Revista de SIDA e investigación clínica

Background: In this study, it was hypothesized that tuberculosis co-infection independently increases the risk of mortality in people living with HIV (PLWHs) even if they are on antiretroviral therapy (ART). Therefore, investigating this hypothesis among cohort of adult PLWHs in south west Ethiopia was the aim of the present work.

Methods: A cohort study was conducted from December to August 2012 at Jimma University Specialized Hospital (JUSH). PLWHs initiating ART between 2008 and 2011 were included using simple random sampling. The effect of TB co-infection on all-cause mortality was assessed using Cox proportional hazard model.

Results: In crude analysis, all-cause mortality of TB co-infected patients was higher by 6.5% (P=0.004). However, multivariate analysis showed that TB co-infection didn’t increase mortality (AHR, 1.31(0.573-3.007), P=0.52). Instead, factors which increased death were low baseline functional status, malnutrition, CD4 count <100cells/mm3 at the initiation of ART.

Conclusion: In this study, it was shown that TB co-infection didn’t independently increase mortality provided that patient is on ART. Therefore, beside TB, addressing patient’s nutritional status and intervention to facilitate early presentation to health facilities before they deteriorate functionally and immunologically is mandatory to reduce mortality on ART.

In countries where highly active antiretroviral therapy (HAART) is available, cardiovascular disease is a major cause of morbidity and mortality in patients infected by the human immunodeficiency virus (HIV). Vascular calcification is used as subclinical marker of atherosclerosis. As vascular calcification is now considered to be an active, inflammatory process, its evaluation in HIV-infected patients may thus be clinically relevant. The primary objective of the present study was to determine and compare the prevalence of abdominal aortic calcification (using the multislice spiral computed tomography) in HIV-positive patients receiving HAART and in HIV-negative control subjects. The secondary objective was to determine the risk factors associated with the presence of abdominal aortic calcification in HIV-positive patients. Seventy-seven HIV-positive patients and 77 HIV-negative controls were included in the study. We found that the prevalence of abdominal aortic calcification was similar in the two groups. Furthermore, the mean abdominal aortic calcification score was not significantly higher in HIV-positive patients than in controls. The following parameters were correlated with the aortic calcification score: age (p<0.0001), total cholesterol (p=0.004), low density lipoprotein cholesterol (p=0.007), estimated creatinine clearance (p=0.039), low viral load (p=0.02) and time since the diagnosis of HIV infection (p=0.005). However, in a multivariate analysis, only age was independently associated with the aortic calcification score (p=0.007). In conclusion, abdominal aortic calcification is neither more frequent nor more severe in HIV-positive patients than in HIV-negative controls, and seems only to be affected by independent HIV factors (such as age) in the patients. It remains to be established whether the progression of abdominal aortic calcification is independent of HIV status (in contrast to what has been observed for coronary calcification).

Introduction: Kaposi Sarcoma (KS) is a soft tissue malignancy that has been categorized into 4 subtypes, however, in the United States, it has frequently been noted in patients with HIV/AIDS and has thus become known as an AIDS-defining illness. When KS is found in the oral cavity, it is usually seen on the hard palate. Oral KS (OKS) is most commonly seen in patients with HIV/AIDS with CD4 counts below 200, and the disease is rarely reported outside of this patient population. HIV patients may be more likely to have KS with the decline of their immune function. Report of case: We report the case of a 31 year old African American male with a 2 year history of HIV who presented to the Otolaryngology clinic with a painful tongue lesion. His CD4 count never fell below 200, which makes this case an outlier among the epidemiology of KS. This case is unique in two different ways. The dorsum of the tongue is one of the least common manifestations of OKS and secondly OKS is usually associated with CD4 counts <200 per microliter, and this patient’s CD4 count stayed above 200 cells per microliter throughout his evaluation and treatment. The tongue lesion was causing dysphagia and odynophagia that was significant enough to cause him to seek medical care. Discussion: Despite the relatively adequate resources for HAART therapy among the American indigent population, some patients still decline this highly efficacious treatment and succumb to its now rare complications. Physicians must actively investigate suspicious oral lesions in HIV patients, particularly when there is a question about the compliance of HAART therapy or other concerning features. The oral cavity may be the initial manifestation site for HIV associated KS thus any suspicious lesion in sexually active patients should lead to testing for HIV.

Transient or chronic pill phagophobia-fear of swallowing pills-affects many adults and can be associated with nonadherence or use of an alternative pill swallowing strategy such as breaking, crushing or chewing medications. Patients with HIV require the chronic use of antiretroviral therapy (ART) to maintain health, but factors such as psychogenic dysphagia for pills may affect their ability to adhere to these medications. Use of alternative strategies such as crushing medications to decrease overall pill size have been shown in several studies to result in altered medication absorption, which may result in incomplete virologic suppression, increased adverse effects, and a suboptimal health outcome. This article reviews potentially useful swallowing strategies for the adult patient without physiologic dysphagia who cannot swallow pills.

Background: Currently, AIDS is considered a chronic, treatable disease for those who have access to Highly Active Antiretroviral Therapy (HAART). However, the decline in morbidity and mortality rates with an increase in life expectancy attributable to drug treatment has adverse effects associated with its continued use, such as changes in the body-fat distribution and metabolic abnormalities that define lipodystrophy syndrome. Objective: To conduct a systematic review of the prevalence of and methods used for defining and grading lipodystrophy in individuals living with HIV in Brazil. Methods: The electronic search was performed in Medline, Lilacs, SciELO, and thesis and dissertation databases. Original observational studies that had determined the prevalence of lipodystrophy in HIV-infected patients were included. Results: 103 articles were retrieved, and 16 were included in this review. The prevalence of lipodystrophy ranged between 32.4% and 88.6%. The methods used to assess lipodystrophy were: (i) Patient self-report and physician examination; (ii) patient self-report alone; (iii) physician examination and anthropometric measurements; (iv) patient self-report and anthropometric measurements; and (v) physician examination alone. Conclusion: The weighted average prevalence of lipodystrophy was 53.5%, and the most commonly used method to assess lipodystrophy was the patient self-report and physician examination. Further longitudinal and diagnostic studies should be conducted to determine the incidence and accuracy of lipodystrophy.

One of the major health problems among HIV sero-positive patients are superimposed infection due to the defect of immunity. Furthermore, intestinal parasites infection and other parasites, which are also one of the basic health problems in tropical region, are common among antiretroviral treatment patients. In this study, was aimed to assess the prevalence of intestinal parasites and other parasites among antiretroviral treatment patients in Dilla Referral Hospital. A cross sectional study design on clinical records of HIV/AIDS patients in ART clinics. Systematic simple random sampling method was used to obtain the required data. The most prevalence parasites infection were on males than females 72.00% and 28.00% in ART patients at 2011 as well as parasite infection were also shown on male ART patients with 52.00% followed by 48.00% females during 2013. And also the most commonly infected with parasites were males with 58.33% followed by females with 41.67% at 2014. Intestinal Parasitic infections were high among young antiretroviral treatment patients while low on children and old antiretroviral treatment patients. Therefore, the high prevalence of intestinal parasites among antiretroviral treatment patients are an evidence for the need of urgent for regular screening and de-worming of antiretroviral treatment patients.

Recent advances in gene targeting have proposed new approaches to treat HIV infection, focused on CCR5, which is a key molecule in virus entry as well as in infection maintenance. Ex vivo cell targeting could make T-cells resistant to infection while reducing cell reservoirs where HIV can escape total eradication. Immunization could provide prompt receptor down regulation and preventive immunity also in limited resources settings. Innovative, gene-based methods and immune-based interventions aimed at silencing CCR5 expression in vivo will be compared.

Background: Sub-Saharan Africa remained the most affected region in the global AIDS epidemic which is 22.4 million and whereas in Ethiopia 980000 of people living with HIV. ART enables a return to normal life, including a resumption of sexual activity and a new or renewed desire for children. Objective: The aim of the study was to assess the magnitude and factors affecting fertility desire among people living with HIV infection in WoreiluWoreda at Worailu health center. Methods: A facility based cross-sectional study design was used to collect data from 392 HIV positive patients/ clients which is supplemented by qualitative in-depth interview. Study subjects were selected using systematic random sampling. univariate analysis such as percentages, frequency distributions was used to describe the data . bivariate analysis usedto cheack association and finally binary logistic regression model was fitted to examine the effect of the independent variables on the fertility desire. Result:The study subjects consisted of 206 (52.55%) females and 186 (47.45%) males. among the study subjects, 155 (39.54%) respondents had fertility desire.Generally, respondents who were single, widow/widowed and divorced were 0.158 (95% CI=0. 035, 0.716),0.042(95% CI=0.004, 0.469) and0.140 (95% CI=0.028, 0.714) times less likely to desire fertility when compared with those respondents who were marriedrespectively. Conclusion:This study revealed that a high number of HIV positive men and women desired children. Fertility decisions in peoples living with HIV are not only affected by their HIV status but depends on different predictor factors. Those who desire fertility are having no children or less number of children, married or in relationship and have partners who also desire children.Therefore concerned body should expand PMTCT service in all health centers including private sectors.

Background: HIV transmission among men who have sex with men (MSM) is a major concern in Portugal. Little is known, however, about HIV transmission among male sex workers (MSW) who have sex with male clients. This study aimed to investigate the prevalence of HIV infection and risk behaviors among MSW in Lisbon, Portugal. Materials and Methods: A cross-sectional study was conducted using outreach sampling among MSW in Lisbon. Behavioral and serological data on HIV was collected. Results: In total, 143 MSW were recruited for the survey (mean age=28.26, SD=5.96). The prevalence of HIV among these workers was 8.4%. 86% of the MSW self-identified as gay or bisexual. More than 75% were Brazilian immigrants, and 94.4% worked indoors (apartments). Consistent condom use was high (95%) for anal sex with clients, but much lower (63.6%) for anal sex with partners. In addition, 21.7% had not been tested for HIV in the previous year. Self-identified gay MSW had been tested for HIV more often in the previous year than self-identified bisexual or heterosexual MSW (p=0.020). This was also the case with MSW who said that they were versatile (p=0.026), when compared with men who said that they had receptive or insertive anal intercourse. The data suggests that the most salient risks for MSW include professional isolation, inconsistent HIV testing, limited perceived HIV risk, and suboptimal levels of condom use in sexual relationships with partners.

Today’s youth is fast changing and developing rebel to conservativeness of society. Their attitude is shifting from romantic relationship to casual sex. West influenced societal norms and liberal sexual culture in metros offers varied avenues for sexual experiences adding opportunity for sexual liaisons. In the present study, we report findings derived from a study in the slums of Mumbai with a randomized cluster sample of 1239 men aged 18-29 using indepth interviews and survey. Results show, 80% of romantic relationships are translated to sexual relations. 10% of respondents reported multi-partner behavior in last one year and 1/5th of respondents reported their “girlfriend” as married. Study reveals that peer network, self assessment as sexual partner and perceived relational satisfaction with girlfriend are significantly affecting safe sexual behavior and coercive sex. Multi-partner behavior is affecting condom use negatively, but catalyzing alcohol use and coercive sex. Findings facilitate understanding of changing sexual culture and behavior, growing liberal sexual attitude and increased vulnerability among the youth. Programmes to fully inform and equip youth to make safe choices is required for ramification of sexual risk behaviour and the interface of alcohol use and risky sexual behavior especially in casual relations.

Aim: To describe the, incidence, the changes in the etiology and the prognosis of HIV infected patients, presenting by the first time to the Emergency Department (ED), during years 2000-2010. Study Design: Retrospective collection of data. Methods: The identification of patients was carried out by consulting, retrospectively, the medical records, of the patients that flocked to ED, by any pathology, in appreciating the diagnosis and known HIV or diagnosed during their hospital admission. Patients referred from other hospitals that had previously been visited at their ED or consultations after the first visit were excluded. Epidemiological and laboratory data were analyzed as well as, the influence of these variables on a 30 days mortality test was analyzed. Poor prognosis was defined by observing mortality at 30 days. Results: A total of 445 HIV patients were included in the study. The mean age was 40.92 ± 10 years. The infectious disease was the most frequent cause of visits to the ED. Neurological affectation was the most common cause of consultation due to non-infectious diseases. The incidence of HIV patients reported to the ED had been declining in the last decade, with a maximum peak inflow in 2001 of 41.21 patients/year. The overall mortality in the study was 8%. Logistic regression analysis showed that admission to ICU (p<0.001) was independent variables predicting mortality. Conclusion. Infectious disease is the most common cause of HIV patient consultation at the ED, with a decreasing incidence, probably related to the widespread utilization increased of HAART. Our results may serve as a benchmark reference to other Spanish centers.

We report a perinatally HIV infected adolescent on a protease-inhibitor containing antiretroviral regimen who developed iatrogenic Cushing's syndrome while receiving intensive ophthalmic corticosteroid therapy for granulomatous panuveitis. Although pharmacokinetic drug interactions between protease inhibitors and oral/inhaled corticosteroids have previously been described, this is the first report involving ophthalmic administration of corticosteroids and lopinavir/ritonavir in an adolescent.

Background: People with HIV have an increased risk for developing atherosclerosis. The objective of our study was to measure the prevalence of carotid ultrasound abnormalities in HIV-positive patients receiving antiretroviral therapy using routine carotid ultrasound. We examined the association between abnormal carotid ultrasounds and traditional cardiovascular and HIV-related risk factors. Methods: A cross-sectional study was carried out on male HIV-positive patients with low-to-moderate cardiovascular risk attending the HIV Metabolic Clinic in Vancouver, British Columbia (BC). Carotid ultrasounds were performed between January 1, 2002 and June 30, 2012, and this information was used to establish patients overall cardiovascular risk. Patient's charts were reviewed to obtain clinical data for traditional and HIV-related risk factors. Antiretroviral treatment information was obtained from the provincial Drug Treatment Program (DTP) data-base. An abnormal carotid ultrasound was defined by the presence of carotid plaque(s) and was used as a surrogate marker for atherosclerotic cardiovascular disease. Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation. Results: A total of 175 patients receiving antiretroviral therapy since 1996 were analyzed. The prevalence of carotid ultrasound abnormality was 47%. By multivariable analysis, the factors associated with carotid ultrasound abnormality included having history of high blood pressure (odds ratio 2.68, 95% confidence interval (CI): 1.17, 6.13) and a history of intravenous drug use (OR: 4.55, 95% CI: 1.40, 14.79). The odds ratios of carotid ultrasound abnormality for patients 46-55 years and ≥56 years old compared to ≤45 years old were 2.57 (95% CI: 1.08, 6.14) and 5.16 (95% CI: 2.02, 13.19), respectively. For every additional year on antiretroviral therapy, the odds ratio of abnormal carotid ultrasound increased by 1.10 (95% CI: 1.01, 1.19). Conclusion: Our study suggests that HIV-positive patients assessed as having low cardiovascular risk have a high prevalence of atherosclerotic vascular disease at younger ages. Some traditional factors and longer exposure to ARV's were associated with carotid ultrasound abnormalities.