Adult HIV-positive Patients Research Articles

1100. Outcomes of HIV-Associated Lymphoma Treatments: A Contemporary Single Center Cohort Study

BackgroundThere is a paucity of outcome studies on HIV-associated lymphoma treated with chemotherapy with or without autologous hematopoietic stem cell transplantation (autoHSCT) in comparison to HIV-uninfected individuals with similar histology.MethodsIn our retrospective matched cohort study, we enrolled adult HIV-positive patients with lymphoma treated with chemotherapy with (group 2) or without autoHSCT (group 1) between January 1, 2007 to December 31, 2018 at the University of Kansas Medical Center and followed until May 1, 2020. Group 1 were matched 1:1 to HIV-negative patients based on age, gender, lymphoma histology, stage at diagnosis, year of lymphoma diagnosis, and Group 2 were matched 1:2 to HIV-negative patients based on age at autoHSCT, gender, lymphoma histology, stage at diagnosis and year of transplantation. Overall survival (OS) and progression-free survival (PFS) at 2 years were calculated using Kaplan-Meier (KM) analysis, and adjustment for ECOG and IPI/IPS scores was done using multivariate Cox model.ResultsWe had 37 HIV+ patients with lymphoma in our cohort: 9 Hodgkin’s disease (HD), 28 Non Hodgkin’s Lymphoma (NHL). Eleven underwent autoHSCT (3 HD, 8 NHL). The majority were white (76.2%), non-hispanic (92.9%), males (90.5%) and mean age was 46 years. Median CD4 was 172.5, HIV viral load was < 50 copies/mL in 43..2%, and 76.2% were on antiretroviral therapy (ART) at diagnosis. ART was interrupted in 14.6% and adjusted in 40.5% of patients. After excluding rare histological types, 22 in group 1 and 9 in group 2 were included in the matched analysis. On KM survival at 2-years, group 1 had worse OS (75% vs 95%, p=0.02), and a trend for worse PFS (75% vs 90%, p=0.07) than the matched referent group, while group 2 had similar OS (100% vs 94%, p= 0.47) and better PFS (100% vs 70%, p=0.02) than the matched referent group. On Cox models adjusting for ECOG and IPI/IPS, HIV status was no longer independently associated with OS in group 1 or PFS in group 2.Group 1 HIV lymphoma cases and controls characteristics Group 2 HIV lymphoma with HSCT cases and controls characteristics ConclusionIn patients with HIV and lymphoma treated with chemotherapy with or without autoHSCT, the outcomes are comparable to those without HIV in our single center contempory cohort.Disclosures Wissam El Atrouni, MD, ViiV (Advisor or Review Panel member)

Incidence and predictors of sexually transmitted infections among adult HIV-positive patients receiving antiretroviral therapy at Themba Lethu HIV clinic in Johannesburg, South Africa.

Sexually transmitted infections (STIs) among people living with HIV/AIDS can facilitate the spread of HIV. To estimate STI incidence and identify predictors of STI acquisition among HIV-positive patients during their first 24months of antiretroviral therapy (ART) in Johannesburg, South Africa. We conducted a cohort study using prospectively collected routine data on patients who initiated ART between January 2004 and January 2015 at the Themba Lethu HIV clinic in Johannesburg. Kaplan-Meier analysis was used to estimate STI incidence rates (based on evidence of laboratory diagnosis and STI syndromic treatment prescription records). STI predictors were identified using Cox regression analysis. Among 26 762 adult patients on ART, there were 1 906 (7.1%) cases of STI (incidence 4.8/100 person-years; 95% confidence interval (CI) 4.7 - 5.1). Non-pregnant women were 60% more likely than men to be diagnosed with an STI (adjusted hazard ratio (aHR) 1.6; 95% CI 1.4 - 1.8). The risk of STI decreased with increasing baseline CD4 count (aHR 0.8, 0.5 and 0.4 for CD4 counts 101 - 200, 201 - 350 and &gt;350 cells/µL, respectively, compared with CD4 count &lt;100 cells/µL). Patients with advanced baseline World Health Organization (WHO) clinical stages had a higher risk (aHR 1.6 for WHO stage 4; 95% CI 1.3 - 1.9) compared with those with WHO stage 1. However, there was a 20% increase in the risk of STI among obese patients compared with underweight patients (aHR 1.3; 95% CI 1.0 - 1.7). Over 80% of obese patients diagnosed with an STI had a CD4 count &lt;200 cells/µL. STIs are common in HIV-infected patients who are receiving ART. While both ART and the syndromic management of STIs are high-impact interventions for controlling the spread of HIV, closer monitoring of STI occurrences is warranted, particularly among immunologically vulnerable patients.

Dietary Diversity and Associated Factors Among Adult HIV Positive Patients on Anti-Retroviral Therapy in Public Hospitals of Kembata Tembaro Zone, Southern Ethiopia.

BackgroundNutrition is a significant factor in all stages of HIV. Dietary management of HIV-positive patients is key to supporting their capacity to continue participating in the workforce and contributing to socio-economic growth. Few studies have been conducted regarding this important public health problem of dietary diversity throughout the developing countries including Ethiopia. Therefore, this study assesses the magnitude and factors associated with dietary diversity among HIV-positive patients attending antiretroviral therapy (ART) clinics at Public Hospitals in Kembata Tembaro Zoni, Southern Ethiopia.Methods and MaterialsAn institutional-based cross-sectional study was conducted from January 01/2019 to 30/2019 on 341 adult HIV-positive patients on ART at two randomly selected public hospitals in the study area. A systematic random sampling technique was applied to select study subjects from each facility proportionally. Bivariable and multivariable logistic regression analyses were done to identify factors associated with individual dietary diversity. Logistic regression analysis with 95% confidence interval (CI) was estimated to measure the strength of association. Level of significance for statistical tests was set at p <0.05.ResultsThis study shows 60.1% (95% CI: 55–65) of patients had inadequate dietary diversity. Average monthly income of less than 1000 Ethiopian Birr (AOR: 1.82, 95% CI: 1.04–3.17), being female (AOR = 2.99, 95% CI: 1.67–5.37), duration of ART less than 1 year (AOR = 3.77, 95% CI: 1.42–10.02) and lack of dietary counseling (AOR =0.54, 95% CI: 0.30–0.97) were factors associated with low dietary diversity.ConclusionLow dietary diversity was a major nutritional problem in HIV-positive patients. Low average monthly income, being female, duration of participants on ART, and lack of dietary counseling were the factors associated with low dietary diversity. To alleviate these problems, exceptional attention in nutritional care should be given to HIV-positive patients and they require appropriate counseling and support during early initiation of ART.

HIV-Positive Status Disclosure and Associated Factors among HIV-Positive Adult Patients Attending Art Clinics at Public Health Facilities of Butajira Town, Southern Ethiopia.

Background Human immunodeficiency virus-positive status disclosure is the process of informing one's HIV-positive status to others. It is the base for accessing care and treatment programs, attaining psychosocial support, reducing stigma, adhering to treatment, and promoting safer health. Even though different strategies were done in Ethiopia to increase the magnitude of HIV status disclosure among HIV-positive patients, the magnitude is still low. The magnitude of HIV-positive status disclosure was not assessed yet after initiation of the new strategy (test and treat strategy). The aim of this study is to assess the magnitude and factors associated with HIV-positive status disclosure among HIV-positive adults attending antiretroviral therapy clinic at the public health facilities of Butajira town. Methods Institution-based cross-sectional study was conducted at public health facilities of Butajira town. A total of 414 study participants were selected by systematic random sampling technique. Data were collected by using pretested interviewer-administered semistructured questionnaire. The collected data were entered into EpiData3.1 and exported to SPSS version 23. Bivariate and multivariable logistic regression analysis was used to identify factors associated with HIV-positive status disclosure. The strength of association was assessed by crude odds ratio and adjusted odds ratio for bivariate and multivariable logistic regression analysis, respectively. Statistically significance was declared at p value <0.05 and 95% CI. Results The magnitude of HIV-positive status disclosure was 90%. Discussing about safer sex (AOR: 3.5; 95% CI: 1.3, 9.4), viral load suppression (AOR: 4; 95% CI: 1.5, 10.1), having good ART adherence (AOR: 6; 95% CI: 2.4, 14.0), receiving counseling (AOR: 2.5; 95% CI: 1.01, 6.3), and perceiving stigma (AOR: 0.25; 95% CI: 0.09, 0.60) were the independent factors associated with HIV-positive status disclosure. Conclusion Although the majority of the participants (90%) of them disclosed their HIV-positive status, lack of disclosure by few people can tackle HIV prevention and control programs. Health programs could improve disclosure of HIV-positive status by providing counseling service, strengthening adherence of antiretroviral therapy, suppressing viral load, and avoiding (reducing) stigma on HIV-positive patients by their community.

Adverse Drug Reactions and associated factors among adult HIV-positive patients taking ART at the Yaoundé Central Hospital, Cameroon

Adverse Drug Reactions and associated factors among adult HIV-positive patients taking ART at the Yaoundé Central Hospital, Cameroon

Perceived Stigma and Associated Factors Among HIV Positive Adult Patients Attending Antiretroviral Therapy Clinics at Public Facilities of Butajira Town, Southern Ethiopia, 2020.

BackgroundStigma refers to attitudes and beliefs that lead people to reject, avoid, or fear those they perceive as being different. It identifies people as criminals, slaves, or traitors to be shunned. Globally 30–80% of people living with HIV experience stigma during their lifetime. There is a paucity of research in identifying determinants of stigma on HIV positive patients in Ethiopia. The aim of this study is to assess magnitude and factors associated with stigma among HIV positive adults attending antiretroviral therapy (ART) clinics at public health facilities of Butajira town.MethodsInstitution-based cross-sectional study was conducted at public health facilities of Butajira town. A total of 403 study participants were selected by systematic random sampling technique. Data were collected by using pre-tested interviewer-administered semi-structured questionnaire. The collected data were entered into EpiData3.1 and exported to SPSS version 23. Bivariate and multivariable logistic regression analysis were used to identify factors associated with stigma. The strength of association was assessed by crude odds ratio and adjusted odds ratio for bivariate and multivariable logistic regression analysis, respectively. Statistical significance was declared at p-value <0.05 and 95% CI.ResultsThe magnitude of stigma among HIV positive patient was 28.9%. Discussing about safer sex (AOR: 2; 95% CI: (1.14,3.18), disclosing HIV positive status (AOR: 6;95% CI: (2.3,14.9), being a female (AOR: 2.5; 95% CI: (1.41,4.12) and age >34 years (AOR: 4; 95% CI: (1.46,12.9) were the independent factors associated with stigma in HIV positive patients.ConclusionThe magnitude of stigma in ART patient is still unresolved problem. Discussing about safer sex, disclosing HIV positive status, being a female and age were the independent factors associated with stigma in HIV positive patients.

Assessment of Markers of Depression and CD4 Cell Count among Adult HIV-Positive Patients on Anti-Retroviral at a Nigerian University Teaching Hospital

Objective: Depression is a common mental health problem among people living with HIV/AIDS (PLWHA); because low count of lymphocytes with cluster of differentiation 4 (CD4 cell count) is associated with severe symptoms of HIV infection, there are thoughts that low CD4 cells count can provoke depressive illness. This study was conducted to determine the relationship between CD4 count and depression among adult HIV positivepatients attending Family Medicine clinics at University of Ilorin Teaching Hospital (UITH), Ilorin, Nigeria.Method: A hospital based descriptive cross-sectional study was done over a period of 6 months among 350 systematically randomly selected adult HIV-positive patients. PHQ-9 was used to obtain information on depression and the CD4 count was determined using a flow-cytometric method. Data were obtained and analyzed using SPSS-17. Chi-square was used to determine degree of association between the depression and the level of CD4 count. P-value of &lt; 0.05 was considered statistically significant.Results: The prevalence of depression among the respondents was 33.4%. The prevalence of depression was highest among respondents with low CD4 count (≤349cells/ul), 37.0%, and least among those with high CD4 count (≥500cells/ul), 28.3%. This relationship was however not statistically significant.Conclusion: The overall prevalence of depression was high among the respondents (33.4%) suggesting the need for routine depression screening among HIV positive patients. There was no statistically significant association between presence of depression and level of CD4 count (p-value=0.302).&#x0D; Keywords: Depression, CD4count, PLWHA, Family Medicine, UITH.

Epidemiology of survival pattern and its predictors among HIV positive patients on highly active antiretroviral therapy in Southern Ethiopia public health facilities: a retrospective cohort study

BackgroundIn resource poor countries like Ethiopia, little is known about the survival of patients treated with antiretroviral therapy which depends on different factors. Evidence shows that mortality has been high particularly in the first 3 to 6 months of initiating antiretroviral therapy. Hence, the study aimed to assess the Epidemiology of survival pattern and its determinants among adult HIV positive patients on highly active antiretroviral therapy.MethodsRetrospective cohort study was employed among a total of 455 records of patients who were enrolled on antiretroviral therapy from September 2006 to August 2010. Socio-demographic, clinical, immunological, behavioral, and date of antiretroviral treatment initiation including date of follow up status were extracted. Significant predictor variables were identified by fitting Cox’s proportional hazard model using a backward stepwise method and statistical significance variables were declared based on a p-value less than 0.05.ResultsA total of 455 adult HIV/AIDS patients on ART contributed to 886.05-person-year of observation and 65.7% were alive and on treatment, 17.1% were lost to follow up and 7.5% died. The study showed that the estimated mortality was 4.4%, 5.3%, 6.1%, 7%, 7.5% and 7.5% at 6, 12, 24, 36, 48 and 60 months of follow up period, respectively. The overall incidence rate of mortality was 4.2 per 100 person-years of observation. In multivariate analysis age 45 and above (AHR: 3.72, 95% CI 1.21–11.4), bedridden functional status (AHR: 17.4, 95% CI 6.21–48.79), poor ART drug adherence (AHR: 4.52,95% CI 2.05–9.96), Tuberculosis co-infection (AHR: 4.1, 95% CI 1.84–9.13), non-disclosure (AHR: 4.9, 95% CI 1.82–12.89) and severe anemia (AHR: 5.1, 95% CI 1.81–14.21) were found predictors.ConclusionPatients with older age, tuberculosis infection, bedridden patients and severe anemia were predictors. Tracing poorly adhered patients and giving drug counseling as well as encouraging them for disclosure to their families is crucial to improve their survival.

Prevalence of depression and associated factors among HIV/AIDS patients attending antiretroviral therapy clinic at Dessie referral hospital, South Wollo, Ethiopia

IntroductionDepression is one of the common mental health disorders and predicted to be the second cause of the global health burden by the year 2020. Depression in HIV patients may lead to poor engagement to their HIV care which may finally result in poor treatment outcomes. Therefore, the aim of this study was to assess the prevalence of depression and associated factors among HIV/AIDS patients on ART at Dessie referral hospital.MethodsAn institution based cross-sectional study was conducted among 395 HIV positive adult patients on antiretroviral treatment from November to January 2019. The study participants were selected by using the systematic random sampling technique among patients who visited the antiretroviral (ART) clinic in the hospital and standardized Patients Health Questionnaire (PHQ-9) was used to measure depression. Descriptive statistics like percentage, median with interquartile range (IQR) was computed and presented in the form of text and table. Binary logistic regression model was fitted to identify factors associated with depression. An adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to identify factors associated with depression.ResultThe prevalence of depression was found to be 20% with (95% CI 16.2, 23.8). Age group of 25–34 years (AOR = 6.58, 95% CI 1.11, 38.9), widowed marital status (AOR = 7.05, 95% CI 2.32, 21.38), perceived stigma (AOR = 2.43, 95% CI 1.13, 5.21)], had opportunistic infections [AOR = 4.96, 95% CI (1.05, 23.34)], HIV non-disclosed HIV status (AOR = 6.34, 95% CI 1.34–29.65), poor and fair drug adherence (AOR = 7.1, 95% CI 2.06, 24.44), CD4 count ≤ 200 (AOR = 5.38, 95% CI 2.37–12.23) were factors significantly associated with depression.ConclusionThe magnitude of depression was relatively lower than the pooled estimates for Ethiopia. Perceived stigma, younger age, widowed, being symptomatic, fair and poor adherence, recent opportunistic infection, low CD4 count, and HIV status not disclosed were positively associated with depression. This finding suggests the integration of mental health care with antiretroviral therapy and the special emphasis ought to be given for those at higher risk of depression.

Administering the HPV Vaccine to People Living with HIV: Providers' Perspectives.

HIV-positive patients suffer disproportionate burden of anal cancer, a disease which is primarily caused by persistent infection with human papillomavirus (HPV) and is potentially preventable with the completion of the HPV vaccine series. Past research qualitatively explored HIV-positive patients' perspectives about the HPV vaccine. However, little is known about their healthcare practitioners' vaccine recommendation behaviors, the strongest influence on vaccine uptake. This study reports on in-depth interviews conducted with 25 healthcare practitioners who provide care for HIV-positive patients. Qualitative themes that emerged from the study included clinicians' HPV vaccination behaviors, HIV patient's willingness to get the HPV vaccine, the role of HIV-positive patients' immune functioning in terms of timing of HPV vaccine administration, and vaccinating HIV-positive patients over age 26. The majority of providers offered the vaccine at their healthcare facility. Participants varied in their opinions related to the importance of patients' CD4 count in terms of timing of HPV vaccine administration; some believed that patients' immune functioning should first be stabilized to receive the most benefit from the vaccine series. They also differed in the perceived benefit of offering the vaccine to patients over age 26. In light of the U.S. Food and Drug Administration's recent approval to extend HPV vaccination to adults up to age 45years, more HIV-positive adults may benefit by receiving this vaccine series. Future efforts should ensure that providers regularly promote the HPV vaccine to their adult HIV-positive patients. Vaccinating HIV-positive patients may help reduce the burden of HPV-related cancers, particularly anal cancer.

Determinants of Active Tuberculosis Occurrences after ART Initiation among Adult HIV-Positive Clients in West Showa Zone Public Hospitals, Ethiopia: A Case-Control Study

Introduction. Tuberculosis is a major public health concern globally, especially in sub-Saharan African countries. It is the most common opportunistic infection and leading cause of mortality among people living with human immunodeficiency virus despite increased deliverance of antiretroviral therapy. Objectives. The aim of this study was to identify determinants of active tuberculosis among adult HIV positive patients after ART initiation in West Showa Zone public hospitals, Ethiopia. Methods. Multicentred unmatched case-control study was conducted on selected public hospitals in West Showa Zone from February to June, 2019. A total of 406 participants (203 cases and 203 controls) were included in the study. Cases were adult HIV patients who developed tuberculosis after ART initiation while controls were adult HIV patients who did not develop tuberculosis after ART initiation. Data were collected using interviewer administered structured questionnaire. Logistic regression analysis was performed using SPSS version 24 statistical software. Statistical significance test was set at 95% confidence level. Results. This study identified that patient’s previous TB history (AOR = 2.41; 95% CI: 1.49, 3.90; P value&lt;0.001), haemoglobin level (AOR = 3.67; 95% CI: 1.98, 6.79; P value&lt;0.001), CD4 cells count (AOR = 2.02; CI: 1.24, 3.29; P value=0.004), adherence level (AOR = 19.00; CI: 5.59, 64.59; P vaue&lt;0.001), and WHO HIV/AIDS clinical stage (AOR = 2.58; CI: 1.59, 4.18; P vaue&lt;0.001) were found to be statistically significant determinants for the occurrence of tuberculosis among PLHIV after ART initiation. Conclusion. Patient’s previous TB history, haemoglobin level, CD4 cells count, adherence level, and WHO clinical stage were significant determinants of occurrence of tuberculosis after ART initiation in PLHIV.

Comparative Diagnosis of Latent Tuberculosis Infection amongst HIV and Diabetic Patients Attending Tertiary Hospitals in Anambra State

Aims: The aim of this research work was to survey the epidemiology and diagnosis of Latent Tuberculosis Infection (LTBI) amongst HIV and Diabetic patients in Anambra state of Nigeria using Tuberculin Skin Test (TST) and Interferon Gamma Release Assay (IGRA).&#x0D; Study Design: This was a multicenter study covering three tertiary hospitals in Anambra State involving 480 adult HIV positive and Diabetic patients with 240 normal participants as control.&#x0D; Place and Duration of Study: This study conducted from February 2016 to April 2018 involved the general hospitals chosen from the three senatorial zones in the state. &#x0D; Methodology: IGRA using T spot TB as well as TST were done for all the participants. HIV screening, CD4 count and Fasting Blood Sugar were also done accordingly.&#x0D; Results: Overall prevalence of Latent Tuberculosis Infection (LTBI) was 24.4% and 22.5% for IGRA and TST respectively, of the two health groups, HIV group had 35% and 20% for IGRA and TST respectively in their overall prevalence, this was significant (P&lt;.05) compared with the controls which had 2.5% and 4% respectively to IGRA and TST. The diabetics group on the other hand had 13.8% and 25% for IGRA and TST respectively, this also was significant (P&lt;.05) in comparison to its control group with 1.6% each for both IGRA and TST. Out of the 480 patients, 74(15.4%) of them had concordant result, this was 63.2% of the total positive value in the two groups worked on while 43(8.95%) and 34(7%) patients constituted the discordant figures for IGRA and TST respectively.CD4 count was inversely proportional to the presence of LTBI amongst HIV patients using the TST method. Age and duration of illness were significantly associated with LTBI in diabetics (P&lt;.05). Participation rates were higher among males, though females recorded a non significant higher prevalence on the two test methods.&#x0D; Conclusion: There was a high prevalence of latent tuberculosis infection amongst HIV and Diabetic patients in Anambra State. IGRA and TST diagnostic results were not concordant with each other but IGRA appeared to be more specific than TST in diagnosing LTBI.

Tuberculosis and its association with CD4+ T cell count among adult HIV positive patients in Ethiopian settings: a systematic review and meta-analysis

BackgroundTuberculosis (TB) and HV have been intertwined and makeup a deadly human syndemic worldwide, especially in developing countries like Ethiopia. Previous studies have reported different TB incidences and its association with CD4+ T cell counts among HIV positive patients in Ethiopia. Thus, the goal of this meta-analysis was, first, to determine pooled incident TB among adult HIV positive patients, and second, to assess the association between incident TB and baseline CD4+ T cell count strata’s.MethodsWe searched PubMed, Cochrane library, Science Direct and Google scholar databases from June 1 to 30, 2018. The I2 statistics and Egger’s regression test was used to determine heterogeneity and publication bias among included studies respectively. A random effects model was used to estimate pooled incident TB and odds ratio with the respective 95% confidence intervals using Stata version 11.0 statistical software.ResultsA total of 403 research articles were identified, and 10 studies were included in the meta-analysis. The pooled incident TB among adult HIV infected patients in Ethiopia was 16.58% (95% CI; 13.25–19.91%). Specifically, TB incidence in Pre-ART and ART was 17.16% (95% CI; 7.95–26.37%) and 16.24% (95% CI; 12.63–19.84%) respectively. Moreover, incident TB among ART receiving patients with baseline CD4+ T cell count < and > 200 cells/mm3 was 28.86% (95% CI; 18.73–38.98%) and 13.7% (95% CI; 1.41–25.98%) correspondingly. The odds of getting incident TB was 2.88 (95% CI; 1.55–5.35%) for patients with baseline CD4+ T cell count < 200 cells/mm3 compared to patients with baseline CD4+ T cell count > 200 cells/mm3.ConclusionHigh incident TB among adult HIV positive patients was estimated, especially in patients with CD4+ T cell count < 200 cells/mm3. Therefore, Early HIV screening and ART initiation, as well as strict compliance with ART and increasing the coverage of TB preventive therapy to more risky groups are important to prevent the problem.Trial registrationStudy protocol registration: CRD42018090802.

A study on the impact of HIV related stigma on adherence to anti-retroviral treatment among people living with HIV/AIDS in central Kerala, India

Background: In India, an estimated 20,88,638 people are living with HIV/AIDS (prevalence 0.27%). The people living with HIV/AIDS (PLHA) are facing double burden of physical and psychosocial impact of infection. This study is conducted to determine prevalence of HIV related stigma among PLHA and to find the association between stigma and adherence to Anti-Retroviral Therapy (ART) among HIV patients in central Kerala.Methods: A cross-sectional study was done from July to December 2018 among 105 adult HIV positive patients who have enrolled in Thrissur Network of People living with HIV/AIDS (TNP PLUS). After obtaining informed consent, the participants were interviewed using a structured interview schedule consisting of questions on socio-demographic details, stigma and ART adherence.Results: The prevalence of high stigma was found to be 21% and moderate stigma 61%.Out of 105 study subjects,68 (64.8%) were found to have a high adherence to ART (≥95%) and 37 (35.2%) were found to have a low adherence (&lt;95%). Patients who had a moderate/high internalized stigma tend to have a low adherence to ART as compared to patients who had low stigma (OR=3.4 (1.2-12.8) p=0.04). On analyzing the association between the different forms of stigma and adherence to ART, isolation by family members, abandoned by friends and verbal stigma were significantly associated with low ART adherence.Conclusions: HIV related internalized stigma was pervasive among the study subjects. These patients also experience other forms of enacted stigma. The presence of internalized stigma was found to be significantly associated with low adherence to ART.

Adverse Event Risk Assessment on Patients Receiving Combination Antiretroviral Therapy in South Africa

Purpose: To determine the risk factors for the development of serious adverse events (AEs) in black adult patients on combination antiretroviral therapy (cART). Methods: This prospective cohort study consisted of 368 adult black HIV positive patients receiving cART at the Grey’s Hospital, KwaZulu-Natal, South Africa. Patients were intensively monitored for incidence of adverse events and the factors associated with their development, under the Antiretroviral Cohort Adverse Event Monitoring in KwaZulu-Natal (ACADEMIK). Multiple logistic regression models were used to identify the risk factors for AEs. Results: A total of 406 AEs were reported across the 13 patient hospital visits in the study. Peripheral neuropathy was the most prevalent adverse event (16%), followed by hypercholesterolaemia (14%), lipoatrophy/lipodystrophy (13%) and skin reaction (11%). Cluster differentiation (CD4) counts (p = 0.0280), age (p = 0.0227) and weight (p = 0.0017) were identified as the significant predictors for hypercholesterolaemia, while sex (p = 0.0309) was significant with respect to skin reaction. CD4 counts (p=0.0200) was also significant for lipoatrophy/lipodystrophy. Skin reaction (23%), diarrhea (18%), hypercholesterolaemia (15%), thrombocytopenia (15%) and peripheral neuropathy (13%) were the top five most incident AEs. Overall, about 46% of the regimens administered were tenofovir-based and 31% zidovudine-based. Conclusions: To enhance the prevention of hypercholesterolaemia, lipoatrophy/lipodystrophy and skin reaction among black adult HIV positive patients on cART, we recommend that CD4 counts and weight be closely monitored and documented during clinic visits.

Impact of the test and treat policy on delays in antiretroviral therapy initiation among adult HIV positive patients from six clinics in Johannesburg, South Africa: results from a prospective cohort study

ObjectivesTo assess delays to antiretroviral therapy (ART) initiation before and after the Universal Test and Treat (UTT) and the same-day initiation (SDI) of ART policy periods in Johannesburg, South Africa.DesignProspective...

The Pattern of Haematological Changes in the Baseline Blood Cell Counts and the CD4&amp;amp;#8314; T Lymphocyte Levels among Antiretroviral Therapy Na&amp;#239;ve Adult HIV Positive Patients in a Nigerian Hospital

Background: Haematological abnormalities are strong independent predictors of morbidity and mortality in HIV infection. Objectives of the Study: This study was carried out to assess the pattern of the changes in the baseline peripheral blood cell counts among adult HIV positive patients. To also determine the CD4+ T cell levels and its correlation with the changes in the baseline cell counts of the patients using HIV negative blood donors as controls. Methods: This was a case controlled prospective study. The subjects were antiretroviral therapy naive adult HIV positive patients and HIV negative blood donor controls. Five milliliters (5 mls) of venous blood was collected from the cubitus of every consecutive consenting subject. Blood sample was analysed for baseline complete blood cell counts and the CD4+ T lymphocyte levels using Sysmex and Cyflow R Counter autoanalysers respectively. Obtained data was analysed with the statistical package for the social scientist (SPSS version 20.0). The Erythrocyte sedimentation rate of subjects was measured by the manual standard Westergreen method. Results: Of 300 subjects, there were 139 (46.3%) males and 161 (53.7%) females in the study. Anaemia was found in 72 (29.2%), leucopenia in 20 (8%) and thrombocytopenia in 6 (2.4%) of the patients. The mean erythrocyte sedimentation rates of the subjects were 81.88 mm/hr and 9.46 mm/hr (p = 0.000) for the patients and the controls respectively. The mean CD4+ T lymphocyte cell counts were 293 cells/μl and 750 cells/μl (p = 0.000) for the patients and controls respectively. Conclusion: Anaemia, leucopenia and thrombocytopenia were more prevalent among the studied HIV positive patients.

Seroprevalence of Toxoplasma gondii in newly diagnosed HIV seropositive patients.

Background & objectives:Immunocompromised individuals mainly HIV infected patients are at a great risk for developing toxoplasmosis. The presence of toxoplasmosis among HIV-infected patients directly correlates with the prevalence of anti- Toxoplasma gondii antibodies and the degree of immunosuppression (measured by CD4 counts). The data regarding the seroprevalence of toxoplasmosis in HIV-infected patients are scarce in India. Therefore, this study was initiated to find out the seroprevalence of toxoplasmosis in treatment-naïve HIV seropositive patients and to determine its association with CD4 counts, if any.Methods:Four hundred newly diagnosed antiretroviral therapy (ART) naïve adult HIV positive patients coming for CD4 count estimation were tested for the presence of anti-Toxoplasma IgG antibodies. Risk factors for acquisition of toxoplasmosis as well as the age, gender and CD4 counts of the patient were noted down.Results:Toxoplasma IgG was positive in 292 (73%) patients, and the positivity was not related to their CD4 counts. The proportion of anti-Toxoplasma IgG positivity showed no significant association with age, gender and risk factors of the patients.Interpretation & conclusions:In the absence of any specific vaccine or prophylaxis for toxoplasmosis, it is pertinent to screen all HIV-positive patients for Toxoplasma IgG at diagnosis, irrespective of their CD4 counts, and sensitize them about the means to prevent either acquisition or activation of infection to avert the development of toxoplasmic encephalitis.

Magnitude of antiretroviral treatment failure and associated factors among adult HIV-positive patients in Harar public hospitals, Eastern Ethiopia.

Background:Antiretroviral treatment failure occurred when the antiretroviral regimen is unable to control HIV infection. There is no information on antiretroviral therapy failure in this study area.Objective:The aim of this study was to assess the magnitude and associated factors of antiretroviral therapy failure among HIV-positive adult patients in Harar public hospitals from January to February 2018.Methods:An institution-based cross-sectional study was conducted using chart review data from February 2005 to July 2017. Systematic sampling technique was used to include a sample of 1094 patient charts. Data were analyzed by Statistical Package for Social Sciences version 20.0. Statistical significance was considered at p < 0.05.Results:The prevalence of first-line antiretroviral treatment failure was 21% (95% confidence interval = 18.3–23.5). Being male in sex, age of 45–54 years, patients with World Health Organization stages 3 and 4 during antiretroviral therapy initiation, a baseline CD4 count <100 cells/mm3, poor drug adherence, and on antiretroviral therapy follow-up for ⩾25 months were predictors of antiretroviral treatment failure.Conclusion:In this study, the rate of antiretroviral treatment failure is relatively high. Therefore, the concerned body should pay attention to the predictors to reduce the risk of treatment failure among this study group.

Retention in HIV/AIDS Management Services: is it Really Poor? The Case of Yaounde Central Hospital in Cameroon.

Background:After consecutively defaulting on their appointments for three months, many HIV positive patients are often reported to have defaulted on their treatment, become lost to follow-up (LTFU), or no longer in care. We sought to determine if retention in HIV/AIDS care and treatment is really poor.Methods:Outcomes of patients with missed clinic appointments and reasons for missing appointments were studied. We sampled adult HIV positive patients on antiretroviral therapy (ART) who by clinic had missed their clinic appointments by more than four weeks between 1997 and 2019 at the HIV Care and Treatment Center (CTC) (Day Hospital) of the Yaoundé Central Hospital. We assumed that patients who missed their clinic appointment also missed some doses of their ART medications. Patients considered LTFU and those who had defaulted for two months were traced by telephone calls and home visits. Reasons for ART discontinuation were recorded for those who stopped or interrupted ART.Results:Of the 1139 patients who were either LTFU or who had defaulted for two months, 247/1139 (22 %) could not be traced. Out of the successfully traced patients, 50 (4%) had died and 798/1139 (70%) were alive and 310/1139 (27%) were on ART of which 35/1139 (3%) had developed informal ways of obtaining ART through clinic personnel. A good number were brought back to and reinitiated on ART after tracking (540/1139 or 47%). Of those known not to be on treatment(ART), 27/1139 (2%) had deliberately stopped ART and 63/1139 (6%) promised to return and took an appointment with CTC pyscho-social workers. Major reasons shared for missing clinic appointments were travel out of city (39%), distance from health facility, and financial cost for getting to health facility.Conclusion and Global Health Implications:Despite clinic data showing many patients had missed monthly appointments or were LTFU, we saw that a sizeable amount of such patients were actually in care and on ART. The above findings lead to the suggestion that clinic data used in program performance evaluation may not always reflect the true picture retention in care for persons in HIV/AIDS programs at hospital and national levels.