Revista de SIDA e investigación clínica

About 84% of world's population is linked to five major religions: Christianity, Islam, Judaism, Buddhism and Hinduism. One thing common in these religions is marriage, which is a life-long cultural and spiritual union between man and women. Religions give great emphasis to marriage and discourage immorality and adultery. In Holy Bible, it is narrated, "Let marriage be held in honor among all, and let marriage bed be undefiled, for God will judge sexually immoral and adulterous" (Hebrews 13:4). Holy Quran describes, "And among His (God Almighty) signs is that He created for you spouses from among yourselves, that you may find peacefulness in them, and He has put between you affection and mercy, verily, in that are signs for a people who reflect" (30; 21). In Judaism, marriage is an important event and avoiding from it is considered as unnatural. In Buddhism and Hinduism also marriage is a sacred ceremony and lifelong commitment between wife and husband. Center for Diseases Control and Prevention recommends to abstain from oral, vaginal, and anal sex; or to be in a long-term, mutually monogamous relationship with an uninfected partner. Marriage is an excellent mod of mutual relationship between spouses, provides ample opportunity for sex entertainment and together with religious attitude helps to abstain from sex outside marriage. Present article is aimed to promote marriage and religions for prevention of sexually transmitted diseases, particularly Human Immune-deficiency Virus infection, which is becoming epidemic worldwide and there is no effective vaccine or treatment for that so far.

Objective: Decreasing the risk of HIV transmission from HIV-positive individuals is an important public health priority. We evaluated the effectiveness of a computer-based sexual risk reduction counseling intervention (CARE+) among HIV-positive persons enrolled in care. Methods: HIV-positive eligible participants (N=1075) were enrolled from 11 care sites in the Bronx, NY and Washington, DC and randomized 1:1 to either a tablet-based self-administered CARE+ intervention or standard of care (SOC). The primary outcome was the proportion of participants reporting any unprotected vaginal/anal sex at last sex, among all partners, HIV-negative or HIV-unknown-status partners and for primary and non-primary partners. Results: At baseline, 7% of participants in both arms reported unprotected sex with an HIV-negative or HIVunknown- status partner, while 13% in the CARE+ arm and 17% in the SOC arm reported unprotected sex with any partner. Most participants (88%) were on antiretroviral therapy (ART) at baseline. There was no significant difference in changes over time in unprotected vaginal/anal sex between the CARE+ and SOC arms for any partners (p=0.67) or either HIV-negative or HIV-unknown-status partners (p=0.40). At the Month 12 visit, most participants (85%) either strongly agreed or agreed that computer counseling would be a good addition to in-person counseling by a provider. Conclusion: The CARE+ intervention was not effective at reducing sexual risk behaviors among HIV-positive patients in care, most of whom were on ART. Further research may be warranted around the utility of computer-based counseling for HIV prevention.

Objective: To illustrate clinical challenges, explore existing literature and identify knowledge gaps in the management of neuropsychiatric issues beyond neurocognitive disorders in HIV patients. Methods: Three case vignettes from a consultation-liaison psychiatry setting in a general hospital were collated and summarised into a case series. Clinical questions were identified from each vignette and pertinent literature reviewed to aid a further discussion of management issues. Results: The first case vignette discusses the potential of a multi-dimensional approach to the formulation of a HIV patient with emergent psychiatric and cognitive symptoms. In the second, pharmacological treatment of a HIV patient with a severe manic relapse of Bipolar 1 Disorder and active TB disease is discussed. Lastly, the collective effects of severe Traumatic Brain Injury (TBI) and HIV infection superimposed on that of an ageing brain are described. Iatrogenic risks of polypharmacy in an elderly HIV patient are further explored. Conclusion: The practical aspects of clinical challenges regarding the management of HIV patients are multi-fold and most apparent in a real-world setting. Existing literature does not yet adequately address the diagnostic dilemmas and pharmacological complexities faced. The management of other neuropsychiatric manifestations in a HIV patient remains a crucial field to be explored.

Introduction: Repeated exposure to Human Immunodeficiency Virus (HIV) does not always result in infection. Understanding the mechanisms that confer protection against progressive infection with HIV-1 may be useful in the development of appropriate interventions. The impact of CX3CR1 polymorphisms on human immunodeficiency virus type 1 (HIV-1) pathogenesis is controversial, with conflicting reports of their role in disease progression in HIV-1 infected individuals. The aim of this study is to characterize polymorphisms of the CX3CR1 co-receptor gene among HIV infected adults and infants in a Kenyan Population. Methods: Clinical samples were obtained from 200 HIV infected infants and 200 HIV infected adults and genotyped for the CX3CR1 gene 280M and 249I mutations. These were identified by PCR–RFLP analysis after amplification of a 588 base pair sequence of CX3CR1 gene. Results: In determining the presence of T280M and V249I haplotypes it was found that overall, infants had higher percentages of the wild type alleles at (42% and 45%), respectively compared to adults (37% and 36%) respectively. In the case of heterozygous mutants, adults had higher percentages (11% and 12%), respectively than among infants (7% and 4%), respectively. Adults also had higher percentages of homozygous mutants of (2%) compared to infants (1%). This study showed that the differences in mutations of CX3CR1 gene allele in I249 and M280 was p=0.075 and p=0.215, respectively which was not statistically significant (p>0.05). Conclusion: This study showed that CX3CR1 gene polymorphisms exist in Kenya though the numbers of mutations are at very low levels to warrant any meaningful impact in the population in terms of HIV-1 disease progression. It is probable that alternative mechanisms are operating in conferring resistance to HIV-I infection. Further in vitro cellular studies need to be carried out to determine the exact role of CX3CR1 gene mutations in HIV/AIDS pathogenesis.

Background: The non-disclosure of HIV positive status has most often been accompanied by risky sexual behaviours which is a complex relationship that facilitates the transmission of sexually transmitted diseases such as HIV. Objective: To determine sexual behaviour, levels of sero-status disclose and willingness to disclose; and the socio-demographic determinants of disclosure and willingness to disclose among HIV positive male patients receiving care in hospitals in Imo State, Nigeria. Methods: A cross sectional analytical design using a simple random sampling technique to select 422 HIV male patients attending the adult HIV clinics of two major hospitals. Data was collected using a pretested, semi structured questionnaire. Descriptive statistics were presented using frequencies and summary indices. Chi square statistics were computed to determine significant relationships and binary logistic regression was used to determine predictors of disclosure and willingness to disclose. A p-value of ≤ 0.05 was considered significant. Results: A majority of the respondents were either traders or artisans (54.6%) with a mean age of 32.0 ± 2.0 years. The results revealed that more than one third of the respondents had two or more sexual partners (35.5%), less than one quarter correctly and consistently use condoms (23.3%) and close to one third had not disclosed their HIV positive status (31.7%); of which, less than two fifths are now willing to disclose (37.8%). It was further revealed that married HIV positive male patients who are traders or artisans above the age of 30 years with monthly income levels less than N40,000 ($110) and living in an urban or semi urban area with family members or other people, were significantly more likely to have disclosed their HIV positive status. Similarly, HIV positive male patients who had not disclosed their status, but are artisans aged above 30 years, were significantly more likely to be willing now to disclose their HIV positive status. Conclusion: To be successful in our efforts of HIV prevention with respect to facilitating disclosure, it is important to design and implement interventions that are tailored to the specific circumstances and characteristics of the individual.

Background: Migration, mobility, and HIV/AIDS are well-documented interlinked phenomena. While the Cameroon AIDS Strategic Plan 2014-2017 focuses on the key populations, little was mentioned on migrant workers. Nevertheless, the inclusion of migrant workers in the road construction sector in the national strategic plan offers a critical opportunity to design and deliver HIV services that meet their needs. Risk perception of HIV/AIDS should accompany risky sexual behaviour change. This study investigated the predictors of perception of risk of contracting HIV among migrant road construction workers in the Southwest region of Cameroon using the Health Belief Model (HBM) as the theoretical framework. Methods: A cross-sectional survey of a stratified sample of 254 road construction workers was conducted at construction sites along the Kumba-Mamfe road in December 2015. Data were collected using a pretested structured questionnaire and analysed using binomial logistic regression using SPSS version 20 at the level 0.05. Results: Only 109 (42.9%) perceived that they are at risk of contracting HIV. Apart from perceived susceptibility to HIV which was found to be a significant predictor of the perception of risk of contracting HIV: OR=5.12 (95% CI 0.667- 15.604, p=0.004), none of the other constructs of the HBM was a significant predictor of perception of risk of contracting HIV. However, the perception that HIV is deadly (perceived severity) was associated with an increased likelihood of perception of risk of contracting HIV: OR=1.23 (95% CI 0.523-2.893, p=0.635); the perception that consistent condom use could prevent HIV transmission (perceived benefit) was associated with an increased likelihood of perception of risk of contracting HIV: OR=1.25 (95% CI 0.518-3.008, p=0.621); the perception by workers that they could refuse sex with their partners if they refused to use condoms (perceived self-efficacy) was associated with an increased likelihood of perception of risk of contracting HIV: OR=2.04 (95% CI 0.888-4.693, p=0.093). Conclusion: There is the need for sensitization programmes and interventions to increase the perception of susceptibility to HIV/AIDS among migrant road construction workers, which will, in turn, increase their perception of risk of contracting HIV and consequently bring about sexual behaviour change.

Introducción: En los países con recursos limitados, el número de medicamentos antirretrovirales (ARV) disponibles es relativamente limitado. Por lo tanto, los cuidadores se enfrentan a cierta cautela y restricciones en los cambios de tratamiento ARV (TAR) en personas que viven con VIH (PVVIH). Nuestro objetivo fue calcular la incidencia, describir las principales causas e identificar los factores predictivos del primer cambio de tratamiento ARV en Senegal. Métodos: Realizamos un estudio de cohorte retrospectivo en 331 pacientes infectados por VIH que iniciaron TAR en 2009-2011 y siguieron hasta marzo de 2012. La incidencia se estimó utilizando el método de Kaplan-Meier. Las causas se han agrupado en cinco categorías. La identificación de factores predictivos se realizó utilizando un modelo de riesgos proporcionales de Cox. Resultados: En el momento de la inclusión, la edad media, el IMC y el recuento de células CD4 fueron 41 años (rango intercuartil (RIC) = 35-48), 18 kg/m² (RIC = 15,6-21,5) y 92 células/μl (RIC = 31-200), respectivamente. Después de una duración media de TAR de 11,4 meses, 65 pacientes habían experimentado al menos un cambio de tratamiento, lo que resultó en una tasa de incidencia general de 10,5/100 personas-año (IC del 95% = 8,4-12,6). La intolerancia a los fármacos ARV fue la principal causa de cambio en el tratamiento (41/65), seguida de los fracasos terapéuticos (5 casos) y el embarazo (tres casos). Los predictores independientes de primer cambio de tratamiento ARV fueron el sexo femenino (hazard ratio (HR)=1,85: IC 95%=1,07-3,19), el bajo peso (HR=2,20, IC 95%=1,24-3,88) y la infección por VIH-1 o dual (HR=3,57, IC 95%=1,11-11,46). Conclusión: En esta cohorte, la incidencia del primer cambio de tratamiento ARV fue baja. Fue más frecuente en mujeres, pacientes con bajo peso y pacientes infectados por VIH-1. La principal causa fue la intolerancia a los ARV. Una mejor evaluación preterapéutica, la disponibilidad de ARV compatibles con el embarazo y el tratamiento antituberculoso parecen ser relevantes en esta población.

Una nueva investigación sugiere que las personas con el virus de inmunodeficiencia humana (VIH) tienen déficits en el procesamiento auditivo central. Para revisar la evidencia de que el VIH afecta partes del sistema nervioso central involucradas en el procesamiento auditivo central, realizamos una revisión sistemática de la literatura. El objetivo era determinar si los estudios existentes muestran evidencia de daño a las estructuras asociadas con las vías auditivas centrales en el VIH. Buscamos en PubMed artículos que usaran imágenes por resonancia magnética estructural (IRM), imágenes por tensor de difusión, espectroscopia por resonancia magnética o IRM funcional en personas infectadas con VIH. La revisión mostró que el VIH afecta varias áreas involucradas en el procesamiento auditivo central, particularmente el tálamo, la cápsula interna y la corteza temporal. Estos hallazgos respaldan la idea de que el VIH puede afectar las vías auditivas centrales y respaldan el uso potencial de pruebas auditivas centrales como una forma de evaluar los efectos del VIH en el sistema nervioso central.