Revista de SIDA e investigación clínica

Los hombres pobres tienen tasas más bajas de asesoramiento y pruebas de VIH en centros de salud y un estado serológico VIH positivo desconocido más alto que las mujeres. La teoría económica sugiere que las personas se harán una prueba de VIH si los beneficios previstos son mayores que los costos previstos. Sin embargo, pocos estudios han investigado la gama de preferencias financieras de la prueba de VIH autodiagnóstica (HIVST) entre los hombres pobres que se niegan a hacerse la prueba o no la realizan regularmente. Se realizaron veintitrés entrevistas para evaluar cualitativamente los costos percibidos ahorrados y los costos incurridos por el uso de kits de HIVST en hombres tanzanos que no se realizan la prueba con frecuencia o nunca. A todos los hombres se les mostró un kit de HIVST y un video. Luego se les preguntó sobre los costos asociados con la prueba de VIH realizada por un proveedor, los beneficios financieros y las preocupaciones sobre el HIVST y la disposición a pagar por el HIVST. Los datos se transcribieron, codificaron y analizaron utilizando análisis de contenido inductivo. Luego agrupamos los códigos en ventajas y desventajas de costos percibidas y tabulamos el rango de precios que los hombres estaban dispuestos a pagar por un kit de autoprueba. Las ventajas percibidas en términos de costo de las pruebas de VIH fueron evitar gastar dinero para realizar la prueba en centros de salud, omitir los honorarios de seguimiento, la asequibilidad en comparación con las clínicas privadas y el aumento del tiempo para generar ingresos y realizar otras actividades. Los hombres también hablaron sobre el desequilibrio entre el beneficio financiero de acceder a pruebas de VIH públicas y gratuitas y los recursos que se gastan en transporte, compra de comidas fuera de casa y largas colas de espera. Las desventajas percibidas en términos de costo de las pruebas de VIH fueron los costos prohibitivos de los kits, los ahorros previos necesarios para comprar los kits, los gastos relacionados con la muerte y las preferencias por pruebas gratuitas realizadas por un proveedor. Los hombres también estaban preocupados por los costos psicológicos de los resultados inexactos. La disposición a pagar por las pruebas de VIH varió entre los hombres. Las decisiones de los hombres de hacerse la prueba de VIH por sí mismos tienen en cuenta las ganancias y pérdidas financieras esperadas. La generación de demanda de pruebas de VIH entre los hombres debe considerar el uso de tarifas bajas o de pruebas de VIH gratuitas, al tiempo que se enfatiza el ahorro potencial de viajes reducidos, costos clínicos o tiempo fuera del trabajo. También se necesitan esfuerzos para abordar los costos emocionales previstos de las pruebas de VIH, como la ansiedad por errores en los kits, la compra de la “muerte” o la prueba por sí sola, que para algunos hombres fue una barrera importante.

Introducción: La nevirapina es el fármaco más frecuentemente acusado en toxidermias en pacientes que viven con VIH. Es responsable de la necrólisis epidérmica tóxica llamada síndrome de Lyell o síndrome de Stevens Johnson, grave durante el embarazo. Reportamos cinco casos en mujeres embarazadas VIH positivas. Reportes de casos: Cinco mujeres embarazadas de 35 años en promedio con una edad gestacional media de 29.6 semanas de amenorrea eran VIH1-positivas. El recuento medio de CD4 fue de 416/mm3. Presentaron toxidermia grave como síndrome de Lyell o síndrome de Stevens Johnson. Estas toxidermias aparecieron en promedio 26 días después de tomar terapia antirretroviral triple incluyendo nevirapina como parte de la prevención de la transmisión del VIH de madre a hijo (PTMIH). El desenlace fue favorable después de la interrupción de los antirretrovirales. La nevirapina fue sustituida por lopinavir/ritonavir. Los recién nacidos habían recibido profilaxis antirretroviral y no estaban infectados con VIH. Conclusión: La toxidermia por nevirapina es frecuente durante el tratamiento antirretroviral. Estas toxidermias son graves durante el embarazo y están relacionadas con riesgos vitales para la madre y el feto. La sustitución de la nevirapina por un antiproteasa es una alternativa terapéutica en nuestros países con recursos limitados.

Background: Liver diseases are among the most frequent causes of non-AIDS-related deaths in human immunodeficiency virus (HIV)-infected patients due to hepatitis B or C virus co-infections, and/or the toxicity of longterm treatment of some antiviral drugs. There are few cohort studies reported in China. Methods: All data from the clinic HIV/AIDS patients in the database of Tianjin Second People’s Hospital, a branch of the National Free Antiretroviral Treatment Program database, from April 1, 2010 to March 31, 2016 were retrospectively assessed and analyzed. Results: We analyzed 2270 HIV-positive, hepatitis B virus (HBV-), hepatitis C virus (HCV-) negative patients, who received cART and followed for 13334.8 person-years. A total of 67 patients (3.0%, or 5.0 per 1000 person-years) died of non-liver-related causes. The incidence of liver-related deaths in persons without HCV or HBV co-infections was zero percent during follow-up. Only 30 cases (1.3% or 2.2 per 1000 person-years) developed hepatotoxicity, but liver function of these patients improved after changing cART regimens. Conclusion: cART-related hepatotoxicity can be well-controlled and managed by modifying the therapeutic regimens. Liver-related mortality in HIV-positive, HBV-, HCV-negative patients is currently zero percent in Tianjin, China.

El virus de inmunodeficiencia humana (VIH)/síndrome de inmunodeficiencia adquirida (SIDA) es un problema de salud pública clave, en particular en el África subsahariana, incluida Kenia. El uso sistemático del preservativo es crucial, especialmente entre las personas VIH positivas, para prevenir la transmisión del VIH, así como la reinfección con diferentes cepas resistentes del virus. Es importante identificar los obstáculos para el uso del preservativo entre las personas VIH positivas a fin de establecer medidas preventivas. Por lo tanto, el estudio se realizó para explorar las barreras y los desafíos del uso del preservativo entre las mujeres que viven con VIH que asisten al Centro de Atención Integral del Hospital de Nivel 5 de Thika, Kenia. Aplicamos un método cualitativo de recopilación de datos utilizando tres debates de grupos focales y diez entrevistas a informantes clave. Se utilizó un muestreo intencional para seleccionar a los participantes. Se identificaron citas descriptivas que representaban temas clave y luego se analizaron temáticamente. El resultado indicó que las principales barreras para el uso del preservativo fueron la incapacidad de negociar el uso del preservativo, el miedo a la desconfianza, la no divulgación del estado serológico a la pareja, el consumo de alcohol y la reducción del placer sexual. Además, entre las creencias negativas y los conceptos erróneos identificados como barreras para el uso del condón se encuentran la sensación de promiscuidad por llevar condones, la religión (ser católico) y la percepción de poros en los condones. Las mujeres VIH positivas enfrentan muchos desafíos para usar condones y las áreas específicas de atención deben incluir las barreras mencionadas anteriormente.

Introduction: Few studies in Iran have explored the potential impact of factors influencing the survival time of patients with HIV and AIDS. Therefore, this study was designed to estimate the time from the HIV to AIDS progression and the time from the AIDS to the AIDS-related death and non-AIDS-related death. The prognostic factors influencing this process were also investigated. Methods: This retrospective cohort study was conducted in Isfahan province, from 2000 to 2014.The outcome was three categories: alive or lost to follow up, and death due to AIDS related, non-AIDS-related. Cox proportional hazard and competing risks Cox model was employed to evaluate the effects of prognostic variables on the survival rate of progression to AIDS and from the AIDS to the AIDS-related death and non-AIDS-related death. Results: We identified 307 patients, 44 were ineligible. At the end of the study period, 197 (74.9%) patients were alive or lost to follow up, 28 (10.6%) died from AIDS-related causes, and 38 (14.4%) died from non-AIDS-related causes. Results showed there was a significant association between gender (P=0.04), increase in age (P=0.022), TB coinfection (P=0.004), and a decreased level of CD4 cell count (P=0.012) with progression to AIDS. Also there was a significant association between CD4 level (P=0.013) and antiretroviral therapy (P<0.001) and AIDS-related deaths. There was a significant association between a level of CD4 cell count (P=0.022) and TB coinfection (P=0.01) with non-AIDS-related deaths. Conclusion: A substantial proportion of the patients had progressed to AIDS in the first year because they were identified very late. This source of HIV infection had the chance to transmit the infection to others. Also patients who died from AIDS-related causes of death had poorer immunological status at recruitment.

Aims and objective: Current study is aimed to explore and observe adverse drug reactions occurrence of antiretroviral therapy and to examine the gender differences in treatment outcomes of HIV/AIDS patients during HAART therapy. Method: An observational retrospective study of all patients on HAART therapy diagnosed with HIV infection from January 2007 to December 2012 was conducted at infectious disease department of Hospital Pulau Pinang, Malaysia. Patients socio-demographic, clinical and laboratory data was retrieved via self developed validated data collection form. Results: Out of 743 patients 571 (76.8%) were male and 172 (23.1%) were female patients. A total number of 425 (57.2%) adverse drug reactions were reported among which 311 (73.1%) occurred in males and 114 (26.8%) in female patients, with a significant statistical relationship (p=0.02, OR=1.21). Out of total ADRs (57.2%) observed in both genders, a significant association was observed in Lipodystrophy (p=0.05), anemia (p=0.02), Peripheral Neuropathy (p=0.02) and pancreatitis (p=0.01). A total of 455 (79.6%) male and 139 (80.8%) female patients have improvement in CD4 cells count at the final follow up, a significant association (p=0.05) was observed among the mode of transmission and treatment outcome. Conclusion: Overall, the ADRs observed in both gender emphasize the importance of developing safer HAART regimens and managing these adverse effects in a timely manner in order to avoid long-term health consequences.

Objective: Vulval tuberculosis (TB) is reported rarely. The histomorphological spectrum and diagnostic mimicry thereof in patients with concomitant HIV infection/ AIDS is unreported to date. This study aimed to appraise the histopathologic spectrum of vulval TB in HIV co-infected patients and to identify histopathological diagnostic challenges, mimicry and pitfalls. Methods: Ten year retrospective study that reappraised the histomorphological features of vulval TB in HIV-infected patients. Results: The clinical descriptions of the biopsied lesions from 19 patients that form the study cohort encompassed nodules (9), ulcers (5), hypertrophy/edema (3) and abscesses (2). The main microscopic features included necrotizing and non-necrotizing granulomatous inflammation, ulceration with a zoned inflammatory response and chronic suppurative inflammation. The necrotizing component had the typical morphology of caseative necrosis or of suppuration/karyorrhexis or an admixture of both necrosis types. Vasculitis, of varied histomorphology, was present in 15 biopsies. Infective special stains were pivotal diagnostic tools. The presence of mycobacteria on Ziehl Neelsen stains (ZNs) and absence of nonmycobacterial infective agents on additional infective stains, underpinned TB diagnosis, especially in biopsies that lacked prototypical granulomatous inflammation or of infective mimickers that manifest with a granulomatous phenotype. ZNs also confirmed mycobacteria in vasculitic foci. The absence of mycobacteria on ZNs facilitated the diagnosis of tuberculids. Conclusion: Lesions with a common clinical appearance had heterogeneous histomorphological features, while lesions with common histopathological features demonstrated divergent clinical morphology. Infective, especially Ziehl Neelsen, stains are pivotal in the histopathological work-up of infective/inflammatory vulval biopsies. It is possible that the rarely reported anergic mononuclear or abscessing features, pseudotumoral spindle cell reactions, ulcers with a zoned inflammatory response and the presence of vasculitis of varied type, are clues to the HIV-TB tissue partnership. Increased clinicopathological investigation of and reporting on vulval TB in the HIV/AIDS afflicted population is pivotal to ascertain this.

Background: The number of Nigerians infected with the HIV infection in 2016 was about 3 million, which was the second highest burden globally and accounted for 9% of the worldwide burden of the HIV/AIDS. The country ART (antiretroviral therapy) programme which commenced in 2001 had adult coverage of 48.3% in 2014. Effectiveness of the antiretroviral drug regimens requires a very good level of adherence (95%) to suppress viral replication. Despite all the strategies to address the adherence barriers to HAART (highly active antiretroviral therapy), the problems of poor adherence are ever-present. Factors determining adherence to HAART drug regimens have been studied in various population but little is known on this subject among PLHIV (people living with HIV) in Nigeria. Identifying and overcoming the factors that reduce adherence to combination antiretroviral agents is of utmost importance for prolonged viral load suppression. Very few of the strategies developed to mitigate the challenges of non-adherence were based on the theories of health behavior. However, behavioural theories, if adopted, could assist in the development of more effective interventions to improve treatment adherence. This cross-sectional study was conducted to explain the dynamics of HAART adherence among Nigerians living with HIV/AIDS; using behaviour change theories such as the Theory of Planned Behavior (TPB) and Health Belief Model (HBM). Methods: This was a questionnaire-based study using closed ended-questionnaires administered by the on the 225 participants. Findings: There were more female (181, 80.40%) than male (19.6%) living with HIV infection among the respondents. More than half, (139, 61.7%), of the respondents were married while less than a fifth (66; 29%) were singles About 96% of the respondents were literate with 2.7% illiteracy rate. Employment rate was also more than half (59%) while the unemployed rate was about 31.6%. Most (202, 89.8%) were of the Christianity faith TPB model factors such as the ability to set realistic goals and objectives with respect to medication adherence and meet such goals did not have any significant association with adherence (P 0.001) among the PLHIV. Likewise other TPB factors like determination and self-discipline to adhere to medications (HAART) did not have statistical association with HAART adherence. On the other hand, Health Believe Model (HBM) components such as the believes that adherence to HAART improves HIV patent's health condition (P=0.004),adherence to HIV medication is feasible in the Nigerian context (P=0.00), refusal to adhere to HAART is a serious health risk for the HIV patient (P=0.00), non-adherence to HAART is life threatening for the HIV patient(P=0.00), non-adherence to HAART can lead to AIDS faster (P=0.00) and the consequences of non-adherence to HAART are severe (P=0.00) all show significant statistical association with HAART adherence .Also significant statistical association was found between HAART adherence and other health believes like adherence to HAART is beneficial (P=0.00). Conclusion: Unlike the theory of planned behaviour, health believes Model was most suited to explaining or predicting patterns of HAART adherence behaviour among Nigerians PLHIV. However, for the model to be most effective it would need to be integrated with other models that take into account the environmental context and recommend strategies for change.

Primary presentation of HIV/AIDS can be greatly varied, with continued emphasis on primary prevention and early detection of infection; there should be a decreasing number of atypical initial presentations. It has been shown that chronic disease results in an increased risk of people developing depression, and that psychiatric features may be the only symptoms of non-malignant brain lesions. These two points combined shows that there is a possibility that HIV, a chronic medical condition, could have a psychiatric presentation. This is atypical though, and therefore is an interesting teaching point, especially in the importance of ruling out organic conditions in the presentation of psychiatric diagnosis.