Acquired Immunodeficiency Syndrome Program Research Articles

Rheumatological and Immunological Manifestations among a Cohort of Human Immunodeficiency Virus Egyptian Patients

Abstract Background The human immunodeficiency virus (HIV) is a lentivirus (a subgroup of retrovirus) that is able to persist in the form of integrated proviruses in a predominantly CD4 T cell reservoir causing HIV infection and over time acquired immunodeficiency syndrome (AIDS). Objective Detection of frequency and pattern of rheumatological and immunological disorders in HIV infected Egyptian patients. Patients and Methods This study was observational cross sectional study conducted in tertiary hospital of infectious diseases in Giza, Egypt outpatient clinics and inpatient departments. It included one hundred human immune deficiency virus infected Egyptian patients diagnosed according to national AIDS program criteria having an immunological or a musculoskeletal disorder with age of ≥ 18 years. Results Results from our study which revealed a highly significant correlation between both CD4 count, HIV-PCR level and the incidence of oral ulcers. There was only a significant value between HIV-PCR level and the presence of myositis or thromboembolic manifestations. Within our 100 HIV positive patients the mean levels of ESR, CRP and SGOT levels were elevated. There was a weak inverse correlation between the CD4-positive lymphocyte count and ESR. There was a highly significant negative correlation between CD4 count and HIV infection duration ESR, CRP, urea, creatinine, blood urea level, SGOT, SGPT. Also, significant negative correlation between CD4 count and uric acid level. Moreover, there were a highly significant positive correlation between the HIVPCR level and ESR, CRP, serum creatinine level, SGOT and SGPT. There was a high significant negative correlation between the HIV-PCR level and hemoglobin level, platelets count and CD4 count. There was a significant negative correlation between HIV-PCR level and absolute lymphocyte count. Conclusion Rheumatologic manifestations are commonly occurring in HIV positive patients. Raynaud’s phenomenon, oral ulcers, and hepatosplenomegaly are significantly more prevalent in patients under non-HAART. ESR and CRP are significantly higher in patients not receiving HAART. Viral load is significantly higher in patients with non-specific antiviral treatment, while CD4 count is significantly lower in the same patient cohort. There is a significant relation between incidence of oral ulcers with lower CD4 count and higher viral load.

Evolution of HIV/AIDS response in Brazil: Policy innovations and challenges in the fourth decade of the epidemic.

Brazil was the first low- and middle-income country to provide universal treatment access to people living with the acquired immunodeficiency syndrome (AIDS), becoming a widely acclaimed model for best practice to managing this epidemic. However, we know little about important challenges to the key pillars of Brazil's response. This article discusses how the evolution of the country's health system institutions and international advancements in AIDS treatment and prevention affected the national response. Decentralization of health system resources and policy making brought fresh challenges to the centralized governance of the national AIDS program and to civil society, weakening their coordination and advocacy capacity. Regardless, AIDS treatment and prevention strategies in Brazil remain aligned with the current international protocols, but unfortunately have been restricted in some geographic areas and/or populations.

Decreases in human immunodeficiency virus infection rates in Kombolcha, Ethiopia: a 10-year data review.

IntroductionAcquired immunodeficiency syndrome is one of the most serious public health and development challenges in sub-Saharan Africa, including Ethiopia. A particular challenge for prevention strategies has been the emergence of hotspot areas. Therefore, human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome programs should not be based on national level statistics, but need to be more focused geographically. Kombolcha is one of the high spot areas with different projects and development corridors. Hence, the aim of this study is to assess the trend of HIV infection rates among patients who visited Africa Service Committee clinic from 2005 to 2014.MethodsAn institutional-based cross-sectional study was conducted from January 1 to January 30, 2016. All records of new patients enrolled from February 8, 2005 to December 31, 2014 were reviewed. Data on sociodemographic information, risky sexual behavior, and HIV test result were collected from each study participant using data collection format. Data were analyzed using SPSS version 20.0. A multivariate logistic regression model was used to identify risk factors of HIV infection.ResultsThe overall HIV infection was 10.8% (2,233/20,674). The rate of infection varied from 13.3% in 2005 to 4.5% in 2014, and its trend had significantly declined from 2008 to 2014. Urban residence (adjusted odds ratio [AOR]: 2.53; 95% confidence interval [CI]: 1.22–5.25), patients who ever had intercourse with penetration (AOR: 5.62; 95% CI: 1.11–28.57), and those who had marriage experience (AOR: 11.65; 95% CI: 4.2–32.3) were more infected with HIV.ConclusionThe trend of HIV infection significantly reduced in the last 10 years in Kombolcha area. However, the HIV infection still remains high (4.5%) that needs intervention of those who had marriage experience, risky sexual behavior, and urban dwellers.

Profile of patients diagnosed with AIDS at age 60 and above in Brazil, from 1980 until June 2009, compared to those diagnosed at age 18 to 59

ObjectivesThe aim of this study was to learn more about people diagnosed with acquired immunodeficiency syndrome (AIDS) at age 60 and above in Brazil, and to compare them with people diagnosed at a younger age. MethodsThis study was based on the analysis of secondary data from the Brazilian AIDS Program. The study population consisted of people diagnosed with AIDS at age 60 and above. The comparison group was comprised of a 20% random sample of people diagnosed at age 18 to 59, frequency-matched by year of diagnosis. Results544,846 cases of AIDS were reported in Brazil from 1980 until June 2009. Over 90% of cases were diagnosed between 18 and 59 years of age, and 13,657 (2.5%) at age 60 and above. The first case of AIDS among the elderly was reported in 1984. The comparison group consisted of 101,528 patients. Gender proportion was similar for both groups, and the proportion of people identified with AIDS after death in the Brazilian Mortality Information System (SIM) was 4% higher among the elderly. Both groups were also similar regarding the region of residence; a markedly higher proportion lived in Southeastern Brazil. Older people were more likely to have lower education and to have contracted AIDS by heterosexual contact, and less likely to be intravenous drug users. Male to female ratio among those diagnosed with AIDS at or above age 60 decreased over the years, in the same way as observed for the whole cohort. Mortality was higher among men in both groups. CD4 category (taken closest to the date of AIDS diagnosis) was very similar in both groups. ConclusionThe characteristics of the epidemic among the elderly show similarities to the younger group considering gender distribution and CD4 category, but differ regarding educational level and exposure category. Also, the elderly were more likely not to have their AIDS condition promptly diagnosed.

TB and HIV/AIDS in Bangladesh

Tuberculosis (TB) is the major opportunistic infection of acquired immunodeficiency syndrome (AIDS) in developing countries. The objective of this paper is to exemplify and review the findings associated with TB in patients with AIDS. 80 TB/AIDS-focused articles from latest internet and literature, including 3 leading Bangladesh daily newspapers between 1999-2009 were analyzed. According to the data provided by a Bangladesh Sheikh Mujib University, the number of detected people living with HIV/AIDS reached 204 as of December 2002. Most of them died of TB indicating the relationship between AIDS and TB. Measures needed in the future, if TB and HIV/AIDS are to be eliminated in Bangladesh. Tuberculosis (TB) is at least as old as human kind, one of the world's deadliest diseases and the history of the disorder is intertwined inevitably with the history of civilization. Break down in health services, the spread of HIV/AIDS and the emergence of multi drug resistant TB causing organisms are contributing to the worsening impact of this disease. Physicians say TB is one of the major syndromes of HIV infection. About 74,000 Bangladeshi people go abroad for jobs every year, which might be the sources of spreading HIV/AIDS, when they come back to the country. It has been known for some time that TB and AIDS are bedfellows. But as the government and civil society still seem impervious to this state of affairs, when the pandemic hits our shores. The AIDS program in Bangladesh and possibly others elsewhere, could consider adapting this experience, to support NGOs serving communities at highest risk towards greater funding for and co-ordination of the national NGO response. Given the link between TB and AIDS, such TB program could also work more closely with AIDS program to absorb some of the HIV surveillance responsibilities of the AIDS program, integrate clinical training and build in cross-referral systems. TB and AIDS target the marginalized; we should all be able to visualize the scale of the problem we would face. If TB and HIV/AIDS are not taken seriously soon, it will ravage our society. Key words: TB and HIV/AIDS, governmental policy and research.

Sustaining treatment costs: who will pay?

Sustaining treatment costs: who will pay?

The effects of AIDS prevention programs by lay health advisors for migrants in The Netherlands

Two studies describe the effectiveness of acquired immunodeficiency syndrome (AIDS) prevention programs by lay health advisors (LHAs) for migrants in The Netherlands. The effects of such AIDS programs were evaluated (Study 1) and compared with the effects of professional health advisors (PHAs, i.e. medical doctors or nurses) (Study 2). The first study concerned Turkish and Moroccan migrants and showed positive effects on knowledge, behavioral control, and social norm towards condom use. Iraqi refugees participated in the second study that concerned a direct comparison of LHA- and PHA-based programs. Both programs result in positive effects in terms of attitude change and knowledge, but the LHA program resulted in a stronger intention to discuss AIDS with children. Analyses predicting intention to use condoms provide evidence that LHA programs lead to a stronger relation between attitudes and intention. This suggests that LHA-based AIDS programs are more successful in inducing internally motivated intentions to safe sex practices, such as condom use.

Alpha Interferon in AIDS-Related Progressive Multifocal Leukoencephalopathy

To determine the efficacy of recombinant interferon alpha in the treatment of progressive multifocal leukoencephalopathy associated with the acquired immunodeficiency syndrome (AIDS). Open label, uncontrolled study. Neurological unit and clinical AIDS program, Boston City Hospital, Boston, MA. Four consecutive AIDS patients with pathologically confirmed progressive multifocal leukoencephalopathy. Each patient received alpha interferon for 4-12 weeks in a dose of 5-10 million units daily, administered subcutaneously. In addition, two of the four were taking acyclovir 2400 mg/day orally over the same period. None of the patients showed any clinical response to the therapy; the mean survival was 14 weeks. No adverse effects of the treatment were encountered. Despite anecdotal evidence that alpha interferon is effective in the treatment of progressive multifocal leukoencephalo pathy in non-AIDS patients, the experience of these patients suggests that the drug is of no benefit in AIDS-related PML.

The Changing Face of AIDS in Argentina

THE NUMBER of individuals infected with and affected by the human immunodeficiency virus (HIV) continues to increase worldwide. The Pan American Health Organization (PAHO) estimates that approximately 2 million people have been infected with HIV in the Region of the Americas. 1 As of June 10, 1995, more than 580 000 cases of the acquired immunodeficiency syndrome (AIDS) and 304 493 AIDS-related deaths had been officially reported since 1981. 1 Argentina reported the second highest incidence rate of AIDS cases (41 per million) in South America during 1993 (the most recent year with complete reporting for the Region of the Americas), preceded only by Brazil (80 per million). 2 AIDS Surveillance In Argentina, AIDS data are obtained from case reports filed by physician assistants, which are sent systematically to the National AIDS Program of Argentina, through the municipal or provincial level. At the national level, reported AIDS cases are reviewed

STDs and AIDS in Ghana.

Gonorrhea and other infectious diseases were introduced to Ghana prior to the colonial period by European settlers. By the 1920s, both gonorrhea and syphilis were widespread in southern Ghana (3760 and 1503 cases, respectively, in 1925-26) and soon disseminated throughout the country. By 1946, there were 82,430 cases of gonorrhea and 9340 cases of syphilis--an increase exacerbated by the influx of laborers and troops during World War II. Although there was no government department responsible for the control of sexually transmitted diseases (STDs), sulpha drugs were widely utilized and distributed through the black market. It was not until 1986, when the first case of acquired immunodeficiency syndrome (AIDS) was diagnosed in Ghana, that government health officials gave serious attention to STDs. At that time, the most prevalent STDs were gonorrhea, chlamydia, and trichomonas. By 1992, 10,285 AIDS cases had been reported to the National AIDS Control Program and high rates of human immunodeficiency virus (HIV) infection existed in prostitutes and blood donors. Awareness of the role that STDs play as co-factors in HIV acquisition prompted in 1993 the decision to integrate AIDS and STD control programs. Campaigns to train health workers in AIDS/STD detection, treatment, and prevention were initiated. Women's subordinate socioeconomic status, which renders them unable to insist on condom use and denies them access to STD treatment, remains a major obstacle.

'Invisible' Epidemic Now Becoming Visible as HIV/AIDS Pandemic Reaches Adolescents

THE NEW face of AIDS worldwide is the face of teenaged girls, the director, Adolescent AIDS (acquired immunodeficiency syndrome) Program, Montefiore Medical Center, Bronx, NY, says. Speaking at the American Medical Association's (AMA's) 2-day Early Intervention Conference for physicians and also at the 1-day press briefing held in Berlin, Germany, just before the Ninth International Conference on AIDS last month, Karen Hein, MD, made this alarming statement. Hein, who is also professor of pediatrics and associate professor of epidemiology and social medicine at Albert Einstein College of Medicine, Bronx, said that the number of 13- to 21-year-olds in the United States who have become infected with the human immunodeficiency virus (HIV) has risen by 77% in the last 2 years. In this age group, half of the transmission of the virus occurs through heterosexual intercourse. Seeing only a few hands raised when she asked her listeners how many had treated

'Invisible' epidemic now becoming visible as HIV/AIDS pandemic reaches adolescents

"THE NEW face of AIDS worldwide is the face of teenaged girls," the director, Adolescent AIDS (acquired immunodeficiency syndrome) Program, Montefiore Medical Center, Bronx, NY, says. Speaking at the American Medical Association's (AMA's) 2-day Early Intervention Conference for physicians and also at the 1-day press briefing held in Berlin, Germany, just before the Ninth International Conference on AIDS last month, Karen Hein, MD, made this alarming statement. Hein, who is also professor of pediatrics and associate professor of epidemiology and social medicine at Albert Einstein College of Medicine, Bronx, said that the number of 13- to 21-year-olds in the United States who have become infected with the human immunodeficiency virus (HIV) has risen by 77% in the last 2 years. In this age group, half of the transmission of the virus occurs through heterosexual intercourse. Seeing only a few hands raised when she asked her listeners how many had treated

Women at Risk: An AIDS Educational Needs Assessment

In order to acquire the information nurses need to develop education and support programs for women at risk for Acquired Immunodeficiency Syndrome (AIDS), a qualitative needs assessment of women at risk was conducted. Interviews were conducted with 21 women who were at risk for AIDS through their own injection drug use or as the heterosexual partners of injection drug users. Results were analyzed using the variables of the Health Belief Model, including the concept of self-efficacy. The perception of AIDS as a serious and a personal health threat motivated these women to practice both "safe sex" and "safe drug use." However, they did not always believe that recommended health behaviors would be effective; and they noted significant costs associated with these behaviors. In addition, the impact of AIDS was seen to be a heightening of the isolation and mistrust which were characteristic of the injection drug using community before the epidemic. AIDS programs for women at risk should facilitate discussion of social and community issues and should emphasize hope rather than fear.

Underreporting of AIDS in South Carolina

To the Editor.— We would like to make a few comments about areas that we feel were not sufficiently addressed in the recent article by Conway et al 1 about underreporting of acquired immunodeficiency syndrome (AIDS) in South Carolina. Their study took place between January 1, 1986, and June 30, 1987, before federal funding was allotted for an active AIDS surveillance program in South Carolina. Staff were hired for an active AIDS surveillance program in South Carolina in August 1987, long before the results of the study were known. Although we were glad to receive federal assistance for this project, it came to South Carolina much later than in high-seroprevalence states. The state general assembly has also contributed significantly to funding of our AIDS program. We feel as strongly about the importance of complete reporting of AIDS cases as Buehler et al 2 in their editorial in the same issue

I. Essay: Private Foundations And The Crisis Of Alcohol And Drug Abuse

I. Essay: Private Foundations And The Crisis Of Alcohol And Drug Abuse

Grants and Outcomes

Grants and Outcomes