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Revista de SIDA e investigación clínica

Volumen 7, Asunto 8 (2016)

Artículo de revisión

Treatment of Human Immunodeficiency Virus-1: Current Challenges and Future Perspectives

Inês Pereira, Cristina Luxo and Ana Miguel Matos

Today, HIV‑1 infection maintains its status as a grave public health problem. The development of effective antiretroviral drugs has greatly increased life expectancy of infected patients by arresting disease progression, but treatment is not able to eliminate the virus from the body, requiring lifelong adherence to prevent viral rebound and its consequent damage on the host immune system. The ability of the virus to remain latent in cellular reservoirs is a major obstacle in the development of curative therapies, in part because there is still a considerable lack of understanding of viral latency processes. A lot of research has been conducted to study and clarify such mechanisms and propose strategies to eradicate the virus (sterilising cure) or at least permanently control it (functional cure) in order to bypass the need for chronic antiretroviral therapy. The purpose of this literature review is to discuss the state of the art in HIV‑1 research, with a particular focus on the mechanisms by which HIV‑1 eradication has thus far remained an unattainable goal. Future perspectives for the development of a functional or sterilising cure to HIV‑1 infection will also be explored.
Artículo de investigación

Cultural Mistrust, Conspiracy Theories and Attitudes towards HIV Testing Among African Americans

Kelsey Ball

Background: With respect to the HIV epidemic, research has shown that health behaviors are affected by a number of attitudinal factors such as cultural mistrust, medical mistrust and conspiracy beliefs. While it is clear that these variables have a deleterious effect on health behaviors, the literature fails to explore how these factors uniquely influence and predict an individual’s attitudes and overall willingness to receive HIV testing. Furthermore, cognitive factors such as the need for cognitive closure have received little attention with regard to HIV testing attitudes. Objective: The aim of this study was to determine inter-correlations between cultural mistrust, medical mistrust, HIV conspiracy theories and the need for cognitive closure and to explore the extent to which these variables predict attitudes towards HIV testing. Methods: This study consisted of 34 Black males and 84 Black females (n=118) between the ages of 16-67 years (μ=26.8 years) recruited from a Historically Black College/University (HBCU), a community college, as well as churches and local health forums in the Washington, D.C. area. Results: Results of the inter-correlations were mixed and regression analyses revealed that cultural mistrust, medical mistrust, HIV conspiracy beliefs and the need for cognitive closure were not significant predictors of attitudes towards HIV testing in these populations. Conclusion: The results are discussed from a psychosocial perspective and implications and future directions for public health, psychotherapy and clinical work are considered.

Artículo de investigación

Various Immunologic and Virologic Responses to Second line Antiretroviral Therapy in Tambaram, India

Ganesh Shanmugasundaram Anusuya, Chandrasekar Chockalingam, Manoharan Gurusamy, Patrick Nadol, Raja Krishnaraj and Ezhil Radhakrishnan

Introduction: We studied the prevalence and associated factors for various immunologic and virologic responses to second line antiretroviral therapy (SLA) in patients enrolled in a government tertiary care hospital in Chennai , India Methods: A cross-sectional study of human immunodeficiency virus patients who have failed first line antiretroviral therapy and subsequently initiated on SLA .Concordant favourable response (CFR) or (CD4+/VL+) was defined as: increase in CD4 count of >=50 cells/mL and achievement of plasma viral load<400 copies/mL after 6 months. Concordant unfavourable response (CUR) or (CD4-/VL-) defined as increase in CD4 count of <50 cells/mL and achievement of plasma viral load>400 copies/mL. Various clinical and demographic factors were analyzed between different response groups using Chi-Square test, t-test, and One way ANOVA Results: From January 2008 to February 2009, 60 patients initiated on SLA. In those 76.7% experienced CD4+/ VL+, 10% CD4+/VL-, 5% CD4-/VL+ and 8.3% CD4-/VL- response. The characteristics of CFR and CUR groups were: 97.8% and 100% males (p- value>0.05), mean baseline CD4 count of 100 and 198 cells/mL (p-value<0.05), mean baseline viral load of 187754 and 265580 copies/mL (p- value>0.05), mean CD4 count at 6 months (313 vs. 147 cells/mL; p-value<0.05), adherence>95% (100% vs. 40%; p-value<0.05). Immunologic only response (CD4+/VL-) was associated with sub optimal adherence. Conclusion: 76.7% of patients after 6 months on SLA indicated CFR and 8.3% experienced CUR. CUR associated with poor adherence.

Artículo de investigación

Acute Pancreatitis in Patients Living with HIV

Elfane Mouna, Dollo Ibrahim, Ouladlahsen Ahd, Sodqi Mustapha, Marih Latifa, Chakib Abdelfettah and Marhoum Elfilali Kamal

Background: Acute pancreatitis in HIV positive patients remains a management challenge even with a Highly Active Antiretroviral Therapy (HAART) era. Objective: Report the prevalence, clinical and radiological features of acute pancreatitis associated with HIV. Patients and methods: Retrospective study conducted from January 1999 to June 2015 in HIV positive patients admitted with acute pancreatitis in the Infectious Disease Unit, Ibn Rochd, Casablanca. The Balthazar Grade score was used to assess radiological severity of the disease. Results: During this period, 39 patients had an acute pancreatitis or an incidence of 0.6/1000 inhabitant/year. The mean age was 33.72 years (range: 18 to 48 years), mostly represented by females (68% to 32% male).The known risk factors included an alcohol abuse in 15 patients (52%), a history of pancreatitis in two patients (5%), cholecystitis in four patients (14%), and intravenous drug abuse in two patients (5%). Nineteen patients (65%) were on HAART regimen and only nine patients (31%) were receiving cotrimoxazole as prophylaxis. Twenty-two patients (76%) were in stage C of CDC. Twenty-one (72%) patients had a mean CD4 count below 200/mm³ and a HIV viral load above 1000 copies/ml in seventy nineteen (65%) patients. Pancreatitis was symptomatic in all cases. The median amylasemia level was 120 IU/L, serum lipase 672.7 IU/L and 1,23 mg/dl triglycerides. All patients had an abnormal pancreas CT scan of which twelve (41%) patients were in stage A of AP. The main causes found were drug toxicity of which 6 cases were due to stavudine, meglumine antimony in 3 cases, didanosine in 1 case, anti-tuberculous treatment in 1 case and opportunistic infections of which 4 cases were tuberculosis, 4 cases of cytomegalovirus disease and cryptosporidiosis in 2 cases respectively. The main complications were: shock in 9 cases, 2 cases of diabetes and pancreatic pseudocysts in 2 cases. The evolution was fatal in 45% of cases. The median duration for hospital course was 10 days (range 6-50 days). Conclusion: Acute pancreatitis is a serious condition in HIV-positive patients. Drug toxicity and opportunistic infections represented the most frequent causes.

Artículo de investigación

Does Mass-Media Public Communication Campaign Normalize Discussion, Attitude and Behavior about Condom Use among Married Men in India?

Dipak Suryawanshi, Sangram Kishor Patel, Rajatashuvra Adhikary and Shalini Bharat

Background: ‘Condom’ is a stigmatized topic in India. Open discussion about its use and promotion are considered inappropriate. This study examines the association between exposure to public service announcements (PSA) around condoms and discussion, attitude and behavioral intentions about condom use among married men by their age and socio-economic status. Methods: A sub-sample of monogamous married men (N=2502) was obtained from 2009 BBC World Service Trust’s condom normalization survey among men in four high HIV prevalence states in India. The multiple logistic regression models were used to analyze the association of exposure to PSA around condoms with discussion, attitudes and behavioral intentions about condom and its usage. Result: More than half married men (55%) were younger (<=35 years), having better socio-economic status (educated above secondary levels and employed) (55%) and exposed to condom PSA (64%). Exposure to PSA was associated with greater likelihood to seek condom information (AOR: 1.33; p=0.010), positive attitude (AOR: 1.24; p=0.008), higher self-efficacy (AOR: 1.53; p=0.006) in using and, last time condom use (AOR: 2.15; p=0.023) among better SES group; with positive caring attitude (AOR: 1.27; p=0.010), ease in purchasing condom (AOR: 2.04, p=0.009) among older (35+ years) men, and with last time condom use among younger men (AOR: 1.85; p=0.037). Conclusion: The findings of the study highlight an important contention that linkage between mass-media campaigns and promotion of condom normalization through discussion, seeking information and intention to use and its usage goes beyond as a behavior change strategy to include dimensions of age, educational attainment and economic status. The effectiveness of mass media campaigns for normalizing condom discussion is largely mediated by demographic and socio-economic variables. Future campaigns need to address these variables to be more effective.
Artículo de revisión

Insights into RNA Interference as Antiviral Defense

Purushottam Narute

The beginning of this century is marked by discovery of “RNA interference (RNAi)” and led to Nobel Prize award in Physiology or Medicine jointly to Andrew Z Fire and Craig C Mello in 2006. Initially discovered as innate antiviral defense mechanism in plant it has great implications as therapeutic tools to combat with animal and human viruses as well as research tool to study disease pathogenesis. This article reviews the mechanism of RNAi and outlines recent research directed toward development as antiviral defense in human and animal diseases.
Artículo de investigación

Compliance to Positive Health, Dignity and Prevention Services among HIV Infected Index Partners in HIV Sero-Discordant Relationships in Nairobi County, Kenya

Akolo M, Gichuki R, Chitwa M, Kimani J and Osero J

Introduction: This study evaluated compliance to Positive Health, Dignity and Prevention [PHDP] practice among index partners in HIV sero-discordant relationships in Nairobi County, Kenya. PHDP involves a set of interventions that helps people living with HIV lead a complete and healthy life besides reducing risk of HIV transmission. These interventions were adopted in Kenya in 2013 by the National AIDS and STI Control Program [NASCOP], Ministry of Health and the United States Government [USG] funded affiliates. The evaluation focused on demographic factors, knowledge, perception and challenges encountered while adopting PHDP practices among index client. Methods: A cross sectional descriptive study design was used, 370 index partners in sero discordant relationship were recruited from three clinics within Nairobi County. The clinic’s patient registry was used to contact sequentially those who met the inclusion criteria. Standardized data collecting tools were administered. Data was cleaned and analyzed using SPSS VER 22.0. Results: Out of 370 respondents 19.7% were male. 40.1% had education level of primary school and below. The group exhibited high PHDP knowledge at 90.8% however, only 66.5% complied with PHDP practice. There was significant relationship between condom supply, condom demonstration and PHDP compliance at P values of 0.034 and 0.018 respectively. Odds ratio showed those index partners who had no challenge in accessing condom demonstration and supply complied more to PHDP practice. Consistence condom use was at 53.4%, while 28.2% had multiple sex partners. Conclusion: PHDP compliance is low which calls for improvement. There is significance relationship between condom supply/demonstration and PHDP compliance.
Artículo de revisión

Occupational Health Hazards Prevailing among Healthcare Workers in Developing Countries

Henrietta Osaretin Owie and Paschal Awingura Apanga

Introduction: Occupational health is a neglected public health issue among healthcare workers in developing countries. This has exposed healthcare workers in developing countries to various forms of hazards which have had negative consequences on their wellbeing and performance at work. The aim of this research was to explore the forms of occupational hazards prevalent with their associated risk factors in developing countries and to recommend measures that can be put in place to remedy the situation. Methods: Relevant literature were selected from search results from databases such as Medline, CINAHL, EMBASE, PsycINFO and Google search engine were included in the review. Results: The review revealed that blood borne diseases, musculoskeletal problems, latex allergy, tuberculosis, violence and work-related stress were the common occupational hazards among healthcare workers and this was largely blamed on several healthcare system issues. Conclusion: Developing countries should prioritize occupational health and safety issues by investing heavily into standard infection control measures and training of healthcare workers on work safety. Mounting surveillance on occupational hazards and implementing policies that will protect the safety of healthcare workers is also key.
Artículo de investigación

Knowledge and Perceptions of HIV/AIDS among High School Students in Jeddah, Saudi Arabia

Ssakher M AlOtaibi, Faisal F Alabbas and Majed S Pacha

The Middle East and North Africa (MENA) region has the world’s third fastest growing AIDS epidemic, but data on HIV/AIDS from this region is considered scarce. In this study, we report a cross-sectional survey of knowledge of and attitudes to HIV and AIDS among 438 high school students in Jeddah, Saudi Arabia. This city is an international gateway with the highest HIV incidence in the country. The survey highlights both good awareness of HIV with regard to transmission by sexual contact and injection, and also deficiencies in knowledge about other routes of transmission. The data indicate substantial stigma associated with HIV/AIDS patients, consistent with other reports from the MENA region. These outcomes highlight a need for greater education on at least some aspects of HIV; they also provide a benchmark for future research and a basis for discussions of public policy towards HIV/AIDS awareness and education in Saudi Arabia.
Artículo de investigación

Antibiotic Resistance of Bacterial Isolates from HIV Positive Patients with Urinary Tract Infection (UTI) in Portharcourt, Nigeria

Tchounga S Kemajou, Anslem O Ajugwo, Cyprian E Oshoma and Enabulele OI

This study was carried out to evaluate the prevalence of HIV associated Urinary tract infections (UTI) in Portharcourt Metropolis. 286 urine samples were collected from 246 HIV seropositive and 40 HIV seronegative individuals. Mid stream urine samples collected from these individuals were processed by standard protocols to examine for bacterial opportunistic pathogens. Antibiotic susceptibility testing was performed using Kirby-Bauer’s disc diffusion method. Out of 246 HIV individuals examined, 141 (57.3%) urine samples yielded growth of bacterial isolates, with age group 24-30 years recording the highest number of isolates 45 (32.9%), while those above 44 years old had the least with 11 (7.8%). About 24 (60%) samples out of 40 seronegative individuals yielded growth of bacteria and age group 17-23 years recorded the highest number of isolates 7 (29.1%), while those above 44 years had the least 1 (4.1%). Female individuals recorded the highest number of bacterial isolates than males. A total of 165 bacteria were identified and grouped into four genera out of which Staphylococcus aureus had the highest percentage of occurrence 49 (29.7%), followed by Escherichia coli 47 (28.5%), Pseudomonas aeruginosa 46 (27.9%) and Klebsiella pneumoniae 23 (13.9%). Out of 111 bacterial isolates that exhibited multidrug resistance, HIV Seropositive individuals had 103 (92.8%) and HIV seronegative individuals 8 (7.2%). Over all, Staphylococcus aureus recorded the highest number of multidrug resistant bacteria 36 (32.4%), followed by Pseudomonas aeruginosa 34 (30.6%). The high levels of multidrug resistance in HIV seropositive individuals are a serious public Health concern. Therefore appropriate health education to reduce selfmedication and drug abuse is very imperative and desirous.

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