Revista de SIDA e investigación clínica

The link between HLA types and HIV disease progression has been well established with alleles and residues associated to progression or non-progression to AIDS. Vertical transmission rate of HIV in Cameroon is still very high (10%). The aim of this study was to describe the diversity of HLA class I in infants born to HIV infected mothers and to determine the influence of HLA genotype in mother to child HIV transmission in Cameroon. Thirty four HIV infected infants and 28 HIV exposed but non infected infants born to HIV-positive mothers were enrolled in this study. HLA-A, HLA-B, group allele frequencies were determined by low-resolution polymerase chain reaction using sequencespecific primers. Nineteen HLA-A, 20 HLA-B allelic groups were identified in the study population. Among all the allelic variants identified, only HLA-B*44 allelic frequency resulted significantly increased in exposed non infected children (12.5% in exposed non infected versus 2.9% in exposed HIV-infected children, p=0.04). HLA-B*44 may be associated with the resistance to HIV infection upon mother to child exposure.

Objective: We assessed the prevalence and risk factors of decreased bone mineral density (BMD) in patients mono-infected with human immunodeficiency virus (HIV) or co-infected with hepatitis C virus (HIV/HCV). We also evaluated whether bone loss was linked to lipid asset in both groups and to severity of liver fibrosis in the co-infected group.

Methods: We consecutively enrolled 194 HIV-patients (129 mono-infected and 65 co-infected). All HIV-patients underwent dual-energy X-ray absorptiometry (DXA), while co-infected patients underwent transient elastography. Advanced liver fibrosis was defined as a median liver stiffness ≥ 9.5 kPa. Fibrosis was also assessed in all the HIVpatients using FIB-4.

Results: The overall prevalence of low BMD and osteoporosis was 26.8% and 26.0%, respectively. It was significantly higher among HIV/HCV co-infected than mono-infected patients in lumbar/femoral sites (P<0.04 and P<0.05, respectively). HDL-cholesterol levels correlated independently with lumbar DXA Z-score (P<0.03) in HIV mono-infected subjects. Liver stiffness correlated negatively and independently with femoral Z- and T-scores among co-infected patients (P<0.003; P<0.01, respectively). Stratifying co-infected subjects by sex, liver stiffness and lumbar/ femoral Z-scores (P<0.04) or T-scores (P<0.05; P<0.04, respectively) correlated negatively only in the females. Longer PI exposure was negatively and independently correlated with BMD.

Conclusion: Our HIV-infected patients appeared at high risk for low BMD and osteoporosis. Severity of liver fibrosis was an independent predictor of bone loss in co-infection, although other factors could affect the skeletal system in HIV/HCV co-infection. Further research into the impact of liver fibrosis and lipid asset on bone disease in HIV-infection is necessary

Introduction: According to 2011 Ethiopian demographic health survey result, about 2.2% mothers were HIV (Human Immunodeficiency Virus) positive in Amhara regional state. HIV testing during pregnancy is the gateway for PMTCT (Prevention of Mother to Child Transmission) of HIV though its coverage was 72.0% to 82.5% in North-West Ethiopia.

Objective: To assess VHCT (Voluntary HIV Counseling and Testing) service utilization and its determinants among pregnant mothers in North-West Ethiopia in 2014. Methods: A community based cross sectional study using both quantitative and qualitative research methods was conducted in Enemay woreda/district. Data was collected on systematically selected 386 pregnant mothers and 4 FGDs (Focus Group Discussion) on purposively selected pregnant mothers and their partners. A pre tested closed ended structured questionnaire and open ended questions were used to collect the quantitative and qualitative data respectively. Binary logistic regression was used for multivariate analysis of quantitative data.

Result: Majority (81.6%) of participants were known transmission of HIV during pregnancy and about three quarter (76.2%) of them were tested for HIV in current pregnancy. In FGD, all participants were not agreed as HIV testing was important during pregnancy. The repeatedly cited reason for not up taking HIV testing during pregnancy was fear of stigma and discrimination if test result becomes positive. Pregnant mothers not knowledgeable about MTCT (Mother to Child Transmission) of HIV; have not intension for ARV Prophylaxisis, unable to bring their partner for test and mothers who believe VHCT was importance before marriage only were less likely utilizing VHCT service thus organizations working on VHCT should further enhance awareness creation by giving especial attention for these groups of pregnant mothers.

Introduction: Acquired Immuno Deficiency Syndrome (AIDS) is caused by the human immunodeficiency virus (HIV) which damages a person’s ability to fight off disease, leaving the body susceptible to secondary and opportunistic infections. Youths are among the risky populations for HIV/AIDS, so equipping them with appropriate level of knowledge and attitude and behavioral change towards HIV/AIDS is one of the important strategies to prevent the HIV/AIDS. So, this assessment was conducted to assess HIV/AIDS related knowledge and attitude among health science students in Debre Markos University (DMU), North West Ethiopia, 2014.

Methods: Cross-sectional study design was conducted among DMU, college of medicine and health science 3rd and 4th year students. A total of 197 students were enrolled in the study. Data was entered using Epi data version 3.1 and it was exported to SPSS version 16 for further analysis. The collected data were analyzed using descriptive analysis, and it was presented with frequency, percentage, mean and standard deviation (SD).

Results: More than three fourth (78.5%) of study participants were male. The mean age of study participants were 22.42 with SD and range of 1.77 and 19 to 35 years old. Mean of correct answer for knowledge related questions was 18.8 with SD of 1.99. More than one third (36.2%) of respondents have poor knowledge while 104(63.8%) have good knowledge towards HIV/AIDS. In addition, 84(51.5%) of respondents have favorable attitude while 79(48.5%) of respondents have unfavorable attitude towards treating and working with HIV/AIDS patients.

Conclusion: Almost half of the respondents had unfavorable attitude towards HIV/AIDS, specifically towards HIV/ AIDS patient support and care. Even if majority of respondents have good knowledge towards HIVAIDS, almost half of the respondents had unfavorable attitude towards treating and working with HIV/AIDS patients, which shows that they did not extend their knowledge to the stigma and reservations identified around working with and treating people with HIV/AIDS. This calls the need for health courses to address not only the medical aspects of HIV but also the social components, related with stigma and discrimination against HIV/AIDS patients.

Polymerase Chain Reaction (PCR) has made a significant improvement in the diagnosis of toxoplasmosis. Nevertheless, a wide variety of targets and primers has been evaluated in different independent assays, and only few comparative studies have been performed. Even when the B1 gene and the 529 repetitive element have been the most studied markers, there no concluding remarks respect the best.

Objetive: The aim of the present study was to design a multiplex PCR assay to simultaneously detect these two markers in a single multiplex PCR to diagnose T. gondii infection.

Methods: Specific PCR primers targeting the B1 gene and 529 repetitive element were evaluated. After a careful optimization of multiplex PCR process, analytical sensitivity and specificity were evaluated. The usefulness of multiplex assay was evaluated using DNA from 8 T. gondii reference strains, corresponding to the three principal genotypes, and 70 clinical samples (blood) from AIDS patients with and without Toxoplasmic encephalitis (TE).

Results: Our preliminar results show that multiplex PCR assay is able to amplify both targets in using DNA from one parasite in the mix PCR reaction. Unspecific reactions for other microorganisms were not observed. The diagnostic sensitivity of multiplex assay in blood, according to the Centers for Disease Control and Prevention (CDC) criteria, was 86.6% while the diagnostic specificity was 100%. Only one sample was positive to one marker (B1 gene) in the multiplex reaction.

Conclusion: This multiplex PCR method is the first multiplex PCR evaluating the detection of T. gondii DNA in TE cases and it proved to be rapid, enough sensitive, highly specific and inexpensive respect to perform independent assays for each marker, real time PCR or nested PCR assays.

Objectives: The aim of this study was to determine the caries rate and periodontal status in a sample of pregnant women with HIV+ infections from Puerto Rico.

Methods: A pilot study was conducted on a cross sectional convenience sample of 25 pregnant women with HIV+ infections from Puerto Rico who visit the CEMI clinic (Centro de Estudios Materno Infantil) at the University of Puerto Rico. The women subjects were evaluated for caries, DMFT (D: Decay tooth; M: Missing tooth due to caries; F: Filled tooth) index, oral lesions associated with HIV+/AIDS and periodontal disease parameters, with a Florida probe by a calibrated dentist on periodontal indexes such as as bleeding on probing, CEJ (cemento-enamel junction) and pocket depth. Periodontal disease was classified as having 4 sites with pocket depth greater than 4 mm and caries were identified following the Radike criteria. Data was statistically analyzed using the SSPS Program (Statistical Software Program for Social Sciences) and descriptive statistics were calculated. 

Results: Mean DT (decayed teeth), MT (missing teeth due to caries), FT (filled teeth) and DMFT ( decay, missing and filled teeth) were 4.8, 1.86, 5.3 and 12, respectively; mean sites of bleeding on probing=12.06; mean sites with pocket depth>4 mm=6.95 and mean sites with loss of attachment greater than 4 mm=7.66. [Almost 50% of the patients had generalized chronic periodontitis. A 72% prevalence of periodontal disease was found. No oral lesions related to HIV+/AIDS were reported. CD4 and viral load was statistically associated with bleeding on probing and severe signs of periodontal disease.

Conclusions: High levels of dental disease were found in pregnant women with HIV+/AIDS infections from Puerto Rico, and these women were in need of substantial dental services.

Objective: Human papillomavirus (HPV)-associated cancers are important public health problems in HIV-infected people. Assays based on HPV virus-like particles (VLP) and pseudoviruses (PsV) are commonly used to examine HPV antibody responses in HIV-infected people, but neutralization assays with native HPV have not been utilized and a comparison of these three assays is lacking. We evaluated the agreement of assays using VLP, native HPV and PsV in detecting HPV16 and 18 antibodies in HIV-infected women.

Methods: The VLP-based ELISA (VLP-ELISA) was used to detect antibody responses to HPV16 and 18 and cottontail rabbit papillomavirus (CRPV) VLP antigens. Neutralization assays with native HPV (NA-HPV) and with PsV (NA-PsV) were conducted to examine HPV16 or 18 neutralizing antibodies. Intra class correlation coefficients (ICC) and kappa coefficients were used to assess the agreements of seropositivity between the assays.

Results: The seroprevalence detected by the VLP-ELISA, NA-HPV and NA-PsV in 94 HIV-infected women was 35%, 51% and 27% for HPV16 and 14%, 44% and 21% for HPV18. Cross-reactivity between HPV16 and HPV18 was 0.35, 0.04 and 0.33 (kappa coefficients) for the VLP-ELISA, NA-HPV and NA-PsV. The agreements of seropositivity between the three assays were low. Six women who were HPV16 DNA positive were seropositive by the NA-HPV but only two were HPV16 seropositive by the VLP-ELISA or NA-PsV. One HPV18 DNA positive woman was seropositive by all three assays. Repeated tests indicated excellent reproducibility of the NA-HPV.

Conclusion: HPV serology results vary across different assays. The NA-HPV appears to be a sensitive and reliable approach in detecting natural HPV antibodies in HIV-infected women. The NA-HPV can be applied in both HPV natural history studies and vaccine studies in HIV-infected people.

In Botswana no study has examined the association between beliefs and attitudes of young people towards ARVs and sexual risky behaviors. This paper aims to assess the association between beliefs and attitudes of youth about ARVs and sexual risk behaviors. It is based on secondary data derived from the Botswana AIDS Impact Survey IV (BAIS IV) which is the latest survey aimed at providing up to date information on HIV/AIDS pandemic in Botswana. A sample of 2632 youth in ages 15-24 years was considered for analysis. About 11% of youth in the sample were of the view that people on ARVs should not always use condoms, 5% believed ARVs cure AIDS, and 52% said that their personal concern about getting HIV has not changed since the introduction of ARVs. Logistic regression results indicate statistically significant association between having multiple sexual partners and the belief that people on ARVs should not always use condoms (AOR, 1.5), and belief that a person on ARVs should stop taking them once they feel better (AOR, 2.5). Moreover, young people who said that their personal concern about getting HIV has not changed (AOR, 1.04) or those less concerned (AOR, 1.6) about getting HIV since the introduction of ARVs were more likely to have multiple sexual partners. Meanwhile, there was no significant association observed between some beliefs and attitudes about ARVs and inconsistent condom use, except for young people who said that they are less concerned about getting HIV since the introduction of ARVs (AOR, 9.9). Beliefs and attitudes of youth about ARVs suggest that more education efforts need to be incorporated in HIV care and treatment to reduce risky sexual behaviors and HIV transmission among youth.

Introduction: Persistent systemic inflammation is associated with mortality among undernourished, HIV-infected adults starting antiretroviral therapy (ART) in sub-Saharan Africa, but the etiology of these deaths is not well understood. We hypothesized that greater systemic inflammation is accompanied by cardiovascular dysfunction over the first 12 weeks of ART. Methods: In a prospective cohort of 33 undernourished (body mass index <18.5 kg/m2) Zambian adults starting ART, we measured C-reactive protein (CRP), tumor necrosis factor-α receptor 1 (TNF-α R1), and soluble CD163 and CD14 at baseline and 12 weeks. An EndoPAT device measured the reactive hyperemia index (LnRHI; a measure of endothelial responsiveness), peripheral augmentation index (AI; a measure of arterial stiffness), and heart rate variability (HRV; a general marker of autonomic tone and cardiovascular health) at the same time points. We assessed paired changes in inflammation and cardiovascular parameters, and relationships independent of time point (adjusted for age, sex, and CD4+ T-cell count) using linear mixed models. Results: Serum CRP decreased (median change -3.5 mg/l, p=0.02), as did TNF-α R1 (-0.31 ng/ml, p<0.01), over the first 12 weeks of ART. A reduction in TNF-α R1 over 12 weeks was associated with an increase in LnRHI (p=0.03), and a similar inverse relationship was observed for CRP and LnRHI (p=0.07). AI increased in the cohort as a whole over 12 weeks, and a reduction in sCD163 was associated with a rise in the AI score (p=0.04). In the pooled analysis of baseline and 12 week data, high CRP was associated with lower HRV parameters (RMSSD, p=0.01; triangular index, p<0.01), and higher TNF-α R1 accompanied lower HRV (RMSSD, p=0.07; triangular index, p=0.06). Conclusions: Persistent inflammation was associated with impaired cardiovascular health over the first 12 weeks of HIV treatment among undernourished adults in Africa, suggesting cardiac events may contribute to high mortality in this population.

Introduction: In this study, statistical techniques were applied to reconstruct the historical HIV infection curve using all available surveillance data sources in Brazil, including AIDS reported cases, HIV incident cases in recent years, and AIDS deaths. Using this model, we estimated the HIV incidence and the number of people living with HIV/ AIDS (PLWHA) in Brazil, 2012.

Methods: To estimate HIV incidence in the period 2005-2012, we used a new method based on a CD4 count depletion model. From SISCEL information, we estimated the time lag between HIV infection and the date of first CD4 count for each treatment-naïve HIV infected case aged 15 years or older. To estimate the HIV incidence in past years, we used an extended back calculation method. Then, we used the back-calculating estimates of HIV incidence from AIDS reported cases together with the estimates of HIV incidence in recent years (2005-2012) to reconstruct the HIV incidence curve, in Brazil. To calculate the total prevalence in the middle of 2012, we used the accumulated incident cases and the total number of deaths up to the middle of year 2012.

Results: By midyear 2012, 672959 AIDS cases have been reported, and from those, 336391 were alive. In the middle of 2012, the prevalence was 715003 and the prevalence rate 3.7 per 1000 population. The number of HIV cases infected in 2012 of 47573 represents 6.6% of the total prevalence, with an incidence rate of 24.5 per 100,000 populations. The number of prevalent cases with no CD4 count in the middle of 2012 was 240333, or 33.6% of the total number of PLWHA.

Discussion: Currently, the Ministry of Health adopted the new policy of offering immediate treatment to those diagnosed with HIV and new challenges have to be faced. In this study, we estimated that around 715,000 people live with HIV/AIDS in Brazil, from which one third do not have a CD4 count, and is not benefiting from the new policy. As patients who belatedly starting therapy have lower survival, consume more resources, and reduce the chances of therapy success, policies to eliminate structural barriers to HIV testing are essential in Brazil.

Background: HIV counseling and testing is one of the key strategies in the HIV/AIDS prevention and control programs in Ethiopia. However utilization of this service is very low. The aim of the study was to assess and compare factors associated with HIV counseling and testing service utilization among Ethiopian males and females.

Methods: The study utilized data from the Ethiopian Demographic and Health Survey (EDHS) 2011, which was a cross-sectional survey conducted on a nationally representative sample. Using cluster sampling, 14110 males aged 15-59 years and 16,834 females aged 15-49 were selected from all the 9 administrative regions and 2 administrative cities of Ethiopia. Descriptive analysis was done and chi-square test was used to test the association of each independent variable with the dependent variable. Multivariable logistic regression was used to identify potential factors associated with HIV testing service utilization.

Results: Generally, 42.5% male and 41.9% female participants had ever been tested and counseled for HIV at least once. Education level, wealth index, area of residence, knowledge about HIV/AIDS and having no stigmatizing attitudes toward people living with HIV/AIDS were found to be strongly and positively associated with HIV testing service utilization in both male and female genders. HIV test rate was higher among younger men and women (aged ≤ 34 years), rich in income, urban residents, exposed to mass media and those of educated secondary and above.

Conclusions: HIV testing service utilization among male and females in Ethiopia is low. HIV/AIDS-related stigma, HIV related knowledge, place of residence, educational level, marital status, wealth index, and media exposure were major factors affecting HIV testing service utilization among males and females in the country.

Objectives: Despite substantial research documenting the relationships between intimate partner violence (IPV) victimization and HIV risks among women worldwide, few studies have examined these relationships among the growing population of migrant women who are disproportionately affected by these co-occurring problems. This cross-sectional study examined associations between lifetime IPV victimization and HIV risks among female migrants in Almaty, Kazakhstan.

Methods: Survey interviews and testing for HIV and Syphilis were conducted among a random sample of 225 female migrant vendors who were employed in one of the largest markets in Central Asia. Multivariate regression estimated associations between experiencing any lifetime physical and/or sexual IPV victimization measured by the revised conflict tactics scale (CTS2) and a number of HIV risks, controlling for potentially confounding sociodemographic variables, drug and alcohol use, and mobility patterns.

Results: Of the total sample, 28.9% reported ever experiencing physical or sexual IPV. Multiple associations were found between a history of IPV victimization and a range of HIV risks, including sex with multiple partners, unprotected sex with a non-primary partner, a higher number of unprotected sex acts with non-primary partners, and a higher number of self-reported sexually transmitted infections (STIs).

Conclusions: The multiple associations found between IPV and HIV risks in this sample underscore the importance of redoubling women-specific HIV prevention efforts that consider both IPV and mobility.