Revista de SIDA e investigación clínica

Objetivo: La incidencia de la sífilis ha aumentado de manera constante entre los hombres infectados por VIH en los Estados Unidos, lo que representa un importante desafío de salud pública para la prevención del VIH. Existen intervenciones de prevención del VIH basadas en la clínica, pero es posible que sea necesario revisarlas en respuesta a la epidemia de sífilis. Queríamos comprender mejor la epidemiología actual de la sífilis en hombres rurales infectados por VIH que recibiendo de manera rutinaria asesoramiento para la reducción del riesgo de VIH con el fin de planificar estrategias de prevención del VIH más efectivas en la atención clínica. Métodos: Realizamos un estudio de cohorte retrospectivo para examinar los factores asociados con las infecciones por sífilis en hombres rurales infectados por VIH que recibieron detección de enfermedades de transmisión sexual y asesoramiento para la reducción del riesgo de VIH durante la atención primaria del VIH desde enero de 2008 hasta junio de 2013. Evaluamos las características demográficas, clínicas, conductuales y psicosociales de los pacientes y realizamos una regresión logística exacta multivariable para identificar los factores relacionados con la sífilis. Resultados: A pesar de las pruebas de detección sistemáticas de riesgo y el asesoramiento para la reducción del riesgo de VIH, se diagnosticaron un total de 51 infecciones por sífilis entre 702 hombres infectados por VIH (5 pacientes fueron diagnosticados con ≥ 2 episodios). La mayoría de los participantes del estudio eran sexualmente activos y reportaron al menos un comportamiento sexual inseguro, principalmente el uso inconsistente del condón. Una edad más joven (<35 años, razón de probabilidades ajustada (ORa) = 3,09), un nivel educativo más alto (algo de universidad o superior, ORa = 3,72) y la percepción de que la pareja puede tener relaciones. . . sexuales con otras personas (ORa = 3,10) se asociaron significativamente con la infección por sífilis. El uso de drogas no inyectables se relacionó con la sífilis en hombres infectados por VIH que tienen relaciones sexuales con hombres (ORa = 2,86). Discusión: Algunos hombres infectados por el VIH, especialmente los hombres jóvenes y educados, o aquellos que percibieron que sus parejas podrían tener relaciones sexuales con otras personas, siguen teniendo conductas de alto riesgo que aumentan sus propios riesgos de contraer sífilis y también pueden facilitar la transmisión del VIH. Es necesario desarrollar nuevas estrategias para que los proveedores de atención primaria del VIH ayuden a los pacientes infectados por el VIH a mantener prácticas sexuales más seguras.

En agosto de 2010, diagnosticamos una enfermedad de Castleman multicéntrica (ECM) en un paciente VIH positivo con linfadenopatía generalizada, esplenomegalia y derrame pericárdico. Unos días antes del inicio de los síntomas, el paciente había iniciado un tratamiento antirretroviral con abacavir/lamivudina (ABC/3TC) + atazanavir potenciado con ritonavir (ATV/r). Durante la hospitalización desarrolló una pancitopenia grave con insuficiencia hepática, por lo que comenzó inmediatamente el tratamiento con esteroides, ganciclovir y rituximab. En el seguimiento a los 46 meses, el paciente se encuentra asintomático, sus valores bioquímicos son esencialmente normales con una regresión completa de las linfadenopatías superficiales y profundas.

Objective: Urban teens disproportionately impacted by HIV may not seek HIV testing. The objectives of this study are to determine factors that impact HIV testing among sexually active and non-sexually active teens seeking care in an urban academic setting; whether teens with high levels of self-efficacy are more likely to receive HIV testing; and whether an teen's ability to cope impacts positive attitudes toward testing.

Methods: We conducted a cross-sectional survey of 228 HIV negative adolescent and young adult participants age 12-21 who received care in an academic urban primary care clinic in Baltimore, Maryland.

Results: Most youth reported being sexually active (N=146, 64%) and reported having been tested at that day's visit (N=135, 85%). Provider recommendation was significantly associated with higher odds of testing among sexually active teens (OR 3.5, 95% CI 1.07-11.7) and those with no prior sexual history (OR 5.89, 95% CI 1.40-24.9), while high HIV stigma was associated with lower odds of testing (OR 0.17, 95% CI 0.04-0.77) among youth with no prior sexual history. Sexually active teens with a positive attitude toward HIV testing were more likely to be older (late: 6.3 (1.0-40)), report intention to be tested in 6 months (OR 7.11, 95% CI 1.48-34.2), and have higher HIV coping self-efficacy (OR 1.12, 95% CI 1.00-1.26).

Conclusions: Provider recommendation may be the most important independent factor for testing in teens, regardless of sexual history, while HIV-related stigma may be an important factor for teens with no prior sexual history and thus may be perceived to have little or no risk for HIV acquisition. In sexually active youth, older age, intention to be tested for HIV and the ability to cope with a positive diagnosis likely dictates adolescent attitudes toward engagement in HIV testing, although it may not directly correspond with HIV testing behavior.

Objetivo: Estudios recientes han demostrado la eficacia de la profilaxis previa a la exposición (PrEP) antirretroviral para la prevención de la infección por VIH-1. El propósito de este estudio fue identificar las barreras para el uso de la PrEP entre hombres con alto riesgo de contraer VIH que tienen relaciones sexuales con hombres en Denver, Colorado.

Métodos: Se utilizó una encuesta en escala Likert de 19 preguntas para evaluar el conocimiento de la PrEP, las actitudes hacia el costo, los efectos secundarios y los métodos de prevención alternativos, y los efectos de la PrEP en las conductas y prácticas sexuales. La encuesta se administró al inicio del estudio y seis meses después a hombres seronegativos al VIH que tienen relaciones sexuales con hombres y mujeres transgénero de hombre a mujer que tienen relaciones sexuales con hombres y participantes en conductas sexuales de alto riesgo.

Resultados: Entre junio y septiembre de 2013, 65 participantes del área metropolitana de Denver completaron la encuesta. La edad media fue de 36 años (rango: 20-52 años); el 88% eran blancos, el 6% hispanos y el 1,5% afroamericanos; el 65% tenía al menos un título universitario o superior y el 27% tenía más de educación secundaria. El número informado de parejas sexuales en los últimos seis meses varió de cero a 150 parejas (media de 3 parejas) y el 75% informó el uso de condón durante todos los encuentros sexuales. Aunque el 72,3% informó conocimiento previo de PrEP, solo cinco participantes (7,7%) informaron haber usado PrEP en el pasado. Los participantes tenían más probabilidades (93,8%) de usar PrEP en el futuro si estaban en una relación monógama con una pareja infectada por VIH y menos probabilidades de usar PrEP si requería costos de bolsillo (10,7%). Una edad más joven se compromete con menores probabilidades de uso futuro de PrEP incluso si la PrEP se proporciona de forma gratuita (OR 0,2; IC del 95 % 0,1, 1,0). Un mayor número de parejas sexuales en los seis meses anteriores se utilizan con menores probabilidades de usar condones si se toma PrEP en el futuro (ORa 0,2; IC del 95 % 0,1, 0,8). No se observaron cambios en las respuestas de la encuesta entre el inicio y los seis meses.

Conclusiones: El uso de la PrEP fue poco común entre los hombres con alto riesgo de contraer la infección por VIH por vía sexual y el costo de los medicamentos antirretrovirales fue una barrera importante para el uso futuro de la PrEP. Si se pretende que la PrEP tenga un impacto importante en la transmisión del VIH-1, se necesitan mayores esfuerzos para reducir el costo y aumentar la conciencia de la comunidad sobre la seguridad y eficacia de la PrEP.

Más de 35 millones de personas están infectadas actualmente con el virus de inmunodeficiencia humana (VIH), de las cuales entre el 30 y el 50 % experimentarán polineuropatía sensitiva distal (PDD), que suele causar parestesias y dolor neuropático, en particular en los pies. . . . Esta presentación es idéntica a la de los pacientes con PDD diabético. Los regímenes actuales para tratar el dolor neuropático tienen beneficios limitados. Por lo tanto, es imperativo comprender mejor los mecanismos de la PDD del VIH para permitir el desarrollo racional de nuevas terapias. Los ratones transgénicos que expresan la proteína viral R del VIH-1 (Vpr) muestran denervación epidérmica de la almohadilla plantar y alodinia, como se observa en los pacientes infectados por el VIH. Descubrimos que la Vpr exógena inhibe el crecimiento de los axones, causa hiperexcitabilidad y aumenta el calcio citosólico en las neuronas ganglionares de la raíz dorsal (GNDR) cultivadas. La exposición de las GNDR al factor de crecimiento nervioso (NGF) o la modulación de las vías de señalización del NGF antes del tratamiento con Vpr pueden bloquear sus efectos. Estos hallazgos se extenderán a modelos in vivo para determinar si alterar la vía de señalización del NGF puede prevenir la denervación y la alodinia inducidas por Vpr.

Background: Guillain-Barré syndrome (GBS) has been reported in HIV-positive individuals, but the incidence and characteristics in this group of patients has not systematically been investigated beyond case reports and retrospective series. The aim of this study was to compare the incidence and characteristics of GBS in HIV positive and -negative individuals. Methods: We performed a prospective, comparative study over a 3 ½ year period in the Western Cape province of South Africa. All adult patients with GBS were included and classified into 2 groups based on HIV status. The two groups were compared with regards to clinical, electrophysiological and laboratory features. Patients were followed until stable or recovered, for a maximum of 12 months. Results: 28 patients were included in the study, of which 15 were HIV-positive. Using estimated HIV prevalence data for the same geographical area during the study period, the incidence of GBS in HIV-positive patients was calculated to be 18.74, 95% CI [7.69, 40.60] times higher than in HIV-negative patients. Except for the frequency of hyponatraemia, there were no statistically significant differences between the 2 groups with regards to presenting features, severity of illness, GBS subtypes, and treatment response. GBS occurred in all stages of HIV infection, and was the presenting feature of HIV infection in 13 patients. Interpretation: The incidence of GBS is strikingly increased in HIV infection. The reason for this is still uncertain, but can probably be explained by immune dysregulation. HIV infection does not appear to influence the short term outcome of GBS.

Objectives: The health and prevention benefits of antiretroviral therapies (ART), delivered as part of comprehensive HIV care programs remain unrealized for men who have sex with men (MSM). This multilevel study explores the correlates of drop-off from the HIV care continuum in an international study of MSM, taking into account individual and regional differences in access to and utilization of care.

Methods: We conducted a study of the continuum of HIV diagnosis and care among 6095 MSM using data collected from an international online survey of MSM conducted in 2012. In this model of the HIV treatment cascade, we treated each point along the continuum as an outcome variable. We then investigated the relationships between clinical care outcomes and a set of demographic and psychosocial factors that were hypothesized to correlate with the outcomes using bivariate and multivariable statistical techniques.

Results: Among MSM living with HIV for longer than 12 months (n=632), 50%(n=319) were virologically suppressed. Among MSM recently infected with HIV (n=91), the proportion was relatively smaller at 33%. Significant correlates of being on ART and retained in care included: accessibility of HIV treatment; comfort with a healthcare provider; and engagement in a gay community. Perceptions of homophobia were negatively associated with being on ART and being retained in care.

Conclusions: These findings underscore the need for service delivery models that sensitively address HIV among MSM. Public health officials should adopt comprehensive HIV programs that include mutually reinforcing components and that address varying needs of MSM newly diagnosed and living with HIV. Comprehensive HIV programs must also support the critical role communities play in linking and retaining MSM into HIV services. Further studies validating the findings in country-specific contexts are warranted.

Background: Studies of Antiretroviral Therapy program in Africa have shown high incidence rate of opportunistic infections in both Antiretroviral Therapy receiving and Pre ART Human Immunodeficiency Virus infected patients. However, incidence of opportunistic infections and factors that contribute for development of it were poorly described in Ethiopia especially in the study area.

Objective: To determine the effect of HAART on incidence rate of opportunistic infections among HIV-positive adults in Public Health facilities of Arba Minch town. Method: Retrospective cohort study was used and the required sample size was 464. Study participants were selected randomly from the list of adult people living with HIV attending the public health facilities for ART. Univariate analysis was used to describe patients’ baseline and follow up characteristics. Kaplan-Meier survival and log rank test were used to estimate survival and compare survival curves respectively. Cox proportional-hazard regression model was used to determine independent predictors of incidence of opportunistic infections.

Result: A total of 464 patients (232 in each cohort) contribute for 898.12 person years of follow up. The incidence of opportunistic infections was 55.8 per 100 person year and 3.4 per 100 person year of follow up in pre ART and HAART cohorts respectively. Being on HAART decreased occurrence of opportunistic infections by 93%. In contrary being male, being widowed, substance use, rural residence and having baseline CD4 count of 350-499 cells/μl are independent predictors of increased risk of opportunistic infections.

Conclusion: The incidence of opportunistic infection was higher in pre ART cohort. Male gender, being widowed, substance use, rural residence and having baseline CD4 count of 350-499 cells/μl were independent predictors of increased risk of opportunistic infections.

Background: United Kingdom has reported the largest documented outbreak of lymphogranuloma venereum (LGV), a re-emerging sexually transmitted infection (STI) which is primarily seen in HIV-positive men who have sex with men (MSM). A diagnostic service was established in response to the outbreak linked to a voluntary LGV Enhanced Surveillance system. We examined the performance of this novel surveillance system to identify utility in tracking a re-emerging infection.

Methods: We described laboratory data on samples and surveillance data from case reports for LGV from 2004- 2010. We performed a cross-sectional analysis comparing clinical and behavioural characteristics of HIV-positive and HIV-negative/unknown LGV cases diagnosed in MSM using multivariable logistic regression models with generalised estimating equations to control for repeat infections.

Results: LGV Surveillance data were available for 87% (1,370/1,581) of LGV cases (after de-duplication). There were 1,342 episodes in 1,281 MSM, most of whom were known to be HIV-positive (1,028/1,281, 80.2%,). HIV-positive men reported a shorter duration of symptoms (aOR 0.5; 95%CI 0.3, 0.8 for reporting more than a week compared to a week or less) in comparison to HIV-negative/unknown MSM, and were more likely to report unprotected receptive anal intercourse (aOR 2.7; 95% CI 1.3, 5.8).

Conclusion: The surveillance identified the population at greater risk of infection based on higher levels of risk behaviour in HIV-positive LGV cases. However, there was diagnostic bias towards HIV-positive LGV cases who presented with a shorter duration of symptoms when compared to HIV-negative/unknown LGV cases.

Introduction: Dyslipidemia is becoming one of the common problems in human immunodeficiency virus infected patients receiving antiretroviral therapy. Data on lipid profile derangements induced by antiretroviral treatment in Ethiopia is scarce. The aim of this study was to assess the prevalence and patterns of lipid profile abnormalities among patients taking first line antiretroviral therapy in Tikur Anbesa hospital, Addis Ababa, Ethiopia.

Methods: comparative cross sectional study was conducted between August and December 2012 in Tikur Anbesa Specialized Hospital in Addis Ababa. The study population consisted of 70 HIV positive individuals who had been receiving first line ART regimen for at least 6 months (treatment group) and 71 individuals with diagnosed HIV infection and who were not yet receiving antiretroviral therapy. An interviewer administered structured questionnaire was used to collect information. Lipid profile was determined after overnight fasting and dyslipidemia was diagnosed according to the United State National Cholesterol Education Program III criteria. Data comparison used chi-square test, Student t-test and logistic regressions.

Result: The prevalence of dyslipidemia was higher in antiretroviral treatment group (80%) as compared to antiretroviral treatment naïve groups (57.7%). Total cholesterol >200 mg/dL was 45.7% in Antiretroviral Therapy groups and 21.1% in Antiretroviral Therapy naïve groups. Similarly low density lipoprotein cholesterol > 130 mg/dL was 40% vs 29.6%, triglyceride >150 mg/dL; 40% vs 32.4%, and high density lipoprotein cholesterol <40; 22.9% vs 16.9% in Antiretroviral Therapy and Antiretroviral Therapy naïve groups respectively, showing more lipid alteration in ART group. Use of ART was also significantly associated with high total cholesterol (>200 mg/dL) (p<0.002), total cholesterol / high density lipoprotein cholesterol ratio >5(P<0.026), an established risk indicator of coronary artery disease and triglyceride / high density lipoprotein cholesterol ratio > 2.4(p<0.036).

Conclusion: Higher prevalence of dyslipidemia was observed among Antiretroviral Therapy treated groups as compared to ART naïve groups. Therefore lipid profiles should be screened in Antiretroviral Therapy treated populations periodically to monitor any changes in lipid profile.