Revista de SIDA e investigación clínica

Background: People infected with human immunodeficiency virus (HIV) develop lipid and glucose metabolic alterations, which predisposes them to cardiovascular disease. The aim of this study was to evaluate the cumulative incidence of dyslipidemia and fasting glucose impairment after 48 weeks of initiating the first antiretroviral (ART) regimen and the association with the type of ART regimen.

Method: Retrospective cohort of HIV-1 infected patients attending in the AIDS clinic of five centers of the country, between February 2009 and March 2013. Lipids (total cholesterol and triglycerides) and fasting glucose, were collected prior and 48 weeks after starting ART. We assessed risk factors for dyslipidemia and fasting glucose. To adjust for the effects of potential confounders of metabolic alterations we used logistic regression model.

Results: During the study, 223 patients on ART were evaluated. Median age was 34 years [interquartile range (IQR): 28-43]. Of the total patients, 201 (90%) were men. Most common OBR regimens were tenofovir/emtricitabine (TDF/FTC), and efavirenz (EFV) in 42%, abacavir/lamivudine (ABC/3TC) +EFV in 16.6% and TDF/FTC+nevirapine (NVP) in 11.7% patients. Cumulative incidence per 1,000 patients/year of glucose ≥ 100 mg/dL was 233.1, total cholesterol >200 mg/dL was 273.5 and tryglicerides >200 mg/dL was 372.2. The proportion of patients with hypertriglyceridemia (>200 mg/dL) at 48 weeks of ART initiation was 37.2% (95% CI: 31.1-43.7%), hypercholesterolemia (>200 mg/dL) 32.3% (95% CI: 26.5-38.6%) and impairment of fasting glucose (IFG) (>100 mg/dL) 23.3% (95% CI: 18.2-29.2%), After adjustment in a logistic regression model for IFG, EFV-containing regimen OR 2.9 (95%CI 1.12-7.45); p=0.027; for hypertriglyceridemia, age >40 years old OR=1.9 (95% CI: 1.01-3.63); p=0.044, ABC/LAM-containing regimen OR=2.69 (95% CI: 1.42-5.09); p=0.002 and LPV/r-containing regimen OR=5.04 (95% CI 2.32-10.92); p=0.001 were significant; finally, for hypercholesterolemia age >40 years old OR=2.4 (95% CI: 1.15- 4.9); p=0.004 and ABC/3TC-containing regimen OR=1.87 (95% CI: 1.01-3.49); p=0.05 remain significant.

Conclusion: These data show high risk of cumulative incidence of IFG and dyslipidemia after initiation of ART. Age >40 years old, ABC/3TC and LPV/r-containing regimens were independent factors to develop dyslipidemia and EFV-containing regimen for IFG in this cohort.

Thirty-day hospital readmission is a benchmark for quality of care. HIV-1-infected individuals have a significantly increased 30-day readmission rate compared to their HIV-1-uninfected peers. Prior work has identified an association between several factors with an increased 30-day readmission rate in HIV-1-infected individuals. With malignancy recognized as a growing problem for HIV-1-infected patients, we sought to determine, in a cohort of 775 hospitalized patients with access to outpatient care, whether the presence of malignancy was a predictor of 30-day readmission. Of these 775 patients, 440 patients met the inclusion criteria for this study. We observed that the presence of a malignant comorbidity was a significant predictor of increased hospital 30-day readmission rates in HIV-1-infected individuals. The odds ratio for 30-day readmission with a co-morbid diagnosis of malignancy was 2.25 with a 95% confidence interval of 01.24-4.11 (p-value=0.008).

Background and objective: Varying degrees of sexual mixing in an intimate partner relationship which provides emotional support and social security, in addition to the economic benefits to female sex workers (FSWs)—often results in risky sexual behaviour (for example, unprotected sex), hence increasing the vulnerability of FSWs to sexually transmitted infections (STIs). This paper analyses the pattern of sexual mixing and the major covariates of STIs in intimate partner sexual relationships among FSWs in Nepal.

Method: The findings are based on information collected from 2901 FSWs, selected by using the modified timelocation cluster sampling as part of mapping and size estimation of MARPs across different districts of Nepal in year 2010-11.

Results: Findings reveal that almost 40 percent or two-fifths of FSWs in Nepal have commercial as well as noncommercial sexual partners. Further, 5.2 percent of the FSWs reported having more than one non-commercial partner along with commercial partners. Half of the FSWs in intimate partner relationships reported their last sexual encounter as unprotected, which was further lower among those currently married. Adjusted effects of socio-demographic and behavioural correlates portray that being married (p<0.01) and having a higher client load—a proxy of poverty and powerlessness (p<0.05)—are significant determinants of unprotected sex, which may also be attributed to a lack of risk perception in intimate relationships. A higher incidence of unprotected sex further leads to substantially higher prevalence of STIs (35%), which is disproportionately higher among those aged 30 and above, and among those having no formal education.

Conclusion: Findings of this study highlight the requirement of strategies to address sexual rights of FSWs within intimate partner relationships, in addition to the need for occupational empowerment of FSWs in order to combat prevalence of STIs and improving their quality of life.

Immune reconstitution inflammatory syndrome (IRIS) is a severe clinical complication emerging during the initial months of antiretroviral therapy (ART) in HIV infected patients. Mycobacterium avium complex (MAC) associated IRIS typically develops in severely immunosuppressed individuals, who have an excellent response to ART. Cutaneous MAC infection is uncommon. The skin lesions almost invariably responded well to specific anti-mycobacterial treatment for MAC infection in IRIS patients. Here, we report a case whose cutaneous MAC lesions continue exacerbation despite with anti-mycobacterial treatment. But rapid clinical remission occurred after thalidomide adding to the antituberculosis treatment. Furthermore, immunomodulatory effect of thalidomide on cytokine levels such as decreasing of TNF-α, increasing of IL-4 and IL-6 were observed in the patient. Thalidomide may be an effective treatment for cutaneous MAC infection during IRIS. This is the first report of talihdomide treatment for cutaneous MAC infection during IRIS, and needs further mechanism and clinical trial investigation in this regard.

The use of highly effective antiretroviral therapy penetration into the central nervous system has indicators for input that can eradicate the viral load in cerebrospinal fluid, thereby helping to prevent the virus compartmentalization in CNS and hence probably preventing perpetuation of these cognitive disorders associated with HIV virus. However, more studies are necessary in order to demonstrate the real pathophysiological mechanisms associated with these effects and to prove that the side effects associated with the use of these medications are harmless than the benefits achieved on the neurocognitive disorders.

Background: The shift from acute to chronic illness of HIV/AIDS requires a self-management model in which patients assume an active and informed role in healthcare decision. Promoting self-care management for people living with AIDS includes addressing complex issues such as keeping to treatment regimen, dietary pattern, physicalexercise and seeking for social support. This study provides baseline information about the self-care practices of people living with AIDS attending antiretroviral clinic of General Hospital Kafanchan, Kaduna State, Nigeria.

Methods: A cross-sectional study was conducted at the antiretroviral clinic of General Hospital Kafanchan, Kaduna between August and September, 2014. A sample size of 412 People living with AIDS was selected using systematicsampling technique. A structured pre-tested questionnaire was used to collect data using four research assistants fromthe antiretroviral clinic who were trained on the purpose of the study, contents of the instrument and how to administerthe instrument on clinic days while maintaining objectivity and confidentiality. Data were analyzed descriptively using frequencies, percentages, means and standard deviation. All analyses were performed using SPSS version 20.0 at 95% confidence interval.

Results: Respondents described their dietary pattern as good. Majority (88%) kept to their clinic appointment and did not miss taking their drugs as prescribed. Respondents felt more at home seeking support from family members, health workers and significant others. Most of the respondents embarked on exercises such as walking, running and doing physical work.

Conclusion: Self-care management practice is critical for people living with AIDS. There is need for continuous counseling and closer monitoring of people living with AIDS by health care providers to enable them sustain their selfcare management. It is also suggested that physical exercise be included in their health education to promote health and wellbeing.

Background: Data on the relative contribution of HIV-infection to aging and age-related diseases remains inconclusive, and the total burden of disease has not been compared to other chronic diseases associated with premature aging. The purpose of this study was to investigate aging with HIV-infection and to compare it to aging with diabetes mellitus (DM) type 2 and aging without severe chronic disease.

Methods: This was a prospective multi-center cohort study evaluating differences in the total burden of disease between different groups of older patients (≥ 50 years). HIV-infected patients were compared to HIV-negative patients with DM type 2 and to a control group of patients without severe chronic disease. Physical constitution and activity, symptoms of aging, cardiovascular risk profile and comorbidities were analyzed. Clinical variables and patient questionnaires were assessed during 18 months follow-up.

Results: Among 761 participants (255 HIV, 249 DM, and 257 controls), weakness was most frequently found in HIV-infected patients. The perceived severity of symptoms of aging was significantly higher in patients with HIVinfection or DM than in the control group. Several comorbidities such as renal, neurological and cardiovascular disorders were more common in patients with HIV-infection or DM than in the control group. After adjusting for smoking and non-modifiable risk factors, the prevalence odds of a high cardiovascular risk remained markedly increased for patients with DM and, to a lesser extent, also for patients with HIV-infection. Malignancy incidence rates were highest in HIV-infected patients, followed by patients with DM and lowest in the control group.

Conclusions: This large cohort study in aging patients showed a considerable burden of disease associated with antiretrovirally treated HIV-infection as well as DM when compared to a control population without severe chronic disease – reflecting the need for specific prevention strategies and screening tools.