Revista de SIDA e investigación clínica

Results are presented of perception of the people living with HIV and AIDS regarding home based care in Malawi. The study was conducted in Lilongwe from April to May, 2009. The participants were people living with HIV and AIDS and were drawn from 3 organizations that deal with people living with HIV and AIDS. These organizations were: Light House, National Association for People Living with HIV and AIDS in Malawi and Lilongwe Diocese. Purposive sampling technique was used to choose people living with HIV and AIDS who had rich experience on home based care. Data was collected through in-depth interviews with the participants using an open ended interview guide. Data saturation was reached when in-depth interviews were conducted with 15 people that were living with HIV and AIDS. Qualitative data was analyzed using ATLAS ti5.0. The participants reported that most of the home based care was rendered by close relatives who were mostly immediate family members such as spouses, daughters, mothers, sisters and brothers. The perception of the participants was that health care workers and volunteers only complemented the care provided by the close family members weekly or fortnightly. They also complained that the biggest challenge with home based care was stigma and discrimination by other community members and distant relatives. They further complained that most care providers lacked knowledge and resources for home based care. It is therefore recommended that the various stakeholders in Malawi such as government, community volunteers and non-governmental organizations support and train the home based care givers

The purpose of this paper was to describe SystemCHANGE™-HIV, a novel self-management intervention for people living with HIV (PLWH) and provide evidence of its initial efficacy to improve physical activity. The rationale and design of the SystemCHANGE™-HIV intervention were reviewed. Intervention detail, including its historical use, learning exercises and content, were provided. Forty PLWH participated in this pilot study, using a randomized clinical trial design. Intervention participants increased their physical activity by 300 Metabolic Equivalent minutes per week, compared to the control condition. Additionally, 70% of intervention participants increased their physical activity, whereas 65% of control subjects either had no change or experienced a decrease in physical activity. SystemCHANGE™-HIV is an innovative intervention for PLWH, representing a new paradigm in health behavior change. Findings support its potential to increase physical activity in PLWH. Future work should refine and rigorously test the effect of this intervention

Background: For most HIV/AIDS patients who adhere to their medication regimens, Highly Active Antiretroviral Therapy (HAART) effectively controls viral load, reduces the incidence of AIDS diagnoses, and lowers HIVassociated mortality. Despite strong evidence that HAART effectively increases survival in people living with HIV/ AIDS, HIV-infected individuals not only need to endure the physiological changes that occur during therapy, but they may also face social and psychological problems. However, few research studies have paid attention to the quality of life of injection drug users (IDUs) living with HIV. This paper examines quality of life among IDUs living with HIV/ AIDS relative to IDUs without HIV/AIDS.

Methods: A total of 71 HIV-infected IDUs from 4 methadone clinics in northern Taiwan completed a structured questionnaire that included demographics and the World Health Organization Quality of Life Scale brief version (WHOQOL-BREF). Another 71 HIV-negative IDUs were randomly sampled from 528 available methadone patients at the same 4 clinics as the control group. Scores from the WHOQOL-BREF were compared between HIV-positive and HIV-negative IDUs.

Results: Results from multivariate multiple linear regression indicated that after controlling for all other demography and clinical factors, average scores in these four domains of WHOQOL-BREF were significantly higher among HIV-negative patients compared with those in HIV-positive patients. The greatest group difference appeared in the social relations domain, followed by the psychological domain and then the environmental domain, with the least difference found in the physical domain.

Conclusion: The findings suggest that social relations and psychological issues are of great concerns for IDUs, especially HIV-positive patients. This indicates that understanding the impact of HIV infection on the quality of life particularly in the psychological and social relations realms is an important topic of future research

Background: The availability of Antiretroviral Treatment (ART) has changed the course of HIV/AIDS, by transforming it into a chronic condition. However, important challenges remain in the management of HIV/AIDS. These challenges are exacerbated by the fact that in resource limited settings, food insecurity and HIV/AIDS overlap. The aim of our study was to evaluate the effect of a food assistance program on adherence to ART in Sofala province, Mozambique.

Methods: In order to assess the effect of the food assistance program on adherence we used propensity score matching with difference in differences estimation. We compared food assistance recipients with controls. We measured adherence based on pill pick-up, a pharmacy adherence measure.

Results: During the food assistance programme, the adherence of food assistance recipients who received food assistance for a period of six and 12 months and non-food assistance recipients is not significantly different as the average impact is only 0.4% (p=0.94) and -2.3% (p=0.73) respectively. For the period after food assistance had been terminated, adherence is still not significantly different between the two groups, as the average impact is 5.3% (p=0.44) and 1.9% (p=0.65).

Conclusion: Our study suggests that food assistance provided to HIV/AIDS patients in Sofala province in Mozambique had no effect on their adherence to ART. Our results indicate that although efforts have been put forth to reduce food insecurity among HIV/AIDS patients, more should be done to ensure that these efforts really result in the improvement of adherence to ART.

Background: Cytomegalovirus (CMV) and T. gondii are two common causes of SNHL (Sensorineural hearing loss) in Iranian children. Immune-mediated vascular damage induced by endothelial cell antibodies may have a prominent role in sensorineural hearing loss. Objectives: To determine the serum CMV and T. gondii antibodies against endothelial cell in children with profound SNHL and cochlear implant surgery.

Materials & Methods: A cross sectional study was performed on 76 cases with severe SNHL (mean age 32 ± 30.6 months) at cochlear implant ward of Rasoul hospital, Tehran Iran (2008-2010). The titers of antibodies against endothelial cell (Indirect immunofluorescence assay); were determined in sera of 66 cases. Specific antibodies (IgG & IgM) against T. gondi, CMV (Enzyme linked immunosorbent assay) determined in Idiopathic SNHL cases.

Results: Idiopathic type of SNHL was diagnosed in 28.8% (19/66) of younger cases (mean age=20 months; PV=0.05). Positive AECAs was detected in 14.4% (11/76) of cases (with mean age 50 vs. 32 months in cases with negative test; P value=0.047). Positive AECAs had not significant differences between Idiopathic and Non idiopathic type of SNHL [10.5% vs. 9%; PV=0.1]. Positive AECAs were more frequent in cases with known postnatal infections (e.g. mumps, meningitis, chicken pox, etc.) in comparison with non-infection cases (P-value=0.05). Positive T. gondii -IgM (recent infection) was found in 8 /19 (%42); 1 case also had positive T. gondii -IgG. Positive CMV-IgM &IgG were determined in 10 /19 (%52); 17/19 (%89) respectively. A meaningful correlation was observed between positive AECAs and those infections (Toxo, CMV) in Idiopathic (and unclassified) SNHL cases.

Conclusion: Idiopathic type of SNHL with a poor outcome is common (28.8%) in children with cochlear implant surgery Positive AECAs cases had not differences between 2 type of SNHL but were more frequent in older cases with known postnatal infections (meningitis, mumps, chicken pox etc.). A good correlation (p=0.05) between the positive AECAs and known infections determined in studied cases. In contrast, those younger cases (<3 years) with positive AECAs had recent CMV /or T. Gondii (Positive IgM) infections (23 %; 17.7%) without known congenital or acquired type of infections. At least in our country, in younger SNHL cases (<2 year old) due to confirmed recent CMV or T. Gondii infections, application of specific drugs are preferred. Immunosuppressive therapy is only recommended in older cases (>2 year old) with Idiopathic SNHL and concomitant positive AECAs.

To date only one published case report exists of the HIV protease inhibitor atazanavir (ATV) causing central nervous system (CNS) side effects. We report two such cases of patients experiencing disabling CNS side effects shortly after starting ATV-containing regimens whose symptoms only resolved after withdrawing the drug.