Revista de SIDA e investigación clínica

The morbidity and mortality associated with HIV infection has decreased significantly in the current era of antiretroviral therapy, with HIV-infected individuals now anticipating a normal life expectancy in developed countries. HIV has transformed from a disease of certain death into a chronic condition that can be managed medically. Reflecting this change, the Infectious Disease Society of America (IDSA) recently released an update on the management of HIV with a new emphasis on primary care and enhanced screening for comorbid conditions. For individuals with well-controlled HIV infection, the frequency of viral load and CD4 cell count monitoringcan is reduced from every 3-4 months to every 6-12 months. Increased attention is devoted to immunizations with new recommendations for HPV vaccination in males and an updated pneumococcal vaccination schedule. There is also an enhanced section on sexually transmitted diseases including annual screening for trichomoniasisin women, yearly screening for gonorrhea and chlamydia in at risk individuals, and anal cytologic screening in certain risk groups. This article reviews the 2013IDSA guidelines, highlights significant changes from prior IDSA guidelines, and contrasts these recommendations with other United States screening guidelines

Background: The prevalence of cardiovascular disease is increased with human immunodeficiency virus (HIV) infection, but the mechanism is unclear. We hypothesized that HIV increases microvascular reactive oxygen species, thereby impairing endothelial function and enhancing contractility.

Method: Subcutaneous micro arterioles were isolated from gluteal skin biopsies in premenopausal, African American, HIV positive women receiving effective anti-retroviral therapy, but without cardiovascular risk factors except for increased body mass index (n=10) and healthy matched controls (n=10). The arterioles were mounted on myographs, preconstricted and relaxed with acetylcholine for: endothelium-dependent relaxation, endotheliumdependent relaxation factor (nitric oxide synthase-dependent relaxation), endothelium-dependent hyperpolarizing factor (potassium-channel dependent relaxation) and endothelium-independent relaxation nitroprusside. Contractions were tested to endothelium-dependent contracting factor (acetylcholine contraction with blockedrelaxation); phenylephrine, U-46,619 and endothelin-1. Plasma L-arginine and asymmetric dimethylarginine were measured by high performance capillary electrophoresis.

Results: The micro-arterioles from HIV positive women had significantly (% change in tension; P<0.05) reduced acetylcholine relaxation (-51 ± 6 vs. -78 ± 3%), endothelium-dependent relaxation factor (-28 ± 4 vs. -39 ± 3%), endothelium-dependent hyperpolarizing factor (-17 ± 4 vs. -37 ± 4%) and decreased nitric oxide activity (0.16 ± 0.03 vs. 0.70 ± 0.16 Δ unit) but unchanged nitroprusside relaxation. They had significantly enhanced endothelium-dependent contracting factor (+21 ± 6 vs. +7 ± 2%) and contractions to U-46,619 (+164 ± 10 vs. +117 ± 11%) and endothelin-1(+151 ± 12 vs. +97 ± 9%), but not to phenylephrine. There was enhanced reactive oxygen species with acetylcholine (0.11 ± 0.02 vs. 0.05 ± 0.01 Δ unit; P<0.05) and endothelin-1 (0.31 ± 0.06 vs. 0.10 ± 0.02 Δ unit; P<0.05). Plasma L-arginine: assymetric dimethyl arginine rates was reduced (173 ± 12 vs. 231 ± 6 μmol·μmol-1, P<0.05).

Conclusion: Premenopausal HIV positive women had microvascular oxidative stress with severe endothelial dysfunction and reduced nitric oxide and arginine: assymetric dimethylarginine ratio but enhanced endothelial, thromboxane and endothelin contractions. These microvascular changes may herald later cardiovascular disease.

This case study was conducted during the year of 2012 on the staffs of Zeway fisheries resources research centre, Oromia. It mainly focused on identifying factors contributing to staffs susceptibility to HIV. Susceptibility refers to the likelihood of being infected by HIV. Qualitative analysis has been widely used. Data has been presented and analysed by use of the following: Discussions, tables, responses were organized together according to their types. The study identified the following as factors that contributed to susceptibility to HIV. These factors were knowledge of staffs on HIV transmission and methods of HIV prevention, decision making, and culture of silence on HIV/AIDS aspects, religious practices and beliefs, long absence from home, use of field allowance and use of stimulant drugs. The study indicated that the likelihood of staffs susceptibility to HIV with regard to their knowledge about HIV transmission and methods of HIV prevention is less likely and with regards to use of stimulant drugs, use of field allowance, long absence from home and culture of silence on HIV and AIDS aspects, the staffs were more likely to be susceptible to HIV infection. Organization need to encourage behavioural change or change from high risk to more responsible sexual behaviour. Due to having disposable field allowances and absence of better recreation centres during field work, men staffs tend to show high susceptibility by spending part of their allowances to drink alcohols. However, no way to reduce their field allowances. Therefore, organization should deal with those identified as a high susceptibility group of men to bring behavioural change. One way of dealing with this is through providing managerial level consultation.

Background: HIV infection is highly prevalent in sub-Saharan Africa. Many people living with HIV infection in the region are malnourished or food insecure, which may affect HIV outcomes such as CD4+ levels. Study purpose and design: We conducted a cross-sectional study of ambulatory HIV-positive adult patients who lived in the vicinity of Kijabe, Kenya, a rural town served by the Kijabe Hospital outpatient clinic and 3 satellite clinics. All patients had received highly active antiretroviral therapy for at least 6 months. The purpose of the study was to determine the daily caloric and protein intake among these patients and their effects on CD4+ levels.

Methods: All patients who consented to participate in the study completed dietary recall surveys to record their food and beverage intake for the previous 3 days. The medical records of the participants were reviewed to confirm that the respondents met the study inclusion criteria. Participant intake was compared to the recommended daily intake of calories and protein using predictive equations. Bivariate correlation was used to analyze the relationship between the CD4+ level and meeting the recommended daily caloric and protein intake.

Results: Among the 122 participants who were eligible for the study, caloric and protein recommended intake, respectively, averaged 68.8% and 102.9% in males and 74.4% and 102.9% in females. There was a statistically significant positive correlation between protein consumption and CD4+ levels for males but not for females.

Conclusion: The study results suggest that predictive equations currently in use underestimate protein recommendations for HIV-positive males. Further investigation is needed to re-evaluate current predictive equations and nutrient requirements in HIV-infected individuals. Research in these areas will likely benefit HIV outcomes as well as raise awareness of the importance to maximize local resources for food security.

Background: There almost three decade years after the first clinical cases of AIDS were reported; it has become the most devastating disease of world particplarly in developing world. Despite massive resources and intensified interventions were made in promoting condom use as prevention methods, desired decline has not been achieved. This study was aimed to evaluate how people controlling the Danger or Fear for condom use as HIV/AIDS preventive message among youths exposed to messages and the response they experience on messages.

Methods: Cross-sectional study design was conducted using quantitative and qualitative methods of data collection. Pre-tested self administered questionnaires were used to collect data. Study participants were selected using stratified random sampling from hosanna public college students. Quantitative data were analyzed using SPSS version 16.0. Thematic analysis was use for qualitative data.

Results: Hundred ninty one (48.1%) of the respodents were found in danger control responses, whereas 206 (51.9%) were found in fear control responses. Perceived susceptibility to and severity of HIV/AIDS was relatively high; however, perceived self efficacy and response efficacy to HIV prevention messages had lower scores. Perceived susceptibility [β (95%CI)=1.07 (1.21 to 7.10)] and severity of [β (95%CI=1.65 (1.25 to 21.81)] HIV/AIDS were positively associated factors for fear control responses. Self efficacy [β (95%CI)=-0.96 (0.16 to 0.92)] and response efficacy [β (95%CI)=-1.21 (0.11 to 0.83)] were negatively associated factors. Totally, 66.3% of the variance in the response of condom use message as HIV prevention could be explained by EPPM model.

Conclusion: Despite higher numbers of students were in fear control psychological responses, there were gaps between discriminative scores and most of the current behavior. Perceived susceptiblity, severity, self efficacy and response efficacy were independent predictors of students’ perceptions to use recommended responses. Due attention should given to fill the gap of perception of both susceptibility and severity.

Background: Tuberculosis (TB) and Human Immunodeficiency Virus (HIV) are major public health problems, especially in Sub-Saharan Africa including Ethiopia. So, updated information on TB-HIV co-infection might be important for the planning, resource allocation, prevention and control activities.

Objective: To determine the TB-HIV co-infection and possible associated factors among patients attended TB clinic in five years (2008-2013) at a referral Hospital in Northwest Ethiopia.

Methods: A retrospective study was conducted among 717 TB patients who are registered at DOTs clinic of Debre Markos referral hospital. Socio-demographic and clinical data of the study participants were collected from the TB log from the DOTS clinic. Data were entered and analyzed using SPSS version 16 software. Results: The prevalence of TB-HIV co-infection was 44% (321/717). The trend of co-infection was decreased from 2008/9 179 (49.2%) to 2012/13 29 (44.6%). Types of TB and age group were significantly associated with TB-HIV co-infection.

Conclusion: The prevalence of TB-HIV co-infection was high. Therefore, actions targeting (health education and early case detection) on those predictors are necessary to effectively reduce TB-HIV co-infection and strengthen the collaborative activities.

This is a case of a 20-year-old male with acute retroviral syndrome and concurrent acute inflammatory demyelinating polyneuropathy (IDP) progressing to chronic IDP. Whereas the patient followed a relapsing and remitting course prior to the initiation of antiretroviral therapy (ART), he demonstrated gradual and sustained clinical improvement in the ten months of follow-up after ART was combined with chronic corticosteroids and intermittent plasmapheresis. This case presents and addresses multiple challenges for the treatment of IDP in the setting of acute HIV infection to include: timing of initiation and selection of appropriate ART, the potential risk for immune reconstitution inflammatory syndrome, ART initiation in the setting of severe gastroparesis with jejunostomy placement, and the effect of plasmapheresis on the levels of antiretroviral therapy.

Introduction: Cryptococcal disease is an important opportunistic infection and a major contributor to mortality in HIV/AIDS. Unfortunately, there has been no data describing the burden of cryptococcosis in Nigerian HIV-infected children.

Methods: A cross-sectional study between January 2013 to September 2013 at the Federal Medical Centre, Makurdi to determine the prevalence and risk factors of cryptococcal antigenaemia among a cohort of consecutive HIV-infected children (≤15 years of age) with a CD4 count of ≤200 cells/mm3, including treatment-naive and those on Antiretroviral Therapy (ART). The cryptococcal antigen Lateral Flow Assay method was used twice on each sample collected from the children.

Results: A total of 699 children were seen but only 88 children had CD4 count of ≤200 cell/mm3. These 88 subjects included 47 Males and 41 Females (M: F, 1:0.9). The age range was from 12-168 months with a mean of 73.23 ± 41.06 months. The CD4 count was from 10 to 198 cells/mm3 with a median of 104 cells/mm3 (Interquartile range, IQR; 53- 157). Twenty (20/88, 22.7%) children had a CD4 count of less than 50 cells/mm3, 24 (27.3%) had CD4 counts between 51-100, and 44 children (50%) had CD4 counts between 101-198 cell/mm3. The median viral load was 3,016 copies/ ml with an IQR of 200-39,354 copies/ml. Only 11 (12.5%) children were not on HAART. There was no cryptococcal antigenaemia (0%) among the 88 children tested. Statistical analysis was thus limited to simple description.

Conclusion: In our setting, cryptococcosis may not be a strong consideration in the differential diagnosis of severely immunosuppressed HIV-infected children (≤15 years of age) presenting with pneumonia and or meningoencephalitis

Background: There is paucity of high-level clinical trials in Nigeria for several reasons, which include: lack of trained investigators and mentorship in the implementation of Clinical trials at international standard; inadequate investment and trained regulatory agencies to provide oversight. Therefore, the need for capacity of the national coordinating agencies (NCA); the investigative team, supporting research laboratory and the community to be developed in preparation for future HIV prevention trials including vaccine trials.

Method: In collaboration with the University of Ottawa, three regulatory agencies (NAFDAC -National Agency for Food and Drug Administration Control, NHREC- National Health Research Ethics Committee and NACA-National Agency for Control of AIDS) were identified for capacity building. We developed a phase IIB mock clinical trial model for the purpose of capacity building which created a platform for hands-on training alongside mentoring, meetings, site base visits with full community engagement.

Result: Eight trainees from NACA, NHREC, NAFDAC and the investigative team completed biostatistics and epidemiology course; three trainees attended a Clinical Trial course at the Institute of Human Virology Nigeria and had additional 2-day training/mentoring at the University of Ottawa and thereafter these trainees conducted a 2-day site assessment of the ongoing sero-discordant study in Jos, Nigeria with full community engagement. A trained research team is a member of the national HIV vaccine plan implementation committee and the supporting research laboratory has updated all standard operating manuals for ISO15198 accreditation.

Conclusion: Sustained interaction/integration through trainings/mentorship of National Coordinating Agencies and investigative team promotes commitment relevant for building in-country capacity for successful HIV vaccine clinical trial. An on-going vaccine preparedness HIV sero-discordant couple’s cohort is being used to apply principles and concepts of this structure and the trainings in preparation for future HIV prevention including vaccine trials.

Introduction: The Pediatric Unit of the Borgou Regional Hospital (CHD-Borgou) in Parakou has initiated treating HIV-infected children with Anti-Retroviral (ARV) drugs since 2005. This study aimed to describe the profile and the future of the HIV-infected children who were provided medical care at the Pediatric Unit of the CHD-Borgou from 2005 to 2009. Patients and methods: It is a retrospective study with descriptive and analytical objective, carried out from January 2005 to December 2009 on 105 HIV-infected children from both sexes cared in that Unit. Results: HIV infection represented 0.43% of the children brought for medical examination during the study period. Among these children, 82.9% were at clinical stages 3 or 4 on inclusion into patient panel and 76.2% had severe immunodeficiciency. The proportion of children on Anti-Retroviral Therapy (ART) was 69.1%. The main opportunistic infections found were digestive (30.3%), pulmonary (28.5%), dermatological (24.1%) and ENT (10.5%) ones. The problems identified included lack of early diagnostic tools, frequent shortage of antiretroviral drugs, treatment or therapeutic failures, causes related to poor compliance and follow up. The lost of follow up rate was 39%. Death rate was 33.3%. Death was significantly associated with the advanced clinical stage of disease on admission (p=0.002), with age at the time of screening (p=0.017) and with follow up duration (p=0.000). Conclusion: Despite the difficulties noted, this study showed that, in limited resources settings like ours, it is possible to improve the clinical outcome of HIV infected children. The high mortality rate noted related to the delayed HIV diagnosis can be reduced by strengthening the Prevention of Mother to Child Transmission (PMTCT) program.

Of the 59 patients (adults) who have been identified to have a virus with a high level resistance to HAART drugs, in 38 (64.4%) patients mutation M184V/I was identified. In 27 (45.8%) patients (13 female and 14 male) K103N mutation was detected. In 20 (33.9%) patients (16 male and 4 female) we found G190G/S/A mutation. Of the 18 childrenpatients, born to HIV-infected mothers, in 15 (83.3%) cases (9 girls and 6 boys) we detected HIV resistance mutation M184V. In 10 (55.6%) and 2 (11.1%) cases mutations in position G190S and K103S were found, respectively. Of 82 samples collected from newly diagnosed HIV-infected antiretroviral naïve patients only 6 samples (7.3%) had other resistance mutations which can be classified as 'minor' or 'other' according to HIVDR database of Stanford University: L10V - PI minor mutation associated with resistance to most PIs when present with other mutations; L33F - PI minor mutation selected by FPV/r, DRV/r, LPV/r, ATV/r, and TPV/r, and contributes decreased susceptibility to these PIs; V118I - accessory mutation usually occurred with multiple TAMs and contributes some resistance to each of the NRTIs including 3TC and FTC; T74S is ‘other’ mutation associated with reduced NFV susceptibility; and V108I - accessory mutation, causes low-level resistance to NVP and EFV.