Active Antiretroviral Treatment Research Articles

Breast cancer, human immunodeficiency virus and highly active antiretroviral treatment; implications for a high-rate seropositive region.

Sub-Saharan Africa is the region in the world with the most people infected with the human immunodeficiency virus (HIV). The incidence of breast cancer is also rising in the region. This transcript focusses on the burden of these two diseases when they converge in the same populace. This comprehensive literature review of the topic suggests a trend towards an increasing incidence of breast cancer in the HIV-infected population, and the rationale for such a tendency is hypothesized, especially in the context of the availability of highly active antiretroviral therapy. Besides the age at diagnosis, all other clinical characteristics appear to be similar in HIV-positive and HIV-negative breast cancer populations. Outcomes of the different treatment modalities for breast cancer in HIV-positive patients are also appraised and finally innovative areas of future research are suggested along with plausible recommendations.

Older HIV-infected adults: complex patients-comorbidity (I).

Life expectancy in people living with HIV has increased in the past decades, since the introduction of highly active antiretroviral treatment. Increased survival comes along with new challenges for the HIV physician, as these patients will present comorbidities inherent to ageing that can appear more frequently and at younger age than the general population. The older HIV patient poses a unique challenge, as management should take into account different factors, some related to global ageing such as geriatric syndromes, traditional risk factors, social vulnerability, and age-related diseases, and others related to HIV infection like ART toxicity, drug-drug interactions, immune dysregulation and chronic inflammation. All the above can amount to great polypharmacy and multimorbidity that physician have to be aware of. Little is known about the best screening, management and treatment strategies to improve long-term health outcomes in this ageing population. The following article briefly reviews the main comorbidities that can affect the ageing HIV patient.

Seeing Through Dreams: On the Efficacy of Antiretroviral Drugs in the South African Lowveld

In Bushbuckridge, South Africa, persons receiving Highly Active Antiretroviral Treatment (HAART) for AIDS often recounted their experiences of vivid, frightening dreams. Drawing on the results of long-term fieldwork and on biographical interviews, I explore the meanings of these dreams in local discourses. Contrary to the biomedical fraternity, which depicted such dreams as a simple biochemical side-effect of the compound Efavirenz, research participants represented them as integral to the working of anti-retroviral drugs (ARVs). Through narrating the content of such dreams, research participants were able to broach topics and concerns otherwise suppressed from social intercourse. These included social isolation, exposure to extreme danger and death, and hopes of recovery. Moreover, users claimed that ARV-induced dreams aided their recovery, hardened them against misfortune and provided glimpses into transcendent realms. I show how gendered experiences, fears and aspirations were important subtexts to the narration of ARV dreams.

Quality of life of people living with HIV/AIDS attending antiretroviral clinic in the center of excellence in HIV care in India.

INTRODUCTION:HIV/AIDS is a serious challenge globally. A plethora of morbidities due to crippling immune system reduces quality of life (QOL). The advent of highly active antiretroviral treatment has changed this deadly disease to a chronic manageable illness with focus shifting from fighting virus to ensuring a good QOL.OBJECTIVE:To assess the QOL among people living with HIV/AIDS (PLHA) and factors influencing, if any in Indian setting.MATERIALS AND METHODS:An institutional-based cross-sectional study was carried out among 220 PLHA (male >15 years) attending Anti-Retroviral Therapy Centre of the center of excellence in HIV care in India (Calcutta School of Tropical Medicine, Kolkata) from May 2012 to April 2013. QOL was assessed using WHO-QOL-BREF questionnaire from January 2013 to December 2013. Statistical analysis was done using SPSS version 16; multivariate logistic regression was computed with adjusted odds ratio in 95% confidence interval; P < 0.05 was considered statistically significant.RESULTS:In this study, all 220 PLHA men participated (response rate 96.5%) where more than half (55.5%) participants rated their QOL as neither poor nor good; only 28.2% replied good. One-third (38.6%) were dissatisfied while only one-fifth (19.1%) satisfied and 41.4% mentioned neither satisfied nor dissatisfied with their health. Mean score ± standard deviation on various domains and facets of WHOQOL-BREF were physical health score 56.2 ± 9.8, psychological health 63.1 ± 8.7, social relationship 48.9 ± 14.8, and environmental health 51.3 ± 13.7.CONCLUSION:PLHA had good QOL on psychological, physical, and environmental domain that reflects better services provided at Calcutta School of Tropical Medicine (CSTM), Kolkata, but they scored poorly in social relationship domain, which may be suggestive of ineffective social services network. This study concludes that increase existing social and emotional support with innovation should be implemented to improve their QOL.

English

Greater access to highly active antiretroviral treatment (HAART) has increased the survival of people living with HIV and AIDS (PLWHA), and health-related quality of life (HRQoL) has emerged as an important indicator of treatment outcomes. However, the success of HAART depends on consistent and optimum adherence. Various cross-sectional studies and few longitudinal studies identified the relationship between HRQoL and HAART; however their association over time is still unclear. The objective of this study is to investigate the relationship between HRQoL and adherence to HAART over time. 431 PLWHAs were followed for one year at 4-monthly intervals. A descriptive adherence self-report rating scale and WHOQOL-HIV BREF were administered to collect adherence and HRQoL data respectively. Optimum adherence was set at ≥95%. Significant differences (p<0.05) in the overall mean HRQoL scores of the HAART adherent (≥95%) and non-adherent (<95%) patients were observed amongst patients on HAART for the periods of 9-28 months, 49-64 months and 81-120 months. This study established a strong relationship between adherence to HAART and HRQoL over time. Adherence to HAART is still a challenge and needs to be addressed through appropriate interventions. Key words: Highly active antiretroviral therapy, health-related quality of life, medication adherence, interrupted time-series analysis, South Africa.

A Feasibility RCT Evaluating a Play-Informed, Caregiver-Implemented, Home-Based Intervention to Improve the Play of Children Who Are HIV Positive.

Background/aim In South Africa, contextual factors have been identified as barriers to outdoor, unstructured play. The human immunodeficiency virus (HIV) and resulting progressive HIV encephalopathy (PHE) is a pandemic in this area, associated with development delays that are not addressed by highly active antiretroviral treatment (HAART). This study aimed to describe the playfulness in children with HIV and PHE on HAART living in challenging socioeconomic areas in South Africa aged 6 months to 8 years and to evaluate the feasibility and preliminary effectiveness of a play-informed, caregiver-implemented, home-based intervention (PICIHBI) for improving play. Methods A feasibility randomized control trial allowed for comparison of PICIHBI and conventional one-on-one occupational therapy interventions. Children were filmed playing pre-, mid-, and postintervention, using the Test of Playfulness (ToP) to assess playfulness. The PICIHBI comprised of 10 monthly sessions facilitated by an occupational therapist, involving group discussions with caregivers and periods of experiential play. Results Twenty-four children with HIV and/or PHE were randomized into one of the two intervention groups. Overall, the group (n = 24) had a median score of 0 (lowest item score) on nine of 24 ToP items and only had a median score of 3 (highest score) on two items. Pre- to postintervention overall ToP scores improved marginally for the PICIHBI group (n = 12) and the conventional group (n = 12). Between-group differences were not significant. The PICIHBI group demonstrated a significant increase in one ToP item score at midassessment. No significant ToP item changes were found in the conventional group. Conclusion Children with HIV were found to have the most difficulty on ToP items relating to the play elements of internal control and freedom from constraints of reality. The PICIHBI did not significantly improve children's play and was not more effective than the conventional intervention. Considerations for feasibility and effectiveness, including barriers to attendance, are discussed.

Nutritional knowledge, dietary practice and associated factors among adults on antiretroviral therapy in Felege Hiwot referral hospital, Northwest Ethiopia

BackgroundNutritional support is identified as one of the most critical and immediate needs for people living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). Adequate nutrition is vital to optimize response to medical treatment, manage opportunistic infections, maintain the immune system, and support optimal quality of life for people living with HIV/AIDS (PLWHA). Evidence has shown that the progression of the disease could be slowed with good nutrition. Nutrition interventions increase compliance with treatment regimens and optimize the benefits of antiretroviral drugs. The nutritional knowledge, dietary practice and associated factors among adults on antiretroviral therapy are not well understood generally in Ethiopia and particularly in Bahir Dar City. Therefore, the aim of this study was to assess the nutritional knowledge, dietary practice and associated factors among adult PLWHA on anti-retroviral therapy (ART) in Felege Hiwot Referral Hospital.MethodsInstitution based cross-sectional study was conducted from April 13 to May 18, 2017 in Felege Hiwot Referral Hospital. Systematic random sampling technique was used to select 539 adults on highly active antiretroviral treatment (HAART). Data were collected using a semi-structured and pretested questionnaire. Bivariate and multivariate logistic regression analyses were carried out to identify factors associated with nutritional knowledge and dietary practice.ResultsThis study shows that 25.8, 52.5 and 21.7% of respondents had poor, average and good nutritional knowledge scores respectively. Ever heard about good nutrition and received dietary counselling were significant factors for nutritional knowledge. This study also reveals that 3.2, 66.4 and 30.4% of respondents had poor, average and good dietary practice scores respectively. Presence of gastrointestinal symptom, ever heard about good nutrition and good nutritional knowledge were significant factors for dietary practice.ConclusionsThis study found that the magnitude of good nutritional knowledge and good dietary practice were 21.7 and 30.4%. Nutrition education and counseling should be given by health care workers for patients on ART to improve their nutritional knowledge. The media should also strengthen its role in disseminating nutrition information. The health professionals should routinely diagnose and treat gastrointestinal symptoms to maintain patients’ appetite for food their by increasing dietary intake.

Cotransmission of Malaria and HIV to Infants of Mothers Coinfected With Malaria and HIV in the HAART Era in Benin City, Nigeria.

Malaria and HIV are vertically transmitted to infants. In an era where specific interventions are available to reduce the burden of malaria in pregnancy and vertical transmission of HIV, we examined the transmission and cotransmission of HIV and malaria to infants of mothers coinfected with malaria and HIV. A cross-sectional analytic study performed on 101 HIV/malaria-coinfected mothers and their infants for whom DNA polymerase chain reaction results were available. Blood film for malaria parasites was performed on cord blood and peripheral blood on days 1, 3, and 7 in the newborns. Maternal peripheral blood film for malaria parasite was performed at delivery, and placental tissue was obtained for confirmation of placental malaria by histology. All infants received DNA polymerase chain reaction testing for HIV at 6-8 weeks of life. Cotransmission of malaria and HIV occurred in 2 (1.98%) infants. Vertical transmission of HIV occurred in 7 (7%) babies, whereas congenital malaria was present in 32 (31.7%) babies. The transmission of HIV and presence of congenital malaria were not significantly associated with each other P = 1.000. Of the 88 babies of mothers who commenced highly active antiretroviral treatment (HAART) before pregnancy, 5 (5.7^) had HIV, which was significantly less than 2 (40%) of 5 babies of mothers who commenced HAART during pregnancy P = 0.04. Among mothers coinfected with malaria and HIV, vertical transmission of malaria and HIV was not associated with each other. HAART reduces vertical transmission of HIV especially if started before pregnancy.

Effectiveness of Systematic Periodontal Treatment in Male HIV-Infected Patients after 9 Years: A Case Series.

Objective To investigate effectiveness of systematic periodontal treatment in the long term in HIV-infected patients undergoing highly active antiretroviral treatment. Methods Longitudinal, prospective, open-label case series over a period of nine years. Periodontal treatment was performed by scaling and root planing and supportive periodontal care (SPC) at regular intervals. To measure effectiveness, reductions of pocket probing depths were defined as primary study endpoint. Results During the study period, there was a proportional increase in periodontal pockets ≥4 mm of +53% and in pockets ≥ 6 mm of +100%. Mean pocket depth reductions on patient's level were, however, 0.4 mm nine years after scaling and root planing and supportive periodontal care (p=0.180). No teeth were lost during the observation period. Conclusions In terms of best evidence available, it is concluded that systematic periodontal treatment including SPC is effective in virologically controlled HIV infection and can be performed in dental practice safely.

Situating Expertise: Lessons from the HIV/AIDS Epidemic.

How do Scientific Advisory Committees (SACs) frame the relationship between political agency and expertise in their work? What are the political implications of the ways in which SACs legitimate or obscure specific forms of political agency? Using a South African case study, human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) activists' participation in clinical trials designed to demonstrate the efficacy of highly active antiretroviral treatment (HAART) in resource‐poor settings, and the process of translating scientific knowledge about HIV/AIDS into public policy under the leadership of a SAC, the South African National AIDS Council (SANAC), is analyzed. The case study suggests that 1) political agency plays a significant role in generating and disseminating scientific data that allow activists to fulfill their political goals; 2) SACs primarily value political agency as a resource for implementing their prescriptions and legitimating their work; 3) processes of political conscientization, movement building, democratic collective action, and deliberation can contribute to the reliability and validity of the technical knowledge SACs rely on, and under some circumstances, contribute to the political resonance their recommendations have with impacted constituencies; and 4) social theory can serve as a resource for negotiating conflicts between technical experts and activists that cannot be settled by appealing to clinical facts.

Blood levels of some toxic metals in Human Immunodeficiency Virus (HIV) Type 1- infection

Background: The introduction of antiretroviral therapy has reduced the mortality rate and increased the average life-expectancy of HIV-infected population. Infection probably due to the combination of the effects of environmental exposures and chronic inflammation and the role of mpact in infected individuals have been under-reported. Objective: To compare the plasma levels of cadmium (Cd), lead (Pb), mercury (Hg) and nickel (Ni) in HIV 1 –positive subjects receiving highly active anti-retroviral therapy treatment (HAART) and treatment-naïve subjects. Methods: The 300 study participants comprised 100 confirmed HIV-1 positive individuals on HAART, 100 HIV-1 positive HAART-naïve and 100 HIV-1 negative controls. Plasma levels of toxic metals were determined using inductively coupled plasma mass spectrometer (Agilent 7500, Norwalk, USA). Results: Plasma levels of toxic metals were significantly higher among HIV-infected subjects than controls (p &lt;0.001), with only Cadmium concentration being significantly higher (p = 0.05) among the HAART-treated subjects than HAART-naïve subjects. Conclusion: High toxic metal levels may lead to increased oxidative stress and adverse prognostic outcomes. Periodic evaluation of the blood levels of some toxic metals in HIV-1 infected individual is suggested and preventive strategies against environmental pollution should be adopted.

2228 The association of gastrointestinal symptoms and hypertension in persons living with HIV on HAART

OBJECTIVES/SPECIFIC AIMS: The advent of Highly Active Antiretroviral Treatments (HAART) has allowed HIV-positive individuals to live longer in recent years. This has resulted in a higher incidence of mortalities occurring in these individuals due to cardiovascular pathologies, as opposed to deaths due to HIV. Even with long-term HAART, persons living with HIV (PLWHIV) still exhibit inflammation, which is associated with deleterious cardiovascular outcomes. PLWHIV on HAART have a higher prevalence of hypertension, which is associated with an increased risk of cardiovascular events. Moreover, chronic inflammation has been shown to be related to the translocation of microbes and endotoxins across the gastrointestinal tract. Such microbial translocation (MT) is increased in individuals with digestive disorders and their associated symptoms (e.g., diarrhea, abdominal pain, and nausea). This study aims to explore the pathologies common to both MT-induced inflammation and cardiovascular symptoms by examining the associations between gastrointestinal symptoms and hypertension in PLWHIV on HAART. METHODS/STUDY POPULATION: The sample included 351 PLWHIV on HAART. Pre-existing de-identified data were analyzed. Sample demographics included 56.98 % African Americans, 41.31% Caucasians, ages 20–66 years (mean age=43.65years), 21% female, 89% male, HIV viral load, CD4 counts. Self-reported data from the Symptom Co-Morbidity Questionnaire and Socio-demographic questionnaire were analyzed with SPSS v.24. RESULTS/ANTICIPATED RESULTS: In total, 86 PLWHIV (24.50%) stated that they have hypertension; 39 subjects (45.3%) reported having diarrhea, 30 subjects (34.8%) reported nausea, and 12 (13.9%) reported constipation and vomiting. Among ethnicities with hypertension and gastrointestinal symptoms, African Americans compared with Caucasians had a higher percentage of diarrhea (28% vs. 17%), nausea (21% vs. 11%), constipation (11% vs. 2%), and vomiting (8% vs. 5%). Women compared with men reported a higher percentage of nausea (28% vs. 24%) and constipation (8% vs. 6%). Men compared with women reported a higher percentage of diarrhea (38% vs. 7%) and vomiting (8% vs. 5%). DISCUSSION/SIGNIFICANCE OF IMPACT: These data support the need for targeted screening to include both blood pressure and associated gastrointestinal symptoms. Further studies supporting these results may assist practitioners to target treatments that may prevent cardiovascular comorbidities.

Adverse effects in children exposed to maternal HIV and antiretroviral therapy during pregnancy in Brazil: a cohort study

BackgroundAntiretroviral therapy (ART) in pregnancy was associated with a drastic reduction in HIV mother-to-child transmission (MTCT), although it was associated with neonatal adverse effects. The aim of this study was to evaluate the neonatal effects to maternal ART.MethodsThis study was a cohort of newborns from HIV pregnant women followed at the CAISM/UNICAMP Obstetric Clinic from 2000 to 2015. The following adverse effects were evaluated: anemia, thrombocytopenia, liver function tests abnormalities, preterm birth, low birth weight and congenital malformation. Data collected from patients’ files was added to a specific database. Descriptive analysis was shown in terms of absolute (n) and relative (%) frequencies and mean, median and standard deviation calculations. The association between variables was tested through Chi-square or Fisher exact test (n < 5) and relative risk (RR) with its respective p values for the categorical ones and t-Student (parametric data) or Mann-Whitney (non-parametric data) for the quantitative ones. The significant level used was 0.05. A multivariate Cox Logistic Regression was done. Statistical analysis was performed using SAS version 9.4.ResultsData from 787 newborns was analyzed. MTCT rate was 2.3%, with 0.8% in the last 5 years. Observed neonatal adverse effects were: liver function tests abnormalities (36%), anemia (25.7%), low birth weight (22.5%), preterm birth (21.7%), children small for gestational age (SGA) (18%), birth defects (10%) and thrombocytopenia (3.6%). In the multivariate analysis, peripartum CD4 higher than 200 cells/mm3 was protective for low birth weight and preterm birth, and C-section was associated with low birth weight, but not with preterm birth. Neonatal anemia was associated with preterm birth and exposure to maternal AZT. Liver function tests abnormalities were associated with detectable peripartum maternal viral load and exposure to nevirapine. No association was found between different ART regimens or timing of exposure with preterm birth, low birth weight or congenital malformation.ConclusionHighly active antiretroviral treatment in pregnant women and viral load control were the main factors associated with MTCT reduction. Antiretroviral use is associated with a high frequency but mainly low severity adverse effects in newborns.

Sexual Health Consequences of Forced Sexual Debut Among Ugandan Women in HIV Serodiscordant Partnerships: Results From the HAARP Study.

Sexual coercion, especially forced sexual debut, is associated with lifelong adverse health consequences. This is compounded in regions, such as Uganda, where the dual impact of HIV and violence critically shapes women's sexual health risks. Among a sample of women in HIV serodiscordant relationships, we investigated the prevalence and consequences of forced sexual debut. Data for this analysis come from the Highly Active Antiretroviral Treatment as Prevention (HAARP) Study, a cohort of HIV serodiscordant couples in Jinja, Eastern Uganda, and investigates the role of forced sexual debut on two outcomes: age of sexual debut and having more than three lifetime sexual partners. Bivariate and multivariate linear regressions were used to model age at sexual debut using β and adjusted (A) β and 95% confidence intervals (CIs). Bivariate and multivariate logistic regressions were used to model having more than three lifetime sexual partners and used odds ratios (ORs) and adjusted OR (AOR) and 95% CI. A total of 574 women were included in this analysis, median age 35 years, and 241 (41.99%) were living with HIV. A quarter (24.21%) of women experienced forced sexual debut at the median age of 16 years. Forced sexual debut was significantly associated with earlier age of sexual debut (β = -1.17, 95% CI: [-1.64, -0.68]). Forced sexual debut was significantly associated with having more than three sexual partners (AOR: 1.99, 95% CI: [1.33, 2.99]), in addition to older age (AOR: 1.02, 95% CI: [1.01, 1.05]). Speaking Lusoga, the primary language in Jinja (the study site) was associated with lower odds of having more than three sexual partners (AOR: 0.63, 95% CI: [0.43, 0.92]). Forced sexual debut was a common experience significantly associated with younger age of sexual debut and higher number of lifetime sexual partners. Safe and consensual first sexual experiences for young women play an important role in reducing HIV risk and lay the foundation for healthy and safe sexual health.

Facilitators and Barriers Affecting Adherence Among People Living With HIV/AIDS: A Qualitative Perspective.

Background:It is widely accepted that for HIV-positive persons on highly active antiretroviral treatment, high levels of adherence to treatment regimens are essential for promoting viral suppression and preventing drug resistance.Objectives:This qualitative study examines factors affecting the adherence to HIV/AIDS treatment among patients with HIV/AIDS at a local hospital in Malaysia.Methods:The data from purposefully selected patients were collected by in-depth interviews using a pretested interview guide. Saturation was reached at the 13th interview. All interviews were audio-taped and transcribed verbatim for analysis using thematic content analysis.Results:Fear and stigma of perceived negative image of HIV diagnosis, lack of disease understating, poor support from the community, and perceived severity or the treatment side effects were among the reasons of nonadherence. Appropriate education and motivation from the doctors and reduction in pill burden were suggested to improve adherence.Conclusion:Educational interventions, self-management, and peer and community supports were among the factors suggested to improve adherence. This necessitates uncovering efficient ways to boost doctor–patient communication and recognizing the role of support group for the social and psychological well-being of the patients.

A Mobile Gaming Intervention to Increase Adherence to Antiretroviral Treatment for Youth Living With HIV: Development Guided by the Information, Motivation, and Behavioral Skills Model.

BackgroundHighly active combination antiretroviral treatment has been shown to markedly improve the health of HIV-infected adolescents and young adults. Adherence to antiretroviral treatment leads to decreased morbidity and mortality and decreases the number of hospitalizations. However, these clinical achievements can only occur when young persons with HIV are adherent to care. Unfortunately, adolescents and young adults have poorer rates of adherence to antiretroviral medications and poorer rates of retention in care than older adults. Novel and engaging digital approaches are needed to help adolescents and young adults living with HIV be adherent to treatment.ObjectiveThe aim of this study was to develop an immersive, action-oriented iPhone gaming intervention to improve adherence to antiretroviral medication and treatment.MethodsGame development was guided by social learning theory, taking into consideration the perspectives of adolescents and young adults living with HIV. A total of 20 adolescents and young adults were recruited from an HIV care clinic in Rhode Island, and they participated in qualitative interviews guided by the information-motivation-behavioral skills model of behavior change. The mean age of participants was 22 years, 60% (12/20) of the participants identified as male, and 60% (12/20) of the sample reported missing a dose of antiretroviral medication in the previous week. Acceptability of the game was assessed with client service questionnaire and session evaluation form.ResultsA number of themes emerged that informed game development. Adolescents and young adults living with HIV desired informational game content that included new and comprehensive details about HIV, details about HIV as it relates to doctors’ visits, and general health information. Motivational themes that emerged were the desire for enhancement of future orientation; reinforcement of positive influences from partners, parents, and friends; collaboration with health care providers; decreasing stigma; and increasing personal relevance of HIV care. Behavioral skills themes centered on self-efficacy and strategies for medical adherence and self-care. On the client service questionnaire, 10 out of the 11 participants indicated they were “satisfied with the game activities,” and 9 out of 11 “would recommend it to a friend.” On the session evaluation form, 9 out of 11 agreed that they “learned a lot from the game.”ConclusionsWe utilized youth feedback, social learning theory (information-motivation-behavioral skills), and agile software development to create a multilevel, immersive, action-oriented iPhone gaming intervention to measure and improve treatment adherence for adolescents and young adults living with HIV. There is a dearth of gaming interventions for this population, and this study is a significant step in working toward the development and testing of an iPhone gaming app intervention to promote adherence to antiretroviral treatment.Trial RegistrationClinicalTrials.gov NCT01887210; http://clinicaltrials.gov/ct2/show/NCT01887210 (Archived by WebCite at http://www.webcitation.org/6xHMW0NI1)

Effect of HIV and Antiretroviral Treatment on Auditory Functions.

Introduction Numerous studies have evaluated auditory functions in human immunodeficiency virus (HIV) patients; however, these studies had a few major limitations in terms of methodology as they used mainly evoked audiometry although this method is expensive, time consuming and not widely available. Therefore, we conducted a study in naïve HIV subjects with routine audiometry. Objective To determine the effect of HIV and of the drugs used to treat it on the auditory functions. Methods A prospective observational study was conducted in a medical college with 25 naive HIV-seropositive patients for over a year. Pure tone audiometry (250–8,000 Hz) and CD4 T-lymphocyte count were performed at the time of enrollment and 6 months after commencement of highly active antiretroviral treatment. Results The subjects had increased hearing thresholds at high frequencies (4 KHz and 8KHz) in both ears at the time of enrollment that persisted at the same level (p > 0.05) on follow-up at 6 months. None of the subjects had any other otological symptom during the 6 months of observation. Seven subjects had sensorineural hearing loss in one or both ears at 0 and 6 months. These observations did not show any significant difference on Wilcoxon-signed-rank test. Spearman correlation did not find a significant correlation (p > 0.05) between CD4 T-lymphocyte counts and pure tone audiometry during the study. Conclusion We found high-frequency hearing loss in all subjects with no relation with highly active antiretroviral therapy (HAART) and severity of the disease. This study advocates hearing assessment with pure tone audiometry in HIV subjects so that intervention can be initiated in a timely manner.

Association of highly active antiretroviral treatment with incident tuberculosis in people living with HIV/AIDS

PurposeTo determine the short-term and long-term effects of highly active antiretroviral therapy (HAART) on incident tuberculosis (TB) in people living with HIV/AIDS (PLWHA). MethodsFrom 2000 to 2012, we identified adult PLWHA from Taiwan Centers for Disease Control HIV Surveillance System. All PLWHA were followed up until December 31, 2012, and observed for TB occurrence. Time-dependent Cox proportional hazards models were used to determine the short-term and long-term effects of HAART on incident TB. ResultsOf 20,072 PLWHA, 628 (3.13%) had incident TB, corresponding to an incident rate of 701/100,000 person-years. After adjusting for potential confounders, PLWHA receiving HAART were more likely to develop TB than those not receiving the drugs (adjusted hazard ratio [AHR] 1.56; 95% confidence interval [CI] 1.18–2.05). While the short-term and long-term effects of HAART on incident TB were considered, HAART was a risk factor for TB development within the first 90 days (AHR 6.06; 95% CI 4.58–8.01) and between 90 and 180 days of treatment (AHR 1.80; 95% CI 1.11–2.94) but was a protective factor after 180 days of HAART use (AHR 0.51; 95% CI 0.39–0.66). ConclusionsHAART is a risk factor for the development of TB in the short term but a protective factor in the long term.

Higher Transplacental Pathogen-Specific Antibody Transfer Among Pregnant Women Randomized to Triple Antiretroviral Treatment Versus Short Course Zidovudine.

HIV-1 infection may impair transplacental antibody transfer to infants. The impact of highly active antiretroviral treatment (ART) given during pregnancy on transplacental antibody transport is unknown. HIV-1 infected pregnant women with CD4 counts between 200 - 500 were randomized to short-course zidovudine (ZDV) or triple ART at 32 weeks gestation for prevention of mother-to-child HIV-1 transmission. Levels of maternal antibody against measles, pneumococcus and rotavirus at delivery, and antibody transfer to the baby through cord blood, were compared between trial arms. Overall, 141 and 148 women were randomized to triple ART and ZDV, respectively; cord blood was available for a subset (n = 20 in triple ART and n = 22 in ZDV). Maternal antibody levels to all pathogens during pregnancy and at delivery were not significantly different between arms. Within each arm, antibody levels at delivery were lower than at enrolment. For all antibodies, a woman's levels before delivery were an important predictor of amount transferred to her infant. Women on triple ART transferred higher levels of pathogen-specific antibodies when compared with women on short course ZDV. Women on triple ART transferred higher levels of pathogen-specific antibodies compared with women on ZDV alone.

Evaluation of Hematological Changes in HIV Infected Pregnant Women After Receiving HAART at Debremarkos Hospital Debremarkos, Ethiopia

Hematological complications are documented as the second most common cause of morbidity and mortality in HIV/AIDS patients. Drugs for HIV/AIDS showed side effects on different hematological parameters. This study was aimed at assessing the changes in hematological profile of HIV infected pregnant women after initiation of highly active antiretroviral treatment. Retrospective cohort study was conducted to assess the hematological changes in HIV infected pregnant women after initiation of highly active antiretroviral (HAART) at ART clinic of Debremarkos hospital in Ethiopia from May to August 2017. Data available between May 2008 and August 2017 was collected from 380 patient cards of pregnant women. The data was entered into Excel spread sheet and was transported into STATA software for analysis. All data were presented as mean ± Standard error of the mean. Comparisons were made using the Paired T-test. A p-value of <0.05 was considered as a statistically significant difference. The result from the present study shows that the HAART initiation in pregnant women with HIV increases the CD4 cell count, the mean corpuscular hemoglobin concentration, white blood cell count, lymphocyte count and total mid cell count at ninety-five percent confidence interval. From the total of 380 patient cards with complete CD4 count, 200 patient cards were recorded with TDF/3TC/EFV ART regimen. The remaining 180 patient cards were documented with AZT/3TC/NVP regimen. Comparing the effect of the two Regimens on CD4 count, TDF/3TC/EFV increases the CD4 count significantly in pregnant women with HIV (p<0.0001). The other regimen (AZT/3TC/NVP) also increases the CD4 count from initial value but this increase in CD4 count after AZT/3TC/NVP initiation in pregnant women with HIV is not statistically significant (P>0.05). HAART initiation in pregnant women with HIV increases lymphocyte count, total mid cell count, red blood cell count, white blood cell count, total hemoglobin, hematocrit, mean cell volume and total platelet. On the contrary, the initial value of granulocyte count, mean cell hemoglobin, mean corpuscular hemoglobin concentration, red cell distribution width and mean platelet volume decreases after antiretroviral treatment in pregnant women with HIV.