Revista de SIDA e investigación clínica

Background/objective: Neurocognitive Impairment (NCI) remains prevalent among people living with HIV (PLWH/AIDS), and may be exacerbated by body core changes. Waist circumference, a metabolic syndrome (MetSy) criterion, is not routinely measured, yet could be particularly useful when considering that both antiretroviral therapy (ART) and Hazardous alcohol use (HAU) have been associated with central fat accumulation. The purpose of this work was to examine the longitudinal associations between body mass index (BMI), waist circumference (WC), and cognitive performance in PLWH/AIDS, and to explore their modifications by age.

Methods: Using a prospective cohort study, we obtained participants’ anthropometrics, along with a comprehensive cognitive assessment over one year. Subjects were classified as overweight if BMI was 25-29.9 kg/m2, and obese if BMI was ≥ 30 kg/m2. Central obesity was defined as a waist >35 inches for females and >40 inches for males. Neurocognitive Impairment was defined using individual and global deficit corrected scores.

Results/conclusion: A sizable proportion of participants met the National Institutes of Health definition of overweight (BMI=25-29.9 kg/m2; 26%) and obese (BMI ≥ 30 kg/m2; 35%). Central obesity was present in more than half of the population (52%) and was higher in males than females (OR=5). Higher BMI and higher WC, both in young individuals and in the elderly, were related to worse cognitive performance. Cognitive performance across different tests was worst in obese individuals. Central obesity subtly impacts mood and motor skills. Analyses uncovered a likely mechanism for these cognitive deficits, as interleukin (IL)-9, 10, 17, 20, 23 and TNF were significantly associated with most cognitive variables. Age has a substantial impact on the relationship between cytokines and cognitive performance as most correlations became non-significant among the older individuals. The results indicate the importance of cytokines and obesity to neurocognitive status.

Introduction: R5-tropic viruses predominated at the time of initial HIV-1 infection and a switch to X4-tropic occurs in about 50% of patients in late-stage disease.

Objective: To associate different variants of Cuban HIV-1 with the co-receptor use, and the implication for the use of co-receptor inhibitors.

Methodology: Viral HIV-1 subtype was determined in 42 Cuban individuals using COMET V.2, Rega subtyping toolV.3 algorithms and phylogenetic analysis. Co-receptor tropism was predicted using the geno2pheno [co-receptor] algorithm. Additionally, all V3 loop HIV-1 Cuban sequences deposited previously at Los Alamos database were also analyzed for comparison of subtype and co-receptor tropism.

Results: The most frequent subtypes detected were CRF20–23–24_BG (35.7%), subtypes B (33.3%) and CRF19_ cpx (14.3%) when pol and V3 regions were analyzed. Overall, 61.9% of the samples were R5 viruses and 14.3% were X4. Viruses CRF19_cpx were more often R5X4/X4 (5/6 samples, p=0.009) or X4 strains (3/6 samples, p=0.019). The additional analysis of 359 Cuban env sequences demonstrated that only 29.3% were X4 viruses. Interestingly, 43.6% of the CRF19_cpx were R5X4/X4 viruses, confirming the previous association (p=0.011). Characteristic amino acids in the V3 loop (V/T12, R13, Q18, V19, G22) were identified at higher frequencies in CRF19_cpx viruses than in subtype B (p<0.0001).

Conclusion: CRF19_cpx is a genetic form with high proportion of X4-tropic viruses. This supports the increased pathogenicity of CRF19_cpx, potentially leading to rapid disease progression. The high frequency of X4 tropism in CRF19_cpx infected patients would imply that CCR5 antagonists could be ineffective in most of these patients.

Objective: To evaluate the prevalence, causes, patterns, severity and risk factors of drug-induced liver injury (DILI) in Chinese HIV-infected patients with opportunistic infections.

Methods: HIV-infected patients with opportunistic infections with DILI were studied in Beijing Ditan Hospital between Jan.1, 2009 and Nov.30, 2012, and risk factors of DILI were evaluated using multivariate Cox Proportional Hazards Model.

Results: In 797 patients, 144 (18.1%) were diagnosed as DILI after receiving treatment of opportunistic infections or antiretroviral therapy. The leading causes were Trimethoprim/sulfamethoxazole (TMP-SMX) (43.9%), anti-tuberculosis medications (13.7%), nevirapine (6.9%), anti-fungal drugs (4.7%) and efavirenz (1.2%). The median duration between agents’ exposure and DILI recognition for hepatocellular, cholestatic and mixed pattern was statistically significant difference among 3 patterns of DILI (p=0.009), and the duration was positively correlated with CD4 count (r=0.223, p=0.007) and R value (r=0.238, p=0.004). Male sex and baseline CD4 counts were significant protective predictors for DILI.

Conclusion: TMP-SMX, anti-tuberculosis medications, non-nucleoside reverse transcriptase inhibitors (NNRTIs) and anti-fungal drugs were the leading causes of DILI. The DILI in HIV-infected patients with opportunistic infections was negatively associated with male sex and CD4 counts.

Background: Global burden of HIV/AIDS remain enormous. Ethiopia is one of the Sub-Saharan countries that are hardly hit by the HIV/AIDS epidemic. Adherence is a vital component and main concern knotted with strategic decisions in service provisions. Therefore, the main objective of this study was to assess adherence to antiretroviral treatment and associated factors among clients attending ART clinics in Hosanna town.

Methods: Cross sectional study design using both quantitative and qualitative methods of data collection was conducted from January to February, 2015. Consecutive sampling technique was applied to select individual client. Data was analyzed by using SPSS version 16.0. Binary logistic regressions were used to identify independent predictors. Qualitative data was collected using in-depth interview with clients and health providers and used for concurrent triangulation with quantitative one.

Results: The study revealed that adherence rate to ART treatment of clients was 90.70%. As independent predictors, rural residents [AOR (95%CI)=2.14 (1.12 to 3.01)], and marital status (divorced) [AOR (95%CI)=2.37 (1.33 to 4.24)] were positively associated with non-adherence whereas living alone [AOR (95%CI)=0.37 (0.19 to 0.72)] and perceived availability of services [AOR (95%CI)=0.16 (1.03 to 1.31)] were negatively associated with non-adherence. In total, 76.98% of the variance in the quality of services in terms of adherence could be explained by Donabedian model.

Conclusion: Despite higher numbers of clients was adherence to ART treatment, considerably intolerable numbers were below level of adherence in the service provided. Therefore, due attention should give to fill the gap of perception of the clients to existing services through ART mentorship by inaugurating with IEC/BCC in the context of their residence, educational level and living conditions.

Background of study: Nigerian national policy on HIV stresses the need for the adoption of multi-sectoral and multi-disciplinary approach in policy formulation, with the health sector taking the lead. This calls for collaboration among the various stakeholders including nurses in policy development initiatives to ensure that diverse health care needs and disciplinary perspectives are captured in HIV health policies.

Purpose: This paper will present the findings of a recent study which examined nurse’s involvement in policy development in the context of mother-to-child transmission (MTCT) of HIV in Nigeria.

Methodology: A qualitative case study design under the guiding tenets of critical social and power theories. The research is a single case study of one state with embedded units. Thirty nurse-leaders from the various embedded units were recruited through purposive and snowball sampling technique. Semi-structured in-depth interviews and document reviews were used for data collection. Focus group discussions were used as a form of member-checking and also to generate data. Data was analysed using thematic analysis.

Results: This paper focuses on the major themes that emerged from the study as well as highlight specific interplay of power dynamics in the health care system which hinders nurse’s involvement in policy formulation.

Conclusion: The paper concludes with some of the lessons learnt in the study and proffer suggestions for effective integration of nurses into policy arena. It suggests the need for a broad-based educational curriculum which will incorporate strategies to build nurses capacity for leadership and policy development in nursing training schools.

To investigate the effects of daily undulating periodization resistance training (DUPRT) program on anthropometric and biochemical profile and muscular strength in an HIV-infected woman with lipodystrophy.

Case report: A 50 year old woman participated in a 6 week DUPRT program. Anthropometric and glycemic profile as well as blood lipid profile pre- and post-DUPRT.

Results: After six weeks, the participant showed increased body lean mass, circumference of arms, thighs and calf, HDL-c, and muscle strength. She also exhibited reduction in fat percentage and fat mass, circumference of neck, chest, waist, abdomen and hip, and levels of fasting glucose, triglyceride, total cholesterol, LDL-c and HBA1C.

Conclusion: Six weeks of DUPRT improved all evaluated profiles in an HIV-infected patient with lipodystrophy.

Objective: Uncontrolled HIV infection progresses to the depletion of systemic and mucosal CD4 and AIDS. Early HIV infection may be associated with increases in the concentration of MIP-3α in the blood and gut fluids. MIP-3α/ CCL20 is the only chemokine known to interact with CCR6 receptors which are expressed on immature dendritic cells and both effector and memory CD8+ and CD4+ T cells. The role and prognostic value of blood levels of MIP-3α in HIVinfected individuals has yet to be described.

Methods: We determined the serum levels of MIP-3α, and IFN-γ, in 167 HIV-1-infected and 27 HIV-1-uninfected men participating in the Multicenter AIDS Cohort Study (MACS). The blood biomarkers were measured using enzymelinked immunosorbent assays (ELISA) and the cell phenotypes using flow cytometry.

Results: Median serum levels of MIP-3α in HIV-1-infected and uninfected men was significantly different (p<0.0001) and were 21.3 pg/mL and 6.4 pg/mL respectively. The HIV-1-infected men with CD4+ T cell count <200 cells/μL showed the highest median serum MIP-3α (23.1 pg/mL). Serum levels of MIP-3α in HIV-1 infected (n=167) were negatively correlated with absolute number of CD4+ T cell (p=0.01) and were positively correlated with CD38 molecules on CD8+ T cells (p=0.0002) and with serum levels of IFN-γ (0.006).

Conclusion: Serum levels of MIP-3α concomitantly increase with plasma levels of IFN-γ, CD38 expression on CD8+ T cells, and decreased of absolute CD4+ T cells in HIV-1-infected men. A higher blood level of MIP-3α may be representation of locally high level of MIP-3α and more recruitment of immature dendritic cell at site of infection. Involvement of CCR6/CCL20 axis and epithelial cells at the recto-colonel level may enhance sexual transmission of HIV-1 in MSM and may be useful as a prognostic marker in HIV-1-infection and AIDS.

Objective: Little research to date has focused on measuring adherence among and tailoring adherence interventions to HIV-positive youth. To explore the potential of emerging mHealth technologies as adherence tools for youth, we assessed the acceptability and feasibility of a real-time web-linked electronic drug monitoring (EDM) device to support antiretroviral (ART) adherence among HIV-positive adolescents in China.

Methods: Twenty patients ages 10-15 years who were on ART at the Guangxi Center for Disease Control ART clinic in Nanning, China used a wireless EDM device for medication for one month. We monitored adherence in real time, and explored the device’s acceptability among patients using a mixed-methods approach.

Results: Using EDM data, median adherence was 93.9% (IQR 10.2) of prescribed doses taken and 90.2% (IQR 13.3) using the on-time measure. Only 20% (4/20) of patients met the strictest generally-accepted criterion for optimal adherence (≥ 95% using on-time measure) over the observation period. Self-reported median adherence for the month was 100% proportion taken. Although they expressed concerns about inconvenience and the device’s size and appearance in open-ended questions, all adolescent participants reported a positive overall experience with the device in closed-ended questions.

Conclusion: Wireless EDM technology represents an acceptable and rigorous method of measuring ART adherence, and a potentially useful adherence support, for HIV-positive adolescents at a critical time in their lives, as well as for adolescents who take medications for other chronic health conditions. Future studies should focus on identifying ways of strengthening caregiver-adolescent relationships and developing tailored, age-appropriate intervention packages to support adherence.

Background: Undernutrition is a major public health problem affecting the physical and mental development of infants and young children in Ghana. Inadequate dietary intakes and the prevalence of infections have largely been implicated. This study was conducted to assess the risk factors for Undernutrition in Children under-five years old in Ghana.

Methods: This was a secondary data analysis of the 2011 Multiple Indicator Cluster Survey which included anthropometric measurements of children under five years old. Using the modified United Nations Children's Emergency Fund conceptual framework for undernutrition, the variables of interest were extracted and classified into biological and non-biological variables. Bivariate and logistic regression analysis was conducted using SPSS 21 to identify the risk factors for stunting, underweight and wasting.

Results: The survey recruited 7,550 children, 22.7% were stunted, 13.4% were underweight and 6.2% were wasted. Child age, gender, reported size at child birth, breastfeeding status, having diarrhoea or fever in the preceding two weeks, number of children in the household, child health insurance status, household wealth, and ethnicity and religion of household health and region were risk factors for undernutrition. However, only child age and sex were risk factors for all three indicators (stunting, underweight and wasting).

Conclusion: Undernutrition in Ghana is a multi-sectorial problem largely influenced by the social determinants of health and health inequalities. To reduce the prevalence of undernutrition in Ghana, strategies and interventions should be targeted at building the capacity of health staff and strengthening existing systems. This should include intensifying public health messages on child care, integration and collaboration with key stakeholders in addressing socio-economic inequalities of households and communities as well as the regional discrepancies.

Introduction: HIV has much comorbidity that includes depression. Additionally, disability has been found to manifest in HIV. However, the intersection between these co-morbidities is unknown. The primary aim is investigating the link between the onset of disability and depressive symptoms amongst a cohort of patients on antiretroviral treatment.

Materials and method: We conducted a cross sectional survey in an urban area of South Africa including measures for depressive symptoms, functional limitations/disability, adherence, HIV-related health symptoms, and livelihood. One thousand and fifty-five adult individuals (≥ 18 years old) were recruited from Themba Lethu HIV clinic in Johannesburg between August 2014–May 2015. Bivariate and logistic regression analysis was used to determine associations.

Results: Participants experiencing depressive symptoms had higher functional limitations on all sub-categories expect for one. The logistic regression model revealed that having depressive symptoms as a bivariate dependent variable and age, physical health, and disability as independent variables were statistically significantly associated, χ² (3)=199.63, p<0.001. The model explained 23.7% (Nagelkerke R²) of the variance in depressive symptom classification, with increases in age, physical health symptoms, and disability being associated with an increase in symptoms.

Conclusion: As reported in a related study functional limitations, age, and health symptoms were directly associated to an increase in depressive symptoms. Gender and ART adherence were not found to be significant contributing variables to depressive symptoms when controlling for other covariates (disability, age, physical health). Hence, the association between depressive symptoms, health, and disability is much more nuanced and complex than previously anticipated. Development of a comprehensive continuum of care needs to consider the importance of disability as both a driver of depression and an outcome. Rehabilitation interventions hold a key to addressing these new health-related needs now that people survive the acute stages of AIDS and can live a long life.