Revista de SIDA e investigación clínica

The authors report a case seen in the internal medicine infirmary, which was diagnosed as acquired immunodeficiency syndrome (AIDS) because of cutaneous and visceral Kaposi´s sarcoma (KS) involvement. They highlight the importance of the dermatologist in the multidisciplinary care and approach some etiopathogenical and therapeutical features of KS. Chemotherapy with paclitaxel together with antiretroviral therapy (HAART) is described by the authors because of the good therapeutic outcome achieved.

A stratified two-stage probability sample design was used in selecting a total of 459 Enumeration areas and 8,275 households drawn systematically for the study with the aim to describe the characteristics of the HIV infected older adults in Botswana and determine how the HIV status of the older adults is influenced by their socio-economic and demographic characteristics. Household and the individual questionnaires developed using the opinions of professionals, users of statistics, as well as experiences from the pre-test formed the instrument for the study. The results revealed that 23.2% of the older adults 50-64 years (25.5%, males and 21.5%, females) were HIV positive. An overwhelming majority of the males (88.7%) and females (83.3%) had either no education or primary education. About half of the males (50.9%) and 19% of the females were married while the majority of the females (43.9%) were never married. All the socio-economic and demographic variables significantly (p<0.01) predicted the probability of an older adult being HIV positive. The older adults with secondary education and higher education were respectively, 65.5 times and 1.8 times more likely to be HIV positive. Type of locality had significant impact in the determination of HIV status of the older adults. There are significant association between the socio-economic, demographic variables and the risk behaviours (use of condom and adherence to ARV treatment). Education, focusing on prevention and education initiatives for HIV and AIDS, including peer education, media awareness campaigns, group workshops, publications for mass consumption, individual and couple counselling is very much desired and should be provided to the older adults.

Objective: HIV/AIDS is increasing in the Kingdom of Saudi Arabia (KSA) and the Middle East. The proper use of antiretroviral therapy (ART), CD4 and VL tests helped control the HIV epidemic elsewhere. We aim in this study to analyze the use of ART, CD4 and VL and stage of presentation. Design: A retrospective analytical descriptive cross sectional study.

Methods: Patients’ medical records were used to obtain laboratory and other predefined variables that are not routinely reported in surveillance; namely: ART, CD4, VL, and CDC stage. Then we have described and analyzed these variables.

Results: A total of 997 cases from 8 HIV/AIDS care providers participated. Of whom 475 (47.6%) on ART, and 522 (52.4%) are not. Among those on ART: 247 (39.5%) took Truvada combined with either efavirenz 147 (14.7%) or Kaletra 100 (10%). And 158 (15.8%) are on Combivir with either efavirenz 32 (3.2%) or Kaletra126 (12.6%). And 70 (7%) are on other combinations. The mean (Std deviation) baseline CD4 and Median (IQR) viral load are 401 cells/μl (322), and 4.6 log copies/ml (1.4) respectively. At diagnosis 72% and 28% were asymptomatic and symptomatic respectively. Late presenters and those with AIDS were 50%, and 20% respectively. Screening settings were low risk screening 35%, high risk 44%, and symptomatic 21%.

Conclusions: ART use is in line with International Guidelines but those on ART are less than expected. Large proportions were LPs or have AIDS at diagnosis. Further data is needed to evaluate the medical care of patients with HIV/AIDS in the KSA.

Objectives: It is critical to understand the HIV transmission dynamics in women, who are married to HIV seropositive men and either go into HIV concordant relationship (WCR) or remain HIV discordant (WDR) over a period of time. Antimicrobial peptides (AMPs) are known to possess anti-HIV activities and may offer protection against acquisition of HIV. We investigated if AMP expression is associated with HIV sero-negative status of the WDR population, and how the co-regulated innate immune responses at the genital mucosa differ between WDR and WCR individuals in eastern-India.

Methods: Levels of human beta-defensins, human neutrophil peptides 1-3 and IL-8 were measured by ELISA in the cervicovaginal lavarge (CVL) collected from WCR and WDR individuals. Moreover, we studied the activation of TLR signalling pathways and TNF-alpha induction in THP-1 cells by the microbial components of CVLs and their modulation by pre-treatment of the cells with recombinant AMPs.

Results: Antimicrobial peptide expression in the CVLs showed no significant association with resistance to HIV infection. We observed a shift toward significant co-regulated expression of hBD2 and hBD3 (r=0.52, p<0.0001) and hBD3 and IL-8 (r=-0.26, p=0.03) in the WCR group compared with the WDR (r=0.30, p=0.13 for hBD2 and hBD3; r=-0.15, p=0.44 for hBD3 and IL-8) population. We also found that hBD3 inhibited the pro-inflammatory immune responses induced by CVL, perhaps through the inhibition of TLR4 and TLR1/2 signalling. This was in agreement with the negative correlation between hBD3 and IL-8 expression in the WCR population.

Conclusions: Previous studies identified different microbial composition of CVLs between women living with and without HIV. This might result in a difference in the co-regulated expression of AMPs and inflammatory mediators between the WCR and WDR populations. hBD3 may be critical to control inflammation at the cervico-vaginal mucosa, indicating its novel therapeutic potential in HIV infection.

Background and Objectives: Urine protein examination is a veritable tool in the management of renal diseases. Proteinuria evaluation from 24-hour urine collection is the gold standard. Prompt urine protein assessment from spot urine sample has become necessary to eliminate inaccuracies inherent in timed urine collection. This study aims at comparing spot urine protein/creatinine ratio (SUPCR) and measured 24-hour urine protein (24 HUP), and also spot urine protein/osmolality ratio (SUPOR) and 24 HUP against measured 24-hour urine protein (24 HUP) for assessment of proteinuria in human immunodeficiency virus (HIV) subjects.

Methodology: Three hundred and ninety three HIV subjects from the HIV/AIDS clinic and 136 age- and sexmatched non-HIV subjects as Control. Investigations performed included 24-hour urine protein (24 HUP), spot urine protein (SUP), spot urine creatinine (SUCr), spot urine osmolality (SUOsm), fasting blood sugar (FBS), urinalysis, HIV screening and confirmatory test, electrolyte, urea and creatinine. SUPCR and SUPOR were calculated. Correlation statistics, 2 × 2 contingency table analysis, receiver operator characteristics (ROC) Curve analysis and Bland Altman plots were used to compare SUPCR and 24 HUP, and also SUPOR and 24 HUP in HIV subjects and control. SPSS version 17 and Medcal statistical software were used to analyze the data. P<0.050 was taken as statistically significant.

Results: Using the 2 × 2 contingency table in the HIV subjects, the Sensitivity for SUPCR and SUPOR with 24 HUP was 43.4% and 11.5% respectively. Specificity for SUPCR and SUPOR with 24 HUP was 92.9% and 99.2% respectively. The SUPCR had a correlation (r) of 0.734 (p<0.001) with 24 HUP. In addition, SUPOR had a correlation coefficient of 0.417 (p<0.001) with 24 HUP. Using the Bland Altman plots, SUPCR compared with 24HUP the limits of agreement were +0.361 g/day to -0.248 g/day in HIV subjects. In addition for SUPOR the limits of agreements were +0.440 g/day to-0.180 g/day in HIV subjects. The bias was 0.060 g/day and 0.130 g/day for SUPCR and SUPOR respectively. The receiver operating characteristics (ROC) curve showed that SUPCR randomly chosen value of 0.042 mg/mg and SUPOR chosen value of 0.010 mg/dl/mOsm/kg H2O predicted 24 HUP at urinary excretion threshold of 0.150 g.

Conclusion: The SUPCR and SUPOR are reliable tests, for quantifying proteinuria in HIV subjects, and should be used in assessment of proteinuria in HIV subjects in Sub Saharan African countries.

Background: Published studies reported a high prevalence of osteoporosis among HIV-1-infected subjects, but none of them were conducted in Sub-Saharan Africa. The objective was to estimate prevalence of osteoporosis based on dual energy X-absorptiometry bone mineral density in Senegalese patients above 50 years of age and to identify associated factors.

Methods: A cross-sectional study was conducted among 193 HIV patients above 50 years of age in Dakar, Senegal. Bone mineral density was measured by dual energy X-absorptiometry at lumbar spine, femoral neck and total hip. Osteoporosis was defined as T-score ≤ -2.5 at any site.

Results: Median age was 55 years. 99% of women were post-menopausal. Prevalence of osteoporosis at any site was 26% and 6% in women and men, respectively. One and eight subjects had osteoporosis at femoral neck and total hip, respectively, while osteoporosis was more prevalent at lumbar spine (25% in women and 4% in men). Factors independently associated with osteoporosis were female gender (OR=10.3; 95% confidence interval (CI): 3.3-32.6) body mass index (OR=0.8; CI: 0.7-1.0) and CD4 count below 350 cells/μl (OR=2.7; CI: 1.0-7.5).

Conclusions: Patients from this African setting had very low prevalence of osteoporosis at femoral neck, but osteoporosis at the lumbar spine was more prevalent especially among women. Consequences of these bone disorders in terms of fracture need to be investigated in future studies.

Introduction: To reduce HIV (human immunodeficiency virus) infection, attention has been focused recently on the promotion of the “ABCs” (being abstinent, remaining faithful to one sexual partner, and using condoms consistently). In Ethiopia, despite the mushrooming number of students in the higher learning institutions, students were not equipped with the necessary skills to protect themselves from HIV infection.

Methods and materials: This cross-sectional study was aimed to identify consistent condom use and students preference. A total of 770 students were sampled and selected using the principle of proportional to size allocation method. Then, students were selected from each department by simple random sampling technique using lists of students as sampling frame. Data were collected using structured self-administered questionnaire, focus group discussion guide and in depth interviews check lists as tools. Statistical tests were employed wherever necessary at the significance level of 0.05.

Result: About 50.4% of students were used condom during sexual intercourse in the last 12 months, 33.2% of them used condom consistently. Male students preferred condom use while female students preferred to be sexually abstinent and being faithful with single regular partner. Students from urban residents were 8.3 times more likely to use condom consistently than those from rural areas. Students who had monthly income were 6 times more likely to use condoms consistently than their counter parts.

Conclusion and recommendation: Less than one third of students use condom consistently and condom preference varies by gender among university students To respond proactively to the current needs of the target group based on evidence and scientific behavioral theories and proven interventions, the university needs not relying on any single intervention approach, rather using a combination of behavioral, structural and biomedical interventions coordinated to achieve maximum effect.

Addition of clinically-relevant levels of 3′-Azido-3′-deoxythymidine (AZT) to cultured HepG2 cells increases the number of reactive radical species (reactive oxygen and nitrogen species [ROS and RNS]) as well as random mutations in mitochondrial DNA (mtDNA). Co-treatment of AZT-exposed cells with palm fruit juice (PFJ) mitigates AZT mutagenesis. These findings suggest that AZT-dependent mtDNA damage resulted from increased reactive species and that PFJ, a known anti-oxidant, mitigated such damage by decreasing the levels of these species. The present report tests the predictions that (1) PFJ mitigates AZT mutagenesis by reducing the burden of AZT-induced reactive species, and (2) AZT-induced mutations in mtDNA should predominantly consist of G → T and C → A substitutions characteristic of DNA oxidative damage. Levels of reactive species and mitochondrial mutagenesis were measured in HepG2 cells exposed AZT in the presence or absence of PFJ. Controls experiments showed that PFJ in HepG2 cells exhibited strong scavenging activity against hydrogen peroxide-induced ROS, the main reactive species generated by dysfunctional mitochondria. Despite this strong antioxidant activity PFJ did not decrease AZT-induced reactive species at a concentration that mitigated mtDNA mutations. Consistent with this observation, the spectrum of AZT-induced mutations did not fit the spectrum expected from direct mtDNA oxidative damage. Instead, the spectrum obtained was consistent with the majority of mutations (80%) arising from mitochondrial DNA polymerase errors induced by AZT. These observations suggest that oxidative damage was not the major contributor to AZT-induced mutations.

The recent studies have focused on the improvement of effective prophylactic and therapeutic approaches to combat persistent viral infections. Several therapeutic vaccine strategies have already used such as live-attenuated microbes, viral vectors and dendritic cell-based vaccines led to suppress and/or clear infections. Among them, improved DNA vaccines have emerged as a promising candidate for treatment of infectious diseases especially HIV infections. These vaccines have the advantages of safety, low cost of production, ease of use due to their stability in room temperature as well as ability to elicit efficient immune responses. Some strategies have been considered to improve immune responses stimulated by DNA vaccines, e.g., genetic optimization of plasmid DNA constructs encoding antigens, in vivo efficient DNA delivery systems, co-delivery with molecular adjuvants as well as the development of potent heterologous prime-boost regimens. DNA vaccines have an intrinsic bias towards generating cellular immunity against intracellular pathogens. By manipulating the DNA formulation and delivery, effective antibody responses can be also induced. For instance, the studies showed that the immunized monkeys with DNA vaccine developed HIVspecific T-cell immune responses that persisted for months. It is important to develop the potency of this modality in the clinic. In this review, the authors will focus on the recent improvements to enhance DNA vaccine potency in combating persistent HIV virus infections

Objective: The aim of this study was to determine the test characteristics of direct and indirect biomarkers for liver fibrosis compared with transient elastography (TE) among a group of human immunodeficiency virus (HIV)-infected and uninfected women with or without Hepatitis C virus (HCV) infection.

Methods: Women enrolled in the Women’s Interagency HIV Study (WIHS) from Washington DC, San Francisco, and Chicago with a body mass index (BMI)<35 underwent liver stiffness measurement using TE between October, 2010 and September, 2012. Serum samples were tested for hyaluronic acid to calculate the SHASTA and aspartate aminotransferase to platelet ratio index (APRI). Receiver operator characteristics (ROC) of significant liver fibrosis (liver stiffness ≥ 7.1 kPa by TE, correlating with a METAVIR fibrosis score of F2-F4) predicted by SHASTA and APRI were compared.

Results: Among 308 women, the median age was 48 years, BMI was 25.6, 67% were non-Hispanic black, 27% HCV+, and 78% HIV+. The overall prevalence of significant liver fibrosis was 20%, and among HIV+ women, 22%. Overall, there was no statistically significant difference in the area under ROC curve (AUROC) between SHASTA and APRI relative to significant fibrosis by TE. Among HCV+ women (with or without HIV), the AUROC ranged from 0.70-0.73 for both the SHASTA and APRI compared to TE. Both SHASTA and APRI were associated with significant misclassification with a false negative rate of 33-40% for significant fibrosis compared with TE among women with HCV infection, with or without HIV.

Conclusion: Both the SHASTA and APRI, direct and indirect serum biomarkers of liver fibrosis respectively, are comparable at detection of significant liver fibrosis among women with HCV infection, regardless of HIV status. However, there was a high false negative rate in detection of significant liver fibrosis of up to 40% which is a significant limitation of use of these biomarkers.