Revista de SIDA e investigación clínica

Objective: Several studies have shown that rates of cerebrovascular events in HIV-infected patients are increased in comparison to uninfected individuals. In addition, cerebral bleeding represents a serious complication in hemophilia patients. Recently, asymptomatic cerebral microbleeds (CMBs), which can be detected by highly sensitive techniques such as T2*-weighted magnetic resonance imaging (MRI), have emerged as an important marker for predicting symptomatic cerebral bleeding. The aim of the present study was to investigate the prevalence of CMBs in HIVinfected hemophilia patients and to evaluate the association between HIV infection and cerebral bleeding.
Methods: All HIV-infected hemophilia patients (HIV+ HemPts) who visited our hospital from January 2015 to December 2016 were enrolled in this study. In addition, all HIV-uninfected hemophilia patients (HIV- HemPts) who visited our hospital in the same period were enrolled as controls. CMBs were assessed using T2*-weighted MRI. The relationship between cerebral bleeding and the patients’ clinical factors was examined. Results: Two HIV+ HemPts had symptomatic cerebral bleedings during the study period. Twenty-one asymptomatic HIV+ HemPts and 13 HIV- HemPts underwent T2*-weighted MRI. CMBs were observed in 7 HIV+ HemPts (30.4%) and 1 HIV- HemPts (7.7%). In the multivariate logistic regression analysis, HIV infection was the factor most closely related to cerebral bleeding (odds ratio: 9.78, p-value: 0.08).
Conclusion: This is the first report to investigate the prevalence of CMBs in HIV-infected patients. The prevalence of CMBs or symptomatic cerebral bleeding in HIV+ HemPts was high in comparison to that in HIV- HemPts. The brain screening test by T2*-weighted MRI seems to be meaningful for HIV+ HemPts.

Tattoos are a common thing in today’s society and seem to be increasing in popularity with younger generations. In the past they seemed reserved for criminals, drug addicts and other people living on the fringe of society and having a negative connotation. However today’s society show a different view of tattoos shifting toward a view of selfexpression or even just a love of art, using tattoos to tell stories, remind them of significant life events or people and for various other reasons? With wider acceptance of tattoos and the amount of people getting tattoos and wanting tattoos increasing significantly there is a potential health risk involved with the process, especially when receiving tattoos in an unprofessional setting. The process of getting and performing a tattoo involves needles and blood both which are ways for HIV to be transmitted although seen mostly when talking about injection drug use and transmission through sexual intercourse.

Background: HIV related Stigma and discrimination is a reflection of fear of the unknown, driven by ignorance and helplessness that results in negative attitude, beliefs and unfair treatment towards those living with HIV.
Objective: To assess knowledge of stigmatization, prevalence of reported discrimination and the socio-demographic and care predictors of discrimination among HIV positive patients receiving care in Health Care Institutions in Imo State, Nigeria. Methods: A cross sectional analytical design using a simple random sampling technique to select 422 HIV positive patients attending the adult HIV clinics from two public health care institutions in Imo State. Data was collected using a pretested semi structured questionnaire. Descriptive analyses were done with frequencies and summary statistics. Chi square statistics were computed to determine significant relationships and simple binary logistic regression was used to determine predictors of HIV related discrimination. The p-value was set at 0.05 significance level.
Results: The mean age of the respondents was 37 ± 6.3 with a male to female ratio of 1:1.7. The overall level of knowledge of stigmatization and discrimination was poor in more than half of the respondents (55.2%). The prevalence of stigmatization and reported discrimination was 33.2% of which, close to two thirds of it occurred among the females (62.9%). The main source of discrimination was from family and relatives (45.0%) with close to half of the respondents having suicidal thoughts after experiencing discrimination (46.4%). The predictors of HIV related discrimination and stigmatization reported in this study were; being within the ages of 26-35 years, (OR 2.16), having at least one or more children (OR: 3.72), residing in their community of origin (2.00), residing in Orlu (OR: 3.77) or Okigwe (OR: 3.29) zones of Imo State, receiving advice to do the HIV test from a health personnel (OR: 2.52) and doing a HIV test and receiving a positive result from a private hospital (OR:2.22) or health centre OR: 2.11).
Conclusion: Stigmatization and discrimination of people living with HIV/AIDS are created by individuals and communities influenced by socio-demographic and care factors which continues to perpetuate the transmission of HIV; and therefore, it remains an important issue of public health concern that must be addressed.

Introduction: Highly active antiretroviral therapy (HAART) played a critical role in the medical management of HIV infected individuals by restoring the immune function and minimizes HIV related outcomes. But treatment failure minimized these advantages and leads to an increment of morbidity and mortality with poor quality of life in all HIV patients.
Objective: The aim at this study was to assess the prevalence of HIV/AIDS treatment failure and its determinants factors of patients on first line HAART at Felegehiwot Referral Hospital.
Methods: Cross sectional study was conducted on 421 participants who had started first line HAART during August 2016 to September 2016. Data were collected from patients’ chart starting from ART commencement and face to face interview using structured questionnaire. CD4 T-cells from whole blood and viral load from separated plasma were analyzed according to protocols. The collected data were enter in to EPI info version 3.5.1 and transfer to and analyzed using SPSS packages version 20. Descriptive statistics, odds ratio, positive and negative predictive values, life table, receiver operating characteristics curves, bi-variate and multiple logistic regression were used to analysis. Independent associations were considered with p<0.05.
Result: Among the 421 participants enrolled, 292 (69.4%) were adult and 129 (30.6%) were children. More than half 243 (57.7%) of the participants were females. The adult median age at ART initiation was 38.0 years with inter quartile rage (IQR) 10 and for children 9.8 years with IQR 4.The median duration of treatment failure from initiation of treatment was 87 months (IQR 110-65 months). A total of 45 (10.7%) participants were found to have treatment failure. The median CD4 T-cells at initiation of Anti retroviral therapy were 147 cells/μl (IQR 226-84.5). The median time to detect virological failure was 47 months. Sensitivity of immunologic failure of predicting virological failure was 62.2%. Clinical stage II 374 (88.8%) was the predominant clinical stage.
Conclusion: The prevalence of treatment failure in this study was 10.7%. Long duration on treatment, conducting faith healing, immunologic failure, high medication dosage, and ambulatory functional status at baseline and not feeling privacy during consultation and counseling were found to be significant predictors of treatment failure.Therefore early identification of associated factors and monitoring treatment failure has to be strengthened to benefit patients from prevent further complication.

Autoimmune hepatitis is a chronic inflammatory liver disease characterized by good response to immunosuppressive therapy, and the treatment is typically long-term or even life-long. The principle of treat-to-target is characterized by closely monitoring and disease-activity-guided therapeutic adaption. To date, the concept has been successfully applied to many chronic diseases, whereas it is not yet applied to the treatment decision in autoimmune hepatitis. The aim of this review is to summarize the current difficulties of the treatment decisions and the treatment targets in AIH. The treatment of autoimmune hepatitis is discussed from the point of treat-to-target strategy which improves outcomes of patients with chronic diseases. To achieve the treat-to-target in autoimmune hepatitis treatment, accurate evaluation of disease activities and stepwise medication choices are key things to go.

Background: Cervical cancer remains one of the leading causes of morbidity and mortality among women of reproductive age in sub Saharan Africa. However there is limited data on the level of awareness and perceived risk among women in peri urban slums of which most of the occupants are mainly women of reproductive age.

Methods: We carried out a population based cross-sectional study in Namuwongo, a peri urban slum in Kampala in 2016. Data was collected using a pretested interviewer administered questionnaire, entered and analyzed using SPSS 22.0. Results: Most participants, 259/311 (83.3%) had heard about cervical cancer and (87.5%) knew that cervical cancer can be prevented by early detection. Their main sources of information included Media such as radio and TV (47.6%) and healthcare professionals at the health facility (37.6%), friends and family (14.1%). Almost half of the participants (47.9 %) didn't know about the possibility of prevention of cervical cancer through HPV vaccination. About 219/311 (70.4%) perceived themselves to be at risk for cervical cancer in this study. Although majority had heard about cervical cancer, 209 (67.2%) didn't know of any signs and symptoms of cervical cancer and the mean age of HPV vaccination mentioned was 2.41 (± 0.77), much younger than the current recommended age category of 10-14 years. The mean age for starting screening was 10.77 (± 9.87) compared to the normal recommended age of screening 21 and above.

Conclusion: Most of participants in this study had heard about cervical cancer although their knowledge of symptoms, preventive measures and importance of cervical cancer screening was low. Majority of the women perceived that they were at risk of developing cervical cancer although they were hardly knowledgeable of any reasons for their perceptions. There is need for more public awareness campaigns to provide detailed in-depth information to enhance knowledge on cervical cancer in informal settlements like slum populations.

Objective: Evaluate PMTCT services in the Lubumbashi Health Zone. Methods: This is a cross-sectional study carried out in the maternity wards of all 18 maternities in the Lubumbashi Health Zone from 1 January 2015 to 31 December 2015; one of the 27 health zones in the province of Haut-Katanga (DR Congo). Included were all women who received prenatal, perinatal and postnatal consultations during the study period.

Results: Of 12496 women admitted to ANC, 6291 (50.1%) were counseled for HIV testing; 6170 (98.5%) were screened and an incidence of 2.4% was observed. Regarding male partners of women diagnosed during ANC consultations, 120 (1.9%) were counseled, 100 (83.3%) of those who were counseled were screened for HIV and an incidence of 20% to HIV was reported. Concerning management of women screened HIV positive during ANC, 106 (89.1%) among them were placed on ART according to Option B+. One hundred and sixteen live-born infants were born from HIV positive mothers and all were placed on nevirapine prophylaxis. Forty-six (39.7%) were tested with DBS at six weeks giving an incidence of 4.3%

Conclusion: These results show that there are still challenges to be faced in preventing mother-to-child transmission of HIV in the Lubumbashi Health Zone. The integration of PMTCT activities with Option B+ in all maternity units in this health zone would reduce the vertical transmission of HIV.

Objective: To identify the impact of professional knowledge and education on willingness to participate in clinical trials.

Methods: The study was conducted during January 2017 at Eastern Michigan University, Michigan, United States. It was a cross-sectional quantitative study in which clinical research professionals were invited to complete a shortened version of the Center for Information and Study on Clinical Research Participation (CISCRP) survey assessing their willingness to participate in clinical trials. A comparison was made between the sample of this study and the results of the CISCRP survey.

Results: The 83 people who answered the survey represent 20% of the total number of people, which are 415, who were invited to participate. The study found that 80.6% of the survey respondents were willing to participate in clinical trials, significantly less than the results of the CISCRP survey on postgraduates, which found that 96.3% of respondents were willing to participate in clinical trials. In the present study, willingness was significantly higher among females and those with previous clinical trials experience. Willingness to participate correlated positively with perception of clinical trials safety (r=0.503, p<0.001).

Conclusion: Overall, the clinical research professionals were moderately willing to participate in clinical trials but they were less willing to participate in clinical trials than the postgraduate participants of the CISCRP survey. Although some factors such as safety and type of medical intervention must be considered when attempting actual participation, knowledge and professional background affected the willingness to participate in clinical trials. These findings should not discourage efforts to recruit clinical research professionals into clinical trials.

Background: Integrating HIV and family planning (FP) services can improve health outcomes, continuity of care, and efficiency. However studies on its cost-efficiency are lacking. The objective of this study is to assess and compare the cost-efficiency of two models of FP/HIV integration in Zambia.

Methods: We considered two integration models – “internal referral” (IR), where patients receive FP counselling within the HIV clinic and a referral to the FP clinic in the same facility for FP method, and “one-stopshop” (OSS), where patients receive FP counselling and a FP method within the HIV clinic. We compared the efficiency of the models using the unit cost per antiretroviral therapy (ART) patient provided with FP services. We also computed the percentage of missed opportunities for FP services provision; when patients with identified FP needs are not offered services.

Results: The unit costs per patient provided with FP method was USD $261 on average for the OSS model and USD $267 on average for the IR model. We found no statistically significant difference in unit costs between the two models (P=0.36). On average, the OSS model had 25 percent missed opportunities for FP counselling compared to 33 percent for the IR model but the difference was also not statistically significant (P=0.3).

Conclusion: A fully integrated model of FP/ART services (OSS) is not necessarily more cost-efficient than the referral model as the performance of each depends on the service delivery settings.

Despite advancements in our understanding of HIV-1 pathogenesis, critical virus components for immunity, vaccines trials, and drugs development, challenges remain in the fight against HIV-1. Of great importance is the inhibitory function of microbicidal cell penetrating peptides and bacterial toxins that interfere with production and neutralize infection of HIV-1 particles. We demonstrate that the neutralizing activity of a cationic 18 amino acids peptide, is similar to a broadly neutralizing human antibody, and inhibits production of two HIV-1 strains in human cell lines. Pretreatment of cells with bacterial toxins or toxoids derived from enterotoxigenic E. coli, boost subsequent activity of the peptide against HIV-1, to inhibit simultaneously production and infection. The synthetic peptide crosses the cell membrane into the cytoplasm and nucleus. In vitro analysis of a possible target for this peptide revealed specific binding to recombinant HIV-1 gag p24. This is the first demonstration of a synergy between bacterial toxins and a cell-penetrating peptide against HIV-1.

The HIV-AIDS pandemic is a problem affecting several African and Latin American countries including Nigeria. It is a scourge that has adversely affected the productivity levels of families, communities and eventually economies. This study is therefore designed to evaluate the Impact of HIV/AIDS on the Performance of the Nigerian Economy. Using annual time series data sourced from the World Bank Database, Central Bank of Nigeria statistical bulletin and econometric tools of analysis, findings indicated that all the variables defined in the model were stationary and there exists a unique long run relationship between the dependent and independent variables in the model. Furthermore, the research concluded that HIV/AIDS had a significant negative impact on productivity and by implication economic growth. Similarly, government spending on health had a significant positive impact on economic growth in Nigeria during the period studied. The study thus recommends that the government should urgently elicit the cooperation of all relevant stakeholders and set up policies for the prevention of the estimated output loss that could result if the disease prevalence is not controlled. Finally, infected individuals should have access to anti-retroviral drugs at the primary health centres to reduce time and resources in care-giving.

Increasing evidence suggests that the immune control of viral replication by HIV-1-specific cytotoxic T lymphocytes (CTLs) is relevant to the selection of human leukocyte antigen (HLA) allele-restricted antigen-specific CTL repertoire. But the underlying factors accounting for CTL functional difference from T cell receptor (TCR) clonal diversity are currently unclear. Here we found that CTL repertoire specific for HLA-B*27-restricted HIV-1 Gag p24 epitope KK10 (KRWIILGLNK, residues 263-272) selected multiple TCR clonotypes. By dissection of the bulk KK10-specific CTL compartment, differential potency and breadth of KK10-specific CTL clones to inhibit HIV-1 replication was defined due to the distinct TCR usage. Superior control of viral replication of wild-type HIV-1 isolates was observed by the TCR-clonotypic CTLs characteristic of higher ability to produce MIP-1β. A unique TCR-equipped KK10- specific CTLs efficiently controlled wide-type HIV-1 isolates and broadly cross-recognized viral variants. These data suggest that clonally diverse CTL responses to a viral epitope increase the likelihood that multiple divergent strains of viruses may be recognized by cross-reactive CTLs through immunization with only a single viral epitope sequence.

Background: The prevalence of opportunistic intestinal parasites is expected to be high among Human Immune Deficiency Virus infected populations in developing countries. For many years, intestinal infections caused by opportunistic organisms have been represented as a major problem in immune compromised patients with Acquired Immune Deficiency Syndromes. Methods: Institution based comparative cross sectional study design was conducted in Gendewoyn health center, Goncha Siso Enesie woreda from March to June 2014. A structured questionnaire was administered to all participants to obtain information on socio demographic characteristics and their source of drinking water. For the laboratory test using a direct saline, Dobell’s iodine separate wet mount, formal ether concentration and modified Ziehl-Neelsen (Zn) method was applied. The minimum sample size for this quantitative study was 312. Binary and multiple logistic regressions were used to identify factors of intestinal parasite infection and odds ratios, 95% CI and p-value were computed to measure the presence and strength of associations. Results: The overall prevalence of intestinal parasite infections in pre-ART and on-ART was 53.7% and 36.5%, respectively with significant decrease of intestinal parasite in the ART era (p<0.006). Majority of Cryptosporidium species infections were found in the pre-ART patients and significantly associated for lower CD4<500 cells/mm3. Absence of toilet (AOR=1.80; 95% CI=1.090-2.975), source of water (AOR=8.260; 95% CI=4.659-14.642), rural residence (AOR=2.292, 95% CI=1.386-3.788); CD4 counts (AOR=1.559; 95% CI=1.093-2.722) HAART status: pre ART patients (AOR=2.13, CI, 1.167-3.905) have significant association with prevalence of intestinal parasite infections. Conclusion and recommendations: The most prevalent parasite in the pre-ART subjects were ova of Ascaris lumbricoides (15.7%) followed by Enteamoeba histolytica (14.8%) while on ART patients the most prevalent parasites were ova of Ascaris lumbricoides (8.8%) and cyst of Enteamoeba histolytica (7.4%). The present study revealed the importance of examining pre-ART and on ART patients for intestinal parasite infections. This study reminded health professionals regarding the occurrence of these parasites in this population. Routine examination of stool samples for parasitic infections could significantly benefit pre-ART and on ART patients for early treatment.