Revista de SIDA e investigación clínica

Rates of coronary heart disease (CHD) are over twice as high in younger HIV-infected patients compared to uninfected patients, but most of these studies were conducted in men or in predominantly male cohorts. In the general population, the death rate from CHD has decreased among men, but continues to increase in women. It is unclear if the same increased rate of deaths due to CHD exist in HIV-infected women, and whether rates or risk of CHD differ between HIV-infected men and women, and between seropositive and seronegative women. We reviewed the literature on the rates of cardiovascular events and surrogate measures of atherosclerosis or CHD risk in HIV-infected women. We also reviewed rates of metabolic disease and other markers of inflammation and immune activation that could contribute to increased cardiovascular risk. We found that HIV-infected women have increased rates of acute myocardial infarctions and ischemic strokes compared to HIV-uninfected women and likely HIV-infected men despite women being projected to have lower CHD risk based on Framingham risk scores. Studies assessing CHD risk by measuring anatomical or physiological measures of subclinical atherosclerosis have reported mixed results, and there are no well-validated risk assessment tools or surrogate measures of subclinical CHD among HIV-infected patients to help identify high-risk women for targeting intensive preventive measures. Potential explanations for the increased rates of CHD and subclinical atherosclerosis may be partly explained by increased levels of inflammation and immune activation in HIV-infected women despite virological suppression on antiretroviral therapy. It appears unlikely that disproportionate representation of traditional CHD risk factors and metabolic indices among HIV-infected women can explain well the observed increased rates of CHD. Future studies that include large numbers of HIV-infected women with extended follow-up periods using surrogate measure of CVD and investigating pathogenic mechanisms underlying these observations are urgently needed.

Background: The number of aging human immunodeficiency virus-infected (HIV+) individuals living in the United States has substantially grown over the past two decades. Advanced age and HIV infection both increase susceptibility to Streptococcus pneumoniae infection due to B cell dysfunction. The combined impact of these factors on pneumococcal vaccine responses remains unknown.

Methods: We assessed serum immunoglobulin (Ig) G and IgM levels and opsonophagocytic killing assay (OPA) titers to pneumococcal serotypes 14 and 23F in HIV+ subjects and HIV-uninfected (HIV–) controls 50-65 years old. HIV+ individuals with CD4+ T cells/μl (CD4) >200 and ≥1 year of antiretroviral therapy (ART) received either a dose of the 13-valent pneumococcal conjugate vaccine followed by the 23-valent pneumococcal polysaccharide vaccine 8 weeks later (PCV/PPV) as currently recommended (n=15) or a single dose of PPV only (n=22). HIV– controls received PCV/PPV (n=14).

Results: HIV+ PCV/PPV and PPV groups exhibited similar increases in IgG levels and OPA titers for both serotypes after immunization. Postvaccination IgM levels for serotype 23F, but not 14, were significantly higher in HIV+ PCV/PPV compared to PPV groups. IgG and IgM levels for serotype 14 and OPA titers to serotype 23F were significantly reduced in HIV+ compared to HIV- PCV/PPV groups. Serotype-specific IgG levels correlated with OPA titers for all groups.

Conclusions: Our data suggest that the recommended PCV/PPV regimen may not significantly improve quantitative or functional antibody responses compared to PPV only in aging HIV+ subjects. Continued efforts aimed at improving vaccine responses in this high risk population are warranted.

Objective: Initiatives aimed at improving patient retention in HIV care in Haiti have focused on a wide range of tactics for identifying individuals who are lost to follow-up yet the patient perspective is often missing from efforts to understand and address the root causes of lost to follow-up.

Methods: As part of a routine quality control audit of the HIV program, structured interviews were conducted with 100 patients who had returned to care after previously being lost to follow-up at three rural health centers in the Lower Artibonite region of Haiti supported by the non-governmental organization Zanmi Lasante. These interviews uncovered factors that contributed to patients’ previous lack of follow up and elucidated factors that influenced their return to care. The interviews sought to capture the patients’ preferred communication methods and their suggestions for improvements in HIV care at the health facility.

Results: As part of a quality of care audit, 100 patients were interviewed in November and December 2014, and their reasons for loss to follow-up were identified. The common factors noted were socio-economic barriers to remaining in care, challenges affecting case management at both provider and the facility level, and patient perceptions of good health. 74% of the respondents identified increased communication by health care professionals through telephone calls and home visits as the reason they chose to return to care. Respondents suggested increase in economic and transportation support, improved communication between providers and patients, improved clinic experience, and increased medication management as factors that would decrease lost to follow up in the future.

Conclusion: Reasons for loss to follow-up in this rural Haitian population reflect similar social and structural barriers common to lost to follow-up populations globally, however patients participating in these interviews reported unique barriers in communication as inhibiting factors to remaining in care. By utilizing this feedback from end users of the health system as an essential component in the design and implementation of service improvements, health systems can more effectively diminish loss to follow-up.

The Centers for Disease Control and Prevention recommends that HIV screening be routine and offered in all healthcare settings, including all mental health care facilities. The psychiatric patient population is known to be at higher risk and have significantly higher prevalence of HIV infection than the general population, but remains inconsistently tested and often missed through screening efforts. The objective of this study was to implement and determine the efficacy of a counselor-based HIV screening program on inpatient psychiatric units, and to identify risk factors and barriers to testing within this population. Utilizing dedicated, trained Public Health Advocates, rapid HIV testing was offered to a convenience sample of psychiatric inpatients determined to have capacity to consent. Pre-test counseling was provided and demographic and risk factor data obtained from participants, while reasons for refusal were obtained from those who denied testing. Of consentable patients, 74.6% were offered testing and 62.9% of offers were accepted, resulting in 405 patients tested and one new HIV diagnosis. Amongst those who were tested, 26.4% were found to be high-risk, 33.1% had a history of drug use and 7.4% had a history of sex abuse, while 38% did not receive regular medical care and 22.2% had never been tested for HIV. The most common reason for patients rejecting testing was the belief that they were not at risk (44%). In sum, many psychiatric inpatients were high-risk for HIV infection but did not receive regular health care, and personal risk perception is the major barrier preventing patients from obtaining testing. Counselor-based rapid testing proved to be acceptable to psychiatric inpatients and an effective model for screening a large number of high-risk and underserved individuals with minimal added burden to the mental health care team.

Background and Methods: Nephropathy is a common complication amongst the HIV positive population. With the advent of Combined Anti-Retroviral Therapy (cART), CD4+ counts and viral replication can be controlled more efficiently. The survival rates are fast approaching that of the general population. In such a scenario, renal transplantation is growing increasingly popular as a treatment modality of End Stage Renal Disease (ESRD) in HIV positive patients.

We studied the psychosocial changes in a subset of such HIV positive renal transplant recipients through a questionnaire which assessed multiple parameters with fixed multiple choice responses. An attempt was made to compare the pre and post-transplant psychosocial status of the patients wherever possible. We selected ten HIV positive patients who had undergone renal transplantation at our center at least one year prior to the study.

Results: Nine out of ten patients (90%) reported better quality of life, an increase in professional productivity and perceived an improvement in behavior of the spouse and colleagues towards them. Out of nine patients who were sexually active, seven (77%) experienced an improvement in their sexual relationship. However, seven (70%) patients recalled that they underwent substantial anxiety and feared an unsuccessful transplant and the relapse of HIV prior to the surgery, while six (60%) answered that they live in constant fear of an HIV relapse even after the surgery. According to all of them, the prominent factors limiting renal transplantation in HIV positive patients were substantial cost and lack of awareness of kidney transplantation as a possible option for them.

Conclusion: Renal Transplantation had a definite positive impact on the psychosocial status of HIV positive renal transplant recipients, enhancing multiple facets like quality of life, sexual relationships and professional life amongst others. Although it was a source of fear and anxiety for some. A larger study with more patients would definitely be more illuminating.

This study had the objective to study obstacles to HIV VCT for vulnerable and non-vulnerable populations at risk of HIV. Data were collected in a cross-sectional survey conducted during May to July, 2013 in eight, purposively-selected provinces which are part of the 31 priority provinces of the NAP for 2012-16. Selection of the vulnerable population was conducted using time-location sampling and quota sampling, yielding a sample of 751 persons. Representatives of the non-vulnerable population were selected using probability proportional to size and cluster sampling, yielding 1,937 cases. This study found that, among those who ever had been tested for HIV before, the deterrents to intention to seek VCT in the coming year include lack of perceived self-risk for HIV, lack of knowledge of right to subsidized VCT, negative attitude toward VCT, and disrespectful service providers. Among those who had never had an HIV test, deterrents include lack of risk behavior, lack of being urged to go for testing, lack of information on VCT, and negative attitude. Thus, in order to increase coverage of VCT for populations vulnerable for HIV there should be interventions to increase accurate self-risk assessment, increased information about VCT and the right to subsidized services, and deployment of peer motivators to encourage testing for those with risk. MSM had lower coverage of VCT than other vulnerable groups. From this study, it is clear that negative attitude toward VCT affects VCT-seeking behavior. Thus, interventions are needed to modify attitudes toward VCT so people see the benefit of knowing one’s serostatus, and enable those newly-infected to receive early treatment. Increasing coverage of VCT for the non-vulnerable population should not be that difficult. However there may be a need for a re-design of prevention interventions so they are more closely linked with treatment to ensure optimal initiation of treatment of the infected.

Objective: To evaluate the differences in gender for epidemiological, immunological, and virological outcomes at baseline, and response after 24 weeks of antiretroviral therapy in patients treated at the Hospital de Infectología “La Raza” National Medical Center.

Methods: We reviewed the medical records from March to August 2014 of outpatients who started treatment in our clinic; 65 women and 138 men in a cross-sectional study. Descriptive results are summarized using the median and 25th-75th interquartile range (IQR). Baseline differences were tested using Fisher’s exact test and the Chi-squared test. Analyses of continuous variables were performed using the Mann-Whitney U test.

Results: Similar proportions of women and men were found in the following factors: living in metropolitan area, age <40 years, economic household income source, baseline CD4+ ≤ 200 cells/μL, CD4+ ≥200 cells/μL at week 24, HIV-1 RNA ≤50 copies/mL at week 24, and opportunistic infections. Women are more usually married than men (75% vs. 10%, p<0.001); men with a higher academic degree (34% vs. 9%, p<0.001); men with an onset of sexual activity <20 years (85% vs. 79%, p=0.26); women with ≤4 sexual partners (92.3% vs. 26.3%, p<0.001); women with children (92% vs. 20%, p<0.001); men with some addiction (29% vs. 10%, p=0.04); women with baseline HIV-1 RNA viral load >100,000 copies/mL (37% vs. 54%, p=0.020); and women with virological treatment failure (10.8% vs. 2.2%, p=0.008).

Conclusion: Compared with men, mostly women showed adverse epidemiological and clinical conditions that made women more vulnerable to transmission through heterosexual activity, and more frequently present virological failure.

Introduction: Getting full personal health information especially from people living with HIV/AIDS has a great challenging due to fear of stigma and discrimination in developing countries like Ethiopia. Lack of knowledge, attitude, practice and willingness of people living with HIV/AIDS to share their health information may affect the quality of their life. This study aimed to assess the knowledge, attitude, practice and willingness of people living with HIV/AIDS to share their personal health information to their community.

Materials and Methods: A hospital based cross -sectional study was conducted from December, 2013 to May, 2014. All information’s were collected through interview using structured questionnaires. The data was entered, processed and analyzed using SPSS version 20 statistical software. The 95% confident interval and the p-value were used to check for association between the dependent and independent variables. A p-value of <0.05 was considered statistically significant.

Results: Out of the total 422 participants included in the study, only 43 (10.2%) of respondents were knowledgeable and 379 (89.8%) were none knowledgeable. Moreover, 12 (2.8%), 408 (96.7%) and 125 (29.6%) of the participants were with a favorable attitude, good practice and favorable willing to share personal health information, respectively.

Conclusion: Majority of study participants have inadequate knowledge, none favorable attitude and willingness but significant proportions of them have good practice on sharing of their personal health information to others. So that new strategies should be established in health facilities to develop knowledge, attitude, practice and willingness of people living with HIV/AIDS to share their personal health information to their community, this will bring a radical change in prevention and control of HIV/AIDS transmission.

A significant proportion of HIV-positive adults in sub-Saharan Africa are in serodiscordant relationships. Identification of such serodiscordant couples through couple HIV testing and counseling (HTC) is thought to promote safe sexual behavior and reduce the probability of within couple seroconversion. However, it is possible HTC benefits are not sustained over time and therefore repeated HTC may be more effective at preventing seroconversion than one time HTC. We tested this theory in Zomba, Malawi by randomly assigning 170 serodiscordant couples to receive repeated HTC and 167 serodiscordant couples to receive one time HTC upon study enrollment (control group). We used linear probability models and probit model with couple fixed effects to assess the impact of the intervention on risky sexual behavior. At one-year follow-up, we found that couples that received repeated HTC reported significantly more condom use. However, we found no difference in rate of seroconversion between groups, nor did we find differences in subjective expectations about seroconversion or false beliefs about HIV, two expected pathways of behavior change. We conclude that repeated HTC may promote safe sexual behavior, but this result should be interpreted with caution, as it is inconsistent with the result from biological and subjective outcomes.