of competing livelihood needs. RUSF intake was motivated by a strong wish to get well, while the risk of HIV disclosure caused concerns. Despite the motivation for improving health, the preservation of social networks was prioritized, and nondisclosure was often a necessary strategy. Food sharing and religious fasting practices were not barriers to the acceptability of RUSF. This study highlights the importance of ensuring that supplementation strategies, like other HIV services, are compatible with the sociocultural context of patients. PMID:23766634

  9. A Suicide Prevention Program for HIV-Positive Patients.

    ERIC Educational Resources Information Center

    Shaw, Seana; Rothberg, Joseph M.

    Research has shown that suicide risk is elevated in the patient who has tested positive for Human Immunodeficiency Virus (HIV). Studies within the Army have found that the three most turbulent periods for the soldier with HIV infection are: (1) at the time of notification of diagnosis; (2) when the family and peer group learn of the diagnosis; and…

  10. Emergence of co-infection of visceral leishmaniasis in HIV-positive patients in northeast Iran: a preliminary study.

    PubMed

    Shafiei, Reza; Mohebali, Mehdi; Akhoundi, Behnaz; Galian, Meysam Sharifdini; Kalantar, Fathollah; Ashkan, Saeedeh; Fata, Abdolmajid; Farash, Bibi Razieh Hosseini; Ghasemian, Mehrdad

    2014-01-01

    Visceral leishmaniasis (VL) serosurvey was carried out on 49 HIV/AIDS patients among 500 asymptomatic HIV/infected patients who registered in the Khorasan Razavi Province during the last 14 years. HIV infections were detected by ELISA and confirmed using western blot assay at the AIDS centre of the Khorasan Razavi Province. All collected sera were screened using the direct agglutination test (DAT). The sera with anti-Leishmania infantum antibodies at a titre of 1:100 were considered positive for VL infection and serum titration was performed from 1:100 to 1:102,400. Nine (18.4%) patients were sero-positive according to DAT. The distribution of sera titrations were as follows: 1:100 (n = 6) 1:1600 (n = 1); 1:25,600 (n = 1) and 1:102,400 (n = 1). All sero-positive cases showed clinical signs and symptoms. The most predominant signs and symptoms of co-infection of visceral leishmaniasis in HIV-positive patients were pneumonia (n = 2), hepatosplenomegaly (n = 2), lymphadenopathy (n = 2), anaemia (n = 1), prolonged fever (n = 1) and cachexia (n = 1). Our finding shows that VL (or kala-azar) is an opportunistic disease in HIV-positive patients that may be occurred in VL endemic areas of Iran.

  11. Hemiballistic movements in a newly HIV patient.

    PubMed

    Magano, Rita; Jorge, Rita; Prata, Margarida; Ventura, Maria Conceição; Saraiva da Cunha, José Gabriel

    2016-01-01

    Infections of central nervous system (CNS) include a broad group of conditions and pose a particular challenge to physicians, especially in immunocompromised individuals. This case refers to a 26-year-old male patient with a history of smoked hashish and drug abuse admitted to the infectious disease department with hemiballismus of left hemibody and a positive HIV serologic test. A magnetic resonance imaging (MRI) study showed lesions at lower left and right cerebellar hemisphere, one of them thalamus - mesencephalic suggesting an opportunistic infection or an HIV associated encephalopathy. Lumbar puncture, brain biopsy and successive neuroimaging were not conclusive for one disease and despite the use of directed therapy for cerebral toxoplasmosis, meningeal tuberculosis, anti-retrovirals and sedative medication, after over 6 weeks of hospitalization pallidotomy was performed. After 5 months of oral and surgical treatment the patient showed clinical, immunological and radiological recovery. PMID:27583209

  12. Solid organ transplants in HIV-infected patients.

    PubMed

    Harbell, Jack; Terrault, Norah A; Stock, Peter

    2013-09-01

    There is a growing need for kidney and liver transplants in persons living with HIV. Fortunately, with the significant advances in antiretroviral therapy and management of opportunistic infections, HIV infection is no longer an absolute contraindication for solid organ transplantation. Data from several large prospective multi-center cohort studies have shown that solid organ transplantation in carefully selected HIV-infected individuals is safe. However, significant challenges have been identified including prevention of acute rejection, management of drug-drug interactions and treatment of recurrent viral hepatitis. This article reviews the selection criteria, outcomes, and special management considerations for HIV-infected patients undergoing liver or kidney transplantation.

  13. Preventive cancer screening practices in HIV-positive patients.

    PubMed

    Momplaisir, Florence; Mounzer, Karam; Long, Judith A

    2014-01-01

    As patients with HIV age, they are at risk of developing non-AIDS defining malignancies. We performed a questionnaire study to evaluate colorectal and breast cancer screening among HIV-positive and HIV-negative patients seeking care from either an integrated (HIV/primary care), nonintegrated (specialized HIV), or general internal medicine clinic between August 2010 and July 2011. We performed a logistic regression to determine the odds of cancer screening. A total of 813 surveys were collected, and 762 were included in the analysis. As much as 401 were from HIV-positive patients. Patients with HIV were less likely to be current with their colorectal cancer screening (CRCS) (54.4% versus 65.0%, p=0.009); mammography rates were 24.3% versus 62.3% if done during the past year (p<0.001), and 42.0% versus 86.7% if done during the past 5 years (p<0.001). In adjusted models, the odds of colorectal cancer screening in HIV-positive patients compared to negative controls was not statistically significant (OR 0.8; 95% CI 0.5-1.3); however, HIV-positive women remained significantly less likely to be current with breast cancer screening (BCS) whether their mammogram was completed within 1 year (OR 0.1, 95% CI 0.1-0.2) or within 5 years (OR 0.1, 95% CI 0.0-0.2). Integrated care was not associated with improved screening; however, having frequent visits to a primary care physician (PCP) increased the likelihood of getting screened. BCS was lower in HIV-positive compared to HIV-negative women. Frequent visits to a PCPs improved cancer screening.

  14. Acute adverse effects of radiation therapy on HIV-positive patients in Japan: study of 31 cases at Tokyo Metropolitan Komagome Hospital.

    PubMed

    Kaminuma, Takuya; Karasawa, Katsuyuki; Hanyu, Nahoko; Chang, Ta-Chen; Kuga, Gencho; Okano, Naoko; Kubo, Nobuteru; Okuma, Yusuke; Nagata, Yasunobu; Maeda, Yoshiharu; Ajisawa, Atsushi

    2010-01-01

    Recently, the number of human immunodeficiency virus (HIV) -positive patients has increased in Japan. HIV-positive patients are at a higher risk of cancer than the general population. This paper retrospectively reports the acute adverse effects of radiation therapy on HIV-positive patients who were treated at Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital (TMCICK). Thirty-one cases involving 24 HIV-positive cancer patients who were treated at TMCICK from January 1997 to March 2009 were included in this study. All acute adverse effects of radiation therapy were examined during, and one month after, the last radiation therapy session. Acute adverse effects were classified according to the site of radiation therapy treatment and analyzed using the Common Terminology Criteria for Adverse Events (CTCAE) version 3.0. Grade 3 acute adverse effects were seen in 17% of cases, and Grade 2 toxicities were found in 23% of patients. Damage to the skin and mucosa, including stomatitis or diarrhea, tended to occur after low-dose radiation therapy; however, no severe acute adverse effects were seen in other organs, such as the brain, lung, and bone. Acute adverse effects tended to occur earlier in HIV-positive patients and became severe more frequently than in the general population. In particular, disorders of the mucosa, such as those of the oral cavity, pharynx, and intestine, tended to occur rapidly. It was shown that radiation therapy is safe when treatment is performed carefully and that it is a very useful treatment for cancer in HIV-positive patients.

  15. Benchmarking HIV health care: from individual patient care to health care evaluation. An example from the EuroSIDA study

    PubMed Central

    2012-01-01

    Background State-of-the-art care involving the utilisation of multiple health care interventions is the basis for an optimal long-term clinical prognosis for HIV-patients. We evaluated health care for HIV patients based on four key indicators. Methods Four indicators of health care were assessed: Compliance with current guidelines on initiation of: 1) combination antiretroviral therapy (cART); 2) chemoprophylaxis; 3) frequency of laboratory monitoring; and 4) virological response to cART (proportion of patients with HIV-RNA < 500copies/ml for >90% of time on cART). Results 7097 EuroSIDA patients were included from Northern (n = 923), Southern (n = 1059), West Central (n = 1290) East Central (n = 1366), Eastern (n = 1964) Europe, and Argentina (n = 495). Patients in Eastern Europe with a CD4 < 200cells/mm3 were less likely to initiate cART and Pneumocystis jiroveci-chemoprophylaxis compared to patients from all other regions, and less frequently had a laboratory assessment of their disease status. The proportion of patients with virological response was highest in Northern, 89% vs. 84%, 78%, 78%, 61%, 55% in West Central, Southern, East Central Europe, Argentina and Eastern Europe, respectively (p < 0.0001). Compared to Northern, patients from other regions had significantly lower odds of virological response; the difference was most pronounced for Eastern Europe and Argentina (adjusted OR 0.16 [95%CI 0.11-0.23, p < 0.0001]; 0.20[0.14-0.28, p < 0.0001] respectively). Conclusions This assessment of HIV health care utilization revealed pronounced regional differences in adherence to guidelines and can help to identify gaps and direct target interventions. It may serve as a tool for the assessment and benchmarking of the clinical management of HIV patients in any setting worldwide. PMID:23009317

  16. Stigma, social reciprocity and exclusion of HIV/AIDS patients with illicit drug histories: A study of Thai nurses' attitudes

    PubMed Central

    Chan, Kit Yee; Stoové, Mark A; Reidpath, Daniel D

    2008-01-01

    Background Stigma is a key barrier for the delivery of care to patients living with HIV/AIDS (PLWHA). In the Asia region, the HIV/AIDS epidemic has disproportionately affected socially marginalised groups, in particular, injecting drug users. The effect of the stigmatising attitudes towards injecting drug users on perceptions of PLWHA within the health care contexts has not been thoroughly explored, and typically neglected in terms of stigma intervention. Methods Semi-structured interviews were conducted with a group of twenty Thai trainee and qualified nurses. Drawing upon the idea of 'social reciprocity', this paper examines the constructions of injecting drug users and PLWHA by a group of Thai nurses. Narratives were explored with a focus on how participants' views concerning the high-risk behaviour of injecting drug use might influence their attitudes towards PLWHA. Results The analysis shows that active efforts were made by participants to separate their views of patients living with HIV/AIDS from injecting drug users. While the former were depicted as patients worthy of social support and inclusion, the latter were excluded on the basis that they were perceived as irresponsible 'social cheaters' who pose severe social and economic harm to the community. Absent in the narratives were references to wider socio-political and epidemiological factors related to drug use and needle sharing that expose injecting drug users to risk; these behaviours were constructed as individual choices, allowing HIV positive drug users to be blamed for their seropositive status. These attitudes could potentially have indirect negative implications on the nurses' opinions of patients living with HIV/AIDS more generally. Conclusion Decreasing the stigma associated with illicit drugs might play crucial role in improving attitudes towards patients living with HIV/AIDS. Providing health workers with a broader understanding of risk behaviours and redirecting government injecting drug

  17. Why HIV positive patients on antiretroviral treatment and/or cotrimoxazole prophylaxis use traditional medicine: perceptions of health workers, traditional healers and patients: a study in two provinces of South Africa.

    PubMed

    Puoane, T R; Hughes, G D; Uwimana, J; Johnson, Q; Folk, W R

    2012-01-01

    The study explored the perceptions, knowledge and attitudes of patients, health workers and traditional healers about the use of traditional medicine and Anti Retroviral Therapy (ART). The study explored the perceptions, knowledge and attitudes of patients, health workers and traditional healers about the use of traditional medicine and Anti Retroviral Therapy (ART), using an exploratory qualitative design in two provinces of South Africa: an urban township health facility in the Western Cape, and a rural district hospital in KwaZulu-Natal (KZN) with antennal HIV rate of 32% and 28%'respectively. In-depth interviews were conducted with 14 participants: six HIV patients on ART and using Traditional Medicine(TM), two doctors, two nurses and four traditional healers. Two focus group discussions -one at each site - were held with community health workers who work with HIV-positive patients (Western Cape [5] and in KZN [4]). Patient said to have used Traditional Healing Practices (THP) before they were diagnosed with HIV, and some who have been diagnosed with HIV continue using TM in conjunction with ART and/or Cotrimoxazole prophylaxis. Patients preferred not to disclose THP to health professionals because of lack of support and understanding. Patients utilize THP because of family expectations, privacy and confidentiality, especially when they have not disclosed their HIV status. Healthcare professionals had strong negative opinions about THP, especially for HIV-positive patients. Traditional healers supported the patient's rationale for THP use. This study revealed a need to better understand factors involved in patients' choosing to use THP concurrently with ART.

  18. Abacavir/Lamivudine plus Rilpivirine Is an Effective and Safe Strategy for HIV-1 Suppressed Patients: 48 Week Results of the SIMRIKI Retrospective Study

    PubMed Central

    Troya, Jesús; Ryan, Pablo; Ribera, Esteban; Podzamczer, Daniel; Hontañón, Victor; Terrón, Jose Alberto; Boix, Vicente; Moreno, Santiago; Barrufet, Pilar; Castaño, Manuel; Carrero, Ana; Galindo, María José; Suárez-Lozano, Ignacio; Knobel, Hernando; Raffo, Miguel; Solís, Javier; Yllescas, María; Esteban, Herminia

    2016-01-01

    Objectives Based on data from clinical practice, we evaluated the effectiveness and safety of switching to abacavir/lamivudine plus rilpivirine (ABC/3TC+RPV) treatment in virologically suppressed HIV-1-infected patients. Methods We performed a multicenter, non-controlled, retrospective study of HIV-1-infected patients who switched treatment to ABC/3TC+RPV. Patients had an HIV-RNA <50 copies/mL for at least 24 weeks prior to changing treatments. The primary objective was HIV-1 RNA <50 copies/mL at week 48. Effectiveness was analyzed by intention-to-treat (ITT), missing = failure and on-treatment (OT) analyses. The secondary objectives analyzed were adverse effects changes in renal, hepatic or lipid profiles, changes in CD4+ cell count and treatment discontinuations. Results Of the 205 patients included, 75.6% were men and the median age was 49. At baseline, before switching to ABC/3TC+RPV, median time since HIV diagnosis was 13.1 years, median time with undetectable HIV-1 RNA was 6.2 years and median time of previous antiretroviral regimen was 3.1 years (48.3% patients were taking efavirenz and ABC/3TC was the most frequent backbone coformulation in 69.7% of patients). The main reasons for switching were drug toxicity/poor tolerability (60.5%) and simplification (20%). At week 48, the primary objective was achieved by 187 out of 205 (91.2%) patients by ITT analysis, and 187 out of 192 (97.4%) patients by OT analysis. The CD4+ lymphocyte count and CD4+ percentage increased significantly from baseline to week 48 by a median of 48 cells/μL (−50 to 189) and 1.2% (−1.3% to 4.1%), respectively, P<0.001. Thirty-eight adverse events (AE) were detected in 32 patients. Of these, 25 had no clear association with treatment. Three patients interrupted therapy due to AE. We observed a decrease in all lipid parameters, P<0.001, and a slight improvement in the glomerular filtration rate, P<0.01. Therapy was considered to have failed in 18 patients owing to virological failure

  19. Prevalence of Adenomas Found on Colonoscopy in Patients With HIV

    PubMed Central

    Gutkin, Ellen; Hussain, Syed A.; Mehta, Preeti; Kim, Sang H.; Pollack, Simcha; Rubin, Moshe

    2012-01-01

    Background The life expectancy of patients with HIV has increased significantly since the introduction of highly active antiretroviral therapy in 1995. Although this population of patients now carries less risk for the development of AIDS defining illnesses and malignancies, they are still at risk for non-AIDS defining cancers, such as colon, prostate, and breast. Several studies have shown that HIV infected patients have a higher prevalence of advanced colonic neoplasia which occur at a younger age. Our aim is to examine the prevalence of adenomas and adenocarcinoma in HIV patients undergoing colonoscopy. Methods HIV patients seen in our gastroenterology clinic and inpatient service undergoing colonoscopy were identified from 2010 - 2011. Indication was screening in 27 patients and diagnostic in 23 patients. Significant lesions were defined as adenomas, serrated polyps, and adenocarcinoma. Results Total 50 patients were included in the study, 32 male and 18 female (mean age: 53.6; range 37 - 72 years), 25 patients were African American, 21 were Hispanic, 3 were Caucasian, and one was Indian, 39 patients had undetectable HIV RNA, 30 patients had CD4 lymphocyte counts greater than 500, 20 had CD4 lymphocyte counts less than 500, and 4 patients had CD4 lymphocyte counts less than 200, 52% (26/50) of patients had polyps. Significant lesions (adenomas and serrated polyps) were seen in 34% (17/50) of patients, 39% in diagnostic and 30% in screening procedures (P = 0.56). Males were found to have significant lesions 28% of the time as compared to 44% of females (P = 0.35), 43% of Hispanics had significant lesions versus 24% of African Americans (P = 0.22), 25% of the patients under age 50 were found to have significant lesions, 45% of the patients with detectable HIV RNA levels were found to have significant lesions vs 31% (P = 0.48). Surprisingly, patients with CD4 counts > 500 had significantly more adenomas than those with CD4 counts < 500, 47% vs 15% (P = 0.03). No

  20. Seroprevalence of hepatitis E in HIV infected patients in Greece.

    PubMed

    Politou, Marianna; Boti, Sofia; Androutsakos, Theodoros; Valsami, Serena; Pittaras, Theodoros; Kapsimali, Violetta

    2015-09-01

    HEV infection is an emerging public health problem worldwide Data concerning HEV infection in HIV+ patients in Greece is scare. The aim of the study was to determine HEV seroprevalence in patients with HIV infection in Greece. We studied 243 HIV(+) patients 214 men (88%) and 29 women (12%) with a median age of 45 years (range 19-83) who attended the HIV unit of Pathophysiology Department of Laikon General Hospital in Athens for the presence of anti-HEV IgG antibodies with (EIA) (EIA HEV IgG, Adaltis, Rome, Italy Eighteen/243 patients (7.3%) were positive for HEV IgG antibodies, a seroprevalence that was not different from that described for the blood donors group from Greece There was no difference of the presence of HbsAg, hepatitis C and hepatitis A between the HEV(+) and HEV(-) patients. There was no statistically significant difference between the HEV(+) and HEV(-) group in terms of HIV acquisition, sexual orientation, median duration of HIV infection, ART treatment, or duration of ART. Only the median age of HEV(+) was 52 years (35-78) while that of HEV(-) was 44 years (19-83)(P = 0.03). Only 2/18(11.1%) HEV(+) HIV(+) patients had abnormal ALT and AST values. The seroprevalence of hepatitis E in HIV(+) patients in Greece seems to be the same with that of the general population thus implying that HIV infection is not a risk factor for HEV infection and only age shows a positive correlation with seropositivity.

  1. ORTHOPEDIC COMPLICATIONS IN HIV PATIENTS

    PubMed Central

    Lima, Ana Lúcia Lei Munhoz; Godoy, Alexandre Leme; Oliveira, Priscila Rosalba Domingos; Gobbi, Ricardo Gomes; de Almeida Silva, Camila; Martino, Patricia Bernardelli; Gutierrez, Eliana Bataggia; Gianna, Maria Clara; Camanho, Gilberto Luis

    2015-01-01

    The considerable increase of the life expectancy of HIV-infected patients in the age of highly-powerful antiretroviral treatment results in important metabolic and bone-joint changes resulting from a long-lasting viral infection time and from this treatment. The most common orthopaedic complications are bone mineralization changes, osteonecrosis, carpal tunnel syndrome and gleno-humeral adhesive capsulitis, with different clinical presentation features, natural disease progression and therapeutic response compared to the overall population. Literature reports are initial, and the experience of the multidisciplinary service of the University of Sao Paulo's Institute of Orthopaedics and Traumatology enables us a more indepth knowledge about the various pathologies involved and the development of treatment protocols that are appropriate to these diagnoses. PMID:27004170

  2. Neuropsychological abnormalities in AIDS and asymptomatic HIV seropositive patients.

    PubMed Central

    Villa, G; Monteleone, D; Marra, C; Bartoli, A; Antinori, A; Pallavicini, F; Tamburrini, E; Izzi, I

    1993-01-01

    Neuropsychological and immunological parameters were studied in 36 AIDS patients with early disease and without clinical, laboratory, and neuroradiological signs of CNS impairment, and also in 33 asymptomatic HIV seropositive subjects. Many AIDS patients performed abnormally on timed psychomotor tasks, tasks involving sequencing and "set-shifting", and memory tasks stressing attention, learning, active retrieval, and monitoring of information. Asymptomatic HIV seropositive subjects as a group did not perform significantly worse than controls. However, on the basis of a cut off number of pathological performances on neuropsychological tasks, 52.8% of AIDS and 30.3% of asymptomatic HIV seropositive subjects had cognitive impairment, compared with 3.9% of HIV seronegative controls. Low values of CD4+ cells and of CD4+/CD8+ ratio and high titres of P-24 antigen in the blood prevailed among subjects with cognitive impairment, especially in the asymptomatic HIV seropositive group. PMID:8350104

  3. Food insecurity, CD4 counts, and incomplete viral suppression among HIV+ patients from Texas Children's Hospital: A pilot study

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Our goal was to determine the relationship between food insecurity and CD4 counts and viral suppression among pediatric HIV-positive patients. Food insecurity was assessed by validated survey. CD4 counts and viral load were abstracted from patients’ charts. We used linear regression for the dependen...

  4. High mortality in tuberculosis patients despite HIV interventions in Swaziland

    PubMed Central

    van Griensven, J.; Hinderaker, S. G.; Kizito, W.; Sikhondze, W.; Manzi, M.; Dlamini, T.; Harries, A. D.

    2016-01-01

    Setting: All health facilities providing tuberculosis (TB) care in Swaziland. Objective: To describe the impact of human immunodeficiency virus (HIV) interventions on the trend of TB treatment outcomes during 2010–2013 in Swaziland; and to describe the evolution in TB case notification, the uptake of HIV testing, antiretroviral therapy (ART) and cotrimoxazole preventive therapy (CPT), and the proportion of TB-HIV co-infected patients with adverse treatment outcomes, including mortality, loss to follow-up and treatment failure. Design: A retrospective descriptive study using aggregated national TB programme data. Results: Between 2010 and 2013, TB case notifications in Swaziland decreased by 40%, HIV testing increased from 86% to 96%, CPT uptake increased from 93% to 99% and ART uptake among TB patients increased from 35% to 75%. The TB-HIV co-infection rate remained around 70% and the proportion of TB-HIV cases with adverse outcomes decreased from 36% to 30%. Mortality remained high, at 14–16%, over the study period, and anti-tuberculosis treatment failure rates were stable over time (<5%). Conclusion: Despite high CPT and ART uptake in TB-HIV patients, mortality remained high. Further studies are required to better define high-risk patient groups, understand the reasons for death and design appropriate interventions. PMID:27358803

  5. Laser palliation of the HIV+ patient

    NASA Astrophysics Data System (ADS)

    Convissar, Robert A.

    2003-12-01

    Many oral manifestations of HIV infection can be used as markers for degree of immunosupression. These manifestations may be treated with antibiotics, analgesics, and antineoplastics, which may interact and interfere with antiviral agents used to treat the disease, and possibly exacerbate it. Dentists will see more HIV-infected patients as medical research transforms this disease into a chronic illness. Lasers have been shown to be effective instruments in palliation of oral manifestations of HIV infection. The use of lasers to palliate the painful symptoms of three oral manifestations of HIV infection is described. The advantages and benefits to both patient and dentist will be discussed. The paper does not address the use of lasers as a modality to treat or cure HIV infection -- only to palliate some of its symptoms.

  6. Clinical significance of hyperbilirubinemia among HIV-1-infected patients treated with atazanavir/ritonavir through 96 weeks in the CASTLE study.

    PubMed

    McDonald, Cheryl; Uy, Jonathan; Hu, Wenhua; Wirtz, Victoria; Juethner, Salome; Butcher, David; McGrath, Donnie; Farajallah, Awny; Moyle, Graeme

    2012-05-01

    CASTLE was a randomized 96-week study that demonstrated that atazanavir/ritonavir (ATV/r) was noninferior to lopinavir/ritonavir (LPV/r) in treatment-naïve HIV-infected patients. Analyses were carried out among patients who received ATV/r in the CASTLE study to better understand the clinical significance of unconjugated hyperbilirubinemia associated with administration of boosted ATV. Hyperbilirubinemia was defined as total bilirubin (conjugated and unconjugated) elevation greater than 2.5 times the upper limit of normal (grade 3-4). Patients in the ATV/r arm were assessed based on the presence or absence of hyperbilirubinemia through week 96. Analyses included number of confirmed virologic responders (CVR; HIV RNA<50 copies per milliliter), impact of hyperbilirubinemia on symptoms, elevations in liver enzymes, patient quality of life, and medication adherence. Through 96 weeks in the CASTLE study, 44% of patients who received ATV/r had hyperbilirubinemia at any time point, and between 12.5% and 21.6% had hyperbilirubinemia at any single study visit. At 96 weeks, 74% of patients overall and 84% and 69% of patients with and without hyperbilirubinemia, respectively, achieved CVR. Symptoms of jaundice or scleral icterus occurred in 5% of patients overall and in 11% with hyperbilirubinemia and 0% without hyperbilirubinemia. Four percent of patients with and 3% of patients without hyperbilirubinemia had grade 3-4 elevations in liver transaminases. Less than 1% of patients discontinued treatment due to hyperbilirubinemia. There were no differences in quality of life or adherence between patients with or without hyperbilirubinemia. In the CASTLE study, hyperbilirubinemia observed in the ATV/r group did not negatively impact clinical outcomes in HIV-infected patients.

  7. Predicting the short-term risk of diabetes in HIV-positive patients: the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study

    PubMed Central

    Petoumenos, Kathy; Worm, Signe W; Fontas, Eric; Weber, Rainer; De Wit, Stephane; Bruyand, Mathias; Reiss, Peter; El-Sadr, Wafaa; Monforte, Antonella D'Arminio; Friis-Møller, Nina; Lundgren, Jens D; Law, Matthew G

    2012-01-01

    Introduction HIV-positive patients receiving combination antiretroviral therapy (cART) frequently experience metabolic complications such as dyslipidemia and insulin resistance, as well as lipodystrophy, increasing the risk of cardiovascular disease (CVD) and diabetes mellitus (DM). Rates of DM and other glucose-associated disorders among HIV-positive patients have been reported to range between 2 and 14%, and in an ageing HIV-positive population, the prevalence of DM is expected to continue to increase. This study aims to develop a model to predict the short-term (six-month) risk of DM in HIV-positive populations and to compare the existing models developed in the general population. Methods All patients recruited to the Data Collection on Adverse events of Anti-HIV Drugs (D:A:D) study with follow-up data, without prior DM, myocardial infarction or other CVD events and with a complete DM risk factor profile were included. Conventional risk factors identified in the general population as well as key HIV-related factors were assessed using Poisson-regression methods. Expected probabilities of DM events were also determined based on the Framingham Offspring Study DM equation. The D:A:D and Framingham equations were then assessed using an internal-external validation process; area under the receiver operating characteristic (AUROC) curve and predicted DM events were determined. Results Of 33,308 patients, 16,632 (50%) patients were included, with 376 cases of new onset DM during 89,469 person-years (PY). Factors predictive of DM included higher glucose, body mass index (BMI) and triglyceride levels, and older age. Among HIV-related factors, recent CD4 counts of<200 cells/µL and lipodystrophy were predictive of new onset DM. The mean performance of the D:A:D and Framingham equations yielded AUROC of 0.894 (95% CI: 0.849, 0.940) and 0.877 (95% CI: 0.823, 0.932), respectively. The Framingham equation over-predicted DM events compared to D:A:D for lower glucose and lower

  8. Attitude of patients with HIV infection towards organ transplant between HIV patients. A cross-sectional questionnaire survey.

    PubMed

    Taha, Huda; Newby, Katie; Das, Archik; Das, Satyajit

    2016-01-01

    This study examined the HIV patients' attitudes towards the practice of organ transplant between HIV patients using a cross-sectional survey design. In total, 206 patients participated with a mean age of 42 (±8.8) years. The majority (70%) were black African and women (54%), and 83% described themselves as heterosexual. Most participants (n = 171, 83%) were on treatment, and 159 (93%) had viral load less than 40 copies/ml. Mean duration of illness and mean duration of treatment were 77 (±42.7) and 68 (±41) months, respectively. Of all participants, 128 (62%) reported that they would consider donating either any organ or a specific organ/s to an HIV patient, 33 (16%) would not consider it and 45 (22%) were unsure about donating their organs. Furthermore, 113 (55%) participants would consider receiving an organ from an HIV patient, 37 (18%) would not consider it, and 56 (27%) were unsure. Ninety-eight participants (42%) reported that they would consider both donating and receiving an organ. Multinomial logistic regression analysis found that significantly more Black African than Caucasian participants were unsure about organ donation (p = 0.011, OR = 3.887). Participants with longer duration of infection were significantly less likely to consider receiving an organ from an HIV patient (p = 0.036, OR = 1.297). Overall, the study findings indicated that the majority of participants were in favour of organ transplant between HIV patients. Use of HIV-infected donors could potentially reduce current organ waiting list among HIV patients.

  9. Multidimensional Patient-Reported Problems within Two Weeks of HIV Diagnosis in East Africa: A Multicentre Observational Study

    PubMed Central

    Simms, Victoria; Gikaara, Nancy; Munene, Grace; Atieno, Mackuline; Kataike, Jeniffer; Nsubuga, Clare; Banga, Geoffrey; Namisango, Eve; Penfold, Suzanne; Fayers, Peter; Powell, Richard A.; Higginson, Irene J.; Harding, Richard

    2013-01-01

    Objectives We aimed to determine for the first time the prevalence and severity of multidimensional problems in a population newly diagnosed with HIV at outpatient clinics in Africa. Methods Recently diagnosed patients (within previous 14 days) were consecutively recruited at 11 HIV clinics in Kenya and Uganda. Participants completed a validated questionnaire, the African Palliative Outcome Scale (POS), with three underpinning factors. Ordinal logistic regression was used to evaluate risk factors for prevalence and severity of physical, psychological, interpersonal and existential problems. Results There were 438 participants (62% female, 30% with restricted physical function). The most prevalent problems were lack of help and advice (47% reported none in the previous 3 days) and difficulty sharing feelings. Patients with limited physical function reported more physical/psychological (OR = 3.22) and existential problems (OR = 1.54) but fewer interpersonal problems (OR = 0.50). All outcomes were independent of CD4 count or ART eligibility. Conclusions Patients at all disease stages report widespread and burdensome multidimensional problems at HIV diagnosis. Newly diagnosed patients should receive assessment and care for these problems. Effective management of problems at diagnosis may help to remove barriers to retention in care. PMID:23431405

  10. Hepatitis C virus infection in HIV-infected patients.

    PubMed

    Sulkowski, Mark S

    2004-09-01

    Because of shared routes of transmission, hepatitis C and HIV coinfection is common in the United States, affecting 15% to 30% of HIV-infected individuals. In the era of highly effective antiretroviral therapy, hepatitis C virus (HCV)-related liver disease has emerged as a significant cause of morbidity and mortality. Accordingly, the Infectious Diseases Society of America and the American Association for the Study of Liver Disease guidelines for the management of HCV recommend that patients with HIV/HCV undergo medical evaluation for HCV-related liver disease and consideration for HCV treatment and, if indicated, orthotopic liver transplantation. However, the treatment of patients with HIV/HCV is complicated by the relatively high prevalence of medical and psychiatric comorbidities and the challenges of anti-HCV therapy in the setting of HIV disease and antiretroviral therapy. Nonetheless, recently completed randomized controlled trials provide evidence of the safety, tolerability, and efficacy of HCV treatment with pegylated interferon-alpha plus ribavirin in HIV-infected individuals. This review focuses on the epidemiology, natural history, and management of HCV in the HIV-infected patient.

  11. Chinese HIV-Positive Patients and Their Healthcare Providers

    PubMed Central

    Chen, Wei-Ti; Starks, Helene; Shiu, Cheng-Shi; Fredriksen-Goldsen, Karen; Simoni, Jane; Zhang, Fujie; Pearson, Cynthia; Zhao, Hongxin

    2013-01-01

    In this qualitative study, 29 HIV-positive, Chinese patients reported highly favorable impressions of their healthcare providers, who were seen as providing important medical-related, financial, and emotional support. Generally, the patient-provider relationship positively impacted the participants and their ability to maintain their health and was especially critical when patients were isolated from familial sources of support due to intense AIDS stigma. Often family members were informed of an HIV diagnosis before the patient, revealing tensions between Confucian principles of collectivism and familial authority and increasingly prevalent Western ideals of individual autonomy and the privileged status of personal health information. PMID:18025868

  12. Cystic benign lymphoepithelial lesion of the salivary glands in HIV-positive patients. Report of two cases with immunohistochemical study.

    PubMed

    d'Agay, M F; de Roquancourt, A; Peuchmaur, M; Janier, M; Brocheriou, C

    1990-01-01

    Two cases of cystic benign lymphoepithelial lesions (CBLL) of the submandibular and parotid glands occurring in HIV-positive patients are reported. The clinical and pathological criteria are defined and the differences from Sjögren's syndrome discussed. The presence, in the epithelial component, of T-cells labelled by the human mucosal lymphocyte antibody argues for a primary involvement of epithelial structures in CBLL, the lymphoid hyperplasia occurring secondarily.

  13. Prevalence of HIV seropositivity among surgical patients in a tertiary care hospital.

    PubMed

    Bhattacharya, Susmita; Chakrabarty, Banya; Kundu, Pratip Kumar; Maji, Abhiram; Ghosal, S R; Dey, Krishna Kamal

    2011-12-01

    The incidence of HIV infection has increased tremendously over the last few years. The new 2006 estimates released by the National AIDS Control Organisation (NACO), supported by UNAIDS and WHO, indicate that national adult HIV prevalence in India is approximately 0.36%, which corresponds to an estimated 2 million to 3.1 million people living with HIV in this country. The positive rate of HIV tested persons has shown a rising trend. So, a study was conducted on patients attending the surgery department for different operative procedures and 13 patients were HIV reactive out of 1697 patients tested. Routine HIV testing is usually not carried out at most centres and the medical fraternity is constantly exposed to the risk of HIV infection which can have wide-ranging implications in a health professional's life. HIV testing should be insisted on every patient before undertaking any surgical procedure routinely.

  14. Retention in Care of Adult HIV Patients Initiating Antiretroviral Therapy in Tigray, Ethiopia: A Prospective Observational Cohort Study

    PubMed Central

    Bucciardini, Raffaella; Fragola, Vincenzo; Abegaz, Teshome; Lucattini, Stefano; Halifom, Atakilt; Tadesse, Eskedar; Berhe, Micheal; Pugliese, Katherina; Binelli, Andrea; De Castro, Paola; Terlizzi, Roberta; Fucili, Luca; Di Gregorio, Massimiliano; Mirra, Marco; Olivieri, Erika; Teklu, Tsigemariam; Zegeye, Teame; Haile, Amanuel; Vella, Stefano; Abraham, Loko; Godefay, Hagos

    2015-01-01

    Introduction Although Ethiopia has been scaling up the antiretroviral therapy (ART) services, low retention in care of patients remains one of the main obstacles to treatment success. We report data on retention in care and its associated determinants in Tigray, Ethiopia. Methods We used data from the CASA project, a prospective observational and multi-site study of a cohort of HIV-infected patients who initiated ART for the first time in Tigray. Four participating health facilities (HFs) located in the South of Tigray were considered for this study. Patients were followed for one year after ART initiation. The main outcome measure was represented by the current retention in care, defined as the proportion of patients who were alive and receiving ART at the same HF one year after ART initiation. Patients who started ART between January 1, 2013 and December 31, 2013 were included in this analysis. Patients were followed for one year after ART initiation. The determinants of retention were analysed using univariate and multivariate Cox Proportional Hazards model with robust sandwich estimates to account for within HF correlation. Results The four participating HFs in Tigray were able to retain overall 85.1% of their patients after one year from starting ART. Loss to follow-up (5.5%) and transfers to other HF (6.6) were the main determinant of attrition. A multivariate analysis shows that the factors significantly associated with retention were the type of HF, gender and active TB. Alamata health center was the HF with the highest attrition rate (HR 2.99, 95% CI: 2.77–3.23). Active TB (HR 1.72, 95% CI: 1.23–2.41) and gender (HR 1.64, 95% CI: 1.10–2.56) were also significantly associated with attrition. Conclusions Although Ethiopia has significantly improved access to the ART program, achieving and maintaining a satisfactory long-term retention rate is a future goal. This is difficult because of different retention rates among HFs. Moreover specific

  15. Porphyria cutanea tarda in a HIV- positive patient.

    PubMed

    Franzon, Valéria Aparecida Zanela; Mikilita, Emanuella Stella; Camelo, Fernanda Henriques; Camargo, Rosana

    2016-01-01

    This is a case report about Porphyria cutanea tarda (PCT) and its relationship with the infection caused by the human immunodeficiency virus (HIV). Cutaneous porphyria is an illness caused by enzymatic modification that results in partial deficiency of uroporphyrinogen decarboxylase (Urod), which may be hereditary or acquired. Several studies suggest that HIV infection associated with cofactors might trigger the development of porphyria cutanea tarda. In this case report, we present a patient infected with HIV, who after the introduction of antiretroviral therapy (ART) enjoyed clinical improvement of porphyria cutanea tarda symptoms. PMID:27579753

  16. Porphyria cutanea tarda in a HIV- positive patient*

    PubMed Central

    Franzon, Valéria Aparecida Zanela; Mikilita, Emanuella Stella; Camelo, Fernanda Henriques; Camargo, Rosana

    2016-01-01

    This is a case report about Porphyria cutanea tarda (PCT) and its relationship with the infection caused by the human immunodeficiency virus (HIV). Cutaneous porphyria is an illness caused by enzymatic modification that results in partial deficiency of uroporphyrinogen decarboxylase (Urod), which may be hereditary or acquired. Several studies suggest that HIV infection associated with cofactors might trigger the development of porphyria cutanea tarda. In this case report, we present a patient infected with HIV, who after the introduction of antiretroviral therapy (ART) enjoyed clinical improvement of porphyria cutanea tarda symptoms. PMID:27579753

  17. New and old complex recombinant HIV-1 strains among patients with primary infection in 1996–2006 in France: The French ANRS CO06 primo cohort study

    PubMed Central

    Frange, Pierre; Galimand, Julie; Vidal, Nicole; Goujard, Cécile; Deveau, Christiane; Souala, Faouzi; Peeters, Martine; Meyer, Laurence; Rouzioux, Christine; Chaix, Marie-Laure

    2008-01-01

    Background Prevalence of HIV-1 non-B subtypes has increased overtime in patients diagnosed at the time of primary infection (PHI) in France. Our objective was to characterize in detail non-B strains which could not be genetically classified into the known subtypes/Circulating Recombinant Forms (CRFs). Methods Among 744 patients enrolled in the ANRS PRIMO Cohort since 1996, 176 (23.7%) were infected with HIV-1 non-B strains. The subtype/CRF could not be identified in RT for 15 (2%). The V3-V5 env region was sequenced and 3 strains (04FR-KZS, 06FR-CRN, 04FR-AUK) were full-length sequenced. Phylogenetic and bootscan analyses were used to characterize the mosaic structures. Results Among V3-V5 sequences, 6 were divergent A, 2 distantly related to E or D, 2 C, 1 B and 2 remained unclassified. 04FR-KZS, isolated in a Congolese woman infected in France, clustered with 2 previously described viruses from the Democratic Republic of Congo. They represent CRF27_cpx involving A/E/G/H/J/K/U subtypes. 06FR-CRN, isolated in a homosexual Caucasian patient, was a B/C/U recombinant involving a Brazilian C strain. 04FR-AUK, isolated in a Congolese patient infected in France, was a A/K/CRF09/U recombinant clustering from gag to vif with HIV-1 MAL. Others PHI were further observed in 2006–2007 with 1 KZS and 5 CRN-like viruses, suggesting their spread in France. Conclusion This study illustrates the increasing HIV-1 diversity in France associating new (06FR-CRN) and old (CRF27_cpx and "MAL-like" 04FR-AUK) strains, which are rare in their region of origin but may have a possible founder effect in France. Our results strengthen the French guidelines recommending viro-epidemiological surveillance of HIV-1 diversity. PMID:18673538

  18. Mortality in HIV-infected patients with tuberculosis treated with streptomycin and a two-week intensified regimen: data from an HIV cohort study using inverse probability of treatment weighting.

    PubMed

    Alvarez-Uria, Gerardo; Midde, Manoranjan; Naik, Praveen K

    2016-01-01

    Background. Despite the dramatic scale-up of antiretroviral therapy in low- and middle-income countries, tuberculosis (TB) is still the main cause of death among HIV-infected patients in resource-limited settings. Previous studies in patients with TB meningitis suggest that the use of higher doses of common anti-TB drugs could reduce mortality. Methods. Using clinical data from an HIV cohort study in India, we compared the mortality among HIV-infected patients diagnosed with TB according to the regimen received during the first two weeks of treatment: standard anti-tuberculosis therapy (ATT) (N = 847), intensified ATT (N = 322), and intensified ATT with streptomycin (N = 446). The intensified ATT comprised double dose of rifampicin and substitution of ethambutol with levofloxacin. Multivariate analysis was performed using Cox proportional hazard models and inverse probability of treatment weighting (IPTW) based on propensity scores. Patients with TB meningitis were excluded. Results. The use of intensified ATT alone did not improve survival. However, when streptomycin was added, the use intensified ATT was associated with reduced mortality in Cox models (adjusted hazard ratio 0.72, 95% CI [0.57-0.91]) and after IPTW (hazard ratio 0.77, 95% CI [0.67-0.96]). Other factors associated with improved survival were high serum albumin concentration, high CD4 lymphocyte cell-counts, and high glomerular filtration rates. Factors associated with increased mortality were high urea concentrations, being on antiretroviral therapy at the time of ATT initiation and high BUN/creatinine ratio. In an effect modification analysis, the survival benefits of the intensified ATT with streptomycin disappeared in patients with severe hypoalbuminemia. Conclusion. The results of this study are in accordance with a previous study from our cohort involving patients with TB meningitis, and suggest that an intensified 2-week ATT with streptomycin could reduce mortality in HIV infected patients

  19. Off-label use of rilpivirine in combination with emtricitabine and tenofovir in HIV-1-infected pediatric patients: A multicenter study.

    PubMed

    Falcon-Neyra, Lola; Palladino, Claudia; Navarro Gómez, María Luisa; Soler-Palacín, Pere; González-Tomé, María Isabel; De Ory, Santiago J; Frick, Marie Antoinette; Fortuny, Clàudia; Noguera-Julian, Antoni; Moreno, Elena Bermúdez; Santos, Juan Luis; Olbrich, Peter; López-Cortés, Luis F; Briz, Verónica; Neth, Olaf

    2016-06-01

    To assess the safety and efficacy of rilpivirine in combination with emtricitabine and tenofovir (RPV/FTC/TDF) as a once-daily single-tablet regimen (STR) in HIV-1-infected children and adolescents we performed a multicenter case series study of HIV-1-infected patients. Inclusion criteria were initiation of therapy with RPV/FTC/TDF before the age of 18. Patients were divided into undetectable viral load (uVL) group, HIV-1 RNA < 20 copies/mL on stable combined antiretroviral therapy (cART), and detectable viral load (dVL) group, HIV-1 RNA ≥ 20 copies/mL at RPV/FTC/TDF initiation. Patients were monitored from the date of RPV/FTC/TDF initiation until June 30, 2015, RPV/FTC/TDF discontinuation or failure to follow-up. Seventeen patients (8 in uVL and 9 in dVL group) with age between 11.6 and 17.6 were included. Reasons for switching were toxicity (n = 4) and simplification (n = 4) in uVL; viral failure (n = 8) and cART initiation (n = 1) in the dVL group. After a median follow-up of 90 (uVL) and 40 weeks (dVL), 7/8 (86%) patients maintained and 8/9 (89%) achieved and maintained HIV-1 suppression. Median CD4 count increased from 542 to 780/μL (uVL, P = 0.069) and 480 to 830/μL (dVL, P = 0.051). Five patients (2 in uVL and 3 in dVL) improved their immunological status from moderate to no immunosuppression. Serum lipid profiles improved in both groups; cholesterol dropped significantly in the dVL group (P = 0.008). Grade 1 laboratory adverse events (AEs) were observed in 3 patients. No clinical AEs occurred. Adherence was complete in 9 patients (5 in uVL and 4 in dVL); 1 adolescent interrupted treatment. Once-daily STR with RPV/FTC/TDF may be a safe and effective choice in selected HIV-1-infected adolescents and children.

  20. Off-label use of rilpivirine in combination with emtricitabine and tenofovir in HIV-1-infected pediatric patients: A multicenter study.

    PubMed

    Falcon-Neyra, Lola; Palladino, Claudia; Navarro Gómez, María Luisa; Soler-Palacín, Pere; González-Tomé, María Isabel; De Ory, Santiago J; Frick, Marie Antoinette; Fortuny, Clàudia; Noguera-Julian, Antoni; Moreno, Elena Bermúdez; Santos, Juan Luis; Olbrich, Peter; López-Cortés, Luis F; Briz, Verónica; Neth, Olaf

    2016-06-01

    To assess the safety and efficacy of rilpivirine in combination with emtricitabine and tenofovir (RPV/FTC/TDF) as a once-daily single-tablet regimen (STR) in HIV-1-infected children and adolescents we performed a multicenter case series study of HIV-1-infected patients. Inclusion criteria were initiation of therapy with RPV/FTC/TDF before the age of 18. Patients were divided into undetectable viral load (uVL) group, HIV-1 RNA < 20 copies/mL on stable combined antiretroviral therapy (cART), and detectable viral load (dVL) group, HIV-1 RNA ≥ 20 copies/mL at RPV/FTC/TDF initiation. Patients were monitored from the date of RPV/FTC/TDF initiation until June 30, 2015, RPV/FTC/TDF discontinuation or failure to follow-up. Seventeen patients (8 in uVL and 9 in dVL group) with age between 11.6 and 17.6 were included. Reasons for switching were toxicity (n = 4) and simplification (n = 4) in uVL; viral failure (n = 8) and cART initiation (n = 1) in the dVL group. After a median follow-up of 90 (uVL) and 40 weeks (dVL), 7/8 (86%) patients maintained and 8/9 (89%) achieved and maintained HIV-1 suppression. Median CD4 count increased from 542 to 780/μL (uVL, P = 0.069) and 480 to 830/μL (dVL, P = 0.051). Five patients (2 in uVL and 3 in dVL) improved their immunological status from moderate to no immunosuppression. Serum lipid profiles improved in both groups; cholesterol dropped significantly in the dVL group (P = 0.008). Grade 1 laboratory adverse events (AEs) were observed in 3 patients. No clinical AEs occurred. Adherence was complete in 9 patients (5 in uVL and 4 in dVL); 1 adolescent interrupted treatment. Once-daily STR with RPV/FTC/TDF may be a safe and effective choice in selected HIV-1-infected adolescents and children. PMID:27310962

  1. HIV-2 Integrase Polymorphisms and Longitudinal Genotypic Analysis of HIV-2 Infected Patients Failing a Raltegravir-Containing Regimen

    PubMed Central

    Cavaco-Silva, Joana; Abecasis, Ana; Miranda, Ana Cláudia; Poças, José; Narciso, Jorge; Águas, Maria João; Maltez, Fernando; Almeida, Isabel; Germano, Isabel; Diniz, António; Gonçalves, Maria de Fátima; Gomes, Perpétua; Cunha, Celso; Camacho, Ricardo Jorge

    2014-01-01

    To characterize the HIV-2 integrase gene polymorphisms and the pathways to resistance of HIV-2 patients failing a raltegravir-containing regimen, we studied 63 integrase strand transfer inhibitors (INSTI)-naïve patients, and 10 heavily pretreated patients exhibiting virological failure while receiving a salvage raltegravir-containing regimen. All patients were infected by HIV-2 group A. 61.4% of the integrase residues were conserved, including the catalytic motif residues. No INSTI-major resistance mutations were detected in the virus population from naïve patients, but two amino acids that are secondary resistance mutations to INSTIs in HIV-1 were observed. The 10 raltegravir-experienced patients exhibited resistance mutations via three main genetic pathways: N155H, Q148R, and eventually E92Q - T97A. The 155 pathway was preferentially used (7/10 patients). Other mutations associated to raltegravir resistance in HIV-1 were also observed in our HIV-2 population (V151I and D232N), along with several novel mutations previously unreported. Data retrieved from this study should help build a more robust HIV-2-specific algorithm for the genotypic interpretation of raltegravir resistance, and contribute to improve the clinical monitoring of HIV-2-infected patients. PMID:24681625

  2. The association of high-sensitivity c-reactive protein and other biomarkers with cardiovascular disease in patients treated for HIV: a nested case–control study

    PubMed Central

    2013-01-01

    Background Elevated high-sensitivity C-reactive protein (hsCRP) increases the risk of cardiovascular disease (CVD) in the general population, but its role as a predictive marker in HIV-positive patients remains unclear. Aim of the study was to evaluate whether hsCRP or other biomarkers are independent predictors of CVD risk in HIV-infected patients. Methods Retrospective, nested case–control study. HIV-positive men and women (35–69 years of age) receiving combination antiretroviral therapy (cART) were included. Cases (n = 35) had a major CVD event. Controls (n = 74) free from CVD events for at least 5 years from starting ART were matched on diabetes and smoking. HsCRP, D-dimer, P-selectin, interleukin-6 (IL-6), tissue plasminogen activator, plasminogen activator inhibitor-1 levels were measured. Results High hsCRP was associated with CVD risk, independently of traditional cardiovascular risk factors, HIV replication and the type of ART received at the time of sampling (adjusted odds ratio 8.00 [1.23-51.94] comparing >3.3 mg/L with <0.9 mg/L; P = 0.03). Higher IL-6 and P-selectin levels were also independently associated with increased CVD risk, although the association was weaker than for hsCRP. Higher total cholesterol and lower HDL cholesterol increased CVD risk, independent of hsCRP. Conclusion hsCRP may be a useful additional biomarker to predict CVD risk in HIV-infected patients receiving cART. PMID:24004495

  3. Rates of cardiovascular disease following smoking cessation in patients with HIV infection: results from the D:A:D Study

    PubMed Central

    Petoumenos, K; Worm, S; Reiss, P; de Wit, S; d’Arminio Monforte, A; Sabin, C; Friis-Moller, N; Weber, R; Mercie, P; Pradier, C; El-Sadr, W; Kirk, O; Lundgren, J; Law, MG

    2010-01-01

    Objective To estimate the rates of cardiovascular disease (CVD) events after stopping smoking in patients with HIV-infection. Design Patients who reported smoking status, and no previous CVD prior to enrolment into D:A:D were included. Smoking status is collected at each visit as current smoker (yes/no) and ever smoker (yes/no). Duration since stopping smoking was calculated for persons who had reported current smoking during follow-up and no current smoking subsequently. Endpoints were: myocardial infarction (MI); coronary heart disease (CHD – MI plus invasive coronary artery procedure or death from other CHD); CVD (CVD – CHD plus carotid artery endarterectomy or stroke); and all-cause mortality. Methods Event rates were calculated for never, previous and current smokers, and smokers who stopped during follow-up. Incidence rate ratios (IRR) were determined using Poisson regression adjusted for age, sex, cohort, calendar year, family history of CVD, diabetes, lipids, blood pressure and antiretroviral treatment. Results 27,136 patients had smoking status reported, with a total of 432, 600, 746 and 1902 MI, CHD, CVD and mortality events respectively. The adjusted IRR of CVD in patients who stopped smoking during follow-up decreased from 2.32 within the first year of stopping to 1.49 after 3+ years compared to those who never smoked. Similar trends were observed for the MI and CHD endpoints. Reductions in risk were less pronounced for all cause mortality. Conclusion The risk of CVD events in HIV-positive patients decreased with increasing time since stopping smoking. Smoking cessation efforts should be a priority in the management of HIV positive patients. PMID:21251183

  4. HIV-related symptoms and patient clusters among Chileans living with HIV

    PubMed Central

    Araya, A. X.; Norr, K. F.; Levy, J.A.; Pérez, C.M.; Park, C.G.; Kim, M.J.

    2012-01-01

    Identifying both HIV-related and co-morbid symptoms experienced by people living with HIV (PLWH) who are receiving antiretroviral therapy treatment (ART) is a major challenge for health care providers globally. Yet little research to date has examined the symptoms of illness experienced by PLWH including patients living in Central and South American. To address this gap, this study was designed to identify symptoms of HIV by socio-demographic and/or clinical characteristics among Chilean patients living with the virus. A convenience sample of 209 Chilean PLWH was recruited from an outpatient clinic in Santiago, Chile. A structured interview was used to elicit socio-demographic information and HIV symptoms status. Additional clinical information was obtained through a review of the participants’ medical records. Results show that patients’ most commonly reported HIV-related symptoms were fear/worries (66%), anxiety (52%), gas/bloating (50%), and thirst (50%). Multivariate analysis revealed a positive association between the number of reported HIV-related symptoms and number of years living with HIV. Having completed college was negatively associated with number of symptoms. Latent class analysis indicated that PLWH in the sample who had completed college were two times more likely to experience a mild intensity of HIV-related symptoms than their lesser educated counterparts. Similarly, logistic regression revealed that college-educated PLWH were twice as likely to be classified in the subgroup reporting mild intensity of symptoms than those who lacked a college degree. Overall, the study’s results reveal that many Chilean PLWH, even those with high CD4 counts and low or undetectable viral loads, are not symptom free. The findings point to the need for clinicians to tailor a plan of care for individuals living with HIV that is based on their symptomatology. PMID:22909386

  5. Management of HIV Infection in Patients With Cancer Receiving Chemotherapy

    PubMed Central

    Mayer, Kenneth H.; Torres, Harrys A.; Mulanovich, Victor

    2014-01-01

    The optimal antiretroviral therapy (ART) regimen for human immunodeficiency virus (HIV)–infected patients with cancer remains unknown, as clinical trials are lacking and published data are insufficient to guide recommendations. When concomitant use of chemotherapy and ART is anticipated, overlap of toxic effects and drug–drug interactions between chemotherapy and ART may alter the optimal choice of ART. Prospective studies are urgently needed to further define the toxic effects of combined chemotherapy and ART in HIV-positive cancer patients. Such studies should aid the development of guidelines for treatment of this population. For now, clinicians should individualize decisions regarding treatment of HIV according to clinical and laboratory findings, cancer treatment plan (chemotherapy, radiotherapy, or surgery), liver or renal disease, potential adverse drug effects (eg, rash, gastrointestinal intolerance, bone marrow suppression), and patient preference. This review focuses on what infectious disease specialists need to know to select the most appropriate ART regimens for patients receiving chemotherapy. PMID:24642555

  6. Impaired Urine Dilution Capability in HIV Stable Patients

    PubMed Central

    Belloso, Waldo H.; de Paz Sierra, Mariana; Navarro, Matilde; Sanchez, Marisa L.; Perelsztein, Ariel G.; Musso, Carlos G.

    2014-01-01

    Renal disease is a well-recognized complication among patients with HIV infection. Viral infection itself and the use of some antiretroviral drugs contribute to this condition. The thick ascending limb of Henle's loop (TALH) is the tubule segment where free water clearance is generated, determining along with glomerular filtration rate the kidney's ability to dilute urine. Objective. We analyzed the function of the proximal tubule and TALH in patients with HIV infection receiving or not tenofovir-containing antiretroviral treatment in comparison with healthy seronegative controls, by applying a tubular physiological test, hyposaline infusion test (Chaimowitz' test). Material & Methods. Chaimowitz' test was performed on 20 HIV positive volunteers who had normal renal functional parameters. The control group included 10 healthy volunteers. Results. After the test, both HIV groups had a significant reduction of serum sodium and osmolarity compared with the control group. Free water clearance was lower and urine osmolarity was higher in both HIV+ groups. Proximal tubular function was normal in both studied groups. Conclusion. The present study documented that proximal tubule sodium reabsorption was preserved while free water clearance and maximal urine dilution capability were reduced in stable HIV patients treated or not with tenofovir. PMID:24800076

  7. MELD Score Kinetics in Decompensated HIV+/HCV+ Patients: A Useful Prognostic Tool (ANRS HC EP 25 PRETHEVIC Cohort Study).

    PubMed

    Gelu-Simeon, Moana; Bayan, Tatiana; Ostos, Maria; Boufassa, Faroudy; Teicher, Elina; Steyaert, Jean-Marc; Bertucci, Inga; Anty, Rodolphe; Pageaux, Georges-Philippe; Meyer, Laurence; Duclos-Vallée, Jean-Charles

    2015-07-01

    To assess prognostic factors for survival and describe Model for End-Stage liver disease (MELD) dynamics in human immunodeficiency virus+/hepatitis C virus+ (HIV+/HCV+) patients after an initial episode of hepatic decompensation.An HIV+/HCV+ cohort of patients experiencing an initial decompensation episode within the year preceding enrollment were followed prospectively. Clinical and biological data were collected every 3 months. Predictors for survival were identified using Kaplan-Meier curves and Cox models. A 2-slope-mixed linear model was used to estimate MELD score changes as a function of survival.Sixty seven patients were included in 32 centers between 2009 and 2012 (72% male; median age: 48 years [interquartile ratio (IQR):45-52], median follow-up: 22.4 months [range: 0.5-65.3]). Overall survival rates were 86%, 78%, and 59% at 6, 12, and 24 months, respectively. Under multivariate analysis, the MELD score at initial decompensation was predictive of survival, adjusted for age, type of decompensation, baseline CD4 counts, and further decompensation during follow-up as a time-dependent variable. The adjusted hazard ratio of death was 1.32 for a score 3 points higher (95% CI: [1.06-1.63], P = 0.012). MELD score kinetics within the 6 months after initial decompensation differed significantly between non-deceased and deceased patients, with a decreased (-0.49/month; P = 0.016), versus a flat (+0.06/month, P = 0.753) mean change in score.MELD is an effective tool to predict survival in HIV+/HCV+ patients with decompensated cirrhosis. A non-decreasing MELD score within 6 months following this initial decompensation episode may benefit from privileged access to liver transplantation in this poor prognosis population. PMID:26222860

  8. Predicting intention to treat HIV-infected patients among Tanzanian and Sudanese medical and dental students using the theory of planned behaviour - a cross sectional study

    PubMed Central

    2009-01-01

    Background The HIV epidemic poses significant challenges to the low income countries in sub Saharan Africa (SSA), affecting the attrition rate among health care workers, their level of motivation, and absenteeism from work. Little is known about how to deal with deterioration of human resources in the health care systems. This study aimed to predict the intention to provide surgical treatment to HIV infected patients among medical- and dental students in Tanzania and Sudan using an extended version of the Theory of Planned Behaviour (TPB). Methods Four hundred and seventy five medical- and dental students at the University of Dar es Salaam (mean age, 25 yr) and 642 dental students attending 6 public and private dental faculties in Khartoum (mean age 21.7 yr) completed self-administered TPB questionnaires in 2005 and 2007, respectively. Results Both Tanzanian and Sudanese students demonstrated strong intentions to provide care for people with HIV and AIDS. Stepwise linear regression revealed that the TPB accounted for 51% (43% in Tanzania and Sudan) of the variance in intention across study sites. After having controlled for country and past behaviour, the TPB in terms of attitudes, subjective norms and perceived behavioural control accounted for 34% and moral norms for an additional 2,3% of the explainable variance in intention. Across both study sites, attitudes were the strongest predictor of intention followed in descending order by subjective norms, moral norms and perceived behavioural control. Conclusion The TPB is applicable to students' care delivery intentions in the context of HIV and AIDS across the two SSA countries investigated. It is suggested that attitudes, subjective norms, moral norms and perceived behavioural control are key factors in students' willingness to treat AIDS and HIV infected patients and should be targets of interventions aimed at improving the quality of health care delivery in this context. PMID:19930555

  9. Immune activation and microbial translocation in liver disease progression in HIV/hepatitis co-infected patients: results from the Icona Foundation study

    PubMed Central

    2014-01-01

    Background We evaluated whether immune activation (IA) and microbial translocation (MT) might play a role in accelerating liver disease progression in HIV-HBV/HCV co-infected patients. Methods ART-naïve HIV/viral hepatitis co-infected patients from Icona with a CD4 cell count >200/μl and with a known date of prior HIV neg/pos tests and ≥1 plasma sample stored were included in the study. Plasma MT (LPS, sCD14) and IA (IL-6,TNFα) were measured using ELISA while activated CD8 + CD38 + HLA-DR + were measured by flow cytometry, with one measurement being performed for all patients and two measurements for a smaller group of subjects. The association between these biomarkers and the time to i) a single ALT >200 IU/l and ii) a Fib-4 >1.45 was also investigated. A standard survival analysis with robust standard errors was used for all evaluations. Follow-up was censored at patients’ last clinical follow-up. Results We studied 127 HIV-infected hepatitis viruses co-infected patients (118 HCV, 9 HBV). Overall median (IQR) CD4, VL, age were 596/μl (208–1303), 3.8 log10cp/mL (3–4.3), 34 years (22–56). While heightened TNF-α was associated with a 13-fold increased risk of Fib-4 > 1.45 (RH 13.05, 95% CI 2.43-70; p = 0.003), markers of MT did not show an association with liver illness. Interestingly, higher sCD14 was associated with a decreased risk of Fib-4 > 1.45, independently of other biomarkers considered (RH 0.20, 95% CI 0.04-0,9; p = 0.04). Conclusions In HIV/hepatitis virus co-infected ART-naive patients, higher TNF-α plasma levels were associated with a 13-fold increase in the risk of progression to a Fib-4 >1.45, suggesting that the pro-inflammatory status in HIV infection might hasten the course of HCV. In view of the fact that sCD14 may hinder the interaction between LPS and the phagocyte membrane CD14, we herewith propose a model which aims to demonstrate that high sCD14 levels might contribute to shelter liver function

  10. Effects of Pitavastatin on Lipid Profiles in HIV-Infected Patients with Dyslipidemia and Receiving Atazanavir/Ritonavir: A Randomized, Double-Blind, Crossover Study

    PubMed Central

    Wongprikorn, Asita; Sukasem, Chonlaphat; Puangpetch, Apichaya; Numthavej, Pawin; Thakkinstian, Ammarin; Kiertiburanakul, Sasisopin

    2016-01-01

    Background Dyslipidemia as a risk factor of cardiovascular disease is common especially in HIV-infected patients who are using protease inhibitors (PIs) including atazanavir. Pitavastatin has less drug-drug interactions and demonstrable efficacy in decreasing lipid levels in non HIV-infected individuals. Materials and Methods This study was a randomized, double-blind, crossover study comparing the safety and efficacy of pitavastatin vs placebo in HIV-infected patients with dyslipidemia and receiving atazanavir/ritonavir (ATV/r). Patients were randomized to receive either placebo or pitavastatin for 12 weeks. The follow-up visits were every 4 weeks until the end of the study. Results A total of 12 HIV-infected patients were enrolled to each study group. Of all, 14 (58%) patients were men and mean (standard deviation, SD) age was 48.1 (1.8) years. At 12 weeks of treatment with pitavastatin compared to placebo; mean [95% confidence interval (CI)] total cholesterol (TC) was 207 (187.3, 226.8) mg/dL vs 246.3 (226.5, 266) mg/dL (p <0.001); mean (95% CI) triglyceride (TG) was 351.3 (193.2, 509.4) mg/dL vs 279.1 (121, 437.2) mg/dL (p = 0.269); mean (95% CI) high density lipoprotein (HDL) was 45.3 (40.4, 50.2) mg/dL vs 44.2 (39.3, 49.1) mg/dL (p = 0.354); and mean (95% CI) low density lipoprotein (LDL) was 113.2 (100.4, 126) mg/dL vs 145.6 (132.8, 158.4) mg/dL (p <0.001). Mean liver enzyme and median creatine phosphokinase levels were not statistically significant between patients receiving placebo and pitavastatin. Conclusions Pitavastatin decreases TC and LDL level at 12 weeks significantly and shows indifferent in hepatotoxicity and creatine phosphokinase levels compared to those of placebo. Thus, pitavastatin can be a good option of lipid-lowering agent in HIV-infected patients who are receiving ATV/r. Trial Registration ClinicalTrials.gov NCT02442700 PMID:27304841

  11. Prognosis of HIV-1-infected patients up to 5 years after initiation of HAART: collaborative analysis of prospective studies

    PubMed Central

    2012-01-01

    Objective To estimate the prognosis over 5 years of HIV-1-infected, treatment-naive patients starting HAART, taking into account the immunological and virological response to therapy. Design A collaborative analysis of data from 12 cohorts in Europe and north America on 20 379 adults who started HAART between 1995 and 2003. Methods Parametric survival models were used to predict the cumulative incidence at 5 years of a new AIDS-defining event or death, and death alone, first from the start of HAART and second from 6 months after the start of HAART. Data were analysed by intention-to-continue-treatment, ignoring treatment changes and interruptions. Results During 61 798 person-years of follow-up, 1005 patients died and an additional 1303 developed AIDS. A total of 10 046 (49%) patients started HAART either with a CD4 cell count of less than 200 cells/μl or with a diagnosis of AIDS. The 5-year risk of AIDS or death (death alone) from the start of HAART ranged from 5.6 to 77% (1.8–65%), depending on age, CD4 cell count, HIV-1-RNA level, clinical stage, and history of injection drug use. From 6 months the corresponding figures were 4.1–99% for AIDS or death and 1.3–96% for death alone. Conclusion On the basis of data collected routinely in HIV care, prognostic models with high discriminatory power over 5 years were developed for patients starting HAART in industrialized countries. A risk calculator that produces estimates for progression rates at years 1 to 5 after starting HAART is available from www.art-cohort-collaboration.org. PMID:17502729

  12. Prevalence of K65R in patients treated with tenofovir disoproxil fumarate: recommendations based on the Frankfurt HIV Cohort Study Resistance Database (FHCS-RD).

    PubMed

    Reinheimer, Claudia; Wesner, Anna; Keppler, Oliver T; Doerr, Hans Wilhelm; Herrmann, Eva; Stürmer, Martin; Stephan, Christoph

    2016-08-01

    Mutations in the genome of HIV-1 can compromise the success of antiretroviral treatments (ARTs) in HIV-1-infected individuals. The Frankfurt HIV Cohort Study Resistance Database (FHCS-RD) has previously documented a decline in the burden of resistance-associated mutations (RAMs) following the implementation of several new antiretroviral therapy regimens in 2007. In the current study, the annual burden of RAMs documented in the FHCS-RD in 2005-2013 was set in relation to the annual number of all cohort patients, drug regimens, available resistance tests, and prevalence for each RAM on relevant codons of reverse transcriptase (RT) and protease (PR) genes. A specific focus was put on the prevalence of the tenofovir disoproxil fumarate (TDF) signature mutation K65R in HIV-1 RT in relation to the application of TDF within ART. Between 2005 and 2012, a total of 4423 HIV genotyping data sets from 4509 patients were analysed. All mutations show a consistent decline, and the most impressive decrease was observed for thymidine analogue mutations (TAMs). The frequency of non-TAMs and PR mutations also decreased, but generally to a lower extent. The prevalence of K65R decreased from 2.6 % in 2005 to 0.2 % in 2012 despite increased use of TDF-containing ART. Both the improved strategic use of TDF in ARTs and generally more effective ART regimens may have resulted in decreasing RAM prevalences in FHCS-RD since 2007. These trends challenge the cost-effectiveness of resistance testing prior to failing ART. PMID:26746222

  13. Microsporidia as emerging pathogens and the implication for public health: a 10-year study on HIV-positive and -negative patients.

    PubMed

    Lobo, Maria Luísa; Xiao, Lihua; Antunes, Francisco; Matos, Olga

    2012-02-01

    Despite recent advances in the understanding and diagnosis of emerging microsporidian pathogens, more research is necessary to elucidate their complex epidemiology. In fact, studies that reflect true human-infecting microsporidian prevalence are still inadequate. The present 10-year study was undertaken to examine the occurrence of Microsporidia in 1989 stools, 69 urine and 200 pulmonary specimens from HIV-positive and HIV-negative patients using PCR and DNA sequencing. In stools, 12.0% were Microsporidia-positive. Prevalences of 13.9% and 8.5% were observed for HIV+ and HIV- samples, respectively. The percentage of children that were Microsporidia-positive (18.8%) was significantly higher than that of adults (10.2%). In stools, Enterocytozoon bieneusi (6.3%) and Vittaforma-like parasites (6.8%) were identified. Based on the internal transcribed spacer (ITS) region of E. bieneusi, Type IV (37.5%), Peru 6 (29.2%), D (12.5%), A (8.3%), C (6.3%) and PtEb II (6.3%) genotypes were identified. Microsporidia were detected in 1.5% and 1.0% of urine and pulmonary specimens, respectively. Encephalitozoonintestinalis was detected in urine. In pulmonary specimens, Encephalitozoon cuniculi and Vittaforma-like parasites were identified. An immunosuppressive condition and youth (children) appear to be risk factors for microsporidian infection. Microsporidia seems to have an important impact on public health in Portugal, highlighting the need to implement routine diagnosis.

  14. Screening of hospital patients for HIV: an experience in a tertiary care hospital of West Bengal.

    PubMed

    Joardar, G K; Chatterjee, C; Sadhukhan, S K; Banerjee, P; Dan, A; Mandal, A

    2012-09-01

    The clinical consequences of HIV infection encompass a wide spectrum. Early recognition of persons who have HIV will help in early interventions to halt or slow down the progress of HIV disease and to extend fruitful lives.This cross-sectional study was conducted among patients referred to the voluntary counselling and testing centre (VCTC) from various departments in North Bengal Medical College & Hospital, Darjeeling, West Bengal, to find out the pattern of disease/symptoms, high risk behaviour (HRB) for HIV, and HIV serostatus among the hospital patients. Following the guidelines prescribed by the National AIDS Control Organisation (NACO), anonymous data were collected through interview from 407 individuals. Where specific diagnosis of a disease was obtained, it was analysed as mutually exclusive disease; and where specific diagnosis was not obtained, mutually exclusive symptoms were considered for analysis.The major diseases/symptoms observed among those patients were tuberculosis in 32.19%, STD in 29.97%, prolonged unexplained fever in 19.41% of patients. The overall rate of HIV seroreactivity was 17.44%. The HIV serostatus by disease/symptoms showed that 32.91% of patients with prolonged unexplained fever were HIV seroreactive; the rate was 12.90% among patients with skin diseases, 12.29% in STD and 12.21% in tuberculosis patients. Overall, 270 patients (66.34%) had HRB for HIV/AIDS.The rate of HIV seroreactivity was more among patients who had HRB for HIV/ AIDS and who were referred from indoor departments (23.24%) compared to outdoor departments (13.65%).The patients suffering from prolonged unexplained fever need greater attention for HIV screening. Early detection of HIV positive patients makes Intervention possible at a very early stage and this can slow down/block the progress of HIV disease and, as a result, can extend fruitful life.

  15. HealthCall: Technology-based extension of Motivational Interviewing to reduce non-injection drug use in HIV primary care patients: a pilot study

    PubMed Central

    Aharonovich, Efrat; Greenstein, Eliana; Johnston, Barbara; O’Leary, Ann; Seol, Simone G.; Hasin, Deborah S.

    2012-01-01

    To reduce non-injection drug use (NIDU) among HIV primary care patients, more than single brief interventions may be needed, but clinic resources are often too limited for extended interventions. To extend brief Motivational Interviewing (MI) to reduce NIDU, we designed and conducted a pilot study of “HealthCall”, consisting of brief (1–3 min) daily patient calls reporting NIDU and health behaviors to a telephone-based Interactive Voice Response system, which provided data for subsequent personalized feedback. Urban HIV adult clinic patients reporting ≥ 4 days of NIDU in the past month were randomized to two groups: MI-only (n=20), or MI+HealthCall (n=20). At 30 and 60 days, patients were assessed and briefly discussed their NIDU behaviors with counselors. The outcome was days used primary drug. Medical marijuana issues precluded HealthCall with patients whose primary substance was marijuana (n=7); excluding these, 33 remained, of whom 28 patients (MI-only n=17; MI+HealthCall n=11) provided post-treatment data for analysis. Time significantly predicted reduction in days used in both groups (p<.0001). At 60 days, between-group differences approached trend level, with an effect size of 0.62 favoring the MI+HealthCall arm. This pilot study suggests that HealthCall is feasible and acceptable to patients in resource-limited HIV primary care settings, and can extend patient involvement in brief intervention with little additional staff time. A larger efficacy trial of HealthCall for NIDU-reduction in such settings is warranted. PMID:22428809

  16. Barriers and Facilitators of Adherence to Antiretroviral Drug Therapy and Retention in Care among Adult HIV-Positive Patients: A Qualitative Study from Ethiopia

    PubMed Central

    Bezabhe, Woldesellassie M.; Chalmers, Leanne; Bereznicki, Luke R.; Peterson, Gregory M.; Bimirew, Mekides A.; Kassie, Desalew M.

    2014-01-01

    Background Antiretroviral therapy (ART) has been life saving for hundreds of thousands of Ethiopians. With increased availability of ART in recent years, achievement of optimal adherence and patient retention are becoming the greatest challenges in the management of HIV/AIDS in Ethiopia. However, few studies have explored factors influencing medication adherence to ART and retention in follow-up care among adult Ethiopian HIV-positive patients, especially in the Amhara region of the country, where almost one-third of the country’s ART is prescribed. The aim of this qualitative study was to collect such data from patients and healthcare providers in the Amhara region of Ethiopia. Methods Semi-structured interviews were conducted with 24 patients, of whom 11 had been lost to follow-up and were non-persistent with ART. In addition, focus group discussions were performed with 15 ART nurses and 19 case managers. All interviews and focus groups were audio-recorded, transcribed, and coded for themes and patterns in Amharic using a grounded theory approach. The emergent concepts and categories were translated into English. Results Economic constraints, perceived stigma and discrimination, fasting, holy water, medication side effects, and dissatisfaction with healthcare services were major reasons for patients being non-adherent and lost to follow-up. Disclosure of HIV status, social support, use of reminder aids, responsibility for raising children, improved health on ART, and receiving education and counseling emerged as facilitators of adherence to ART. Conclusions Improving adherence and retention requires integration of enhanced treatment access with improved job and food security. Healthcare providers need to be supported to better equip patients to cope with the issues associated with ART. Development of social policies and cooperation between various agencies are required to facilitate optimal adherence to ART, patient retention, and improved patient outcomes

  17. Leptin expression in HIV-infected patients during antiretroviral therapy

    PubMed Central

    Tiliscan, Cătălin; Aramă, Victoria; Mihăilescu, Raluca; Munteanu, Daniela Ioana; Streinu-Cercel, Adrian; Ion, Daniela Adriana; Rădulescu, Mihaela Andreea; Popescu, Cristina; Lobodan, Alina Elena; Negru, Anca Ruxandra; Aramă, Ştefan Sorin

    2015-01-01

    Background Leptin is an adipokine with complex metabolic, neuroendocrine and immune functions. Our objective was to evaluate leptin serum levels in a cohort of Romanian HIV-infected patients undergoing antiretroviral therapy in relation to their immune-virological status, lipid and glucose metabolic abnormalities and the presence of metabolic syndrome (MS). Methods We enrolled consecutive non-diabetic HIV-infected patients aged 18 and over on stable cART for at least 6 months. Blood samples were tested for: leptin, CD4 T cells count, HIV viral load and lipid panel. Results A total of 90 HIV-infected patients were included in the study: 50 males (55.6%) with a mean age of 33.3 years and 40 females with a mean age of 30.4 years. Most patients (74.4%) had HIV viral load below the limit of detection and the median CD4 count for the cohort was 476 (410) cells/cmm. More than one third of the patients (41.1%) had hypoleptinemia. The prevalence of MS was 13.3%. Hypoleptinemia was significantly more frequent in men. In a subset of patients with undetectable HIV viral load, the median leptin value was 0.6 (6.07) ng/mL in patients with poor immune recovery (CD4 count ≤ 200/cmm) compared to 2 (3.07) ng/mL for those with better immune response (CD4 count > 200/cmm), without statistical significance. The median values of leptin were similar for persons with and without MS criteria. HDL-cholesterol values were positively correlated to leptin values in a linear regression model. Conclusion A significant proportion of patients in our study presented low levels of leptin; this finding was not associated with immune and virological parameters or the presence of MS. Hypoleptinemia was significantly correlated with lower levels of HDL-cholesterol, a key cardiovascular risk factor. PMID:26405677

  18. HIV DNA loads, plasma residual viraemia and risk of virological rebound in heavily treated, virologically suppressed HIV-infected patients.

    PubMed

    Gianotti, N; Canducci, F; Galli, L; Cossarini, F; Salpietro, S; Poli, A; Nozza, S; Spagnuolo, V; Clementi, M; Sampaolo, M; Ceresola, E R; Racca, S; Lazzarin, A; Castagna, A

    2015-01-01

    In this single-centre, retrospective study, we analyzed data of 194 patients receiving antiretroviral therapy with <50 human immunodeficiency virus (HIV) RNA copies/mL in plasma and 318 HIV RNA/DNA paired samples. By kinetic polymerase chain reaction (kPCR) molecular system analysis, 104 (54%) subjects had undetectable HIV RNA and 90 (46%) had residual viraemia. Median (interquartile range) HIV DNA load was 780 (380-1930) copies/10(6) peripheral blood lymphocytes (PBL), and HIV DNA loads were independently associated with residual viraemia (p 0.002). Virological rebound occurred in 29/194 (15%) patients over a median (interquartile range) follow-up of 17.5 (13.5-31.5) months. Residual viraemia (p 0.002), but not HIV DNA load, was independently associated with virological rebound.

  19. Frailty Characteristics in Chronic HIV Patients are Markers of White Matter Atrophy Independently of Age and Depressive Symptoms: A Pilot Study

    PubMed Central

    Kallianpur, Kalpana J.; Sakoda, Marissa; Gangcuangco, Louie Mar A.; Ndhlovu, Lishomwa C.; Umaki, Tracie; Chow, Dominic; Wongjittraporn, Suwarat; Shikuma, Cecilia M.

    2016-01-01

    Background Chronic HIV disease is associated with neurocognitive impairment and age-related conditions such as frailty. Objective To determine whether regional brain volumetric changes correlate with frailty parameters in older (≥ 40 years) HIV+ patients on stable combination antiretroviral therapy. Method Thirty-five HIV-infected participants in the Hawaii Aging with HIV Cohort - Cardiovascular Disease study underwent T1-weighted brain magnetic resonance imaging, frailty assessment and neuropsychological testing. Five physical frailty traits were assessed: low physical activity; exhaustion; unintentional weight loss; weak hand grip strength; slow walking speed. Linear regression quantified cross-sectional relationships of 12 brain regions to walking times and hand grip strength. Results Participants were 50.6 ± 6.8 years old and 77% had undetectable plasma viral load. One subject was frail (possessing ≥ 3 frailty traits); 23% were pre-frail (1–2 frailty traits) and had worse composite learning and memory z-scores than did non-frail individuals (p=0.06). Pre-frail or frail subjects had reduced hand grip strength relative to the non-frail group (p=0.001). Longer walking times (slower gait) related independently to lower volumes of cerebellar white matter (p<0.001, β=−0.6) and subcortical gray matter (p<0.05, β=−0.30). Reduced thalamus volume was linked to weaker grip strength (p < 0.05, β=0.4). Caudate volume was negatively associated with grip strength (p<0.01, β=−0.5). Conclusion Volumetric changes in cerebellar white matter and subcortical gray matter, brain regions involved in motor control and cognition, may be connected to frailty development in well-controlled HIV. Gait speed is particularly sensitive to white matter alterations and should be investigated as a predictor of frailty and brain atrophy in chronically infected patients. PMID:27721908

  20. Patient knowledge of HIV and its treatment in South Africa

    PubMed Central

    Stellenberg, Ethelwynn L.

    2014-01-01

    Background Patients on antiretroviral therapy (ART) need to achieve a 90% adherence rate to ART in order to prevent disease progression and drug resistance. The patients’ knowledge of ART and HIV is thus crucial to ensuring good adherence, decreased risk for drug resistance and cost-effective treatment for these patients. Aim To determine the knowledge of infected patients with regard to HIV and the ART they were receiving. Setting The study was conducted at a comprehensive community health centre in a developing low socio-economic community near Cape Town, South Africa. Methods A quantitative descriptive correlative research design was applied. A sample consisting of 200 (8.5%) respondents was selected from a population of 2349. A multiple-choice questionnaire, comprising 29 questions, including 14 critical knowledge testing questions, was used in individual interviews conducted by either the researcher or fieldworker who assessed the respondents’ knowledge regarding various key aspects of HIV and ART. Results Misconceptions regarding HIV and ART were revealed and scores for the 14 critical knowledge testing questions in the questionnaire revealed that 0% of the respondents had good knowledge, 20% had average knowledge and 80% had poor knowledge. Conclusion The respondents on ART in this particular community health centre had poor knowledge of HIV and ART. This may contribute to poor adherence rates, increased drug resistance, disease progression and increased costs for the government with regard to treating such patients. Increased attention needs to be given to patient education. PMID:26245399

  1. Evaluation of cotrimoxazole use as a preventive therapy among patients living with HIV/AIDS in Gondar University Referral Hospital, northwestern Ethiopia: a retrospective cross-sectional study

    PubMed Central

    Gebresillassie, Begashaw Melaku; Gebeyehu, Minaleshewa Biruk; Abegaz, Tadesse Melaku; Erku, Daniel Asfaw; Mekuria, Abebe Basazn; Tadesse, Yokabd Dechassa

    2016-01-01

    Purpose Cotrimoxazole preventive therapy (CPT) is a feasible, inexpensive, and well-tolerated way of using cotrimoxazole intervention for patients living with HIV/AIDS to reduce HIV/AIDS-related morbidities and mortalities caused by various bacteria, fungi, and protozoa. The aim of this study was to evaluate the use of cotrimoxazole as a prophylaxis therapy among patients living with HIV/AIDS at Gondar University Referral Hospital (GURH), northwestern Ethiopia. Materials and methods A retrospective cross-sectional study was used to evaluate the use of cotrimoxazole as a prophylaxis therapy among people living with HIV/AIDS at GURH, northwestern Ethiopia from September 2013 to October 2015. Medical records of 264 patients were selected by using systematic random sampling technique from the sampling frame list of all patients’ medical records. Data were collected from patients’ medical records using the structured checklist and evaluated against World Health Organization (WHO) guidelines on the use of cotrimoxazole prophylaxis. The quantitative data were analyzed using the statistical packages for social sciences Version 20. Descriptive and binary logistic regression analyses were used to describe and assess the association between different variables. Results Approximately 95 (36.0%) patients were at WHO clinical stage III at the start of CPT. The use of CPT was consistent with the guidelines in the rationale for indication 200 (75.75%) and dose 263 (99.62%), despite the presence of contraindications in 24 (9.90%) patients. The occurrence of cotrimoxazole-associated side effects was higher in the first month of therapy. Problems regarding drug–drug interactions were identified in 63 (23.86%) patients, and 92 (34.84%) patients discontinued CPT due to different reasons. Conclusion Although the practice of discontinuation of CPT and follow-up for adverse drug effects were not consistent with WHO guidelines on the rational use of cotrimoxazole prophylaxis, the use

  2. Socioeconomic disadvantage increasing risk for depression among recently diagnosed HIV patients in an urban area in Brazil: cross-sectional study.

    PubMed

    Nomoto, Silmara Harumi; Longhi, Renata Marrona Praça; de Barros, Bruna Paes; Croda, Julio; Ziff, Edward Benjamin; Castelon Konkiewitz, Elisabete

    2015-01-01

    Depression is the most common psychiatric co-morbidity among people living with HIV (PLHIV), with prevalence rates ranging from 25% to 36%. Depression impacts negatively upon adherence and response to combined antiretroviral therapy (CART) and the transmission of HIV infection through increased sexually risky behavior. This cross-sectional study presents data from a reference HIV-outpatient service in Dourados (Brazil) that evaluated the association between depressive symptoms, health-related quality of life, and clinical, socioeconomic, and demographic factors in newly diagnosed HIV/AIDS patients. Using the Beck Depression Inventory (BDI), the prevalence of depressive symptoms was 61% with a predominance of self-deprecating and cognitive-affective factors. Depressive symptoms were associated with lower income (p=0.019) and disadvantaged social class (p=0.005). Poorer quality of life was related to depressive symptoms (p<0.0001), low educational level (p=0.05), and lower income (p=0.03). These data suggest that socioeconomic factors, including level of income and education, are mediating the risk of depression and poor quality of life of PLHIV. Possible explanations for this effect are discussed, including the possible role of stigma. PMID:25741909

  3. The effect of HIV infection on the incidence and severity of circular external fixator pin track sepsis: a retrospective comparative study of 229 patients.

    PubMed

    Ferreira, Nando; Marais, Leonard Charles

    2014-08-01

    Pin track sepsis is a common complication of circular external fixation. HIV status has been implicated as an independent risk factor for the development of pin track infection and has been cited as a reason not to attempt complex limb reconstruction in HIV-positive patients. This retrospective review of patients treated with circular external fixators looked at the incidence of pin track sepsis in HIV-positive, HIV-negative and patients whose HIV status was unknown. The records of 229 patients, 40 of whom were HIV-positive, were reviewed. The overall incidence of pin track sepsis was 22.7 %. HIV infection did not affect the incidence of pin track sepsis (p = 0.9). The severity of pin track sepsis was not influenced by HIV status (p = 0.9) or CD4 count (p = 0.2). With the employment of meticulous pin insertion techniques and an effective postoperative pin track care protocol, circular external fixation can be used safely in HIV-positive individuals. PMID:25056512

  4. Baseline characteristics of HIV & hepatitis B virus (HIV/HBV) co-infected patients from Kolkata, India

    PubMed Central

    Sarkar, Jayeeta; Saha, Debraj; Bandyopadhyay, Bhaswati; Saha, Bibhuti; Kedia, Deepika; Guha Mazumder, D.N.; Chakravarty, Runu; Guha, Subhasish Kamal

    2016-01-01

    Background & objectives: Hepatitis B virus (HBV) and HIV co-infection has variable prevalence worldwide. In comparison to HBV mono-infection, the course of chronic HBV infection is accelerated in HIV/HBV co-infected patients. The present study was carried out to analyse the baseline characteristics (clinical, biochemical, serological and virological) of treatment naïve HIV/HBV co-infected and HIV mono-infected patients. Methods: Between July 2011 and January 2013, a total number of 1331 HIV-seropositive treatment naïve individuals, enrolled in the ART Centre of Calcutta School of Tropical Medicine, Kolkata, India, were screened for hepatitis B surface antigen (HBsAg). A total of 1253 HIV mono-infected and 78 HIV/HBV co-infected patients were characterized. The co-infected patients were evaluated for HBeAg and anti-HBe antibody by ELISA. HIV RNA was quantified for all co-infected patients. HBV DNA was detected and quantified by real time-PCR amplification followed by HBV genotype determination. Results: HIV/HBV co-infected patients had proportionately more advanced HIV disease (WHO clinical stage 3 and 4) than HIV mono-infected individuals (37.1 vs. 19.9%). The co-infected patients had significantly higher serum bilirubin, alanine aminotransferase (ALT), alkaline phosphatase and ALT/platelet ratio index (APRI). CD4 count was non-significantly lower in co-infected patients. Majority (61.5%) were HBeAg positive with higher HIV RNA (P<0.05), HBV DNA (P<0.001) and APRI (P<0.05) compared to those who were HBeAg negative. HBV/D was the predominant genotype (73.2%) and D2 (43.7%) was the commonest subgenotype. Interpretation & conclusions: HIV/HBV co-infected patients had significantly higher serum bilirubin, ALT, alkaline phosphatase and lower platelet count. HBeAg positive co-infected patients had higher HIV RNA and HBV DNA compared to HBeAg negative co-infected patients. Prior to initiation of antiretroviral treatment (ART) all patients should be screened for HBsAg to

  5. Determinants of survival among HIV-infected chronic dialysis patients.

    PubMed

    Rodriguez, Rudolph A; Mendelson, Michael; O'Hare, Ann M; Hsu, Ling Chin; Schoenfeld, Patricia

    2003-05-01

    Over 100 HIV-infected patients have initiated chronic dialysis at San Francisco General Hospital (SFGH) since 1985. This study employed retrospective analysis to identify determinants of and trends in survival among HIV-infected patients who have initiated chronic dialysis at SFGH from January 1, 1985 to November 1, 2002 (n = 115). Cohort patient survival was compared with survival after an AIDS-opportunistic illness in all HIV-infected patients in San Francisco during the study period. Higher CD4 count (hazard ratio [HR], 0.86 per 50 cells/mm(3) increase; 95% confidence interval [CI], 0.80 to 0.93) and serum albumin (HR, 0.53 per 1 g/dl increase; CI, 0.36 to 0.78) at initiation of dialysis were strongly associated with lower mortality. Survival for those initiating dialysis during the era of highly active antiretroviral therapy (HAART) was 16.1 mo versus 9.4 mo for those initiating dialysis before this time, but this difference was not statistically significant. In adjusted analysis, only a non-statistically significant trend toward improved survival during the HAART era was noted (HR, 0.59; CI, 0.34 to 1.04). By comparison, survival for all HIV-infected patients after an AIDS-opportunistic illness in San Francisco increased from 16 mo in 1994 to 81 mo in 1996. The dramatic improvement in survival that has occurred since the mid-1990s for patients with HIV appears to be greatly attenuated in the sub-group undergoing dialysis. Although this may partly reflect confounding by race, injection drug use and HCV co-infection, future attempts to improve survival among HIV-infected dialysis patients should focus on barriers to the effective use of HAART in this group.

  6. Preparatory studies for possible HIV vaccine trials in northern Thailand.

    PubMed

    Nelson, K E; Beyrer, C; Natpratan, C; Eiumtrakul, S; Celentano, D D; Khamboonruang, C

    1994-01-01

    We studied several populations of human immunodeficiency virus (HIV)-seronegative individuals from northern Thailand who were believed to be at relatively high risk of HIV infection in order to assess their potential suitability for inclusion in a preventive HIV vaccine trial. Included were female commercial sex workers (CSWs), male sexually transmitted disease (STD) clinic patients, male conscripts into the Royal Thai Army (RTA), and men who were recently discharged from the army. We evaluated their HIV prevalence, their interest in study participation, their compliance with prospective follow-up, and their HIV incidence. Among 1068 female CSWs the baseline HIV prevalence was 38.3%; of 659 HIV seronegatives 395 (59.9%) agreed to enrollment in the study. Follow-up at 6-9 months was 73.2%; it was 58% in brothel-based CSWs and 85% in non-brothel-based CSWs. Overall HIV incidence in CSWs was 8.2 per 100 person-years; incidence was 29 per 100 person-years in brothel-based CSWs and 4 per 100 person-years in non-brothel-based CSWs. Among 1031 male STD clinic patients, baseline HIV prevalence was 15.9%, follow-up was successful in 98.1%, and HIV incidence was 4.0 per 100 person-years. Among four cohorts of RTA conscripts who entered the military in 1991 and 1993, baseline HIV prevalence has been about 12%, follow-up about 90%, and HIV incidence has varied from 1.2-3.2 per 100 person-years. Discharged RTA conscripts have had baseline HIV prevalence of about 13%, successful follow-up of 94%, and an HIV incidence of about 5 per 100 person-years.(ABSTRACT TRUNCATED AT 250 WORDS)

  7. Safety and therapeutic efficacy of the switch to maraviroc+darunavir/ritonavir in HIV/HCV coinfected patients: initial results from GUSTA study

    PubMed Central

    Gagliardini, Roberta; Rossetti, Barbara; Bianco, Claudia; Rusconi, Stefano; Colafigli, Manuela; Prinapori, Roberta; Francisci, Daniela; Fantauzzi, Alessandra; Orofino, Giancarlo; Vignale, Francesca; Di Giambenedetto, Simona; De Luca, Andrea

    2014-01-01

    Introduction HIV/HCV coinfection is a risk factor for hepatic injury in patients receiving HAART and previous studies support a favourable effect of antiretroviral regimens including maraviroc (MVC) on the course of coinfection compared with other antiretroviral drugs. There are few observations about MVC use in simplified treatment of coinfected patients.Objective: To evaluate the efficacy and the safety of simplification to darunavir (DRV)/ritonavir (r)/maraviroc (MVC) in virologically HIV-suppressed patients and to explore the effect of simplified treatment on coinfected patients. Material and Methods GUSTA study is a randomized two arms trial that compares the switch to DRV/r/MVC with standard HAART with three drugs. The study enrols patients with HIV-1 RNA<50cp/mL>6 months, R5 tropism, CD4>200 cells/mm. Survival analysis was used to analyze factors associated to time-to a single viral load (VL) over 50cp/mL and FIB-4>1.45. Results We included 62 patients with at least the 24 week follow-up for FIB-4 analysis: males 75.8%, heterosexuals 48.4%, HCV+12.9% median age 48.3 years (IQR41.1;53.5), time from HIV diagnosis 11.0 years (IQR7.3;16.7), CD4 cells 659/mm (IQR478;882), nadir CD4 203/mm (IQR115;286), FPR 46 (IQR30;70), baseline (BL) FIB-4 1.11 (IQR0.75;1.35). At BL no differences were observed in the two arms, except for platelets (−34.96 109/L, in the study arm, p=0.028) and CD4 at nadir (−70cell/µL, p0.051). After 24 weeks a significant reduction in total bilirubin (TB) (−0.55 mg/dL, p=0.025) and alkaline phosphatase(AP) (−12.96 UI/L, p=0.002) was observed in the study group. A statistically significant difference in mean change of TB (0.61 mg/dL, p=0.016) and AP (13.23 UI/L, p=0.04) at 24 week between control and study group was observed. No grade 3/4 transaminase elevation was observed for any patient even if HIV/HCV coinfected and receiving MVC. A single HCV negative patient in the control arm had grade 3 bilirubin increase. Including all patients

  8. Activation of HIV Transcription with Short-Course Vorinostat in HIV-Infected Patients on Suppressive Antiretroviral Therapy

    PubMed Central

    Solomon, Ajantha; Ghneim, Khader; Ahlers, Jeffrey; Cameron, Mark J.; Smith, Miranda Z.; Spelman, Tim; McMahon, James; Velayudham, Pushparaj; Brown, Gregor; Roney, Janine; Watson, Jo; Prince, Miles H.; Hoy, Jennifer F.; Chomont, Nicolas; Fromentin, Rémi; Procopio, Francesco A.; Zeidan, Joumana; Palmer, Sarah; Odevall, Lina; Johnstone, Ricky W.; Martin, Ben P.; Sinclair, Elizabeth; Deeks, Steven G.; Hazuda, Daria J.; Cameron, Paul U.; Sékaly, Rafick-Pierre; Lewin, Sharon R.

    2014-01-01

    Human immunodeficiency virus (HIV) persistence in latently infected resting memory CD4+ T-cells is the major barrier to HIV cure. Cellular histone deacetylases (HDACs) are important in maintaining HIV latency and histone deacetylase inhibitors (HDACi) may reverse latency by activating HIV transcription from latently infected CD4+ T-cells. We performed a single arm, open label, proof-of-concept study in which vorinostat, a pan-HDACi, was administered 400 mg orally once daily for 14 days to 20 HIV-infected individuals on suppressive antiretroviral therapy (ART). The primary endpoint was change in cell associated unspliced (CA-US) HIV RNA in total CD4+ T-cells from blood at day 14. The study is registered at ClinicalTrials.gov (NCT01365065). Vorinostat was safe and well tolerated and there were no dose modifications or study drug discontinuations. CA-US HIV RNA in blood increased significantly in 18/20 patients (90%) with a median fold change from baseline to peak value of 7.4 (IQR 3.4, 9.1). CA-US RNA was significantly elevated 8 hours post drug and remained elevated 70 days after last dose. Significant early changes in expression of genes associated with chromatin remodeling and activation of HIV transcription correlated with the magnitude of increased CA-US HIV RNA. There were no statistically significant changes in plasma HIV RNA, concentration of HIV DNA, integrated DNA, inducible virus in CD4+ T-cells or markers of T-cell activation. Vorinostat induced a significant and sustained increase in HIV transcription from latency in the majority of HIV-infected patients. However, additional interventions will be needed to efficiently induce virus production and ultimately eliminate latently infected cells. Trial Registration ClinicalTrials.gov NCT01365065 PMID:25393648

  9. Active tuberculosis case finding and detection of drug resistance among HIV-infected patients: A cross-sectional study in a TB endemic area, Gondar, Northwest Ethiopia

    PubMed Central

    Alemayehu, Martha; Gelaw, Baye; Abate, Ebba; Wassie, Liya; Belyhun, Yeshambel; Bekele, Shiferaw; Kempker, Russell R.; Blumberg, Henry M.; Aseffa, Abraham

    2016-01-01

    Background Tuberculosis (TB) patients co-infected with human immunodeficiency virus (HIV) often lack the classic symptoms of pulmonary tuberculosis, making the diagnosis difficult. Current practices in resource-limited settings often indicate that these co-infected patients are diagnosed when they clinically manifest disease symptoms, resulting in a delayed diagnosis and despite continued transmission. The aim of this study is to determine the prevalence of undiagnosed pulmonary tuberculosis cases through active case finding and including multidrug-resistant TB (MDR-TB) among HIV-infected patients. Materials and methods A total of 250 HIV-infected patients, aged 18 years and above were evaluated in a cross-sectional design between February 2012 and November 2012. Socio-demographic and clinical data were collected using a structured questionnaire. Sputum samples were collected from all participants for acid fast bacilli (AFB) direct smear microscopy and Mycobacteria culture. A PCR-based RD9 deletion and genus typing, as well as first-line anti-TB drug susceptibility testing, was performed for all culture-positive isolates. Results Following active TB case finding, a total of 15/250 (6%) cases were diagnosed as TB cases, of whom 9/250 (3.6%) were detected by both smear microscopy and culture and the remaining 6/250 (2.4%) only by culture. All the 15 isolates were typed through RD9 typing of which 10 were Mycobacterium tuberculosis species; 1 belonged to Mycobacterium genus and 4 isolates were non-tuberculous mycobacteria. The prevalence of undiagnosed pulmonary TB disease among the study participants was 4.4%, which implies the possibility of identifying even more undiagnosed cases through active case finding. A multivariate logistic regression showed a statistically significant association between the presence of pneumonia infection and the occurrence of TB (OR = 4.81, 95% CI (1.08–21.43), p = 0.04). In addition, all the isolates were sensitive to all first

  10. Effect of Integrated Yoga (IY) on psychological states and CD4 counts of HIV-1 infected patients: A randomized controlled pilot study

    PubMed Central

    Naoroibam, Rosy; Metri, Kashinath G; Bhargav, Hemant; Nagaratna, R; Nagendra, HR

    2016-01-01

    Background: Human immunodeficiency virus (HIV) infected individuals frequently suffer from anxiety and depression. Depression has been associated with rapid decline in CD4 counts and worsened treatment outcomes in HIV-infected patients. Yoga has been used to reduce psychopathology and improve immunity. Aim: To study the effect of 1-month integrated yoga (IY) intervention on anxiety, depression, and CD4 counts in patients suffering from HIV-1 infection. Methods: Forty four HIV-1 infected individuals from two HIV rehabilitation centers of Manipur State of India were randomized into two groups: Yoga (n = 22; 12 males) and control (n = 22; 14 males). Yoga group received IY intervention, which included physical postures (asanas), breathing practices (pranayama), relaxation techniques, and meditation. IY sessions were given 60 min/day, 6 days a week for 1 month. Control group followed daily routine during this period. All patients were on anti-retroviral therapy (ART) and dosages were kept stable during the study. There was no significant difference in age, gender, education, CD4 counts, and ART status between the two groups. Hospital anxiety and depression scale was used to assess anxiety and depression, CD4 counts were measured by flow cytometry before and after intervention. Analysis of variance – repeated measures was applied to analyze the data using SPSS version 10. Results: Within group comparison showed a significant reduction in depression scores (F [1, 21] =4.19, P < 0.05) and non-significant reduction in anxiety scores along with non significant increment in CD4 counts in the yoga group. In the control group, there was a non-significant increase in anxiety and depression scores and reduction in CD4 counts. Between-group comparison revealed a significant reduction in depression scores (F [1, 21] =5.64, P < 0.05) and significant increase in CD4 counts (F [1, 21] =5.35, P < 0.05) in the yoga group as compared to the control. Conclusion: One month practice of IY

  11. Characteristics and Outcome of Patients Diagnosed With HIV at Older Age.

    PubMed

    Asher, Ilan; Guri, Keren Mahlab; Elbirt, Daniel; Bezalel, Shira Rosenberg; Maldarelli, Frank; Mor, Orna; Grossman, Zehava; Sthoeger, Zev M

    2016-01-01

    To characterize the clinical, virological, and immunological status at presentation as well as the outcome of patients diagnosed with HIV above the age of 50. A retrospective study of 418 patients newly diagnosed with HIV in 1 Israeli center, between the years 2004 and 2013. Patients with new HIV diagnosis ≥ 50 years of age defined as "older' and < 50 defined as "younger.' Patients were evaluated every 1 to 3 months (mean follow-up 53 ± 33 months). Patients with < 2 CD4/viral-load measurements or with < 1 year of follow-up were excluded. Time of HIV infection was estimated by HIV sequence ambiguity assay. Ambiguity index ≤ 0.43 indicated recent (≤ 1 year) HIV infection. Eighty nine (21%) patients were diagnosed with HIV at an older age. Those older patients presented with significant lower CD4 cell counts and higher viral-load compared with the younger patients. At the end of the study, the older patients had higher mortality rate (21% vs 3.5%; P < 0.001) and lower CD4 cell counts (381 ± 228 vs 483 ± 26 cells/μL; P < 0.001) compared with the younger patients. This difference was also observed between older and younger patients with similar CD4 cell counts and viral load at the time of HIV diagnosis and among patients with a recent (≤ 1 year) HIV infection. One-fifth of HIV patients are diagnosed at older age (≥ 50 years). Those older patients have less favorable outcome compared with the younger patients. This point to the need of educational and screening programs within older populations and for a closer follow-up of older HIV patients. PMID:26735534

  12. The Vancouver Lymphadenopathy-AIDS Study: 5. Antecedent behavioural, clinical and laboratory findings in patients with AIDS and HIV-seropositive controls.

    PubMed

    Boyko, W J; Schechter, M T; Craib, K J; Constance, P; Nitz, R; Fay, S; McLeod, A; O'Shaughnessy, M

    1986-10-15

    In a group of homosexual men in Vancouver studied prospectively since November 1982, 26 cases of acquired immune deficiency syndrome (AIDS) have arisen. To identify behavioural, clinical and laboratory findings that might predict the development of AIDS in people with antibody to human immunodeficiency virus (HIV), we compared data for 25 patients with AIDS with corresponding data for 80 controls serologically positive for HIV selected from the cohort. The clinical and laboratory data for the patients with AIDS preceded the diagnosis of the syndrome by a mean of 17.5 months. The controls had been both seropositive and AIDS-free for a mean of 16.7 months after acquisition of their data. We detected significant differences between the patients with AIDS and the controls in IgG and IgA levels, absolute number of helper T cells and ratio of helper to suppressor T cells but not in lifetime number of male sexual partners, frequency of receptive anal intercourse or receptive fisting, illicit drug use or history of infectious disease. We also detected an increased risk of AIDS among those who had an elevated number of sexual contacts in AIDS-endemic areas in the 5 years before enrollment. A history of increased early sexual contact in AIDS-endemic areas is likely to be associated with early infection and with an increased risk of AIDS among men with HIV infection of unknown duration. Thus, although our analysis had limited statistical power, we conclude that most lifestyle variables appear to act as exposure factors in HIV infection but not as cofactors in the development of AIDS.

  13. Histoplasmosis in patients with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS): multicenter study of outcomes and factors associated with relapse.

    PubMed

    Myint, Thein; Anderson, Albert M; Sanchez, Alejandro; Farabi, Alireza; Hage, Chadi; Baddley, John W; Jhaveri, Malhar; Greenberg, Richard N; Bamberger, David M; Rodgers, Mark; Crawford, Timothy N; Wheat, L Joseph

    2014-01-01

    Although discontinuation of suppressive antifungal therapy for acquired immunodeficiency syndrome (AIDS)-associated histoplasmosis is accepted for patients with immunologic recovery, there have been no published studies of this approach in clinical practice, and minimal characterization of individuals who relapse with this disease. We performed a multicenter retrospective cohort study to determine the outcome in AIDS patients following discontinuation of suppressive antifungal therapy for histoplasmosis. Ninety-seven patients were divided into a physician-discontinued suppressive therapy group (PD) (38 patients) and a physician-continued suppressive therapy group (PC) (59 patients). The 2 groups were not statistically different at baseline, but at discontinuation of therapy and at the most recent follow-up there were significant differences in adherence to therapy, human immunodeficiency virus (HIV) RNA, and urinary Histoplasma antigen concentration. There was no relapse or death attributed to histoplasmosis in the PD group compared with 36% relapse (p < 0.0001) and 5% death (p = 0.28) in the PC group. Relapse occurred in 53% of the nonadherent patients but not in the adherent patients (p < 0.0001). Sixty-seven percent of patients with initial central nervous system (CNS) histoplasmosis relapsed compared to 15% of patients without CNS involvement (p = 0.0004), which may be accounted for by nonadherence. In addition, patients with antigenuria above 2.0 ng/mL at 1-year follow-up were 12.82 times (95% confidence interval, 2.91-55.56) more likely to relapse compared to those with antigenuria below 2.0 ng/mL. Discontinuation of antifungal therapy was safe in adherent patients who completed at least 1 year of antifungal treatment, and had CD4 counts >150 cells/mL, HIV RNA <400 c/mL, Histoplasma antigenuria <2 ng/mL (equivalent to <4.0 units in second-generation method), and no CNS histoplasmosis.

  14. Coping With Stress Strategies in HIV-infected Iranian Patients.

    PubMed

    Mahmoudi, Maryam; Dehdari, Tahereh; Shojaeezadeh, Davoud; Abbasian, Ladan

    2015-01-01

    Stress has significant adverse impacts on health outcomes of HIV-infected patients. Our study explored coping with stress strategies by HIV-infected Iranian patients. A qualitative content analysis study was conducted at the Consultation Clinic of HIV at the Imam Khomeini Hospital in Tehran, Iran in 2012. Twenty-six semi-structured in-depth interviews were done. Participants were asked about coping strategies for stress. After the first interview, continuous analysis of data was started and continued up to data saturation. Results showed that participants used two categories of strategies (emotion-based coping and problem-based coping) to cope with stress. Emotion-based coping had two sub-themes: adaptive and maladaptive. The problem-based coping category had three sub-themes: participation in education sessions, adherence to medication, and efforts to maintain a healthy lifestyle. Explanations of different strategies available to HIV-infected patients to cope with stress may help develop tailored interventions to improve the psychological conditions of people living with HIV.

  15. Late implant sepsis after fracture surgery in HIV positive patients.

    PubMed

    Graham, Simon Matthew; Bates, Jes; Mkandawire, Nyengo; Harrison, William J

    2015-04-01

    A prospective cohort study was undertaken to assess the incidence of late-implant sepsis after internal fixation in HIV-positive patients. A total of 91 HIV-positive patients (67 males and 24 females) who underwent 103 procedures (111 implants) were followed up for a mean period of 27 months (range 12-66 months). No occurrences of late implant sepsis were found in 100 implants (94 procedures) in 82 patients at 27 months' follow-up (range 12-66 months). Nine patients (9 procedures, 9 implants) developed early infections within 6 weeks and were treated with antibiotics (6 patients), amputation (1 patient) or removal of metal work (2 patients). There was no evidence of subsequent late implant sepsis in any of these patients, at a mean follow-up of 25 months (range 12-52 months). This study demonstrates that it is safe to perform internal fixation in HIV-positive patients, with no observed increase risk of late implant sepsis. There is no indication to remove implants after fracture union, other than for the general clinical indications that may lead to removal of metal work in any patient.

  16. Optimal management of cervical cancer in HIV-positive patients: a systematic review

    PubMed Central

    Ntekim, Atara; Campbell, Oladapo; Rothenbacher, Dietrich

    2015-01-01

    The clinical management of cervical cancer in HIV-positive patients has challenges mainly due to the concerns on immune status. At present, their mode of management is similar to HIV-seronegative patients involving the use of chemotherapy and radiotherapy concurrently as indicated. HIV infection, cancer, radiotherapy, and chemotherapy lower immunity through reduction in CD4 cell counts. At present there are no treatment guidelines for HIV-positive patients. This study was done to systematically review the literature on cervical cancer management in HIV-positive patients and treatment outcomes. A systematic literature search was done in the major databases to identify studies on the management of HIV-positive patients with cervical cancer. Identified studies were assessed for eligibility and inclusion in the review following the guidelines of The Cochrane Handbook for Systematic Reviews and CRD's (Centre for Reviews and Dissemination) guidance for undertaking reviews in health care. Eight eligible studies were identified from the literature. Three of them were prospective while five were retrospective studies. Notably, the average age at diagnosis of cervical cancer in HIV-positive patients was a decade lower than in seronegative patients. There was no difference in distribution of stages of disease at presentation between HIV-positive and negative patients. Mild acute toxicity (Grades 1 and 2) was higher in HIV-positive patients than in HIV-negative patients in hematopoietic system. In the grades 3 and 4 reactions, anemia was reported in 4% versus 2% while gastrointestinal reactions were reported in 5% versus 2% respectively. In general, patients who were started early on HAART had higher rates of treatment completion. The study supports the suggestion that HAART should be commenced early at cervical cancer diagnosis in HIV-positive patients diagnosed with cervical cancer to ensure less toxicity and better treatment compliance. PMID:26136407

  17. Optimal management of cervical cancer in HIV-positive patients: a systematic review.

    PubMed

    Ntekim, Atara; Campbell, Oladapo; Rothenbacher, Dietrich

    2015-09-01

    The clinical management of cervical cancer in HIV-positive patients has challenges mainly due to the concerns on immune status. At present, their mode of management is similar to HIV-seronegative patients involving the use of chemotherapy and radiotherapy concurrently as indicated. HIV infection, cancer, radiotherapy, and chemotherapy lower immunity through reduction in CD4 cell counts. At present there are no treatment guidelines for HIV-positive patients. This study was done to systematically review the literature on cervical cancer management in HIV-positive patients and treatment outcomes. A systematic literature search was done in the major databases to identify studies on the management of HIV-positive patients with cervical cancer. Identified studies were assessed for eligibility and inclusion in the review following the guidelines of The Cochrane Handbook for Systematic Reviews and CRD's (Centre for Reviews and Dissemination) guidance for undertaking reviews in health care. Eight eligible studies were identified from the literature. Three of them were prospective while five were retrospective studies. Notably, the average age at diagnosis of cervical cancer in HIV-positive patients was a decade lower than in seronegative patients. There was no difference in distribution of stages of disease at presentation between HIV-positive and negative patients. Mild acute toxicity (Grades 1 and 2) was higher in HIV-positive patients than in HIV-negative patients in hematopoietic system. In the grades 3 and 4 reactions, anemia was reported in 4% versus 2% while gastrointestinal reactions were reported in 5% versus 2% respectively. In general, patients who were started early on HAART had higher rates of treatment completion. The study supports the suggestion that HAART should be commenced early at cervical cancer diagnosis in HIV-positive patients diagnosed with cervical cancer to ensure less toxicity and better treatment compliance. PMID:26136407

  18. A Binational Study of Patient-Initiated Changes to Antiretroviral Therapy Regimen Among HIV-positive Latinos Living in the Mexico–U.S. Border Region

    PubMed Central

    Zúñiga, María Luisa; Muñoz, Fátima; Kozo, Justine; Blanco, Estela; Scolari, Rosana

    2015-01-01

    Research is lacking on factors associated with antiretroviral therapy (ART) sub-optimal adherence among U.S. Latinos, who are disproportionately affected by HIV and face substantial health care barriers. We examined self-reported, patient-initiated changes to ART (i.e., made small/major changes from the antiretroviral drugs prescribed) among HIV-positive Latinos. Trained interviewers administered surveys to 230 participants currently on ART in San Diego, U.S. and Tijuana, Mexico. We identified factors independently associated with ART changes. Participants were Spanish-language dominant (86%), mean age of 41 years, male (77%), and born in Mexico (93%). Patient-initiated changes to ART were reported in 43% of participants. Being female, having ≥1 sexual partner (past 3 months), ≥6 years since HIV diagnosis and poor health were associated with increased odds of ART changes. Findings raise concern about sub-optimal adherence among this binational population. Longitudinal studies are needed to further explore adherence barriers and avenues for intervention. PMID:21800182

  19. Cardiovascular risk and dyslipidemia management in HIV-infected patients.

    PubMed

    Stein, James H

    2012-01-01

    HIV infection and antiretroviral therapy each appear to increase cardiovascular disease risk. Increased risk may be attributable to the inflammatory effects of HIV infection and dyslipidemia associated with some antiretroviral agents. The prevalence of cardiovascular disease is increasing as patients live longer, age, and acquire traditional coronary heart disease (CHD) risk factors. In general, any additional cardiovascular risk posed by HIV infection or antiretroviral therapy is of potential concern for patients who are already at moderate or high risk for CHD. Long-term and well-designed studies are needed to more accurately ascertain to what degree HIV infection and antiretroviral therapy affect long-term cardiovascular disease risk. Management of dyslipidemia to reduce CHD risk in HIV-infected patients is much the same as in the general population, with the cornerstone consisting of statin therapy and lifestyle interventions. Smoking cessation is a major step in reducing CHD risk in those who smoke. This article summarizes a presentation by James H. Stein, MD, at the IAS-USA live continuing medical education activity held in New York City in March 2012.

  20. Insulin Resistance Predicts Retreatment Failure in an Efficacy Study of Peginterferon-α-2a and Ribavirin in HIV/HCV Co-infected Patients

    PubMed Central

    Vachon, Marie-Louise C.; Factor, Stephanie H.; Branch, Andrea D.; Fiel, Maria-Isabel; Rodriguez-Torres, Maribel; Bräu, Norbert; Sterling, Richard K.; Slim, Jihad; Talal, Andrew H.; Dieterich, Douglas T.; Sulkowski, Mark S.

    2010-01-01

    Background and Aims Few studies evaluated the efficacy of HCV re-treatment and the predictors of response in HIV/HCV co-infected patients. The role of insulin resistance as a predictor of response in this population is unknown. To evaluate safety and efficacy of pegylated interferon-α-2a and ribavirin in re-treatment of HIV/HCV co-infected patients, predictors of sustained virological response including insulin resistance, and the relationship between insulin resistance and liver histology. Methods This prospective, multi-centered study included HIV/HCV co-infected patients with prior interferon-based treatment failure. Patients received pegylated interferon-α-2a and ribavirin for 48 weeks. Serum HCV RNA was measured 24 weeks post treatment to assess sustained virological response. Insulin resistance was defined as HOMA-IR >2. Correlations between baseline insulin resistance and steatosis and/or cirrhosis were determined. Results Sustained virological response was achieved by 14/96 (15%) patients. Of those with HOMA-IR <2, 35% (6/17) achieved sustained virological response vs 14% (15/36) of those with HOMA-IR between 2–4 and 7% (3/41) of those with HOMA-IR >4 (p=0.01). In multivariable analysis, insulin resistance and log10 HCV RNA were negatively associated with sustained virological response [AOR 0.17; 95%CI 0.05–0.64, p=0.009, and AOR 0.36; 95%CI 0.14–0.93, p=0.04, respectively). Steatosis and cirrhosis correlated with insulin resistance (p=0.02 and 0.03, respectively) but neither independently predicted sustained virological response. Discontinuations due to severe adverse events occurred in 8% and 2 patients died of unrelated cause. Conclusions In HIV/HCV co-infected patients undergoing re-treatment, sustained virological response rate is low; those without insulin resistance are significantly more likely to achieve sustained virological response. PMID:20974502

  1. Retention and Treatment Outcomes of an Undernutrition Program for HIV patients involving Ready-to-Use Therapeutic Food at Gondar University Hospital, Ethiopia: A Cross-Sectional Study

    PubMed Central

    Bhagavathula, Akshaya Srikanth; Dawson, Angela; Elnour, Asim Ahmed; Shehab, Abdulla

    2016-01-01

    Introduction Despite global efforts to eradicate poverty and hunger, under-nutrition is still a major health problem, especially in Sub-Saharan Africa, where HIV/AIDS prevalence is also a serious burden. Aim To assess the retention and outcomes of under-nutrition treatment program in Gondar University Hospital, Ethiopia. Settings and Design: A cross-sectional study was conducted in HIV positive children and adults participating in the Ready-to-use Therapeutic Food (RUTF) treatment program at Gondar University Hospital ART clinic for one year from November 2012 to November 2013. Materials and Methods Six hundred and thirty six patient records were followed-up for one year. Outcome variables were Mid-Upper Arm Circumference (MUAC) values measured as severe, moderate acute malnutrition, normal after treatment, non-respondent, relapsed and lost to follow-up using the hospital records of HIV positive children and adults eligible for the program. Statistical Analysis: Univariate and multivariate analysis were performed to compute Crude Odds Ratio (COR) and Adjusted Odds Ratio (AOR). Statistical significance was set at p-value<0.05. Results Among 636 clients, 44.2% achieved MUAC measures ≥ 125 mm for children and ≥ 21 cm for adults at 4 and 6 months. 70.1% of those were children while 29.9% of the 281 were adults. Moreover, a more positive initial response to ready-to-use therapeutic food was found among children as there was significant increase (p<0.05) in MUAC value after the second month of initiating treatment while adults achieved a significant (p<0.05, p<0.01) in MUAC at the 4th and 6th month respectively. There was a significant association between age, nutrition status and treatment outcome, while sex, HIV status, education and residency were not associated with treatment outcome. Conclusion Recovery and weight gain rates were below 50%. Defaulter rates were higher than the Sphere standards and recovery was better in children than adults. Integrated RUTF and

  2. Clinical Evaluation of Shilajatu Rasayana in patients with HIV Infection

    PubMed Central

    Gupta, G. D.; Sujatha, N.; Dhanik, Ajay; Rai, N. P.

    2010-01-01

    AIDS is one of the serious global health concerns caused by Human Immuno Deficiency(HIV) virus and is predominantly a sexually transmitted disease. Currently there is no vaccine or cure for AIDS still Anti Retroviral Therapy (ART) is successful. It reduces both the mortality and the morbidity of HIV infection, but is expensive and inaccessible in many countries. However intense the therapy may be, HIV virus is rarely eliminated, and drug resistance is a major setback during long-term therapy. The development of new drugs and strategies and exploring alternative systems of medicine for antiviral herbs or drugs is the need of the age to improve treatment outcomes. Ayurveda describes many diseases which incorporate HIV like illness e.g. Rajayakshma, Ojo Kshaya, Sannipata jwara etc. HIV infection affects multisystems, chiefly the Immune System which can be correlated to Ojo Kshaya. Rasayana Chikitsa is the frontline therapy employed to treat Ojus disorders. Therefore Shilajatu (Mineral pitch), Centella asiatica (Mandukaparni), Tinospora cordifolia (Guduchi) and Emblica officinalis (Amalaki), well known for their Immuno-modulator and antioxidant properties were selected to evaluate their role on immune system. The study was carried on 20 patients from OPD and IPD of Kayachikitsa, S.S.Hospital, IMS, BHU and was randomly allocated into Treated group (Shilajatu+ART) and Control group (ART). Treated Group responded better to ART both clinically and biochemically. The results show that Shilajatu decreases the recurrent resistance of HIV virus to ART and improves the outcome of the therapy PMID:22131681

  3. Endothelial and platelet function alterations in HIV-infected patients.

    PubMed

    Gresele, P; Falcinelli, E; Sebastiano, M; Baldelli, F

    2012-03-01

    The HIV epidemic has huge dimensions: in 2009, 33.3million people worldwide, including 2.5million children, were affected by human immunodeficiency virus (HIV) infection. The introduction of Highly Active Anti-Retroviral Therapy (HAART) has significantly modified the course of HIV disease, with longer survival and improved quality of life, but it has simultaneously lead to the appearance of previously unrecognized complications, such as ischemic cardiovascular events. Many studies have shown a higher rate of premature atherosclerosis in patients with HIV infection, leading to coronary, cerebrovascular, or peripheral arterial disease. However, it is still debated whether cardiovascular complications are a consequence of HIV infection itself or of the long-term use of HAART. In particular, myocardial infarction has been suggested to be associated with the use of abacavir. Endothelial dysfunction and platelet activation are markers of atherosclerosis and of increased cardiovascular risk. Here we review the evidence that endothelial dysfunction and platelet alterations are associated with chronic HIV infection, the possible role of different HAARTs, and the possible pathophysiologic mechanisms. Potential therapeutic implications are also discussed.

  4. Electrocardiographic spatial QRS-T angle and incident cardiovascular disease in HIV-infected patients (from the Strategies for the Management of Antiretroviral Therapy [SMART] study).

    PubMed

    Dawood, Farah Z; Khan, Faraaz; Roediger, Mollie P; Zhang, Zhu-Ming; Swaminathan, Shobha; Klinker, Hartwig; Hoy, Jennifer; Lundgren, Jens D; Neaton, James D; Soliman, Elsayed Z

    2013-01-01

    Widening of the electrocardiographic (ECG) spatial QRS-T angle has been predictive of cardiovascular disease (CVD) events in the general population. However, its prognostic significance in human immunodeficiency virus (HIV)-infected patients remains unknown. The spatial QRS-T angle was derived from the baseline resting 12-lead electrocardiogram of 4,453 HIV-infected patients aged 43.5 ± 9.3 years from the Strategies for Management of Antiretroviral Therapy (SMART) trial. CVD events were identified during a median follow-up of 28.7 months. Quartiles of the spatial QRS-T angle was calculated for men and women separately, and values in the upper quartile were considered as a widened angle (values >74° for women and >93° for men). A multivariate Cox proportional hazards analysis was used to examine the association between a widened baseline spatial QRS-T angle and incident CVD events. During 11,965 person-years of follow-up, 152 CVD events occurred at a rate of 1.27 events/100 person-years. The rate of CVD events in those with a widened spatial QRS-T angle was almost double the rate in those with a normal spatial QRS-T angle (rate ratio 1.94, 95% confidence interval 1.40 to 2.69; p <0.001). In a model adjusted for study treatment arm, demographics, CVD risk factors, HIV characteristics, inflammatory markers, and other ECG abnormalities, a widened spatial QRS-T angle was associated with a >50% increased risk of CVD events compared to a normal spatial QRS-T angle (hazard ratio 1.53, 95% confidence interval 1.07 to 2.17; p = 0.02). No interaction was seen by SMART trial arm (p value for interaction = 0.37) or gender (p value for interaction = 0.84). In conclusion, a widened spatial QRS-T angle was independently predictive of CVD events in HIV-infected patients receiving antiretroviral therapy. This highlights the potential role of routine electrocardiography as a simple noninvasive CVD risk-screening tool in HIV-infected patients.

  5. Pathophysiology of HIV related thrombocytopenia: an analysis of 41 patients.

    PubMed Central

    Domínguez, A; Gamallo, G; Garcia, R; Lopez-Pastor, A; Peña, J M; Vazquez, J J

    1994-01-01

    AIM--To analyse the pathogenic mechanism of HIV related thrombocytopenia. METHODS--Forty one patients with thrombocytopenia and HIV-1 infection were investigated over two years. Anticardiolipin antibodies were measured using an enzyme linked immunosorbent assay and antiplatelet antibodies were measured using an immunocapture technique. Tests for VDRL, C3 and C4, antinuclear antibodies and rheumatoid factor were also carried out in all patients and 80 control subjects (HIV-1 positive but non-thrombocytopenic). Indiumoxine labelled platelets were transfused in 13 patients. P24 antigen were also measured in 12 bone marrow aspirates. RESULTS--Antiplatelet antibodies and circulating immune complexes were found exclusively in the thrombocytopenic group; values for antiplatelet antibodies and circulating immune complexes were both higher in homosexual and bisexual patients. Three kinds of pattern were observed using 111 In-labelled platelets: splenic (n = 10); hepatic (n = 2); and destruction of bone marrow in just one case. The two most influential factors in the sequestration pattern were antiplatelet antibodies in the splenic uptake and circulating immune complexes in the hepatic and marrow sequestration. All patients, except three, had decreased platelet recovery. In those patients with a CD4 lymphocyte count of less than 200 x 10(6) cells/l the recovery was clearly greater (53%) than in patients who had more than 200 x 10(6) /l (28%). Finally, in seven of the 12 patients who were chosen for immunohistochemical study, p24 antigen was detected in the megakaryocytes, verifying that HIV-1 infects such cells. CONCLUSIONS--The pathogenic mechanism of HIV related thrombocytopenia is probably multifaceted. Antiplatelet antibodies and circulating immune complexes would cause peripheral destruction in the spleen, liver, and bone marrow, in that order; and, on the other hand, there would be an ineffective immune thrombopoiesis and direct infection of the megakaryocytes which

  6. Meaning of care for terminally Ill HIV-infected patients by HIV-infected peer caregivers in a simulation-based training program in South Korea.

    PubMed

    Kim, Sunghee; Shin, Gisoo

    2015-01-01

    The purpose of this study was to develop a simulation-based training program for people living with HIV (PLWH) as peer caregivers who would take care of terminally ill, HIV-infected patients. We used qualitative research methods and standardized patients to explore the meaning of caring for patients as peer caregivers. Study participants included 32 patients registered as PLWH at the South Korea Federation for HIV/AIDS. The meanings of peer caregiving were categorized into four dimensions: physical, psychological, relational, and economic. Our study had benefits in knowledge acquisition for caregivers as well as care recipients, empathy with HIV-infected care recipients, improvement in self-esteem and social participation, and financial self-sufficiency to enable independent living for caregivers. The simulation training program for PLWH peer caregivers for terminally ill HIV-infected patients demonstrated value, for both PLWH caregivers and terminally ill HIV-infected patients in South Korea, to improve the quality of care.

  7. Is Multi-Drug Resistant Tuberculosis More Prevalent in HIV-Infected Patients in Korea?

    PubMed

    Lee, Shinwon; Lee, Sun Hee; Mok, Jeong Ha; Lee, Su Jin; Kim, Kye Hyung; Lee, Jeong Eun; Lee, Seung Geun; Chung, Joo Seop; Kwak, Ihm Soo

    2016-11-01

    The epidemiological synergy between human immunodeficiency virus (HIV) and tuberculosis (TB) is a major threat to public health. However, the association between HIV and multi-drug resistant tuberculosis (MDR-TB) is not clear. To explore the association between HIV and MDR-TB infection, a case-control study was performed in Korea. A total of 1606 culture-proven TB patients (45 HIV vs. 1561 non-HIV) from January 2006 to October 2014 were included in this analysis. MDR-TB rates were 11.1% and 8.2% in the HIV and non-HIV groups, respectively (p=0.42), thus indicating that MDR-TB was not significantly associated with HIV infection in Korea. PMID:27593882

  8. High HIV-1 Genetic Diversity in Patients from Northern Brazil.

    PubMed

    da Costa, Carolina Marinho; Costa de Oliveira, Cintia Mara; Chehuan de Melo, Yonne Francis; Delatorre, Edson; Bello, Gonzalo; Couto-Fernandez, Jose Carlos

    2016-09-01

    The HIV-1 epidemic in Brazil is driven by subtypes B, F1, and C and recombinants forms among those subtypes. The distribution of HIV-1 subtypes, however, may vary across different Brazilian regions and the molecular epidemiologic profile in Northern Brazil remains poorly explored. HIV-1 pol sequences were obtained from 305 patients failing antiretroviral therapy followed at outpatient clinics from five Northern Brazilian states. The most prevalent HIV-1 clade observed in the Northern Brazilian region was subtype B (81%), followed by BF1 recombinants (10%), subtype F1 (4%), subtype C (3%), BC recombinants (2%), and BU recombinants (1%). Although HIV-1 subtype B was the predominant HIV-1 clade in Northern Brazil, its prevalence greatly varies among different states, ranging from 63% in Rondônia to 92% in Acre. Among the 37 HIV-1 recombinant sequences detected in the Northern Brazilian region, nine (24%) displayed a unique recombinant form structure, five (14%) a CRF28/29_BF-like structure, and four (11%) a CRF31_BC-like structure. Two other BF1 recombinant patterns were identified in 16 (43%) and three (8%) samples that may correspond to two potentially new CRFs_BF characteristic of the Northern region. This study reveals that despite the low spatial connectivity with other Brazilian regions, the genetic complexity of the HIV-1 epidemic in Northern Brazil is very high and that the molecular epidemiologic pattern may vary across different northern states, reflecting a complex epidemic with multiple independent viral introductions into this Brazilian region. PMID:27091699

  9. High HIV-1 Genetic Diversity in Patients from Northern Brazil.

    PubMed

    da Costa, Carolina Marinho; Costa de Oliveira, Cintia Mara; Chehuan de Melo, Yonne Francis; Delatorre, Edson; Bello, Gonzalo; Couto-Fernandez, Jose Carlos

    2016-09-01

    The HIV-1 epidemic in Brazil is driven by subtypes B, F1, and C and recombinants forms among those subtypes. The distribution of HIV-1 subtypes, however, may vary across different Brazilian regions and the molecular epidemiologic profile in Northern Brazil remains poorly explored. HIV-1 pol sequences were obtained from 305 patients failing antiretroviral therapy followed at outpatient clinics from five Northern Brazilian states. The most prevalent HIV-1 clade observed in the Northern Brazilian region was subtype B (81%), followed by BF1 recombinants (10%), subtype F1 (4%), subtype C (3%), BC recombinants (2%), and BU recombinants (1%). Although HIV-1 subtype B was the predominant HIV-1 clade in Northern Brazil, its prevalence greatly varies among different states, ranging from 63% in Rondônia to 92% in Acre. Among the 37 HIV-1 recombinant sequences detected in the Northern Brazilian region, nine (24%) displayed a unique recombinant form structure, five (14%) a CRF28/29_BF-like structure, and four (11%) a CRF31_BC-like structure. Two other BF1 recombinant patterns were identified in 16 (43%) and three (8%) samples that may correspond to two potentially new CRFs_BF characteristic of the Northern region. This study reveals that despite the low spatial connectivity with other Brazilian regions, the genetic complexity of the HIV-1 epidemic in Northern Brazil is very high and that the molecular epidemiologic pattern may vary across different northern states, reflecting a complex epidemic with multiple independent viral introductions into this Brazilian region.

  10. Brief Report: Macrophage Activation in HIV-2-Infected Patients Is Less Affected by Antiretroviral Treatment-sCD163 in HIV-1, HIV-2, and HIV-1/2 Dually Infected Patients.

    PubMed

    Hønge, Bo L; Andersen, Morten N; Jespersen, Sanne; Medina, Candida; Correira, Faustino G; Jakobsen, Martin R; Laursen, Alex; Erikstrup, Christian; Møller, Holger J; Wejse, Christian

    2016-07-01

    The course of disease among HIV-2, HIV-1, and HIV-1/2 dually infected patients is different. We investigated the macrophage activation marker soluble CD163 (sCD163) dynamics in 212 HIV-1, HIV-2, and HIV-1/2 dually infected patients. There were no differences in sCD163 levels at baseline or during follow-up without antiretroviral therapy (ART). At follow-up on ART, median sCD163 levels were decreased for HIV-1-infected patients (P < 0.001), but not among HIV-2 (P = 0.093) or HIV-1/2 dually infected patients (P = 0.145). The larger decrease in sCD163 levels among HIV-1-infected patients during ART may indicate an HIV type-dependent differential effect of ART on macrophage activation during HIV infection. PMID:26825178

  11. Interferon-free regimens improve health-related quality of life and fatigue in HIV/HCV-coinfected patients with advanced liver disease: A retrospective study.

    PubMed

    Scheiner, Bernhard; Schwabl, Philipp; Steiner, Sebastian; Bucsics, Theresa; Chromy, David; Aichelburg, Maximilian C; Grabmeier-Pfistershammer, Katharina; Trauner, Michael; Peck-Radosavljevic, Markus; Reiberger, Thomas; Mandorfer, Mattias

    2016-07-01

    Health-related quality of life (HRQoL) is impaired in HIV/HCV-coinfected patients (HIV/HCV) and further decreased by interferon (IFN)-based therapies. We aimed to investigate the impact of IFN- and ribavirin (RBV)-free therapies on HRQoL and fatigue.Thirty-three HIV/HCV-coinfected patients who underwent HCV therapy with sofosbuvir in combination with daclatasvir or ledipasvir were retrospectively studied and compared to 17 patients who received boceprevir (BOC)/PEGIFN/RBV. HRQoL (mental [MCS] and physical [PCS] component score) and fatigue were assessed using the SF-36 (Short Form 36 Health Survey) and the FSS (Fatigue Severity Scale), respectively. HRQoL/fatigue was evaluated at baseline (BL), midway, and 12 weeks after the end of treatment (FU).At BL, both domains of HRQoL as well as the severity of fatigue were significantly impaired in HIV/HCV, when compared to a healthy population. Already during treatment, IFN/RBV-free therapy improved physical health (PCS: 41.4 ± 9.7 vs. 47.0 ± 11.2; P < 0.01) and reduced fatigue (37.8 ± 14.0 vs. 31.9 ± 15.2; P = 0.01), whereas we observed a substantial worsening of both factors in patients treated with BOC/PEGIFN/RBV. Since these improvements were maintained, patients treated with IFN/RBV-free therapy reported an improvement in physical health (PCS: 41.4 ± 9.7 vs. 45.8 ± 12.7; P < 0.01) and fatigue (37.8 ± 14.0 vs. 30.9 ± 14.8; P = 0.04) at FU. While AIDS-patients had a higher severity of fatigue at BL and showed a reduction of fatigue (42.5 ± 14.0 vs. 31.6 ± 15.7; P = 0.01), mental health only improved in patients without AIDS (MCS: 35.7 ± 5.3 vs.40.7 ± 6.4; P = 0.04). HIV/HCV with severe fatigue at BL (>median BL-FSS) showed most pronounced improvements in severity of fatigue (49.7 ± 7.0 vs. 32.0 ± 16.7; P < 0.01).In contrast to IFN-based regimens, highly effective and well-tolerated IFN-/RBV-free regimens improve HRQo

  12. Characteristics of HIV-2 and HIV-1/HIV-2 Dually Seropositive Adults in West Africa Presenting for Care and Antiretroviral Therapy: The IeDEA-West Africa HIV-2 Cohort Study

    PubMed Central

    Ekouevi, Didier K.; Balestre, Eric; Coffie, Patrick A.; Minta, Daouda; Messou, Eugene; Sawadogo, Adrien; Minga, Albert; Sow, Papa Salif; Bissagnene, Emmanuel; Eholie, Serge P.; Gottlieb, Geoffrey S.; Dabis, François; Zannou, Djimon Marcel; Ahouada, Carin; Akakpo, Jocelyn; Ahomadegbé, Christelle; Bashi, Jules; Gougounon-Houéto, Alice; Azon-Kouanou, Angèle; Houngbé, Fabien; Koumakpaï, Sikiratou; Alihonou, Florence; d’Almeida, Marcelline; Hodonou, Irvine; Hounhoui, Ghislaine; Sagbo, Gracien; Tossa-Bagnan, Leïla; Adjide, Herman; Drabo, Joseph; Bognounou, René; Dienderé, Arnaud; Traore, Eliezer; Zoungrana, Lassane; Zerbo, Béatrice; Sawadogo, Adrien Bruno; Zoungrana, Jacques; Héma, Arsène; Soré, Ibrahim; Bado, Guillaume; Tapsoba, Achille; Yé, Diarra; Kouéta, Fla; Ouedraogo, Sylvie; Ouédraogo, Rasmata; Hiembo, William; Gansonré, Mady; Messou, Eugène; Gnokoro, Joachim Charles; Koné, Mamadou; Kouakou, Guillaume Martial; Bosse, Clarisse Amani; Brou, Kouakou; Assi, Achi Isidore; Chenal, Henri; Hawerlander, Denise; Soppi, Franck; Minga, Albert; Abo, Yao; Bomisso, Germain; Eholié, Serge Paul; Amego, Mensah Deborah Noelly; Andavi, Viviane; Diallo, Zelica; Ello, Frédéric; Tanon, Aristophane Koffi; Koule, Serge Olivier; Anzan, Koffi Charles; Guehi, Calixte; Aka, Edmond Addi; Issouf, Koffi Ladji; Kouakou, Jean-Claude; N’Gbeche, Marie-Sylvie; Touré, Pety; Avit-Edi, Divine; Kouakou, Kouadio; Moh, Magloire; Yao, Valérie Andoblé; Folquet, Madeleine Amorissani; Dainguy, Marie-Evelyne; Kouakou, Cyrille; Méa-Assande, Véronique Tanoh; Oka-Berete, Gladys; Zobo, Nathalie; Acquah, Patrick; Kokora, Marie-Berthe; Eboua, Tanoh François; Timité-Konan, Marguerite; Ahoussou, Lucrèce Diecket; Assouan, Julie Kebé; Sami, Mabéa Flora; Kouadio, Clémence; Renner, Lorna; Goka, Bamenla; Welbeck, Jennifer; Sackey, Adziri; Owiafe, Seth Ntiri; Wejse, Christian; Silva, Zacarias José Da; Paulo, Joao; Rodrigues, Amabelia; da Silva, David; Medina, Candida; Oliviera-Souto, Ines; Østergaard, Lars; Laursen, Alex; Sodemann, Morten; Aaby, Peter; Fomsgaard, Anders; Erikstrup, Christian; Eugen-Olsen, Jesper; Maïga, Moussa Y; Diakité, Fatoumata Fofana; Kalle, Abdoulaye; Katile, Drissa; Traore, Hamar Alassane; Minta, Daouda; Cissé, Tidiani; Dembelé, Mamadou; Doumbia, Mohammed; Fomba, Mahamadou; Kaya, Assétou Soukho; Traoré, Abdoulaye M; Traoré, Hamady; Toure, Amadou Abathina; Dicko, Fatoumata; Sylla, Mariam; Berthé, Alima; Traoré, Hadizatou Coulibaly; Koïta, Anta; Koné, Niaboula; N'Diaye, Clémentine; Coulibaly, Safiatou Touré; Traoré, Mamadou; Traoré, Naïchata; Charurat, Man; Ajayi, Samuel; Dapiap, Stephen; Otu; Igbinoba, Festus; Benson, Okwara; Adebamowo, Clément; James, Jesse; Obaseki; Osakede, Philip; Olasode, John; Sow, Papa Salif; Diop, Bernard; Manga, Noël Magloire; Tine, Judicael Malick; Signate Sy, Haby; Ba, Abou; Diagne, Aida; Dior, Hélène; Faye, Malick; Gueye, Ramatoulaye Diagne; Mbaye, Aminata Diack; Patassi, Akessiwe; Kotosso, Awèrou; Kariyare, Benjamin Goilibe; Gbadamassi, Gafarou; Komi, Agbo; Mensah-Zukong, Kankoé Edem; Pakpame, Pinuwe; Lawson-Evi, Annette Koko; Atakouma, Yawo; Takassi, Elom; Djeha, Améyo; Ephoévi-gah, Ayoko; Djibril, Sherifa El-Hadj; Dabis, François; Bissagnene, Emmanuel; Arrivé, Elise; Coffie, Patrick; Ekouevi, Didier; Jaquet, Antoine; Leroy, Valériane; Lewden, Charlotte; Sasco, Annie; Azani, Jean-Claude; Allou, Gérard; Balestre, Eric; Bohossou, Franck; Karcher, Sophie; Gonsan, Jules Mahan; Carrou, Jérôme Le; Lenaud, Séverin; Nchot, Célestin; Malateste, Karen; Yao, Amon Roseamonde; Siloué, Bertine; Clouet, Gwenaelle; Djetouan, Hugues; Doring, Alexandra; Kouakou, Adrienne; Rabourdin, Elodie; Rivenc, Jean; Anglaret, Xavier; Ba, Boubacar; Essanin, Jean Bosco; Ciaranello, Andrea; Datté, Sébastien; Desmonde, Sophie; Diby, Jean-Serge Elvis; Gottlieb, Geoffrey S.; Horo, Apollinaire Gninlgninrin; Kangah, Serge N'zoré; Malvy, Denis; Meless, David; Mounkaila-Harouna, Aida; Ndondoki, Camille; Shiboski, Caroline; Thiébaut, Rodolphe; PAC-CI; Abidjan

    2013-01-01

    Background HIV-2 is endemic in West Africa. There is a lack of evidence-based guidelines on the diagnosis, management and antiretroviral therapy (ART) for HIV-2 or HIV-1/HIV-2 dual infections. Because of these issues, we designed a West African collaborative cohort for HIV-2 infection within the framework of the International epidemiological Databases to Evaluate AIDS (IeDEA). Methods We collected data on all HIV-2 and HIV-1/HIV-2 dually seropositive patients (both ARV-naive and starting ART) and followed-up in clinical centres in the IeDEA-WA network including a total of 13 clinics in five countries: Benin, Burkina-Faso Côte d’Ivoire, Mali, and Senegal, in the West Africa region. Results Data was merged for 1,754 patients (56% female), including 1,021 HIV-2 infected patients (551 on ART) and 733 dually seropositive for both HIV-1 and HIV 2 (463 on ART). At ART initiation, the median age of HIV-2 patients was 45.3 years, IQR: (38.3–51.7) and 42.4 years, IQR (37.0–47.3) for dually seropositive patients (p = 0.048). Overall, 16.7% of HIV-2 patients on ART had an advanced clinical stage (WHO IV or CDC-C). The median CD4 count at the ART initiation is 166 cells/mm3, IQR (83–247) among HIV-2 infected patients and 146 cells/mm3, IQR (55–249) among dually seropositive patients. Overall, in ART-treated patients, the CD4 count increased 126 cells/mm3 after 24 months on ART for HIV-2 patients and 169 cells/mm3 for dually seropositive patients. Of 551 HIV-2 patients on ART, 5.8% died and 10.2% were lost to follow-up during the median time on ART of 2.4 years, IQR (0.7–4.3). Conclusions This large multi-country study of HIV-2 and HIV-1/HIV-2 dual infection in West Africa suggests that routine clinical care is less than optimal and that management and treatment of HIV-2 could be further informed by ongoing studies and randomized clinical trials in this population. PMID:23824279

  13. Prevention of atherosclerosis in patients living with HIV

    PubMed Central

    De Lorenzo, Ferruccio; Boffito, Marta; Collot-Teixeira, Sophie; Gazzard, Brian; McGregor, John L; Shotliff, Kevin; Xiao, Han

    2009-01-01

    Investigational product: Rosuvastatin (Crestor®; Astra Zeneca). Active ingredients: Rosuvastatin (5 mg). Study title: Prevention of Atherosclerosis in Patients Living with HIV. Phase of study: Phase III. Aims: Primary aim: To assess whether rosuvastatin therapy could slow the progression of the carotid intima-media thickness (C-IMT; as measured by the change in the mean IMT of the near and far walls of the distal common carotid arteries) over 2 years in HIV-infected patients (HIV-IP). Secondary aims: To assess whether rosuvastatin therapy could reduce highly sensitive C reactive protein (hs-CRP) inflammatory marker that is increased in HIV-IP.To assess the effect of rosuvastatin therapy on serum lipid levels (total cholesterol [TC], low-density lipoprotein [LDL] cholesterol, high-density lipoprotein [HDL] cholesterol and triglycerides [TG]) and apolipoproteins (APO A1, APO B and APO B/A1).To assess the safety of rosuvastatin in HIV-IP through the evaluation of clinical laboratory analyses (liver function tests and creatine kinase) and adverse events (AEs). Study design: Two-year randomized, double-blind, placebo-controlled, parallel group study. Planned sample size: 320 HIV-IP. Summary of eligibility criteria: HIV-IP who are aged between 30 and 60 years, with a CD4 count. greater than 200 cells/mm3. Patients must be stable on combination antiretroviral therapy (cART) for at least 12 months and have a 10-year CVD risk of less than 20% (using the Framingham risk score). Number of study centers: One. Duration of treatment: Two years (5 mg rosuvastatin or placebo once daily). Dose and route of administration: Oral rosuvastatin (5 mg) once daily. The incidence of cardiovascular disease (CVD) in HIV-IP is at least three times higher than in the general population and further increases each year with combination anti-retroviral therapy (cART). The carotid atherosclerosis progression rate is 10 times higher in HIV-IP than in uninfected individuals. The aim of this study

  14. Dolutegravir in Antiretroviral-Experienced Patients With Raltegravir- and/or Elvitegravir-Resistant HIV-1: 24-Week Results of the Phase III VIKING-3 Study

    PubMed Central

    Castagna, Antonella; Maggiolo, Franco; Penco, Giovanni; Wright, David; Mills, Anthony; Grossberg, Robert; Molina, Jean-Michel; Chas, Julie; Durant, Jacques; Moreno, Santiago; Doroana, Manuela; Ait-Khaled, Mounir; Huang, Jenny; Min, Sherene; Song, Ivy; Vavro, Cindy; Nichols, Garrett; Yeo, Jane M.; Aberg, J.; Akil, B.; Arribas, J. R.; Baril, J.-G.; Blanco Arévalo, J. L.; Blanco Quintana, F.; Blick, G.; Boix Martínez, V.; Bouchaud, O.; Branco, T.; Bredeek, U. F.; Castro Iglesias, M.; Clumeck, N.; Conway, B.; DeJesus, E.; Delassus, J.-L.; De Truchis, P.; Di Perri, G.; Di Pietro, M.; Duggan, J.; Duvivier, C.; Elion, R.; Eron, J.; Fish, D.; Gathe, J.; Haubrich, R.; Henderson, H.; Hicks, C.; Hocqueloux, L.; Hodder, S.; Hsiao, C.-B.; Katlama, C.; Kozal, M.; Kumar, P.; Lalla-Reddy, S.; Lazzarin, A.; Leoncini, F.; Llibre, J. M.; Mansinho, K.; Morlat, P.; Mounzer, K.; Murphy, M.; Newman, C.; Nguyen, T.; Nseir, B.; Philibert, P.; Pialoux, G.; Poizot-Martin, I.; Ramgopal, M.; Richmond, G.; Salmon Ceron, D.; Sax, P.; Scarsella, A.; Sension, M.; Shalit, P.; Sighinolfi, L.; Sloan, L.; Small, C.; Stein, D.; Tashima, K.; Tebas, P.; Torti, C.; Tribble, M.; Troisvallets, D.; Tsoukas, C.; Viciana Fernández, P.; Ward, D.; Wheeler, D.; Wilkin, T.; Yeni, G.-P.; Louise Martin-Carpenter, J.; Uhlenbrauck, Gina

    2014-01-01

    Background. The pilot phase IIb VIKING study suggested that dolutegravir (DTG), a human immunodeficiency virus (HIV) integrase inhibitor (INI), would be efficacious in INI-resistant patients at the 50 mg twice daily (BID) dose. Methods. VIKING-3 is a single-arm, open-label phase III study in which therapy-experienced adults with INI-resistant virus received DTG 50 mg BID while continuing their failing regimen (without raltegravir or elvitegravir) through day 7, after which the regimen was optimized with ≥1 fully active drug and DTG continued. The primary efficacy endpoints were the mean change from baseline in plasma HIV-1 RNA at day 8 and the proportion of subjects with HIV-1 RNA <50 c/mL at week 24. Results. Mean change in HIV-1 RNA at day 8 was −1.43 log10 c/mL, and 69% of subjects achieved <50 c/mL at week 24. Multivariate analyses demonstrated a strong association between baseline DTG susceptibility and response. Response was most reduced in subjects with Q148 + ≥2 resistance-associated mutations. DTG 50 mg BID had a low (3%) discontinuation rate due to adverse events, similar to INI-naive subjects receiving DTG 50 mg once daily. Conclusions. DTG 50 mg BID–based therapy was effective in this highly treatment-experienced population with INI-resistant virus. Clinical Trials Registration. www.clinicaltrials.gov (NCT01328041) and http://www.gsk-clinicalstudywww.gsk-clinicalstudyregister.com (112574). PMID:24446523

  15. A ‘good hospital’: Nurse and patient perceptions of good clinical care for HIV-positive people on antiretroviral treatment in rural Zimbabwe—A mixed-methods qualitative study

    PubMed Central

    Campbell, Catherine; Scott, Kerry; Madanhire, Claudius; Nyamukapa, Constance; Gregson, Simon

    2011-01-01

    Background Antiretroviral treatment for HIV is gradually being made available across sub-Saharan Africa. With antiretroviral treatment, HIV can be approached as a chronic, manageable condition rather than a shorter-term issue of palliative care. This treatment involves repeated interaction between health staff and patients for ongoing check-ups and prescription refills. Objective This study aimed to understand patient and healthcare staff perceptions of good clinical antiretroviral treatment care. Design Over 100 h of ethnographic observation at healthcare sites; interviews and focus groups with 25 healthcentre workers (mostly nurses), 53 HIV-positive adults taking ARVs and 40 carers of children on ART. The data were analyzed using thematic content analysis. Setting Three healthcare sites providing free antiretroviral drugs in rural Zimbabwe, where the adult HIV infection rate is approximately 20%. Results Contrary to reports of poor antiretroviral treatment adherence and task-oriented rather than patient-oriented nursing, our study found great patient commitment to adherence, outstanding nurse dedication and a pervasive sense of hope about coping with HIV. Within this context however there were some situations where patients and nurses had different expectations of the medical encounter, leading to stress and dissatisfaction. Patients and staff both emphasized the importance of nurse kindness, understanding, confidentiality and acceptance (i.e. treating HIV patients ‘like normal’) and patient adherence to medical directions. However, nurses at times overlooked the negative effects of long wait times and frequent hospital visits. Further, nurses sometimes conflated medical adherence with general patient obedience in all aspects of the nurse–patient relationships. Patients and staff were frustrated by the ambiguity and unpredictability surrounding key elements of hospital visits such as how much patients had to pay for service, how long it would take to be

  16. Predictors of HIV/AIDS Related Ocular Manifestations among HIV/AIDS Patients in Felege Hiwot Referral Hospital, Northwest Ethiopia.

    PubMed

    Sharew, Guadie; Azage, Muluken

    2015-01-01

    Background. Ocular manifestations in people living with HIV/AIDS are varied and affect almost all the structures of eye leading to visual impairment or blindness. Therefore, the aim of this study was to identify the predictors of HIV related ocular manifestation among ART clinic clients. Methods. Institution based cross-sectional study was employed among ART clients at Felege Hiwot referral hospital, northwest Ethiopia. The study was conducted from 1 January 2013 to 30 January 2013. A total of 369 systematically and randomly selected clients were included in the study. Data were collected using structured questionnaires and ophthalmologic clinical examination. Data were entered and analyzed using SPSS version 16.0. Binary and multivariable logistic regression analyses were computed to identify independent predictors of HIV related ocular manifestation. Results. Twenty-five percent (25.7%) of HIV patients had ocular manifestations. The three most frequent signs were Squamoid Conjuctival growth (26.9%), ophthalmic herpes zoster (22.1%), and Bacterial Conjuctivitis (17.2%). History of eye problem, CD4 count, and visual acuity of the eye were the predictors of HIV related ocular manifestation. Conclusion. In this study, a higher proportion of ocular manifestations were detected in HIV/AIDS patients. Visual acuity and CD4 counts were the independent predictors of ocular manifestations. This finding gives an insight for policy makers and concerned body to integrate ophthalmic examination in ART clinics to improve the health condition of HIV/ADIS patients.

  17. Predictors of HIV/AIDS Related Ocular Manifestations among HIV/AIDS Patients in Felege Hiwot Referral Hospital, Northwest Ethiopia

    PubMed Central

    Sharew, Guadie

    2015-01-01

    Background. Ocular manifestations in people living with HIV/AIDS are varied and affect almost all the structures of eye leading to visual impairment or blindness. Therefore, the aim of this study was to identify the predictors of HIV related ocular manifestation among ART clinic clients. Methods. Institution based cross-sectional study was employed among ART clients at Felege Hiwot referral hospital, northwest Ethiopia. The study was conducted from 1 January 2013 to 30 January 2013. A total of 369 systematically and randomly selected clients were included in the study. Data were collected using structured questionnaires and ophthalmologic clinical examination. Data were entered and analyzed using SPSS version 16.0. Binary and multivariable logistic regression analyses were computed to identify independent predictors of HIV related ocular manifestation. Results. Twenty-five percent (25.7%) of HIV patients had ocular manifestations. The three most frequent signs were Squamoid Conjuctival growth (26.9%), ophthalmic herpes zoster (22.1%), and Bacterial Conjuctivitis (17.2%). History of eye problem, CD4 count, and visual acuity of the eye were the predictors of HIV related ocular manifestation. Conclusion. In this study, a higher proportion of ocular manifestations were detected in HIV/AIDS patients. Visual acuity and CD4 counts were the independent predictors of ocular manifestations. This finding gives an insight for policy makers and concerned body to integrate ophthalmic examination in ART clinics to improve the health condition of HIV/ADIS patients. PMID:26000175

  18. How Patient Interactions with a Computer-Based Video Intervention Affect Decisions to Test for HIV

    ERIC Educational Resources Information Center

    Aronson, Ian David; Rajan, Sonali; Marsch, Lisa A.; Bania, Theodore C.

    2014-01-01

    The current study examines predictors of HIV test acceptance among emergency department patients who received an educational video intervention designed to increase HIV testing. A total of 202 patients in the main treatment areas of a high-volume, urban hospital emergency department used inexpensive netbook computers to watch brief educational…

  19. Bloodstream infections in HIV-infected patients.

    PubMed

    Taramasso, Lucia; Tatarelli, Paola; Di Biagio, Antonio

    2016-04-01

    In the combined antiretroviral therapy era, HIV-infected patients remain a vulnerable population for the onset of bloodstream infections (BSI). Worldwide, nontyphoid salmonellae, Streptococcus pneumoniae, Escherichia coli, Staphylococcus aureus and coagulase negative staphylococci are the most important pathogens. Intravenous catheter associated infection, skin-soft tissue infection and endocarditis are associated with Gram-positive bacteremia. Among the Gram-negative, nontyphoidal Salmonella have been previously correlated to sepsis. Other causes of BSI in HIV-infected patients are mycobacteria and fungi. Mycobacteria constitute a major cause of BSI in limited resource countries. Fungal BSI are not frequent and among them Cryptococcus neoformans is the most common life-threatening infection. The degree of immunosuppression remains the key prognostic factor leading to the development of BSI. PMID:26950194

  20. Clinical experience of the 23-valent capsular polysaccharide pneumococcal vaccination in HIV-1-infected patients receiving highly active antiretroviral therapy: a prospective observational study.

    PubMed

    Hung, Chien-Ching; Chen, Mao-Yuan; Hsieh, Szu-Min; Hsiao, Chin-Fu; Sheng, Wang-Hwei; Chang, Shan-Chwen

    2004-05-01

    To assess the impact of vaccination with 23-valent pneumococcal polysaccharide vaccine on the risks for development of pneumococcal disease, all-cause community-acquired pneumonia, HIV progression, and mortality and immunologic and virologic responses among HIV-1-infected patients treated with highly active antiretroviral therapy (HAART), we conducted a 2-year prospective observational cohort study at a university hospital in Taiwan. A total of 305 HIV-1-infected patients who received 23-valent pneumococcal vaccine (vaccinees) and 203 patients who did not (non-vaccinees) were prospectively observed between 1 June 2000 and 31 October 2002. Changes of CD4+ and plasma viral load (PVL) from baseline to week 4 of vaccination were assessed in 31 randomly selected vaccinees. The incidence of pneumococcal disease and bacteremia of vaccinees was 2.1 per 1000 patient-years (PY) (95% confidence interval (95% CI), 1.7-2.5 per 1000 PY) over the median observation of 641 days (range, 37-832 days) following vaccination while that of non-vaccinee was 21.8 per 1000 PY (95% CI, 20.1-23.7 per 1000 PY) and 7.3 per 1000 PY (95% CI, 7.0-7.6 per 1000 PY), respectively, over the observation of 500 days (range, 32-851 days), with an adjusted odds ratio (AOR) for developing pneumococcal disease of 0.085 (95% CI, 0.010-0.735) and for bacteremia of 0.22 (95% CI, 0.018-2.561). The median CD4+ count increased by 45 x 10(6) l(-1) (P = 0.01) and median PVL change was 0 log(10) copies/ml (range of decrease, -0.74 to 2.47 log(10) copies/ml) after 1 month of pneumococcal vaccination among the subgroup of 31 vaccinees receiving HAART. The median CD4+ count increase from baseline to the end of study was 149 x 10(6) l(-1) for vaccinees and 107 x 10(6) l(-1) for non-vaccinees (P = 0.21). The AOR of developing all-cause community-acquired pneumonia and new AIDS-defining opportunistic illnesses (OI) of vaccinees as compared to non-vaccinees was 1.876 (95% CI, 0.785-4.485) and 0.567 (95% CI, 0

  1. Methadone Maintenance for HIV Positive and HIV Negative Patients in Kyiv: Acceptability and Treatment Response

    PubMed Central

    Dvoriak, Sergii; Karachevsky, Andrey; Chhatre, Sumedha; Booth, Robert; Metzger, David; Schumacher, Joseph; Chychula, Nina; Pecoraro, Anna; Woody, George

    2014-01-01

    Background With up to 40% of opioid injectors infected with HIV, Ukraine has one of the most concentrated HIV epidemics in the world, mainly due to unsterile injection practices and a historical absence of effective prevention services. Harm reduction programs, including syringe exchange and a small buprenorphine treatment program, were introduced in 2004 and methadone maintenance was allowed in 2007. Despite an initial expansion, by 2009, only 3221 injectors were receiving methadone treatment. A growing body of research on methadone maintenance has found high retention rates with reduction in opioid use and HIV risk behaviors. We report on the acceptability and initial outcome of methadone treatment as a function of HIV status, an issue that has not yet been reported for injectors in Ukraine. Methods Longitudinal observational study of a 12-week course of methadone treatment in 25 HIV+ and 25 HIV− opioid addicted individuals recruited from a harm reduction program and the city AIDS Center. Drug use and HIV risk were assessed at baseline and weeks 4, 8, 12 and 20; all patients were offered continued methadone maintenance in the Kyiv city program at the end of 12 weeks. Results Fifty-four individuals were asked if they were interested in the study and 50, demographically similar to other samples of opioid addicted Ukrainians, agreed to participate. Two died of non-study related causes; the other 48 completed assessments at weeks 4, 8 and 12, and 47 completed followups at week 20. Significant reductions were seen in use of heroin (p<. 0001), other opiates/analgesics (p< 0.0001), and HIV risk behaviors (drug, sex, total; all p <0.0001). All 48 patients chose to continue methadone after the 12-weeks of study medication ended. Unlike most opioid treatment studies, sexual risk was somewhat higher than injecting risk at study intake. Conclusions Methadone maintenance was well accepted by HIV+ and HIV− opioid dependent individuals and has the potential for significant

  2. Routine HIV Testing among Hospitalized Patients in Argentina. Is It Time for a Policy Change?

    PubMed Central

    Socías, María Eugenia; Hermida, Laura; Singman, Mariana; Kulgis, Gisela; Díaz Armas, Andrés; Cando, Osvaldo; Sued, Omar; Pérez, Héctor; Hermes, Ricardo; Presas, José Luis; Cahn, Pedro

    2013-01-01

    Introduction The Argentinean AIDS Program estimates that 110,000 persons are living with HIV/AIDS in Argentina. Of those, approximately 40% are unaware of their status, and 30% are diagnosed in advanced stages of immunosuppression. Though studies show that universal HIV screening is cost-effective in settings with HIV prevalence greater than 0.1%, in Argentina, with the exception of antenatal care, HIV testing is always client-initiated. Objective We performed a pilot study to assess the acceptability of a universal HIV screening program among inpatients of an urban public hospital in Buenos Aires. Methods Over a six-month period, all eligible adult patients admitted to the internal medicine ward were offered HIV testing. Demographics, uptake rates, reasons for refusal and new HIV diagnoses were analyzed. Results Of the 350 admissions during this period, 249 were eligible and subsequently enrolled. The enrolled population was relatively old compared to the general population, was balanced on gender, and did not report traditional high risk factors for HIV infection. Only 88 (39%) reported prior HIV testing. One hundred and ninety (76%) patients accepted HIV testing. In multivariable analysis only younger age (OR 1.02; 95%CI 1.003-1.05) was independently associated with test uptake. Three new HIV diagnoses were made (undiagnosed HIV prevalence: 1.58%); none belonged to a most-at-risk population. Conclusions Our findings suggest that universal HIV screening in this setting is acceptable and potentially effective in identifying undiagnosed HIV-infected individuals. If confirmed in a larger study, our findings may inform changes in the Argentinean HIV testing policy. PMID:23936034

  3. Hepatic safety of RPV/FTC/TDF single tablet regimen in HIV/HCV-coinfected patients. Preliminary results of the hEPAtic Study

    PubMed Central

    Neukam, Karin; Espinosa, Nuria; Merino, Dolores; Rivero-Juárez, Antonio; Carrero, Ana; José Ríos, María; Ruiz-Morales, Josefa; Gómez-Berrocal, Ana; Téllez, Francisco; Díaz-Menéndez, Marta; Collado, Antonio; Pérez-Camacho, Inés; Delgado-Fernández, Marcial; Vera-Méndez, Francisco; Pineda, Juan A

    2014-01-01

    Introduction Although hepatotoxicity related to antiretroviral treatment (ART) has become less frequent, hepatotoxic events, such as transaminase elevations (TE), are still a matter of concern. RPV/FTC/TDF (EPA) is a new single tablet regimen which is widely used in real life practice. Clinical trials showed an adequate profile of liver safety in the sub-population of HIV/HCV-coinfected patients receiving rilpivirine. However, the number of individuals included in these analyses is low [1]. The aim of this ongoing study is to evaluate the incidence of TE and total bilirubin elevations (TBE) during the first 48 weeks of EPA-based therapy in a large population of HIV/HCV-coinfected subjects outside of clinical trials. Patients and Methods This is a retrospective analysis of HIV/HCV-coinfected subjects who started EPA at the infectious diseases units of 14 centres throughout Spain, included as cases. Subjects who started an ART different to EPA during the study period at the same hospitals were selected as controls. The primary outcome variables were grade 3 or 4 TE and grade 4 TBE. Results Of the 191 patients included, 31 (16.2%) subjects were naïve to ART. Eighty-seven individuals started EPA and the remaining ones were controls. The most common NRTI backbone among the controls was TDF/FTC [59 (56.7%) patients] followed by NRTI-sparing regimens [24 (23.1%) individuals] and ABC/3TC [17 (16.3%) subjects]. Among controls, 67 (64.4%) started a ritonavir-boosted protease inhibitor, mainly DRV/r [41 (39.4%) patients] followed by ATV/r [16 (15.4%) subjects]. EFV, ETV and RAL were started in 16 (15.4%), 12 (11.5%) and 13 (12.5%) subjects, respectively. The median (Q1–Q3) follow-up was 5.79 (3.65–8.61) months for the cases and 11.44 (5.8–12.88) months for the controls. TE was observed in two (2.3%) cases versus five (4.8%) controls (p=0.358), accounting for a density of incidence of 4.32/100 person-years versus 5.51/100 person-years [incidence rate difference (95

  4. Prevalence and clinical characteristics of HIV type 1-infected patients receiving dialysis in Spain: results of a Spanish survey in 2006: GESIDA 48/05 study.

    PubMed

    Trullàs, J-C; Barril, G; Cofan, F; Moreno, A; Cases, A; Fernandez-Lucas, M; Martinez-Ara, J; Ceballos, M; Garcia-de-Diego, J; Muñiz, M-L; Molina, J; Martínez-Castelao, A; González-Garcia, J; Miró, J-M

    2008-10-01

    End-stage renal diseases (ESRD) are becoming more frequent in HIV-infected patients. In Europe there is little information about HIV-infected patients on dialysis. A cross-sectional multicenter survey in 328 Spanish dialysis units was conducted in 2006. Information from 14,876 patients in dialysis was obtained (81.6% of the Spanish dialysis population). Eighty-one were HIV infected (0.54%; 95% CI, 0.43-0.67), 60 were on hemodialysis, and 21 were on peritoneal dialysis. The mean (range) age was 45 (28-73) years. Seventy-two percent were men and 33% were former drug users. The mean (range) time of HIV infection was 11 (1-27) years and time on dialysis was 4.6 (0.4-25) years. ESRD was due to glomerulonephritis (36%) and diabetes (15%). HIV-associated nephropathy was not reported. Eighty-five percent were on HAART, 76.5% had a CD4 T cell count above 200 cells, and 73% had undetectable viral load. Thirty-nine percent of patients met criteria for inclusion on the renal transplant (RT) waiting list but only 12% were included. Sixty-one percent had HCV coinfection. HCV-coinfected patients had a longer history of HIV, more previous AIDS events, parenteral transmission as the most common risk factor for acquiring HIV infection, and less access to the RT waiting list (p < 0.05). The prevalence of HIV infection in Spanish dialysis units in 2006 was 0.54% HCV coinfection was very frequent (61%) and the percentage of patients included on the Spanish RT waiting list was low (12%).

  5. Complementary therapy use among HIV-infected patients.

    PubMed

    Bates, B R; Kissinger, P; Bessinger, R E

    1996-02-01

    This study investigates factors associated with the self-reported use of complementary therapies, types of therapies used, and sources of complementary therapy information among HIV-positive patients attending a public, HIV outpatient clinic in New Orleans. A convenience sample of 287 clients (220 men and 67 women) was given a self-administered anonymous questionnaire. Overall, complementary therapy use was 31%. Patients who used complementary therapy were more likely to be white (O.R., 2.5), female (O.R. 3.3), a high school graduate (O.R. 2.9), and to know another complementary therapy user (O.R. 7.8). Age, sexual orientation, CD4 cell count, injection drug use, living with another HIV-infected person, having pain, and HIV support group membership were not associated. Men were more likely than women, and whites were more likely than nonwhites, to use vitamins/minerals, imagery/meditation, and dietary regimens. Nonwhites were more likely than whites, and women more likely than men, to use spiritual healing. Of those using complementary therapy, men were more likely than women, and whites more likely than nonwhites, to get information about complementary therapy from HIV organizations, friends, and homosexual-oriented media. Doctors and nurses were the most frequently cited source of complementary therapy information for women. Frequency, type of therapies used, and source of information about complementary therapy among HIV-infected persons vary by race and gender. Clinicians should be educated about complementary therapies so that they can provide information to their patients and be aware of self-treatment behavior.

  6. Platelet-derived growth factor expression in primary pulmonary hypertension: comparison of HIV seropositive and HIV seronegative patients.

    PubMed

    Humbert, M; Monti, G; Fartoukh, M; Magnan, A; Brenot, F; Rain, B; Capron, F; Galanaud, P; Duroux, P; Simonneau, G; Emilie, D

    1998-03-01

    Primary pulmonary hypertension (PPH) is characterized by intimal fibrosis and cell proliferation (including fibroblasts, smooth muscle and endothelial cells) in the distal pulmonary arterial tree. Considerable interest has been generated by recent reports of PPH in human immunodeficiency virus (HIV)-1-infected individuals. Although the lack of evidence for a pulmonary artery infection has suggested that in such cases HIV may act through mediator release rather than by direct endothelial infection, the mechanisms underlying HIV-associated PPH remain poorly defined. Platelet-derived growth factor (PDGF) has the ability to induce smooth muscle cell and fibroblast proliferation and migration. Given these considerations, we have attempted to document a possible role for PDGF in PPH occurring in HIV seropositive and seronegative patients. Using semiquantitative polymerase chain reaction (PCR), PDGF A-chain messenger ribonucleic acid (mRNA) expression was analysed in surgical lung biopsies from 13 HIV seronegative patients and one HIV seropositive patient, all displaying severe PPH. In parallel, lung samples from two patients with HIV-1-associated PPH were studied by immunohistochemistry and in situ hybridization. Results were compared to those obtained in three HIV-1-infected individuals with no pulmonary complication (as demonstrated by clinical, radiological, bacteriological, and necropsy findings) and five control lung biopsies. As compared to controls, PDGF A-chain mRNA expression is elevated in lung biopsies from patients displaying PPH (p=0.029). In HIV-1-associated PPH, interstitial perivascular cells expressing PDGF A-chain mRNA and protein could be detected by in situ hybridization and immunohistochemistry, respectively. Platelet-derived growth factor expression is elevated in lung biopsies of patients displaying primary pulmonary hypertension. Growth factors such as platelet-derived growth factor may play a part in the initiation and/or progression of primary

  7. Discrepancies between physician's perception of depression in HIV patients and self-reported CES-D-20 assessment: the DHIVA study

    PubMed Central

    Marando, F.; Gualberti, G.; Costanzo, A.M.; di Luzio Paparatti, U.; Franzetti, M.; Ammassari, A.; Antinori, A.; Galli, M.

    2016-01-01

    ABSTRACT Depression in HIV/AIDS patients affects adherence and disease progression and often goes unnoticed. DHIVA is a cross-sectional epidemiologic survey, investigating the prevalence of depression in people living with HIV through use of a validated self-administered scale (CES-D-20), as well and the degree of concordance between the physician's perception and patients' reports. A total of 690 HIV-infected patients attending 24 centers across Italy were enrolled. Concordance was calculated by K statistics. Association between depression and subject characteristics were evaluated through univariate and multivariate logistic models (OR and 95%CI). The prevalence of depressive symptoms was 48.8% from patient's questionnaires and 49.5% from physicians' reports, with a low/fair concordance (K = .38, p < .001). CES-D-20 found severe depression in 22.5% of the patients vs 4% identified by physicians. 135/155 (87%) of the severely depressed patients (according to CES-D-20) were considered as non or mildly/moderately depressed by physicians. Risk of severe depression was associated with unemployment (p < .001), previous depression (p < .001), treatment failure (p = .001), and former smoking status (p = .018). Depression is frequent in HIV-infected patients in the HAART era, with significant discrepancy between physician perception and the self-reported CES-D-20 results. Screening should be mandatory in all HIV patients. PMID:26461177

  8. Recurrent focal epithelial hyperplasia due to HPV13 in an HIV-positive patient.

    PubMed

    Moerman, M; Danielides, V G; Nousia, C S; Van Wanzeele, F; Forsyth, R; Vermeersch, H

    2001-01-01

    There are few reports on focal epithelial hyperplasia (FEH) in association with human immunodeficiency virus (HIV) infection; thus the relationship between them has not been completely clarified yet. We present a case of recurrent FEH in an HIV-positive man (the first described in Belgium), which, according to the PCR-DNA testing, was due to human papilloma virus type 13 (HPV13). To our knowledge, based on the accessible literature, this type of HPV has not been detected in any other documented study of FEH in HIV-positive patients before. Our patient experienced three recurrences of FEH in 1 year. It is therefore suggested that immunodeficiency due to HIV infection is responsible for the HPV-related FEH and the subsequent recurrences. In order to support the consideration of FEH as an oral manifestation of an HIV-related opportunistic infection, every new 'HPV-type' oral lesion in HIV-positive patients must be completely documented.

  9. The VACS Index Accurately Predicts Mortality and Treatment Response among Multi-Drug Resistant HIV Infected Patients Participating in the Options in Management with Antiretrovirals (OPTIMA) Study

    PubMed Central

    Brown, Sheldon T.; Tate, Janet P.; Kyriakides, Tassos C.; Kirkwood, Katherine A.; Holodniy, Mark; Goulet, Joseph L.; Angus, Brian J.; Cameron, D. William; Justice, Amy C.

    2014-01-01

    Objectives The VACS Index is highly predictive of all-cause mortality among HIV infected individuals within the first few years of combination antiretroviral therapy (cART). However, its accuracy among highly treatment experienced individuals and its responsiveness to treatment interventions have yet to be evaluated. We compared the accuracy and responsiveness of the VACS Index with a Restricted Index of age and traditional HIV biomarkers among patients enrolled in the OPTIMA study. Methods Using data from 324/339 (96%) patients in OPTIMA, we evaluated associations between indices and mortality using Kaplan-Meier estimates, proportional hazards models, Harrel’s C-statistic and net reclassification improvement (NRI). We also determined the association between study interventions and risk scores over time, and change in score and mortality. Results Both the Restricted Index (c = 0.70) and VACS Index (c = 0.74) predicted mortality from baseline, but discrimination was improved with the VACS Index (NRI = 23%). Change in score from baseline to 48 weeks was more strongly associated with survival for the VACS Index than the Restricted Index with respective hazard ratios of 0.26 (95% CI 0.14–0.49) and 0.39(95% CI 0.22–0.70) among the 25% most improved scores, and 2.08 (95% CI 1.27–3.38) and 1.51 (95%CI 0.90–2.53) for the 25% least improved scores. Conclusions The VACS Index predicts all-cause mortality more accurately among multi-drug resistant, treatment experienced individuals and is more responsive to changes in risk associated with treatment intervention than an index restricted to age and HIV biomarkers. The VACS Index holds promise as an intermediate outcome for intervention research. PMID:24667813

  10. Intestinal parasitic infections in HIV infected and non-infected patients in a low HIV prevalence region, West-Cameroon.

    PubMed

    Nkenfou, Céline Nguefeu; Nana, Christelle Tafou; Payne, Vincent Khan

    2013-01-01

    The magnitude of intestinal parasitic infection in acquired immunodeficiency syndrome patients requires careful consideration in the developing world where poor nutrition is associated with poor hygiene and several tropical diseases. However, there have been very few studies addressing this issue in Cameroon. This study was conducted to determine the prevalence of intestinal parasitosis in HIV/AIDS patients in Dschang -Cameroon. Stool and blood specimens from HIV/AIDS patients and control group were screened respectively for intestinal parasites and for HIV antibodies. Intestinal parasites were identified using direct microscopy, formalin-ether concentration and Ziehl Neelsen methods. Out of 396 participants recruited among patients consulting at hospital, 42 (10.6%) were HIV positive, thirty of them treatment naïve. The overall prevalence of intestinal parasites was 14.64%. Out of 42 HIV/AIDS patients, 59.5% (25/42) were infected with intestinal parasites, while only 9.32% (33/354) of the HIV negative patients were infected with intestinal parasites. The parasites detected in our study population included Crystosporidium parvum (2.53%), Entamoeba histolytica (7.52%), Entamoeba coli (4.04%), Giardia lamblia (0.25%), Trichuris trichura (0.25%), Strongyloides stercoralis (0.25%) and Taenia spp. (0.25%). In the HIV infected group, Crystosporidium parvum (19.04%), Entamoeba histolytica (19.04%), Entamoeba coli (21.42%), Giardia lamblia (2.38%), Strongyloides stercoralis (0.25%) and Taenia spp. (0.25%) were found. Crystosporidium parvum was found to be significantly higher in HIV/AIDS patients than in controls (P<0.05). Multivariate analysis showed that the HIV status and the quality of water were the major risk factors for intestinal parasitosis. Routine examinations of stool samples for parasites would significantly benefit the HIV patients by contributing in reducing morbidity and improving the efficiency of antiretroviral treatment. Even after the introduction of

  11. High prevalence of giardiasis and stronglyloidiasis among HIV-infected patients in Bahia, Brazil.

    PubMed

    Feitosa, G; Bandeira, A C; Sampaio, D P; Badaró, R; Brites, C

    2001-12-01

    Diarrhea due to intestinal microbial infections is a frequent manifestation among HIV-infected patients. It has been postulated that HIV-infected patients may have special types of intestinal infections, and that immune activation from such parasites may affect the progression of HIV disease. To evaluate these associations, the frequency of infections was examined in HIV-infected patients in Bahia, Brazil. To determine the potential impact of the presence of intestinal parasitic infections on HIV disease progression, a retrospective study approach was used. The medical charts of 365 HIV-infected patients who had been treated at the AIDS Clinic of the Federal University of Bahia Hospital were reviewed, and the prevalence of parasites was compared with 5,243 HIV-negative patients who had attended the hospital during the same period of time. Among HIV-infected subjects, CD(4) count, RNA plasma viral load (VL), and number of eosinophils were compared according to their stool examination results. The overall prevalence of each parasite was similar for HIV-positive and HIV-negative patients. However, the prevalence of S. stercoralis (p<10(-7)) and G. lamblia (p=0.005) was greater for HIV-infected subjects. The mean CD(4) count and viral load of HIV patients in our clinic who had stool examinations was 350 cells +/- 340 and 4.4 +/- 1.4 log RNA viral load, respectively. In this patient group there was no clear association between the level of the absolute CD(4) count or the viral load and a specific parasitic infection. The presence of an intestinal parasitic infection was not associated with faster progression of the HIV disease among HIV-infected patients. We conclude that strongyloidiasis and giardiasis are more frequent in HIV-infected patients in Bahia, Brazil. If this association is due to immune dysregulation, as has been proposed elsewhere, it must occur in patients after only minor shifts in CD(4) count from normal levels, or as a result of immune dysfunction not

  12. Pharmacists’ perspectives on promoting medication adherence among patients with HIV

    PubMed Central

    Kibicho, Jennifer W.; Owczarzak, Jill

    2015-01-01

    Objectives To provide pharmacists’ perspectives on medication adherence barriers for patients with human immunodeficiency virus (HIV) and to describe pharmacists’ strategies for promoting adherence to antiretroviral medications. Design Multisite, qualitative, descriptive study. Setting Four midwestern U.S. states, from August through October 2009. Participants 19 pharmacists at 10 pharmacies providing services to patients with HIV. Intervention Pharmacists were interviewed using a semistructured interview guide. Main outcome measures Barriers to medication adherence, pharmacist interventions, challenges to promoting adherence. Results Pharmacists reported a range of adherence barriers that were patient specific (e.g., cognitive factors, lack of social support), therapy related (e.g., adverse effects, intolerable medications), and structural level (e.g., strained provider relationships). They used a combination of individually tailored, patient-specific interventions that identified and resolved adherence barriers and actively anticipated and addressed potential adherence barriers. Pharmacist interventions included medication-specific education to enhance patient self-efficacy, follow-up calls to monitor adherence, practical and social support to motivate adherence, and patient referrals to other health care providers. However, the pharmacists faced internal (e.g., lack of time, lack of trained personnel) and external (e.g., insurance policies that disallowed patient enrollment in automatic prescription refill program) challenges. Conclusion Pharmacists in community settings went beyond prescription drug counseling mandated by law to provide additional pharmacy services that were tailored to the needs of patients with HIV. Given that many individuals with HIV are living longer, more research is needed on the effectiveness and cost effectiveness of pharmacists’ interventions in clinical practice, in order to inform insurance reimbursement policies. PMID

  13. Use of dental care by HIV-infected medical patients.

    PubMed

    Coulter, I D; Marcus, M; Freed, J R; Der-Martirosian, C; Cunningham, W E; Andersen, R M; Maas, W R; Garcia, I; Schneider, D A; Genovese, B; Shapiro, M F; Bozzette, S A

    2000-06-01

    Although increasing attention has been paid to the use of dental care by HIV patients, the existing studies do not use probability samples, and no accurate population estimates of use can be made from this work. The intent of the present study was to establish accurate population estimates of the use of dental services by patients under medical care. The study, part of the HIV Cost and Services Utilization Study (HCSUS), created a representative national probability sample, the first of its kind, of HIV-infected adults in medical care. Both bivariate and logistic regressions were conducted, with use of dental care in the preceding 6 months as the dependent variable and demographic, social, behavioral, and disease characteristics as independent variables. Forty-two percent of the sample had seen a dental health professional in the preceding 6 months. The bivariate logits for use of dental care show that African-Americans, those whose exposure to HIV was caused by hemophilia or blood transfusions, persons with less education, and those who were employed were less likely to use dental care (p < 0.05). Sixty-five percent of those with a usual source of care had used dental care in the preceding 6 months. Use was greatest among those obtaining dental care from an AIDS clinic (74%) and lowest among those without a usual source of dental care (12%). We conclude that, in spite of the high rate of oral disease in persons with HIV, many do not use dental care regularly, and that use varies by patient characteristics and availability of a regular source of dental care. PMID:10890713

  14. Drinking Motives Among HIV Primary Care Patients

    PubMed Central

    Elliott, Jennifer C.; Aharonovich, Efrat; O’Leary, Ann; Wainberg, Milton; Hasin, Deborah

    2013-01-01

    Heavy drinking among individuals with HIV is associated with poor medication adherence and other health problems. Understanding reasons for drinking (drinking motives) in this population is therefore important and could inform intervention. Using concepts of drinking motives from previous alcohol research, we assessed these motives and drinking in 254 HIV-positive primary care patients (78.0% male; 94.5% African American or Hispanic) prior to their participation in an alcohol intervention trial. Three motives had good factor structure and internal consistency: “drinking to cope with negative affect”, “drinking for social facilitation” (both associated with heavier drinking), and “drinking due to social pressure” (associated with less drinking). Drinking motives may provide important content for alcohol intervention; clinical trials could indicate whether inclusion of such content improves intervention efficacy. Discussing motives in session could help providers assist clients in better managing psychological and social aspects of their lives without reliance on alcohol. PMID:24165984

  15. Multicenter study of trimethoprim/sulfamethoxazole-related hepatotoxicity: incidence and associated factors among HIV-infected patients treated for Pneumocystis jirovecii pneumonia.

    PubMed

    Yang, Jen-Jia; Huang, Chung-Hao; Liu, Chun-Eng; Tang, Hung-Jen; Yang, Chia-Jui; Lee, Yi-Chien; Lee, Kuan-Yeh; Tsai, Mao-Song; Lin, Shu-Wen; Chen, Yen-Hsu; Lu, Po-Liang; Hung, Chien-Ching

    2014-01-01

    The incidence of hepatotoxicity related to trimethoprim/sulfamethoxazole (TMP/SMX) administered at a therapeutic dose may vary among study populations of different ethnicities and hepatotoxic metabolites of TMP/SMX may be decreased by drug-drug interaction with fluconazole. We aimed to investigate the incidence of hepatotoxicity and the role of concomitant use of fluconazole in HIV-infected patients receiving TMP/SMX for Pneumocystis jirovecii pneumonia. We reviewed medical records to collect clinical characteristics and laboratory data of HIV-infected patients who received TMP/SMX for treatment of P. jirovecii pneumonia at 6 hospitals around Taiwan between September 2009 and February 2013. Hepatotoxicity was defined as 2-fold or greater increase of aminotransferase or total bilirubin level from baselines. Roussel UCLAF Causality Assessment Method (RUCAM) was used to analyze the causality of drug-induced liver injuries. NAT1 and NAT2 acetylator types were determined with the use of polymerase-chain-reaction (PCR) restriction fragment length polymorphism to differentiate common single-nucleotide polymorphisms (SNPs) predictive of the acetylator phenotypes in a subgroup of patients. During the study period, 286 courses of TMP/SMX treatment administered to 284 patients were analyzed. One hundred and fifty-two patients (53.1%) developed hepatotoxicity, and TMP/SMX was considered causative in 47 (16.4%) who had a RUCAM score of 6 or greater. In multivariate analysis, concomitant use of fluconazole for candidiasis was the only factor associated with reduced risk for hepatotoxicity (adjusted odds ratio, 0.372; 95% confidence interval, 0.145-0.957), while serostatus of hepatitis B or C virus, NAT1 and NAT2 acetylator types, or receipt of combination antiretroviral therapy was not. The incidence of hepatotoxicity decreased with an increasing daily dose of fluconazole up to 4.0 mg/kg. We conclude that the incidence of TMP/SMX-related hepatotoxicity was 16.4% in HIV

  16. Computer-Based Video to Increase HIV Testing Among Emergency Department Patients Who Decline

    PubMed Central

    Aronson, Ian David; Marsch, Lisa A.; Rajan, Sonali; Koken, Juline; Bania, Theodore C.

    2014-01-01

    The Centers for Disease Control and Prevention (CDC) recommend routine HIV screening in clinical settings, including emergency departments (EDs), because earlier diagnosis enables treatment before symptoms develop and delivery of interventions to reduce continued transmission. However, patients frequently decline testing. This study delivered a 16-minute video-based intervention to 160 patients who declined HIV tests in a high volume, urban ED. One third of participants (N=53) accepted an HIV test post-intervention. Interviews with a subset of participants (n=40) show that before the video, many were unaware HIV testing could be conducted without drawing blood, or that results could be delivered in 20 minutes. PMID:25064047

  17. Hepatitis C virus coinfection independently increases the risk of cardiovascular disease in HIV-positive patients.

    PubMed

    Fernández-Montero, J V; Barreiro, P; de Mendoza, C; Labarga, P; Soriano, V

    2016-01-01

    Patients infected with HIV are at increased risk for cardiovascular disease despite successful antiretroviral therapy. Likewise, chronic hepatitis C virus (HCV) infection is associated with extrahepatic complications, including cardiovascular disease. However the risk of cardiovascular disease has not been formally examined in HIV/HCV-coinfected patients. A retrospective study was carried out to assess the influence of HCV coinfection on the risk of cardiovascular events in a large cohort of HIV-infected patients recruited since year 2004. A composite event of cardiovascular disease was used as an endpoint, including myocardial infarction, angina pectoris, stroke or death due to any of them. A total of 1136 patients (567 HIV-monoinfected, 70 HCV-monoinfected and 499 HIV/HCV-coinfected) were analysed. Mean age was 42.7 years, 79% were males, and 46% were former injection drug users. Over a mean follow-up of 79.4 ± 21 months, 3 patients died due to cardiovascular disease, whereas 29 suffered a first episode of coronary ischaemia or stroke. HIV/HCV-coinfected patients had a greater incidence of cardiovascular disease events and/or death than HIV-monoinfected individuals (4% vs 1.2%, P = 0.004) and HCV-monoinfected persons (4% vs 1.4%, P = 0.5). After adjusting for demographics, virological parameters and classical cardiovascular disease risk factors (smoking, hypertension, diabetes, high LDL cholesterol), both HIV/HCV coinfection (HR 2.91; CI 95%: 1.19-7.12; P = 0.02) and hypertension (HR 3.65; CI 95%: 1.34-9.94; P = 0.01) were independently associated with cardiovascular disease events and/or death in HIV-infected patients. Chronic hepatitis C and hypertension are independently associated with increased cardiovascular disease risk in HIV-infected patients. Therefore, treatment of chronic hepatitis C should be prioritized in HIV/HCV-coinfected patients regardless of any liver fibrosis staging.

  18. Care of Patients With HIV Infection: Antiretroviral Drug Regimens.

    PubMed

    Bolduc, Philip; Roder, Navid; Colgate, Emily; Cheeseman, Sarah H

    2016-04-01

    The advent of combination antiretroviral drug regimens has transformed HIV infection from a fatal illness into a manageable chronic condition. All patients with HIV infection should be considered for antiretroviral therapy, regardless of CD4 count or HIV viral load, for individual benefit and to prevent HIV transmission. Antiretroviral drugs affect HIV in several ways: entry inhibitors block HIV entry into CD4 T cells; nucleotide and nucleoside reverse transcriptase inhibitors prevent reverse transcription from RNA to DNA via chain-terminating proteins; nonnucleoside reverse transcriptase inhibitors prevent reverse transcription through enzymatic inhibition; integrase strand transfer inhibitors block integration of viral DNA into cellular DNA; protease inhibitors block maturation and production of the virus. Current guidelines recommend six combination regimens for initial therapy. Five are based on tenofovir and emtricitabine; the other uses abacavir and lamivudine. Five include integrase strand transfer inhibitors. HIV specialists should assist with treating patients with complicated HIV infection, including patients with treatment-resistant HIV infection, coinfection with hepatitis B or C virus, pregnancy, childhood infections, severe opportunistic infections, complex drug interactions, significant drug toxicity, or comorbidities. Family physicians can treat most patients with HIV infection effectively by choosing appropriate treatment regimens, monitoring patients closely, and retaining patients in care. PMID:27092564

  19. Neuroretinal Degeneration in HIV Patients Without Opportunistic Ocular Infections in the cART Era.

    PubMed

    Demirkaya, Nazli; Wit, Ferdinand; Schlingemann, Reinier; Verbraak, Franciscus

    2015-10-01

    Subtle structural and functional retinal abnormalities, termed 'HIV-associated Neuroretinal Disorder (HIV-NRD)', have been reported in HIV patients receiving combination antiretroviral therapy (cART), without infectious retinitis or any apparent fundus abnormalities otherwise. In this review, we provide an overview of studies investigating HIV-NRD in HIV patients without opportunistic ocular infections in the cART era, and try to elucidate underlying mechanisms and associated risk factors. Most studies focused on patients with severe immune-deficiency and demonstrated that patients with nadir CD4 counts<100 cells/μL are most at risk for neuroretinal damage, with a thinner retinal nerve fiber layer, subtle loss of color vision and/or contrast sensitivity, visual field deficits, and subnormal electrophysiological responses. In contrast, alterations in retinal vascular calibers and retinal blood flow were not associated with nadir CD4 counts, but instead with detectable viremia, suggesting a role for (chronic) inflammation in microvascular damage. Although the alterations in visual function are subtle, they can lead to difficulties in activities, such as reading or driving, thereby affecting quality of life. Since HIV has become a chronic disease, its long-term effects with respect to visual function loss become more important, as is recently emphasized by a longitudinal study, reporting that AIDS patients with HIV-NRD have higher risks of developing bilateral visual impairment and even blindness than patients without HIV-NRD. The question remains whether patients with high (>350 cells/μL) nadir CD4 counts and well-suppressed HIV infection on cART remain at risk for HIV-NRD, as this group constitutes a growing part of the aging HIV-infected population. PMID:26258992

  20. Expectation and satisfaction of HIV/AIDS patients toward the pharmaceutical care provided at Gondar University Referral Hospital, Northwestern Ethiopia: a cross-sectional study

    PubMed Central

    Abebe, Tamrat Befekadu; Erku, Daniel Asfaw; Gebresillassie, Begashaw Melaku; Haile, Kaleab Taye; Mekuria, Abebe Basazn

    2016-01-01

    Purpose Measurements of patient satisfaction help to assess the performance of health service provision and predict treatment adherence and outcomes. This study aimed to assess human HIV/AIDS patients’ expectation of and satisfaction with the pharmaceutical service delivered at Gondar University Referral Hospital, Ethiopia. Patients and methods An institution-based cross-sectional study was performed from May 11 to 25, 2015. A total of 291 patients living with HIV/AIDS were included using a simple random sampling method. Data were collected using structured questionnaires measuring expectation and satisfaction of respondents using a Likert scale of 1–5 through face-to-face interviews. The data collected were entered into and analyzed using Statistical Packages for Social Sciences. Comparison was made between those respondents who lived in and outside the town. Results The overall mean expectation and satisfaction of respondents toward pharmacy setting and services were 3.62 and 3.13, respectively. More than half (56.1%) of the participants were dissatisfied with the comfort and convenience of waiting area and private counseling room. Similarly, 69.3% of the respondents claimed that pharmacy professionals did not give information about side effects and drug–drug and drug–food interactions of antiretroviral medications. There was a statistically significant difference between respondents who live in and outside Gondar town in overall expectation (t=3.415, P=0.001) with the pharmacy setting and services. Conclusion In this study, the overall satisfaction level of respondents with pharmaceutical service (pharmacy setting and services) provided at Gondar University Referral Hospital was found to be low, while the overall respondents’ expectation from the pharmaceutical services were exceedingly high. The hospital should implement good dispensing practice systems in relation to the services and continuing professional development to professionals in order to

  1. Outcomes of a clinical diagnostic algorithm for management of ambulatory smear and Xpert MTB/Rif negative HIV infected patients with presumptive pulmonary TB in Uganda: a prospective study

    PubMed Central

    Walusimbi, Simon; Semitala, Fred; Bwanga, Freddie; Haile, Melles; De Costa, Ayesha; Davis, Lucian; Joloba, Moses; Hoffner, Sven; Kamya, Moses

    2016-01-01

    Introduction Diagnostic guidelines for Tuberculosis (TB) in HIV infected patients previously relied on microscopy where the value of initial antibiotic treatment for exclusion of pulmonary TB (PTB) was limited. New guidelines rely on the Xpert MTB Rif test (Xpert). However, the value of the antibiotic treatment remains unclear particularly in individuals who are smear-negative and Xpert-negative-given Xpert has only moderate sensitivity for smear-negative PTB. We assessed an algorithm involving initial treatment with antibiotics prior empiric TB treatment in HIV patients with presumptive PTB who were both smear and Xpert negative. Methods We performed a prospective study with six month follow-up to establish patient response to a course of broad spectrum antibiotics prior empiric TB treatment between March 2012 and June 2013. We calculated the proportion of patients who responded to the antibiotic treatment and those who did not. We computed the crude and adjusted odds ratios with their 95% confidence intervals, for response to the antibiotic treatment on various patient characteristics. We report treatment outcomes for patients who received broad spectrum antibiotics only or who were initiated empiric TB treatment. Results Our cohort comprised 162 smear-negative and Xpert-negative patients, of whom 59% (96 of 162) were female, 81% (131 of 162) were on antiretroviral therapy (ART) for a median of 8.7 months. Overall, 88% (141 of 160) responded to the antibiotic treatment, 8% (12 of 160) got empiric TB treatment and 4% (7 out of 160) were treated for other respiratory disease. The odds of improvement on antibiotics were lower in patients with advanced HIV disease than in patients with early HIV disease. Adjusted odds ratios were significant for HIV clinical stage (AOR; 0.038,) and duration on ART (AOR; 1.038,). Conclusion The majority of HIV patients with presumptive PTB with smear-negative and Xpert negative results improved on the antibiotic treatment and did not

  2. Risk Factors for DOTS Treatment Default Among New HIV-TB Coinfected Patients in Nalgonda (Dist.) Telangana (State): A Case Control Study

    PubMed Central

    Reddy Satti, Siva Balaji; Kondagunta, Nagaraj

    2016-01-01

    Background: The therapeutic regimens as recommended by the Revised National TB Control Programme (RNTCP) have been shown to be highly effective for both preventing and treating tuberculosis, but poor adherence to medication is a major barrier to its global control. Aim and Objectives: The study was conducted to assess the influence of patient related factors for DOTS Treatment Default among HIV-TB Co-infected cases. Setting and Design: This was a case control study conducted in Nalgond, Telangana. Materials and Methods: All new HIV-TB coinfected and DOTS-defaulted patients registered under RNTCP for the period from January 2010 to December 2012 were selected. Of the 154 patients, 23 had died and 11 could not be traced, and these were excluded. Thus the total number of available cases were 120 for those age- and sex-matched controls (HIV-TB coinfected patients and those who had completed the DOTS regimen successfully) were selected. Results: The mean age was 36.5 ± 9 years; the majority (23.3%) of patients defaulted during the second month of treatment. Significant risk factors associated with defaulting included unskilled occupation [adjusted odds ratio (AOR: 3.56; 95% confidence interval (CI): 1.1-11.56], lower middle class socioeconomic status (AOR: 17.16; 95% CI: 3.93-74.82), small family size (AOR: 21.3; 95% CI: 6.4-70.91), marital disharmony (AOR: 6.78; 95% CI: 1.93-23.76), not being satisfied with the conduct of health personnel (AOR: 7.38; 95% CI: 2.32-23.39), smoking (AOR: 8.5; 95% CI: 2.31-31.21), and side effects of drugs (AOR: 4.18; 95% CI: 1.35-12.9). Conclusion: Unskilled occupation, marital disharmony, small family size, lower middle class socioeconomic status, not being satisfied with the conduct of health personnel, smoking, and drug side effects were significantly associated with defaulting. Information on the pattern of tuberculosis (TB), the outcome of anti-tuberculosis treatment (ATT), and the factors associated with it will help in planning

  3. Hepatitis C virus–HIV-coinfected patients and liver transplantation

    PubMed Central

    Kardashian, Ani A.; Price, Jennifer C.

    2016-01-01

    Purpose of review To review the experience to date and unique challenges associated with liver transplantation in hepatitis C virus (HCV)/HIV-coinfected patients. Recent findings The prevalence of cirrhosis and hepatocellular carcinoma is rising among HIV-infected individuals. With careful patient selection and in the absence of HCV infection, HIV-infected and HIV-uninfected liver transplant recipients have comparable posttransplant outcomes. However, in the presence of HCV infection, patient and graft survival are significantly poorer in HIV-infected recipients, who have a higher risk of aggressive HCV recurrence, acute rejection, sepsis, and multiorgan failure. Outcomes may be improved with careful recipient and donor selection and with the availability of new highly potent all-oral HCV direct acting antivirals (DAAs). Although all-oral DAAs have not been evaluated in HIV/HCV-coinfected transplant patients, HIV does not adversely impact treatment success in nontransplant populations. Therefore, there is great hope that HCV can be successful eradicated in HIV/HCV-coinfected transplant patients and will result in improved outcomes. Careful attention to drug–drug interactions with HIV antiretroviral agents, DAAs, and posttransplant immunosuppressants is required. Summary Liver transplant outcomes are poorer in HIV/HCV-coinfected recipients compared with those with HCV-monoinfection. The new HCV DAAs offer tremendous potential to improve outcomes in this challenging population. PMID:25944240

  4. No clinical predictors of intraepithelial neoplasia in HIV-positive patients with external condilomata acuminata

    PubMed Central

    Giacaman, Paula; Martínez, María José; Chnaiderman, Jonas; Ampuero, Sandra; Santander, Ester; Ramis, Claudia; Sazunic, Ivo; Garmendia, María Luisa; Gómez, Orietta

    2011-01-01

    To identify clinical parameters in association with human papilloma virus (HPV) genotypes and histopathology diagnosis in HIV-positive patients with external condylomata acuminata (ECA), 400 Chilean HIV-positive patients were included in the study. Forty-seven patients presented ECA. Clinical parameters and socio demographic data were recorded. Histopathology study and HPV linear array genotyping assay were performed. Intraepithelial neoplasia (IEN) grade 2 or 3 was found in 8.5% of patients, associated to HPV-16. Patients were mainly single, MSM, with history of sexually transmitted disease (STD), multiple sexual partners, receiving antiretroviral therapy and with recurrent lesions. All ECA were mainly perianal, grey or pink colored, exophytic with less than two years evolution. No clinical parameter could predict the development of high grade IEN in HIV patients with ECA. It seems necessary to perform biopsy and genotype all HIV positive patients with ECA. PMID:21799573

  5. A Single Quantifiable Viral Load Is Predictive of Virological Failure in Human Immunodeficiency Virus (HIV)-Infected Patients on Combination Antiretroviral Therapy: The Austrian HIV Cohort Study

    PubMed Central

    Leierer, Gisela; Grabmeier-Pfistershammer, Katharina; Steuer, Andrea; Sarcletti, Mario; Geit, Maria; Haas, Bernhard; Taylor, Ninon; Kanatschnig, Manfred; Rappold, Michaela; Ledergerber, Bruno; Zangerle, Robert

    2016-01-01

    Background. Viral loads (VLs) detectable at low levels are not uncommon in patients on combination antiretroviral therapy (cART). We investigated whether a single quantifiable VL predicted virological failure (VF). Methods. We analyzed patients receiving standard regimens with at least 1 VL measurement below the limit of quantification (BLQ) in their treatment history. The first VL measurement after 6 months of unmodified cART served as baseline VL for the subsequent analyses of the time to reach single VL levels of ≥200, ≥400, and ≥1000 copies/mL. Roche TaqMan 2.0 was used to quantify human immunodeficiency virus-1 ribonucleic acid. Factors associated with VF were determined by Cox proportional hazards models. Results. Of 1614 patients included in the study, 68, 44, and 34 experienced VF ≥200, ≥400, and ≥1000 copies/mL, respectively. In multivariable analyses, compared with patients who were BLQ, a detectable VL ≤ 50 and VL 51–199 copies/mL predicted VF ≥ 200 copies/mL (hazards ratio [HR] = 2.19, 95% confidence interval [CI] = 1.06–4.55 and HR = 4.21, 95% CI = 2.15–8.22, respectively). In those with VL 51–199 copies/mL, a trend for an increased risk of VF ≥400 and VF ≥1000 copies/mL could be found (HR = 2.13, 95% CI = 0.84–5.39 and HR = 2.52, 95% CI = 0.96–6.60, respectively). Conclusions. These findings support closer monitoring and adherence counseling for patients with a single measurement of quantifiable VL <200 copies/mL. PMID:27419163

  6. Managing dyslipidemia in HIV/AIDS patients: challenges and solutions

    PubMed Central

    Husain, Nazik Elmalaika OS; Ahmed, Mohamed H

    2015-01-01

    Human immunodeficiency virus (HIV) is a chronic disease associated with dyslipidemia and insulin resistance. In addition, the administration of combination antiretroviral therapy is associated with an increase in the incidence of metabolic risk factors (insulin resistance, lipoatrophy, dyslipidemia, and abnormalities of fat distribution in HIV patients). HIV dyslipidemia is a common problem, and associated with an increase in incidence of cardiovascular disease. Further challenges in the management of HIV dyslipidemia are the presence of diabetes and metabolic syndrome, nonalcoholic fatty liver disease, hypothyroidism, chronic kidney disease, the risk of diabetes associated with statin administration, age and ethnicity, and early menopause in females. Dyslipidemia in patients with HIV is different from the normal population, due to the fact that HIV increases insulin resistance and HIV treatment not only may induce dyslipidemia but also may interact with lipid-lowering medication. The use of all statins (apart from simvastatin and lovastatin) is safe and effective in HIV dyslipidemia, and the addition of ezetimibe, fenofibrate, fish oil, and niacin can be used in statin-unresponsive HIV dyslipidemia. The management of dyslipidemia and cardiovascular disease risks associated with HIV is complex, and a certain number of patients may require management in specialist clinics run by specialist physicians in lipid disorders. Future research is needed to address best strategies in the management of hyperlipidemia with HIV infection. PMID:25565897

  7. Correlation between imaging features of Pneumocystis Jiroveci Pneumonitis (PCP), CD4+ T lymphocyte count, and plasma HIV viral load: A study in 50 consecutive AIDS patients

    PubMed Central

    Deng, Ying-Ying; Liu, Shui-Teng; Liu, Yan; Liu, Ying-Xia; Wang, Yi-Xiang J; Zhu, Wen-Ke; Le, Xiao-Hua; Yu, Wei-Ye; Zhou, Bo-Ping

    2012-01-01

    Purpose To investigate the imaging manifestations of Pneumocystis Jiroveci Pneumonitis (PCP) in AIDS patients, and the correlation between imaging features, CD4+ lymphocyte count, and plasma HIV viral load. Materials and methods A total of consecutive 50 AIDS patients with PCP were reviewed retrospectively. Chest CT manifestations, CD4+ lymphocyte count, and plasma HIV viral load were analyzed to investigate their correlation. Results PCP chest CT manifestations included ground-glass opacities dominated in 28 cases (28/50, 56%), lung cysts dominated in 10 cases (10/50, 20%), consolidation dominated in 6 cases (6/50, 12%), interstitial lesion dominated in 3 cases (3/50, 6%), and mixed lesions in 3 cases (3/50, 6%). In these 50 patients, CD4+ lymphocyte count ranged from 2 to 373 cells/µL. Plasma HIV viral load ranged from 500 to 5.28×107 copies/mL. CD4+ lymphocyte count in ground-glass opacities dominated patients was higher than that of lung cyst dominated patients (P<0.05). Plasma virus load of lung cysts dominated PCP patients was higher than that of consolidation dominated patients (P<0.05). Conclusions The typical chest imaging features of PCP in AIDS patients included lung ground-glass opacities and lung cysts. The chest imaging features were correlated with CD4+ T lymphocyte count and plasma HIV viral load. PMID:23256070

  8. [Spectrum of cardiovascular disease in HIV-infected patients].

    PubMed

    Lozano, Fernando

    2009-09-01

    A large body of evidence indicates that HIV-infected patients, both men and women, as well as adults and children, have a higher risk of developing arteriosclerotic cardiovascular disease. This evidence comes from studies whose main primary variables were the clinical manifestations of arteriosclerotic cardiovascular disease (acute myocardial infarction, silent myocardial ischemia, stroke and peripheral arterial disease) and the distinct markers of premature atherosclerosis and endothelial dysfunction determined in different sites (carotid, coronary or peripheral arteries) and with distinct diagnostic procedures (carotid intimamedia thickening, coronary artery calcification, flow-mediated vasodilation, arterial rigidity, ankle/arm index, etc.). This excess risk of arteriosclerotic cardiovascular disease in HIV-positive patients is clearly associated with the HIV infection per se and with classical cardiovascular risk factors, and, to a lesser extent and less uniformly, with the use of first-generation protease inhibitors. Hypertension, whose association with HIV infection is far less clear, is related to both traditional cardiovascular risk factors and to lipodystrophy.

  9. Spoligotype profile of Mycobacterium tuberculosis complex strains from HIV-positive and -negative patients in Nigeria: a comparative analysis.

    PubMed

    Cadmus, Simeon; Hill, Véronique; van Soolingen, Dick; Rastogi, Nalin

    2011-01-01

    We ran a comparative analysis of all patients for whom a positive culture of Mycobacterium tuberculosis complex was available between April 2004 and October 2005 and whose HIV serology results were known, with spoligotyping results (n = 163) split into 49 HIV-positive patients and 114 HIV-negative patients. Spoligotype international type 373 (SIT373) (T1 lineage), which was highly prevalent among the HIV(+) patients, was totally absent from the HIV(-) population, suggesting that we had a specific clone affecting nearly 1/3 of all HIV-tuberculosis (TB)-coinfected patients. Among the LAM10-CAM sublineage strains, we had only a single strain of SIT403 among HIV(-) patients (0.88%), as opposed to 12.25% of the HIV(+) population (χ(2) = 10.77; P < 0.01), indicating a strong association between the strain and the HIV(+) population. The LAM10-CAM lineage spoligotype SIT61 was prevalent among the 2 subsets (37.72% in HIV(-) versus 12.24% in HIV(+) populations), though, with a significant difference between the 2 groups (χ(2) = 10.53; P < 0.01). However, there was no significant difference for SIT53 (T1 lineage) in the 2 subsets: 6.14 versus 8.2% (χ(2) = 0.22; P > 0.05). A total of 7/49, or 14.3%, other SITs among HIV(+) patients were not found among the HIV(-) patients. When added to the most prevalent SIT among HIV(+) patients (SIT373; n = 16), 23/49, or 47%, isolates among HIV-TB-coinfected patients were unique. We conclude that further studies should be carried out to investigate the evolution of these genotypes and others in the emergence of multidrug resistance and control of tuberculosis in Nigeria. PMID:21048016

  10. Creatine Fails to Augment the Benefits from Resistance Training in Patients with HIV Infection: A Randomized, Double-Blind, Placebo-Controlled Study

    PubMed Central

    Sakkas, Giorgos K.; Mulligan, Kathleen; DaSilva, Makani; Doyle, Julie W.; Khatami, Hootan; Schleich, Thomas; Kent-Braun, Jane A.; Schambelan, Morris

    2009-01-01

    Background Progressive resistance exercise training (PRT) improves physical functioning in patients with HIV infection. Creatine supplementation can augment the benefits derived from training in athletes and improve muscle function in patients with muscle wasting. The objective of this study was to determine whether creatine supplementation augments the effects of PRT on muscle strength, energetics, and body composition in HIV-infected patients. Methodology/Principal Findings This is a randomized, double blind, placebo-controlled, clinical research center-based, outpatient study in San Francisco. 40 HIV–positive men (20 creatine, 20 placebo) enrolled in a 14-week study. Subjects were randomly assigned to receive creatine monohydrate or placebo for 14 weeks. Treatment began with a loading dose of 20 g/day or an equivalent number of placebo capsules for 5 days, followed by maintenance dosing of 4.8 g/day or placebo. Beginning at week 2 and continuing to week 14, all subjects underwent thrice-weekly supervised resistance exercise while continuing on the assigned study medication (with repeated 6-week cycles of loading and maintenance). The main outcome measurements included muscle strength (one repetition maximum), energetics (31P magnetic resonance spectroscopy), composition and size (magnetic resonance imaging), as well as total body composition (dual-energy X-ray absorptiometry). Thirty-three subjects completed the study (17 creatine, 16 placebo). Strength increased in all 8 muscle groups studied following PRT, but this increase was not augmented by creatine supplementation (average increase 44 vs. 42%, difference 2%, 95% CI −9.5% to 13.9%) in creatine and placebo, respectively). There were no differences between groups in changes in muscle energetics. Thigh muscle cross-sectional area increased following resistance exercise, with no additive effect of creatine. Lean body mass (LBM) increased to a significantly greater extent with creatine. Conclusions

  11. Patient and Provider Perspectives on HIV and HIV-Related Stigma in Dutch Health Care Settings

    PubMed Central

    Sicking, Lenneke; Brands, Ronald; Baas, Ineke; Roberts, Hilde; van Brakel, Wim H.; Lechner, Lilian; Kok, Gerjo; Bos, Arjan E. R.

    2014-01-01

    Abstract Ensuring that people living with HIV (PLWH) feel accepted in health care settings is imperative. This mixed methods study explored the perspectives of PLWH and health professionals on their interactions. A total of 262 predominantly gay men of Dutch origin participated in a survey study of possible negative interactions with health professionals, and semi-structured interviews were subsequently conducted with 22 PLWH and 14 health professionals. Again, most PLWH were gay men of Dutch origin. All health professionals were Dutch. PLWH reported negative experiences with health professionals including awkward interactions, irrelevant questions, rude treatment, blame, pity, excessive or differential precautions, care refusal, unnecessary referrals, delayed treatment, poor support, and confidentiality breaches. They also reported positive experiences including equal treatment, being valued as a partner in one's health, social support provision, and confidentiality assurances. Health professionals reported having little experience with PLWH and only basic knowledge of HIV. They contended that PLWH are treated equally and that HIV is no longer stigmatized, but also reported fear of occupational infection, resulting in differential precautions. Additionally, they conveyed labeling PLWH's files to warn others, and curiosity regarding how patients acquired HIV. The findings suggest that there is a gap in perception between PLWH and health professionals regarding the extent to which negative interactions occur, and that these interactions should be improved. Implications for stigma reduction and care optimization are discussed. PMID:25459231

  12. Fatal haemorrhage following liver biopsy in patients with HIV infection.

    PubMed Central

    Churchill, D R; Mann, D; Coker, R J; Miller, R F; Glazer, G; Goldin, R D; Lucas, S B; Weber, J N; De Cock, K M

    1996-01-01

    A retrospective review of all 248 liver biopsies performed in patients with HIV infection at two referral centres in London over a 12 year period revealed five cases of major bleeding following biopsy, with four deaths. The risk of major bleeding was 2.0%, and mortality was 1.6% following liver biopsy. The risk of bleeding as much higher than in published series of biopsies done in patients without HIV infection, owing in part to the high prevalence of thrombocytopaenia and clotting abnormalities in patients with HIV infection. HIV infection per se may also increase the risk of bleeding following liver biopsy. PMID:8655172

  13. Survival on antiretroviral treatment among adult HIV-infected patients in Nepal: a retrospective cohort study in far-western Region, 2006–2011

    PubMed Central

    2013-01-01

    Background Though financial and policy level efforts are made to expand antiretroviral treatment (ART) service free of cost, survival outcome of ART program has not been systematically evaluated in Nepal. This study assesses the mortality rates and determinants among adult HIV-infected patients on ART in Far-western region of Nepal. Methods This retrospective cohort study included 1024 (51.2% men) HIV-infected patients aged ≥15 years, who started ART between May 15th 2006 and May 15th 2011 in five ART sites in the Far-western region, Nepal. Follow-up time was calculated from the date of ART initiation to date of death or censoring (loss to follow-up, transferred out, or 15 November 2011). Mortality rates (per 100 person-years) were calculated. Kaplan-Meier and Cox-regression models were used to estimate survival and explore determinants of mortality. Results The median follow-up time was 19.1 months. The crude mortality rate was 6.3 (95% confidence interval (CI) 5.3-7.6) but more than three-times higher in first 3 months after ART initiation (21.9 (95% CI 16.6- 28.8)). About 12% (83% men) of those newly initiated on ART died during follow-up. The independent determinants of mortality were male sex (hazard ratio (HR) 4.55, 95% CI 2.43-8.51), poor baseline performance scale (bedridden <50% of the day during the past month, HR 2.05, 95% CI 1.19-3.52; bedridden >50% of the day during the past month, HR 3.41, 95% CI 1.67-6.98 compared to normal activity), one standard deviation decrease in baseline bodyweight (HR 1.04, 95% CI 1.01-1.07), and poor WHO clinical stage (stage III, HR 2.96, 95% CI 1.31-6.69; stage IV, HR 3.28, 95% CI 1.30-8.29 compared to WHO clinical stage I or II). Conclusions High mortality was observed within the first 3 months of ART initiation. Patients with poor baseline clinical characteristics had higher mortality, especially men. Earlier initiation of ART through expanded testing and counselling should be encouraged in HIV-infected patients. PMID

  14. Willingness to Participate in HIV Therapeutic Vaccine Trials among HIV-Infected Patients on ART in China

    PubMed Central

    Dong, Yuan; Shen, Xiaoxing; Guo, Ruizhang; Liu, Baochi; Zhu, Lingyan; Wang, Jing; Zhang, Linxia; Sun, Jun; Zhang, Xiaoyan; Xu, Jianqing

    2014-01-01

    Background More and more HIV therapeutic vaccines will enter clinical trials; however, little is known about the willingness to participate (WTP) in HIV therapeutic vaccine trials among HIV-positive individuals. Objective To investigate the WTP in HIV therapeutic vaccine trials among Chinese HIV-infected patients. Methods We conducted a cross-sectional survey on HIV-positive inpatients and outpatients at Shanghai Public Health Center. A total of 447 participants were recruited into this study. Following an introduction with general information on HIV therapeutic vaccine and its potential effectiveness and side effects, each participant completed a questionnaire in a self-administered form. The questionnaires covered demographics, high-risk behaviors, clinical characteristics and willingness to participate in HIV therapeutic vaccine trial. Results The overall willingness to participate in HIV therapeutic vaccine trials was 91.5%. Interestingly, multivariate logistic regression analyses demonstrated that the willingness was higher for those sexually infected by HIV (odds ratio [OR]: 4.36; 95% confidence interval [CI]: 1.53–12.41), diagnosed as HIV-1 infection for greater than 5 years (OR: 7.12, 95% CI: 1.83–27.76), and with the presence of infectious complications (OR: 2.75; 95% CI: 1.02–7.45). The primary reason for participation was to delay or reduce antiretroviral treatment (ART) and to avoid ART side effects (76.6%), and then followed by delaying disease progression (74.9%), increasing immune response to suppress opportunistic infections (57.7%) and preventing the development of drug resistance (37.1%). Reasons for unwillingness to participate mainly included concern for safety (37.0%), lack of knowledge on therapeutic vaccine (33.3%), and satisfaction with ART effectiveness (22.2%). Conclusions The WTP in HIV therapeutic vaccine trials was high among HIV-infected Chinese patients. HIV+ subjects who acquired infection through sexual contact and who were

  15. HIV coinfection shortens the survival of patients with hepatitis C virus-related decompensated cirrhosis.

    PubMed

    Pineda, Juan A; Romero-Gómez, Manuel; Díaz-García, Fernando; Girón-González, José A; Montero, José L; Torre-Cisneros, Julián; Andrade, Raúl J; González-Serrano, Mercedes; Aguilar, José; Aguilar-Guisado, Manuela; Navarro, José M; Salmerón, Javier; Caballero-Granado, Francisco J; García-García, José A

    2005-04-01

    The impact of human immunodeficiency virus (HIV) coinfection on the survival of patients with hepatitis C virus (HCV)-related end-stage liver disease (ESLD) is unknown. Because HIV infection is no longer considered an absolute contraindication for liver transplantation in some countries, it has become a priority to address this topic. The objective of this study was to compare the survival of HIV-infected and HIV-uninfected patients with decompensated cirrhosis due to HCV. In a retrospective cohort study, the survival of 1,037 HCV monoinfected and 180 HCV/HIV-coinfected patients with cirrhosis after the first hepatic decompensation was analyzed. Of the group, 386 (37%) HCV-monoinfected and 100 (56%) HCV/HIV-coinfected subjects died during the follow-up. The median survival time of HIV-infected and HIV-uninfected patients was 16 and 48 months, respectively (P < .001). The relative risk (95% CI) of death for HIV-infected patients was 2.26 (1.51-3.38). Other independent predictors of survival were age older than 63 years (2.25 [1.53-3.31]); Child-Turcotte-Pugh class B versus class A (1.95 [1.41-2.68]) and class C versus class A (2.78 [1.66-4.70]); hepatitis D virus infection (1.56 [1.12-4.77]); model for end-stage liver disease score, (1.05 [1.01-1-11]); more than one simultaneous decompensation (1.23 [1.12-3.33]); and the type of the first hepatic decompensation, with a poorer prognosis associated with encephalopathy compared with portal hypertensive gastrointestinal bleeding (2.03 [1.26-3.10]). In conclusion, HIV coinfection reduces considerably the survival of patients with HCV-related ESLD independently of other markers of poor prognosis. This fact must be taken into account to establish the adequate timing of liver transplantation in HIV-coinfected subjects.

  16. Maraviroc 150 mg daily plus lopinavir/ritonavir, a nucleoside/nucleotide reverse transcriptase inhibitor-sparing regimen for HIV-infected naive patients: 48-week final results of VEMAN study.

    PubMed

    Nozza, S; Galli, L; Antinori, A; Chiappetta, S; Mazzotta, F; Zaccarelli, M; Ottou, S; De Battista, D; Pogliaghi, M; Di Pietro, M; Malnati, M; Ripa, M; Bonora, S; Lazzarin, A

    2015-05-01

    Non-conventional strategies with nucleoside/nucleotide reverse transcriptase inhibitor-sparing regimens in antiretroviral naive human immunodeficiency virus (HIV) -infected patients have been explored in clinical trials. A prospective, open-label, randomized (1:1), multicentre, proof-of-concept trial (VEMAN study, EUDRACT number 2008-006287-11) was conducted assigning HIV-infected naive patients to once-daily maraviroc plus lopinavir/ritonavir (MVC group) or to tenofovir/emtricitabine plus lopinavir/ritonavir (TDF/FTC group). Clinical and laboratory data were collected at baseline, and after 4, 12, 24, 36 and 48 weeks with the objective to evaluate the 48-week virological and immunological efficacy. HIV-1 DNA load and CD4(+) T-cell subsets were analysed on frozen peripheral blood mononuclear cells collected at baseline, 4 and 48 weeks to explore the trend in HIV reservoirs. Fifty patients were randomized and included in the analysis. During follow up, HIV-1 RNA decreased similarly in both groups and, at week 48, all patients in the MVC group and 22/24 (96%) in the TDF/FTC group had < 50 copies/ml of HIV-1 RNA. CD4(+) trend during follow up was higher in maraviroc-treated patients (MVC group: 286 (183-343) versus TDF/FTC group: 199 (125-285); Mann-Whitney U-test: p 0.033). A significant 48-week increase of CCR5(+) CD4(+) T cells and CD4(+) effector memory cells was observed among maraviroc-treated patients (Wilcoxon signed rank test: p 0.016 and p 0.007, respectively). No significant variations were found in naive and central memory CD4(+) T cells. Among naive patients with an R5 virus, treatment with maraviroc and lopinavir/ritonavir was shown to provide a virological response compared to a triple therapy and a greater immunological benefit.

  17. HIV Protease Inhibitors Do Not Cause the Accumulation of Prelamin A in PBMCs from Patients Receiving First Line Therapy: The ANRS EP45 “Aging” Study

    PubMed Central

    Perrin, Sophie; Cremer, Jonathan; Faucher, Olivia; Reynes, Jacques; Dellamonica, Pierre; Micallef, Joëlle; Solas, Caroline; Lacarelle, Bruno; Stretti, Charlotte; Kaspi, Elise; Robaglia-Schlupp, Andrée; Tamalet, Corine Nicolino-Brunet Catherine; Lévy, Nicolas; Poizot-Martin, Isabelle; Cau, Pierre; Roll, Patrice

    2012-01-01

    Background The ANRS EP45 “Aging” study investigates the cellular mechanisms involved in the accelerated aging of HIV-1 infected and treated patients. The present report focuses on lamin A processing, a pathway known to be altered in systemic genetic progeroid syndromes. Methods 35 HIV-1 infected patients being treated with first line antiretroviral therapy (ART, mean duration at inclusion: 2.7±1.3 years) containing boosted protease inhibitors (PI/r) (comprising lopinavir/ritonavir in 65% of patients) were recruited together with 49 seronegative age- and sex-matched control subjects (http://clinicaltrials.gov/, NCT01038999). In more than 88% of patients, the viral load was <40 copies/ml and the CD4+ cell count was >500/mm3. Prelamin A processing in peripheral blood mononuclear cells (PBMCs) from patients and controls was analysed by western blotting at inclusion. PBMCs from patients were also investigated at 12 and 24 months after enrolment in the study. PBMCs from healthy controls were also incubated with boosted lopinavir in culture medium containing various concentrations of proteins (4 to 80 g/L). Results Lamin A precursor was not observed in cohort patient PBMC regardless of the PI/r used, the dose and the plasma concentration. Prelamin A was detected in PBMC incubated in culture medium containing a low protein concentration (4 g/L) but not in plasma (60–80 g/L) or in medium supplemented with BSA (40 g/L), both of which contain a high protein concentration. Conclusions Prelamin A processing abnormalities were not observed in PBMCs from patients under the PI/r first line regimen. Therefore, PI/r do not appear to contribute to lamin A-related aging in PBMCs. In cultured PBMCs from healthy donors, prelamin A processing abnormalities were only observed when the protein concentration in the culture medium was low, thus increasing the amount of PI available to enter cells. ClinicalTrials.gov NCT01038999 http://clinicaltrials.gov/ct2/show/NCT01038999. PMID

  18. Deep sequencing analysis of HIV-1 reverse transcriptase at baseline and time of failure in patients receiving rilpivirine in the phase III studies ECHO and THRIVE.

    PubMed

    Van Eygen, Veerle; Thys, Kim; Van Hove, Carl; Rimsky, Laurence T; De Meyer, Sandra; Aerssens, Jeroen; Picchio, Gaston; Vingerhoets, Johan

    2016-05-01

    Minority variants (1.0-25.0%) were evaluated by deep sequencing (DS) at baseline and virological failure (VF) in a selection of antiretroviral treatment-naïve, HIV-1-infected patients from the rilpivirine ECHO/THRIVE phase III studies. Linkage between frequently emerging resistance-associated mutations (RAMs) was determined. DS (llIumina®) and population sequencing (PS) results were available at baseline for 47 VFs and time of failure for 48 VFs; and at baseline for 49 responders matched for baseline characteristics. Minority mutations were accurately detected at frequencies down to 1.2% of the HIV-1 quasispecies. No baseline minority rilpivirine RAMs were detected in VFs; one responder carried 1.9% F227C. Baseline minority mutations associated with resistance to other non-nucleoside reverse transcriptase inhibitors (NNRTIs) were detected in 8/47 VFs (17.0%) and 7/49 responders (14.3%). Baseline minority nucleoside/nucleotide reverse transcriptase inhibitor (NRTI) RAMs M184V and L210W were each detected in one VF (none in responders). At failure, two patients without NNRTI RAMs by PS carried minority rilpivirine RAMs K101E and/or E138K; and five additional patients carried other minority NNRTI RAMs V90I, V106I, V179I, V189I, and Y188H. Overall at failure, minority NNRTI RAMs and NRTI RAMs were found in 29/48 (60.4%) and 16/48 VFs (33.3%), respectively. Linkage analysis showed that E138K and K101E were usually not observed on the same viral genome. In conclusion, baseline minority rilpivirine RAMs and other NNRTI/NRTI RAMs were uncommon in the rilpivirine arm of the ECHO and THRIVE studies. DS at failure showed emerging NNRTI resistant minority variants in seven rilpivirine VFs who had no detectable NNRTI RAMs by PS. PMID:26412111

  19. [Investigation of occult hepatitis B in HIV infected patients].

    PubMed

    Altınbaş, Akif; Ergünay, Koray; Calık Başaran, Nursel; Alp, Alpaslan; Turgut, Didem; Hasçelik, Gülşen; Uzun, Ömrüm; Unal, Serhat

    2011-04-01

    Due to their shared transmission route, hepatitis B virus (HBV) or hepatitis C virus (HCV) co-infections can be observed in human immunodeficiency virus (HIV)-infected cases and are associated with more severe clinical courses. The detection of HBV DNA despite HBV surface antigen (HBsAg) seronegativity is defined as occult HBV infections. According to the current seroepidemiological data, Turkey is classified as an intermediate HBV, low HIV endemic region. Occult HBV infections have previously been reported from Turkey but has not been investigated previously in HIV infected cohorts. The aim of this study was to identify occult HBV infections in HIV-infected persons. Twenty-eight HIV-positive cases followed-up at Hacettepe University Hospital, Infectious Diseases Unit were included in the study after informed consent. For the detection of HBsAg, anti-HBs and anti-HCV, commercial ELISA tests (Architect System, Abbott Diagnostics, USA) were employed. Absolute CD4+ and CD8+ T-cell counts were determined via flow cytometry. HIV viral load was calculated via COBAS TaqMan HIV-1 Real-time PCR (Roche Diagnostics, USA) and the presence of HBV DNA was evaluated via COBAS TaqMan HBV Real-time PCR (Roche Diagnostics, USA), in addition to a nested PCR assay targeting HBV S gene. The mean age of the study group was 43.2 (range between 27-65) years, 64.3% (18/28) of them were males and the mean duration of HIV infection was 4.2 (2-11) years. Mean CD4+ ve CD8+ T-cell counts were 414 ± 267 cells/mm3 and 854 ± 293 cells/mm3, respectively. Twenty-six (92.8%) cases were under highly-active anti-retroviral therapy at the time of the study, 88.5% of which included HBV-active drugs (lamivudine or tenofovir). HIV RNA were found negative in 11 (39.3%) patients, of those nine (81.8%) were the cases who treated with HBV-active antiretroviral therapy. HBsAg were negative in all of the 28 patients, while the positivity rates of anti-HBs and anti-HCV were 39.3% (11/28) and 3.6% (1

  20. Xerostomy, dental caries and periodontal disease in HIV+ patients.

    PubMed

    Cavasin Filho, Julio César; Giovani, Elcio Magdalena

    2009-02-01

    We studied xerostomy and its correlation with periodontal and dental cavity diseases in HIV patients, through measurement of salivary flow and through variables such as saliva buffer capacity, salivary pH, periodontal index, MDF index, dental carie risk and risk of periodontal disease. One hundred patients were analyzed. They were distributed into two groups: Group I (test) - 50 patients evidently HIV+, from whom information was collected and analyzed regarding age, gender, skin color, habits, general and oral diseases, levels of T-CD4 lymphocytes, viral load and highly active antiretroviral therapy (HAART); and Group II - (control) 50 HIV- patients, from whom information was collected and analyzed regarding age, gender, skin color, habits, general and oral diseases. In both groups, measurement of salivary flow, pH and buffer capacity was made. Group I presented high MDF, bacteria plaque and bleeding, with a greater susceptibility to the risks of oral cavities and periodontal disease. The salivary flow and the buffering capacity of the saliva were low, indicating a high level of xerostomy. Two important modifying factors influence these pathologies in an incisive way: one is immunossuppression and the other is HAART therapy. The control exhibited results that are closer to normality; it had better oral-health conditions.

  1. Determination of drug resistance and virus typology in HIV-1-positive pediatric patients in Istanbul, Turkey.

    PubMed

    Yoldaş, Ozlem; Ağaçfidan, Ali; Lübke, Nadine; Somer, Ayper; Hançerli, Selda; Verheyen, Jens; Kaiser, Rolf; Akgül, Baki

    2014-01-01

    The aim of the study was to determine the prevalence of drug resistance of HIV-1 in pediatric patients from Istanbul, Turkey. Genotypic drug resistance testing revealed transmission of drug resistance from mother to child in 20%. Due to rising numbers of children with HIV-1, baseline resistance testing is recommended for Turkey.

  2. HBV/HIV coinfection is associated with poorer outcomes in hospitalized patients with HBV or HIV.

    PubMed

    Rajbhandari, R; Jun, T; Khalili, H; Chung, R T; Ananthakrishnan, A N

    2016-10-01

    We examined the impact of HBV/HIV coinfection on outcomes in hospitalized patients compared to those with HBV or HIV monoinfection. Using the 2011 US Nationwide Inpatient Sample, we identified patients who had been hospitalized with HBV or HIV monoinfection or HBV/HIV coinfection using ICD-9-CM codes. We compared liver-related admissions between the three groups. Multivariable logistic regression was performed to identify independent predictors of in-hospital mortality, length of stay and total charges. A total of 72 584 discharges with HBV monoinfection, 133 880 discharges with HIV monoinfection and 8156 discharges with HBV/HIV coinfection were included. HBV/HIV coinfection was associated with higher mortality compared to HBV monoinfection (OR 1.67, 95% CI 1.30-2.15) but not when compared to HIV monoinfection (OR 1.22, 95% CI 0.96-1.54). However, the presence of HBV along with cirrhosis or complications of portal hypertension was associated with three times greater in-hospital mortality in patients with HIV compared to those without these complications (OR 3.00, 95% CI 1.80-5.02). Length of stay and total hospitalization charges were greater in the HBV-/HIV-coinfected group compared to the HBV monoinfection group (+1.53 days, P < 0.001; $17595, P < 0.001) and the HIV monoinfection group (+0.62 days, P = 0.034; $8840, P = 0.005). In conclusion, HBV/HIV coinfection is a risk factor for in-hospital mortality, particularly in liver-related admissions, compared to HBV monoinfection. Overall healthcare utilization from HBV/HIV coinfection is also higher than for either infection alone and higher than the national average for all hospitalizations, thus emphasizing the healthcare burden from these illnesses.

  3. Reassessing Medical Students' Willingness to Treat HIV-Infected Patients.

    ERIC Educational Resources Information Center

    Carter, Darren; And Others

    1996-01-01

    Surveyed 297 matriculating medical students at 3 Chicago medical schools concerning their willingness to treat HIV-infected patients. Found that 92% of the students agreed that patients with HIV would be welcome in their medical practices. Fear of infection and homophobia were associated with decreased willingness to treat. (MDM)

  4. Anti-HIV-1 activity of salivary MUC5B and MUC7 mucins from HIV patients with different CD4 counts

    PubMed Central

    2010-01-01

    Background We have previously shown that MUC5B and MUC7 mucins from saliva of HIV negative individuals inhibit HIV-1 activity by 100% in an in vitro assay. The purpose of this subsequent study was to investigate whether MUC5B and MUC7 from saliva of HIV patients or with full blown AIDS had a similar inhibitory activity against the virus. Methods Salivary MUC5B and MUC7 from HIV patients with different CD4 counts (< 200, 200-400 and > 400) were incubated with HIV-1 prior to infection of the human T lymphoblastoid cell line (CEM SS cells). Cells were then cultured and viral replication was measured by a qualitative p24 antigen assay. The size, charge and immunoreactivity of mucins from HIV negative and positive individuals was also analysed by SDS-PAGE, Western blot and ELISA respectively. Results It was shown that irrespective of their CD4 counts both MUC5B and MUC7 from HIV patients, unlike the MUC5B and MUC7 from HIV negative individuals, did not inhibit HIV-1 activity. Size, charge and immunoreactivity differences between the mucins from HIV negative and positive individuals and among the mucins from HIV patients of different CD4 count was observed by SDS-PAGE, Western blot and ELISA. Conclusions Purified salivary mucins from HIV positive patients do not inhibit the AIDS virus in an in vitro assay. Although the reason for the inability of mucins from infected individuals to inhibit the virus is not known, it is likely that there is an alteration of the glycosylation pattern, and therefore of charge of mucin, in HIV positive patients. The ability to inhibit the virus by aggregation by sugar chains is thus diminished. PMID:20946627

  5. Contraception Use Among Iranian Women With HIV: A Qualitative Study

    PubMed Central

    Saeieh, Sara E.; Nasrabadi, Alireza N.; Ebadi, Abbas; Moghadam, Zahra B.; Mohraz, Minoo; Jozani, Zahra B.; Rezaei, Elham

    2016-01-01

    Background: The application of family planning methods to people with HIV not only prevents unwanted pregnancy, but also leads to a reduction in the possibility of transmission of the virus from the patient to the sexual partner and the fetus. In order to prevent the spread of HIV and enhance reproductive rights, it is necessary to inform women with HIV of the contraception methods. Objective: The aim of this study was to explore experiences of HIV positive women about contraception use. Method: This qualitative study was conducted on 18 women with HIV who were at reproductive age and had referred the Center for clients with Risky Behavior in Imam Khomeini Hospital. Data were analyzed using the conventional content analysis method in MAXQDA 10. Results: The following two themes were derived from descriptions of the use of contraception methods by women with HIV: 1) Contraception is the forgotten component of reproductive health services; 2) inconsistent condom use. Each theme also contained three sub-themes. Conclusion: Results of investigations showed that Risky Behavior consultation Centers mostly stress the use of condom for husband/sexual partners without HIV. In addition, since health care practitioners play an important role in provision of reproductive health services, their lack of knowledge and cooperation considerably contribute to the spread of the disease and violation of patient rights. PMID:26234989

  6. Factors associated with quality of life in middle-aged and older patients living with HIV

    PubMed Central

    Monteiro, Fabiana; Canavarro, Maria Cristina; Pereira, Marco

    2016-01-01

    ABSTRACT HIV infection has been historically considered a disease of young adults; however, adults aged 50 years and older represent now an increasing proportion of HIV cases worldwide, including in Portugal. In this context, given the considerable burden associated with living with HIV, the topic of quality-of-life (QoL) assessment has become increasingly relevant. The aims of this study were to examine the age-related differences in QoL and depressive symptoms of younger and middle-aged and older adults with HIV as well as the sociodemographic, HIV-related and depressive symptoms (cognitive-affective and somatic) associated with QoL domains. The sample consisted of 1194 HIV-infected patients, recruited from 10 Portuguese hospitals. QoL data were collected using the WHOQOL-HIV-Bref questionnaire. Patients also completed the Beck Depression Inventory. Of the 1194 patients, 185 (15.5%) were over 50 years old. Middle-aged and older patients reported significantly lower QoL in the physical, independence and social relationships domains. Regarding the specific facets of QoL, middle-aged and older patients reported significantly lower scores in seven of the 29 specific facets of the WHOQOL-HIV-Bref and higher scores in one facet (financial resources). Overall, among middle-aged and older patients, higher education, being employed, a shorter time since HIV diagnosis, use of combination anti-retroviral therapy and fewer depressive symptoms were significantly associated with higher QoL ratings. Our findings suggest that both cognitive-affective and somatic depressive symptoms account for significant variability in QoL scores in middle-aged and older patients. Because an important feature of healthy ageing is maintaining QoL, these data may provide useful information for tailoring age-appropriate and effective interventions to improve the mental health and QoL of middle-aged and older patients living with HIV. PMID:26881294

  7. Factors associated with quality of life in middle-aged and older patients living with HIV.

    PubMed

    Monteiro, Fabiana; Canavarro, Maria Cristina; Pereira, Marco

    2016-01-01

    HIV infection has been historically considered a disease of young adults; however, adults aged 50 years and older represent now an increasing proportion of HIV cases worldwide, including in Portugal. In this context, given the considerable burden associated with living with HIV, the topic of quality-of-life (QoL) assessment has become increasingly relevant. The aims of this study were to examine the age-related differences in QoL and depressive symptoms of younger and middle-aged and older adults with HIV as well as the sociodemographic, HIV-related and depressive symptoms (cognitive-affective and somatic) associated with QoL domains. The sample consisted of 1194 HIV-infected patients, recruited from 10 Portuguese hospitals. QoL data were collected using the WHOQOL-HIV-Bref questionnaire. Patients also completed the Beck Depression Inventory. Of the 1194 patients, 185 (15.5%) were over 50 years old. Middle-aged and older patients reported significantly lower QoL in the physical, independence and social relationships domains. Regarding the specific facets of QoL, middle-aged and older patients reported significantly lower scores in seven of the 29 specific facets of the WHOQOL-HIV-Bref and higher scores in one facet (financial resources). Overall, among middle-aged and older patients, higher education, being employed, a shorter time since HIV diagnosis, use of combination anti-retroviral therapy and fewer depressive symptoms were significantly associated with higher QoL ratings. Our findings suggest that both cognitive-affective and somatic depressive symptoms account for significant variability in QoL scores in middle-aged and older patients. Because an important feature of healthy ageing is maintaining QoL, these data may provide useful information for tailoring age-appropriate and effective interventions to improve the mental health and QoL of middle-aged and older patients living with HIV. PMID:26881294

  8. Perceptions and acceptability of mHealth interventions for improving patient care at a community-based HIV/AIDS clinic in Uganda: a mixed methods study

    PubMed Central

    Chang, Larry W; Njie-Carr, Veronica; Kalenge, Sheila; Kelly, Jack F; Bollinger, Robert C; Alamo-Talisuna, Stella

    2013-01-01

    mHealth (mobile technologies for health) represents a growing array of tools being applied in diverse health care settings. mHealth interventions for improving HIV/AIDS care is a promising strategy, but its evidence-base is limited. We conducted a formative research evaluation to inform the development of novel, mHealth HIV/AIDS care interventions to be used by community health workers (CHWs) in Kampala, Uganda. A mixed methods formative research approach was utilized. Qualitative methods included 20 in-depth interviews and 6 focus groups with CHWs, clinic staff, and patients. Thematic analysis was performed and selected quotations used to illustrate themes. Quantitative methods consisted of a survey administered to CHWs and clinic staff using categorical and Likert scale questions regarding current mobile phone and internet access and perceptions on the potential use of smartphones by CHWs. Qualitative results included themes on significant current care challenges, multiple perceived mHealth benefits, and general intervention acceptability. Key mHealth features desired included tools to verify CHW task completions, clinical decision support tools, and simple access to voice calling. Inhibiting factors identified included concerns about CHW job security and unrealistic expectations of mHealth capabilities. Quantitative results from 27 staff participants found that 26 (96%) did not have internet access at home; yet, only 2 (7.4%) did not own a mobile phone. Likert scale survey responses (1–5, 1=Strongly Disagree, 5=Strongly Agree) indicated general agreement that smartphones would improve efficiency (Mean=4.35) and patient care (4.31) but might be harmful to patient confidentiality (3.88) and training was needed (4.63). Qualitative and quantitative results were generally consistent, and, overall, there was enthusiasm for mHealth technology. However, a number of potential inhibiting factors were also discovered. Findings from this study may help guide future design

  9. Occult Hepatitis B Virus Infection among HIV Positive Patients in Nigeria.

    PubMed

    Opaleye, Oluyinka Oladele; Oluremi, Adeolu Sunday; Atiba, Adetona Babatunde; Adewumi, Moses Olubusuyi; Mabayoje, Olatunji Victor; Donbraye, Emmanuel; Ojurongbe, Olusola; Olowe, O Adekunle

    2014-01-01

    HIV has been known to interfere with the natural history of hepatitis B virus (HBV) infection. In this study we investigate the prevalence of occult hepatitis B virus infection (OBI) among HIV-infected individuals in Nigeria. Overall, 1200 archived HIV positive samples were screened for detectable HBsAg using rapid technique, in Ikole Ekiti Specialist Hospital. The HBsAg negative samples were tested for HBsAg, anti-HBc, and anti-HCV by ELISA. Polymerase chain reaction was used for HBV DNA amplification and CD4 counts were analyzed by cytometry. Nine hundred and eighty of the HIV samples were HBsAg negative. HBV DNA was detected in 21/188 (11.2%) of patients without detectable HBsAg. CD4 count for the patients ranged from 2 to 2,140 cells/ μ L of blood (mean = 490 cells/ μ L of blood). HCV coinfection was detected only in 3/188 (1.6%) of the HIV-infected patients (P > 0.05). Twenty-eight (29.2%) of the 96 HIV samples screened were positive for anti-HBc. Averagely the HBV viral load was <50 copies/mL in the OBI samples examined by quantitative PCR. The prevalence of OBI was significantly high among HIV-infected patients. These findings highlight the significance of nucleic acid testing in HBV diagnosis in HIV patients. PMID:24868208

  10. Male preponderance in HIV seropositive patients with mucocutaneous complaints in a tertiary care hospital in North India

    PubMed Central

    Sharma, Shivani; Puri, Karan Jeet Pal Singh; Gambhir, Mankesh Lal

    2014-01-01

    Objective A panorama of mucocutaneous manifestations is seen at every stage of HIV. This study was done to study the sex prevalence in HIV/AIDS patients with mucocutaneous disorders. Methods A total of 1 000 HIV seropositive patients attending Skin-STD clinic, Govt. Medical College, Amritsar, for any dermatologic complaints were studied in respect to the sex group preponderance. Results Males constituted the majority as 75.6% while females were 24.4%. Conclusions Women, in most of the cases, get infected from their spouses, who have acquired infection through extramarital sexual contact. HIV infection in female patients increases the risk of HIV transmission to neonates and infants, thus further spreading the HIV in a community. So it is very crucial to initiate early preventive measures to reduce HIV burden. PMID:25183078

  11. Prevalence of intestinal parasites among HIV patients in Baringo, Kenya

    PubMed Central

    Kipyegen, Cornelius Kibet; Shivairo, Robert Shavulimo; Odhiambo, Rose Ogwang

    2012-01-01

    Introduction HIV patients have reduced immune response which makes them more susceptible to different infections. This cross-sectional study was carried out to document the prevalence of intestinal parasites among HIV patients in Baringo County, Kenya. Methods Structured questionnaires were used to collect clinical information after obtaining consent from the participants. Stool samples were collected from 285 respondents for intestinal parasitic examination using direct and formol-ether concentration to detect ova and cysts. Chi-square (X2) statistical analysis was used to test level of significance at P = 0.05 using SPSS. Results A prevalence of 50.9% of intestinal parasites was recorded. Majority of the parasitic infections were waterborne protozoa with few helminthes. There was an association (P < 0.05) between intestinal parasitic infection and place of residence, agro-ecological location, family size, water source, treatment and reliability and diarrheal status. There was no association (P > 0.05) between age groups and gender with parasitic infection. Parasites identified were Entamoeba histolytica/dispar (58.3%), Giardia lamblia (16.6%), Ascaris lumbricoides (8.6%), Entamoeba coli (5.9%), Taenia saginata (5.3%), Trichuris trichuria (1.9%), Enterobius vermicularis (1.9%) and hookworm (1.3%). Conclusion There was high prevalence of intestinal parasites, therefore, health education to HIV patients and community health workers on the importance of good environmental sanitation and personal hygiene could curb water, food and individual contamination promoting good management and care of HIV patients, hence improving their health status. PMID:23330028

  12. Resistance to Cotrimoxazole and Other Antimicrobials among Isolates from HIV/AIDS and Non-HIV/AIDS Patients at Bugando Medical Centre, Mwanza, Tanzania

    PubMed Central

    Marwa, Karol J.; Mushi, Martha F.; Konje, Eveline; Alele, Paul E.; Kidola, Jeremiah; Mirambo, Mariam M.

    2015-01-01

    Bacterial resistance has increased in the AIDS era and is attributed to the widespread use of cotrimoxazole prophylaxis against opportunistic infections in HIV/AIDS patients. In Tanzania, cotrimoxazole prophylaxis has been used for more than ten years. Little is known, however, about its impact on the spread of antibiotic resistance in HIV positive patients. This cross-sectional study was done to compare magnitude of bacterial resistance to cotrimoxazole and other antimicrobials among isolates from HIV infected patients on cotrimoxazole prophylaxis and those not on prophylaxis and non-HIV patients attending Bugando Medical Centre (BMC). Susceptibility testing on obtained urine and swab specimens followed Clinical Laboratory Standard Institute, 2010, Guidelines. Of 945 samples collected, 155 had positive bacterial growth after 24 hours of incubation. Of the positive samples (72), 46.4% were from HIV positive patients. The common isolates were E. coli 41.3% (64/155), Klebsiella pneumoniae 17.5% (27/155), and Staphylococcus aureus 16.1% (25/155). Overall, bacterial resistance to cotrimoxazole was 118 (76.1%); among isolates from HIV patients bacterial resistance was 54 (75%), and for isolates from HIV patients on prophylaxis bacterial resistance was 36 (81.3%). HIV seropositivity and cotrimoxazole prophylaxis are not associated with antibiotic resistance observed in bacteria infecting patients attending BMC, Mwanza, Tanzania. PMID:25793123

  13. Health care students' reactions towards HIV patients: examining prejudice, emotions, attribution of blame and willingness to interact with HIV/AIDS patients.

    PubMed

    Philip, Jannel; Chadee, Derek; Yearwood, Rosana Patricia

    2014-01-01

    One of the most pervasive stigmatising conditions in society today is HIV/AIDS. In Trinidad and Tobago, stigma and discrimination are still pervasive especially against persons living with HIV/AIDS (PLHIV) and at-risk groups. HIV stigmatisation takes place at all levels including health care institutions, and is a major obstacle to effective HIV/AIDS prevention and care. This study examined health care students' reactions towards HIV patients. A stratified random sample of 339 health care students from Trinidad was used. A 2 × 2 factorial design using vignettes manipulated a male patient's sexual orientation (heterosexual/homosexual) and HIV onset controllability (high/low). Multivariate analysis of variance and discriminant function analysis were used to analyse the data. There was a significant main effect of HIV onset controllability on participants' attribution of blame, emotions, prejudicial evaluation and willingness to interact with PLHIV, Λ (.64) F(6, 330) = 31.44, p <.001, [Formula: see text] = .37. Attribution of blame and prejudicial evaluation discriminated between reactions to patients in low onset control and high onset control vignettes. Cognitive-affective appraisal processes are instrumental in determining health care providers' reaction towards PLHIV.

  14. Liver Fibrosis in HIV Patients Receiving a Modern cART

    PubMed Central

    Mohr, Raphael; Schierwagen, Robert; Schwarze-Zander, Carolynne; Boesecke, Christoph; Wasmuth, Jan-Christian; Trebicka, Jonel; Rockstroh, Jürgen Kurt

    2015-01-01

    Abstract Liver-related death in human immunodeficiency virus (HIV)-infected individuals is about 10 times higher compared with the general population, and the prevalence of significant liver fibrosis in those with HIV approaches 15%. The present study aimed to assess risk factors for development of hepatic fibrosis in HIV patients receiving a modern combination anti-retroviral therapy (cART). This cross-sectional prospective study included 432 HIV patients, of which 68 (16%) patients were anti-hepatitis C virus (HCV) positive and 23 (5%) were HBsAg positive. Health trajectory including clinical characteristics and liver fibrosis stage assessed by transient elastography were collected at inclusion. Liver stiffness values >7.1 kPa were considered as significant fibrosis, while values >12.5 kPa were defined as severe fibrosis. Logistic regression and Cox regression uni- and multivariate analyses were performed to identify independent factors associated with liver fibrosis. Significant liver fibrosis was detected in 10% of HIV mono-infected, in 37% of HCV co-infected patients, and in 18% of hepatitis B virus co-infected patients. The presence of diabetes mellitus (odds ratio [OR] = 4.6) and FIB4 score (OR = 2.4) were independently associated with presence of significant fibrosis in the whole cohort. Similarly, diabetes mellitus (OR = 5.4), adiposity (OR = 4.6), and the FIB4 score (OR = 3.3) were independently associated with significant fibrosis in HIV mono-infected patients. Importantly, cumulative cART duration protected, whereas persistent HIV viral replication promoted the development of significant liver fibrosis along the duration of HIV infection. Our findings strongly indicate that besides known risk factors like metabolic disorders, HIV may also have a direct effect on fibrogenesis. Successful cART leading to complete suppression of HIV replication might protect from development of liver fibrosis. PMID:26683921

  15. Normal Myocardial Flow Reserve in HIV-Infected Patients on Stable Antiretroviral Therapy

    PubMed Central

    Knudsen, Andreas; Christensen, Thomas E.; Ghotbi, Adam Ali; Hasbak, Philip; Lebech, Anne-Mette; Kjær, Andreas; Ripa, Rasmus Sejersten

    2015-01-01

    Abstract Studies have found HIV-infected patients to be at increased risk of myocardial infarction, which may be caused by coronary microvascular dysfunction. For the first time among HIV-infected patients, we assessed the myocardial flow reserve (MFR) by Rubidium-82 (82Rb) positron emission tomography (PET), which can quantify the coronary microvascular function. MFR has proved highly predictive of future coronary artery disease and cardiovascular events in the general population. In a prospective cross-sectional study, HIV-infected patients all receiving antiretroviral therapy (ART) with full viral suppression and HIV-uninfected controls were scanned using 82Rb PET/computed tomography at rest and adenosine-induced stress, thereby obtaining the MFR (stress flow/rest flow), stratified into low ≤1.5, borderline >1.5 to 2.0, or normal >2.0. Fifty-six HIV-infected patients and 25 controls were included. The HIV-infected patients had a mean age of 53 years (range 37–68 years) with 23% active smokers. The controls had a mean age of 52 years (range 36–68 years) and 26% active smokers. In the HIV-infected group 73% had a normal MFR, 17% borderline, and 10% low values of MFR. Among controls these values were 71%, 19%, and 10%, respectively (P = 0.99). However, the HIV-infected group had lower values of stress myocardial blood flow (MBF) (2.63 ± 0.09 mL/g/min vs 2.99 ± 0.14 mL/g/min; P = 0.03). We found no evidence of decreased MFR as assessed by 82Rb PET among HIV-infected patients on stable ART with full viral suppression compared with HIV-uninfected controls. We did notice a decreased MBF during stress. PMID:26512605

  16. Effectiveness, durability, and safety of darunavir/ritonavir in HIV-1-infected patients in routine clinical practice in Italy: a postauthorization noninterventional study

    PubMed Central

    Antinori, Andrea; Meraviglia, Paola; Monforte, Antonella d’Arminio; Castagna, Antonella; Mussini, Cristina; Bini, Teresa; Gianotti, Nicola; Rusconi, Stefano; Colella, Elisa; Airoldi, Giuseppe; Mancusi, Daniela; Termini, Roberta

    2016-01-01

    Current antiretroviral (ARV) therapy for the treatment of human immunodeficiency virus (HIV-1)-infected patients provides long-term control of viral load (VL). Darunavir (DRV) is a nonpeptidomimetic protease inhibitor approved for use with a ritonavir booster (DRV/r). This study evaluated the effectiveness of DRV/r in combination with other ARV agents in routine clinical practice in Italy. In this descriptive observational study, data on utilization of DRV/r, under the conditions described in the marketing authorization, were collected from June 2009 to December 2012. Effectiveness (VL <50 copies/mL), tolerability, and durability in four patient groups (two DRV/r-experienced, one ARV-experienced DRV/r-naïve, and one ARV-naïve) were analyzed. Secondary objectives included immunological response, safety, and persistence/discontinuation rates. In total, 875 of 883 enrolled patients were included in the analysis: of these, 662 (75.7%) completed the follow-up until the end of 2012 and 213 (24.3%) withdrew from the study earlier. Initial DRV dose was 600 mg twice daily (67.1%) or 800 mg once daily (32.9%). Only 16 patients (1.8%) withdrew from the study due to virological failure. Virological response proportions were higher in patients virologically suppressed at study entry versus patients with baseline VL ≥50 copies/mL in each ARV-experienced group, while there was no consistent difference across study groups and baseline VL strata according to baseline CD4+ cell count. CD4+ cell count increased from study entry to last study visit in all the four groups. DRV/r was well tolerated, with few discontinuations due to study-emergent nonfatal adverse events (3.0% overall, including 2.1% drug-related) or deaths (3.0% overall, all non-drug-related); 35.3% of patients reported ≥1 adverse events. These observational data show that DRV/r was effective and well tolerated in the whole patient population described here. The DRV/r-containing regimen provided viral suppression

  17. Effectiveness, durability, and safety of darunavir/ritonavir in HIV-1-infected patients in routine clinical practice in Italy: a postauthorization noninterventional study.

    PubMed

    Antinori, Andrea; Meraviglia, Paola; Monforte, Antonella d'Arminio; Castagna, Antonella; Mussini, Cristina; Bini, Teresa; Gianotti, Nicola; Rusconi, Stefano; Colella, Elisa; Airoldi, Giuseppe; Mancusi, Daniela; Termini, Roberta

    2016-01-01

    Current antiretroviral (ARV) therapy for the treatment of human immunodeficiency virus (HIV-1)-infected patients provides long-term control of viral load (VL). Darunavir (DRV) is a nonpeptidomimetic protease inhibitor approved for use with a ritonavir booster (DRV/r). This study evaluated the effectiveness of DRV/r in combination with other ARV agents in routine clinical practice in Italy. In this descriptive observational study, data on utilization of DRV/r, under the conditions described in the marketing authorization, were collected from June 2009 to December 2012. Effectiveness (VL <50 copies/mL), tolerability, and durability in four patient groups (two DRV/r-experienced, one ARV-experienced DRV/r-naïve, and one ARV-naïve) were analyzed. Secondary objectives included immunological response, safety, and persistence/discontinuation rates. In total, 875 of 883 enrolled patients were included in the analysis: of these, 662 (75.7%) completed the follow-up until the end of 2012 and 213 (24.3%) withdrew from the study earlier. Initial DRV dose was 600 mg twice daily (67.1%) or 800 mg once daily (32.9%). Only 16 patients (1.8%) withdrew from the study due to virological failure. Virological response proportions were higher in patients virologically suppressed at study entry versus patients with baseline VL ≥50 copies/mL in each ARV-experienced group, while there was no consistent difference across study groups and baseline VL strata according to baseline CD4(+) cell count. CD4(+) cell count increased from study entry to last study visit in all the four groups. DRV/r was well tolerated, with few discontinuations due to study-emergent nonfatal adverse events (3.0% overall, including 2.1% drug-related) or deaths (3.0% overall, all non-drug-related); 35.3% of patients reported ≥1 adverse events. These observational data show that DRV/r was effective and well tolerated in the whole patient population described here. The DRV/r-containing regimen provided viral

  18. Frequency and subtype of BK virus infection in Iranian patients infected with HIV.

    PubMed

    Akhgari, Shahla; Mohraz, Minoo; Azadmanesh, Kayhan; Vahabpour, Rouhollah; Kazemimanesh, Monireh; Aghakhani, Arezoo; Jozpanahi, Manizheh; Banifazl, Mohammad; Bavand, Anahita; Ramezani, Amitis

    2016-02-01

    Human polyomavirus BK virus (BKV) is a double-stranded DNA virus that infects approximately 90 % of the general population as a subclinical or mild infection. In immunosuppressed patients, such as HIV cases, BKV may be reactivated resulting hemorrhagic cystitis and tubulointerstitial nephritis. However, there are limited studies on prevalence and molecular epidemiology of BKV in Iran. We therefore aimed to evaluate the prevalence and subtypes of BKV in Iranian HIV patients. A total of 99 patients with HIV infection were enrolled in the study. Presence of BKV DNA in plasma was evaluated by nested PCR. PCR products were sequenced directly, and phylogenetic analysis was performed. BKV DNA was detected in 8.08 % of HIV patients. BKV viremia presented in 4 out of 25 patients (16 %) not receiving antiretroviral therapy in comparison with 4 out 74 of HAART-treated patients (5.4 %) (P = 0.023). In patients with CD4 counts ≥200 cells/mm(3), viremia was found more commonly (7/80 = 8.8 %) than in those with lower counts (1/19 = 5.2 %) (not significant). All sequenced BKV isolates belonged to subtype Ib-2. Our findings indicated that the prevalence of BKV viremia is relatively prevalent in patients with HIV infection and significantly higher in naïve than HAART-treated cases. Therefore, HAART can eliminate BKV infection from plasma and reduce viremia although the actual implication of BKV viremia in HIV patients is not clear.

  19. Challenges facing providers caring for HIV/HCV-coinfected patients

    PubMed Central

    Lekas, Helen-Maria; Siegel, Karolynn; Leider, Jason

    2015-01-01

    Despite the high prevalence of Hepatitis C virus (HCV) infection among injection drug users also infected with Human immunodeficiency virus (HIV), and the synergistic adverse effect of the two diseases on patients' health and survival, the research on the clinical management of these patients and particularly the low uptake of HCV therapy is limited. We conducted qualitative interviews with 17 HIV providers from two urban public hospitals. We discovered that the limitations of the current state of medical knowledge, the severe side effects of HIV and HCV therapies, and the psychosocial vulnerability of HIV/HCV-coinfected patients combined with their resistance to becoming informed about HCV posed significant challenges for providers. To contend with these challenges, providers incorporated key dimensions of patient-centered medicine in their practice such as considering their patients' psychosocial profiles and the meaning patients assign to being coinfected, and finding ways to engage their patients in a therapeutic alliance. PMID:21825278

  20. System and Patient Barriers to Care among People Living with HIV/AIDS in Houston/Harris County, Texas: HIV Medical Care Providers' Perspectives.

    PubMed

    Mgbere, Osaro; Khuwaja, Salma; Bell, Tanvir K; Rodriguez-Barradas, Maria C; Arafat, Raouf; Essien, Ekere James; Singh, Mamta; Aguilar, Jonathan; Roland, Eric

    2015-01-01

    In the United States, a considerable number of people diagnosed with HIV are not receiving HIV medical care due to some barriers. Using data from the Medical Monitoring Project survey of HIV medical care providers in Houston/Harris County, Texas, we assessed the HIV medical care providers' perspectives of the system and patient barriers to HIV care experienced by people living with HIV/AIDS (PLWHA). The study findings indicate that of the 14 HIV care barriers identified, only 1 system barrier and 7 patient barriers were considered of significant (P ≤ .05) importance, with the proportion of HIV medical care providers' agreement to these barriers ranging from 73.9% (cost of health care) to 100% (lack of social support systems and drug abuse problems). Providers' perception of important system and patient barriers varied significantly (P ≤ .05) by profession, race/ethnicity, and years of experience in HIV care. To improve access to and for consistent engagement in HIV care, effective intervention programs are needed to address the barriers identified especially in the context of the new health care delivery system.

  1. Late HIV testing in a cohort of HIV-infected patients followed in Puerto Rico

    PubMed Central

    Tossas-Milligan, Katherine Y.; Hunter-Mellado, Robert F.; Mayor, Angel M.; Fernandez-Santos, Diana M.; Dworkin, Mark S.

    2016-01-01

    Objective Late HIV testing (LT) defined as an AIDS diagnosis within a year of first positive HIV test is associated with higher HIV transmission, lower HAART effectiveness, and worse outcomes. Latinos represent 36% of LT in the US, yet research concerning LT among HIV cases in Puerto Rico is scarce. Methods Multivariable logistic regression analysis was used to identify factors associated with LT and Cochran-Armitage test to describe LT trends in an HIV infected cohort followed at a specialized HIV clinic in Puerto Rico. Results From 2000 to 2011, 47% of eligible patients were LT, with lower median CD4 count (54 vs. 420 cells/mm3) and higher median HIV viral load counts (253,680 vs. 23,700 copies/mL), when compared to non-LT patients. LT prevalence decreased significantly, from 47% in 2000 to 37% in 2011. In a mutually adjusted logistic regression model, males, older age at enrolment and past history of IDU significantly increased LT odds whereas history of amphetamine use decreased LT odds. Stratified by mode of transmission, only men who have sex with men (MSM), had a significant reduction in the proportion of LT, from 67% in 2000 to 33% in 2011. Conclusion These results suggest a gap in early HIV detection in Puerto Rico that decreased only among MSM. A closer evaluation of HIV testing guideline implementation among non MSM in the Island is needed. PMID:26356739

  2. Substance Use in Older HIV-Infected Patients

    PubMed Central

    Edelman, E. Jennifer; Tetrault, Jeanette M.; Fiellin, David A.

    2014-01-01

    Purpose of the Review Substance use may persist throughout the life course and has a substantial impact on health outcomes globally. As HIV-infected individuals are disproportionately impacted by substance use and living longer, it is critical that providers and researchers alike understand the impact of substance use on older, HIV-infected patients and potential treatment options. To this end, we conducted a review of the literature focusing on the most commonly used substances to outline the epidemiology, health consequences, treatment options and latest research relevant to older, HIV-infected patients. Recent Findings Substance use impacts older, HIV-infected patients with regards to HIV-related and non-HIV related outcomes. Counseling strategies are available for marijuana and stimulant use disorders. Brief counseling is useful alongside medications for alcohol, tobacco and opioid use disorders. Many medications for alcohol, tobacco, and opioid use disorders are safe in the setting of antiretroviral therapy. Unfortunately, few interventions targeting substance use in older, HIV-infected patients have been developed and evaluated. Summary As older, HIV-infected patients continue to experience substance use and its related health consequences, there will be a growing need for the development of safe and effective interventions which address the complex needs of this population. PMID:24824888

  3. Clinical evolution of chronic renal patients with HIV infection in replacement therapy.

    PubMed

    Saracho, Ramón; Martín Escobar, Eduardo; Comas Farnés, Jordi; Arcos, Emma; Mazuecos Blanca, Auxiliadora; Gentil Govantes, Miguel Ángel; Castro de la Nuez, Pablo; Zurriaga, Óscar; Ferrer Alamar, Manuel; Bouzas Caamaño, Encarnación; García Falcón, Teresa; Portolés Pérez, José; Herrero Calvo, José A; Chamorro Jambrina, Carlos; Moina Eguren, Íñigo; Rodrigo de Tomás, María Teresa; Abad Díez, José María; Sánchez Miret, José I; Alvarez Lipe, Rafael; Díaz Tejeiro, Rafael; Moreno Alía, Inmaculada; Torres Guinea, Marta; Huarte Loza, Enma; Artamendi Larrañaga, Marta; Fernández Renedo, Carlos; González Fernández, Raquel; Sánchez Álvarez, Emilio; Alonso de la Torre, Ramón

    2015-01-01

    Patients on renal replacement therapy (RRT) infected with the human immunodeficiency virus (HIV) are a special group with growing interest. In order to study the epidemiological data of HIV+ patients on RRT in Spain, we collected individual information from 2004-2011 (period of use of highly active antiretroviral therapy [HAART] in the Autonomous Communities of Andalusia, Aragon, Asturias, Catalonia, Valencia, Castilla la Mancha, Castilla León, Galicia, Madrid, La Rioja and the Basque Country, comprising 85% of the Spanish population. A total of 271 incident and 209 prevalent patients were analysed. They were compared with the remaining patients on RRT during the same period. The annual incidence was 0.8 patients per one million inhabitants, with a significant increase during the follow-up period. The proportion of prevalent HIV+ patients was 5.1 per 1,000 patients on RRT (95% confidence interval [CI] 4.4-5.8. Although glomerular diseases constituted the majority of cases (42%), diabetic nephropathy was the cause in 14% of patients. The nation-wide totals for these percentages were 13 and 25%, respectively. Compared to the total of patients in treatment, the risk of death was significantly higher in the HIV+ group: hazard ratio (HR) adjusted for age, sex and diabetes was 2.26 (95% CI 1.74 - 2.91). Hepatitis C coinfection increased the risk of death in the HIV+ group (HR 1.77; 95% CI 1.10 - 2.85). The probability of kidney transplantation in HIV+ was only 17% after 7 years, comparing with total RTT patients (HR 0.15; 95% CI: 0.10-0.24). Despite the use of HAART, the incidence of HIV+ patients on dialysis has increased; their mortality still exceeds non-HIV patients, and they have a very low rate of transplantation. It is necessary to further our knowledge of this disease in order to improve results.

  4. An 84-month observational study of the changes in CD4 T-lymphocyte cell count of 110 HIV/AIDS patients treated with traditional Chinese medicine.

    PubMed

    Wang, Jian; Liang, Biyan; Zhang, Xiaoping; Xu, Liran; Deng, Xin; Li, Xiuhui; Fang, Lu; Tan, Xinghua; Mao, Yuxiang; Zhang, Guoliang; Wang, Yuguang

    2014-09-01

    This study aimed to evaluate the therapeutic effect of traditional Chinese medicine (TCM) by observing the changes in CD4 T-lymphocyte cell count of 110 cases with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) treated continuously with TCM for 84 months. Information of 110 HIV/AIDS patients from 19 provinces and cities treated with TCM from 2004 to 2013 was collected. Changes in the indexes of CD4 counts ( ≤ 200, 201-350, 351-500 and > 500 cells/mm(3)) at five time points (0, 12, 36, 60 and 84 months) and different treatments [TCM and TCM plus antiretroviral therapy (ART)] were compared. Repeated measures test indicated no interaction between group and time (P > 0.05). Degrees of increasing and decreasing CD4 count of the two groups at four different frames were statistically significant compared with the baseline. The CD4 count between the two groups was not statistically significant. For CD4 count of ≤ 200 cells/mm(3), the mean CD4 count changes were 21 and 28 cells/mm(3) per year for the TCM group and TCM plus ART group, respectively. For CD4 count of 201-350 cells/mm(3), the mean CD4 count changes were 6 and 25 cells/mm(3) per year for the TCM group and TCM plus ART group, respectively. For CD4 count of 351-500 cells/mm(3), the mean CD4 count changes were -13 and -7 cells/mm(3) per year for the TCM group and TCM plus ART group, respectively. For CD4 count of > 500 cells/mm(3), the mean CD4 count changes were -34 and -17 cells/mm(3) per year for the TCM group and TCM plus ART group, respectively. Long-term use of TCM could maintain or slow the pace of declining CD4 counts in patients with HIV/AIDS, and may achieve lasting effectiveness.

  5. Post-ART Symptoms Were Not the Problem: A Qualitative Study on Adherence to ART in HIV-Infected Patients in a Mozambican Rural Hospital

    PubMed Central

    Maixenchs, Maria; Boene, Helena; Anselmo, Rui; Mindu, Carolina; Alonso, Pedro; Menéndez, Clara; Macete, Eusébio; Pool, Robert; Letang, Emílio; Naniche, Denise; Munguambe, Khátia

    2015-01-01

    Objective The objective of this qualitative study was to explore how clinical symptoms may affect adherence to antiretroviral therapy (ART) in HIV patients, and to explore factors, perceptions and attitudes related to adherence to therapy. Design A qualitative study was carried out in the context of the prospective cohort study “Evaluation of Immune Reconstitution Following Initiation of Highly Active Antiretroviral Treatment in Manhiça, Mozambique”. In-depth Interviews were conducted twice in a sub-sample of the study cohort (51 participants), at six-month intervals. Results Most participants (73%) knew that AIDS is a chronic disease and that ART does not cure it. Nine participants (18%) were non-adherent at some point and two (4%) abandoned ART. All participants but five reported having symptoms after starting ART, mainly attributed to pills needing time to act and body’s reaction to the treatment. In spite of the perceived severity of the symptoms, only two people reported they discontinued the treatment due to symptoms. Almost all participants reported feeling comfortable with the HIV clinic organization and procedures, but afraid of staff being hostile if they did not follow the rules or if the health worker visited their home. Family was one of the most important source of support according participants. Almost all participants with children said that a decisive factor to follow the treatment was the desire to be able to look after them. Conclusions Experiencing symptoms after starting treatment was not a barrier to adherence to ART. Factors related to adherence included control measures set up by the health facility (exhaustive follow up, support, information) and family and community support. Indirect ART-related expenses did jeopardise adherence. PMID:26332680

  6. Characteristics of HIV patients who missed their scheduled appointments

    PubMed Central

    Nagata, Delsa; Gutierrez, Eliana Battaggia

    2016-01-01

    ABSTRACT OBJECTIVE To analyze whether sociodemographic characteristics, consultations and care in special services are associated with scheduled infectious diseases appointments missed by people living with HIV. METHODS This cross-sectional and analytical study included 3,075 people living with HIV who had at least one scheduled appointment with an infectologist at a specialized health unit in 2007. A secondary data base from the Hospital Management & Information System was used. The outcome variable was missing a scheduled medical appointment. The independent variables were sex, age, appointments in specialized and available disciplines, hospitalizations at the Central Institute of the Clinical Hospital at the Faculdade de Medicina of the Universidade de São Paulo, antiretroviral treatment and change of infectologist. Crude and multiple association analysis were performed among the variables, with a statistical significance of p ≤ 0.05. RESULTS More than a third (38.9%) of the patients missed at least one of their scheduled infectious diseases appointments; 70.0% of the patients were male. The rate of missed appointments was 13.9%, albeit with no observed association between sex and absences. Age was inversely associated to missed appointment. Not undertaking anti-retroviral treatment, having unscheduled infectious diseases consultations or social services care and being hospitalized at the Central Institute were directly associated to missed appointments. CONCLUSIONS The Hospital Management & Information System proved to be a useful tool for developing indicators related to the quality of health care of people living with HIV. Other informational systems, which are often developed for administrative purposes, can also be useful for local and regional management and for evaluating the quality of care provided for patients living with HIV. PMID:26786472

  7. Frequency and predictors of estimated HIV transmissions and bacterial STI acquisition among HIV-positive patients in HIV care across three continents

    PubMed Central

    Safren, Steven A; Hughes, James P; Mimiaga, Matthew J; Moore, Ayana T; Friedman, Ruth Khalili; Srithanaviboonchai, Kriengkrai; Limbada, Mohammed; Williamson, Brian D; Elharrar, Vanessa; Cummings, Vanessa; Magidson, Jessica F; Gaydos, Charlotte A; Celentano, David D; Mayer, Kenneth H

    2016-01-01

    with increased STI incidence. In bivariate models for both HIV transmissions and STI incidence, higher depressive symptoms were significant predictors. Conclusions These data help to estimate the potential number of HIV infections transmitted and bacterial STIs acquired over time in patients established in care, a group typically considered at lower transmission risk, and found substantial numbers of estimated HIV transmissions. These findings provide an approach for evaluating the impact (in phase 2 studies) and potentially cost-effectiveness of global TasP efforts. PMID:27687145

  8. The spectrum of polyneuropathies in patients infected with HIV.

    PubMed Central

    Leger, J M; Bouche, P; Bolgert, F; Chaunu, M P; Rosenheim, M; Cathala, H P; Gentilini, M; Hauw, J J; Brunet, P

    1989-01-01

    Twenty five patients with peripheral neuropathy at different stages of human immunodeficiency virus (HIV) infection are reported. Cerebrospinal fluid (CSF) findings were available in 17 cases, electrophysiology in all and a neuromuscular biopsy in 11. Of six otherwise asymptomatic HIV+ patients, five had chronic inflammatory demyelinating polyneuropathy (CIDP) and one acute inflammatory demyelinating polyneuropathy (AIDP). CSF showed pleocytosis in all cases. Infiltration of the endoneurium and/or the epineurium by mononuclear cells was seen in biopsies from three cases. These six patients recovered either spontaneously, or with corticosteroids or plasmaphereses. Of five patients with AIDS related complex (ARC), three had distal predominantly sensory peripheral neuropathy (DSPN), one CIDP and one mixed neuropathy. Of 14 patients with AIDS, one had mononeuropathy multiplex and 13 painful DSPN. Electrophysiological studies were consistent with an axonopathy. Nerve biopsies in six cases showed axonal changes but surprisingly associated with marked segmental demyelination in two cases. Cell infiltration was present in nerve samples in two cases. Five patients died within six months after the onset of the neuropathy. PMID:2559161

  9. Perception of Patients With HIV/AIDS From Stigma and Discrimination

    PubMed Central

    Saki, Mandana; Mohammad Khan Kermanshahi, Sima; Mohammadi, Eesa; Mohraz, Minoo

    2015-01-01

    Background: Stigma and discrimination among patients with HIV/AIDS cause various problems for the patients and their health systems. Objectives: The purpose of this study was to explain the perceived experiences of the patients from stigma and discrimination and their roles on health-seeking services among patients. Patients and Methods: This was a qualitative research using content analysis approach and semi-structured interviews, conducted on patients living with HIV/ADS, during 2013 - 2014 in Iran. Sampling started purposefully and continued in a snowball. Results: The experiences of patients with HIV/AIDS from stigma and discrimination led to exploring three main themes and nine subthemes. The main themes were multidimensional stigma, rejection, and insult and discrimination in receiving health services. Conclusions: Stigma and discrimination play an important role in patients' lives and hinder them from accessing the treatment. The patients' responses to this event by secrecy strategy can be an important factor in the disease prevalence. PMID:26290751

  10. Management of lipid disorders in patients living with HIV.

    PubMed

    Myerson, Merle; Malvestutto, Carlos; Aberg, Judith A

    2015-09-01

    Since the discovery and development of antiretroviral therapy (ART), HIV has become a chronic disease with patients living longer lives and to ages where co-morbidities, such as cardiovascular disease (CVD) are prevalent. Diagnosis and management of risk factors for CVD, in particular dyslipidemia, have become an important part of the overall care for patients living with HIV infection. Existing guidelines and recommendations for the management of dyslipidemia for persons with HIV infection are largely based on guidelines for the general population. Clinical and epidemiologic research efforts are ongoing to provide information specific to patients living with HIV. This review offers a detailed guide for clinicians who manage dyslipidemia in patients infected with HIV. The first sections provide background information on dyslipidemia, risk stratification, and targets for lipid therapy. This is followed by a step-by-step approach for diagnosis and treatment with specific information on lipid drug use for patients with HIV. The recommendations presented here are based on existing guidelines for the general population, evidence from research in patients infected with HIV, and the clinical experience of the authors. Management issues for which little or no information is available specific to this patient population are noted and serve to highlight the many gaps in our knowledge that will need to be addressed.

  11. Fifteen-Year Trends in the Prevalence of Diabetes among Hospitalized HIV-Infected Patients in Spain (1997-2012)

    PubMed Central

    Alvaro-Meca, Alejandro; Jimenez-Trujillo, Isabel; Hernandez-Barrera, Valentin; de Miguel-Diez, Javier

    2016-01-01

    Objective To describe trends in the prevalence of diabetes among hospitalized HIV-infected patients between 1997 and 2012 in Spain and compare them with those of age- and sex-matched non–HIV-infected patients. Methods The study was based on Spanish national hospital discharge data. We performed a retrospective study for the period 1997–2012. HIV infection (HIV-infected versus non–HIV-infected [control group])and calendar period in relation to widespread use of combination antiretroviral therapy (cART) (1997–1999; 2000–2003; 2004–2007 and 2008–2012), were the exposure variables The outcome variables were diagnosis of diabetes and in-hospital mortality (IHM). Results From 1997 to 2012, we identified 91,752 cases of diabetes: 15,398 in the HIV-infected group (403,277 hospital admissions) and 76,354 in the non–HIV-infected group (1,503,467 hospital admissions). Overall, HIV-infected patients had lower prevalence values for diabetes than non–HIV-infected patients throughout the follow-up (3.8% vs. 5.1%; p<0.001). The prevalence of diabetes increased 1.56-fold among non–HIV-infected patients and 4.2-fold among HIV-infected patients. The prevalence of diabetes in females was almost twice as high in HIV-infected patients as in non–HIV-infected patients during the last study period (4.72% vs. 2.88%; p<0.001). Diabetes showed a protective effect against IHM throughout the study period (aOR = 0.70; 95%CI, 0.65–0.75). Conclusions During the cART era, the prevalence of diabetes has increased sharply among HIV-infected hospitalized patients compared with matched non–HIV-infected subjects. The prevalence of diabetes is rising very fast among HIV-infected women. Diabetes has a protective effect on IHM among HIV-infected patients. Nevertheless, our study has several limitations. No information is available in the database used on important sociodemographic characteristics and relevant clinical variables including duration of the HIV infection, treatments

  12. Higher HIV RNA Viral Load in Recent Patients with Symptomatic Acute HIV Infection in Lyon University Hospitals

    PubMed Central

    Girerd-Genessay, Isabelle; Baratin, Dominique; Ferry, Tristan; Chidiac, Christian; Ronin, Vincent; Vanhems, Philippe

    2016-01-01

    Introduction Increased human immunodeficiency virus (HIV) virulence at infection has been suggested by a meta-analysis based on viral load and CD4 T lymphocytes (CD4) count during acute infection. This result was obtained after secondary analyses of large databases, facilitating the detection of differences. Similar finding in cohorts of more modest sample size would indicate that the effect could be more substantial. Methods Change from initial CD4 count and HIV viral load after acute HIV infection by calendar year was explored in patients treated at Lyon University hospitals. All patients admitted to our hospitals with acute HIV infection between 1996 and 2013 were included in our study. Initial CD4 count and viral load before the start of anti-retroviral treatment were analyzed. Trends over time were assessed in linear models. Results Initial CD4 count remained similar over time. However, in 2006–2013, initial viral load rose significantly (+1.12 log10/ml/year, p = 0.01). Conclusion Our data, obtained from a single hospital cohort, confirmed findings from a large meta-analysis, showed increased initial viremia at acute HIV infection since 2006 and suggesting potentially higher HIV virulence in recent years. PMID:26799390

  13. Cardiovascular Diseases in HIV-infected Subjects (HIV-HEART Study)

    ClinicalTrials.gov

    2010-05-07

    Detection of Frequency, Severity and Progression of Cardiovascular Diseases in Patients With HIV-infection.; Effect on Cardiovascular Risk and Life Quality by Age, Gender, Classic Cardiovascular Risk Factors,; HIV-specific Cardiovascular Risk Factors, Cardiovascular Medication, Antiretroviral Medication

  14. Cost of hospital care for HIV/AIDS infected patients in three general reference hospitals in Lubumbashi, DR Congo: prospective cohort study

    PubMed Central

    Tshamba, Henri Mundongo; a Kaut, Clarence Mukeng; Kyalubile, Nono Mulubwa; Kakambal, Alphonse Kaij; Yav, Grevisse Ditend; Kaj, Françoise Malonga; Vancaillie, Didier

    2013-01-01

    Introduction This article analyses the composition of healthcare costs for HIV/AIDS infected patients in a country with limited resources and attempts to identify the factors that influence these costs. The aims are to calculate medical care costs, analysing how they vary depending on patients’ income, and to evaluate the factors explaining healthcare consumption. Methods This is a prospective cohort study focusing on patients who were admitted to hospital for a short stay between January 2010 and June 2011, before their integration into a specialised program. The patients were selected randomly. Free consent was obtained from all participants. Data were analysed using the SPSS 19.0 software. The significance threshold was set at 5% and the CI (Confidence Interval) at 95%. We used Kruskal-Wallis tests, Fisher's exact test and multiple linear regression. Results We monitored 209 patients. Their average age was 36.37 years (SD: 8.72). The sex ratio was 0.58 and the women patients were generally younger than the male ones (p=0.011). The overall cost of healthcare amounted to $US 41,922. The cost of Antiretroviral Therapy represented 21.6% ($US 9,045). The price of para-clinical examinations represented 46% ($US 19,136) of the overall cost. The patient's average monthly income was $US 157.40 whereas the average direct cost per patient was$US 201.45. Both monthly income (t=4.385; p=0.0000) and education level (t=3.703 p=0.0003) were statistically significant predictive factors for healthcare consumption. The medical care costs for patients with opportunistic infections were nine times higher than those for patients who presented none. The presence of opportunistic infections increased healthcare consumption by approximately 31$ US (CI 95%: 15-46.9). Conclusion The average direct cost for patients on each short-term stay was higher than the average monthly income. To be able to access the necessary services, the patients need additional resources, which are derived

  15. Oral candidiasis and oral yeast carriage among institutionalised South African paediatric HIV/AIDS patients.

    PubMed

    Blignaut, Elaine

    2007-02-01

    South Africa currently has an estimated 500,000 AIDS orphans, many of whom are HIV-positive. Oral candidiasis commonly occurs in both adult and paediatric HIV/AIDS patients. Published information on HIV-positive children in Africa mainly concerns hospitalised patients. The objective of this study was to determine the prevalence of oral candidiasis and oral yeast carriage among paediatric HIV/AIDS patients residing in orphanages in Gauteng, South Africa, and to compare the prevalence of isolated yeast species with species obtained from adult HIV/AIDS patients. Eighty-seven paediatric HIV/AIDS patients residing in five homes were examined and a swab taken from the dorsal surface of the tongue, cultured on CHROMagar and yeast isolates identified with the ATB 32C commercial system. The species prevalence of 57 identified isolates was compared with that of 330 isolates from adult HIV/AIDS patients. Twelve (13.8%) children presented with clinically detectable candidiasis. Yeasts were isolated from 0% to 53% of children in the individual homes, with Candida albicans (40.4%) and C. dubliniensis (26.3%) constituting the most frequently isolated species. Gentian violet prophylaxis was administered in one particular home and a higher carriage rate (66.6%) of non-C. albicans and non-C. dubliniensis was observed among these children. The prevalence of C. albicans was lower while the prevalence of C. dubliniensis, C. glabrata and C. tropicalis was significantly higher (p < or = 0.001) among the children than among adult HIV/AIDS patients. These findings indicate a role for yeast culture and species determination in cases with candidiasis in institutionalized paediatric HIV/AIDS patients.

  16. Increased mitochondrial DNA content in peripheral blood lymphocytes from HIV-infected patients with lipodystrophy.

    PubMed

    Cossarizza, Andrea; Riva, Agostino; Pinti, Marcello; Ammannato, Silvia; Fedeli, Paolo; Mussini, Cristina; Esposito, Roberto; Galli, Massimo

    2003-08-01

    We have evaluated mitochondrial (mt) DNA content in CD4 and CD8 peripheral blood lymphocytes (PBLs) from HIV-infected patients taking highly active antiretroviral therapy (HAART) who display different types of adipose tissue alterations. A cross-sectional study was performed in a total of 23 patients with lipodystrophy (LD): nine patients with fat accumulation, six patients with fat loss, eight patients with combined form, who were compared to 11 individuals infected by HIV without LD (HIV-positive) and 10 seronegative controls (CTRL). PBLs were obtained by standard methods, that is, gradient density centrifugation on Ficoll, and CD4 or CD8 cells were positively isolated by magnetic sorting to eliminate the contamination of platelets. mtDNA content was then measured by an original assay based upon real-time PCR. mtDNA content was significantly increased in CD4 T cells from patients with LD, while no differences were present between CD4 and CD8 cells from HIV-positive and CTRL individuals. Nor were any differences found when comparing LD or HIV-positive patients treated with stavudine or zidovudine, or taking D-drugs or non D-drugs. Patients with fat accumulation had significantly higher mtDNA content compared to HIV-positive and CTRL, this phenomenon regarding both CD4 and CD8 PBLs. Considering all HIV-positive patients (including LD), mtDNA content showed a significant, positive correlation with cholesterolaemia but not with triglyceridaemia and glycaemia. Relatively high mtDNA content in LD patients, as well as the correlation between mtDNA content and cholesterol in all HIV-positive subjects, suggest the involvement of mitochondria in such a pathology. However, further studies are needed to confirm these initial observations and ascertain whether the quantification of mtDNA in PBL is a useful and reliable marker to investigate and monitor HAART-related changes in fat distribution.

  17. Lipid Changes in Virologically Suppressed HIV-Infected Patients Switching from any Antiretroviral Therapy to the Emtricitabine/Rilpivirine/Tenofovir Single Tablet: GeSida Study 8114.

    PubMed

    Palacios, Rosario; Mayorga, Marisa; Pérez-Hernández, Isabel A; Rivero, Antonio; Arco, Alfonso Del; Lozano, Fernando; Santos, Jesús

    2016-05-01

    We carried out a retrospective, multicenter study of a cohort of 298 asymptomatic HIV-infected patients who switched from a regimen based on 2 nucleoside reverse transcriptase inhibitors + protease inhibitor (PI)/nonnucleoside reverse transcriptase inhibitor or ritonavir-boosted PI monotherapy to emtricitabine/rilpivirine/tenofovir disoproxil fumarate (FTC/RPV/TDF) to analyze lipid changes. At 24 weeks, 284 (95.3%) patients were still taking the same regimen, maintaining similar CD4 counts as at baseline (651 versus 672 cells/mm(3), P = .08), and 98.9% of them with an undetectable viral load. Eight of the other 14 patients were lost to follow up and 6 (2.0%) ceased the new regimen: 3 due to adverse effects, 2 due to virologic failure, and 1 due to abandonment. The mean levels of fasting total cholesterol (TC), low-density lipoprotein cholesterol, high-density lipoprotein cholesterol (HDL-C), and triglycerides fell at 12 and 24 weeks, with no changes detected in the TC to HDL-C ratio. PMID:26858314

  18. Lipid Changes in Virologically Suppressed HIV-Infected Patients Switching from any Antiretroviral Therapy to the Emtricitabine/Rilpivirine/Tenofovir Single Tablet: GeSida Study 8114.

    PubMed

    Palacios, Rosario; Mayorga, Marisa; Pérez-Hernández, Isabel A; Rivero, Antonio; Arco, Alfonso Del; Lozano, Fernando; Santos, Jesús

    2016-05-01

    We carried out a retrospective, multicenter study of a cohort of 298 asymptomatic HIV-infected patients who switched from a regimen based on 2 nucleoside reverse transcriptase inhibitors + protease inhibitor (PI)/nonnucleoside reverse transcriptase inhibitor or ritonavir-boosted PI monotherapy to emtricitabine/rilpivirine/tenofovir disoproxil fumarate (FTC/RPV/TDF) to analyze lipid changes. At 24 weeks, 284 (95.3%) patients were still taking the same regimen, maintaining similar CD4 counts as at baseline (651 versus 672 cells/mm(3), P = .08), and 98.9% of them with an undetectable viral load. Eight of the other 14 patients were lost to follow up and 6 (2.0%) ceased the new regimen: 3 due to adverse effects, 2 due to virologic failure, and 1 due to abandonment. The mean levels of fasting total cholesterol (TC), low-density lipoprotein cholesterol, high-density lipoprotein cholesterol (HDL-C), and triglycerides fell at 12 and 24 weeks, with no changes detected in the TC to HDL-C ratio.

  19. Cognitive Deficits in Psychiatric Patients: Constraints on HIV Prevention.

    ERIC Educational Resources Information Center

    Tunnell, Gil

    Some mental health experts have suggested that particular subgroups of the chronic mentally ill may be especially vulnerable to human immunodeficiency virus (HIV) infection. Patients with mood disorders (manic type), schizophrenia, and dual diagnosis of either disorder with substance abuse are considered at high risk for HIV infection, as are…

  20. [THE MOLECULAR TECHNIQUES OF DIAGNOSTIC OF GINGIVITIS AND PERIODONTITIS IN HIV-INFECTED PATIENTS].

    PubMed

    Tsarev, V N; Nikolaeva, E N; Iagodina, E V; Trefilova, Yu A; Ippolitov, E V

    2016-01-01

    The examination was carried out in the Moscow clinical infectious hospital No 2 concerning 102 patients with verified diagnosis "AIDS-infection" and seropositive according results of detection of anti-HIV-antibodies in blood serum. The study was organized to analyze rate ofcolonization of gums with virulent anaerobic bacteria in HIV-infected (polymerase chain reaction) and antibodies to HIV in gingival fluid (enzyme-linked immunosorbent assay). It is established that in HIV-infected patients, in scrape from gingival sulcus dominate anaerobic bacteria P. gigngivalis and A. ctinomycetemcomitans and in case of periodontitis--P. gingivalis and T. forsythia. The received data permits recommending the test-system "Multident-5" for polymerase chain reaction diagnostic. The reagents kit "Calypte®HIV-1/2"--for enzyme-linked immunosorbent assay gingival fluid. The results of polymerase chain reaction and enzyme-linked immunosorbent assay have no impact of concomitant stomatological (periodontitis, gingivitis) and somatic pathology.

  1. [THE MOLECULAR TECHNIQUES OF DIAGNOSTIC OF GINGIVITIS AND PERIODONTITIS IN HIV-INFECTED PATIENTS].

    PubMed

    Tsarev, V N; Nikolaeva, E N; Iagodina, E V; Trefilova, Yu A; Ippolitov, E V

    2016-01-01

    The examination was carried out in the Moscow clinical infectious hospital No 2 concerning 102 patients with verified diagnosis "AIDS-infection" and seropositive according results of detection of anti-HIV-antibodies in blood serum. The study was organized to analyze rate ofcolonization of gums with virulent anaerobic bacteria in HIV-infected (polymerase chain reaction) and antibodies to HIV in gingival fluid (enzyme-linked immunosorbent assay). It is established that in HIV-infected patients, in scrape from gingival sulcus dominate anaerobic bacteria P. gigngivalis and A. ctinomycetemcomitans and in case of periodontitis--P. gingivalis and T. forsythia. The received data permits recommending the test-system "Multident-5" for polymerase chain reaction diagnostic. The reagents kit "Calypte®HIV-1/2"--for enzyme-linked immunosorbent assay gingival fluid. The results of polymerase chain reaction and enzyme-linked immunosorbent assay have no impact of concomitant stomatological (periodontitis, gingivitis) and somatic pathology. PMID:27183732

  2. Metabolic Syndrome and Subclinical Atherosclerosis in Patients Infected with HIV

    PubMed Central

    Mangili, Alexandra; Jacobson, Denise L.; Gerrior, Jul; Polak, Joseph F.; Gorbach, Sherwood L.; Wanke, Christine A.

    2009-01-01

    Background The present study examines the association between carotid and coronary atherosclerosis and metabolic syndrome in human immunodeficiency virus (HIV)–infected adults. Methods We measured the common and internal carotid intima-media thickness (c-IMT) using B-mode ultrasonography, and we measured coronary artery calcium (CAC) using high-resolution, electrocardiographic, synchronized, computed tomography, for 314 HIV-infected men and women. Metabolic syndrome was defined by National Cholesterol Education Program/Adult Treatment Panel III criteria. We compared the c-IMT measurements and CAC scores of patients with metabolic syndrome with the scores of those without metabolic syndrome using a Wilcoxon test for continuous variables and a χ2 test for categorical variables. To examine the association between surrogate markers and metabolic syndrome, we used logistic regression analysis. Results Participants with metabolic syndrome were more likely to have a common c-IMT measurement >0.8 mm than were those without metabolic syndrome (17% vs.7%; P=.009), but both groups were equally likely to have an internal c-IMT measurement >1.0 mm (20% vs. 13%; P=.15). Any positive CAC score was more likely to occur for participants with metabolic syndrome (80.3% vs. 46.7%; P < .0001). In a multivariate model adjusted for sex, age, ethnicity, and smoking status, participants with metabolic syndrome were more likely than those without metabolic syndrome to have an abnormal common c-IMT measurement (odds ratio [OR], 2.9; P= .020) and detectable CAC scores (OR, 4.9; P < .0001) but not a higher internal c-IMT measurement (OR, 1.6; P=.255). Conclusion Our study demonstrates that HIV-infected individuals with metabolic syndrome may be at increased risk for subclinical atherosclerosis and supports screening for metabolic syndrome among HIV-infected patients at risk for cardiovascular disease. PMID:17443477

  3. Depression and diagnosis of neurocognitive impairment in HIV-positive patients

    PubMed Central

    Pinheiro, C.A.T.; Souza, L.D.M.; Motta, J.V.S.; Kelbert, E.F.; Souza, M.S.; Martins, C.S.R.; Coelho, F.M.C.; Pinheiro, K.A.T.; Pinheiro, R.T.

    2016-01-01

    Neurocognitive impairment (NCI) is frequently observed in patients infected with human immunodeficiency virus (HIV) and results from the compromise of subcortical brain structures by the virus. The manifestations of NCI range from asymptomatic impairment to dementia. In addition to cognitive impairment resulting from HIV infection, other factors such as depression are associated with the loss of cognitive functions. The aim of this study was to estimate the prevalence of NCI in HIV-positive patients in a city in southern Brazil and to establish possible associations for the prevalence of NCI with HIV-related and other risk factors. This cross-sectional study of HIV-positive outpatients was conducted in a specialized care service in the city of Pelotas in Southern Brazil. Sociodemographic data and HIV-related information were collected, and all patients underwent psychiatric and neurocognitive evaluations. The prevalence of NCI among the 392 patients was 54.1% when tracked using the IHDS (International HIV Dementia Scale) and 36.2% when the IHDS was associated with a battery of complementary tests. A bivariate analysis suggested an association of NCI with gender, age, educational level, depression, current CD4 count and lowest CD4 count. The association of NCI with depression remained in the Poisson regression (PR=1.96, 95%CI=1.12-3.42). The prevalence of cognitive impairment in HIV-positive patients estimated in this study is in accordance with international and Brazilian data. Of the factors analyzed, depression showed the greatest evidence of association with neurocognitive loss. Based on our findings, the inclusion of instruments to evaluate depression in our services for patients with HIV and acquired immunodeficiency syndrome (AIDS) is recommended. PMID:27626305

  4. Depression and diagnosis of neurocognitive impairment in HIV-positive patients.

    PubMed

    Pinheiro, C A T; Souza, L D M; Motta, J V S; Kelbert, E F; Souza, M S; Martins, C S R; Coelho, F M C; Pinheiro, K A T; Pinheiro, R T

    2016-01-01

    Neurocognitive impairment (NCI) is frequently observed in patients infected with human immunodeficiency virus (HIV) and results from the compromise of subcortical brain structures by the virus. The manifestations of NCI range from asymptomatic impairment to dementia. In addition to cognitive impairment resulting from HIV infection, other factors such as depression are associated with the loss of cognitive functions. The aim of this study was to estimate the prevalence of NCI in HIV-positive patients in a city in southern Brazil and to establish possible associations for the prevalence of NCI with HIV-related and other risk factors. This cross-sectional study of HIV-positive outpatients was conducted in a specialized care service in the city of Pelotas in Southern Brazil. Sociodemographic data and HIV-related information were collected, and all patients underwent psychiatric and neurocognitive evaluations. The prevalence of NCI among the 392 patients was 54.1% when tracked using the IHDS (International HIV Dementia Scale) and 36.2% when the IHDS was associated with a battery of complementary tests. A bivariate analysis suggested an association of NCI with gender, age, educational level, depression, current CD4 count and lowest CD4 count. The association of NCI with depression remained in the Poisson regression (PR=1.96, 95%CI=1.12-3.42). The prevalence of cognitive impairment in HIV-positive patients estimated in this study is in accordance with international and Brazilian data. Of the factors analyzed, depression showed the greatest evidence of association with neurocognitive loss. Based on our findings, the inclusion of instruments to evaluate depression in our services for patients with HIV and acquired immunodeficiency syndrome (AIDS) is recommended. PMID:27626305

  5. Fecal bacterial microbiome diversity in chronic HIV-infected patients in China

    PubMed Central

    Sun, Yang; Ma, Yingfei; Lin, Ping; Tang, Yi-Wei; Yang, Liying; Shen, Yinzhong; Zhang, Renfan; Liu, Li; Cheng, Jun; Shao, Jiashen; Qi, Tangkai; Tang, Yan; Cai, Rentian; Guan, Liqian; Luo, Bin; Sun, Meiyan; Li, Ben; Pei, Zhiheng; Lu, Hongzhou

    2016-01-01

    The purpose of this study was to identify fecal bacterial microbiome changes in patients with chronic human immunodeficiency virus (HIV) infection in China. Bacterial 16S rRNA genes were amplified, sequenced (454 pyrosequencing), and clustered into operational taxonomic units using the QIIME software. Relative abundance at the phylum and genus levels were calculated. Alpha diversity was determined by Chao 1 and observed-species indices, and beta diversity was determined by double principal component analysis using the estimated phylogeny-based unweighted Unifrac distance matrices. Fecal samples of the patients with chronic HIV-infection tended to be enriched with bacteria of the phyla Firmicutes (47.20%±0.43 relative abundance) and Proteobacteria (37.21%±0.36) compared with those of the non-HIV infected controls (17.95%±0.06 and 3.81%±0.02, respectively). Members of the genus Bilophila were exclusively detected in samples of the non-HIV infected controls. Bacteroides and arabacteroides were more abundant in the chronic HIV-infected patients. Our study indicated that chronic HIV-infected patients in China have a fecal bacterial microbiome composition that is largely different from that found in non-HIV infected controls, and further study is needed to evaluate whether microbiome changes play a role in disease complications in the distal gut, including opportunistic infections. PMID:27048741

  6. Cocaine enhances HIV-1-induced CD4(+) T-cell apoptosis: implications in disease progression in cocaine-abusing HIV-1 patients.

    PubMed

    Pandhare, Jui; Addai, Amma B; Mantri, Chinmay K; Hager, Cynthia; Smith, Rita M; Barnett, Louis; Villalta, Fernando; Kalams, Spyros A; Dash, Chandravanu

    2014-04-01

    Substance abuse is a major barrier in eradication of the HIV epidemic because it serves as a powerful cofactor for viral transmission, disease progression, and AIDS-related mortality. Cocaine, one of the commonly abused drugs among HIV-1 patients, has been suggested to accelerate HIV disease progression. However, the underlying mechanism remains largely unknown. Therefore, we tested whether cocaine augments HIV-1-associated CD4(+) T-cell decline, a predictor of HIV disease progression. We examined apoptosis of resting CD4(+) T cells from HIV-1-negative and HIV-1-positive donors in our study, because decline of uninfected cells plays a major role in HIV-1 disease progression. Treatment of resting CD4(+) T cells with cocaine (up to 100 μmol/L concentrations) did not induce apoptosis, but 200 to 1000 μmol/L cocaine induced apoptosis in a dose-dependent manner. Notably, treatment of CD4(+) T cells isolated from healthy donors with both HIV-1 virions and cocaine significantly increased apoptosis compared with the apoptosis induced by cocaine or virions alone. Most important, our biochemical data suggest that cocaine induces CD4(+) T-cell apoptosis by increasing intracellular reactive oxygen species levels and inducing mitochondrial depolarization. Collectively, our results provide evidence of a synergy between cocaine and HIV-1 on CD4(+) T-cell apoptosis that may, in part, explain the accelerated disease observed in HIV-1-infected drug abusers.

  7. Trends in annual incidence of methicillin-resistant Staphylococcus aureus (MRSA) infection in HIV-infected and HIV-uninfected patients.

    PubMed

    Delorenze, G N; Horberg, M A; Silverberg, M J; Tsai, A; Quesenberry, C P; Baxter, R

    2013-11-01

    We describe trends in incidence rates of methicillin-resistant Staphylococcus aureus (MRSA) in HIV-infected and HIV-uninfected patients enrolled in a large northern California Health Plan, and the ratio of MRSA to methicillin-susceptible S. aureus (MSSA) case counts. Between 1995 and 2010, 1549 MRSA infections were diagnosed in 14060 HIV-infected patients (11·0%) compared to 89546 MRSA infections in 6597396 HIV-uninfected patients (1·4%) (P = 0·00). A steady rise in MRSA infection rates began in 1995 in HIV-uninfected patients, peaking at 396·5 infections/100000 person-years in 2007. A more rapid rise in MRSA infection rates occurred in the HIV-infected group after 2000, peaking at 3592·8 infections/100000 in 2005. A declining trend in MRSA rates may have begun in 2008-2009. Comparing the ratio of MRSA to MSSA case counts, we observed that HIV-infected patients shouldered a greater burden of MRSA infection during most years of study follow-up compared to HIV-uninfected patients.

  8. Necrotising herpetic retinopathy in patients with advance HIV disease.

    PubMed Central

    Miller, R F; Brink, N S; Cartledge, J; Sharvell, Y; Frith, P

    1997-01-01

    OBJECTIVES: To describe the presenting features, clinical and laboratory diagnosis, response to treatment, and outcome of necrotising herpetic retinopathy (NHR) in HIV infected patients. METHODS: Retrospective case records/laboratory data review of five HIV infected patients presenting to the specialist HIV/AIDS unit at UCL Hospitals, London from April 1994 to August 1996 with a clinical diagnosis of NHR. RESULTS: All patients had advanced HIV disease with a median CD4 count of 20.10(6)/1. Three patients had cutaneous varicella zoster virus (VZV) infection within the preceding 8 weeks. All had uniocular loss of visual acuity; one also had headache and another ocular pain. All had typical retinal appearances. VZV DNA was detected in cerebrospinal fluid of four patients (and in vitreous fluid of one of the four) and in vitreous fluid of one other. One patient refused therapy and rapidly became blind. Four patients received intravenous foscarnet with intravenous aciclovir for 6 weeks: three subsequently received oral famciclovir and one oral valaciclovir; two patients also had intravitreal injections of foscarnet. In none of the four did treatment bring about improvement in visual acuity, but in all four visual loss from retinitis was halted. CONCLUSIONS: NHR occurs in HIV infected patients with advanced HIV disease and is strongly associated with evidence of VZV infection. With aggressive use of antiviral drugs the outcome is not uniformly poor. Images PMID:9582461

  9. Toxoplasma gondii - Prevalence and Risk Factors in HIV-infected Patients from Songklanagarind Hospital, Southern Thailand.

    PubMed

    Chemoh, Waenurama; Sawangjaroen, Nongyao; Siripaitoon, Pisut; Andiappan, Hemah; Hortiwakul, Thanaporn; Sermwittayawong, Natthawan; Charoenmak, Bunsri; Nissapatorn, Veeranoot

    2015-01-01

    Toxoplasmosis is one of the most common opportunistic parasitic diseases in patients living with HIV/AIDS. This study aimed to determine the seroprevalence of Toxoplasma infection in HIV-infected patients and to identify associated risk factors in Toxoplasma seropositive patients. This study was conducted at a regional public hospital in Hat Yai, southern Thailand during October 2009 to June 2010. Blood samples were collected from 300 HIV-infected patients. Each subject also answered a socio-demographic and risk factors associated with Toxoplasma infection. The prevalence of anti-Toxoplasma IgG antibodies in HIV-infected patients was 109 (36.3%), of which 83 (76.2%) had past infection and 26 (23.9%) had recently acquired Toxoplasma infection as indicated by their IgG avidity. Multivariate analysis using logistic regression showed that gender difference (adjusted OR = 1.69, 95% CI = 1.05-2.72) was the only factor associated with Toxoplasma infection. From the results obtained, these HIV-infected patients could be at high risk of developing clinical evidence of severe toxoplasmosis. Therefore, it is necessary to introduce primary behavioral practices to prevent Toxoplasma infection among HIV-infected patients. PMID:26635769

  10. [The usefulness of a genogram as a tool in therapeutic patient education: an exploratory study of parents of children living with HIV/AIDS in Benin].

    PubMed

    Juré, Estelle; Iguenane, Jacqueline; Toudonou, Annicette; Azondekon, Alain; Gagnayre, Rémi

    2010-01-01

    Understanding family dynamics and relationship is an important facet of care, therapeutic education and psychosocial support. As part of a therapeutic education program organized within a pediatric service in Cotonou, Benin, we have experimented with the genogram at the time of diagnosis and tested it as an educational tool. This study evaluates the usefulness of the genogram for therapeutic patient education, and its capacity to serve as an aid to better understand family structure and dynamics. The study was conducted in 2007 with 29 parents of children living with HIV / AIDS. Six professionals observed the conditions for the development and application of the genograms their effects on the production of information of an educational nature. The results indicate that it can provide families and caregivers benchmarks essential for understanding the role of the family and community in which the child-patient is situated and how they function. It facilitates the identification of key resource persons for the child and selfcare to be mobilized and fostered within the family.

  11. Depression in caregivers of status-naïve pediatric HIV patients participating in a status disclosure study in Haiti and the Dominican Republic: preliminary report.

    PubMed

    Beck-Sagué, Consuelo M; Dévieux, Jessy G; Pinzón-Iregui, María Claudia; Abreu-Pérez, Rosa; Lerebours-Nadal, Leonel; Gaston, Stephanie; Dean, Andrew G; Halpern, Mina; Rouzier, Vanessa; Bertrand, Rachel; Rosenberg, Rhonda; Pape, Jean William; Nicholas, Stephen W; Blasini, Ileana

    2015-02-01

    A pilot study is underway to assess safety and acceptability of an intervention to disclose their HIV infection status to status-naïve pediatric antiretroviral therapy patients in Hispaniola [the island shared by Haiti and the Dominican Republic (DR)]. Of 22 Haiti and 47 DR caregivers recruited to date, 68.2% Haiti and 34.0% DR caregivers had clinically significant depressive symptomatology at the time of enrollment (p = 0.008). Depressive symptom prevalence was higher in Haiti caregivers who were female (81.3% vs. 0 in males; p = 0.02) and in DR caregivers who were patients' mothers (50.0%) or grandmothers (66.7%; 56.0% combined) than others (9.1%), (p < 0.001). Internalized stigma was more commonly reported by Haiti (85.7%) than DR (53.2%; p = 0.01) caregivers; 56.4% of Haiti and DR caregivers reporting internalized stigma vs. 26.1% of caregivers denying it had depressive symptoms (p = 0.02). Depression is common in Hispaniola caregivers possibly affecting disclosure timing. Study participation presents opportunities for addressing caregiver depression.

  12. STIGMA, SOCIAL SUPPORT, AND TREATMENT ADHERENCE AMONG HIV-POSITIVE PATIENTS IN CHIANG MAI, THAILAND

    PubMed Central

    Li, Michael Jonathan; Murray, Jordan Keith; Suwanteerangkul, Jiraporn; Wiwatanadate, Phongtape

    2016-01-01

    Our study assessed the influence of HIV-related stigma on treatment adherence among people living with HIV in Chiang Mai, Thailand, and whether social support had a moderating effect on this relationship. We recruited 128 patients living with HIV from Sansai Hospital, a community hospital in Chiang Mai, Thailand, and collected data through structured interviews. All forms of HIV-related stigma considered in this study (personalized experience, disclosure, negative self-image, and public attitudes) were negatively correlated with adherence to anti-retroviral regimens. Multiple linear regression indicated that total HIV-related stigma was more predictive of treatment adherence than any individual stigma type, after adjusting for socio-demographic and health characteristics. Tests of interaction showed that social support did not appear to moderate the association between HIV stigma and treatment adherence. Our findings suggest that community and government efforts to improve public perceptions about people living with HIV might promote treatment adherence behaviors among HIV-positive patients. PMID:25299810

  13. Stigma, social support, and treatment adherence among HIV-positive patients in Chiang Mai, Thailand.

    PubMed

    Li, Michael Jonathan; Murray, Jordan Keith; Suwanteerangkul, Jiraporn; Wiwatanadate, Phongtape

    2014-10-01

    Our study assessed the influence of HIV-related stigma on treatment adherence among people living with HIV in Chiang Mai, Thailand, and whether social support had a moderating effect on this relationship. We recruited 128 patients living with HIV from Sansai Hospital, a community hospital in Chiang Mai, Thailand, and collected data through structured interviews. All forms of HIV-related stigma considered in this study (personalized experience, disclosure, negative self-image, and public attitudes) were negatively correlated with adherence to anti-retroviral regimens. Multiple linear regression indicated that total HIV-related stigma was more predictive of treatment adherence than any individual stigma type, after adjusting for socio-demographic and health characteristics. Tests of interaction showed that social support did not appear to moderate the association between HIV stigma and treatment adherence. Our findings suggest that community and government efforts to improve public perceptions about people living with HIV might promote treatment adherence behaviors among HIV-positive patients. PMID:25299810

  14. Perceptions of HIV infected patients on the use of cell phone as a tool to support their antiretroviral adherence; a cross-sectional study in a large referral hospital in Kenya

    PubMed Central

    2013-01-01

    Background Clinical trials were conducted to assess the feasibility of using a cell phone text messaging-based system to follow up Human Immunodeficiency Virus (HIV) infected patients on antiretroviral (ARTs) and assess for improved adherence to their medication. However there is need to evaluate the perceptions of the HIV infected patients towards the use of these cell phones in an effort to better aid in the clinical management of their HIV infection. The objective of this study was therefore to determine the perceptions of HIV infected patients on the use of cell phone text messaging as a tool to support adherence to their ART medication. Methods A cross sectional survey was conducted among patients receiving Highly Active Anti-Retroviral Therapy (HAART) at the Kenyatta National Hospital Comprehensive Care Clinic in Nairobi between May and July, 2011. Pre-tested questionnaires were used to collect the socio-demographic and perceptions data. The recruitment of the participants was done using the random probability sampling method and statistical analysis of data performed using Statistical Package for Social Sciences (SPSS) version 16.0. Results A total of 500 HIV infected patients (Male-107, Female-307) aged 19-72 years were interviewed. The majority of individuals (99%) had access to cell phones and 99% of the HIV infected patients interviewed supported the idea of cell phone use in management of their HIV infection. A large proportion (46%) claimed that they needed cell phone access for medical advice and guidance on factors that hinder their adherence to medication and only 3% of them needed it as a reminder to take their drugs. The majority (72%) preferred calling the healthcare provider with their own phones for convenience and confidential purposes with only 0.4% preferring to be called or texted by the health care provider. Most (94%), especially the older patients, had no problem with their confidentiality being infringed in the process of the

  15. Epidemiological profile of naive HIV-1/AIDS patients in Istanbul: the largest case series from Turkey.

    PubMed

    Yemisen, Mucahit; Aydın, Ozlem Altuntas; Gunduz, Alper; Ozgunes, Nail; Mete, Bilgul; Ceylan, Bahadir; Karaosmanoglu, Hayat Kumbasar; Yildiz, Dilek; Sargin, Fatma; Ozaras, Resat; Tabak, Fehmi

    2014-01-01

    The aim of the study was to report the epidemiological profile of HIV-1 positive patients from, Istanbul, Turkey, which has one of the lowest HIV-1/AIDS prevalences in Europe. The patients were followed by ACTHIV-IST group which was established by the Infectious Diseases Departments of five teaching hospitals (three university hospitals and two public hospitals) in Istanbul, Turkey. The HIV-1 positive patients were added to the standard patient files in all of the centers; these files were then transferred to the ACTHIV-IST database in the Internet. A total of 829 naiv-untreated HIV-1 positive patients were chosen from the database. The number of male patients was 700 (84.4%) and the mean age of the patients was 37 years (range, 17-79). In our study group 348 (42%) of the patients were married and 318 (38.7%) of the patients were single. The probable route of transmission was heterosexual intercourse in 437 (52.7%) patients and homosexual intercourse in 256 (30.9%) patients. In 519 (62.6%) patients the diagnose was made due to a screening test and in 241 (29.1%) patients, the diagnose was made due to an HIV-related/non-related disease. The mean CD4+ T cell number in 788 of the patients was 357.8/mm(3) (±271.1), and the median viral load in 698 of the patients was 100,000 copies/mL (20-9,790,000). In Turkey, the number of HIV-1 positive patients is still low and to diagnose with a screening test is the most common way of diagnostic route.

  16. [Cervical cancer: particularities in HIV patients].

    PubMed

    Grellier, Noémie; Quéro, Laurent

    2014-11-01

    Cervical cancer is the second most common cancer in women worldwide. It represents one of the most challenging public health problems in developing countries. HIV-infected women have a higher risk of cervical cancer which is an AIDS defining cancer. Cervical cancer treatment in HIV-infected and non-infected women is the same. HIV naive women must be prescribed combination antiretroviral therapy at the moment of HIV cancer diagnosis. A close collaboration between oncologist and infectiologist is mandatory to optimize HIV treatment. Among HIV-infected women, PAP-smear screening for early detection and treatment of precancerous cervical lesions is recommended. HPV vaccination is also recommended with the same efficacy and safety profile as the general population.

  17. Social Work and the HIV Care Continuum: Assisting HIV Patients Diagnosed in an Emergency Department.

    PubMed

    Edmonds, Amy; Moore, Eric; Valdez, Andre; Tomlinson, Cheri

    2015-07-01

    Social workers have played an integral role in society's response to the HIV/AIDS pandemic since the discovery of the disease. As the landscape of the epidemic has changed, so has the social work response to it. Social workers are, and have been, central to the success of TESTAZ (Test, Educate, Support, and Treat Arizona), which is a nontargeted, routine opt-out HIV screening program in the emergency department (ED) of Maricopa Medical Center. This article focuses on the crucial role social workers play in every stage of program development, implementation, and patient movement through the stages of the HIV care continuum. Social worker involvement with HIV-positive patients diagnosed in the ED is imperative to achieving patient viral suppression.

  18. 'I believe that the staff have reduced their closeness to patients': an exploratory study on the impact of HIV/AIDS on staff in four rural hospitals in Uganda

    PubMed Central

    Dieleman, Marjolein; Bwete, Vincent; Maniple, Everd; Bakker, Mirjam; Namaganda, Grace; Odaga, John; van der Wilt, Gert Jan

    2007-01-01

    Background Staff shortages could harm the provision and quality of health care in Uganda, so staff retention and motivation are crucial. Understanding the impact of HIV/AIDS on staff contributes to designing appropriate retention and motivation strategies. This research aimed 'to identify the influence of HIV/AIDS on staff working in general hospitals at district level in rural areas and to explore support required and offered to deal with HIV/AIDS in the workplace'. Its results were to inform strategies to mitigate the impact of HIV/AIDS on hospital staff. Methods A cross-sectional study with qualitative and quantitative components was implemented during two weeks in September 2005. Data were collected in two government and two faith-based private not-for-profit hospitals purposively selected in rural districts in Uganda's Central Region. Researchers interviewed 237 people using a structured questionnaire and held four focus group discussions and 44 in-depth interviews. Results HIV/AIDS places both physical and, to some extent, emotional demands on health workers. Eighty-six per cent of respondents reported an increased workload, with 48 per cent regularly working overtime, while 83 per cent feared infection at work, and 36 per cent reported suffering an injury in the previous year. HIV-positive staff remained in hiding, and most staff did not want to get tested as they feared stigmatization. Organizational responses were implemented haphazardly and were limited to providing protective materials and the HIV/AIDS-related services offered to patients. Although most staff felt motivated to work, not being motivated was associated with a lack of daily supervision, a lack of awareness on the availability of HIV/AIDS counselling, using antiretrovirals and working overtime. The specific hospital context influenced staff perceptions and experiences. Conclusion HIV/AIDS is a crucially important contextual factor, impacting on working conditions in various ways. Therefore

  19. Hospital pharmacists’ knowledge about and attitude toward HIV/AIDS and patients living with HIV/AIDS in Kedah, Malaysia

    PubMed Central

    Baig, Mirza Rafi

    2012-01-01

    Introduction The current study aims to explore the knowledge, attitude, and perception of hospital pharmacists towards HIV/AIDS and patients living with HIV/AIDS (PLWHA) in the state of Kedah, Malaysia. Material and methods This was a cross-sectional study conducted among the hospital pharmacists in three government hospitals in Kedah, using a self-administered 43-item questionnaire. Data analysis was done using non-parametric and multinomial regression. Results A total of 75 respondents participated in this study, resulting in a response rate of 60.8%. The majority were found to be well aware of the causes of HIV/AIDS. However, about 34 (45.3%) believed erroneously that HIV/AIDS cannot be transmitted through tattooing or body piercing. Nearly 25 (33.3%) of the respondents believed that preventing the use of intravenous drugs may not be effective to prevent HIV/AIDS and endorsed social isolation as a measure to prevent HIV/AIDS. The majority (66.6%) had negative attitudes and about 20% held extremely negative attitudes. Findings from regression modelling revealed that hospital (–2 log likelihood = 215.182, χ2 = 18.060, Df = 8, p = 0.021) and gender (–2 log likelihood = 213.643, χ2 = 16.521, Df = 8, p = 0.035) were more likely to affect the attitudes of respondents. Conclusions Overall, more than one third of the respondents were found to have negative attitudes towards PLWHA. Gender, job experience, and hospitals with more HIV/AIDS patient visits were the main factors affecting attitudes. PMID:24482660

  20. Probiotics Differently Affect Gut-Associated Lymphoid Tissue Indolamine-2,3-Dioxygenase mRNA and Cerebrospinal Fluid Neopterin Levels in Antiretroviral-Treated HIV-1 Infected Patients: A Pilot Study

    PubMed Central

    Scagnolari, Carolina; Corano Scheri, Giuseppe; Selvaggi, Carla; Schietroma, Ivan; Najafi Fard, Saeid; Mastrangelo, Andrea; Giustini, Noemi; Serafino, Sara; Pinacchio, Claudia; Pavone, Paolo; Fanello, Gianfranco; Ceccarelli, Giancarlo; Vullo, Vincenzo; d’Ettorre, Gabriella

    2016-01-01

    Recently the tryptophan pathway has been considered an important determinant of HIV-1 infected patients’ quality of life, due to the toxic effects of its metabolites on the central nervous system (CNS). Since the dysbiosis described in HIV-1 patients might be responsible for the microbial translocation, the chronic immune activation, and the altered utilization of tryptophan observed in these individuals, we speculated a correlation between high levels of immune activation markers in the cerebrospinal fluid (CSF) of HIV-1 infected patients and the over-expression of indolamine-2,3-dioxygenase (IDO) at the gut mucosal surface. In order to evaluate this issue, we measured the levels of neopterin in CSF, and the expression of IDO mRNA in gut-associated lymphoid tissue (GALT), in HIV-1-infected patients on effective combined antiretroviral therapy (cART), at baseline and after six months of probiotic dietary management. We found a significant reduction of neopterin and IDO mRNA levels after the supplementation with probiotic. Since the results for the use of adjunctive therapies to reduce the levels of immune activation markers in CSF have been disappointing so far, our pilot study showing the efficacy of this specific probiotic product should be followed by a larger confirmatory trial. PMID:27689995

  1. Talaromyces (Penicillium) marneffei infection in non-HIV-infected patients

    PubMed Central

    Chan, Jasper FW; Lau, Susanna KP; Yuen, Kwok-Yung; Woo, Patrick CY

    2016-01-01

    Talaromyces (Penicillium) marneffei is an important pathogenic thermally dimorphic fungus causing systemic mycosis in Southeast Asia. The clinical significance of T. marneffei became evident when the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome epidemic arrived in Southeast Asia in 1988. Subsequently, a decline in the incidence of T. marneffei infection among HIV-infected patients was seen in regions with access to highly active antiretroviral therapy and other control measures for HIV. Since the 1990s, an increasing number of T. marneffei infections have been reported among non-HIV-infected patients with impaired cell-mediated immunity. Their comorbidities included primary adult-onset immunodeficiency due to anti-interferon-gamma autoantibodies and secondary immunosuppressive conditions including other autoimmune diseases, solid organ and hematopoietic stem cell transplantations, T-lymphocyte-depleting immunsuppressive drugs and novel anti-cancer targeted therapies such as anti-CD20 monoclonal antibodies and kinase inhibitors. Moreover, improved immunological diagnostics identified more primary immunodeficiency syndromes associated with T. marneffei infection in children. The higher case-fatality rate of T. marneffei infection in non-HIV-infected than HIV-infected patients might be related to delayed diagnosis due to the lack of clinical suspicion. Correction of the underlying immune defects and early use of antifungals are important treatment strategies. Clinicians should be familiar with the changing epidemiology and clinical management of T. marneffei infection among non-HIV-infected patients. PMID:26956447

  2. Propensity of HIV Patients to Seek Urgent and Emergent Care

    PubMed Central

    Gifford, Allen L; Collins, Rebecca; Timberlake, David; Schuster, Mark A; Shapiro, Martin F; Bozzette, Samuel A; Kanouse, David E

    2000-01-01

    OBJECTIVE To assess the propensity of HIV-infected adults to seek care for common symptoms, and to determine whether they would seek care in the emergency department (ED) or with their primary care provider. DESIGN Cross-sectional interview study. SETTING Patients in care in the 48 contiguous United States. PARTICIPANTS A nationally representative group of HIV- infected adults selected using multistage probability sampling. MEASUREMENTS Subjects were interviewed between January 1996 and April 1997. Patients with advanced disease (past AIDS diagnosis and/or CD4 cell count <200/μL) and early disease were asked how they would seek care for key HIV-associated symptom complexes. Three advanced disease and 3 early disease symptom scenarios were used. MAIN RESULTS Most advanced disease patients (78% to 87%) would seek care right away from the ED or primary care provider for the symptoms asked. Most early disease patients (82%) would seek care right away for new respiratory symptoms; fewer would do so for headache (46%) or oral white patches (62%). In a multivariate model, independent predictors of propensity to use the ED for advanced disease symptoms included African-American ethnicity (adjusted odds ratio [OR], 2.5; 95% confidence interval [95% CI], 1.8 to 3.4); less education (adjusted OR, 1.4; 95% CI, 1.1 to 1.7); drug dependence (adjusted OR, 1.4; 95% CI, 1.1 to 1.7); annual income less than $5,000 (adjusted OR, 1.5; 95% CI, 1.0 to 2.3); and lower psychological well-being (adjusted OR, 0.9; 95% CI, 0.9 to 1.0). In early disease, the following independently predicted ED use: African American (adjusted OR, 4.7; 95% CI, 3.1 to 7.1) or Hispanic ethnicity (adjusted OR 2.4; 95% CI, 1.4 to 4.3), female gender (adjusted OR, 1.6; 95% CI, 1.2 to 2.2), annual income less than $5,000 (adjusted OR, 1.8; 95% CI, 1.1 to 3.0), and lower psychological well-being (adjusted OR, 0.9; 95% CI, 0.8 to 1.0). CONCLUSIONS Many patients would use the ED instead of same-day primary care for

  3. No relationship between TNF-α genetic variants and combination antiretroviral therapy-related lipodystrophy syndrome in HIV type 1-infected patients: a case-control study and a meta-analysis.

    PubMed

    Veloso, Sergi; Olona, Montserrat; Peraire, Joaquim; Viladés, Consuelo; Pardo, Pedro; Domingo, Pere; Asensi, Victor; Broch, Montserrat; Aguilar, Carmen; López-Dupla, Miguel; Aragonés, Gerard; Garcia-Pardo, Graciano; Sirvent, Joan-Josep; Vendrell, Joan; Richart, Cristóbal; Vidal, Francesc

    2011-02-01

    Tumor necrosis factor alpha (TNF-α) is thought to be involved in the pathogenic and metabolic events associated with HIV-1 infection. We assessed whether carriage of the TNF-α gene promoter single nucleotide polymorphism (SNP) is associated with lipodystrophy and metabolic derangements in HIV-1-infected patients treated with cART. We also assessed variations in TNF-α receptor plasma levels. The study group comprised 286 HIV-1-infected patients (133 with and 153 without lipodystrophy) and 203 uninfected controls (UC). TNF-α -238G > A, -308G > A, and -863 C > A SNP were assessed using PCR-RFLPs on white cell DNA. Plasma sTNF-α R1 and R2 levels were measured by ELISA. Student's t test, the χ(2) test, Pearson correlations, and the logistic regression test were performed for statistical analysis. The TNF-α -308G > A SNP was significantly associated with lipodystrophy in the univariate analysis (p = 0.04). This association, however, was no longer significant in the multivariate analysis. A meta-analysis of the published literature and our own data, which included 284 patients with lipodystrophy and 338 without lipodystrophy, showed that there was no relationship between the TNF-α -238G > A and -308G > A SNP and lipodystrophy (p > 0.05 for all comparisons). HIV-1-infected patients had greater sTNF-α R2 plasma levels than UC (p = 0.001) whereas sTNF-α R1 and R2 levels were not significantly different in both the HIV-1-infected cohorts, lipodystrophy vs. nonlipodystrophy (p = NS). In our cohort of white Spaniards the TNF-α -238G > A, -308G > A, and -863C > A SNP were not associated with lipodystrophy in HIV-1-infected patients treated with cART. This finding was replicated in a meta-analysis of the published data, which showed no associations between the TNF-α -238G > A and -308G > A SNP and lipodystrophy. In HIV-1-infected patients under cART there is a systemic overproduction of sTNF-α R2, which is unrelated to

  4. Care of Patients With HIV Infection: Diagnosis and Monitoring.

    PubMed

    Bolduc, Philip; Roder, Navid; Colgate, Emily; Cheeseman, Sarah H

    2016-04-01

    Appropriate screening for HIV infection is the cornerstone of HIV-related care. There have been several recent changes in testing technology and screening recommendations. The US Preventive Services Task Force recommends universal HIV screening at least once for adolescents and adults ages 15 to 65 years, and additional screening for patients at higher risk, although evidence is insufficient to determine optimum rescreening intervals. All pregnant women should be screened for HIV infection in the first trimester, and pregnant women at high risk should be screened again in the third trimester. The Centers for Disease Control and Prevention recommends use of an algorithm using fourth-generation tests for screening; this decreases the window period between infection and detection to as few as 14 days, thereby reducing the number of false-negative results. Home HIV testing kits, which require follow-up confirmatory testing, also are available. Clinicians should be aware of HIV-specific laws in their states, including those criminalizing HIV exposure and transmission. Thorough medical and laboratory evaluations are essential at initiation of care for patients with HIV infection, along with appropriate follow-up monitoring, as recommended in various guidelines. PMID:27092562

  5. Expansion of the E138A mutation in newly diagnosed HIV-infected patients in Gran Canaria.

    PubMed

    Chamizo, Francisco; Gilarranz, Raúl; Tosco, Tomás; Carrillo, Deyanira; Holguín, África; Santana, Évora; Pérez-Arellano, Jose Luís; Hernández, Michele; Francés, Adela; Cárdenes, Miguel Ángel; Zarzalejos, Jose María; Pena-López, María José

    2016-09-01

    Molecular epidemiology allows us to know local HIV transmission and to design strategies of prevention. We studied 25 HIV newly diagnosed patients with the E138A mutation since the year 2010. Most transmission networks involved young and promiscuous men who have sex with men. Recent infection was only documented in patients grouped into the smaller clusters. PMID:27352730

  6. Correction options for lipoatrophy in HIV-infected patients.

    PubMed

    Engelhard, Peter

    2006-03-01

    Lipoatrophy (LA) is a form of lipodystrophy, characterized by volume depletion caused by fat loss in the limbs, buttocks, and face. Facial volume loss is the most obvious outward sign of LA because it alters the facial contours in the cheeks, temples, and orbits. Lipodystrophy and LA are most commonly seen in patients with HIV on highly active antiretroviral therapy (HAART), which was introduced in the mid-1990s for the management of HIV, and is currently considered the mainstay therapy for HIV-infected patients. However, the etiology of LA is likely multifactorial as underlying patient conditions, including duration and severity of HIV and increasing age, have also been found to contribute to its occurrence. The volume loss of LA can be very dramatic with some patients exhibiting no signs of facial fat. As a result, many HIV-infected patients with associated LA suffer from psychological and lifestyle effects, which can lead to noncompliance with HAART. Thus, increases in facial volume and improvement in morphology is anticipated to reduce anxiety caused by LA in HIV-infected patients, and improve quality of life. This review discusses the benefits and limitations of several treatment options available to correct the volume depletion associated with LA, including antiretroviral switching, permanent surgical implants and injectables, poly-L-lactic acid, collagen, and hyaluronic acid derivatives. PMID:16548712

  7. HLA Immunogenotype Determines Persistent Human Papillomavirus Virus Infection in HIV-Infected Patients Receiving Antiretroviral Treatment.

    PubMed

    Meys, Rhonda; Purdie, Karin J; de Koning, Maurits N C; Quint, Koen D; Little, Ann-Margaret; Baker, Finnuala; Francis, Nick; Asboe, David; Hawkins, David; Marsh, Steven G E; Harwood, Catherine A; Gotch, Frances M; Bunker, Christopher B

    2016-06-01

    A proportion of human immunodeficiency virus (HIV)-infected patients develop persistent, stigmatizing human papillomavirus (HPV)-related cutaneous and genital warts and anogenital (pre)cancer. This is the first study to investigate immunogenetic variations that might account for HPV susceptibility and the largest to date to categorize the HPV types associated with cutaneous warts in HIV-positive patients. The HLA class I and II allele distribution was analyzed in 49 antiretroviral (ART)-treated HIV-positive patients with persistent warts, 42 noninfected controls, and 46 HIV-positive controls. The allele HLA-B*44 was more frequently identified in HIV-positive patients with warts (P = .004); a susceptible haplotype (HLA-B*44, HLA-C*05; P = .001) and protective genes (HLA-DQB1*06; P = .03) may also contribute. Cutaneous wart biopsy specimens from HIV-positive patients harbored common wart types HPV27/57, the unusual wart type HPV7, and an excess of Betapapillomavirus types (P = .002), compared with wart specimens from noninfected controls. These findings suggest that HLA testing might assist in stratifying those patients in whom vaccination should be recommended. PMID:26908737

  8. Knowledge and Attitude of Faculty Members Working in Dental Institutions towards the Dental Treatment of Patients with HIV/AIDS

    PubMed Central

    Oberoi, Sukhvinder Singh; Sharma, Nilima; Mohanty, Vikrant; Marya, Charumohan; Rekhi, Amit; Oberoi, Avneet

    2014-01-01

    Background. Dentists have an ethical responsibility to provide treatment to HIV-infected patients, particularly because oral lesions are common among these patients. However, there are no official guidelines as to how to treat people living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) (PLWHA) or how to screen for potentially infectious people. Materials and Method. A descriptive cross-sectional questionnaire based study which assessed the knowledge and attitude of the faculty members towards the treatment of patients with HIV/AIDS was carried out in the Sudha Rustagi College of Dental Sciences, Faridabad, and Maulana Azad Institute of Dental Sciences, New Delhi. Results. The willingness to treat patients with HIV was found to be 86.0% among the faculty members in the present study. The majority (79%) of the faculty members thought that treating an HIV-positive patient is ethical responsibility of the dentist. There was a positive attitude (88.0%) among faculty members that routine dental care should be a part of the treatment of patients with HIV/AIDS. Conclusion. The level of knowledge regarding HIV and AIDS was acceptable in the present study. However, continuing dental education (CDE) programmes should be conducted on a regular basis for updating the knowledge level of the faculty members towards the dental treatment of patients with HIV/AIDS patients. PMID:27379262

  9. The effect of weekly short message service communication on patient retention in care in the first year after HIV diagnosis: study protocol for a randomised controlled trial (WelTel Retain)

    PubMed Central

    van der Kop, Mia L; Ojakaa, David I; Patel, Anik; Thabane, Lehana; Kinagwi, Koki; Ekström, Anna Mia; Smillie, Kirsten; Karanja, Sarah; Awiti, Patricia; Mills, Edward; Marra, Carlo; Kyomuhangi, Lennie Bazira; Lester, Richard T

    2013-01-01

    Introduction Interventions to improve retention in care after HIV diagnosis are necessary to optimise the timely initiation of antiretroviral therapy (ART) and HIV/AIDS control outcomes. Widespread mobile phone use presents new opportunities to engage patients in care. A randomised controlled trial (RCT), WelTel Kenya1, demonstrated that weekly text messages led to improved ART adherence and viral load suppression among those initiating ART. The aim of this study was to determine whether the WelTel intervention is an effective and cost-effective method of improving retention in care in the first year of care following HIV diagnosis. Methods and analysis WelTel Retain is an open, parallel group RCT that will be conducted at the Kibera Community Health Centre in Nairobi, Kenya. Over a 1-year period, we aim to recruit 686 individuals newly diagnosed with HIV who will be randomly allocated to an intervention or control arm (standard care) at a 1:1 ratio. Intervention arm participants will receive the weekly WelTel SMS ‘check-in’ to which they will be instructed to respond within 48 h. An HIV clinician will follow-up and triage any problems that are identified. Participants will be followed for 1 year, with a primary endpoint of retention in care at 12 months. Secondary outcomes include retention in stage 1 HIV care (patients return to the clinic to receive their first CD4 results) and timely ART initiation. Cost-effectiveness will be analysed through decision-analytic modelling. Ethics and dissemination Ethical approval has been obtained from the University of British Columbia and the African Medical and Research Foundation. This trial will test the effectiveness and cost-effectiveness of the WelTel intervention to engage patients during the first year of HIV care. Trial results and economic evaluation will help inform policy and practice on the use of WelTel in the early stages of HIV care. Trial registration ClinicalTrials.gov NCT01630304. PMID:23794578

  10. Dawn of antioxidants and immune modulators to stop HIV-progression and boost the immune system in HIV/AIDS patients: An updated comprehensive and critical review.

    PubMed

    Singh, Gurinder; Pai, Roopa S

    2015-06-01

    In the last two decades, human immunodeficiency virus (HIV), the retrovirus responsible for the acquired immunodeficiency syndrome (AIDS), is one of the leading causes of morbidity and mortality, worldwide. Providing the optimum management of HIV/AIDS is a major challenge in the 21st century. Since, HIV-infected persons have an extended lifespan due to the development of effective antiretroviral therapies, malnutrition is becoming central factors of long-term survivors. The nutrition status of AIDS patients has a significant influence on the maintenance and optimal effectiveness of the immune system. Micronutrient therapy in combination with allopathic treatments can extend and improve the quality and quantity of life in individuals infected with HIV/AIDS. HIV infection is thought to lead to augmented oxidative stress which may in turn lead to faster development of HIV disease. Hence, antioxidants might have a significant role in the treatment of HIV/AIDS. An additional approach to treating HIV infection is fortifying the immune response of infected people. Immune modulators help to activate and boost the normal immune function. The present review first describes the boon of antioxidants (especially Vitamin A) and immune modulators (cytolin, resveratrol, murabutide, setarud, tucaresol, AVR118, Immunitin (HE2000), reticulose, and interleukin-7) in the treatment of HIV/AIDS. Then, providing a comparatively succinct outline on updated patents study on antioxidants and immune modulators to treat HIV/AIDS will be discussed.

  11. Optimizing treatment outcomes in HIV-infected patients with substance abuse issues.

    PubMed

    Celentano, David D; Lucas, Greg

    2007-12-15

    Drug abuse is associated with poorer virologic and clinical outcomes for patients with human immunodeficiency virus (HIV) infection. Limited evidence, primarily from in vitro and animal studies, shows that some abused drugs (e.g., opioids) may have direct effects on HIV pathology and the immune response to infection, but the clinical effects are not known. Clinical data indicate that the primary effect of drug abuse on HIV disease progression is mediated via factors that may limit access and/or adherence to highly active antiretroviral therapy (HAART). Drug abuse is associated with reduced adherence to HAART, which is strongly correlated with poorer virologic and clinical outcomes. However, the virologic and clinical effects of HAART are generally equivalent among drug abusers and non-drug abusers who adhere to therapy. These results underscore the importance of integrating medical and substance abuse interventions for HIV-positive drug abusers, to improve adherence to HAART and optimize outcomes of treatment for HIV infection.

  12. Depression in Caregivers of Status-Naïve Pediatric HIV Patients Participating in a Status Disclosure Study in Haiti and the Dominican Republic: Preliminary Report

    PubMed Central

    Dévieux, Jessy G.; Pinzón-Iregui, María Claudia; Abreu-Pérez, Rosa; Lerebours-Nadal, Leonel; Gaston, Stephanie; Dean, Andrew G.; Halpern, Mina; Rouzier, Vanessa; Bertrand, Rachel; Rosenberg, Rhonda; Pape, Jean William; Nicholas, Stephen W.; Blasini, Ileana

    2015-01-01

    A pilot study is underway to assess safety and acceptability of an intervention to disclose their HIV infection status to status-naïve pediatric antiretroviral therapy patients in Hispaniola [the island shared by Haiti and the Dominican Republic (DR)]. Of 22 Haiti and 47 DR caregivers recruited to date, 68.2% Haiti and 34.0% DR caregivers had clinically significant depressive symptomatology at the time of enrollment (p = 0.008). Depressive symptom prevalence was higher in Haiti caregivers who were female (81.3% vs. 0 in males; p = 0.02) and in DR caregivers who were patients’ mothers (50.0%) or grandmothers (66.7%; 56.0% combined) than others (9.1%), (p < 0.001). Internalized stigma was more commonly reported by Haiti (85.7%) than DR (53.2%; p = 0.01) caregivers; 56.4% of Haiti and DR caregivers reporting internalized stigma vs. 26.1% of caregivers denying it had depressive symptoms (p = 0.02). Depression is common in Hispaniola caregivers possibly affecting disclosure timing. Study participation presents opportunities for addressing caregiver depression. PMID:25389181

  13. Comparison of Serum Lipid Profile in HIV Positive Patients on ART with ART Naïve Patients

    PubMed Central

    V, Vijay; Shekhanawar, M.S.; Rajeshwari; M, Amareshwaras; D, Shantala

    2014-01-01

    Introduction: The widespread use of effective highly active antiretroviral therapy (HAART) in HIV patients has coincided with increasing reports of complications like HIV-associated lipodystrophy syndrome and the metabolic alterations, affecting the lipid and glucose metabolism. Evidences in support of lipodystrophy and dyslipidaemia associated with First- line HAART in our area is scarce. The aim of the present study was 1) to study and compare Lipid profile in HIV positive patients on ART with that of freshly diagnosed HIV positive patients who were yet to be started on ART. 2) To assess lipodystrophy syndrome in patients on ART. Materials and Methods: Hundred newly diagnosed HIV positive patients who were yet to be started on ART were taken as controls (ART-Naïve).Hundred randomly selected HIV+ patients who were already on First-line ART regimen (Stavudine/Zudovudine + Lamivudine + Nevirapine) for more than 12 months were taken as cases (ART). This study was conducted for a period of 12 months at the VIMS ART centre, Bellary, Karnataka, India. Results: There was a significant increase (p<0.001) in serum Total Cholesterol, LDL-C, TG, VLDL, Non-HDL -C & TC/HDL-C ratio in ART patients compared to ART-naïve patients. Of the 100 ART patients 23 had lipodystrophy syndrome (buffalo hump, abnormal fat deposition around neck & back, buccal fat resorption, increase in abdominal fat). Conclusion: To conclude, it is evident from our study that there is increase in lipid profile (except HDL) in ART patients compared to ART Naïve group and 23 ART patients showed lipodystrophy syndrome. Hence it appears reasonable to measure fasting lipid levels before and 3-6 months after antiretroviral therapy is initiated or when ART regimen is changed. PMID:25478335

  14. Myelopathy in a previously asymptomatic HIV-1-infected patient.

    PubMed

    Eyer-Silva, W A; Auto, I; Pinto, J F; Morais-de-Sá, C A

    2001-01-01

    A wide variety of disorders of diverse pathogenic mechanisms can trigger spinal cord dysfunction in HIV-1-infected patients. The most common such condition is HIV-1-associated myelopathy (HM) which characteristically complicates advanced HIV-1 disease in patients with low CD4 cell counts and previous AIDS-defining diagnoses. We describe an unusual presentation of HM in a previously asymptomatic patient with a relatively preserved CD4 cell count (458 cells/mm3) who was even unaware of his serological status. The patient presented with a clinically severe, slowly progressive myelopathy and could not walk unassisted. Significant neurological improvement could be obtained as rapidly as within 4 weeks after the institution of an antiretroviral combination of only two nucleoside analog HIV-1 reverse transcriptase inhibitors (zidovudine and didanosine). An HIV-1 protease inhibitor was also prescribed at that point but could only be added to intensify the regimen 3 months later, when significant neurological improvement had already been recorded. We also review the disorders reported to derange spinal cord function in previously asymptomatic HIV-1-infected patients.

  15. Erectile Dysfunction Among HIV Patients Undergoing Highly Active Antiretroviral Therapy: Dyslipidemia as a Main Risk Factor

    PubMed Central

    Romero-Velez, Gustavo; Lisker-Cervantes, Andrés; Villeda-Sandoval, Christian I; Sotomayor de Zavaleta, Mariano; Olvera-Posada, Daniel; Sierra-Madero, Juan Gerardo; Arreguin-Camacho, Lucrecia O; Castillejos-Molina, Ricardo A

    2014-01-01

    Objective To assess the prevalence and risk factors of erectile dysfunction (ED) in HIV patients from the HIV clinic of a tertiary referral center in Mexico City. Design Prevalence was obtained from cross-sectional studies, and the International Index of Erectile Function (IIEF), a standardized method, was used to assess ED. Methods A cross-sectional study was performed in the HIV clinic. Participants completed the IIEF to allow ED assessment. Information on demographics, clinical and HIV-related variables was retrieved from their medical records. Results One hundred and nine patients were included, with a mean age of 39.9 ± 8.8 years. ED was present in 65.1% of the individuals. Patients had been diagnosed with HIV for a mean of 92.7 ± 70.3 months and had undergone a mean 56.4 ± 45.5 months of HAART. The only variable associated with ED in the univariate analysis was dyslipidemia, and this association was also found in the multivariate analysis (P = 0.01). Conclusions ED is highly prevalent in HIV patients. Dyslipidemia should be considered as a risk factor for ED in HIV patients. Romero-Velez G, Lisker-Cervantes A, Villeda-Sandoval CI, Sotomayor de Zavaleta M, Olvera-Posada D, Sierra-Madero JG, Arreguin-Camacho LO, and Castillejos-Molina RA. Erectile dysfunction among HIV patients undergoing highly active antiretroviral therapy: Dyslipidemia as a main risk factor. Sex Med 2014;2:24–30. PMID:25356298

  16. Isolation of Methicillin-Resistant Staphylococcus aureus (MRSA) from HIV Patients Referring to HIV Referral Center, Shiraz, Iran, 2011-2012.

    PubMed

    Hassanzadeh, Parvin; Hassanzadeh, Yashgin; Mardaneh, Jalal; Rezai, Esmaeel; Motamedifar, Mohammad

    2015-11-01

    Extension of drug resistant Staphylococcus aureus strains is one of the problems of modern society. Presence of methicillin-resistant Staphylococcus aureus (MRSA) in HIV-infected individuals is an important cause of severe infections. Therefore, the main goal of this study was to determine the prevalence rate of MRSA carriage rate among HIV patients referring to the Shiraz HIV referral center (Shiraz, Iran) during 2011-2012. Nasal swabs were obtained from HIV positive patients and were cultured on differential and selective media to isolate Staphylococcus aureus, which was confirmed by standard biochemical tests. For isolation of MRSA isolates, bacterial suspensions were cultured on Muller-Hinton Agar containing NaCl and Oxacillin. Finally, data were analyzed by the SPSS software. Of 180 HIV patients, MRSA was isolated from nasal cavity of 23 (12.8%) patients. Most of the isolates were recovered from male subjects who were under 40 years old. No variables such as skin disease, history of hospitalization or infectious disease had significant association with the MRSA colonization rate. The presence of MRSA isolates in the nasal cavity of HIV patients in such a rate warns us about the potential spreading of MRSA among HIV patients in our society and emphasizes on establishing better prevention strategies.

  17. Isolation of Methicillin-Resistant Staphylococcus aureus (MRSA) from HIV Patients Referring to HIV Referral Center, Shiraz, Iran, 2011-2012

    PubMed Central

    Hassanzadeh, Parvin; Hassanzadeh, Yashgin; Mardaneh, Jalal; Rezai, Esmaeel; Motamedifar, Mohammad

    2015-01-01

    Extension of drug resistant Staphylococcus aureus strains is one of the problems of modern society. Presence of methicillin-resistant Staphylococcus aureus (MRSA) in HIV-infected individuals is an important cause of severe infections. Therefore, the main goal of this study was to determine the prevalence rate of MRSA carriage rate among HIV patients referring to the Shiraz HIV referral center (Shiraz, Iran) during 2011-2012. Nasal swabs were obtained from HIV positive patients and were cultured on differential and selective media to isolate Staphylococcus aureus, which was confirmed by standard biochemical tests. For isolation of MRSA isolates, bacterial suspensions were cultured on Muller-Hinton Agar containing NaCl and Oxacillin. Finally, data were analyzed by the SPSS software. Of 180 HIV patients, MRSA was isolated from nasal cavity of 23 (12.8%) patients. Most of the isolates were recovered from male subjects who were under 40 years old. No variables such as skin disease, history of hospitalization or infectious disease had significant association with the MRSA colonization rate. The presence of MRSA isolates in the nasal cavity of HIV patients in such a rate warns us about the potential spreading of MRSA among HIV patients in our society and emphasizes on establishing better prevention strategies. PMID:26538782

  18. HIV-Prevalence in Tuberculosis Patients in Germany, 2002–2009: An Estimation Based on HIV and Tuberculosis Surveillance Data

    PubMed Central

    Fiebig, Lena; Kollan, Christian; Hauer, Barbara; Gunsenheimer-Bartmeyer, Barbara; an der Heiden, Matthias; Hamouda, Osamah; Haas, Walter

    2012-01-01

    Tuberculosis (TB) and HIV comorbidity is a major challenge in TB prevention and control but difficult to assess in Germany as in other countries, where data confidentiality precludes notifying the HIV status of TB patients. We aimed to estimate the HIV-prevalence in TB patients in Germany, 2002–2009, and to characterize the HIV/TB patients demographically. Data from the long-term observational open multicentre cohort ClinSurv HIV were used to identify incident TB in HIV-positive individuals. We assessed the cohort’s coverage for the nationwide HIV-positive population by contrasting ClinSurv HIV patients under antiretroviral therapy (ART) with national HIV patient numbers derived from ART prescriptions (data by Insight Health; available for 2006–2009). The HIV-prevalence in TB patients was calculated as the number of HIV/TB cases projected for Germany over all culture-positive TB notifications. From 2002 to 2009, 298 of 15,531 HIV-positive patients enrolled in the ClinSurv HIV cohort were diagnosed with TB. A 21% cohort coverage was determined. The annual estimates of the HIV-prevalence in TB patients were on average 4.5% and ranged from 3.5% (95%CI 2.3–5.1%) in 2007 to 6.6% (95%CI 5.0–8.5%) in 2005. The most recent estimate for 2009 was 4.0% (95%CI 2.6–5.9%). The 298 HIV/TB patients were characterized by a male-to-female ratio of 2.1, by a median age of 38 years at TB diagnosis, and by 59% of the patients having a foreign origin, mainly from Subsahara Africa. We provide, to our knowledge, the first estimate of the HIV-prevalence in TB patients for Germany by joint evaluation of anonymous HIV and TB surveillance data sources. The identified level of HIV in TB patients approximates available surveillance data from neighbouring countries and indicates a non-negligible HIV/TB burden in Germany. Our estimation approach is valuable for epidemiological monitoring of HIV/TB within the current legal frameworks. PMID:23145087

  19. The incidence and consequences of early wound infection after internal fixation for trauma in HIV-positive patients.

    PubMed

    Bates, J; Mkandawire, N; Harrison, W J

    2012-09-01

    We report a prospective single-blind controlled study of the incidence of early wound infection after internal fixation for trauma in 609 patients, of whom 132 were HIV-positive. Wounds were assessed for healing using the ASEPSIS score. There was no significant difference in the rate of infection between HIV-positive and HIV-negative patients undergoing clean surgery (4.2% vs 6%, respectively; p = 0.65). HIV-positive patients did not receive additional antibiotic prophylaxis or antiretroviral therapy as part of their management. The difference in the rate of infection between HIV-positive and HIV-negative patients with an open fracture or other contamination was not significant (33% vs 15%, respectively; p = 0.064). There was no relationship between CD4 count and infection rate. HIV status did not significantly influence the number of secondary surgical procedures (p = 0.183) or the likelihood of developing chronic osteomyelitis (p = 0.131). Although previous contamination from the time of injury was a risk factor for infection in mal- and nonunions, it was not significantly increased in HIV-positive patients (p = 0.144). We conclude that clean implant surgery in HIV-positive patients is safe, with no need for additional prophylaxis.

  20. Quantitative Diffusion Tensor Imaging Tractography Metrics are Associated with Cognitive Performance Among HIV-Infected Patients

    PubMed Central

    Conley, Jared; Paul, Robert H.; Coop, Kathryn; Zhang, Song; Zhou, Wenjin; Laidlaw, David H.; Taylor, Lynn E.; Flanigan, Timothy; Navia, Bradford; Cohen, Ronald; Tashima, Karen

    2010-01-01

    There have been many studies examining HIV-infection-related alterations of magnetic resonance imaging (MRI) diffusion metrics. However, examining scalar diffusion metrics ignores the orientation aspect of diffusion imaging, which can be captured with tractography. We examined five different tractography metrics obtained from global tractography maps (global tractography FA, average tube length, normalized number of streamtubes, normalized weighted streamtube length, and normalized total number of tubes generated) for differences between HIV positive and negative patients and the association between the metrics and clinical variables of disease severity. We also examined the relationship between these metrics and cognitive performance across a wide range of cognitive domains for the HIV positive and negative patient groups separately. The results demonstrated a significant difference between the groups for global tractography FA (t=2.13, p= 0.04), but not for any of the other tractography metrics examined (p-value range=0.39 to 0.95). There were also several significant associations between the tractography metrics and cognitive performance (i.e., tapping rates, switching 1 and 2, verbal interference, mazes; r≥0.42) for HIV infected patients. In particular, associations were noted between tractography metrics, speed of processing, fine motor control/speed, and executive function for the HIV-infected patients. These findings suggest that tractography metrics capture clinically relevant information regarding cognitive performance among HIV infected patients and suggests the importance of subtle white matter changes in examining cognitive performance. PMID:20503115

  1. Switching to Tenofovir Alafenamide, Coformulated With Elvitegravir, Cobicistat, and Emtricitabine, in HIV-Infected Patients With Renal Impairment: 48-Week Results From a Single-Arm, Multicenter, Open-Label Phase 3 Study

    PubMed Central

    Pozniak, Anton; Arribas, Jose R.; Gathe, Joseph; Gupta, Samir K.; Post, Frank A.; Bloch, Mark; Avihingsanon, Anchalee; Crofoot, Gordon; Benson, Paul; Lichtenstein, Kenneth; Ramgopal, Moti; Chetchotisakd, Ploenchan; Custodio, Joseph M.; Abram, Michael E.; Wei, Xuelian; Cheng, Andrew; McCallister, Scott; SenGupta, Devi

    2016-01-01

    Background: Tenofovir alafenamide (TAF) is a novel tenofovir prodrug with improved renal and bone safety compared with TDF-containing regimens. We report the 48 week safety and efficacy of a once-daily single tablet regimen of elvitegravir 150 mg (E), cobicistat 150 mg (C), emtricitabine 200 mg (F), and TAF 10 mg (E/C/F/TAF) in HIV-1-infected patients with mild to moderate renal impairment. Methods: We enrolled virologically suppressed HIV-1-infected subjects with estimated creatinine clearance (CrCl) 30–69 mL/min in a single-arm, open-label study to switch regimens to E/C/F/TAF. The primary endpoint was the change from baseline in glomerular filtration rate estimated using various formulae. This study is registered with ClinicalTrials.gov, number NCT01818596. Findings: We enrolled and treated 242 patients with mean age 58 years, 18% Black, 39% hypertension, 14% diabetes. Through week 48, no significant change in estimated CrCl was observed. Two patients (0.8%) discontinued study drug for decreased creatinine clearance, neither had evidence of renal tubulopathy and both had uncontrolled hypertension. Subjects had significant improvements in proteinuria, albuminuria, and tubular proteinuria (P < 0.001 for all). Hip and spine bone mineral density significantly increased from baseline to week 48 (mean percent change +1.47 and +2.29, respectively, P < 0.05). Ninety-two percent (222 patients) maintained HIV-1 RNA <50 copies per milliliter at week 48. Interpretation: Switch to E/C/F/TAF was associated with minimal change in GFR. Proteinuria, albuminuria and bone mineral density significantly improved. These data support the efficacy and safety of once daily E/C/F/TAF in HIV+ patients with mild or moderate renal impairment without dose adjustment. PMID:26627107

  2. Brief Report: Switch to Ritonavir-Boosted Atazanavir Plus Raltegravir in Virologically Suppressed Patients With HIV-1 Infection: A Randomized Pilot Study

    PubMed Central

    van Lunzen, Jan; Pozniak, Anton; Gatell, Jose M.; Antinori, Andrea; Serrano, Oscar; Baakili, Adyb; Osiyemi, Olayemi; Sevinsky, Heather; Girard, Pierre-Marie

    2016-01-01

    Abstract: This open-label, multinational, pilot study randomized (1:2 ratio) adults with HIV-1 RNA <40 copies per milliliter and nucleos(t)ide-related safety/tolerability issues to switch to ritonavir-boosted atazanavir (ATV/r) plus tenofovir disoproxil fumarate/emtricitabine (n = 37) or the nucleos(t)ide reverse transcriptase inhibitor-sparing regimen of ATV/r plus raltegravir (RAL) (n = 72). At 24 weeks, 35/37 (94.6%) and 58/72 (80.6%) of patients, respectively, maintained virological suppression, the primary endpoint, and 1 (2.7%) and 7 (9.7%), respectively, experienced virological rebound. Corresponding 48-week proportions were 86.5%, 69.4%, 2.7%, and 12.5%, respectively. Adherence was lower and treatment discontinuation was higher with ATV/r+RAL. In conclusion, switching to ATV/r+RAL resulted in a higher virological rebound rate than switching to ATV/r plus tenofovir disoproxil fumarate/emtricitabine. PMID:26605505

  3. Brief Report: Switch to Ritonavir-Boosted Atazanavir Plus Raltegravir in Virologically Suppressed Patients With HIV-1 Infection: A Randomized Pilot Study.

    PubMed

    van Lunzen, Jan; Pozniak, Anton; Gatell, Jose M; Antinori, Andrea; Klauck, Isabelle; Serrano, Oscar; Baakili, Adyb; Osiyemi, Olayemi; Sevinsky, Heather; Girard, Pierre-Marie

    2016-04-15

    This open-label, multinational, pilot study randomized (1:2 ratio) adults with HIV-1 RNA <40 copies per milliliter and nucleos(t)ide-related safety/tolerability issues to switch to ritonavir-boosted atazanavir (ATV/r) plus tenofovir disoproxil fumarate/emtricitabine (n = 37) or the nucleos(t)ide reverse transcriptase inhibitor-sparing regimen of ATV/r plus raltegravir (RAL) (n = 72). At 24 weeks, 35/37 (94.6%) and 58/72 (80.6%) of patients, respectively, maintained virological suppression, the primary endpoint, and 1 (2.7%) and 7 (9.7%), respectively, experienced virological rebound. Corresponding 48-week proportions were 86.5%, 69.4%, 2.7%, and 12.5%, respectively. Adherence was lower and treatment discontinuation was higher with ATV/r+RAL. In conclusion, switching to ATV/r+RAL resulted in a higher virological rebound rate than switching to ATV/r plus tenofovir disoproxil fumarate/emtricitabine. PMID:26605505

  4. Timing of antiretroviral therapy and TB treatment outcomes in patients with TB-HIV in Myanmar

    PubMed Central

    Shewade, H. D.; Kyaw, N. T. T.; Oo, M. M.; Aung, T. K.; Aung, S. T.; Oo, H. N.; Win, T.; Harries, A. D.

    2016-01-01

    Setting: Integrated HIV Care programme, Mandalay, Myanmar. Objectives: To determine time to starting antiretroviral treatment (ART) in relation to anti-tuberculosis treatment (ATT) and its association with TB treatment outcomes in patients co-infected with tuberculosis (TB) and the human immunodeficiency virus (HIV) enrolled from 2011 to 2014. Design: Retrospective cohort study. Results: Of 1708 TB-HIV patients, 1565 (92%) started ATT first and 143 (8%) started ART first. Treatment outcomes were missing for 226 patients and were thus not included. In those starting ATT first, the median time to starting ART was 8.6 weeks. ART was initiated after 8 weeks in 830 (53%) patients. Unsuccessful outcome was found in 7%, with anaemia being an independent predictor. In patients starting ART first, the median time to starting ATT was 21.6 weeks. ATT was initiated within 3 months in 56 (39%) patients. Unsuccessful outcome was found in 12%, and in 20% of those starting ATT within 3 months. Patients with CD4 count <100/mm3 had a four times higher risk of an unsuccessful outcome. Conclusions: Timing of ART in relation to ATT was not an independent risk factor for unsuccessful outcome. Extensive screening for TB with rapid and sensitive diagnostic tests in HIV-infected persons and close monitoring of anaemia and immunosuppression are recommended to further improve TB treatment outcomes among patients with TB-HIV. PMID:27358804

  5. The effects of HIV-1 subtype and ethnicity on the rate of CD4 cell count decline in patients naive to antiretroviral therapy: a Canadian−European collaborative retrospective cohort study

    PubMed Central

    Young, Jim; Dunn, David; Ledergerber, Bruno; Sabin, Caroline; Cozzi-Lepri, Alessandro; Dabis, Francois; Harrigan, Richard; Tan, Darrell H.; Walmsley, Sharon; Gill, John; Cooper, Curtis; Scherrer, Alexandra U.; Mocroft, Amanda; Hogg, Robert S.; Smaill, Fiona

    2014-01-01

    Background Ethnic differences have the potential to confound associations between HIV-1 subtype and immunologic progression. We compared declines in CD4 cell counts during untreated infection for the most prevalent HIV-1 subtypes, focusing on distinguishing between the effects of viral subtype and ethnicity. Methods We combined data from 4 European and 6 Canadian cohorts, selecting adults in the stable chronic phase of untreated HIV infection. We estimated the change in square root CD4 cell count over time for subtypes and ethnicities using mixed models, adjusting for covariates selected for their potential effect on initial CD4 cell count or its decline. Results Data from 9772 patients were analyzed, contributing 79 175 measurements of CD4 cell count and 24 157 person-years of follow-up. Overall, there were no appreciable differences in CD4 cell count decline for viral subtypes A, CRF01_AE, CRF02_AG, C and G compared with viral subtype B; whereas the decline in CD4 cell count in patients of African ancestry was considerably slower than in patients of other ethnicity. When ethnic groups were studied separately, there was evidence for slower declines in CD4 cell count in viral subtypes C, and possibly A and G, compared with viral subtype B in patients of African ancestry but not among patients of other ethnicities, suggesting an interaction between subtype and ethnicity. Interpretation Ethnicity is a major determinant of CD4 cell count decline; viral subtype differences may have existed but were small compared with the effect of ethnicity and were most apparent in patients of African ancestry. In developing countries, slower CD4 cell count declines among individuals of African descent may translate to a longer asymptomatic phase and increase the opportunity for HIV transmission. PMID:25485259

  6. Characteristics of Drug-Susceptible and Drug-Resistant Staphylococcus aureus Pneumonia in Patients with HIV

    PubMed Central

    Everett, Charles K.; Subramanian, Anuradha; Jarisberg, Leah G.; Fei, Matthew; Huang, Laurence

    2013-01-01

    Objectives To examine predictors and outcomes of Staphylococcus aureus Pneumonia (SAP) in people with HIV compared with Streptococcus pneumoniae Pneumonia (SPP), and to compare Methicillin-Resistant S. aureus (MRSA) with Methicillin-Sensitive S. aureus (MSSA) pneumonias in this population. Methods We conducted a retrospective case-control study of HIV-infected patients admitted to a single center with culture-proven S. aureus or S. pneumoniae pneumonia. We identified patients through a computerized database, conducted structured chart reviews, and performed bivariate and multivariate analyses using logistic regression. Results We compared 47 SAP episodes in 42 patients with 100 SPP episodes in 93 patients. Use of any antibiotics prior to admission (OR=3.5, p=0.02), a co-morbid illness (OR=4.2, p=0.04), and recent healthcare contact (OR=12.0, p<0.001) were significant independent predictors of SAP. Patients with SAP were more likely to require intensive care (OR=2.7, p=0.02) and mechanical ventilation (OR=3.1, p=0.02), but not to die. MRSA was more common (57% of cases) than MSSA, but outcomes were not significantly worse. Conclusions Patients with HIV and SAP have worse outcomes than those with SPP. Clinicians should consider empiric antibiotic coverage for MRSA in patients admitted with HIV and pneumonia, given the high prevalence of MRSA. Further studies are warranted to examine morbidity differences between HIV-associated MSSA and MRSA pneumonia. PMID:25346868

  7. Social constraints to TB/HIV healthcare: accounts from coinfected patients in South Africa.

    PubMed

    Daftary, Amrita; Padayatchi, Nesri

    2012-01-01

    There is a growing imperative to improve the coordination and collaboration of tuberculosis (TB) and HIV healthcare services in response to escalating rates of TB/HIV coinfection. Patient-specific challenges associated with the delivery of TB/HIV care have been minimally explored in this regard. As part of a larger study conducted in South Africa, this article highlights coinfected patients' experiences with TB and HIV healthcare in light of their broader social environments. Qualitative, in-depth interviews were conducted with 40 adult, coinfected patients (24 women and 16 men) and eight key-informant healthcare workers at three urban/peri-urban, ambulatory, public health clinics in the high-burden province of KwaZulu-Natal. Transcribed interviews were analyzed under a modified grounded theory approach to capture subjective meanings of healthcare experience subsequent to patients' codiagnosis with TB and HIV. Emerging analytic themes highlighted critical sociomedical constraints to TB/HIV care in relation to patients' income and employment, eligibility for social assistance and antiretroviral treatment, fears around illness disclosure, social and material support, and treatment adherence. Patients' healthcare experiences were bound by their poor access to essential resources, multiple life responsibilities, disparate gender roles, limits within the healthcare system, and the stigmatizing social symbolism of their illness. Overlapping social inequalities perpetuated coinfected patients' experiences with stigma and collectively mediated their health decisions around disclosure, adherence, and retention in medical care. The study urges a contextualized understanding of the social challenges associated with TB/HIV healthcare and helps inform more patient-sensitive and socially responsive interventions against the co-epidemic.

  8. Postmortem findings and opportunistic infections in HIV-positive patients from a public hospital in Peru.

    PubMed

    Eza, Dominique; Cerrillo, Gustavo; Moore, David A J; Castro, Cecilia; Ticona, Eduardo; Morales, Domingo; Cabanillas, Jose; Barrantes, Fernando; Alfaro, Alejandro; Benavides, Alejandro; Rafael, Arturo; Valladares, Gilberto; Arevalo, Fernando; Evans, Carlton A; Gilman, Robert H

    2006-01-01

    There is a paucity of HIV autopsy data from South America and none that document the postmortem findings in patients with HIV/AIDS in Peru. The purpose of this autopsy study was to determine the spectrum of opportunistic infections and the causes of mortality in HIV-positive patients at a public hospital in Lima. Clinico-epidemiological information regarding HIV infection in Peru is also reviewed. Sixteen HIV-related hospital postmortems, performed between 1999 and 2004, were included in this retrospective analysis. The primary cause of death was established in 12 patients: one died of neoplasia and 11 of infectious diseases, including 3 from pulmonary infection, 7 from disseminated infection, and 2 from central nervous system infection (one case had dual pathology). Opportunistic infections were identified in 14 cases, comprising cytomegalovirus, histoplasmosis, cryptococcosis, toxoplasmosis, Pneumocystis pneumonia, aspergillosis, tuberculosis, varicella zoster virus, and cryptosporidiosis. Fourteen patients had at least one AIDS-related disease that had been neither clinically suspected nor diagnosed premortem. Moreover, 82% of the diagnoses considered to be of important clinical significance had not been suspected antemortem. The spectrum and frequency of certain opportunistic infections differed from other South American autopsy studies, highlighting the importance of performing HIV/AIDS postmortems in resource-limited countries where locally specific disease patterns may be observed. PMID:16979302

  9. Postmortem findings and opportunistic infections in HIV-positive patients from a public hospital in Peru

    PubMed Central

    Eza, Dominique; Cerrillo, Gustavo; Moore, David A.J.; Castro, Cecilia; Ticona, Eduardo; Morales, Domingo; Cabanillas, Jose; Barrantes, Fernando; Alfaro, Alejandro; Benavides, Alejandro; Rafael, Arturo; Valladares, Gilberto; Arevalo, Fernando; Evans, Carlton A.; Gilman, Robert H.

    2010-01-01

    There is a paucity of HIV autopsy data from South America and none that document the postmortem findings in patients with HIV/AIDS in Peru. The purpose of this autopsy study was to determine the spectrum of opportunistic infections and the causes of mortality in HIV-positive patients at a public hospital in Lima. Clinico-epidemiological information regarding HIV infection in Peru is also reviewed. Sixteen HIV-related hospital postmortems, performed between 1999 and 2004, were included in this retrospective analysis. The primary cause of death was established in 12 patients: one died of neoplasia and 11 of infectious diseases, including 3 from pulmonary infection, 7 from disseminated infection, and 2 from central nervous system infection (one case had dual pathology). Opportunistic infections were identified in 14 cases, comprising cytomegalovirus, histoplasmosis, cryptococcosis, toxoplasmosis, Pneumocystis pneumonia, aspergillosis, tuberculosis, varicella zoster virus, and cryptosporidiosis. Fourteen patients had at least one AIDS-related disease that had been neither clinically suspected nor diagnosed premortem. Moreover, 82% of the diagnoses considered to be of important clinical significance had not been suspected antemortem. The spectrum and frequency of certain opportunistic infections differed from other South American autopsy studies, highlighting the importance of performing HIV/AIDS postmortems in resource-limited countries where locally specific disease patterns may be observed. PMID:16979302

  10. Postmortem findings and opportunistic infections in HIV-positive patients from a public hospital in Peru.

    PubMed

    Eza, Dominique; Cerrillo, Gustavo; Moore, David A J; Castro, Cecilia; Ticona, Eduardo; Morales, Domingo; Cabanillas, Jose; Barrantes, Fernando; Alfaro, Alejandro; Benavides, Alejandro; Rafael, Arturo; Valladares, Gilberto; Arevalo, Fernando; Evans, Carlton A; Gilman, Robert H

    2006-01-01

    There is a paucity of HIV autopsy data from South America and none that document the postmortem findings in patients with HIV/AIDS in Peru. The purpose of this autopsy study was to determine the spectrum of opportunistic infections and the causes of mortality in HIV-positive patients at a public hospital in Lima. Clinico-epidemiological information regarding HIV infection in Peru is also reviewed. Sixteen HIV-related hospital postmortems, performed between 1999 and 2004, were included in this retrospective analysis. The primary cause of death was established in 12 patients: one died of neoplasia and 11 of infectious diseases, including 3 from pulmonary infection, 7 from disseminated infection, and 2 from central nervous system infection (one case had dual pathology). Opportunistic infections were identified in 14 cases, comprising cytomegalovirus, histoplasmosis, cryptococcosis, toxoplasmosis, Pneumocystis pneumonia, aspergillosis, tuberculosis, varicella zoster virus, and cryptosporidiosis. Fourteen patients had at least one AIDS-related disease that had been neither clinically suspected nor diagnosed premortem. Moreover, 82% of the diagnoses considered to be of important clinical significance had not been suspected antemortem. The spectrum and frequency of certain opportunistic infections differed from other South American autopsy studies, highlighting the importance of performing HIV/AIDS postmortems in resource-limited countries where locally specific disease patterns may be observed.

  11. Urinary Markers of Tubular Injury in HIV-Infected Patients

    PubMed Central

    Gebreweld, Angesom

    2016-01-01

    Renal disease is a common complication of HIV-infected patients, associated with increased risk of cardiovascular events, progression to AIDS, AIDS-defining illness, and mortality. Early and accurate identification of renal disease is therefore crucial to improve patient outcomes. The use of serum creatinine, along with proteinuria, to detect renal involvement is essentially to screen for markers of glomerular disease and may not be effective in detecting earlier stages of renal injury. Therefore, more sensitive and specific markers are needed in order to early identify HIV-infected patients at risk of renal disease. This review article summarizes some new and important urinary markers of tubular injury in HIV-infected patients and their clinical usefulness in the renal safety follow-up of TDF-treated patients. PMID:27493802

  12. Alcohol Drinking Pattern: A Comparison between HIV-Infected Patients and Individuals from the General Population

    PubMed Central

    Ikeda, Maria Leticia R.; Barcellos, Nemora T.; Alencastro, Paulo R.; Wolff, Fernando H.; Moreira, Leila B.; Gus, Miguel; Brandão, Ajacio B. M.; Fuchs, Flavio D.; Fuchs, Sandra C.

    2016-01-01

    Background Alcohol consumption is highly prevalent in the general population and among HIV-infected population. This study aimed to compare the pattern of alcohol consumption and to describe characteristics associated with heavy alcohol consumption in individuals from the general population with patients infected with HIV. Methods Participants for this analysis came from a population-based cross-sectional study and from a consecutive sampling of patients infected with HIV. Participants aged 18 years or older were interviewed using similar questionnaires with questions pertaining to socio-demographic characteristics, alcohol consumption, smoking, physical activity, and HIV-related characteristics, among others. Blood pressure and anthropometric measures were measured using standardized procedures. Results Weekly alcohol consumption was more prevalent among individuals from the general population than HIV-infected patients: 57.0 vs. 31.1%, P<0.001. The prevalence of heavy episodic drinking was higher in the population sample as well: 46.1 vs. 17.0%, P<0.001. In the general population, heavy alcohol consumption was more prevalent in men. Cigarette smoking was independently associated with heavy alcohol consumption among HIV infected (Prevalence Ratio; PR = 5.9; 95%CI 2.6–13.9; P<0,001) and general population (PR = 2.6; 95%CI 1.9–3.0; P<0.001). Years at school were inversely associated with heavy alcohol consumption among HIV-infected patients and directly associated among participants from the general population, even after controlling for sex, age, skin color, and smoking. Conclusions Heavy alcohol consumption is more prevalent in the general population than among HIV-infected patients. Individuals aware about their disease may reduce the amount of alcoholic beverages consumption comparatively to healthy individuals from the general population. PMID:27362541

  13. Allergen Immunotherapy in an HIV+ Patient with Allergic Fungal Rhinosinusitis

    PubMed Central

    Myles, Ian A.; Gada, Satyen

    2015-01-01

    Patients with HIV/AIDS can present with multiple types of fungal rhinosinusitis, fungal balls, granulomatous invasive fungal rhinosinusitis, acute or chronic invasive fungal rhinosinusitis, or allergic fungal rhinosinusitis (AFRS). Given the variable spectrum of immune status and susceptibility to severe infection from opportunistic pathogens it is extremely important that clinicians distinguish aggressive fungal invasive fungal disease from the much milder forms such as AFRS. Here we describe a patient with HIV and AFRS to both remind providers of the importance of ruling out invasive fungal disease and outline the other unique features of fungal sinusitis treatment in the HIV-positive population. Additionally we discuss the evidence for and against use of allergen immunotherapy (AIT) for fungal disease in general, as well as the evidence for AIT in the HIV population. PMID:25954557

  14. No Evidence of Human Herpesvirus 8 among Iranian Patients Infected with HIV

    PubMed Central

    RAMEZANI, Amitis; SABOORI, Elham; AZADMANESH, Kayhan; MOHRAZ, Minoo; KAZEMIMANESH, Monireh; KARAMI, Afsaneh; BANIFAZL, Mohammad; GOLCHEHREGAN, Hanieh; AGHAKHANI, Arezoo

    2016-01-01

    Background: Kaposi’s sarcoma is a vascular malignancy, which frequently occurs among immunocompromised individuals such as transplant recipients and patients with acquired immunodeficiency syndrome. Human herpesvirus 8 (HHV-8) is considered the etiological agent of all forms of Kaposi’s sarcoma. Though some seroepidemiological studies conducted on the prevalence of HHV-8 in Iran, there are insufficient data on the prevalence of HHV-8 viremia in HIV infected patients. We therefore, aimed to determine the prevalence of HHV-8 viremia in general population and HIV infected patients without Kaposi’s sarcoma in Tehran, Iran. Methods: We conducted a cross sectional survey on 99 patients with HIV infection referred to Iranian Research Center for HIV/AIDS and 40 healthy controls in Tehran, Iran from January to April 2014. The presence of HHV-8 DNA was detected in buffy coat samples of enrolled subjects using nested PCR assay. Results: A total of 99 HIV infected patients with mean age of 37.9±10 yr and 40 healthy controls with mean age of 39±11.5 yr were enrolled in the study. The mean CD4 count was 410.3± 211.4 cells/mm3. HHV-8 DNA was not detected in both healthy control and HIV patient groups. Conclusion: This survey showed low rate of HHV-8 DNA in healthy controls and HIV patients. Considering our findings HHV-8 infection does not seem to be widespread in our population. Further studies focusing on different regions of Iran appear to be required to have a more accurate estimation. PMID:27517001

  15. Thrombotic microangiopathy as an initial manifestation in HIV patients

    PubMed Central

    Dineshkumar, Thanigachalam; Dhanapriya, Jeyachandran; Jaganathan, Palanivel; Sakthirajan, Ramanathan; Gopalakrishnan, Natarajan; Balasubramaniyan, T.

    2016-01-01

    Thrombotic microangiopathy (TMA) is characterized by microangiopathic hemolytic anemia, thrombocytopenia, microvascular thrombosis, and various organ dysfunctions. TMA usually occurs in a more advanced stage of HIV disease. TMA as an initial presenting feature is rare. We here report a male patient who presented with oliguric renal failure. Investigations revealed anemia, thrombocytopenia, schistocytes in peripheral smear, and HIV-positive. Renal biopsy revealed TMA. He was treated with hemodialysis and started on highly active antiretroviral therapy. PMID:27390466

  16. [Organ transplants in HIV infected patients. Update and recommendations].

    PubMed

    Barcan, Laura; Gadano, Adrian; Casetti, Isabel; Villamil, Federico

    2011-01-01

    Until few years ago, HIV infection was an absolute contraindication to consider organ transplants. Since HAART introduction, patient survival increased dramatically, but high mortality due to liver and kidney diseases became evident. For these reasons, this group of patients is now reconsidered for organ transplantation. In 2008, the Argentine Society of Transplants (SAT) and the Argentine Infectious Diseases Society (SADI), encouraged by the increasing published experience on kidney and liver transplants in this population, decided to form a Working Group, to prepare an update on this issue and elaborate practical recommendations for the better management of these patients. The first meeting was held on December 4th 2008. The most important conclusion was that HIV infection did not contraindicate a solid organ transplant. Later on, taking into account the accumulated experience and the available literature, the current document was prepared. HIV infected patients must fulfill certain clinical, immunological, virological and psychosocial criteria to be considered for solid organ transplants. HIV infected recipients of kidney and liver transplants currently show similar short and middle term survival to non HIV infected patients. There is not yet enough data on intrathoracic transplants in these patients in order to include them on a waiting list for these organs-transplants. Interactions between immunosupressors and antiretroviral drugs (specially protease inhibitors) are very important, and require a strict monitoring of immunosupressor levels.

  17. Understanding HIV-positive patients' preferences for healthcare services: a protocol for a discrete choice experiment

    PubMed Central

    Youssef, Elaney; Cooper, Vanessa; Miners, Alec; Llewellyn, Carrie; Pollard, Alex; Lagarde, Mylene; Sachikonye, Memory; Sabin, Caroline; Foreman, Claire; Perry, Nicky; Nixon, Eileen; Fisher, Martin

    2016-01-01

    Introduction While the care of HIV-positive patients, including the detection and management of comorbidities, has historically been provided in HIV specialist outpatient clinics, recent years have seen a greater involvement of non-HIV specialists and general practitioners (GPs). The aim of this study is to determine whether patients would prefer to see their GP or HIV physician given general symptoms, and to understand what aspects of care influence their preferences. Methods/analysis We have developed and piloted a discrete choice experiment (DCE) to better understand patients' preferences for care of non-HIV-related acute symptoms. The design of the DCE was informed by our exploratory research, including the findings of a systematic literature review and a qualitative study. Additional questionnaire items have been included to measure demographics, service use and experience of non-HIV illnesses and quality of life (EQ5D). We plan to recruit 1000 patients from 14 HIV clinics across South East England. Data will be analysed using random-effects logistic regression and latent class analysis. ORs and 95% CIs will be used to estimate the relative importance of each of the attribute levels. Latent class analysis will identify whether particular groups of people value the service attribute levels differently. Ethics/dissemination Ethical approval for this study was obtained from the Newcastle and North Tyneside Research Ethics Committee (reference number 14/NE/1193). The results will be disseminated at national and international conferences and peer-reviewed publications. A study report, written in plain English, will be made available to all participants. The Patient Advisory Group will develop a strategy for wider dissemination of the findings to patients and the public. PMID:27431895

  18. Monotherapy with lopinavir/ritonavir versus standard of care in HIV-infected patients virologically suppressed while on treatment with protease inhibitor-based regimens: results from the MoLo study.

    PubMed

    Gianotti, Nicola; Poli, Andrea; Galli, Massimo; Pan, Angelo; Rizzardini, Giuliano; Soria, Alessandro; Viale, Pierluigi; Di Biagio, Antonio; Quirino, Tiziana; Viganò, Paolo; Bonfanti, Paolo; d'Arminio Monforte, Antonella; Fortino, Ida; Lazzarin, Adriano

    2014-10-01

    This study compared the cost-efficacy ratios of lopinavir/ritonavir monotherapy (LPV/r-MT) and of standard of care in virologically suppressed HIV-infected patients. The results of the efficacy and safety analyses are presented. We conducted a multicentre, randomised, open-label trial of HIV-infected adults on stable treatment, with HIV- RNA <50 copies/mL, randomised to continue the ongoing regimen (cART-arm) or to switch to LPV/r (400/100 mg BID) MT (MT-arm). Time to virological rebound (VR = confirmed HIV-RNA ?50 copies/mL) was estimated by Ka- plan-Meier method and changes in laboratory values during follow-up were evaluated by univariate mixed-linear models. Ninety-four patients were randomised and analysed (43 in the MT-arm and 51 in the cART-arm). Five (four in the MT and 1 in the cART-arm; p=0.175) had VR, but time to VR did not statistically differ between the two arms (p=0.143). Major PI mutations were not detected at VR. Patients on MT had significant increases in total choles- terol [difference in mean change between MT and cART arm: 0.77 (±0.30) mg/dL per month; p=0.012] and eGFR [difference in mean change between MT and cART arm: 0.24 (±0.11) mL/min/1.73 m2 per month; p=0.029]. LPV/r-MT seems safe in most patients and should be considered in patients who have developed kidney toxicity from tenofovir.

  19. Meaning of care for terminally Ill HIV-infected patients by HIV-infected peer caregivers in a simulation-based training program in South Korea.

    PubMed

    Kim, Sunghee; Shin, Gisoo

    2015-01-01

    The purpose of this study was to develop a simulation-based training program for people living with HIV (PLWH) as peer caregivers who would take care of terminally ill, HIV-infected patients. We used qualitative research methods and standardized patients to explore the meaning of caring for patients as peer caregivers. Study participants included 32 patients registered as PLWH at the South Korea Federation for HIV/AIDS. The meanings of peer caregiving were categorized into four dimensions: physical, psychological, relational, and economic. Our study had benefits in knowledge acquisition for caregivers as well as care recipients, empathy with HIV-infected care recipients, improvement in self-esteem and social participation, and financial self-sufficiency to enable independent living for caregivers. The simulation training program for PLWH peer caregivers for terminally ill HIV-infected patients demonstrated value, for both PLWH caregivers and terminally ill HIV-infected patients in South Korea, to improve the quality of care. PMID:26279386

  20. Drug Transporter Genetic Variants Are Not Associated with TDF-Related Renal Dysfunction in Patients with HIV-1 Infection: A Pharmacogenetic Study

    PubMed Central

    Nishijima, Takeshi; Hayashida, Tsunefusa; Kurosawa, Takuma; Tanaka, Noriko; Oka, Shinichi; Gatanaga, Hiroyuki

    2015-01-01

    Objective To investigate whether single nucleotide polymorphisms (SNP) of drug transporter proteins for TDF is a risk factor for TDF-related renal function decrement. Methods This study investigated the association between 3 SNPs (ABCC2–24, 1249, and ABCB1 2677), which are shown to be associated with TDF-induced tubulopathy, and clinically important renal outcomes (>10ml/min/1.73m2 decrement in eGFR relative to baseline, >25% decrement in eGFR, and eGFR <60ml/min/1.73m2) in 703 HIV-1-infected Japanese patients who initiated TDF-containing antiretroviral therapy (ART). Genotyping was performed by allelic discrimination using TaqMan 5’-nuclease assays. Results 95% of the study patients were males and 66% were treatment-naïve, with median CD4 count of 249/μl, median baseline eGFR of 96ml/min/1.73m2 (IQR 84.6–109.2), and median exposure to TDF of 3.66 years (IQR 1.93–5.59). The frequencies of genotypes at -24, 1249 of ABCC2, and 2677 of ABCB1 were neither different between patients with decrement in eGFR of >10ml/min/1.73m2 and those without such decrement (ABCC2: -24, p = 0.53, 1249, p = 0.68; ABCB1: 2677, p = 0.74), nor between those without and with the other two renal outcomes (>25% decrement: ABCC2: -24, p = 0.83, 1249, p = 0.97, ABCB1: 2677, p = 0.40; eGFR <60ml/min/1.73m2: ABCC2: -24, p = 0.51, 1249, p = 0.81, ABCB1: 2677, p = 0.94). Logistic regression analysis showed that the risk genotype of the three SNPs were not associated with any of the three renal outcomes, respectively. Logistic regression model that applied either dominant, recessive, or additive model yielded the same results. Conclusions SNPs of the drug transporters for TDF are not associated with clinically important renal outcomes in patients who initiated TDF-containing ART. PMID:26535588

  1. [Contact tracing and partner notification among a cohort of HIV-1 infected patients. A prospective study carried out in Palermo in 2012].

    PubMed

    Dalle Nogare, Fabrizio; Di Lorenzo, Francesco; Sanfilippo, Adriana; Dalle Nogare, Ernesto Renato; Arena, Nunzia; Prestileo, Tullio

    2014-09-01

    Introduction. Contact tracing and partner notification are tools to prevent the spread of the HIV and other sexually transmitted infections. These tools protect the rights of the individual contrasting healthcare policies that encourage dangerous kinds of discrimination. Objective. Pointing out the opinion of a sample of HIV-1 infected patients about the possibility of starting a support helpdesk for contract tracing and partner notification. Design and setting. A survey about contact tracing and partner notification procedures was conducted through anonymous questionnaires filled by a sample of 110 HIV-infected patients, involved in a follow-up stage at the Infectious Diseases Outpatients Clinic from the Civic Hospital Benfratelli in Palermo. The survey took place in May 2012. Results. An efficient partner notification is considered essential, both to protect people with whom the patient has come into contact and to contribute to the reduction of HIV spread. The questions dealing with this issue recorded more than 90% of positive answers. The questions about protecting the privacy during the diagnosis notification processes enlightened that notifying the partner is always felt as a greater need compared to the risk of losing one's own privacy; in fact, the positive answers were 81%. As for the role played by the physician during the contact tracing and partner notification process, 34% of the interviewees think that the physician should ask the patient to disclose the names of partners with whom he/she had a risky behavior. Finally, as for the question concerning how partner notification should happen, the results showed that 31% of the interviewees declare to be favorable to a full mandate by the physician, while just above 25% would choose to notify it personally, even though with the physician's help. Conclusion. Overall, the survey showed that more than 70% of people interviewed are favorable to a personal notification, against 25% of the interviewees who

  2. Virulence Factors and Anti Fungal Sensitivity Pattern of Candida Sp. Isolated from HIV and TB Patients.

    PubMed

    Ramesh, Nachimuthu; Priyadharsini, Maruthupandian; Sumathi, Chettipalayam Samiappan; Balasubramanian, Velramar; Hemapriya, Janarthanam; Kannan, Rajesh

    2011-07-01

    The study comprised of 60 Candida spp., 50 isolates from HIV and TB positive individuals (immunocompromised) and 10 isolates from non-HIV and -TB patients (immunocompetent). Among the 60 Candidal isolates, 83.3% were identified as C. albicans, 11.6% as C. glabrata and rest 5% as C. krusei. There is no study in production pattern of extracellular enzymes of Candida spp. isolated from HIV and TB patients in comparison with non-HIV and -TB patients in India. The comparison of phospholipase activities showed that there was a significant difference between the groups at (P = 0.001). The non-HIV and -TB groups of C. glabrata and C. krusei did not show detectable phospholipase activity when compared to the HIV and TB groups. The mean difference in the phospholipase activities of these two groups was significant (P = <0.001). Candida spp. of both the groups do not possess the ability to hydrolyze gelatin. All the strains possessed the ability to show alpha haemolysis. Even though it had shown alpha haemolysis, the significant difference in haemolytic activity was observed only in C. albicans (P = <0.001). None of the isolates from the two groups possessed the ability to hydrolyze gelatin. In the resistance profile of Candida spp., C. albicans of HIV and TB groups had shown resistance to fluconazole, Itraconazole, ketaconazole, nystatin but showed 100% sensitivity towards amphotericin-B. The isolates of C. krusei and C. glabrata showed no resistance to any of the drugs tested. In the case of, non-HIV and -TB patients the resistance pattern was low.

  3. Cryptococcal Infections in Non-Hiv-Infected Patients

    PubMed Central

    Pappas, Peter G.

    2013-01-01

    Infections due to Cryptococcus species occur globally and in a wide variety of hosts, ranging from those who are severely immunosuppressed to those who have phenotypically “normal” immune systems. Approximately 1 million cases of cryptococcosis occur throughout the world, and is it estimated that there are 650,000 associated deaths annually. Most of these cases occur among patients with advanced HIV disease, but a growing number occur among solid organ transplant recipients and others receiving exogenous immunosuppression, patients with innate and acquired immunodeficiency, and otherwise immunologically normal hosts. Much of our recent knowledge is solely derived from clinical experience over the last 2 to 3 decades of cryptococcosis among HIV-infected patients. However, based on recent observations, it is clear that there are substantial differences in the epidemiology, clinical features, approaches to therapy, and outcome when comparing HIV-infected to non–HIV-infected individuals who have cryptococcosis. If one carefully examines cryptococcosis in the three largest subgroups of patients based on host immune status, specifically, those with HIV, solid organ transplant recipients, and those who are non-HIV, non-transplant (NHNT) infected persons, then one can observe very different risks for infection, varied clinical presentations, long-term complications, mortality, and approaches to therapy. This article focuses on cryptococcosis in the non–HIV-infected patient, including a brief review of ongoing events in the Pacific Northwest of the United States and Canada relative to the outbreak of Cryptococcus gattii infections among a largely immunologically normal population, and highlights some of the key insights and questions which have emerged as a result of these important new observations. PMID:23874010

  4. Seroprevalence of Toxoplasma gondii Infection among HIV/AIDS Patients in Eastern China.

    PubMed

    Shen, Guoqiang; Wang, Xiaoming; Sun, Hui; Gao, Yaying

    2016-02-01

    Toxoplasmosis, a neglected tropical disease caused by the protozoan parasite Toxoplasma gondii, occurs throughout the world. Human T. gondii infection is asymptomatic in 80% of the population; however, the infection is life-threatening and causes substantial neurologic damage in immunocompromised patients such as HIV-infected persons. The major purpose of this study was to investigate the seroprevalence of T. gondii infection in subjects infected with HIV/AIDS in eastern China. Our findings showed 9.7% prevalence of anti-T. gondii IgG antibody in HIV/AIDS patients, which was higher than in intravenous drug users (2.2%) and healthy controls (4.7%), while no significant difference was observed in the seroprevalence of anti-Toxoplasma IgM antibody among all participants (P>0.05). Among all HIV/AIDS patients, 15 men (7.7%) and 10 women (15.9%) were positive for anti-T. gondii IgG antibody; however, no significant difference was detected in the seroprevalence of anti-Toxoplasma IgG antibody between males and females. The frequency of anti-Toxoplasma IgG antibody was 8.0%, 13.2%, 5.5%, and 0% in patients with normal immune function (CD4(+) T-lymphocyte count ≥500 cells/ml), immunocompromised patients (cell count ≥200 and <500 cells/ml), severely immunocompromised patients (cell count ≥50 and <200 cells/ml), and advanced AIDS patients, respectively (cell count <50 cells/ml), while only 3 immunocompromised patients were positive for anti-T. gondii IgM antibody. The results indicate a high seroprevalence of T. gondii infection in HIV/AIDS patients in eastern China, and a preventive therapy for toxoplasmosis may be given to HIV/AIDS patients based on CD4(+) T lymphocyte count.

  5. HIV-related Pneumocystis carinii Pneumonia in Older Patients Hospitalized in the Early HAART Era

    PubMed Central

    Kim, Benjamin; Lyons, Thomas M; Parada, Jorge P; Uphold, Constance R; Yarnold, Paul R; Hounshell, Jennie B; Sipler, Alison M; Goetz, Matthew B; DeHovitz, Jack A; Weinstein, Robert A; Campo, Rafael E; Bennett, Charles L

    2001-01-01

    OBJECTIVE To determine whether older age continues to influence patterns of care and in-hospital mortality for hospitalized persons with HIV-related Pneumocustis carinii pneumonia (PCP), as determined in our prior study from the 1980s. DESIGN Retrospective chart review. PATIENTS/SETTING Patients (1,861) with HIV-related PCP at 78 hospitals in 8 cities from 1995 to 1997. MEASUREMENTS Medical record notation of possible HIV infection; alveolar-arterial oxygen gradient; CD4 lymphocyte count; presence or absence of wasting; timely use of anti-PCP medications; in-hospital mortality. MAIN RESULTS Compared to younger patients, patients ≥50 years of age were less likely to have HIV mentioned in their progress notes (70% vs 82%, P < .001), have mild or moderately severe PCP cases at admission (89% vs 96%, P < .002), receive anti-PCP medications within the first 2 days of hospitalization (86% vs 93%, P <.002), and survive hospitalization (82% vs 90%, P < .003). However, age was not a significant predicator of mortality after adjustment for severity of PCP and timeliness of therapy. CONCLUSIONS While inpatient PCP mortality has improved by 50% in the past decade, 2-fold age-related mortality differences persist. As in the 1980s, these differences are associated with lower rates of recognition of HIV, increased severity of illenss at admission, and delays in initiation of PCP-specific treatments among older individuals—factors suggestive of delayed recognition of HIV infection, pneumonia, and PCP, respectively. Continued vigilance for the possibility of HIV and HIV-related PCP among persons ≥50 years of age who present with new pulmonary symptoms should be encouraged. PMID:11556938

  6. Antiretroviral Therapy Normalizes Autoantibody Profile of HIV Patients by Decreasing CD33⁺CD11b⁺HLA-DR⁺ Cells: A Cross-Sectional Study.

    PubMed

    Meng, Zhefeng; Du, Ling; Hu, Ningjie; Byrd, Daniel; Amet, Tohti; Desai, Mona; Shepherd, Nicole; Lan, Jie; Han, Renzhi; Yu, Qigui

    2016-04-01

    Autoimmune manifestations are common in human immunodeficiency virus (HIV) patients. However, the autoantibody spectrum associated with HIV infection and the impact of antiretroviral therapy (ART) remains to be determined. The plasma autoantibody spectrum for HIV patients was characterized by protein microarrays containing 83 autoantigens and confirmed by enzyme-linked immunosorbent assay (ELISA). Regulatory T cells (Tregs) and myeloid-derived suppressor cells (MDSCs) were analyzed by flow cytometry and their effects on autoantibodies production were determined by B cell ELISpot. Higher levels of autoantibody and higher prevalence of elevated autoantibodies were observed in ART-naive HIV patients compared to healthy subjects and HIV patients on ART. The highest frequency of CD33(+)CD11b(+)HLA-DR(+) cells was observed in ART-naive HIV patients and was associated with the quantity of elevated autoantibodies. In addition, CD33(+)CD11b(+)HLA-DR(+) cells other than Tregs or MDSCs boost the B cell response in a dose-dependent manner by in vitro assay. In summary, HIV infection leads to elevation of autoantibodies while ART suppresses the autoimmune manifestation by decreasing CD33(+)CD11b(+)HLA-DR(+) cells in vivo.The roles of CD33(+)CD11b(+)HLA-DR(+) cells on disease progression in HIV patients needs further assessment. PMID:27082567

  7. SLEEVE GASTRECTOMY IN PATIENTS WITH MORBID OBESITY AND HIV

    PubMed Central

    PINTO, José Máximo Costa; de LIMA, Marianna Gomes Cavalcanti Leite; de ALMEIDA, Ana Luiza Melo Cavalcanti; SOUSA, Marcelo Gonçalves

    2016-01-01

    ABSTRACT Introduction: It is estimated that there are nearly 40 million people with the human immunodeficiency virus (HIV) worldwide. Due to the advent of antiretroviral drugs, it has been observed increasing in obesity and metabolic rates among patients undergoing treatment. Thus, numerous surgical therapies for weight loss are proposed for continuous improvement in health of patients with HIV, being the vertical gastrectomy an option for intact intestinal transit. Objective: To evaluate the applicability of the vertical gastrectomy in patients with morbid obesity and HIV. Methods: Was conducted a systematic review of the literature, in the electronic databases Scopus, Pubmed, Cinahl, Scielo, Cochrane and Lilacs, from 1998 to 2015. MeSH headings used in data collection were "Gastrectomy" and "Morbid obesity" being combined with the descriptor "HIV". Were found 2148 articles in Scopus, 1234 in PubMed and 784 in Cinahl. The articles were analyzed by the Jadad Quality Scale, being reduced to 40 articles, subsequently reassessed using an elaborated form by the Critical Appraisal Skills Programme (CASP), reaching 12 articles in the end. Conclusion: It was found that vertical gastrectomy constitutes a safe and effective method, with low mortality and low rate of postoperative complications, being recommended as surgical technique in patients with obesity, HIV and comorbidities. PMID:27683793

  8. Prevalence of HLA-B*57:01 allele in Argentinean HIV-1 infected patients.

    PubMed

    Moragas, M; Belloso, W H; Baquedano, M S; Gutierrez, M I; Bissio, E; Larriba, J M; Fay, F; Aulicino, P; Gurevich, J M; Yaunguzian, M F; Maldonado, A C; Falistocco, C; Sen, L; Mangano, A

    2015-07-01

    Hypersensitivity reaction to abacavir (ABC hypersensitivity syndrome, AHS) is strongly associated with the presence of the HLA-B*57:01 allele. This study was designed to estimate the prevalence of HLA-B*57:01 allele in Argentinean HIV-1 infected patients. We analyzed the presence of HLA-B*57:01 allele in 1646 HIV-1 infected patients from different regions of Argentina. This allele was detected in 81 patients; most of them corresponded to patients living in the central region of the country. The prevalence of HLA-B*57:01 was 4.9%, similar to other Caucasian populations and higher than other data reported for South American populations. This strongly supports screening for the presence of HLA-B*57:01 in abacavir treatment of HIV-1 in our country. PMID:25922880

  9. HIV Testing among Patients with Presumptive Tuberculosis: How Do We Implement in a Routine Programmatic Setting? Results of a Large Operational Research from India

    PubMed Central

    Kumar, Ajay MV; Gupta, Devesh; Kumar, Ashok; Gupta, R. S.; Kanchar, Avinash; Rao, Raghuram; Shastri, Suresh; Suryakanth, MD; Rangaraju, Chethana; Naik, Balaji; Guddemane, Deepak K.; Bhat, Prashant; Nair, Achuthan Sreenivas; Harries, Anthony David; Dewan, Puneet

    2016-01-01

    Background In March 2012, World Health Organization recommended that HIV testing should be offered to all patients with presumptive TB (previously called TB suspects). How this is best implemented and monitored in routine health care settings in India was not known. An operational research was conducted in Karnataka State (South India, population 64 million, accounts for 10% of India’s HIV burden), to test processes and learn results and challenges of screening presumptive TB patients for HIV within routine health care settings. Methods In this cross-sectional study conducted between January-March 2012, all presumptive TB patients attending public sector sputum microscopy centres state-wide were offered HIV testing by the laboratory technician, and referred to the nearest public sector HIV counselling and testing services, usually within the same facility. The HIV status of the patients was recorded in the routine TB laboratory form and TB laboratory register. The laboratory register was compiled to obtain the number of presumptive TB patients whose HIV status was ascertained, and the number found HIV positive. Aggregate data on reasons for non-testing were compiled at district level. Results Overall, 115,308 patients with presumptive TB were examined for sputum smear microscopy at 645 microscopy centres state-wide. Of these, HIV status was ascertained for 62,847(55%) among whom 7,559(12%) were HIV-positive, and of these, 3,034(40%) were newly diagnosed. Reasons for non-testing were reported for 37,700(72%) of the 52,461 patients without HIV testing; non-availability of testing services at site of sputum collection was cited by health staff in 54% of respondents. Only 4% of patients opted out of HIV testing. Conclusion Offering HIV testing routinely to presumptive TB patients detected large numbers of previously-undetected instances of HIV infection. Several operational challenges were noted which provide useful lessons for improving uptake of HIV testing in this

  10. HIV Transmission Risk Behavior Among HIV-Positive Patients Receiving Antiretroviral Therapy in KwaZulu-Natal, South Africa

    PubMed Central

    Kiene, Susan M.; Mahlase, Gethwana; MacDonald, Susan; Christie, Sarah; Cornman, Deborah H.; Fisher, William A.; Greener, Ross; Lalloo, Umesh G.; Pillay, Sandy; van Loggerenberg, Francois; Fisher, Jeffrey D.

    2014-01-01

    The aim of this investigation was to identify factors associated with HIV transmission risk behavior among HIV-positive women and men receiving antiretroviral therapy (ART) in KwaZulu-Natal, South Africa. Across 16 clinics, 1,890 HIV+ patients on ART completed a risk-focused audio computer-assisted self-interview upon enrolling in a prevention-with-positives intervention trial. Results demonstrated that 62 % of HIV-positive patients’ recent unprotected sexual acts involved HIV-negative or HIV status unknown partners. For HIV-positive women, multivariable correlates of unprotected sex with HIV-negative or HIV status unknown partners were indicative of poor HIV prevention-related information and of sexual partnership-associated behavioral skills barriers. For HIV-positive men, multivariable correlates represented motivational barriers, characterized by negative condom attitudes and the experience of depressive symptomatology, as well as possible underlying information deficits. Findings suggest that interventions addressing gender-specific and culturally-relevant information, motivation, and behavioral skills barriers could help reduce HIV transmission risk behavior among HIV-positive South Africans. PMID:24158486

  11. [Pneumocystosis in non-HIV-infected immunocompromised patients].

    PubMed

    Fillâtre, P; Revest, M; Belaz, S; Robert-Gangneux, F; Zahar, J-R; Roblot, F; Tattevin, P

    2016-05-01

    Pneumocystis jiroveci (formerly P. carinii) is an opportunistic fungus responsible for pneumonia in immunocompromised patients. Pneumocystosis in non-HIV-infected patients differs from AIDS-associated pneumocystosis in mostly two aspects: diagnosis is more difficult, and prognosis is worse. Hence, efforts should be made to target immunocompromised patients at higher risk of pneumocystosis, so that they are prescribed long-term, low-dose, trimethoprime-sulfamethoxazole, highly effective for pneumocystosis prophylaxis. Patients at highest risk include those with medium and small vessels vasculitis, lymphoproliferative B disorders (chronic or acute lymphocytic leukaemia, non-Hodgkin lymphoma), and solid cancer on long-term corticosteroids. Conversely, widespread use of prophylaxis in all patients carrier of inflammatory diseases on long-term corticosteroids is not warranted. The management of pneumocystosis in non-AIDS immunocompromised patients follows the rules established for AIDS patients. The diagnosis relies on the detection of P. jiroveci cyst on respiratory samples, while PCR does not reliably discriminate infection from colonization, in 2015. High-doses trimethoprim-sulfamethoxazole is, by far, the treatment of choice. The benefit of adjuvant corticosteroid therapy for hypoxic patients, well documented in AIDS patients, has a much lower level of evidence in non-HIV-infected patients, most of them being already on corticosteroid by the time of pneumocystosis diagnosis anyway. However, based on its striking impact on morbi-mortality in AIDS patients, adjuvant corticosteroid is recommended in hypoxic, non-HIV-infected patients with pneumocystosis by many experts and scientific societies.

  12. [Enteropathogens responsible for gastrointestinal disorders in HIV patients].

    PubMed

    Vizzi, Esmeralda; Angulo Medina, Luis A

    2013-03-01

    Gastrointestinal disorders or GID are debilitating conditions common in individuals infected by the human immunodeficiency virus (HIV), capable of leading to death. Numerous etiological agents and pathophysiological mechanisms have been involved in this status. Although the use of highly active antiretroviral therapy (HAART) in many countries has greatly reduced the prevalence of gastrointestinal infections, enteric pathogens such as bacteria, parasites, fungi and viruses may still act as opportunist agents in these patients. Cytomegalovirus, adenovirus, calicivirus, astrovirus, rotavirus, enterovirus, picobirnavirus and some more recently described, like bocavirus and Aichi virus, have been detected in HIV patients. However, except for cytomegalovirus, which is an established etiological agent of GID in these patients, the role of the other viruses remains unclear. Several species of Cryptosporidium, microsporidia, Salmonella, atipical mycobacteria and Campylobacter jejuni, have also been recognized as important causes of GID in HIV patients. The progressive incorporation of increasingly sensitive immunological and molecular assays for antigen, antibody and pathogens detection from faeces, has improved the diagnosis of diarrhea and contributed to clarify the etiological significance of some microorganisms in immunocompetent patients. In Venezuela, some information is available about the prevalence of enteric pathogens in immunocompromised patients infected with HIV. The identification of the etiologic agent responsible for this condition may be useful for the management and treatment of these patients, for whom viral enteritis is a disease, which reduces their quality of life and causes a high public health spending.

  13. Arterial hypertension and cardiovascular risk in HIV-infected patients.

    PubMed

    Calò, Lorenzo A; Caielli, Paola; Maiolino, Giuseppe; Rossi, Gianpaolo

    2013-08-01

    The dramatic change of the natural history of HIV-infected patients by highly active antiretroviral therapy (HAART) has exposed these patients to cardiovascular risk, including cardiovascular disease and hypertension. In HIV-infected patients, the development of arterial hypertension, at least in the medium-long term is an established feature, although recognized predictors of its development have not been clearly identified. In addition, conflicting data regarding the influence of antiretroviral therapy (ART) are reported. The presence of a proinflammatory state and oxidative stress-mediated endothelial dysfunction seem, however, to play a pathophysiologic role. In this review, we examine and provide a comprehensive, literature based, consideration of the pathophysiologic aspects of hypertension in these patients. HIV-infected patients, independently of the presence of hypertension, remain at very high cardiovascular risk due to the presence of the same cardiovascular risk factors recognized for the general population with, in addition, the indirect influence of the ART, essentially via its effect on lipid metabolism. This review based on the evidence from the literature, concludes that the management of HIV-infected patients in terms of cardiovascular prevention emerges as a priority. The consideration of cardiovascular risk in these patients should receive the same emphasis given for the general population at high cardiovascular risk, including adequate blood pressure control according to international guidelines.

  14. First report of Babesia divergens infection in an HIV patient.

    PubMed

    González, Luis M; Castro, Emma; Lobo, Cheryl A; Richart, Alberto; Ramiro, Raquel; González-Camacho, Fernando; Luque, Daniel; Velasco, Aurelio C; Montero, Estrella

    2015-04-01

    Human babesiosis is a zoonosis primarily transmitted through Ixodes ticks and alternatively by routes such as blood transfusions from asymptomatic donors. We report the first case of human babesiosis caused by Babesia divergens in a patient with HIV. This study also focuses on elucidating the possible transmission route of infection in this patient, who received numerous blood transfusions but showed patent symptoms only after splenectomy. A battery of detection tools along with a novel Western-Blot Assay and Enzyme Linked Immunosorbent Assay using the major surface protein of B. divergens (Bd37) as a target were used to evaluate the presence of B. divergens or antibodies against the parasite in samples from the patient and the blood donors involved in this case. A retrospective study of the humoral status against the parasite revealed B. divergens IgG antibodies in one of the implicated donors, but also showed that the patient had been already exposed to the parasite before any transfusion. Thus, this analysis of natural and transfusion transmission routes suggests a pre-existing subclinical babesiosis in the patient. PMID:25686807

  15. Prime, Shock, and Kill: Priming CD4 T Cells from HIV Patients with a BCL-2 Antagonist before HIV Reactivation Reduces HIV Reservoir Size

    PubMed Central

    Cummins, Nathan W.; Sainski, Amy M.; Dai, Haiming; Natesampillai, Sekar; Pang, Yuan-Ping; Bren, Gary D.; de Araujo Correia, Maria Cristina Miranda; Sampath, Rahul; Rizza, Stacey A.; O'Brien, Daniel; Yao, Joseph D.

    2016-01-01

    ABSTRACT Understanding how some HIV-infected cells resist the cytotoxicity of HIV replication is crucial to enabling HIV cure efforts. HIV killing of CD4 T cells that replicate HIV can involve HIV protease-mediated cleavage of procaspase 8 to generate a fragment (Casp8p41) that directly binds and activates the mitochondrial proapoptotic protein BAK. Here, we demonstrate that Casp8p41 also binds with nanomolar affinity to the antiapoptotic protein Bcl-2, which sequesters Casp8p41 and prevents apoptosis. Further, we show that central memory CD4 T cells (TCM) from HIV-infected individuals have heightened expression of BCL-2 relative to procaspase 8, possibly explaining the persistence of HIV-infected TCM despite generation of Casp8p41. Consistent with this hypothesis, the selective BCL-2 antagonist venetoclax induced minimal killing of uninfected CD4 T cells but markedly increased the death of CD4 T cells and diminished cell-associated HIV DNA when CD4 T cells from antiretroviral therapy (ART)-suppressed HIV patients were induced with αCD3/αCD28 to reactivate HIV ex vivo. Thus, priming CD4 T cells from ART suppressed HIV patients with a BCL-2 antagonist, followed by HIV reactivation, achieves reductions in cell-associated HIV DNA, whereas HIV reactivation alone does not. IMPORTANCE HIV infection is incurable due to a long-lived reservoir of HIV+ memory CD4 T cells, and no clinically relevant interventions have been identified that reduce the number of these HIV DNA-containing cells. Since postintegration HIV replication can result in HIV protease generation of Casp8p41, which activates BAK, causing infected CD4 T cell death, we sought to determine whether this occurs in memory CD4 T cells. Here, we demonstrate that memory CD4 T cells can generate Casp8p41 and yet are intrinsically resistant to death induced by diverse stimuli, including Casp8p41. Furthermore, BCL-2 expression is relatively increased in these cells and directly binds and inhibits Casp8p41's

  16. Association between risk behaviors and antiretroviral resistance in HIV-infected patients receiving opioid agonist treatment

    PubMed Central

    Tetrault, Jeanette M.; Kozal, Michael J.; Chiarella, Jennifer; Sullivan, Lynn E.; Dinh, An T; Fiellin, David A.

    2013-01-01

    Objectives Antiretroviral (ARV) resistance is of concern. Opioid agonist treatment ( i.e., methadone or buprenorphine) is effective and decreases HIV transmission risk behaviors and HIV seroconversion. Despite prevention efforts, injection drug use (IDU) and risky sexual behaviors remain prevalent in patients receiving opioid agonist treatment. The purpose of this study is to determine in HIV-infected patients receiving opioid agonist treatment, the prevalence of HIV transmission risk behaviors, the prevalence of ARV resistance, and the prevalence of ARV resistance among those with risk behaviors. Methods The design was a cross-sectional, study of patients recruited from opioid treatment programs and outpatient practices. We measured demographic, drug treatment, and HIV clinical information (including ARV adherence), self-reported HIV risk behaviors and drug use, urine toxicologies, and genotype testing for ARV resistance (with both standard assays and Ultradeep sequencing). Data analysis included descriptive statistics. Results 59 subjects enrolled. 64% were male, 24% were white, and mean age was 46 years. 53% were receiving methadone and 47% buprenorphine. 80% were on opioid agonist treatment for 12 weeks or more. 14% reported unprotected sex, 7% reported sharing needles or works, and 60% had positive urine toxicology for illicit drug use. 15% had evidence of HIV resistance by standard genotyping, 7% with single class resistance, 3% with double class resistance, and 5% with triple class resistance. Ultradeep sequencing found additional class resistance in 5 subjects. 22% of subjects with evidence of transmission risk behaviors vs. 14% of subjects without risk behaviors had evidence of ARV resistance. Conclusions Improved prevention and treatment efforts may be needed for HIV-infected, opioid dependent individuals receiving opioid agonist treatment to decrease transmission of ARV resistant virus, especially in resource limited settings. PMID:23388678

  17. Candida infection in HIV positive patients 1985-2007.

    PubMed

    Traeder, Christian; Kowoll, Susann; Arastéh, Keikawus

    2008-09-01

    Infection with Candida species remains a major problem in HIV infected patients. The analysis of over 15,000 hospitalisations (1985-2007) in the AVK cohort shows an increasing incidence of non-albicans species in candida esophagitis. Although our analysis shows a decreasing incidence of opportunistic infections like PCP, cerebral toxoplasmosis and others since the introduction of highly active antiretroviral therapy the incidence of candida esophagitis remains as high as in the years before the HAART era. This observation might reflect the development of resistance against fluconazole and the selection of non-albicans species as a consequence of a long-term prophylactic treatment of HIV+ patients over years.

  18. An Acute Abdominal Catastrophe in a HIV Positive Patient

    PubMed Central

    Gaduputi, Vinaya; Patel, Harish; Vootla, Vamshidhar; Khan, Usman; Chilimuri, Sridhar

    2012-01-01

    We report this case of a 45-year-old man with HIV-AIDS on HAART therapy who presented with acute abdominal pain and renal failure. He was found to have pneumatosis intestinalis on computerized axial tomography scan of the abdomen. He underwent emergent explorative laparotomy, which revealed a necrotic large bowel segment for which a right-sided hemicolectomy and ileostomy were performed. The patient subsequently developed septic shock and hypoxic respiratory failure. He expired a week after the surgical procedure. Acute abdominal events due to vascular catastrophes secondary to hypercoagulability, endothelial dysfunction and accelerated atherosclerosis have been reported in HIV positive patients.

  19. Increased numbers of granzyme-B-expressing cytotoxic T-lymphocytes in the small intestine of HIV-infected patients.

    PubMed

    Snijders, F; Wever, P C; Danner, S A; Hack, C E; ten Kate, F J; ten Berge, I J

    1996-07-01

    The objective of this study was to determine whether granzyme B-expressing cells, which identify activated cytotoxic lymphocytes, are present in the small intestinal mucosa of human immunodeficiency virus (HIV)-infected patients with and without diarrhea. Therefore, duodenal biopsy specimens from 29 HIV-infected patients (11 with diarrhea and 18 without diarrhea) and 15 control patients were stained for the presence of granzyme B expressing cells. In HIV-infected patients, a significantly increased expression of granzyme B in the lamina propria was observed (p = 0.00001): In 22 of 29 patients, at least 5-10 cells per high-power field were counted. In contrast, in 13 of 15 control patients, granzyme B was not expressed or minimally so, and in two others a maximum of five granzyme-B-expressing cells could be detected per high-power field. No significant difference was found between the HIV-infected patients with and without diarrhea. Double staining revealed that the granzyme-B-expressing cells were mainly CD3 positive. These data show that activated cytotoxic T lymphocytes (CTLs) are present in the duodenal mucosa of HIV-infected patients. No relation between the number of CTLs and the presence of diarrhea was demonstrated. CTLs are known to be involved in the pathogenesis of HIV infection and in the production of tissue injury, but their functional role in intestinal HIV-related pathology has yet to be elucidated.

  20. Molecular epidemiology of Cryptosporidium in HIV/AIDS patients in Malaysia.

    PubMed

    Asma, I; Sim, B L H; Brent, R D; Johari, S; Yvonne Lim, A L

    2015-06-01

    Cryptosporidiosis is a particular concern in immunocompromised individuals where symptoms may be severe. The aim of this study was to examine the epidemiological and molecular characteristics of Cryptosporidium infections in HIV/AIDS patients in Malaysia in order to identify risk factors and facilitate control measures. A modified Ziehl-Neelsen acid fast staining method was used to test for the presence of Cryptosporidium oocysts in the stools of 346 HIV/AIDS patients in Malaysia. Standard coproscopical methods were used to identify infections with other protozoan or helminths parasites. To identify the species of Cryptosporidium, DNA was extracted and nested-PCR was used to amplify a portion of the SSU rRNA gene. A total of 43 (12.4%) HIV-infected patients were found to be infected with Cryptosporidium spp. Of the 43 Cryptosporidium-positive HIV patients, 10 (23.3%) also harboured other protozoa, and 15 (34.9%) had both protozoa and helminths. The highest rates of cryptosporidiosis were found in adult males of Malay background, intravenous drug users, and those with low CD4 T cell counts (i.e., < 200 cells/mm3). Most were asymptomatic and had concurrent opportunistic infections mainly with Mycobacterium tuberculosis. DNA sequence analysis of 32 Cryptosporidium isolates identified C. parvum (84.3%), C. hominis (6.3%), C. meleagridis (6.3%), and C. felis (3.1%). The results of the present study revealed a high prevalence of Cryptosporidium infection in hospitalized HIV/AIDS patients. The results also confirmed the potential significance of zoonotic transmission of C. parvum in HIV infected patients, as it was the predominant species found in this study. However, these patients were found to be susceptible to a wide range of Cryptosporidium species. Epidemiological and molecular characterization of Cryptosporidium isolates provides clinicians and researchers with further information regarding the origin of the infection, and may enhance treatment and control

  1. Molecular epidemiology of Cryptosporidium in HIV/AIDS patients in Malaysia.

    PubMed

    Asma, I; Sim, B L H; Brent, R D; Johari, S; Yvonne Lim, A L

    2015-06-01

    Cryptosporidiosis is a particular concern in immunocompromised individuals where symptoms may be severe. The aim of this study was to examine the epidemiological and molecular characteristics of Cryptosporidium infections in HIV/AIDS patients in Malaysia in order to identify risk factors and facilitate control measures. A modified Ziehl-Neelsen acid fast staining method was used to test for the presence of Cryptosporidium oocysts in the stools of 346 HIV/AIDS patients in Malaysia. Standard coproscopical methods were used to identify infections with other protozoan or helminths parasites. To identify the species of Cryptosporidium, DNA was extracted and nested-PCR was used to amplify a portion of the SSU rRNA gene. A total of 43 (12.4%) HIV-infected patients were found to be infected with Cryptosporidium spp. Of the 43 Cryptosporidium-positive HIV patients, 10 (23.3%) also harboured other protozoa, and 15 (34.9%) had both protozoa and helminths. The highest rates of cryptosporidiosis were found in adult males of Malay background, intravenous drug users, and those with low CD4 T cell counts (i.e., < 200 cells/mm3). Most were asymptomatic and had concurrent opportunistic infections mainly with Mycobacterium tuberculosis. DNA sequence analysis of 32 Cryptosporidium isolates identified C. parvum (84.3%), C. hominis (6.3%), C. meleagridis (6.3%), and C. felis (3.1%). The results of the present study revealed a high prevalence of Cryptosporidium infection in hospitalized HIV/AIDS patients. The results also confirmed the potential significance of zoonotic transmission of C. parvum in HIV infected patients, as it was the predominant species found in this study. However, these patients were found to be susceptible to a wide range of Cryptosporidium species. Epidemiological and molecular characterization of Cryptosporidium isolates provides clinicians and researchers with further information regarding the origin of the infection, and may enhance treatment and control

  2. [SSRI AND BONE METABOLISM IN HIV + PATIENTS WITH ANTIRETROVIRAL THERAPY].

    PubMed

    Mazzoglio y Nabar, Martín J; Muñiz, Milagros María; Mejías Delamano, Alexis A; Muñoz, Santiago; Magrath Guimet, Nahuel

    2015-01-01

    We report a series of 9 male HIV + patients, average age of 41.2 years, viral load negative (<50 copies RNA/ml), treated with antiretroviral (nucleoside and non-nucleoside inhibitors of reverse transcriptase) without systemic infections, the CNS diseases or marker or corticoidoterapia in progress. Were evaluated and supported by their infectologists interconsultation during the period October 2008-October 2013 by depressive syndrome. Psychotherapeutic and psychiatric treatment was initiated with SSRIs and clonazepam; Neuroimaging control and biochemical laboratory studies at baseline and 2 months of treatment were conducted. In the course of psychopharmacological treatment not suffer fractures due to falls and alterations were detected in bone metabolism markers and images. He studied with endocrinology and interdisciplinary medical clinic, decided to withdraw the SSRIs with normalization of biochemical values and psychotherapeutic treatment was continued. We will raise the associations between the use of SSRIs, disturbances of bone metabolism with clinical correlation and possible drug interactions between antidepressants and antiretroviral. PMID:26650557

  3. Imaging Serotonergic Transmission with [11C]DASB-PET in Depressed and Non-Depressed Patients Infected with HIV

    PubMed Central

    Hammoud, Dima A.; Endres, Christopher J.; Hammond, Edward; Uzuner, Ovsev; Brown, Amanda; Nath, Avindra; Kaplin, Adam I.; Pomper, Martin G.

    2009-01-01

    Introduction Site-selective imaging can provide significant insight into the mechanism of HIV-associated neurological disease. The goal of this study was to evaluate the involvement of serotonergic transmission in HIV-associated depression using [11C]DASB, a serotonin transporter (5-HTT)-specific radiopharmaceutical for positron emission tomography (PET). Methods 9 depressed HIV+ subjects (HIV-D), 9 nondepressed HIV+ subjects (HIV-ND) and 7 healthy controls (HC) underwent an MRI scan and a [11C]DASB-PET scan. The outcome measure was 5-HTT binding potential normalized to nondisplaceable tissue radioligand (BPND). Results HIV-ND subjects had lower mean regional 5-HTT BPND estimates across regions, compared to HC, while HIV-D subjects demonstrated higher mean regional binding values than HIV-ND subjects in most regions. Prior to correction for the false discovery rate, HIV-ND had significantly lower BPND values compared to HC subjects in two regions (insula and anterior cingulate) and all HIV+ patients had significantly lower binding than HC in all regions except for the midbrain, thalamus and pons. After correction for the false discovery rate, only the insula showed significantly lower binding in HIV+ subjects compared to HC (P < 0.0045). Despite a significant difference in the duration of illness between the HIV-D and HIV-ND groups, there was no definite correlation between the duration of illness and BPND. Conclusion Lower [11C]DASB binding in HIV+ patients compared to HC may reflect serotonergic neuronal loss as a component of generalized HIV-associated neurodegeneration. Higher mean regional BPND values in HIV-D compared to HIV-ND subjects could reflect increased density of 5-HTT, leading to increased clearance of serotonin from the synapse, which could account, in part, for symptoms of depression. The lack of correlation between duration of illness and binding argues against these findings being the result of differential neurodegeneration only. Our findings

  4. Nigella sativa concoction induced sustained seroreversion in HIV patient.

    PubMed

    Onifade, Abdulfatah Adekunle; Jewell, Andrew Paul; Adedeji, Waheed Adeola

    2013-01-01

    Nigella sativa had been documented to possess many therapeutic functions in medicine but the least expected is sero-reversion in HIV infection which is very rare despite extensive therapy with highly active anti-retroviral therapy (HAART). This case presentation is to highlight the complete recovery and sero-reversion of adult HIV patient after treatment with Nigella sativa concoction for the period of six months. The patient presented to the herbal therapist with history of chronic fever, diarrhoea, weight loss and multiple papular pruritic lesions of 3 months duration. Examination revealed moderate weight loss, and the laboratory tests of ELISA (Genscreen) and western blot (new blot 1 & 2) confirmed sero-positivity to HIV infection with pre-treatment viral (HIV-RNA) load and CD4 count of 27,000 copies/ml and CD4 count of 250 cells/ mm(3) respectively. The patient was commenced on Nigella sativa concoction 10 mls twice daily for 6 months.. He was contacted daily to monitor side-effects and drug efficacy. Fever, diarrhoea and multiple pruritic lesions disappeared on 5th, 7th and 20th day respectively on Nigella sativa therapy. The CD4 count decreased to 160 cells/ mm3 despite significant reduction in viral load (≤1000 copies/ml) on 30th day on N. sativa. Repeated EIA and Western blot tests on 187th day on Nigella sativa therapy was sero-negative. The post therapy CD4 count was 650 cells/ mm(3) with undetectable viral (HIV-RNA) load. Several repeats of the HIV tests remained sero-negative, aviraemia and normal CD4 count since 24 months without herbal therapy. This case report reflects the fact that there are possible therapeutic agents in Nigella sativa that may effectively control HIV infection.

  5. Barriers and Facilitators of Linkage to and Engagement in HIV Care Among HIV-Positive Men Who Have Sex with Men in China: A Qualitative Study.

    PubMed

    Liu, Yu; Osborn, Chandra Y; Qian, Han-Zhu; Yin, Lu; Xiao, Dong; Ruan, Yuhua; Simoni, Jane M; Zhang, Xiangjun; Shao, Yiming; Vermund, Sten H; Amico, K Rivet

    2016-02-01

    Linking and engaging HIV-positive patients in care is the key bridging step to glean the documented health and prevention advantages of antiretroviral therapy (ART). In China, HIV transmission among men who have sex with men (MSM) is surging, yet many HIV-positive MSM do not use HIV care services. We conducted a qualitative study in order to help positive interventions to promote linkage-to-care in this key population. Four focus group discussions (FGD) were held among HIV-positive MSM in Beijing, China, to ascertain knowledge, beliefs, attitudes, and practices related to HIV care. FGD participates highlighted six major barriers of linkage to/engagement in HIV care: (1) perceived discrimination from health care workers; (2) lack of guidance and follow-up; (3) clinic time or location inconvenience; (4) privacy disclosure concerns; (5) psychological burden of committing to HIV care; and (6) concerns about treatment. Five major sub-themes emerged from discussions on the facilitators of linkage to/engagement in care: (1) peer referral and accompaniment; (2) free HIV care; (3) advocacy from HIV-positive MSM counselors; (4) extended involvement for linking MSM to care; and (5) standardization of HIV care (i.e., reliable high quality care regardless of venue). An understanding of the barriers and facilitators that may impact the access to HIV care is essential for improving the continuum of care for MSM in China. Findings from our study provide research and policy guidance for how current HIV prevention and care interventions can be enhanced to link and engage HIV-positive MSM in HIV care.

  6. [African histoplasmosis in a patient with HIV-2 infection].

    PubMed

    Eichmann, A; Schär, G

    1996-05-01

    9 months after immigration into Switzerland, a 38-year-old male patient from Liberia/West Africa developed granulomatous and subsequently ulcerative nodules in the face. The heterosexual patient, with no history of i.v. drug abuse, tested positive for HIV-2. Histology of a skin biopsy revealed superficial colonization by numerous fungal elements described as spores and hyphae that were compatible with the initial isolation of Candida parapsilosis. The definite diagnosis of African histoplasmosis was established 3 weeks later after review of the PAS-stained direct smear and after cultures had grown a cream-colored mold subsequently identified as Histoplasma capsulatum var. duboisii. There were no signs of disseminated disease. The lesions cleared under therapy with itraconazole (200 mg q 24h for 2 weeks, subsequently 100 mg q 24h) as well as ketoconazole and Aqua Dalibour (A. zinco-cuprica) locally for 2 months. Follow-up was not possible. Despite alarmingly increasing numbers of HIV-positive patients in Africa, the general incidence of African histoplasmosis seems to be stable with only a few cases per year. To our knowledge only four cases of disseminated African histoplasmosis have been reported in HIV-positive patients; localized cutaneous infection as in our patient, seems to be the exception. The low incidence of this infection is in contrast to the substantial number of HIV-positive patients with disseminated histoplasmosis by H. capsulatum var. capsulatum in the United States. PMID:8693301

  7. Effects of vitamins, including vitamin A, on HIV/AIDS patients.

    PubMed

    Mehta, Saurabh; Fawzi, Wafaie

    2007-01-01

    increase lymphoid cell differentiation, which leads to an increase in CCR5 receptors. These receptors are essential for attachment of HIV to the lymphocytes and therefore, an increase in their number is likely to increase HIV replication. Vitamin A supplementation in HIV-infected children, on the other hand, has been associated with protective effects against mortality and morbidity, similar to that seen in HIV-negative children. The risk for lower respiratory tract infection and severe watery diarrhea has been shown to be lower in HIV-infected children supplemented with vitamin A. All-cause mortality and AIDS-related deaths have also been found to be lower in vitamin A-supplemented HIV-infected children. The benefits of multivitamin supplementation, particularly vitamins B, C, and E, have been more consistent across studies. Multivitamin supplementation in HIV-infected pregnant mothers has been shown to reduce the incidence of adverse pregnancy outcomes such as fetal loss and low birth weight. It also has been shown to decrease rates of MTCT among women who have poor nutritional or immunologic status. Further, multivitamin supplementation reduces the rate of HIV disease progression among patients in early stage of disease, thus delaying the need for ART by prolonging the pre-ART stage. In brief, there is no evidence to recommend vitamin A supplementation of HIV-infected pregnant women; however, periodic vitamin A supplementation of HIV-infected infants and children is beneficial in reducing all-cause mortality and morbidity and is recommended. Similarly, multivitamin supplementation of people infected with HIV, particularly pregnant women, is strongly suggested.

  8. Oral candidiasis in HIV+ patients under treatment with protease inhibitors.

    PubMed

    Witzel, Andréa Lusvarghi; Silveira, Fernando Ricardo Xavier da; Pires, Maria de Fátima Costa; Lotufo, Mônica Andrade

    2008-01-01

    The purpose of this work was to evaluate the influence of Protease Inhibitors (PI) on the occurrence of oral candidiasis in 111 HIV+ patients under PI therapy (Group A). The controls consisted of 56 patients that were not using PI drugs (Group B) and 26 patients that were not using any drugs for HIV therapy (Group C). The patient's cd4 cell counts were taken in account for the correlations. One hundred and ninety three patients were evaluated. The PI did not affect the prevalence of oral candidiasis (p = 0.158) or the frequency of C. albicans isolates (p = 0.133). Patients with lower cd4 cell counts showed a higher frequency of C. albicans isolates (p = 0.046) and a greater occurrence of oral candidiasis (p = 0.036).

  9. Brain magnetic resonance imaging screening is not useful for HIV-1-infected patients without neurological symptoms.

    PubMed

    Nishijima, Takeshi; Gatanaga, Hiroyuki; Teruya, Katsuji; Tajima, Tsuyoshi; Kikuchi, Yoshimi; Hasuo, Kanehiro; Oka, Shinichi

    2014-10-01

    We investigated the diagnostic usefulness of brain magnetic resonance imaging (MRI) screening in HIV-1-infected patients without neurological symptoms in detecting intracranial diseases at early stages. In this retrospective analysis, the study patients were HIV-1-infected patients who underwent brain MRI scan in clinical practice between 2001 and 2013. We excluded patients with MRI for (1) follow-up examination for prediagnosed intracranial diseases, (2) cancer staging, (3) screening mycobacterium/bacteria/fungi disease proliferation in the brain, and (4) evaluation for meningitis/encephalitis. The study patients (n=485) were classified into two groups: those who underwent brain MRI scan without any neurological symptoms/signs (asymptomatic patients, n=158) and those who underwent MRI due to such symptoms (symptomatic patients, n=327). Asymptomatic patients had lower CD4 counts than symptomatic patients (median 78 versus 241/μl). Intracranial diseases were detected in three (2%) of the asymptomatic patients [two toxoplasmosis and one progressive multifocal leukoencephalopathy (PML)] compared to 58 (19%) of the symptomatic patients (the χ(2) test, p<0.01). The latter included toxoplasmosis (n=10), PML (n=7), cytomegalovirus encephalitis (n=3), primary central nervous system lymphoma (n=3), cryptococcoma/meningitis (n=3), and HIV-associated dementia (n=17). Among symptomatic patients, intracranial diseases were common in those with slurred speech (3/6, 50%), seizure (4/10, 40%), eyesight/vision abnormality (5/16, 31%), altered mental status (8/31, 26%), and hemiplegia/numbness (13/50, 26%). For patients with CD4 count <200/μl, intracranial diseases were detected in only 3 (3%) of 144 asymptomatic patients, compared with 46 (32%) of 113 symptomatic patients (p<0.01). Brain MRI screening for HIV-1-infected patients without neurological symptoms is of little value.

  10. Hepatitis C Virus Infection in HIV-infected Patients.

    PubMed

    Sulkowski, Mark S.

    2001-10-01

    The hepatitis C virus (HCV) is a spherical enveloped RNA virus of the Flaviviridae family, classified within the Hepacivirus genus. Since its discovery in 1989, HCV has been recognized as a major cause of chronic hepatitis and hepatic fibrosis that progresses in some patients to cirrhosis and hepatocellular carcinoma. In the United States, approximately 4 million people have been infected with HCV, and 10,000 HCV-related deaths occur each year. Due to shared routes of transmission, HCV and HIV co-infection are common, affecting approximately one third of all HIV-infected persons in the United States. In addition, HIV co-infection is associated with higher HCV RNA viral load and a more rapid progression of HCV-related liver disease, leading to an increased risk of cirrhosis. HCV infection may also impact the course and management of HIV disease, particularly by increasing the risk of antiretroviral drug-induced hepatotoxicity. Thus, chronic HCV infection acts as an opportunistic disease in HIV-infected persons because the incidence of infection is increased and the natural history of HCV infection is accelerated in co-infected persons. Strategies to prevent primary HCV infection and to modify the progression of HCV-related liver disease are urgently needed among HIV/HCV co-infected individuals.

  11. Hepatitis C virus infection in HIV-infected patients.

    PubMed

    Sulkowski, Mark S

    2007-10-01

    The hepatitis C virus (HCV) is a spherical enveloped RNA virus of the Flaviviridae family, classified within the Hepacivirus genus. Since its discovery in 1989, HCV has been recognized as a major cause of chronic hepatitis and hepatic fibrosis that progresses in some patients to cirrhosis and hepatocellular carcinoma. In the United States, approximately 4 million people have been infected with HCV, and 10,000 HCVrelated deaths occur each year. Due to shared routes of transmission, HCV and HIV co-infection are common, affecting approximately one third of all HIV-infected persons in the United States. In addition, HIV co-infection is associated with higher HCV RNA viral load and a more rapid progression of HCV-related liver disease, leading to an increased risk of cirrhosis. HCV infection may also impact the course and management of HIV disease, particularly by increasing the risk of antiretroviral drug-induced hepatotoxicity. Thus, chronic HCV infection acts as an opportunistic disease in HIV-infected persons because the incidence of infection is increased and the natural history of HCV infection is accelerated in co-infected persons. Strategies to prevent primary HCV infection and to modify the progression of HCV-related liver disease are urgently needed among HIV/HCV co-infected individuals.

  12. Approach to dyslipidemia, lipodystrophy, and cardiovascular risk in patients with HIV infection.

    PubMed

    Troll, J Gregory

    2011-02-01

    There is a significant prevalence (20%-80% depending on the population and the study) of lipid disorders and other cardiovascular risk factors in people living with HIV infection. This review focuses on HIV and HIV treatment-associated metabolic and cardiovascular concerns, including dyslipidemias, lipodystrophy syndromes, endothelial dysfunctions, and associated metabolic events such as insulin resistance. Emerging hypotheses of the underlying pathophysiology of these issues, with impact on selection of specific antiretroviral treatment (ART) strategies, therapy, and preventive approaches to decreasing cardiovascular risk and other problems associated with these syndromes are discussed. Screening for cardiovascular risk as part of the decision of starting antiretroviral therapy, and during care of patients with HIV regardless of ART therapy status, is suggested with particular areas of focus. Statins, other hyperlipidemic therapies, treatment for specific problems arising due to lipodystrophy, and implications on ART selection to avoid drug interactions and adverse effects are also discussed.

  13. Antimicrobial susceptibility patterns of enterobacteriaceae isolated from HIV-infected patients in Kinshasa

    PubMed Central

    Iyamba, Jean-Marie Liesse; Wambale, José Mulwahali; Takaisi-Kikuni, Ntondo za Balega

    2014-01-01

    Introduction People infected by Human Immunodeficiency Virus (HIV) are susceptible to develop severe bacterial infections. We set out to determine the frequency and the sensitivity to antibiotics of enterobaceriaceae isolated from urine and feces of HIV-infected persons. Methods Urine and feces samples were collected from HIV-infected patients of the Centre de Traitement Ambulatoire de Kabinda (CTA/Kabinda, Kinshasa) and analyzed at the Reference National Laboratory for HIV/AIDS and Sexually Transmitted Infections. The isolated enterobacteriaceae strains were identified by conventional microbiological methods. Antibiotic sensitivity pattern was carried out by disc diffusion method. Results The following bacteria pathogens were isolated: Escherichia coli, Klebsiella, Enterobacter, Proteus, and Providencia. Most species were sensitive to cefotaxim, ceftriaxon, and gentamicin and resistant to chloramphenicol, cotrimoxazole, tetracycline, and norfloxacin. Conclusion The results of the present study show that the most frequently bacteria isolated were Esherichia coli and cefotaxim, ceftriaxon, and gentamicin were the most active antibiotics. PMID:25392725

  14. [ANALYSIS OF A LETHAL OUTCOME RISK AFTER TRAUMA IN HIV-INFECTED PATIENTS IN POLYSYSTEMIC INJURY].

    PubMed

    Guryev, S O; Solovyov, O S; Tanasiyenko, P V

    2016-02-01

    Abstract The data, concerning clinic--epidemiologic and clinic--nosological characteristic of a HIV-infected injured persons in polytrauma were adduced. There was established, that polysystemic injuries (PSI) in a HIV-infected persons occur in a younger injured patients, a trauma environment is quite a speciphic one (criminal trauma prevails), as well as mechanism of the injury occurrence (falling down is much more freqent), and the risk of a lethal outcome is determined by predominantly cranial, thoracic and abdominal components of injury. A lethal outcome occurrence risk in HIV-infected injured persons in PSI in accordance to the age signs and traumagenesis is lesser, than in a control body. It is necessary to prolong the investigations, concerning studying this phenomenon and other peculiarities of a traumatic disease in HIV-infected injured persons in polytrauma. PMID:27244924

  15. The Study of Gonadal Hormonal Abnormalities and Sexual Dysfunction in HIV Positive Females: An Exploratory Study

    PubMed Central

    Kallikadavil, Abithraj; Shivaswamy, Rajendraprasad; Menon, Vineetha Bharathan

    2016-01-01

    Introduction Every endocrine gland has been reported to be affected at varying rates in HIV. HIV is a highly stigmatized chronic disease with a substantial co-occurrence of mental and sexual health problems; however the sexual health problems in women have not been extensively studied. Aim To study the gonadal hormonal abnormalities and sexual dysfunction in HIV positive female patients and its possible association. Materials and Methods This descriptive/exploratory study was conducted in the Department of General Medicine at a tertiary care hospital from September 2013 to August 2015. The study group included 50 diagnosed HIV-positive patients. They were also subjected to specific questions regarding sexual dysfunction by female counselors using female sexual function index. Visits of the subjects were scheduled independent of the menstrual cycle. Hormonal levels (free testosterone, FSH, LH) were measured. Results Out of 50 patients, 26 patients in our study had sexual dysfunction (52%). Patients with age group between 30-39 years had the maximum sexual dysfunction compared to the other groups (<0.001). Patients with a CD4 count between 200 and 499 had the maximum sexual dysfunction (<0.02). Mean duration of HIV in the study was 30 months in sexual dysfunction group which was significant (p<0.005). Hormonal levels were found to be in normal range. All the study patients reported desire, arousal and lubrication problems whereas orgasm and satisfaction problems were noted in 60% patients with pain reported in 52%. Conclusion We identified that although the hormonal levels were in the normal range, they were comparatively in the lower range in the dysfunction group than the non-dysfunctional group. Both free testosterone and FSH levels were low indicating involvement of the pituitary rather than the gonads. We also conclude that duration of HIV and also level of CD4 count is related to sexual dysfunction. PMID:27190860

  16. Is the clinical course of HIV-1 changing? Cohort study.

    PubMed Central

    Sinicco, A.; Fora, R.; Raiteri, R.; Sciandra, M.; Bechis, G.; Calvo, M. M.; Gioannini, P.

    1997-01-01

    OBJECTIVE: To assess whether the clinical course of HIV infection has changed from 1985 to 1995. DESIGN: Cohort Study. SETTING: Infectious disease clinic. SUBJECTS: 285 patients recruited from September 1985 to January 1995 with < or = 12 months between the dates of their last seronegative and first seropositive test result and with first follow up visit in the six months after seroconversion and at least 12 months' follow up. Patients were grouped according to the date of seroconversion. MAIN OUTCOME MEASURES: Time to CD4 cell count of < 500, 400, and 200 x 10(6) cells/l, and clinical outcome defining AIDS; variation in cell count per day between consecutive visits, and ratio between this variation and time from estimated date of seroconversion at each visit. RESULTS: The groups were similar in age, number with acute primary HIV infection, CD4 cell count at intake, and cell count at the beginning of antiretroviral treatment; they differed in sex ratio, risk factors for HIV, probability of CD4 cell decline to < 500, 400, and 200 x 10(6) cells/l. and risk of developing AIDS. Acute infection, seroconversion after December 1989, and serum beta 2 microglobulin > 296 nmol/l were independent predictors of poor clinical course. The speed of CD4 cell decline, expressed as cell variation divided by the number of days between consecutive visits, increased with more recent seroconversion (P = 0.02). Ratio between the speed of CD4 cell decline and time from estimated date of seroconversion at each visit was also higher in the patients who seroconverted after December 1989. CONCLUSIONS: The faster disease progression and the higher speed of CD4 cell decline at early stages in the patients with recently acquired HIV infection suggest changes in the clinical course of HIV infection. PMID:9154026

  17. Mitigating HIV Health Disparities: The Promise of Mobile Health for a Patient-Initiated Solution

    PubMed Central

    Kumar, Disha; Patel, Sajani; Street, Richard L.; Giordano, Thomas Peter; Viswanath, Kasisomayajula

    2014-01-01

    The HIV epidemic is an ongoing public health problem fueled, in part, by undertesting for HIV. When HIV-infected people learn their status, many of them decrease risky behaviors and begin therapy to decrease viral load, both of which prevent ongoing spread of HIV in the community. Some physicians face barriers to testing their patients for HIV and would rather their patients ask them for the HIV test. A campaign prompting patients to ask their physicians about HIV testing could increase testing. A mobile health (mHealth) campaign would be a low-cost, accessible solution to activate patients to take greater control of their health, especially populations at risk for HIV. This campaign could achieve Healthy People 2020 objectives: improve patient–physician communication, improve HIV testing, and increase use of mHealth. PMID:25322292

  18. Lay Counsellor-Based Risk Reduction Intervention with HIV Positive Diagnosed Patients at Public HIV Counselling and Testing Sites in Mpumalanga, South Africa

    ERIC Educational Resources Information Center

    Peltzer, Karl; Tabane, Cily; Matseke, Gladys; Simbayi, Leickness

    2010-01-01

    Objective: To evaluate the feasibility, fidelity, and effect of a human immunodeficiency virus (HIV) risk reduction intervention delivered to HIV-infected patients by lay counsellors during routine HIV counselling and testing (HCT) public service in Mpumalanga, South Africa. Methods: A total of 488 HIV-infected patients, aged 18 years and older,…

  19. Sentinel hospital surveillance of HIV infection in Quebec. Quebec Sentinel Hospital HIV-Seroprevalence Study Group.

    PubMed Central

    Alary, M; Joly, J R; Parent, R; Fauvel, M; Dionne, M

    1994-01-01

    OBJECTIVE: To measure the HIV seroprevalence rate in a surrogate sample of the general population in the province of Quebec, using a network of sentinel hospitals. DESIGN: Anonymous unlinked sentinel surveillance study. SETTING: Outpatient surgery units in 19 acute care hospitals throughout Quebec. PARTICIPANTS: All patients attending the outpatient surgery units from November 1990 to October 1992. A total of 61,547 plasma samples were obtained from leftover blood samples collected for cell counts. Fifty samples were excluded because of an insufficient amount of plasma and one because of an indeterminate result. INTERVENTION: HIV antibody testing with enzyme-linked immunosorbent assay; positive results confirmed with radioimmunoprecipitation assay. OUTCOME MEASURES: HIV antibody status, sex, year of birth and area of residence. RESULTS: The crude seroprevalence rate among the subjects aged 15 years or more was 0.4 per 1000 population (95% confidence interval [CI] 0.2 to 0.7) among the women and 3.6 per 1000 population (95% CI 2.8 to 4.4) among the men (p < 0.001). The rate after adjustment for age, sex and geographic distribution of the study population was 2.3 per 1000 population (95% CI 1.9 to 2.7). The seroprevalence rate among the male patients in the City of Montreal was much higher than the rates elsewhere in the province. It increased progressively during each of the four 6-month intervals of the study: 8.1, 8.7, 13.9 and 18.3 per 1000 respectively (chi 2 linear trend = 4.76; p = 0.029). No similar trends were observed outside Montreal for the male patients. There were too few seropositive female patients to draw any solid conclusion. CONCLUSIONS: Despite the possible drawbacks of a nonrandomized sampling scheme, this study suggests that in the male population the HIV seroprevalence rate is increasing in Montreal and is stable in all other areas of the province. The continued surveillance of HIV infection through anonymous unlinked studies is useful to

  20. Ankle brachial index screening for occult vascular disease is not useful in HIV-positive patients.

    PubMed

    Johns, Kevin; Saeedi, Ramesh; Mancini, G B John; Bondy, Greg

    2010-09-01

    Metabolic complications common to the HIV-positive population may increase the risk for cardiovascular disease. Asymptomatic peripheral arterial disease (PAD) is associated with increased cardiovascular risk. The ankle-brachial pressure index (ABI) is a screening tool commonly used for the detection of asymptomatic PAD. The prevalence of asymptomatic PAD based on ABI in HIV-positive patients is unknown. This study was cross-sectional in design and assessed PAD by measuring the systolic ABI as determined by a handheld 8-MHz Doppler probe with the patient at rest in a supine position. A brief medical history including pertinent risk factors was obtained. One hundred and sixty-seven HIV-positive patients were evaluated (97.6% male; mean age 52.0 years; 31.2% current smokers, 29.4% former smokers, 26.3% diabetes mellitus). Asymptomatic PAD (ABI < or = 0.9) was found in four patients (2.4%, 95% CI: 0.3-4.5%). Smoking was a significant predictor of PAD. Patients with a positive test for PAD had at least two major risk factors for the disease including smoking, a history of disease in another vascular bed, dyslipidemia, diabetes, and hypertension. All patients with a positive test for PAD had a high risk (>20%) for cardiovascular disease according to the Framingham risk score. Three of the four patients with positive tests had previously diagnosed vascular disease (CAD, stroke). Three patients presenting with PAD were evaluated and all had a positive ABI. The prevalence of PAD compared to previous studies on PAD in HIV was low and identified only those patients with high cardiovascular risk based on other features. ABI was not useful in detecting occult vascular disease in HIV-positive patients and offers no additional information to that derived from cardiovascular risk stratification.

  1. Provider and patient correlates of provider decisions to recommend HCV treatment to HIV co-infected patients.

    PubMed

    Wagner, Glenn; Osilla, Karen Chan; Garnett, Jeffrey; Ghosh-Dastidar, Bonnie; Bhatti, Laveeza; Witt, Mallory; Goetz, Matthew Bidwell

    2012-01-01

    Despite low uptake of hepatitis C virus (HCV) treatment among HIV co-infected patients, few studies have examined the factors that contribute to provider decisions to recommend treatment. Surveys of 173 co-infected patients and their primary care providers, as well as patient chart data, were collected at 3 HIV clinics in Los Angeles; 73% of the patients had any history of being recommended HCV treatment. Multivariate predictors of being offered treatment included being Caucasian, greater HCV knowledge, receiving depression treatment if depressed, and one's provider having a lower weekly patient load and more years working at the study site. These findings suggest that provider decisions to recommend HCV treatment are influenced by patient factors including race and psychosocial treatment readiness, as well as characteristics of their own practice and treatment philosophy. With changes to HCV treatment soon to emerge, further evaluation of factors influencing treatment decisions is needed to improve HCV treatment uptake. PMID:22564797

  2. Prevalence of Hepatitis B Co-Infection among HIV Positive Patients: Narrative Review Article

    PubMed Central

    ASKARI, Azam; HAKIMI, Hamid; NASIRI AHMADABADI, Behzad; HASSANSHAHI, Gholamhossein; KAZEMI ARABABADI, Mohammad

    2014-01-01

    Hepatitis B virus (HBV) is the most prevalent viral infection and is among the leading causes of human liver diseases. Nearly 360 millions of people are world widely infected with prolonged forms of hepatitis B including active and inactive chronic forms. Chronic hepatitis B (CHB) is associated with cirrhosis and hepatocellular carcinoma (HCC) in patients suffering from congenital and/or acquired immunodeficiency and also following immunosuppressive therapy. The target cell of human acquired immunodeficiency virus (HIV) is CD4 positive T cells. These cells play central role(s) in both cellular and humoral immunity so that the HIV attack of CD4 positive T cells causes suppression of both cell-mediated and humoral immune responses. One of the frequent complications in HIV positive patients is HBV co-infection and as a result, the co-transmission of these viral diseases is common. Due to the paramount importance of the co-infection of HBV and HIV, it is noteworthy to investigate the prevalence of hepatitis B in these patients for planning of an effective therapeutic strategy. Based on these considerations, the main aim of this review article was to collect and analyze the recent and relevant studies regarding the prevalence rate of hepatitis B co-infection among HIV positive patients world widely. PMID:26110141

  3. Predictors of Immunological Failure of Antiretroviral Therapy among HIV Infected Patients in Ethiopia: A Matched Case-Control Study

    PubMed Central

    Teshome, Wondu; Assefa, Anteneh

    2014-01-01

    Background In resource constrained settings, immunological assessment through CD4 count is used to assess response to first line Highly Active Antiretroviral Therapy (HAART). In this study, we aim to investigate factors associated with immunological treatment failure. Methods A matched case-control study design was used. Cases were subjects who already experienced immunological treatment failure and controls were those without immunological failure after an exactly or approximately equivalent duration of first line treatment with cases. Data were analyzed using SPSS v16.0. Conditional logistic regression was carried out. Results A total of 134 cases and 134 controls were included in the study. At baseline, the mean age ±1 SD of cases was 37.5±9.7 years whereas it was 36.9±9.2 years among controls. The median baseline CD4 counts of cases and controls were 121.0 cells/µl (IQR: 47–183 cells/µl) and 122.0 cells/µl (IQR: 80.0–189.8 cells/µl), respectively. The median rate of CD4 cells increase was comparable for the two groups in the first six months of commencing HAART (P = 0.442). However, the median rate of CD4 increase was significantly different for the two groups in the next 6 months period (M6 to M12). The rate of increment was 8.8 (IQR: 0.5, 14.6) and 1.8 (IQR: 8.8, 11.3) cells/µl/month for controls and cases, respectively (Mann-Whitney U test, P = 0.003). In conditional logistic regressions grouped baseline CD4 count (P = 0.028), old age group and higher educational status (P<0.001) were significant predictors of immunological treatment failure. Conclusion Subjects with immunological treatment failure have an optimal rate of immunological recovery in the first 6 months of treatment with first line HAART, but relative to the non-failing group the rate declines at a later period, notably between 6 and 12 months. Low baseline CD4 count, old age and higher educational status were associated with immunological treatment failure. PMID:25536416

  4. Oral Human Papillomavirus Infection and Oral Lesions in HIV-Positive and HIV-Negative Dental Patients.

    PubMed

    Muller, Katia; Kazimiroff, Julie; Fatahzadeh, Mahnaz; Smith, Richard V; Wiltz, Mauricio; Polanco, Jacqueline; Grossberg, Robert M; Belbin, Thomas J; Strickler, Howard D; Burk, Robert D; Schlecht, Nicolas F

    2015-09-01

    We evaluated the risk factors associated with oral human papillomavirus (HPV) infection and oral lesions in 161 human immunodeficiency virus (HIV)-positive patients and 128 HIV-negative patients presenting for oral examination at 2 urban healthcare centers. Patients were interviewed on risk factors and provided oral-rinse samples for HPV DNA typing by polymerase chain reaction. Statistical associations were assessed by logistic regression. Oral HPV was prevalent in 32% and 16% of HIV-positive patients and HIV-negative patients, respectively, including high-risk HPV type 16 (8% and 2%, respectively; P = .049) and uncommon HPV types 32/42 (6% and 5%, respectively; P = .715). Among HIV-negative patients, significant risk factors for oral HPV included multiple sex partners (≥21 vs ≤5; odds ratio [OR], 9.1; 95% confidence interval [CI], 1.7-49.3), heavy tobacco smoking (>20 pack-years vs none; OR, 9.2; 95% CI, 1.4-59.4), and marijuana use (OR, 4.0; 95% CI, 1.3-12.4). Among HIV-positive patients, lower CD4(+) T-cell count only was associated with oral HPV detection (≤200 vs ≥500 cells/mm(3); OR, 4.5; 95% CI, 1.3-15.5). Detection of high-risk HPV was also associated with concurrent detection of potentially cancerous oral lesions among HIV-negative patients but not among HIV-positive patients. The observed risk factor associations with oral HPV in HIV-negative patients are consistent with sexual transmission and local immunity, whereas in HIV-positive patients, oral HPV detection is strongly associated with low CD4(+) T-cell counts.

  5. Oral Human Papillomavirus Infection and Oral Lesions in HIV-Positive and HIV-Negative Dental Patients

    PubMed Central

    Muller, Katia; Kazimiroff, Julie; Fatahzadeh, Mahnaz; Smith, Richard V.; Wiltz, Mauricio; Polanco, Jacqueline; Grossberg, Robert M.; Belbin, Thomas J.; Strickler, Howard D.; Burk, Robert D.; Schlecht, Nicolas F.

    2015-01-01

    We evaluated the risk factors associated with oral human papillomavirus (HPV) infection and oral lesions in 161 human immunodeficiency virus (HIV)–positive patients and 128 HIV-negative patients presenting for oral examination at 2 urban healthcare centers. Patients were interviewed on risk factors and provided oral-rinse samples for HPV DNA typing by polymerase chain reaction. Statistical associations were assessed by logistic regression. Oral HPV was prevalent in 32% and 16% of HIV-positive patients and HIV-negative patients, respectively, including high-risk HPV type 16 (8% and 2%, respectively; P = .049) and uncommon HPV types 32/42 (6% and 5%, respectively; P = .715). Among HIV-negative patients, significant risk factors for oral HPV included multiple sex partners (≥21 vs ≤5; odds ratio [OR], 9.1; 95% confidence interval [CI], 1.7–49.3), heavy tobacco smoking (>20 pack-years vs none; OR, 9.2; 95% CI, 1.4–59.4), and marijuana use (OR, 4.0; 95% CI, 1.3–12.4). Among HIV-positive patients, lower CD4+ T-cell count only was associated with oral HPV detection (≤200 vs ≥500 cells/mm3; OR, 4.5; 95% CI, 1.3–15.5). Detection of high-risk HPV was also associated with concurrent detection of potentially cancerous oral lesions among HIV-negative patients but not among HIV-positive patients. The observed risk factor associations with oral HPV in HIV-negative patients are consistent with sexual transmission and local immunity, whereas in HIV-positive patients, oral HPV detection is strongly associated with low CD4+ T-cell counts. PMID:25681375

  6. HIV infection in dialysis centers in Italy: a nationwide multicenter study.

    PubMed

    Barbiano di Belgiojoso, G; Trezzi, M; Scorza, D; Barone, M T; Landriani, N; Genderini, A; Bertoli, S

    1998-01-01

    The prevalence of HIV infection in dialysis populations varies according to different countries and geographic areas. We performed a nationwide epidemiological study by means of a questionnaire in the period from January 1990 to December 1995. Questions were about whether and which HIV tests were performed and which preventive measures were adopted. A separate survey evaluated the data the HIV-positive patients. Only 62% of the centers responded to the questionnaire, corresponding to 21,500 dialysis patients in 1990 and 27,000 in 1995. The prevalence of HIV-positive subjects was 0,13% for 1995. A total of 48 patients with HIV infection were identified: risk factors were drug abuse in 16 cases, homosexuality in 9, heterosexual contact in 8, transfusion in 7, renal transplant in 3 and unknown cause in 5. Forty-five patients were on hemodialysis, and 3 were receiving peritoneal dialysis. At follow-up, 19 patients died: infection and malnutrition were the most frequent causes of death. The death rate of patients who were already HIV positive when dialysis was started (group 1, 29 cases) was 19.36 deaths/1,000 patient/month. The correlations, performed only for group 1, showed a significantly worse prognosis for patients with CD4 < 200/mm3 and for those with AIDS. In conclusion, in Italy the prevalence of HIV infection in the dialysis population is low, and the outcome of HIV-positive patients in dialysis was found to be better than earlier literature reports. The use of chronic dialysis for HIV patients with uremia should not be discouraged.

  7. Fever in hospitalized HIV-infected patients in Western French Guiana: first think histoplasmosis.

    PubMed

    Vantilcke, Vincent; Boukhari, Rachida; Jolivet, Anne; Vautrin, Cyrille; Misslin, Caroline; Adenis, Antoine; Nacher, Mathieu

    2014-08-01

    In Western French Guiana, there was a dramatic increase in HIV prevalence between 1990 and 2000. The present study describes the causes of fever among HIV patients hospitalized in the medical ward of the only hospital in the western part of French Guiana. A retrospective descriptive study was conducted between 1 January 2008 and 30 June 2010 in the department of medicine of Saint Laurent du Maroni Hospital. The main characteristics of 67 patients having presented with fever in the first 48 hours of hospitalization were described. Among patients with CD4 <200/mm(3)the main febrile opportunistic infection was disseminated histoplasmosis (41.1%). Among patients with CD4 counts <50/mm(3)and fever without focal points 85.7% had disseminated histoplasmosis. Three patients died and all had disseminated histoplasmosis. Disseminated histoplasmosis is the most common febrile opportunistic infection in western French Guiana. Primary prophylaxis with itraconazole among immunocompromised patients seems warranted.

  8. Multi-drug-resistant tuberculosis in HIV positive patients in Eastern Europe.

    PubMed

    Post, Frank A; Grint, Daniel; Werlinrud, Anne Marie; Panteleev, Alexander; Riekstina, Vieja; Malashenkov, Evgeniy A; Skrahina, Alena; Duiculescu, Dan; Podlekareva, Daria; Karpov, Igor; Bondarenko, Vasiliy; Chentsova, Nelly; Lundgren, Jens; Mocroft, Amanda; Kirk, Ole; Miro, Jose M

    2014-03-01

    Observational data from Eastern Europe on the management and outcome of multi-drug-resistant tuberculosis (MDR TB) in HIV positive populations remain sparse in the English-language literature. We compared clinical characteristics and outcomes of 55 patients who were diagnosed with HIV and MDR TB in Eastern Europe between 2004 and 2006 to 89 patients whose Mycobacterium tuberculosis isolates were susceptible to isoniazid and rifampicin. Patients with HIV and MDR TB were young and predominantly male with high rates of intravenous drug use, imprisonment and hepatitis C co-infection. Eighty-four per cent of patients with MDR TB had no history of previous TB drug exposure suggesting that the majority of MDR TB resulted from transmission of drug-resistant M. tuberculosis. The use of non-standardized tuberculosis treatment was common, and the use of antiretroviral therapy infrequent. Compared to those with susceptible tuberculosis, patients with MDR TB were less likely to achieve cure or complete tuberculosis treatment (21.8% vs. 62.9%, p < 0.0001), and they were more likely to die (65.5% vs. 27.0%, p < 0.0001). Our study documents suboptimal management and poor outcomes in HIV positive patients with MDR TB. Implementation of WHO guidelines, rapid TB diagnostics and TB drug susceptibility testing for all patients remain a priority in this region. PMID:24247067

  9. Low-Cost Method to Monitor Patient Adherence to HIV Antiretroviral Therapy Using Multiplex Cathepsin Zymography.

    PubMed

    Platt, Manu O; Evans, Denise; Keegan, Philip M; McNamara, Lynne; Parker, Ivana K; Roberts, LaDeidra M; Caulk, Alexander W; Gleason, Rudolph L; Seifu, Daniel; Amogne, Wondwossen; Penny, Clement

    2016-01-01

    Monitoring patient adherence to HIV antiretroviral therapy (ART) by patient survey is inherently error prone, justifying a need for objective, biological measures affordable in low-resource settings where HIV/AIDS epidemic is highest. In preliminary studies conducted in Ethiopia and South Africa, we observed loss of cysteine cathepsin activity in peripheral blood mononuclear cells of HIV-positive patients on ART. We optimized a rapid protocol for multiplex cathepsin zymography to quantify cysteine cathepsins, and prospectively enrolled 350 HIV-positive, ART-naïve adults attending the Themba Lethu Clinic, Johannesburg, South Africa, to test if suppressed cathepsin activity could be a biomarker of ART adherence (103 patients were included in final analysis). Poor adherence was defined as detectable viral load (>400 copies/ml) or simplified medication adherence questionnaire, 4-6 months after ART initiation. 86 % of patients with undetectable viral loads after 6 months were cathepsin negative, and cathepsin-positive patients were twice as likely to have detectable viral loads (RR 2.32 95 % CI 1.26-4.29). Together, this demonstrates proof of concept that multiplex cathepsin zymography may be an inexpensive, objective method to monitor patient adherence to ART. Low cost of this electrophoresis-based assay makes it a prime candidate for implementation in resource-limited settings. PMID:26589706

  10. Intermittent Courses of Corticosteroids Also Present a Risk for Pneumocystis Pneumonia in Non-HIV Patients

    PubMed Central

    Calero-Bernal, Maria L.; Martin-Garrido, Isabel; Donazar-Ezcurra, Mikel; Limper, Andrew H.

    2016-01-01

    Introduction. Pneumocystis pneumonia (PCP) is rising in the non-HIV population and associates with higher morbidity and mortality. The aggressive immunosuppressive regimens, as well as the lack of stablished guidelines for chemoprophylaxis, are likely contributors to this increased incidence. Herein, we have explored the underlying conditions, immunosuppressive therapies, and clinical outcomes of PCP in HIV-negative patients. Methods. Retrospective analysis of PCP in HIV-negative patients at Mayo Clinic from 2006–2010. The underlying condition, immunosuppressive therapies, coinfection, and clinical course were determined. PCP diagnosis required symptoms of pneumonia and identification of the organisms by visualization or by a real-time polymerase chain reaction. Results. A total of 128 cases of PCP were identified during the study period. Hematological malignancies were the predisposing condition for 50% of the patients. While 87% had received corticosteroids or other immunosuppressive therapies for >4 weeks prior to the diagnosis, only 7 were receiving PCP prophylaxis. Up to 43% of patients were not on daily steroids. Sixty-seven patients needed Intensive Care Unit (ICU) and 53 received mechanical ventilation. The mortality for those patients requiring ICU was 40%. Conclusions. PCP diagnosis in the HIV-negative population requires a high level of suspicion even if patients are not receiving daily corticosteroids. Mortality remains high despite adequate treatment. PMID:27721666

  11. Vascular Tumor on the Forehead of an HIV Patient

    PubMed Central

    Ibarguren, Ander Mayor; Ramos, Jéssica González; Merino, María Beato; Pedrero, Rocío Maseda; Fernández, Cristina Gómez; Pinto, Pedro Herranz

    2015-01-01

    Cirsoid aneurysm is a small vascular proliferation characterized by small to medium-sized channels with features of arteries and veins, that present as small, blue or red asymptomatic papule. We report a case of a crisoid aneurysm on the forhead of an HIV patient that suggested a Kaposi sarcoma as a differential diagnosis. PMID:26288449

  12. HIV providers' likelihood to prescribe pre-exposure prophylaxis (PrEP) for HIV prevention differs by patient type: a short report.

    PubMed

    Adams, Leah M; Balderson, Benjamin H

    2016-09-01

    Pre-exposure prophylaxis (PrEP), the antiretroviral treatment regimen for HIV-negative people at high risk of acquiring HIV, has demonstrated efficacy across clinical trials in several patient populations. The Centers for Disease Control (CDC) have released detailed guidelines to aid providers in prescribing PrEP for their high-risk patients, including men who have sex with men (MSM), high-risk heterosexuals, and injection drug users (IDUs). Given that much attention in PrEP has focused on MSM patients, the present study used an online survey to assess factors involved in HIV care providers' (n = 363) decisions about prescribing PrEP, along with their willingness to prescribe PrEP to patients from various risk populations (e.g., MSM, heterosexuals, IDUs). The efficacy of PrEP was an important factor in providers' decisions about prescribing PrEP, as were considerations about patients' adherence to the regimen, regular follow-up for care, and medication costs. This survey's findings also suggest that providers' willingness to prescribe PrEP varies by patient group, with providers most willing to initiate the regimen with MSM who have an HIV-positive partner, and least willing to prescribe to high-risk heterosexuals or IDUs. In the context of the current CDC recommendations for PrEP that include MSM, heterosexuals, and IDUs, examining providers' rationales for and barriers against supporting this HIV prevention strategy across patient groups merits further attention.

  13. Epidemiological Distribution and Genotype Characterization of the Hepatitis C Virus Among HIV Patients in Kashan, Iran

    PubMed Central

    Afzali, Hasan; Momen-Heravi, Mansooreh; Farokhzad, Asefeh

    2016-01-01

    Background Parenteral transmission is a common route of transmission for both human immunodeficiency virus (HIV) and hepatitis C virus (HCV); therefore, hepatitis C viral infection is highly prevalent among people infected with HIV. Objectives This study was designed to examine the epidemiology and describe the clinical manifestation as well as the HCV genotypes in patients from the city of Kashan, Iran, who are coinfected with HIV and HCV. Patients and Methods This descriptive study was conducted in 2014 in the city of Kashan. The population consisted of all the HIV-infected patients who were referred to the behavioral counseling center and jail in Kashan. Demographic information and HCV- and HIV-related risk behaviors were obtained through the use of an interviewer-assisted questionnaire. After the participants gave written informed consent to participate, 10 cc venous blood samples were collected. The serum samples were screened for HCV infection using an enzyme-linked immunosorbent assay (ELISA). In the event of a positive test for HCV, the RNA was then amplified by polymerase chain reaction (PCR) amplification. The HCV subtypes were determined via the direct sequencing of the amplicons. All data analysis was performed using SPSS version 16.0 for the descriptive statistics, and then the chi-square test and Pearson coefficient were performed for additional analysis. Results The results of the analysis indicated that 54 (85%) of the 63 HIV-infected patients were males who were also HCV positive and who had less than a high school level education. There was a significant association between HCV infection and both occupation (P < 0.0001) and level of education (P < 0.05). All the HIV/HCV coinfected cases had a history of illicit drug use, while 92.6% had a history of imprisonment and 40.7% had high risk sexual contacts. Overall, genotype 1 was found in 75.9% of HCV patients, while genotype 3 was found in 24.1%. Some 94.4% of HCV patients had subtype A. There were

  14. Serological markers of hepatitis B and C in patients with HIV/AIDS and active tuberculosis.

    PubMed

    Araújo-Mariz, Carolline; Lopes, Edmundo Pessoa; Ximenes, Ricardo A A; Lacerda, Heloísa R; Miranda-Filho, Demócrito B; Montarroyos, Ulisses R; Barreto, Silvana; Salustiano, Daniela Medeiros; Albuquerque, Maria Fátima Pessoa Militão

    2016-06-01

    Infection with hepatitis B virus (HBV) and C virus (HCV) are common in patients with HIV/AIDS and tuberculosis (TB). This is a cross-sectional study with patients infected with HIV/AIDS and active TB in Recife, Brazil, aiming to verify the prevalence of markers for HBV: antibody to hepatitis B core antigen (anti-HBc); and HCV: antibody to hepatitis C virus (anti-HCV) by chemiluminescence, and to identify the frequency of associated factors. Data were collected through questionnaires, and blood was drawn from patients for analysis. We used the chi-square test and the Fisher exact test when necessary. We conducted a bivariate logistic regression analysis and the magnitude of the associations was expressed as odds ratio (OR) with a confidence interval of 95%. Among 166 patients studied with HIV/AIDS and active TB, anti-HBc was positive in 61 patients [36.7%; 95%CI (29.4-44.6%)] and anti-HCV in 11[6.6%; 95%CI (3.4-11.5%)]. In the logistic regression analysis, male sex, and age ≥40 years were independent factors associated with the occurrence of anti-HBc. In conclusion, we verified a high frequency of HBV contact marker and a low frequency of HCV markers in patients with HIV/AIDS and TB in Recife.

  15. Seroprevalence of Mycoplasma pneumoniae in HIV-infected patients using a microparticle agglutination test.

    PubMed

    Shankar, Esaki Muthu; Kumarasamy, Nagalingeswaran; Balakrishnan, Pachamuthu; Vengatesan, A; Kownhar, Hayath; Solomon, Suniti; Rao, Usha Anand

    2006-06-01

    Mycoplasma pneumoniae is increasingly recognized as a common and important pathogen in community settings, and is responsible for various pulmonary and extrapulmonary conditions in the normal population. However, the seroepidemiology of acute M. pneumoniae infection in HIV-infected individuals is still unclear worldwide. This study examined the seroprevalence of antibodies to M. pneumoniae in HIV-infected patients admitted with respiratory complaints at a tertiary AIDS care centre in Chennai, India. A commercial gelatin microparticle agglutination test (Serodia-Myco II, Fujirebio) was used for the determination of antibodies against M. pneumoniae in acute serum specimens. Of the 200 HIV-infected patients with underlying pulmonary conditions tested, 34 (17 % positivity; 95 % CI 12-23 %) had antibodies specific to M. pneumoniae, while among the 40 patients with no underlying pulmonary symptoms, five (12.5 % positivity; 95 % CI 4-27 %) had evidence of anti-M. pneumoniae antibody. This shows that the incidence of M. pneumoniae seropositivity is greater in patients with underlying pulmonary complaints. Most positive titres were found in the age group 28-37 years in the symptomatic and symptom-free groups (64.7 and 60 %, respectively). The positive titres ranged from 40 to >20 480. High titres (> or =320) were found in 10 out of the 39 patients (25.6 %). This seroprevalence study reports a 16.2 % prevalence of M. pneumoniae infections in HIV-infected patients by a particle agglutination test.

  16. HIV/Tuberculosis Co-Infection among Patients Attending a Referral Chest Clinic in Nasarawa State, Nigeria

    NASA Astrophysics Data System (ADS)

    Umeh, E. U.; Ishaleku, D.; Iheukwumere, C. C.

    Human immunodeficiency virus (HIV) and Mycobacterium tuberculosis (TB) coinfection rate was investigated among patients referred to a chest clinic in Nasarawa State, Nigeria. Out of the 344 patients who presented with respiratory problems at the clinic, 44.8% had M. tuberculosis infection, 24.7% HIV infection and 12.8% HIV/tubercle bacilli co-infection. Coinfection rate in HIV infected persons (HIV+) was 51.8 and 28.6% in those with M. tuberculosis infection. The relative risk of HIV positive persons being coinfected was 1.075, while it was 0.401 for TB infected persons. The estimated Odds Ratio (OR) shows that the risk of co-infection was 2.68 times higher among HIV+ persons than among those with tuberculosis. The attributable risk was 45% and shows the extent to which co-infection could be attributed to HIV infection. A key socio-economic variable, eating in groups, was significantly correlated with coinfection (r = 0.107; p< 0.05). The results of this study may provide a useful policy guide in the formulation of HIV and tuberculosis control measures in Nigeria.

  17. Trends in Any and High-Dose Opioid Analgesic Receipt Among Aging Patients With and Without HIV

    PubMed Central

    Gordon, Kirsha; Edelman, E. Jennifer; Kerns, Robert D.; Crystal, Stephen; Dziura, James D.; Fiellin, Lynn E.; Gordon, Adam J.; Goulet, Joseph L.; Justice, Amy C.; Fiellin, David A.

    2016-01-01

    Harms of opioid analgesics, especially high-dose therapy among individuals with comorbidities and older age, are increasingly recognized. However, trends in opioid receipt among HIV-infected patients are not well characterized. We examined trends, from 1999 to 2010, in any and high-dose (≥120 mg/day) opioid receipt among patients with and without HIV, by age strata, controlling for demographic and clinical correlates. Of 127,216 patients, 64 % received at least one opioid prescription. Opioid receipt increased substantially among HIV-infected and uninfected patients over the study; high-dose therapy was more prevalent among HIV-infected patients. Trends in high-dose receipt stratified by three age groups revealed an increasing trend in each age strata, higher among HIV-infected patients. Correlates of any opioid receipt included HIV, PTSD and major depression. Correlates of high-dose receipt included HIV, PTSD, major depression and drug use disorders. These findings suggest a need for appropriate balance of risks and benefits, especially as these populations age. PMID:26384973

  18. Do More to Fight HIV in Africa: Study

    MedlinePlus

    ... news/fullstory_159839.html Do More to Fight HIV in Africa: Study Male circumcision, broader use of preventive drugs ... a long way to go in curbing the HIV epidemic in Africa," said Kong. "People need to adopt these strategies, ...

  19. Oral Kaposi's sarcoma: Sole presentation in HIV seropositive patient

    PubMed Central

    Arul, A. Sri Kennath J.; Kumar, A. Ramesh; Verma, Sonika; Arul, A. Sri Sennath J.

    2015-01-01

    Acquired immunodeficiency syndrome (AIDS)-associated Kaposi's sarcoma (KS) occurs with increased frequency in all HIV transmission groups and at a particularly high rate among homosexual men. It usually presents initially as violaceous cutaneous lesions, but oral mucosa, lymph nodes and visceral organs may be affected, sometimes without skin involvement. KS in a 20-year-old HIV-seropositive patient with oral involvement as the sole presentation of the disease is presented herewith; thus contributing a new AIDS-related KS case reported in Indian Literature. PMID:26283853

  20. FAmily CEntered (FACE) advance care planning: Study design and methods for a patient-centered communication and decision-making intervention for patients with HIV/AIDS and their surrogate decision-makers

    PubMed Central

    Kimmel, Allison L.; Wang, Jichuan; Scott, Rachel; Briggs, Linda; Lyon, Maureen E.

    2016-01-01

    Although the Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) has become a chronic illness, disease-specific advance care planning has not yet been evaluated for the palliative care needs of adults with HIV/AIDS. This prospective, longitudinal, randomized, two-arm controlled clinical trial aims to test the efficacy of FAmily CEntered Advance Care Planning among adults living with AIDS and/or HIV with co-morbidities on congruence in treatment preferences, healthcare utilization, and quality of life. The FAmily CEntered intervention arm is two face-to-face sessions with a trained, certified facilitator: Session 1) Disease-Specific Advance Care Planning Respecting Choices Interview; Session 2) Completion of advance directive. The Healthy Living control arm is: Session 1) Developmental/Relationship History; Session 2) Nutrition. Follow-up data will be collected at 3, 6, 12, and 18-month post-intervention. A total of 288 patient/surrogate dyads will be enrolled from five hospital-based, out-patient clinics in Washington, District of Columbia. Participants will be HIV positive and ≥21 years of age; surrogates will be ≥18 years of age. Exclusion criteria are homicidality, suicidality, psychosis, and impaired cognitive functioning. We hypothesize that this intervention will enhance patient-centered communication with a surrogate decision-maker about end of life treatment preferences over time, enhance patient quality of life and decrease health care utilization. We further hypothesize that this intervention will decrease health disparities for Blacks in completion of advance directives. If proposed aims are achieved, the benefits of palliative care, particularly increased treatment preferences about end-of-life care and enhanced quality of life, will be extended to people living with AIDS. PMID:26044463

  1. FAmily CEntered (FACE) advance care planning: Study design and methods for a patient-centered communication and decision-making intervention for patients with HIV/AIDS and their surrogate decision-makers.

    PubMed

    Kimmel, Allison L; Wang, Jichuan; Scott, Rachel K; Briggs, Linda; Lyon, Maureen E

    2015-07-01

    Although the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) has become a chronic illness, disease-specific advance care planning has not yet been evaluated for the palliative care needs of adults with HIV/AIDS. This prospective, longitudinal, randomized, two-arm controlled clinical trial aims to test the efficacy of FAmily CEntered advance care planning among adults living with AIDS and/or HIV with co-morbidities on congruence in treatment preferences, healthcare utilization, and quality of life. The FAmily CEntered intervention arm is two face-to-face sessions with a trained, certified facilitator: Session 1) Disease-Specific Advance Care Planning Respecting Choices Interview; Session 2) Completion of advance directive. The Healthy Living Control arm is: Session 1) Developmental/Relationship History; Session 2) Nutrition. Follow-up data will be collected at 3, 6, 12, and 18 months post-intervention. A total of 288 patient/surrogate dyads will be enrolled from five hospital-based, out-patient clinics in Washington, District of Columbia. Participants will be HIV positive and ≥ 21 years of age; surrogates will be ≥ 18 years of age. Exclusion criteria are homicidality, suicidality, psychosis, and impaired cognitive functioning. We hypothesize that this intervention will enhance patient-centered communication with a surrogate decision-maker about end of life treatment preferences over time, enhance patient quality of life and decrease health care utilization. We further hypothesize that this intervention will decrease health disparities for Blacks in completion of advance directives. If proposed aims are achieved, the benefits of palliative care, particularly increased treatment preferences about end-of-life care and enhanced quality of life, will be extended to people living with AIDS.

  2. Effect of SLCO1B1 Polymorphisms on Rifabutin Pharmacokinetics in African HIV-Infected Patients with Tuberculosis.

    PubMed

    Hennig, Stefanie; Naiker, Suhashni; Reddy, Tarylee; Egan, Deirdre; Kellerman, Tracy; Wiesner, Lubbe; Owen, Andrew; McIlleron, Helen; Pym, Alexander

    2016-01-01

    Rifabutin, used to treat HIV-infected tuberculosis, shows highly variable drug exposure, complicating dosing. Effects of SLCO1B1 polymorphisms on rifabutin pharmacokinetics were investigated in 35 African HIV-infected tuberculosis patients after multiple doses. Nonlinear mixed-effects modeling found that influential covariates for the pharmacokinetics were weight, sex, and a 30% increased bioavailability among heterozygous carriers of SLCO1B1 rs1104581 (previously associated with low rifampin concentrations). Larger studies are needed to understand the complex interactions of host genetics in HIV-infected tuberculosis patients. (This study has been registered at ClinicalTrials.gov under registration no. NCT00640887.). PMID:26482301

  3. Effect of SLCO1B1 Polymorphisms on Rifabutin Pharmacokinetics in African HIV-Infected Patients with Tuberculosis

    PubMed Central

    Naiker, Suhashni; Reddy, Tarylee; Egan, Deirdre; Kellerman, Tracy; Wiesner, Lubbe; Owen, Andrew; McIlleron, Helen; Pym, Alexander

    2015-01-01

    Rifabutin, used to treat HIV-infected tuberculosis, shows highly variable drug exposure, complicating dosing. Effects of SLCO1B1 polymorphisms on rifabutin pharmacokinetics were investigated in 35 African HIV-infected tuberculosis patients after multiple doses. Nonlinear mixed-effects modeling found that influential covariates for the pharmacokinetics were weight, sex, and a 30% increased bioavailability among heterozygous carriers of SLCO1B1 rs1104581 (previously associated with low rifampin concentrations). Larger studies are needed to understand the complex interactions of host genetics in HIV-infected tuberculosis patients. (This study has been registered at ClinicalTrials.gov under registration no. NCT00640887.) PMID:26482301

  4. HIV positive patient with HSV-2 encephalitis: case report.

    PubMed

    Pagliano, Pasquale; Ascione, Tiziana; Carleo, Maria Aurora; Boccia, Giovanni; De Caro, Francesco; Tortora, Fabio

    2016-09-01

    Incidence of brain infections in Human Immunodeficiency Virus (HIV) positive patients is reduced after the availability of current high active antiretroviral therapy (HAART). Herpes Simplex Virus type 2 (HSV-2) is an infrequent cause of encephalitis in HIV patients despite it is frequently involved in sexual transmitted infections. Here, we report a case of HSV-2 encephalitis occurring in a patient without full suppression of HIV replication within the brain. A 38 year-old HIV infected man was admitted to our department because of recurrent generalized seizure and fever during the previous 24 hours. Eight months before our observation the patient was switched from a protease inhibitor based regimen to a rilpivirine-based regimen without any evidence of HIV-RNA replication in the plasma. When the patient was admitted in our hospital, he was febrile and moderately confused, no deficit of cranial nerves was reported, motility was conserved, but he was unable to walk. Laboratory examinations performed at admission demonstrated an increase of cerebrospinal fluid (CSF) protein and cells with lymphocyte prevalence, and normal CSF glucose. HSV-2-DNA and HIV-RNA were present within CSF at admission. Nuclear Magnetic Resonance imaging of the brain revealed lesions of the medial part of both temporal lobes including hippocampus without any sign of bleeding. A 21-day course of acyclovir therapy was administered with consistent improvement of clinical findings and disappearance of HSV-2-DNA within CSF. After the episode, HAART was switched to a regimen with high CSF penetrability containing abacavir, lamivudine, darunavir and ritonavir. Twelve months after HSV-2 encephalitis neurologic evaluation was normal, but symptoms of depression were reported, HIV-RNA remained undetectable both in the plasma and CSF, and CD4+ lymphocytes were above 500/μL. No opportunistic infection was reported. Patients switched to regimen well tolerated such those containing rilpivirine, that have

  5. HIV positive patient with HSV-2 encephalitis: case report.

    PubMed

    Pagliano, Pasquale; Ascione, Tiziana; Carleo, Maria Aurora; Boccia, Giovanni; De Caro, Francesco; Tortora, Fabio

    2016-09-01

    Incidence of brain infections in Human Immunodeficiency Virus (HIV) positive patients is reduced after the availability of current high active antiretroviral therapy (HAART). Herpes Simplex Virus type 2 (HSV-2) is an infrequent cause of encephalitis in HIV patients despite it is frequently involved in sexual transmitted infections. Here, we report a case of HSV-2 encephalitis occurring in a patient without full suppression of HIV replication within the brain. A 38 year-old HIV infected man was admitted to our department because of recurrent generalized seizure and fever during the previous 24 hours. Eight months before our observation the patient was switched from a protease inhibitor based regimen to a rilpivirine-based regimen without any evidence of HIV-RNA replication in the plasma. When the patient was admitted in our hospital, he was febrile and moderately confused, no deficit of cranial nerves was reported, motility was conserved, but he was unable to walk. Laboratory examinations performed at admission demonstrated an increase of cerebrospinal fluid (CSF) protein and cells with lymphocyte prevalence, and normal CSF glucose. HSV-2-DNA and HIV-RNA were present within CSF at admission. Nuclear Magnetic Resonance imaging of the brain revealed lesions of the medial part of both temporal lobes including hippocampus without any sign of bleeding. A 21-day course of acyclovir therapy was administered with consistent improvement of clinical findings and disappearance of HSV-2-DNA within CSF. After the episode, HAART was switched to a regimen with high CSF penetrability containing abacavir, lamivudine, darunavir and ritonavir. Twelve months after HSV-2 encephalitis neurologic evaluation was normal, but symptoms of depression were reported, HIV-RNA remained undetectable both in the plasma and CSF, and CD4+ lymphocytes were above 500/μL. No opportunistic infection was reported. Patients switched to regimen well tolerated such those containing rilpivirine, that have

  6. Dental Health Status of HIV-Positive Patients and Related Variables in Southeast Iran

    PubMed Central

    Saravani, Shirin; Nosrat Zehi, Tahereh; Kadeh, Hamideh; Mir, Sarvar

    2016-01-01

    Background Different factors can be responsible for the increased prevalence of dental caries and missing teeth in HIV-positive patients. Objectives This study evaluates dental health status and its relationship with social, behavioral, and medical factors in HIV-positive patients under the coverage of Zahedan University of Medical Sciences in Southeast Iran. Patients and Methods In a cross-sectional study, the dental health status of 119 HIV-positive patients was assessed in accordance with WHO indices and included decayed, missing, and filled teeth (DMFT). A questionnaire on different social, behavioral, and medical variables was filled out for every case and the relationship and correlation of the variables to dental health status were investigated using One-way ANOVA, the Kruskal Wallis test, the t-test, the Mann-Whitney test, Spearman’s rho correlation coefficient, and Pearson correlation. Results The mean value of DMFT index was 11.87 ± 8.08, where the mean values of decayed and missing teeth were 8.42 ± 5.44 and 3.43 ± 4.07, respectively. DMFT index, decayed, and missing teeth correlated only with age (P < 0.0001, P = 0.009, P < 0.0001) and duration of HIV involvement (P = 0.004, P = 0.031, P = 0.007). Conclusions The dental health status of HIV-positive patients in this region was almost inappropriate. Most social, behavioral, and medical factors had no influence on dental health; only a correlation between dental health, age, and duration of HIV involvement was observed. PMID:27622173

  7. Brief Training of HIV Medical Providers Increases Their Frequency of Delivering Prevention Counselling to Patients at Risk of Transmitting HIV to Others

    ERIC Educational Resources Information Center

    Patel, Shilpa N.; Marks, Gary; Gardner, Lytt; Golin, Carol E.; Shinde, Sanjyot; O'Daniels, Christine; Wilson, Tracey E.; Quinlivan, E. Byrd; Banderas, Julie W.

    2013-01-01

    Objective: The aim of this study was to examine whether brief training of human immunodeficiency virus (HIV) medical providers increased the frequency with which they routinely delivered prevention counselling to patients, and whether patient characteristics were associated with receipt of that counselling. Design: Longitudinal. Setting: Seven HIV…

  8. Pattern of microbial translocation in patients living with HIV-1 from Vietnam, Ethiopia and Sweden

    PubMed Central

    Abdurahman, Samir; Barqasho, Babilonia; Nowak, Piotr; Cuong, Do Duy; Amogne, Wondwossen; Larsson, Mattias; Lindquist, Lars; Marrone, Gaetano; Sönnerborg, Anders

    2014-01-01

    Introduction The role of microbial translocation (MT) in HIV patients living with HIV from low- and middle-income countries (LMICs) is not fully known. The aim of this study is to investigate and compare the patterns of MT in patients from Vietnam, Ethiopia and Sweden. Methods Cross-sectional samples were obtained from treatment-naïve patients living with HIV-1 and healthy controls from Vietnam (n=83; n=46), Ethiopia (n=9492; n=50) and Sweden (n=51; n=19). Longitudinal samples were obtained from a subset of the Vietnamese (n=24) in whom antiretroviral therapy (ART) and tuberculostatics were given. Plasma lipopolysaccharide (LPS), sCD14 and anti-flagellin IgG were determined by the endpoint chromogenic Limulus Amebocyte Assay and enzyme-linked immunosorbent assay. Results All three biomarkers were significantly increased in patients living with HIV-1 from all countries as compared to controls. No differences were found between males and females. Vietnamese and Ethiopian patients had significantly higher levels of anti-flagellin IgG and LPS, as compared to Swedes. ART reduced these levels for the Vietnamese. Vietnamese patients given tuberculostatics at initiation of ART had significantly lower levels of anti-flagellin IgG and higher sCD14. The biomarkers were lower in Vietnamese who did not develop opportunistic infection. Conclusions Higher MT is common in patients living with HIV compared to healthy individuals, and in patients from LMICs compared to patients from a high-income country. Treatment with tuberculostatics decreased MT while higher levels of MT are associated with a poorer clinical outcome. PMID:24461466

  9. Enteric parasites and HIV infection: occurrence in AIDS patients in Rio de Janeiro, Brazil.

    PubMed

    Moura, H; Fernandes, O; Viola, J P; Silva, S P; Passos, R H; Lima, D B

    1989-01-01

    The occurrence of intestinal parasites, its relation with the transmission mechanism of HIV, and the clinical state of the AIDS patients, were analyzed in 99 Group IV patients (CDC, 1986), treated at "Hospital Universitário Pedro Ernesto" (HUPE), between 1986 and 1988. The group consisted of 79 (79.8%) patients whose HIV transmission mechanism took place through sexual contact and of 16 (20.2%) who were infected through blood. Feces samples from each patient were examined by four distincts methods (Faust et al., Kato-Katz, Baermann-Moraes and Baxby et al.). The most occurring parasites were: Cryptosporidium sp., Entamoeba coli and Endolimax nana (18.2%), Strongyloides stercoralis and Giardia lamblia (15.2%), E. histolytica and/or E. hartmanni (13.1%), Ascaris lumbricoides (11.1%) and Isospora belli (10.1%). Furthermore, 74.7% of the patients carried at least one species. Intestinal parasites were found in 78.5% of the patients who acquired the HIV through sexual intercourse and in 56.3% of those infected by blood contamination. The difference, was not statistically significant (p greater than 0.05). In the group under study, the increase of the occurrence of parasitic infections does not seem to depend on the acquisition of HIV through sexual contact. It appears that in developing countries, the dependency is more related to the classic mechanisms of parasites transmission and its endemicity. PMID:2487448

  10. Mycobacterium tuberculosis infection in a HIV-positive patient.

    PubMed

    Montales, Maria Theresa; Beebe, Alexandria; Chaudhury, Arun; Patil, Naveen

    2015-01-01

    Mycobacterium tuberculosis (MTB) and human immunodeficiency virus (HIV) coinfection remains a global public health challenge. We report a 40 year old African American male who is a known HIV-positive patient, non-compliant with his antiretrovirals and developed pulmonary tuberculosis. His chief complaints were chronic cough, fever, night sweats and undocumented weight loss. He had a prior positive T-SPOT-TB test; however, chest radiograph and sputum smear examination revealed normal results. PCR-based GeneXPERT MTB/RIF assay was ordered and confirmed MTB infection. The sputum cultures grew MTB and sensitivities showed susceptibility to all primary anti-tuberculosis medications. A delay in diagnosis and initiation of MTB therapy, in the setting of HIV or AIDS, may result in rapid disease progression and worse clinical outcome. PMID:26744689

  11. [Study of an HIV positive, tropical origin population in a refugee center in France].

    PubMed

    Bourée, P; Lamour, P; Bisaro, F; Didier, E

    1995-01-01

    The study describes HIV positive refugee patients, who were seen over a 3 years period at COMEDE, a dispensary for foreign nationals. COMEDE offered a HIV test to every patient, and it followed up on the disease and its prevention. Out of 5,234 tests, 328 were positive (6.3%). Less than 5% of the patients refused the test. All the patients returned for the result; 88.4% were African and 11.3% Haitian. The mean age was 31.5 years. The male/female sex ratio was 1.28. In this study, 94.5% of the HIV patients were HIV1, 3% HIV2 and 2.5% carried both strains; 78% were asymptomatic, 7% had ARC and 12.5% had AIDS. The prevalence of tuberculosis was high (10.6%), especially for AIDS patients (65%); Treponematosis prevalence was 13% and toxoplasmosis was 62.8%; 40% had intestinal parasites. 36.4% of the women became pregnant during the study; 41% of the pregnancies were terminated, while 27% went full term. The proportion of missing patients after 6 months was high (57%) because of numerous factors which prevented them from returning. This study shows the importance of proposing a HIV test to this immigrant population, although follow-up is difficult, due to social and economic factors.

  12. [Condylomata acuminata and HIV infection--an epidemiologic study].

    PubMed

    Senff, H; Kuhlwein, A; Caspar, A; Stieler, W

    1988-11-15

    Within a period of 15 months, 134 patients suffering from condylomata acuminata were investigated with regard to simultaneous infection with HIV. 3 of these patients--2 showing warts in the anal region, 1 on the glans penis--were found positive for anti-HIV antibodies.

  13. Low-cost CD4 enumeration in HIV-infected patients in Thailand.

    PubMed

    Pattanapanyasat, Kovit; Lerdwana, Surada; Shain, Hla; Noulsri, Egarit; Thepthai, Charin; Prasertsilpa, Varipin; Eksaengsri, Achara; Kraisintu, Krisana

    2003-06-01

    In Thailand, over one million people have been infected with HIV since the beginning of the epidemic. This has created a great burden on the country's limited health care budget. Monitoring CD4+ T-lymphocytes is important to determine the success of any antiretroviral therapy as well as HIV vaccine trials. However, the high cost of CD4 counts makes monitoring of every HIV-infected patient impossible in Thailand. Therefore, the development of affordable strategies is necessary in order to allow more HIV infected persons to access CD4 testing to control the disease. The current standard methods for enumeration of CD4+ T-lymphocytes are performed on whole blood by flow cytometric immunophenotyping using the 6-tube 2-color and 3-tube 3-color panels recommended by the Centers for Diseases Control (CDC). In this study, percentage CD4+ T-lymphocyte values (from 142 HIV-seropositive patients and 26 anti-HIV negative adult blood donors) generated by the use of just 2 reagents (CD45/CD4) in a 1-tube 2-color panel employing side scatter/CD45 morphospectral gating were compared to those obtained by state of the art methods. We also compared the use of generic monoclonal antibody reagents with commercial reagents and found the results to be comparable with an overall correlation coefficient (r) of more than 0.95 for both CD4+ and CD8+ T-lymphocytes. Bland-Altman analysis of the mean CD4 values plotted against the difference in values between the generic reagents and the commercial reagents showed no bias. The 1-tube 2-color method using generic monoclonal antibody reagents potentially permits more affordable but reliable CD4 testing and therefore could increase access for more HIV-infected patients in resource-poor countries.

  14. Dyslipidemia and cardiovascular disease risk profiles of patients attending an HIV treatment clinic in Harare, Zimbabwe.

    PubMed

    Zhou, Danai Tavonga; Kodogo, Vitaris; Chokuona, Kudzai Fortunate Vongai; Gomo, Exnevia; Oektedalen, Olav; Stray-Pedersen, Babill

    2015-01-01

    The chronic inflammation induced by human immunodeficiency virus (HIV) contributes to increased risk of coronary heart disease (CHD) in HIV-infected individuals. HIV-infected patients generally benefit from being treated with antiretroviral drugs, but some antiretroviral agents have side effects, such as dyslipidemia and hyperglycemia. There is general consensus that antiretroviral drugs induce a long-term risk of CHD, although the levels of that risk are somewhat controversial. The intention of this cross-sectional study was to describe the lipid profile and the long-term risk of CHD among HIV-positive outpatients at an HIV treatment clinic in Harare, Zimbabwe. Two hundred and fifteen patients were investigated (females n=165, mean age 39.8 years; males n=50; mean age 42.0 years). Thirty of the individuals were antiretroviral-naïve and 185 had been on antiretroviral therapy (ART) for a mean 3.9±3.4 years. All participants had average lipid and glucose values within normal ranges, but there was a small difference between the ART and ART-for total cholesterol (TC) and high-density lipoprotein (HDL). Those on a combination of D4T or ZDV/NVP/3TC and PI-based ART were on average oldest and had the highest TC levels. Framingham risk showed 1.4% prevalence of high CHD risk within the next ten years. After univariate analysis age, sex, TC/HDL ratio, HDL, economic earnings and systolic BP were associated with medium to high risk of CHD. After multivariate regression analysis and adjusting for age or sex only age, sex and economic earnings were associated with medium to high risk of CHD. There is small risk of developing CHD, during the next decade in HIV infected patients at an HIV treatment clinic in Harare.

  15. Group-Based Randomized Trial of Contingencies for Health and Abstinence in HIV Patients

    ERIC Educational Resources Information Center

    Petry, Nancy M.; Weinstock, Jeremiah; Alessi, Sheila M.; Lewis, Marilyn W.; Dieckhaus, Kevin

    2010-01-01

    Objective: Contingency management (CM) treatments are usually applied individually for drug abstinence, but CM can also be targeted toward health behaviors and implemented in groups. This study evaluated effects of a group-based CM intervention that focused on reinforcing health behaviors. Method: HIV-positive patients with cocaine or opioid use…