Revista de SIDA e investigación clínica

La falta de comprensión del trabajo sexual migrante y de las trabajadoras sexuales migrantes hace que se coloquen barreras legales y culturales involuntariamente entre las trabajadoras sexuales migrantes y los servicios de salud e información. Estas barreras legales y culturales comprometen la capacidad de las trabajadoras sexuales migrantes de acceder a los servicios y de controlar su propia salud sexual, aumentando así los riesgos de transmisión de ETS y VIH. La confusión incorrecta entre el trabajo sexual migrante y la trata de personas y la esclavitud sexual y la amplificación de esta confusión incorrecta por parte de los medios de comunicación populares hasta niveles de “pánico moral” refuerzan las barreras que enfrentan las trabajadoras sexuales migrantes para lograr una buena salud sexual.

Antecedentes: La epidemia de VIH en los EE. UU. continúa afectando desproporcionadamente la salud de las mujeres jóvenes afroamericanas. El enfoque aquí se centra en los predictores de los guiones sexuales, que son hojas de ruta para la toma de decisiones sexuales. El objetivo es examinar las experiencias de vida, las creencias normativas y los predictores culturales de los guiones sexuales que colocan a las mujeres afroamericanas jóvenes, sexualmente activas y consumidoras de sustancias (YSSAAW), una población con una vulnerabilidad significativa al VIH, en un riesgo aún mayor de volverse VIH positivas. Métodos: Se realizaron entrevistas semiestructuradas cara a cara con la ayuda de una tableta a 30 YSSAAW en un departamento de emergencias privado o público en Houston, TX, EE. UU. Las entrevistas fueron transcritas profesionalmente y luego codificadas por un equipo de codificación capacitado de 3 miembros. Se utilizó una entrevista para crear el libro de códigos. Los códigos se organizaron en temas principales durante las reuniones cara a cara. La confiabilidad entre codificadores se evaluó y confirmó utilizando las estadísticas Kappa de Cohen, lo que demostró un acuerdo casi perfecto entre los codificadores 1 y 2 (K = 0,93). Resultados: Se describieron tres temas principales como predictores de los guiones sexuales: heridas emocionales, normas y toma de decisiones. Los códigos predominantes entre las YSSAAW dentro del tema de las heridas emocionales incluyeron la infidelidad (43,33%) y la dinámica parental (56,67%). Bajo el tema de las normas, encontramos que el 66,7% de las YSSAAW discutieron sus normas de comunicación y el 30% reveló normas culturales. Dentro del tema de la toma de decisiones sexuales, obtuvimos información relevante e implicaciones sobre la longevidad de la relación y tener un historial de ITS entre el 46,67% de la muestra. Conclusión: Los predictores primarios del sexo de alto riesgo revelaron guiones sexuales que demostraron diferenciales de poder basados ??en el género; por lo tanto, respaldan la utilidad de un marco teórico que incluye la Teoría del Guión Sexual y la Teoría del Género y el Poder. El modelo lógico ilustra cómo las heridas emocionales de las experiencias de vida (es decir, trauma, abuso, abandono) y las normas socialmente aceptables establecen el guión sexual de las YSSAAW; por lo que el sexo de alto riesgo es el resultado más probable en relación con las estrategias de prevención.

Objective: Ghana like most African countries, still carry the communicable disease burden. The introduction of antiretroviral drugs in Ghana has improved survival rates amongst HIV patients. According to the National Guidelines for antiretroviral treatment in Ghana, administration of nevirapine, a frontline antiretroviral drug leads to hypersensitivity reactions in some patients. This study examines the clinical risk factors and specific genotypic alleles associated with nevirapine hypersensitivity reactions. Methods: Seventy (70) antiretroviral naïve HIV patients, initiating nevirapine-based HAART therapy were enrolled in this cohort study and monitored clinically over a period of 24 weeks from July 2013 through to June 2014. Blood samples were evaluated for aminotransferase activity and DNA genotyped for specific ABCB1 and CYP2B6 markers. Results: Eleven (15.7%) patients were identified as cases and 59 (84.3%) patients classed as comparisons out of the study population at the end of the 24 week-monitoring periods. Eight out of the observed cases were categorized as nevirapine hypersensitivity rash and 4 as hepatotoxicity. The concentration of AST was much higher in the cases (119.44 ± 155.86) compared to the comparisons group (68.80 ± 42.65), p=0.056. The Concentration of ALT was also higher in the cases (136.44 ± 165.99) compared to the control (56.72 ± 33.02) p=0.003. The CYP2B6 516 G>T, variant allele frequency observed in the study was 62 (44.3%). However, there was no variant allele detected for the three SNPs in ABCB1 gene genotyped. Conclusion: The observed NVP HSR outcome suggests an adverse reaction among the cohort of HIV-1 infected patients within the Ghanaian population studied. The effect of this outcome although not statistically significant, might be clinically traced to non-adherence to medication and hospitalization of patients which seem to be a major factor to treatment failure in resource-limited countries.

Objective: Apolipoprotein B mRNA-editing enzyme catalytic polypeptide-Like 3B (APOBEC3B) is involved in innate immune response, exhibiting insertion–deletion polymorphism across the world in human population. A naturally occurring 29.5 kb deletion removes complete APOBEC3B gene. Human APOBEC3B family of proteins restricts HIV- 1 replication. Very few studies have been conducted on this subject and the deductions regarding the effects of APOBEC3B deletion on HIV-1 susceptibility and pathogenesis have been largely inconsistent. Therefore, we studied the association of APOBEC3B deletion with HIV-1 in the North Indian population. Methods: Insertion (I)/Deletion (D) APOBEC3B polymorphism was analyzed using Polymerase chain reaction. Infection rates as wells as stages of HIV were compared among the three genotypes: deletion-homozygous (D/D), Insertionhomozygous (I/I) and hemizygous (I/D) in 150 HIV-1 seropositive (HSP) and 250 HIV-1 seronegative (HSN) subjects. Results and discussion: The genotypic analysis revealed insignificant associations among homozygous deletion (D/D) genotype (P=0.130, OR=1.93, 95% CI=0.95–4.30) and moderate associations among hemizygous (I/D) genotypes (P=0.057, OR=1.56, 95% CI-1.03–2.44) with HIV-1 susceptibility and also the single copy of variant allele was more susceptible to HIV-1 infection. The severity of HIV-1 infection on the basis of CD4 count was not associated significantly with the disease progression to AIDS. Conclusion: In conclusion, we found that the deletion genotype of APOBEC3B gene polymorphism does not play any significant role on HIV-1 susceptibility. Hence, further studies with the expansion of sample size are needed to validate the results.

This study examines the impact of ethnicity and multiple types of HIV-related stigma on adherence to antiretroviral therapy (ART) among 2,146 people living with HIV/AIDS (PLWHA) in Guangxi, China who had initiated ART. The results of multiple binary logistic regressions indicate that those who had experienced enacted stigma tended to report lower adherence, while better adherence was associated with older age, being women and having a job. Ethnicity had a moderator effect on the association between internalized stigma and adherence since better adherence was associated with lower internalized stigma among participants in ethnic minority groups other than Zhuang. Our findings indicate that PLWHA of other ethnic minority groups could benefit from internalized stigma reduction interventions; PLWHA, overall, could benefit most from increased employment opportunities and acquisition of coping skills to mitigate the negative effects of enacted stigma.

Objective: Tenofovir Disoproxil Fumerate (TDF) is contraindicated for use in HIV infected patients when creatinine clearance (CrCl) is below 50ml/min. We determined prevalence and factors associated with renal dysfunction at 18 months follow up in adult HIV positive patients on TDF-based antiretroviral therapy (ART). Methods: We conducted a cross sectional study of 445 HIV positive patients’ records on a TDF-regimen at Ronald Ross General Hospital in Zambia. Patient’s records in data management software (SMARTCARE) from 2008 to 2014 were reviewed to determine proportions of patients on TDF developing renal dysfunction. We estimated glomerular filtration rate (GFR) by creatinine clearance using the Cockcroft-Gault formula to determine renal dysfunction. CrCl level ≤ 50 ml/min indicated renal dysfunction. Multiple logistic regression was used to determine factors associated with renal dysfunction. Results: At baseline (n=429), median age of patients was 35 years (IQR 30, 42), median CrCl level 106.2 ml/ min (IQR: 79.9, 127.8). At 18 months, median CrCl 102 ml/min (IQR: 81.6, 123.2) which remained within normal physiological range (88-137 ml/min). Point prevalence of renal dysfunction was 18.6% (95% CI; 0.2-28.3). Multivariable analysis showed that ages <50 years than older (AOR: 0.06 95%CI 0.01-0.27; p<0.0001), and those with higher CD4+ cell count ≥ 350 cells/uL than lower (AOR: 0.19 95%CI 0.03-0.21; P=0.014) had lower likelihood of renal dysfunction. Conclusion: We found a high prevalence of renal dysfunction among HIV positive adults on tenofovir-based therapy. This was concentrated in older patients with low CD4+ cell counts suggesting a need for close renal function monitoring in this population when initiating tenofovir-based treatment.

ART has become the mainstay in the management of HIV/AIDS worldwide as it has considerably reduced the mortality and morbidity that would have been associated with this disease. The ART however, has transformed the perception of HIV/AIDS from a fatal incurable disease to a manageable chronic illness. The study assessed PLWHA’s perception of ART in a tertiary hospital in south western Nigeria. Mixed methods were used to assess the perceptions from the respondents between 18 and 60 years with the aid of structured questionnaire, Focus group discussions and in-depth interviews. Quantitative data were analyzed using percentages, frequency distributions and chi-square while qualitative data were thematically analysed. The study revealed a positive perception of ART among the respondents which was about 86.3% as they perceived positive effects of the ART on their health. Furthermore the study was able to identify, improved health status and fear of drug resistance as their major positive perception towards ART from the interview as these were elicited to have contributed to the clients’ adherence to ART. The study in its entirety revealed an overall positive perception to ART among them with the following determinants as factors enhancing the positivity: sex, age, marital status and level of education.

Visceral Leishmaniasis (VL) disease, endemic to Algeria, is a major public health problem for children from rural areas and suffering from malnutrition, this disease currently tends to decrease. However, we found a constant progression in adults over the last twenty years. Indeed, 64 cases of VL in adults were recorded between 1991 and 2010 in Kabylia (Tizi-Ouzou, Bejaia and Bouira) with 18 cases with VL/HIV co-infections. Co-infected men is predominant with 15 cases, a sex ratio of 5 and an average age 35.57 +/- 2.3 years. Typical clinical signs, namely; fever, splenomegaly and hepatomegaly are observed only in 22.2% of the cases; absence of fever (n=4), splenomegaly (n=2), two (n=2) and presence lymphadenopathy (n=5). We also noted the presence of risk factors such as the advanced age of patients and late diagnosis of visceral leishmaniasis usually associated with the advanced stages of HIV infection (III, IV) in mostly multi-infected patients. We also identified five (5) cases of shingles and four (4) cases of digestive candidacies who were the most opportunistic infections observed in our series. Pancytopenia, observed in 2/3 of the cases has been the most consistent biological sign and contributing in the evocation of the VL as the clinical presentation was atypical. The confirmation, by direct examination of bone marrow smears by identifying amastigotes, is observed in all HIV patients (PVIH). Western blot and PCR techniques have allowed better monitoring of patients. In 5 cases, the VL revealed the infection of HIV. The care was difficult because of the numerous observed relapses. The unavailability of Amphotericin B, inherent in different factors, compelled us, in some situations, to use the Glucantime as first-line treatment (n=4). Prophylactic treatment based on Pentamidine (n=2), Glucantime (n=2) and amphotericin B (n=12). The evolution was marked by 5 deaths during the first days of treatment anti-Leishmanial and one after several relapses were observed as well as a resistance perhaps to Glucantime resulting in splenectomy.

Background: African American/Black and Hispanic persons living with HIV (AABH-PLWH) are under-represented in AIDS clinical trials (ACTs) in the United States. Barriers AABH-PLWH experience to ACTs are multi-faceted, including distrust of medical research, low levels of knowledge, unsupportive social norms, lack of referral, and challenges navigating ACT systems. In past research we found a multi-component peer-driven intervention was efficacious in boosting rates of screening for/enrollment into ACTs. The present qualitative study seeks to understand AABH-PLWH's perspectives on which specific intervention features or components had utility. Interventions features explored included structural elements (e.g., small group sessions, individual sessions on the ACT research unit); approaches (e.g., Motivational Interviewing); and specific components (e.g., small-group discussion of historical and cultural factors reducing participation among AABH-PLWH). Methods: A total of 37 AABH-PLWH (mean age 50.6 years, SD=7.5 years; 48.6% female; 62.2% African American/ Black, 27.0% Hispanic) were purposively selected from a larger study for in-depth interviews, which were audiorecorded, transcribed verbatim, and analyzed using systematic content analysis. Results: We found the intervention improved knowledge and positive attitudes toward ACTs, and triggered sociallevel facilitators such as altruism and more positive social norms. Discussions of cultural/historical barriers to ACTs associated with race/ethnicity had utility. Holding a session on the ACT research unit reduced fear and increased motivation. Results highlighted the value of Motivational Interviewing, and several components were perceived as less useful (e.g., involving social network members in ACT decisions). Conclusion: Findings can inform future intervention designs to address racial/ethnic disparities in ACTs and have implications for trials of other conditions where racial/ethnic disparities persist.

Objective: To assess factors associated with non-adherence to antiretroviral therapy among adults living with HIV/ AIDS in Arsi zone. Methods: This is a multiple facility-based cross-sectional study, where 306 adult aged over 18 years who were receiving antiretroviral therapy had interviewed using a structured questionnaire about their experience of taking antiretroviral therapy between June 1, 2015-June1, 2016. Additional data was extracted from each facilities record. Participants were defined as non-adherent if they missed at least one dose of their highly active antiretroviral therapy prescriptions within the last 30 days. Participants were also asked to indicate reasons for missing doses of highly active antiretroviral therapy. Descriptive analysis and Multivariable logistic regression model was used to determine predictors of non-adherence. The odds ratios in the binary logistic regression along with 95% confidence interval were used. Results: Overall, 306 clients responded; 35% were non-adherent. Seventy five (24.5%) and 214(69.9%) patients agreed and strongly agreed that the use of antiretroviral therapy is essential in their life. Thirty seven (12.1%) do not know whether drug resistance develop when antiretroviral therapy are missed or not. The reasons for missing doses include forgetting 71 (23.2%) and hiding from colleagues 90 (29.4%). Respondents who reported hiding from colleagues were found to be 2 times more likely to be non-adherent to antiretroviral therapy compared to respondents who had not reported hiding from colleagues (adjusted odds ratio = 2.02; 95% Confidence interval: 1.19-3.43). Conclusion: Prevalence of non-adherence to antiretroviral therapy is high. Some of the respondents do not know whether drug resistance develop when antiretroviral therapy are missed or not. Forgetfulness and hiding from colleague were the most common reason for missing doses. Hence, antiretroviral therapy counselors need to emphasis on memory aids. Creation of awareness on the risks of non-adherence is needed.

Introduction: During the first six months of their life replacement feeding is recommended for infants born from HIV positive women under the condition of acceptable, feasible, affordable, sustainable and safe. Where this is not achievable, exclusive breastfeeding (EBF) is suggested during the first six months of life. Objective: To assess the EBF practice of HIV positive women and its determinants with in a selected health facilities of West showa zone Oromia region. Methods: Institutional based cross-sectional study was carried out among HIV-positive women attending PMTCT service using structured questioners. Consecutive sampling technique was applied in order to interview women. Data was analyzed using SPSS version 16.0 and multiple variable logistic regressions were done to identify risk factors of Exclusive breast feeding. Result: The proportion of exclusive breast feeding was 23.98%. Majority (79.34%) of the study subjects knew that HIV can transmit from mother to child during breast feeding. Mothers who had secondary educational status were three times more likely to give exclusive breast feeding than those who had no formal education (OR, 3.04 95% CI=2.72, 6.52). Mothers with household income earned 500-1000 birr were 2 times more likely to practice EBF than who earned 2000 birr (OR, 2.11 95% CI=1.93, 3.50). Compared to government employee women those who have self employee were 3.5 times more likely to practice EBF (OR, 3.51 95% CI=1.65-6.37). Mothers who delivered by C/S were 2.01 times more likely to practice EBF than those delivered by SVD (OR, 2.01 95% CI=1.07-4.38). Conclusion: The study revealed important findings which affect the practice of exclusive breast feeding of HIV positive mothers. All concerned bodies involvement is necessarily on infant feeding counseling to bring behavioral change in within communities for the better life of newborns.