Revista de SIDA e investigación clínica

Characteristics of hidden populations (e.g. population of injection drug users) cannot be studied using standard sampling and estimation procedures. This article considers methods for estimating the population proportion of hidden population using social network. We compare the sampling and estimation technique of respondent-driven sampling with the simplified sampling procedure based on Markov-chain model and discusses the equivalence of these procedures. These procedures fail to provide formulae for estimating the variances of their estimators due to the complexities of their methods. We describe a simplified sampling procedure for collecting data on both the population and its social network, and provide a simple formula to estimate the population proportion efficiently. We further derive a formula to compute an estimate of the variance of the proposed estimator using the delta method. Simulation study is provided to illustrate the new sampling and estimation method.

Introduction: Boosted protease inhibitor monotherapy (PI/r ) : Darunavir/ritonavir (DRV/r) or Lopinavir/ritonavir (LPV/r) monotherapy is only provided in the major treatment guidelines in pre-treated HIV patients to prevent toxicity associated with nucleoside/nucleotide reverse transcriptase inhibitor (NRTIs), reduce costs and simplify antiretroviral treatment. To start PI/r monotherapy, according to GESIDA g uidelines 2016, patients need to meet the following criteria: absence of chronic hepatitis B, plasma viral load <50 copies/ mL for at least 6 months and absence protease inhibitors mutations or previous virologic failures to PI/r. Currently, there are no studies that evaluate the efficacy and safety of DRV/COBI monotherapy. Methods: This prospective study analyzed pretreated HIV patients with DRV/r monotherapy that were switched to DRV/COBI monotherapy. The aim of the study is to describe the effectiveness and safety of the DRV/COBI monotherapy. Results: A total of 78 patients were evaluated. In total 11.53% (9/78) patients developed "blips" (Plasma viral load: 50-200 copies/ml) in our study and four patients had a viral load ≥ 200 copies/mL. Twelve patients (15.38%) switched to another antiretroviral treatment, so at week 48 only 66 of the 78 patients continued with DRV/COBI monotherapy. Three patients continued with "blips" at week 48. Despite "blips", virological rebounds and switch in treatments, 95.45% (63/66) of the patients with DRV/COBI monotherapy were maintained with a viral load <37 copies/mL at week 48 of the follow-up. In addition, there had been a slight increase in the CD4+ T cell count at week 48 of follow up. As for safety, there were no significant differences in lipid profile, liver function (transaminases) and renal function between DRV/r and DRV/COBI monotherapy. Conclusions: DRV/COBI monotherapy seems to be effective and safe (lipid profile, liver and kidney function). However, it will be necessary to design specific studies comparing DRV/r vs DRV/COBI monotherapy to confirm these results.

Introduction: Opportunistic infections, which mostly manifest at advanced stage of HIV/AIDS, are the leading causes of morbidity and mortality despite the existence of prevention and treatment modalities. People with advanced HIV infection are vulnerable to opportunistic infections and malignancies because of the opportunity offered by a weakened immune system. Since the types of opportunistic infections vary from region to region, for the strategies of morbidity and mortality to be reduced, identification of opportunistic infections, their frequency and distribution plays significant role. Methodology: A facility based cross-sectional study was conducted from August - September, 2016 in Wolaita Sodo teaching and referral hospital, Southern Ethiopia, among HIV/AIDS patients who were taking ante-retroviral therapy with in the past five years preceding the survey. A total of 377 study participants were selected through systematic sampling technique and a pre-tested checklist was used to collect data from clinical records of study subjects. The data was entered and analyzed by SPSS version 20. Result: The overall magnitude of opportunistic infections was 45.3%. Only 6.9% of them had co-infections. The most prevalent opportunistic infection was oral candidiasis (17.7%), followed by herpes zoster (15.5%) and pulmonary tuberculosis (11.9%). The cumulative prevalence of all forms of tuberculosis, (19.4%), was identified as the leading opportunistic infection. Cryptoccocal meningitis (2.8%), cryptosporidiosis (2.5%) and recurrent mycosis (1.4%) were the least commonly observed opportunistic infections. AIDS defining illnesses such as CNS toxoplasmosis, Cryptoccocal meningitis, pneumocystis carini pneumonea and cryptosporidiosis with diarrhea, which commonly manifest during the end stage of HIV/AIDS, cumulatively account for 14.6% of opportunistic infections. Conclusion: A high prevalence of opportunistic infection was identified among HIV/AIDS patients taking antiretroviral therapy. This indicates that the threatening burden of opportunistic infections couldn’t be averted by sole provision of ante-retroviral therapy. Therefore, in order to reduce the magnitude of the diseases, strategies beyond providing ante-retroviral therapy are required. In addition, researchers and other stake holders have to conduct longitudinal studies in order to identify risk factors for respective opportunistic infections.

Issued by the Ministry of Health and care, the directorate of health organized an expert group that through all 2014 and some months into 2015 worked on issues of legal right to gender and on the health services to individuals within the gender incongruent group in Norway. The background was expressed dissatisfaction with the state of affairs expressed both from organizations for gender incongruent, from the legal and health professions and form human rights organizations. The report delivered from the expert group in April 2015 confirms the needs for improvement on many levels both in the legal and in the health systems of Norway. The expert group’s conclusions are in very short: Self-determined gender and health-care organized by the principle of lowest effective level of care and the smallest effective dose of treatment on all levels. The right to self-determined gender down to the age of six with caretakers’ approval was issued July first 2016. The health part of the report is as of yet not implemented.

Background and methods: We studied the HIV status of patients on renal replacement therapy (RRT) and their spouses via a questionnaire. We selected 24 HIV positive patients who were either on maintenance hemodialysis (n=14) or renal allograft recipients (n=10). Patient's spouses (20) were also included. Results: Out of the 24 patients 21 were male (85.5%) and 3 females (14.5%). Only 20 patients had living spouses. Regarding probable source of infection; 20 (83.3%) patients pointed towards multiple sexual contacts, while 1 each (4.2%) stated blood transfusion and multiple needle pricks as the cause, while 2 were unsure of any cause (8.4%). Out of 20 spouses, 18 were sexually active of which 8 (44.4%) were found to be HIV Positive and all answered that they contracted the infection through sexual contact with their spouses. Among the 18 sexually active couples, 12 were using condoms, while 6 who were not using condoms were found to be HIV positive. Out of 8 HIV positive spouses, 2 were infected despite of using condoms. 15 patients out of 24 were chronic alcoholics (62.5%). Out of 44 subjects (24 patients and 20 spouses) 40 opined that social worker counselling was the most effective way of preventing spread (90.9%) followed by increasing awareness through media (n=36, 81.8%) while 30 subjects (68.2%) stated that an addition to school curriculum would be helpful in preventing its spread whereas 28 (63.6%) thought that counselling by the family physician could help in preventing the spread of the infection. Conclusion: This study concludes that people with multiple sexual contacts, intravenous drug abusers and spouses of infected patients are at high risk of contracting HIV infection. Barrier contraception, though extremely effective, is not a full proof method of protection from the spread of HIV infection. Social workers have tremendous impact in increasing awareness of HIV and restricting its spread along with media, educational curriculum and physician counselling.

While HIV is now considered a chronic and manageable disease in many developed countries largely attributable to advances in antiretroviral therapy (ART); there are unanswered questions regarding certain aspects of disease progression. The global literature consistently demonstrates that creating effective access to healthcare and antiretroviral therapy (ART), providing substance abuse prevention and treatment programs, and optimizing adherence to ART will improve HIV treatment outcomes. Nonetheless, psychosocial and cultural factors such as stigma and discrimination (as a consequence of being a sexual minority, HIV-positive, an active drug user), depression, and social isolation have been documented to have an adverse effect on HIV treatment. Macro-social determinants like access to healthcare and sociocultural like stigma and discrimination as well as psychosocial determinants like depression have an adverse effect on HIV outcomes such as ART adherence as well as overall health status or outcomes. In this study, I provide a framework incorporating all biomedical, behavioral, and structural interventions that comprehensively and systemically pose the dire need for more effective preventative care strategies for HIV in MSM. With the knowledge gained I posit that a clearer understanding of these issues among MSM living with HIV will emerge and guide further action along more specific directions. Also, I anticipate that these findings will permit a more precise quantification of each major risk factor’s contribution to treatment outcome, thus informing policy and education efforts aimed at risk factor modification. This study points the way for future biologic, behavior, and structural interventions that could improve the quality of life for people living with HIV.

Objective: Rates and determinants of first-line antiretroviral (ARV) discontinuation or change in prescribed regimen were assessed between old (pre-2006) and modern (post-2006) era stratified by dosing frequency [(once daily (QD) versus twice or more daily (BID+)]. Methods: A single-center retrospective cohort study was conducted. All adult HIV patients initiating ARVs from January 1995-November 2015 were included. Patients were stratified by old- or modern-era and by dosing frequency. The primary outcome was rate of ARV therapy discontinuation or change in initial regimen. The secondary outcome was reason for discontinuation. Results: 1,127 patients were included from the old (n=621) and modern era (n=506). Modern-era patients were more likely to receive QD regimens (p<0.001) and had increased viral suppression at the last recorded testing than oldera patients (70.9% vs. 43.2%, p<0.001). Modern-era and QD patients had better adherence and treatment duration. Patients on integrase inhibitor (INSTI)- and NNRTI-based therapy had longer treatment durations and better ARV adherence. Risk factors for treatment switch or discontinuation included old-era therapy, IDU and PI+NRTI treatment. Older ages and immigrants were less likely to discontinue therapy. Common reasons for treatment discontinuation included changing treatments to improve regimen profile, gastrointestinal side effects, and neuropsychological issues. Conclusion: In patients initiating first-line ARV, risk of discontinuation or regimen changes has diminished in the modern-era with QD, INSTI- or NNRTI-based regimens. More attention to high risk patients including IDU is advised in attempts to improve outcomes. These findings provide ‘real world’ support for current clinical practice guidelines.

Background: Medical male circumcision (MMC) is a recommended strategy for HIV prevention, but attendance for scheduled MMC is often suboptimal. We assessed the impact of cell phone and in-person reminders on uptake of MMC. Methods: Between October 2010 and June 2011, men participating in the Rakai Community Cohort Study (RCCS) were educated about the risks and benefits of MMC and those who wished to receive free MMC were referred to the Rakai MMC program. Cell phone reminders (calls and/or short message service (SMS)) and in-person renotification or persons without phone contacts were used to remind clients two days before the surgical appointment date. Proportions of men coming for scheduled surgery before (control period) and after the reminders were computed and logistic regression used to estimate adjusted odds ratios (AdjOR) and 95% confidence intervals of attendance for scheduled MMC. Results: Approximately 66.7% of men had cell phone contacts. Overall, the intervention increased attendance for scheduled MMC from 20.5% to 32.4%, AdjOR 2.01 (95%CI, 1.42, 2.83), p<0.001. Among men with no phone contacts, uptake increased from 22.2% to 31.9%, adjusted AdjOR 1.71 (95% CI, 0.97, 3.01) p=0.064, compared to an increase from 19.4% (40/206) to 32.6% (92/282), AdjOR 2.15 (95%CI, 1.39, 3.32) p=0.001 among men who had cell phone contact. Conclusion: Cell phone and in-person reminders of surgery appointments increased MMC uptake, but cell phone reminders are cheaper than in-person re-notification.

Background: The sheer amount of research being conducted in Africa, the under-resourced research ethics committees (RECs), and the lack of modern review technologies have resulted in unprecedented ethics review timelines. Method: The Research for Health Innovation Organiser (RHInnO Ethics), an automated review platform, facilitates and manages the entire ethics review process. In 2015, RHInnO Ethics was used by 25 RECs in 8 African countries. We evaluated its impact on efficiency, data security and cost using an online questionnaire administered to REC administrators in user countries. Results: The RECs interviewed were diverse with membership of 9-46 members; reviewing between 50–2000 protocols annually including observational, investigational new drugs and diagnostics. Reported areas of high impact (81%-100% of respondents) included improved: protocol submission and distribution process, quality of communication between RECs and researchers, standardized review process and data security. Reported areas of medium impact (60%-80% of respondents) included reduced; REC administrator’s workload and RECs’ administrative costs. Improved reviews of multicenter trials were reported by <60% of respondents. 20% of respondents who used RHInnO Ethics for >2 years reported 57% reduction in review time while those who used RHInnO Ethics for ± 1 year, (80%) reported it is too early to tell. Conclusion: RHInnO Ethics has achieved high-impact on data security, submission process, communication, standardization and cost reduction. However, a long-term evaluation approach is needed to determine impact on review timelines. Integration of new M&E indicators on efficiency into the platform would improve RECs capacity to conduct long-term impact.

Background: More than 90% of human immunodeficiency virus (HIV+) infected patients develop skin lesions at some time throughout the course of the disease. Several skin diseases have proved to be sensitive and useful indicators of progression of HIV+ infection. Although these conditions may be seen in general healthy population, their occurrence in patients with acquired immunodeficiency syndrome is often atypical, more severe and explosive. Objective: The aim of the study was to assess the magnitude and prevalence of skin manifestation among HIV patients in JUSH ART Clinic. Methods: A retrospective study was conducted among HIV patients in JUSH ART Clinic using a structured data collection format and the data was collected from patient’s record (card) and was analyzed by using SPSS version 20. The result was presented using numbers, ratios and tables. Results: Of 268 HIV/AIDS, patients who have follow-up in Jimma University Specialized Hospital (JUSH) Antiretroviral therapy (ART) clinic 137 (51.1%) were having skin manifestations. The commonest type of skin lesion identified was Herpes Zoster, 74 (54%). This study showed that HIV positive (HIV+) patients with advanced stages of skin disorders had relatively lower CD4+ cell counts. Skin manifestation was significantly associated with WHO clinical stage with P=0.019 and CD4+ cell count with a P-value 0.0001. Conclusion: Skin diseases are highly prevalent among HIV- Positive patients and the frequency and number of these manifestations are well correlated to the patient’s immune status and World Health Organization (WHO) staging. Therefore, examination of skin disorders, as early diagnosis and management of skin problems will improve the quality of life in HIV positive patients.