Revista de SIDA e investigación clínica

Objectives: HIV-positive patients have an increased risk for CVD; however, the underlying mechanisms are not well understood. Our goal was to assess traditional and emerging CVD-risk factors in the CARE Study, a welldescribed cohort of HIV-infected adults.

Methods: We analyzed demographic and clinical (viral load, CD4 count, ART regimen, cIMT) data including markers of lipid and glucose homeostasis in 176 HIV-positive subjects receiving regular care for HIV infection.

Results: No significant association between cIMT and LDL-C level was observed. HIV patients had significantly lower level of the large α-1 HDL particles and about 3-fold higher level of the small pre β-1 HDL particles than the normal population, but these parameters were not significantly associated with cIMT. Components of the metabolic syndrome, high TG/low HDL-C, insulin resistance and high BMI, as well as viral load were significant but moderate contributors to increased cIMT.

Conclusion: The major lipid disorder was low HDL-C and high TG level in this HIV-positive cohort. LDL-C was not elevated. These and previously published data indicate that HIV infection and HIV medications influence CVD risk by impairing cholesterol removal (efflux) via ABCA1 from macrophages. Decreasing CVD risk in HIV patients, with impaired cholesterol efflux from macrophages, may require a lower LDL-C goal than recommended for HIV-negative patients and also a better control of TG level.

Background: Studies have shown high initial mortality in Antiretroviral Therapy (ART) programs from resource-limited settings. However, there is dearth of evidence on treatment outcomes and associated determinant factors in public hospitals. Therefore, the objective of this study is to assess survival and identify predictors of death in adult HIV-infected patients initiating ART at a public hospital in Eastern Ethiopia.

Methods: A retrospective cohort study was conducted by reviewing baseline and follow-up records of patients who started ART between December 1, 2007 and December 31, 2011 at Kharamara hospital. Time to death was the main outcome measure. Kaplan- Meier models were used to estimate mortality and Cox proportional hazards models to identify predictors of mortality.

Results: A total of 784 patients (58.4% females) were followed for a median of 60 months. There were 87 (11.1%) deaths yielding an overall mortality rate of 5.15/100 PYO (95% CI: 4.73-6.37). The estimated mortality was 8.4%, 9.8%, 11.3%, 12.7% and 14.1% at 6, 12, 24, 36 and 48 months respectively. The independent predictors of death were single marital status (AHR: 2.31; 95%CI: 1.18-4.50), a bedridden functional status (AHR: 5.91; 95%CI: 2.87-12.16), advanced WHO stage (AHR: 7.36; 95%CI: 3.17-17.12), Body Mass Index (BMI)< 18.5 Kg/m2 (AHR: 2.20; 95%CI: 1.18-4.09), CD4 count < 50 cells/μL (AHR: 2.70; 95%CI: 1.26-5.80), severe anemia (AHR: 4.57; 95%CI: 2.30-9.10), and Tuberculosis (TB) co-infection (AHR: 2.30; 95%CI: 1.28-4.11).

Conclusion: Improved survival was observed in patients taking ART in Somali region of Ethiopia. The risk for death was higher in patients with advanced WHO stage, low CD4 count, low Hgb, low BMI, and concomitant TB infection. Intensive case management is recommended for patients with the prognostic factors. Optimal immunologic and weight recoveries in the first 6 months suggest increased effort to retain patients in care at this period.

Objectives: Plans are in the pipeline to commence field trials to determine the efficacy of HIV vaccines amongst the Nigerian population. This study was conducted to assess the willingness to participate as subjects in HIV vaccine trials among female hairdressers in Ibadan, Nigeria.

Materials and Methods: A hypothethical vaccine candidate was explained to the respondents in the form of lecture modules. Interviewer-administered questionnaires were completed by 247 respondents with age ranging from 16 to 49 years. The questions were in Pidgin English which is an adulterated form of English language widely spoken among the respondents. SPSS version 10 data editor was used to analyze data. Univariate odds ratios (OR) and multivariate adjusted odds ratios (AOR) and 95% confidence intervals (95% CI) were used to evaluate the correlates of willingness to participate (WTP) in vaccine trials.

Results: A total of 86 respondents (35%) of the respondents reported that they will be willing to join HIV vaccine trials. Greater willingness was associated with prior sexual experience (OR=1.23, 95% CI: 1.12-1.53), involvement in high risk sexual behavior (OR=1.35, 95% CI: 1.05-1.62), higher levels of awareness about HIV/AIDS (OR=1.37, 95% CI: 1.14-1.45) and tangible incentives (OR=1.39, 95% CI: 1.02-1.42). Decreased WTP was associated with concerns about physical harm (OR=0.42, 95% CI: 0.21-0.54), social stigmatization (OR=0.51, 95% CI: 0.42-0.68), use of parenteral route for vaccine administration (OR=0.66, 95% CI: 0.53-0.76) and multiple doses of vaccines (OR=0.81, 95% CI: 0.46-0.94).

Conclusion: The level of WTP recorded indicates that much work still needs to be done in the area of educating potential subjects in HIV vaccine trials about the safety of these vaccines. Incentives for would-be subjects should also be a part of the planning to encourage greater participation in these trials.

Background: Health facilities in rural, resource limited settings face multiple challenges responding to a growing demand for HIV treatment, including lack of adequate numbers of trained health workers. Many programs have used community health support workers (CHSWs) to provide specific services related to HIV care, and to complement facility-based treatment.

Methods: In rural southern Ethiopia, 13 HIV-positive CHSWs were assigned to 142 newly diagnosed HIV patients from the same community to provide: education on HIV treatment and health promoting behaviors; counseling and social support; and linkage to the HIV Clinic.

Results: Lessons learned in planning and implementing CHSW programs for PLWH include the benefits of: involving local health bureaus, clinicians, and the community; careful recruitment processes and selection criteria for CHSWs; use of local PLWH as CHSWs to facilitate relationships with HIV-positive clients; initial and on-going training of CHSWs with didactic information and counseling skills; clearly defined responsibilities and regular, supportive supervision with constructive feedback; emphasizing importance of client confidentiality; and financial compensation for CHSWs.

Conclusion: Use of CHSWs can be an effective strategy to support the HIV health care system, and offers a strong complement to facility-based care in rural and other resource-limited settings. However, such programs may be most successful if they attend to the multiple issues described above in planning and implementation.

Objective: Examine changes in, and factors associated with changing body mass index (BMI) in women following highly active antiretroviral therapy (HAART) initiation. Methods: 1177 HIV-infected Women’s Interagency HIV Study participants who contributed 10,754 years of followup following HAART initiation were studied. Changes in median BMI up to 15 years following HAART initiation, and the highest and lowest BMI reached following HAART initiation were summarized by pre-HAART BMI category (<18.5 [underweight], 18.5-<25.0 [normal weight], 25.0-<30.0 [overweight], 30.0-<40.0 [obese], and ≥ 40.0 [morbidly obese]). Multivariate mixed effects ordinal logistic regression estimated the degree of association of each exposure of interest with post-HAART BMI. Results: Before HAART, 39% percent of women had normal BMI, 31% were overweight, 23% were obese, and 5% were morbidly obese. Following HAART initiation, median BMI change (per 5 years) was 0.21 kg/m2 (90% confidence interval [CI]: -1.33, 0.42) for those with normal pre-HAART BMI, 0.39 kg/m2 (90% CI: 0.15,0.66) for overweight, 0.31 kg/ m2 (90% CI: -1.18,0.67) for obese, and -0.36kg/m2 for morbidly obese women. After initiating HAART, 40% with normal pre-HAART BMI became overweight at some point; of those overweight, 46% remained overweight and 47% became obese; 71% of obese women remained obese and 27% became morbidly obese. Each year of nucleoside analog reverse transcriptase inhibitor use was associated with a 3% decreased odds of reaching a higher BMI category (OR 0.97, 95% CI: 0.95, 0.99), while each year of protease inhibitor or non-nucleoside analog reverse transcriptase inhibitor use were associated with a 6% (OR 1.06, 95% CI: 1.04, 1.08) and 5%(OR 1.05, 95% CI: 1.01, 1.08) increased odds of having a higher BMI category, respectively. Conclusions: Although overweight and obesity are highly prevalent in this large cohort of HIV-infected, minority women, HAART use was associated with only a modest increase in BMI over time.

Background and objective: Malaria and HIV co-infection pose significant health concerns in many regions of the world. Co-infection significantly increases the burden of these diseases in pregnancy, yet the interactions of these diseases in pregnant women are not well understood. The aim of the study was to determine the prevalence and examine the factors that could be associated with malaria in HIV positive infected pregnant women on antiretroviral therapy.

Methodology: Blood samples were collected from 301 confirmed HIV positive pregnant women in various trimesters and examined for malaria parasite presence and density with other laboratory indices. Baseline socio-demographic information, antenatal information, CD4 levels, and viral load were collected from clinical records. Information on type of treatment, such as intermittent malaria preventive treatment (IPT) and ART therapy/ prophylaxis, was extracted from care cards. Information on the prior use of antimalarial drugs and cotrimoxazole intake was obtained from direct interviews.

Results: The prevalence of malaria among HIV-positive pregnant women was 49.83% and the odds of having malaria doubledwith living in a rural community (AOR 2.04, CI [1.07-3.91] P<0.001). Also, being on ART therapy increased the odds of having malaria by 133% (AOR 2.33 CI [1.06-5.10] P<0.05). A higher level of CD4 counts reduced the odds of malaria parasitaemia though not significant. Those whose CD4 count was 200-350 and >350 had reduced odds of malaria parasitaemia (AOR 0.50, CI [0.81-1.44] P=0.202) and (AOR 0.65, CI [0.24-1.73] P=0.391), respectively, compared with those with lower CD4 counts. Malaria parasites were unlikely in those with normal haemoglobin levels (AOR 0.08 CI [0.04-0.16] P<0.001). Pregnant women who were not on treatment before coming to the hospital ANC were about nine times more likely to have malaria parasites than those who had it recently (AOR 9.30, CI [4.44-19.50] P<0.001).

Conclusion: The prevalence of malaria in HIV-positive pregnant women was influenced by the locality, level of haemoglobin and self-medication prior to coming to the hospital. Low haemoglobin, which serves as an index of malnutrition, was also a serious factor that should be evaluated to reduce the scourge and burden of malaria complications, and programs geared towards provision of mosquito and environmental barriers should be improved.

Background: Prevalence of sexually transmitted infections (STI) and risk behaviours among street and establishment-based sex workers (SW) were compared.

Method: Between August and November 2008, face to face interviews and testing for sexually transmitted infections (STI) were conducted among Jamaican SW recruited by convenience and snowball sampling.

Results: Forty-five street-based SW (SBSW) and 231 establishment-based SW (EBSW) were recruited. STI Prevalence was: HIV 4.9%, syphilis 6.2%, gonorrhea 12.7%, Chlamydia trachomatis 23.6%, and Trichomonas vaginalis 35.5%. 56.1% SW had at least one STI and STI prevalence was similar for both groups. Condom use with paying partners was >90% but lower with non-paying partners (33.3% SBSW and 20.8% EBSW, p = 0.166). Streetbased SW had more partners, initiated sex at an earlier age, operated in fewer parishes, and were more likely to have been exposed to prevention interventions. Daily alcohol, marijuana, and ecstasy use were higher among EBSW compared to SBSW (54.6 vs. 24.4%, p<0.001; 63.2% vs. 46.7%, p=0.029; 34.6% vs. 6.7%, p<0.001, respectively).

Conclusion: Prevention programmes targeting key populations such as SW must address the different risk profiles of sub-populations. Inclusion of strategies to address substance use is critical for effective STI prevention among Jamaican SW.

Background: Migrant wives have been increasing in some poor rural regions of China and they may bridge HIV transmission across regions. This study aimed to assess HIV/AIDS-related knowledge, attitudes and sexual practices among this population in rural Anhui Province, China.

Methods: A cross-sectional survey was conducted with questionnaire of HIV/AIDS-related knowledge, attitudes, and sexual practices between June 2011 and May 2012. A total of 730 migrant wives and 207 local women were enrolled in this study. Unpaired T-test, Chi-square was utilized to compare the difference of HIV/AIDS knowledge, attitudes and sexual practices between migrant wives and local women.

Results: Around 80% of the migrant wives were from Yunnan, Guizhou, or Sichuan Provinces. The main sources of HIV/AIDS information were TV/radio, posters, and newspapers/periodicals. HIV/AIDS knowledge level among migrant wives was significantly lower than that among local women (e.g. 47.1% vs 57.0% (p<0.001) answered “Yes” for the question “Can an apparently healthy person be HIV-infected?”), and stigma and prejudice towards HIV/AIDS among migrant wives were more common than those among local women (e.g. 73.2% vs 65.7% (p=0.006) answered “No” for the question “If a shopkeeper or food seller had the HIV, would you buy food from them?”). Compared to local women, migrant wives were more likely to have ever had sex during menstruation (6.8% vs 3.4%, p=0.065) and extramarital sex (17.5% vs 10.1%, p=0.01), and were less likely to consistently use condoms with their husbands (45.8% vs 57.5%, p<0.001) or extramarital sex partners (48.8% vs 58.95, p<0.001).

Conclusions: Migrant wives in rural China had a low HIV/AIDS knowledge level and high prevalence of stigma and prejudice and risky sexual behaviors. Local HIV/AIDS prevention programs should target this neglected population.

Background: Given the growing interest in the cancer burden in persons living with HIV/AIDS, we examined the validity of data sources for cancer diagnoses (cancer registry versus International Classification of Diseases, Ninth Revision [ICD-9 codes]) and compared the association between HIV status and cancer risk using each data source in the Veterans Aging Cohort Study (VACS), a prospective cohort of HIV-infected and uninfected veterans from 1996 to 2008.

Methods: We reviewed charts to confirm potential incident cancers at four VACS sites. In the entire cohort, we calculated cancer-type-specific age-, sex-, race/ethnicity-, and calendar-period-standardized incidence rates and incidence rate ratios (IRR) (HIV-infected versus uninfected). We calculated standardized incidence ratios (SIR) to compare VACS and Surveillance, Epidemiology, and End Results rates.

Results: Compared to chart review, both Veterans Affairs Central Cancer Registry (VACCR) and ICD-9 diagnoses had approximately 90% sensitivity; however, VACCR had higher positive predictive value (96% versus 63%). There were 6,010 VACCR and 13,386 ICD-9 incident cancers among 116,072 veterans. Although ICD-9 rates tended to be double VACCR rates, most IRRs were in the same direction and of similar magnitude, regardless of data source. Using source, all cancers combined, most viral-infection-related cancers, lung cancer, melanoma, and leukemia had significantly elevated IRRs. Using ICD-9, eight additional IRRs were significantly elevated, most likely due to false positive diagnoses. Most ICD-9 SIRs were significantly elevated and all were higher than the corresponding VACCR SIR.

Conclusions: ICD-9 may be used with caution for estimating IRRs, but should be avoided when estimating incidence or SIRs. Elevated cancer risk based on VACCR diagnoses among HIV-infected veterans was consistent with other studies.

The high incidence of anal dysplasia is related to many factors. The infections caused by HPV and HIV seem to be determinants of the following anal Pap smear changes: atypical squamous cells of undetermined significance (ASCUS), low-grade anal intraepithelial neoplasia (LAIN) and high-grade anal intraepithelial neoplasia (HAIN). Highrisk HPV infection is confirmed by the HPV DNA test, using hybrid capture technology. Screening for anal lesions should be complemented with the anal Pap smear protocol and high-resolution anoscopy. The aim of this study was to evaluate the influence of the high-risk HPV DNA test on screening for anal lesions. We evaluated 70 HIV-positive and negative patients who had previously had anal intercourse, at CRT/AIDS São Paulo from January 2013 to December 2013. All of the patients underwent the high-risk HPV DNA test, anal Pap smear protocol and highresolution anoscopy. The anal lesions were treated with 90% trichloroacetic acid (TCA) and 5% imiquimod for 12 weeks. The statistical analysis was performed using hypothesis tests on proportions and the significance level was set at less than 5%. 31 HIV-positive male patients, 19 HIV-negative male patients and 20 HIV-negative female patients were evaluated. 28 HIV-positive patients were positive for the high-risk HPV DNA test and 29 patients were positive for the high-risk HPV DNA test and had anal dysplasia. Our conclusion is that it was more common for HIVpositive patients to be infected with oncogenic HPV and the oncogenic HPV was more frequent in patients with anal dysplasia.