Revista de SIDA e investigación clínica

Background: The clinical consequences of the magnitude and the duration of detectable viremia in HIV-infected children have not been well characterized. We examined the predictors and immunologic consequences over time of frequent episodes of detectable viremia in HIV-infected children followed at Yale-New Haven Hospital.

Methods: We analyzed the CD4+ T-cell and HIV viral load over a 19-year period (1996 to 2013) of 104 HIVinfected children enrolled in the Yale Prospective Longitudinal Pediatric HIV Cohort. Both CD4+ T-lymphocytes and HIV viral load were measured at clinic visits every 3 to 4 months. Longitudinal data analyses using polynomial random coefficients models were conducted to examine overtime changes in CD4+ T-cell counts by frequency of episodes of detectable viremia. Moreover, regression analyses using logistic regression models were used to assess the predictors of frequent episodes of detectable viremia.

Results: One hundred and four (104) HIV-infected children with more than one HIV viral load measurement between 1996 and November 2013 were included in the analysis Over 80% (N=86) of the children had detectable viral load (HIV RNA viral load ≥50 copies/ml) during more than 50% of their clinic visits. Children with infrequent episodes of detectable viremia had significantly higher CD4+ T-cell counts overtime compared to those with frequent episodes of detectable viremia (P<0.0001).

Conclusions: Both frequency and magnitude of episodes of detectable viremia had effect on CD4+ T-cells. Strict adherence to a treatment goal of undetectable HIV viremia in children is likely to be beneficial.

Many factors may be associated with depressive symptomatology among HIV seropositive pregnant women, in whom the prevalence of depression is relevant. Several studies have suggested that depression is an inflammatory condition, in terms of cytokine production. Moreover, pregnant women infected with HIV may have altered cytokine levels due to their infectious condition and pregnancy-related immunomodulation. Thus, we propose that depressive symptomatology during pregnancy could affect not only cytokine production but gestational outcomes as well. The aim of this observational, prospective, cross-sectional and non-random sampled study was to evaluate the prevalence of depressive symptomatology and its relationship to perinatal outcomes and levels of pro-inflammatory cytokines among HIV-infected pregnant women. Depressive symptomatology was related to lower newborn weight, and gestational age at delivery among HIV-infected pregnant women with CD4+ lymphocytes below 350 cells/mm3. Participants who obtained higher scores in the Zung Self-rated Depression Scale had lower levels of Tumor Necrosis Factor alpha (TNF-α,) whereas Interferon-gamma (IFN-γ) levels were similar in participants with low and high depressive symptomatology. In this study, it was found that increased maternal depressive symptomatology, combined with CD4+ lymphocytes below 350 cells/mm3, was related not only to lower newborn weight and height, but to lower gestational age at delivery as well.

African Americans continue to be disproportionately affected by sexually transmitted infections (STIs) such as HIV, Chlamydia and Syphilis. Consistent correct condom use is the most effective way to prevent STIs. Based on the theory of planned behavior, hierarchical multiple regressions were used to determine whether condom efficacy, condom attitudes, gender, and partner status could predict condom use among college students. Each step of the hierarchical multiple regression was significant ultimately resulting in 27% of the overall variance in condom use with partner status as the strongest predictor, followed by condom attitudes, condom efficacy, and gender. These results suggest that increased condom negotiation training for individuals with main partners may greatly contribute to reducing STI among African Americans.

Objective: Plasma is currently the specimen of choice for routine HIV drug resistance (HIVDR) testing. However, HIV compartmentalization has been well documented in different reservoirs, including peripheral blood mononuclear cells (PBMCs). We molecularly characterized paired plasma and PBMC sample pairs and compared their HIVDR mutation patterns.

Methods: To compare HIVDR mutation patterns in plasma and PBMC sample pairs, whole blood was collected for plasma and PBMC isolation from 43 treatment-naïve and 10 treatment-experienced individuals, and HIVDR profiles determined by sequencing the pol gene. Treatment-naïve individuals were initiated on Efavirenz/Emtricitabine/ Tenofovir fixed dose combination therapy and follow up HIV-1 viral loads were performed after at least 6 months of treatment.

Results: HIVDR mutation prevalence in the treatment-naïve group was 5.1% in plasma samples compared to 10.3% when both plasma and PBMC sequences were considered. Variable amino acid positions were detected in 21% and 12% of the protease and reverse transcriptase genes, respectively. These were generally not in HIVDR positions and did not form signature patterns. The subset of patients with additional resistance associated sequence variations detected in PBMCs had undetectable HIV-1 viral loads after at least 6 months of anti-retroviral therapy.

Conclusions: The sequencing of paired plasma and PBMC specimens provided additional HIVDR data which were not detected when only plasma samples were tested. However the resistant variants detected in the PBMCs did not seem to negatively affect treatment outcome at 6 months as viral suppression was achieved. These data highlight proviral HIVDR mutations in HIV infected individuals and longer follow up on patients on treatment may be needed to determine their clinical impact.

Introduction: HIV positive people are the main source of new infections, which occur mainly through risk behaviours with a high-risk partner. Awareness of HIV status has been proposed as a key factor underlying sexual and HIV risk behaviour. This study sought to determine whether awareness of one’s HIV positive status translates to reduced sexual risk behaviour among HIV positive individuals.

Methods: The analysis was based on the 2012 South African National HIV Prevalence, Incidence and Behaviour Survey, which included socio-demographic characteristics, age at sexual debut, age disparate partnerships, multiple sexual partners, condom use at last sex, self-perceived risk of HIV infection and alcohol use. Bivariate and multivariate logistic regression was used to assess sexual and HIV risk behavioural factors associated with awareness of HIV status.

Results: Of 2565 HIV positive individuals, 48.3% reported that they were aware of their HIV status while the remainder indicated they were aware not aware of their HIV status. HIV positive females were more likely to report that they knew their status than their male counterparts [OR=1.6 (95% CI: 1.0-2.7), p=0.049]. Knowing that one was HIV positive was associated with increased likelihood of condom at last sex [OR=1.5 (95% CI: 1.1-2.0), p=0.010], low risk perception of HIV infection ([OR=0.7 (95% CI: 0.5-0.9), p=0.011], and reduced likelihood of risky/hazardous drinking of alcohol among males [OR=0.3 (95% CI: 0.2-0.6), p<0.001].

Conclusion: The current findings confirm that gaining knowledge of one's own HIV status is key to adopting HIV prevention behaviours. Given the large number of people living with HIV/AIDS in South Africa more efforts should be made to promote positive prevention programmes.

Background: Condoms are an integral part of sexual transmitted disease, unwanted pregnancy and human immune deficiency virus (HIV) acquiring immune deficiency syndrome (AIDS) prevention and their use has increased significantly over the past decade. Correct use of them reduces the risk of HIV transmission by almost 100 percent. Therefore condom promotion has received considerable attention in the light against the AIDS pandemic (WHO 1995). This is particularly important in sub Saharan Africa, were HIV transmission is mainly through sexual contact.

Objective: To determine knowledge, attitude and practice of condom utilization in students of Axum preparatory school

Methodology: the study was conducted in Axum preparatory school from April to June 2015. Total of 358 samples was taken using systematic random sampling techniques. The data was collected using self-administered questions by using structured question. The data will be interred and analyzed using SPSS software.

Result: Majority of the participants 315 (90.8%) indicated that they heard and knew that about condom. The majority of the respondents 194 (55.5%) they indicated that there were no supply of male condom from their school, but 40 (11.5%) indicated that they have access. The study revealed that majority 196 (56.5%) students believed that condom use during sexual intercourse can decreases sexual pleasure (sensation), while 151 (43.5%) were disagreed. A summary of all the attitude variables revealed that 290 (83.6%) had positive attitude to majority of the questions measure the respondents attitude. The study revealed that 59 (17%) students were used male condom, and 50 (14.4%) respondents were not giving any response. Of these 17%, 31 (42.5%) students were use condom consistently, 29 (39.7%) use sometimes, 13 (17.8%) do not like to use.

Conclusion: Knowledge, attitude and practices are an important tool for HIV/AIDS and STIs prevention and control. Despite the presence of adequate knowledge, positive attitude the preparatory school students had less condom use practice and the study highlighted some risky sexual practice, this might be related to low access, which needs to be addressed.

Background: Women living in Sub-Saharan Africa endure disproportionate burden of HIV/AIDS. Correct and comprehensive knowledge can change attitude and behavior related to HIV markedly. The aim of this study was to investigate the relationship between comprehensive HIV/AIDS knowledge and acceptance attitude towards people living with HIV/AIDS among women in three east African countries.

Methods: Demographic and Health Surveys in 2009, 2010, 2011 from Kenya, Burundi and Ethiopia respectively were analyzed in SPSS, using multivariate logistic regression.

Results: Awareness was more than 96% in the three countries. The variables, age (except Ethiopia), place of residence (except Kenya), educational level, religion, marital status (except Ethiopia and Kenya) and wealth index were significant associates of comprehensive HIV/AIDS knowledge. Similarly, age (except Ethiopia), residence (except Burundi and Kenya), educational level, religion, marital status, wealth index and comprehensive HIV/AIDS knowledge showed significant associations with acceptance attitude towards people living with HIV/AIDS. After controlling the socio-demographic characteristics, higher comprehensive HIV/AIDS knowledge was observed among women in Burundi (OR=4.01, P<0.001) than in Ethiopia, Burundi (OR=1.11, P<0.001) than in Kenya and Kenya (OR=3.62, P<0.001) than in Ethiopia. Similarly, more acceptance attitude towards people living with HIV/AIDS was observed among women in Burundi (OR=3.39, P<0.001) than in Ethiopia, Burundi (OR=1.93, P<0.001) than in Kenya and Kenya (OR=1.75, P<0.001) than in Ethiopia.

Conclusion: The level of comprehensive knowledge and acceptance attitude varied significantly among women of the three countries, though associate variables were similar. Despite awareness of the disease, respondents lacked comprehensive knowledge on HIV/AIDS and acceptance attitude towards people living with HIV/AIDS hence education and communication activities on HIV/AIDS are recommended.

Background: HIV-1-infected patients are living longer since the introduction of highly effective antiretroviral therapy (HAART). There is evidence that hepatitis C virus (HCV)/HIV-1 co-infection may result in an increased risk of death compared to patients infected only with HIV-1. Prior studies looking at this association have been limited by their enrollment of populations composed of mainly young MSM males. We investigated HCV/HIV-1-co-infection for an increased odds ratio for all cause mortality in a cohort representative of the current population in the US living with HIV-1-infection.

Methods: We performed an age-and-sex 1:1 matched case control study. We evaluated all deaths (n=153) that occurred in a cohort of ~2000 patients from January 1, 2010-December 31, 2014 (~10,000 patient life years) at a suburban clinic outside the NYC metropolitan area with a significant number of women and older individuals living with HIV-1-infection. We compared this cohort to an age and sex matched population selected from among 395 enrolled living HIV-1-infected controls.

Results: We observed that HCV/HIV-1-co-infection was associated with an increased odds ratio for all cause mortality of 1.83 (95% CI, 0.99, 3.43; P=0.038) compared to HIV-1-mono-infected patients. Liver related deaths were the main cause of death with an odds ratio for liver related death with of 6.59 (95% CI, 1.70, 25.70; P=0.0005).

Conclusion: In an HIV-1-infected cohort, HCV/HIV-1-co-infection is associated with an increased odds ratio for all cause mortality driven by liver related mortality.