Revista de SIDA e investigación clínica

Background: The contribution of hepatitis B viral infection in HIV positive individuals is becoming increasingly recognized especially with the advent of Highly Active Antiretroviral drugs (HAART) which tend to prolong the life expectancy of HIV patients, thus increasing the tendency for chronic sequalae of hepatitis B in HIV/HBV co infection.

Method: A total of 300 HIV positive adults who were >18years and residing in Owerri were enrolled in this study. Participants were drawn from twenty (20) private laboratory services between January, 2013 and August, 2013.

Result: Out of the three hundred (300) individuals who tested positive for HIV, thirty two (32) persons (10.6%) showed positive serology test for Hepatitis B in our series. Out of these persons, twenty one (21) (65.6%) were females while eleven (11) (34.4%) were males. Among the study population, persons aged 25-34.9 years had the highest prevalence of co infection (56.25%), while patients aged 55-64.9 years had the least prevalence. Males aged 35-44.9 years had the highest prevalence. Majority of the females were secondary school holders (46.9%) who were selfemployed and having multiple unprotected heterosexual lifestyles.

Conclusions: HIV and Hepatitis B viral infections share common route of transmission and they synergistically accelerate each progression. Greater public health enlightenment in areas of health seeking behavior, safer sex practice, and overall health promotion must be intensified if reduction of this hepatitis B viral burden is to be achieved.

Background: Antiretroviral therapy has reduced HIV/AIDS related mortality and more of people living with HIV/ AIDS alive longer. Hence, this study tried to assess the health related quality of life and associated factors among people on highly active antiretroviral therapy at Felege Hiwot Referral Hospital in Bahir Dar, North West Ethiopia.

Methods: Institutional based cross sectional study was conducted among 424 people on highly active antiretroviral therapy at Bahir Dar Felege Hiwot Referral Hospital, North West Ethiopia. Study participants were obtained with a systematic sampling and interviewed to respond for structured pre-tested questionnaires. Clinical variables of highly active antiretroviral therapy were collected from their hospital charts. Data were entered into EPI info version 3.5.1 and analyzed by using SPSS version 20 software for windows. Bivariate and multivariate logistic regression analyses were done.

Result: The proportion of respondents with low health related quality of life in all domains was 56.4%. Unemployment (AOR = 2.32 [95% CI = 1.49, 3.59]), poor adherence (AOR = 3.24 [95% CI = 1.02, 10.32]) and being ambulatory (AOR = 3.19 [95% CI = 1.36, 7.48]) were found to have statistically significant association with health related quality of life.

Conclusion: This study finding stress the need for enhanced support and a better environment for improving the health related quality of life among people living with HIV/AIDS.

Incidence of anal cancer is increasing in HIV+ patients. We have structured a control program in HIV-positive MSM with anal PAP-test and HPV genotyping based on the outcome of anal cytology. Follow-up has been listed according to the HPV genotype infection. Traditional anoscopy and histological exam (also if no visible mucosal lesions, by quadrant random biopsies) was offered to every patient with every abnormal cytology for detection and treatment of squamous anal lesions. Of 87 subjects enrolled, 22 patients (25%) had pathological cytology and 65 patients had PAP-smear negative. No differences in demographic and immuo-virological profile were found in the two groups. Precancerous anal lesions and cancer (1 AIN2, 2 AIN3 and 1 SCC) were treated surgically if advanced otherwise with imiquimod cream into the anal canal; squamous cell carcinoma was referred to oncologist. High prevalence of HPV infection and anal intraepithelial neoplasia are important risk factors for anal cancer: anal precancerous lesions can be detected early and treated in at-risk populations

The purpose of this review was to determine whether prolonged aerobic exercise training was as safe and effective as shorter aerobic exercise training. Shorter time period studies up to and including four months were summarized for aerobic exercise training parameters and results. Similarly, aerobic exercise training studies that were six and more months were also summarized. Predicted or measured maximum oxygen uptake (VO2max) results for the shorter term studies generally ranged from 10-29%. All the studies used 3x/wk. as a training frequency. Aerobic exercise training intensity averaged 75% of predicted heart rate (PHR) maximum and exercise duration ranged from 20-60 minutes. Since many of the subjects were on highly active antiretroviral therapy (HAART), blood lipids and body fat abnormalities were prevalent. In the few shorter aerobic exercise training studies to measure lipids and body fat, there appeared to be a favorable effect. Prolonged aerobic exercise training results were sparse. Studies indicated similar training parameters with the exception of using a higher aerobic training intensity for one study. VO2max results for the higher intensity study demonstrated a higher aerobic fitness than other studies. All the prolonged aerobic exercise regimes increased VO2max similar to the shorter term studies or maintained higher levels of aerobic fitness. Triglyceride levels were elevated and unfavorably increased during prolonged aerobic training. Body fat was favorably modified in another prolonged study in spite of HAART. Considering the paucity of studies it appears that prolonged aerobic exercise training is equally safe and effective as compared to shorter aerobic exercise training.

Background: The HIV Dementia scale (HDS) has been recommended as a cross-sectional screen for HIVassociated neurocognitive disorder (HAND) but its longitudinal usefulness has not been optimally established.

Method: 55 HIV+ participants underwent baseline and follow-up HDS screening after an average of 3.9 (SD=1.1) months. They had completed standard neuropsychological (NP) evaluations within the last 6-18 months to calculate a baseline HAND rate (49.1%) and gold standard cognitive change performance: 12.7% showed mild to moderate decline compared to normative standards for NP change; 80% confidence interval; 1-tailed, the rest of the sample was cognitively stable. After normalizing HDS raw-scores, standard regression-based change scores were developed to quantify HDS-based decline, which corrected for practice effect, regression towards the mean, and yielded individual predictions of neurocognitive change. Clinically significant decline was defined as a z-score outside the 80% confidence interval; 1-tailed. Baseline HIV disease and laboratory data were collected.

Results: The magnitude of HDS reliability was very large r=0.76 (p<0.0001). HDS-testing found that 21.8% significantly declined. Compared to gold standard NP decline, the HDS showed 57% sensitivity and 82% specificity. Only participants (n=4) that declined moderately (median HDS-change z-score=-2 SD below mean of zero; at least 3-4 points decline in raw HDS-score) were congruently identified. Standard regression-based change scores did not operate optimally at smaller magnitudes of decline. HAND diagnosis (gold standard) at baseline (p<0.03) and more severe HAND were associated with greater chance of decline (p<0.03). No baseline HIV biomarkers were associated with decline.

Conclusions: The HDS is a reliable screen to detect at least moderate neurocognitive decline in individuals with MND and HAD. Other screening instruments are needed to detect milder levels of neurocognitive decline. Alternatively, non-parametric statistical modelling is needed to improve predictions of individual cognitive change on such scales that typically have a restricted range of values.

Background: According to the World Health Organization (WHO), Nutritional support is an integral part of a comprehensive response to HIV/AIDS. Receiving appropriate nutrition can help improve the health and quality of life of HIV-infected individuals. So, Nutritional support is increasingly recognized as a critical part of the essential package of patients care among acquired immune deficiency syndrome (AIDS) patients. However, the outcome of ready to use nutritional support and factors affecting it among HIV/AIDS patients are not yet well investigated. So, this study aims to determine the nutritional outcome of ready-to-use food therapy (RUFT) and factors affecting it among peoples on HIV/AIDS care.

Methods: Retrospective cohort study was conducted among patients on food by prescription and HIV/AIDS care. Data was collected from a total of 531 patient records selected by systematic random sampling method using food by prescription registers as sampling frame. After determining the outcome of ready to use food therapy among HIV/AIDS patients on HIV care, Multivariate analysis was used to determine the independent predictors of outcome of food by prescription.

Results: In this study 62.2% of patients on ready to use food therapy were recovered. Severity of malnutrition Adjusted odds ratio [AOR (95% CI)=2.594 (1.251-5.377)], sex [AOR (95%CI)=2.157 (1.340-3.473)], WHO stage [AOR (95% CI)=(3.345 (1.652-6.772)],education [AOR (95% CI) =1.820 (1.110-2.983)], and presence of opportunistic infection [AOR (95%CI)=2.791 (1.047-7.439)] were the independent predictors of outcome of ready to use food therapy.

Conclusions: In this study 62.2% of patients admitted to ready to use food therapy were recovered from malnutrition. The factors that affect Outcome of ready to use therapeutic food by prescription was severity of malnutrition, sex, WHO clinical stage, education, and opportunistic infection. For this reason, regular and comprehensive nutritional screening of patients on HIV chronic care and strengthening of nutritional adherence counseling for patients on ready to use therapeutic food is very crucial to improve the outcome of ready to use food therapy among HIV patients.