Revista de SIDA e investigación clínica

This paper examines marital partner selection and the significance of fertility status among couples living with HIV using qualitative research methods. This study was conducted in the Maun and Gaborone areas in Botswana in southern Africa where patrilineal marriage traditions are normative and both civil as well as traditional marriage practices remain prevalent. Data were collected from 32 respondents using in-depth interviews after new civil marriages and where HIV status was positive for both partners. Results from the research demonstrate that HIV status is socially significant in the decisions that the couples living with HIV make in terms of selecting marriage partners. Yet once new marital relationships are established based on concordant HIV status, the cultural importance of fertility and childbearing remains paramount and rates of unprotected sex remain high. HIV positive and concordant couples engaged in unprotected sex in order to reinforce positive social status through reproductive success even when knowledge about mother to child transmission and increased viral loads in their own bodies was evident. This paper demonstrates the value of understanding cultural norms that surround fertility desires and fears of infertility in crafting efficacious HIV prevention programmes. HIV concordant couples still seek fertility success with partners in a context where HIV infection rates have remained high and this paper contributes to literature on both partner selection with respect to HIV status as well as the value of qualitative investigation to elucidate cultural challenges to HIV prevention. The paper concludes with further recommendations for understanding of the often overlooked cultural significance of infertility in areas with high HIV infection in order to better inform policies in the formulation of evidence based prevention strategies in Botswana with respect to people living with HIV and AIDS.

Introduction: Remarkable strides have been made in controlling the HIV epidemic, although not enough to achieve epidemic control. More recently, interest in biomedical HIV control approaches has increased, but substantial challenges with the HIV cascade of care hinder successful implementation. We summarise all available HIV prevention methods and make recommendations on how to address current challenges.

Discussion: In the early days of the epidemic, behavioural approaches to control the HIV dominated, and the few available evidence-based interventions demonstrated to reduce HIV transmission were applied independently from one another. More recently, it has become clear that combination prevention strategies targeted to high transmission geographies and people at most risk of infections are required to achieve epidemic control. Biomedical strategies such as male medical circumcision and antiretroviral therapy for treatment in HIV-positive individuals and as preexposure prophylaxis in HIV-negative individuals provide immense promise for the future of HIV control. In resourcerich settings, the threat of HIV treatment optimism resulting in increased sexual risk taking has been observed and there are concerns that as ART roll-out matures in resource-poor settings and the benefits of ART become clearly visible, behavioural disinhibition may also become a challenge in those settings. Unfortunately, an efficacious vaccine, a strategy which could potentially halt the HIV epidemic, remains elusive.

Conclusion: Combination HIV prevention offers a logical approach to HIV control, although what and how the available options should be combined is contextual. Therefore, knowledge of the local or national drivers of HIV infection is paramount. Problems with the HIV care continuum remain of concern, hindering progress towards the UNAIDS target of 90-90-90 by 2020. Research is needed on combination interventions that address all the steps of the cascade as the steps are not independent of each other. Until these issues are addressed, HIV elimination may remain an unattainable goal.

The objective of the study was to explore sexual behavior and HIV-testing practices among men who have sex with men (MSM) in Portugal, in light of current international health guidelines that recommend frequent HIV testing for MSM who engage in high-risk behavior. Participants were 304 mostly young, gay or bisexual self-identified MSM. They provided information regarding their HIV status (67% negative, 7% positive, 26% didn’t know), 24% had never been tested for HIV, and 15.5% had been tested only once; main reasons for never having tested previously were: always using condoms, and not feeling at risk. Thus, HIV testing was infrequent and insufficient for early detection of infection, entry into treatment, and protection of sexual partners, since many unprotected sexual practices still occur. Those who tested more were older, self-identified as gay, living in major urban areas and employed. Linear regression predicted that the number of times MSM had penetrative sex without a condom was associated with the number of times they got tested, indicating that they might be using the test itself as a means to gain control of their unprotected sexual practices. Testing campaigns should aim to help MSM become more aware of their risk behavior, decrease fear of testing by explaining available treatment resources and decreasing the stigma associated with HIV, and by publicizing information about free and confidential testing locations.

Objectives: To estimate changes of AIDS and non-AIDS mortalities from 1996 to 2010 comparing (2004-2010) vs. (1996-2003) periods from the time of HIV-seroconversion (SC).

Methods: Data derived from an Italian multicentre prospective and open cohort; competing risks approach was applied estimating the cumulative incidence functions (CIF) for AIDS and non-AIDS deaths over time from SC with delayed entries in the two cART periods. Cox-cause-specific hazards models were applied to estimate relative hazards (RH) of AIDS and non-AIDS related deaths.

Results: Of 2,249 individuals with known SC date followed from SC and from January 1996 to December 2010, 1,779 were survived, seroconverted or followed during 1996-2003, while 1,715 during 2004-2010. A total of 278 deaths occurred from 1996 to 2010: 197 in the early years of cART [61 (31%) non-AIDS deaths], and 81 during more recent cART period [48 (59%) non-AIDS deaths]. The CIF of AIDS related deaths was higher than CIF of non-AIDS related deaths in the early period [for instance, estimates at 15 yrs from SC: CIF of AIDS-related death = 0.15 (95% CI: 0.12-0.19 ) and CIF of non-AIDS related = 0.09 (95% CI: 0.07-0.12)], whilst in 2004-2010 period the CIF of non-AIDS related deaths was slightly higher [estimates at 15 yrs from SC: CIF of non-AIDS related = 0.03 (95% CI: 0.02-0.04) vs. CIF of AIDS-related death = 0.02 (95% CI: 0.02-0.04)]. Comparing the two periods by Cox proportional-cause-specific models, the hazard was lower for AIDS deaths than for non-AIDS related deaths [RH of non-AIDS deaths from last viral load (VL) < 200 copies/mL was 0.60 (95% CI (0.35-1.03)], while of AIDS-deaths was 0.32 (95% CI: 0.17-0.62), both RH relative to (2004-2010) vs. (1996- 2003)].

Conclusions: Considering early years of the cART period as a reference, we observed a decrease in both AIDS and non-AIDS-mortalities. In more recent cART years, non-AIDS mortality tended to decline less than AIDS-relatedmortality since HIV-SC, even after effective cART.

Objective: The latest advancement in HIV prevention, Pre-Exposure Prophylaxis (PrEP), could reduce incidence among women. However, PrEP uptake has remained low among US women since its approval in 2012, while use has increased among men who have sex with men. This study addresses women’s knowledge, attitudes and potential behaviors regarding PrEP. While HIV-negative women are the potential users of antiretroviral (ARV) medications for PrEP, HIV-positive women who have used ARVs could contribute immensely to our understanding of the complexities related to taking such medications. This study is the first to synthesize the opinions of both groups of women.

Method: We conducted eight focus group discussions, segregated by sero-status; four with at-risk HIV-negative (20) and four with HIV-positive (19) women in Washington DC during 2014. Topics discussed include PrEP awareness, likelihood of use, barriers and target populations.

Results: PrEP awareness was almost non-existent and the HIV-negative women urged publicity. They expressed much enthusiasm about PrEP and wanted to use and recommend it to others despite recognizing potential complexities related to taking PrEP, such as side effects, access, duration and frequency of use. HIV-positive women were less supportive of PrEP for those same reasons based on their experience with taking ARVs. They preferred condoms over PrEP given relative efficacy, affordability, accessibility, and prevention of other STIs.

Conclusion: There is an urgent need for PrEP public health campaigns catered to the needs and concerns of women.

Background: Early entry to antenatal care is important for early detection and treatment of adverse pregnancy related outcomes. However, only 11% of Ethiopian women had an antenatal care visit before their fourth month of pregnancy, as recommended by world health organization. Hence, this study was aimed to assess predictors of early ante natal booking in government health facilities of Hossana town, Hadiya zone, South Ethiopia.

Methods: Health facility based an unmatched case control study was conducted in government health facilities in Hossana town, from December, 1/2014-April, 30/2015 using interviewer guided questionnaire. Total sample size was 255 (85 cases and 170 controls) and taken from all government health facilities in case to control ratio 1:2 until the total sample of cases and controls obtained. Bivariate regression analysis was done and all explanatory variables associated with early ANC booking at p-value <0.25 were entered in to multivariable logistic regression analysis. Finally, p-value <0.05 was used to identify independent predictors of early antenatal booking.

Results: Visiting antenatal care alone [Adjusted Odds Ratio (AOR)=3.43(95% confidence interval (CI: 1.06, 11.09)], being employed in non-governmental organizations [AOR=6.82(95%CI: 1.56, 29.77)], venders [AOR=6.25(95%CI: 2.16, 18.06)], housewife [AOR= 3.3(95%CI: 1.09, 9.97)], perceived time of antenatal care initiation at < 4 months of pregnancy [AOR= 5.51(95%CI: 1.28, 23.67)], recognition of pregnancy at 1-2 months [AOR= 7.21(95%CI: 2.47, 21.08)] and perceived number of 4 and more antenatal care visit per pregnancy [AOR=3.53(95%CI: 1.22, 10.21)] were independent predictors of early antenatal care booking among pregnant women attending antenatal care unit in government health facilities of Hossana town.

Conclusions and recommendations: Health service managers, health care providers, Medias and community at large should give emphasis for the predictors of early antenatal booking like number of antenatal care visit per pregnancy, early recognition of pregnancy and time of antenatal care initiation to improve early antenatal care booking and to enable women benefit from the services in Hossana town.

Objectives: The objective of this study is to estimate the level of antibodies to EBV and Human Cytomegalovirus (HCMV) in peripheral blood in seropositive HIV-1 patients and its correlation with CD4 cell count and clinical and demographical details.

Materials and Methods: 60 patients who are HIV-1 seropositive were included in the study, with 30 seronegative patients as control group. After proper written consent, thorough oral examination was done and CD4 cell count of the patient was noted. Serological assessment of antibodies against EBV & CMV was done as an indicator for viral coinfection in these patients.

Results: There was a significant increase in the antibody titer against EBV & CMV in the patients with CD4 count less than 200 as compared to HIV-1 seropositive patients with CD4 count more than 200. The oral manifestations were seen more prominently in direct correlation with CD4 count of the patients.

Conclusion: There was a higher titre of EBV-1 and CMV antibodies in HIV-1 seropositive patients. A correlation between antibodies to CMV and CD4 count is seen in our population, with 86.4% of patients presenting with oral manifestations.

This study examines underlying stigmatizing opinions and attitudes of health care workers (HCWs) that may drive discrimination towards HIV-infected co-workers and patients in the workplace. Socio-demographics, opinions regarding managing HIV-infected co-workers, and attitudes regarding working with HIV-infected patients were measured using a self-administered anonymous questionnaire in a sample of 392 HCWs (113 doctors, 236 nurses and 43 technicians) in Beijing. Participants perceived a high risk of HIV transmission in both co-worker and HCW-patient relationships. Half of participants agreed that HCWs should routinely and mandatorily receive HIV-tests, HIV-infected co-workers should disclose their diagnosis to relevant parties, and should be restricted from performing invasive procedures. Most of participants feel disgusted by patients infected through sexual contact, and believed that HCWs have the right to refuse to care for infected patients, and that those patients should be treated only in designated hospitals. Almost all participants intended to avoid performing invasive clinical procedures or nursing services for HIV-infected patients. Nurses had significantly more stigmatizing attitudes towards HIV-infected patients than doctors and technicians. The identified rigid opinions on managing HIV-infected co-workers, together with stigmatizing attitudes towards HIV-infected persons, underscores an urgent need for interventions to prevent discriminatory practices in health care settings.

Background: Human immunodeficiency virus (HIV) infection has become a disease in epidemiological transition since the introduction of antiretroviral therapy (ART); however, its control depends on adherence to therapy. There are some studies in Mexico regarding such adherence but they have had heterogeneous results. We aimed to determine the prevalence of ART adherence and risk factors associated with non-adherence among HIV-infected adults in a tertiary care hospital in Mexico.

Methods: This was a cross-sectional study conducted at the Hospital de Infectología, “La Raza” National Medical Center, Mexico City. The subjects of the study were HIV-infected adults after at least 6 months on ART. They answered a questionnaire involving socio-demographics, biochemical, and clinical variables. Adherence was measured using the simplified medication adherence questionnaire

Results: Three hundred seventy-six HIV-infected patients were included in the study. The median age was 35 years (interquartile range, IQR, 29-44) and most of them were men (79.3%). Among the participants, 73% (95% confidence interval, CI, 68.2-77.4%) adhered to the medications prescribed. Factors associated with good adherence were being male (odds ratio, OR, 0.43; 95% CI, 0.22-0.83) and the absence of alcohol use (OR, 0.27; 95% CI, 0.12- 0.58); factors associated with non-adherence were a history of ≥2 ART regimens (OR, 1.95; 95% CI, 1.05-3.62), time spend attending medical care or receiving drugs (OR, 2.40; 95% CI, 1.22-4.70), and persistent viremia (OR, 2.72; 95% CI, 1.42-5.19; P<0.005).

Conclusion: In the era of ART as prevention for transmission of HIV as well as treatment for HIV-positive individuals irrespective of CD4 cell counts, the importance of adherence has grown. Treatment failure reduces future treatment options and therefore long-term clinical success as well as increases the possibility of developing drug resistant mutations. Being male and a lack of alcohol use were factors associated with higher rates of adherence, whereas previous use of ART, more ARV regimens, and a longer time waiting for medical care or drugs, were associated with nonadherence in this HIV-infected population. Incomplete ART adherence is associated with persistent viremia.

Objectives: Despite combination antiretroviral therapy (cART) introduction, human immunodeficiency virus (HIV) patients have increased risk for neurocognitive impairment (NCI). However, NCI assessment methods in these patients have limitations. Many neurocognitive screening tests, although quicker, identify only the most severe form of impairment and are not suitable for early neurological disorder detection. We previously stated that determination of neutral lipids (NLs) by oil red O (ORO) staining in the cytoplasm of unstimulated peripheral blood mononuclear cells (PBMCs), combined with their tendency to cluster formation (CF), may represent a novel non-invasive approach to detect and monitor neuronal injury in the disease’s early stages. In an attempt to find rapid, feasible tools to screen for NCI in HIV patients, we determined ORO staining and CF in unstimulated PBMCs from HIV-infected adults.

Methods: We analyzed demographic and clinical data including ORO and CF markers in 158 HIV-positive subjects receiving regular HIV infection care.

Results: We found 45% of HIV patients have higher ORO score (2 to 4) and 46% higher CF score (1-2) compared to age-matched controls. As shown in our previous study, NL accumulation in PBMC cytoplasm appears correlated with cognitive impairment. Also in this HIV patient population, correlation of PBMC NL accumulation with cognitive performance reduction, as highlighted by RBANS, may be indicative of NCI. In addition, according to data given in literature, the prevalence of NCI in HIV patients is high (about 30 -60%).

Conclusion: Our data shed light on the fact that as HIV patients have, as indicated by RBANS, lower cognitive performance than controls, and, in addition, that they have higher ORO and CF scores than controls, future studies are needed. Such studies might show that NL/CF screening, together with RBANS, could be useful for the rapid and practical detection of NCI in HIV-infected patients.