Revista de SIDA e investigación clínica

Cardiovascular disease (CVD) has become one of the leading causes of morbidity and mortality among HIVinfected patients with seropositive patients developing CVD at higher rates than seronegative patients. Therefore, it is critical to have inexpensive, non-invasive assessment tools for CVD risk assessment in HIV-infected patients. Nearly all CVD risk assessment tools were derived from the general population, and their ability to predict CVD in the HIV population has been variable. In order to more accurately predict CVD risk in HIV-infected patients, a new CVD risk assessment tool derived from the HIV population that accounted for factors specific to HIV infection, disease course, and/or sequelae of treatment with antiretroviral therapy is needed. An improved CVD risk assessment tool for HIVinfected patients will help determine which patients would most benefit from primary prevention strategies.

Background: As an extension of previous research in rural Alabama on HIV/AIDS, the purpose of this study is to assess the prevalence of food insecurity among African American women living with HIV/AIDS and examine the coping strategies they use to get food for themselves and their children.

Methods: Quantitative and qualitative methods were used in the study. Two hundred and fifty African American women living with HIV/AIDS were recruited from two HIV/AIDS clinics and interviewed about food insecurity and coping strategies.

Results: The findings showed that most of the women were food insecure and used numerous strategies to cope with food insecurity. The strategies included receiving food from food banks, supplemental Nutrition Assistance Program, receiving food from family members and friends, making cheaper meals, food from churches, and reducing the amount food cooked for meals. The food insecure women were more likely to be depressed and suffer from psychological distress than do others. Food insecurity is a barrier to medication adherence among these women living with HIV/AIDS.

Conclusion: These findings suggested that addressing food insecurity should be a significant issue in HIV/AIDS treatment and prevention programs in the 21st Century. There is a need for continuous monitoring of food insecurity among people living with AIDS by health care providers in their education to promote adherence to medications and health well-being.

Protease inhibitors (PIs) are a potent class of antiretroviral agents which have been used to successfully treat many patients with HIV disease. As with other classes of antiretroviral agents, drug resistance has been described with each of the PIs. PI resistance can occur in newly infected individuals due to transmission of drug resistant strains or, more commonly, evolves from the selective pressure of antiretroviral therapy. When present, PI resistance results in an increased likelihood of drug failure. Individual protease gene mutations have been identified which are associated with phenotypic resistance to these agents. However, protease mutations can exert different effects on individual PIs, as some will produce resistance to one agent and may enhance susceptibility to another. In patients failing PIs, particularly in the setting of prior treatment with multiple agents, protease resistance patterns may be complex and result in broad cross-resistance to the class. Strategies to limit the development of resistance to these agents and manage its occurrence are important for the on-going care of individuals with HIV infection.

Background: Obstructive sleep apnea (OSA) is a common disorder that is linked to daytime fatigue and increased risk of cardiovascular disease. The general population prevalence of OSA is estimated to be 2-9%. The prevalence of OSA in people with HIV infection is unknown, although many patients with HIV report daytime fatigue. The diagnosis of OSA is typically established during an overnight study in a sleep laboratory. Sleep surveys designed to select have been previously validated for selecting patients for definitive study. Nocturnal oxygen desaturation index (ODI) measurement has also been used to screen for reliably predicting over 85% of moderate to severe cases when the ODI >10.

Methodology: Patients with HIV infection presenting for routine medical care were invited to participate in this prospective OSA screening trial. Informed consent was obtained; subjects completed the Four-Variable Screening Tool, the STOP-BANG questionnaire, Epworth Sleepiness Scale, and were provided a fingertip oximeter for overnight use at home. Overnight oxygen saturation data was analyzed and correlated to corresponding sleep surveys. All subjects with ODI >10 were referred for a formal sleep study.

Results: 156 subjects completed the study and 66 (42.3%) demonstrated an ODI >10. Of the 66, 21 pursued formal sleep studies. 14 of the 21 tested positive for OSA. The Four-Variable Screening Tool had the highest positive predictive value of 59.5%, and the STOP-BANG questionnaire had the highest negative predictive value of 76.9%.

Conclusions: HIV-infected patients in our clinic demonstrated a high prevalence of nocturnal oxygen desaturation suggesting a high prevalence of OSA. Three commonly used screening tools did not reliably predict nocturnal desaturation in our population. The high prevalence of nocturnal oxygen desaturation and in HIV patients indicates the need for additional HIV-related OSA research.

The physical exercise is a tool that assists the treatment of various diseases because it improves from aspects of functional capacity (mobility, balance, muscle strength) to the risk factors for several diseases (obesity, Diabetes mellitus, systemic arterial hypertension). Among the many exercise types, the combined physical training has been considered a very interesting method due to responses generated in several populations, for instance, people living with HIV/AIDS.

HIV-1 persistent low-level-viremia under 500 copies RNA/ml (PLV) is associated with an increased risk of virological progression and resistance. We performed a study on 18 HIV-1 treated patients who received ARV treatment intensification with maraviroc (MVC) because of PLV during the 6 last months or more. During the 12 months following intensification, CD4 T-cells increased by an average of 104/mm3. Percentage of patients with a plasmatic viral load under 50 copies/ml increased regularly since intensification to reach 71% after 12 months of follow-up. MVC intensification could improve virological and immunological responses in case of PLV.

Cryptococcal meningitis is a common opportunistic infection among persons with advanced HIV-associated immunosuppression and is associated with high mortality. The prevalence of asymptomatic cryptococcal antigenemia (CrAg) can inform the potential utility of screening and pre-emptive treatment prevention strategies. We assessed CrAg prevalence in a cohort of patients infected with HIV at 28 health facilities from February to September 2014 in order to inform Haitian national clinical guidelines. Of 13,000 patients that underwent CD4 cell count, 1,025 (7.9%) had a count ≤200 cells/mm3. Of these, 11 (1.1%) were CrAg positive. The CrAg positivity rate among patients with CD4 cell counts <100 cell/mm3 was 1.8%. Patients with CD4 cell counts <50 cells/mm3 had the highest CrAg rate (2.3%). CrAg prevalence was low but still warranted a CrAg screening and pre-emptive therapy approach for people infected with HIV with CD4 cell counts <100 cell/mm3 in Haiti.

Introduction: Very minimal efforts have been made, especially in rural settings to address adolescent sexual and reproductive health concerns, or to provide the required sexual and reproductive health services. The Study of adolescents’ knowledge, services utilization, and associated factors is pertinent to the design of appropriate program interventions.

Materials and methods: A junior secondary school-based cross-sectional study of 714 eligible Nigerian adolescents interviewed with the use of self-administered questionnaires. Univariate, bivariate, and multivariate logistic regression analyses were conducted.

Results: About half of the respondents were knowledgeable about sexually transmitted infections while 31% were knowledgeable about fertility issues. The overall mean score for sexual and reproductive knowledge was 28.08±9.70 (out of a maximum of 48). The predictors of being knowledgeable were being male (AOR=3.048, p=0.028), and having regular access to a telephone (AOR=1.487, p=0.029) and the internet (AOR=1.554, p=0.022).Almost twothirds, (64.7%), of the respondents, had ever heard about sexual and reproductive health services while 51.0% had ever used the services. Schools were the main sources of information (29.7%). The predictors of service utilization were knowledge, regular access to telephone and parent-adolescent communication (p<0.001).

Conclusion: Sexual and reproductive health knowledge of in-school rural adolescents in Nigeria is fair but some misconceptions still exist. Service utilization, however, remains low largely due to lack of awareness. It is, therefore, important to design interventions that increase awareness of sexual and reproductive health issues; correct existing misconceptions, and to showcase and increase available RSH services using veritable tools including telephone and the internet.