Advanced Stages Of AIDS Research Articles

Suicidal ideation, attempt, and its associated factors among HIV/AIDS patients in Africa: a systematic review and meta-analysis study

BackgroundSuicidal ideation and suicidal attempt are warning signs for and determine the prognosis of completed suicide. These suicidal behaviors are much more pronounced in people living with HIV/AIDS. Despite this, there is a scarcity of aggregate evidence in Africa. This study was therefore aimed to fill this gap.Methodswe extensively searched Psych-info, PubMed, Scopus, and EMBASE to obtain eligible studies. Further screening for a reference list of articles was also done. Meta XL package was used to extract data and the Stata-11 was also employed. Cochran’s Q- and the Higgs I2 test were engaged to check heterogeneity. Sensitivity and subgroup analysis were implemented. Egger’s test and funnel plots were used in detecting publication bias.ResultsThe pooled prevalence of suicidal ideation was 21.7% (95% CI 16.80, 26.63). The pooled prevalence of suicidal ideation in Ethiopia, Nigeria, Uganda, and South Africa was 22.7%, 25.3%, 9.8%, and 18.05% respectively. The pooled prevalence of suicidal ideation was larger; 27.7% in studies that used Composite International Diagnostic Interview (CIDI) than Mini-international Neuropsychiatric Interview (MINI); 16.96%. Moreover, the prevalence of suicidal ideation in studies with a sample size of < 400 was 23.42% whereas it was 18.3% in studies with a sample size ≥ of 400 participants. The pooled prevalence of suicidal attempts in this study was 11.06% (95% CI 6.21, 15.92). A suicidal attempt was higher in Ethiopia (16.97%) and Nigeria (16.20%) than Uganda (3.51%). This pooled prevalence of suicidal attempt was higher among studies that used a smaller sample (< 400 participants) (15.5%) than studies that used a larger sample size (≥ 400 participants) (8.4%). The pooled prevalence of suicidal attempt was 3.75%, and 16.97% in studies that used MINI and CIDI respectively. Our narrative synthesis revealed that advanced stages of AIDS, co-morbid depression, perceived HIV stigma, and poor social support was among the factors strongly associated with suicidal ideation and attempt.ConclusionThe pooled magnitude of suicidal ideation and attempt was high and factors like advanced stages of AIDS, co-morbid depression, perceived stigma, and poor social support were related to it. Clinicians should be geared towards this mental health problem of HIV patients during management.

Depressive symptoms and their determinants in patients who are on antiretroviral therapy in the case of a low-income country, Ethiopia: a systematic review and meta-analysis

BackgroundThe presence of depression in people living with HIV/AIDS could lead to non-adherence to antiretroviral medications. It also leads to further comorbid and opportunistic illness and then lowering the patient's quality of life. The objective of this study was therefore to determine the pooled prevalence of depression and its related factors in HIV patients.MethodsRelevant articles in PubMed, Scopus, and EMBASE were investigated. The Meta-XL version 5.3 was used to extract data and STATA-11 Meta-prop packages with the Random effect model was used to quantify depression and its related factors. Sensitivity and subgroup analysis were performed to explore sources of heterogeneity. The Cochran’s Q-statistic and the Higgs I2 test were also done. Besides, the Eggers test and symmetry in the funnel plot were used to detect the presence/absence of publication bias.ResultIn this meta-analysis, we included 21 articles that assessed 10,090 participants. The average prevalence of depression among people with HIV/AIDS was 35.8% (95% CI 28.29, 43.25). The average estimated prevalence of depressive symptoms was 59.4% in the Oromia region and 29.25% in southern Ethiopia. Besides, the average prevalence of depression was 45.6% and 26.2% as measured with Beck’s depression inventory and Hospital anxiety and depression scale respectively. Moreover, the prevalence of depression was 47.7% in studies that used a sample size ≤ of 400 participants and 28.5% in studies that used a sample size of > 400 participants. The pooled adjusted odds ratio (AOR) of perceived HIV stigma was 3.75 (95% CI 2.34, 5.16) and that of poor social support was 6.22 (95% CI 2.96, 9.47). Moreover, the average odds ratio of poor medication adherence, opportunistic infection, and advanced stages of AIDS were 3.03 (95% CI 1.00, 5.05), 5.5 (95% CI 1.97, 10.03), and 5.43 (95% CI 1.60, 9.28) respectively.ConclusionThe pooled prevalence of depression among individuals living with HIV/AIDS was high. Factors such as perceived HIV stigma, poor social support, opportunistic infection, advanced AIDS stage, and poor medication adherence were related to it. Routine screening and management of depression and its related factors should be given due consideration.

Anemia in HIV/AIDS Patients on Antiretroviral Treatment at Ayder Specialized Hospital, Mekele, Ethiopia: A Case-Control Study.

BackgroundHuman immunodeficiency virus and anemia are the major public health problems in Sub-Sahara Africa. Untreated anemia is associated with rapid progression and poor prognosis of the disease in HIV. This study was aimed at determining the magnitude, severity and associated factors of anemia among HIV infected patients taking zidovudine and tenofovir-containing first-line HAART in Ayder Comprehensive Specialized Hospital, Mekele, Ethiopia.MethodsA case-control study was conducted from February to August 2019 using both convenient and quota sampling methods. Anemia is defined as hemoglobin value below 13 g/dl for male and below 12 g/dl for female. Sociodemographic and clinical characteristics were assessed using a structured questionnaire, medical records, electronic weighing scale, adult height board, automated hematology analyzer (Sysmex XT-4000i), and Becton Dickinson’s FACS caliber flow cytometer. Descriptive statistics, tables, graphs, Student’s t-test and l logistic regression were used to analyze the data.ResultsAbout one-third (33.5%) of study participants were found to be anemic (ZDV: 20.3%; TDF: 13.2%, and p<0.05). Among these anemic cases, the majority was found to have mild, and the remaining was moderate types. The most common form was normocytic-normochromic anemia (46.5%). Cotrimoxazole prophylaxis, poor adherence, advanced AIDS stage at baseline and underweight at baseline were the factors associated with anemia in patients taking zidovudine-containing regimen (p<0.05). Advanced stage at baseline, cotrimoxazole prophylaxis, poor adherence status and lack of regular income were significantly associated with anemia in patients taking tenofovir-containing regimen (p<0.05).ConclusionWe find that the prevalence of anemia was significantly higher among patients taking ZDV-containing regimen. But different risk factors for anemia had been identified among ZDV-containing regimen, showing that appropriate follow-up, nutritional supplementation, continuous evaluation of patients on cotrimoxazole intake can reduce the risks of anemia in both types of regimens.

Hematologic abnormalities and associated factors among HIV infected children pre- and post-antiretroviral treatment, North West Ethiopia.

IntroductionThere are few studies on the hematologic parameters of HIV-infected individuals in Ethiopia; of these, almost all studies researched adults. Our current study is unique in that it mainly focused on the pediatric population and compared both pre- and post-antiretroviral therapy (ART) children. Inference from this study can be used for other developing countries where the burden of HIV disease is high.ObjectiveThe aim of this study was to identify hematologic abnormalities in HIV-infected children before and after initiation of ART.MethodologyA cross-sectional study was conducted on HIV-infected children from June 1 to August 30, 2015. Data were collected using a pretested and structured questionnaire. Statistical analysis was performed using SPSS 20 version.ResultsThe median age of study subjects was 10 years with an interquartile range (IQR) of (6, 12). Two-thirds (74.3%) of study subjects received ART for >1 year. The median of CD4 count before ART was 490 cells/mm3 with an IQR of (286, 765); this increased to 663 cells mm3 with an IQR of (499, 908) after ART. Likewise, the median of hemoglobin before ART was 11.5 mg/dL with an IQR of (9.9, 13), which increased after ART to 13 mg/dL with an IQR of (11.8, 14). The prevalence of anemia was 42.8% before and 18.9% after ART initiation. The median of absolute neutrophil count before ART was 3×103 with an IQR of (2.1, 4.6) and after ART, it became 3×103 with IQR of (1.9, 4.2). Age <5 years (adjusted odds ratio [AOR]: 2.76; 95% CI: 1.5, 5.0), an advanced stage of AIDS (AOR: 2.8; 95% CI: 1.4, 5.6) and CD4% <25% (AOR: 2.4; 95% CI: 1.2, 4.9) were significantly associated with anemia before ART initiation, while opportunistic infections were associated with anemia after initiation of ART (AOR: 2.3; 95% CI: 1.08, 4.8).ConclusionART positively or negatively affects the hematologic profile of HIV-infected children. The current study demonstrated a significant reduction of anemia after initiation of ART.

Human Immuno-Deficiency Virus Co-Infection with Hepatitis B Virus and Baseline CD4+ T Cell Count among Patients Attending a Tertiary Care Hospital, Nepal

Background: Since 1981, when the first AIDS case was reported, worldwide, more than 34 million people have been infected with HIV. Almost 95 percent of the people infected with HIV live in developing countries. As HBV &amp; HIV share similar routes of transmission by sexual intercourse or drug use by parenteral injection, co-infection is common. Because of the limited access to healthcare &amp; HIV treatment in developing countries, HIV-infected individuals are present late for care. Enumeration of CD4+ T cell count at the time of diagnosis has been useful to initiate the therapy in HIV infected individuals. The baseline CD4+ T cell count shows high immunological variability among patients. Methods: This prospective study was done in the serology section of the Department of Microbiology over a period of one year from august 2012 to July 2013. A total of 13037 individuals subjected for HIV test were included in the study comprising of 4982 males &amp; 8055 females. Blood sample was collected by vein puncture aseptically with standard operational procedure in clean &amp; dry test-tube. All blood samples were screened for HIV as described by WHO algorithm by Immuno-chromatography rapid kits. Further confirmation was done by biokit ELISA method as per the manufacturer’s guidelines. After informed consent, HIV positive individuals were screened for HBsAg by Immuno-chromatography rapid kits (Hepacard). Further confirmation was done by biokit ELISA method as per the manufacturer’s guidelines. EDTA blood samples were collected from the HIV sero-positive individuals for baseline CD4+ T count. Then, CD4+ T cells count was determined by using FACS Calibur Flow Cytometer (BD). Results: Among 13037 individuals screened for HIV, 104 (0.8%) were found to be infected comprising of 69(66.34%) males &amp; 35 (33.65%) females. The study showed that the high infection was noted in active age group (30.76%), housewives (28.7%) &amp; in heterosexual route (80.9%) of transmission. Out of total HIV infected individuals, distribution of HBV co-infection was found to be 6 (5.7%). Baseline CD4+ T cell count of HIV infected patient was found higher (mean CD4+ T cell count; 283cells/cu.mm) than HBV co infected patients (mean CD4+ T cell count; 91 cells/cu.mm). Majority (77.2%) of HIV infected &amp; all co-infected individuals were presented in our center late (CD4+ T cell count;&lt; 350/cu. mm) for diagnosis and care. Majority of co- infected 4 (80%) were late presented with advanced AIDS stage (CD4+ count; &lt;200/cu.mm). Conclusions: The study showed a high percentage of HIV sero-positive &amp; co- infected individuals. Baseline CD4+ T cell count of majority of HIV infected individuals was found to be low. Hence, more sustained and vigorous awareness campaigns &amp; counseling still need to be done in order to promote early diagnosis and management.

Metacognitive Interpersonal Therapy Improves Adherence to Antiretroviral Therapies in a Man with a Severe Personality Disorder: A Case Report

Treatment adherence by patients with HIV ensures they gain the full benefit of antiretroviral medications and extend their lives. One problem which may contribute to poor adherence is deficits in metacognition or the capacity to make sense of mental states. In particular, persons who struggle to notice and think about their thoughts and feelings may be less able to direct their own recovery by taking advantage of effective treatments. This raises the possibility that treatments which lead to improved metacognitive function may enhance treatment adherence. We describe the case of a man in an advanced stage of AIDS with Kaposi’s sarcoma. The patient was treated with Metacognitive Interpersonal Therapy combined with psychoeducation about pharmacological treatment for HIV. Primary medical outcomes were suppression of viral load, increase of CD4 count and control of AIDS related conditions such as Kaposi’s sarcoma. The primary psychological outcome was reduction of personality disorders criteria. The patient was able to understand what led him to discontinue medication and then later regain full adherence. He achieved suppression of viral load and restore of CD4 count. As regard severity of personality disorder, he achieved reliable change. Interventions such as Metacognitive Interpersonal Therapy may assist patients with HIV to gain the metacognitive capacities to make sense of their medical and psychological challenges and adhere to antiretroviral therapies leading to enhanced levels of health. Future studies are needed to explore these findings in larger controlled studies.

Structural inequalities drive late HIV diagnosis: The role of black racial concentration, income inequality, socioeconomic deprivation, and HIV testing

In the United States, research is limited on the mechanisms that link socioeconomic and structural factors to HIV diagnosis outcomes. We tested whether neighborhood income inequality, socioeconomic deprivation, and black racial concentration were associated with gender-specific rates of HIV in the advanced stages of AIDS (i.e., late HIV diagnosis). We then examined whether HIV testing prevalence and accessibility mediated any of the associations above. Neighborhoods with highest (relative to lowest) black racial concentration had higher relative risk of late HIV diagnosis among men (RR=1.86; 95%CI=1.15, 3.00) and women (RR=5.37; 95%CI=3.16, 10.43) independent of income inequality and socioeconomic deprivation. HIV testing prevalence and accessibility did not significantly mediate the associations above. Research should focus on mechanisms that link black racial concentration to HIV diagnosis outcomes.

Encefalitis por virus de inmunodeficiencia humana, reporte de un caso y revisión de tema

En este artículo se presenta el caso de un paciente con diagnóstico histológico de encefalitis por virus de inmunodeficiencia humana - (VIH), con múltiples coinfecciones incluyendo oportunistas. Es un caso llamativo, pues claramente la incidencia de dicha enfermedad ha decrecido ostensiblemente en la era post terapia antiretroviral de gran efectividad (TARGA). Es un paciente masculino heterosexual de 63 años con conductas sexuales de riesgo, que ingresó a un hospital de cuarto nivel con síntomas respiratorios y durante su hospitalización se le diagnosticó VIH / SIDA estadio C3, múltiples infecciones tales como: hepatitis B, neurosífilis, criptococosis sistémica, toxoplasmosis cerebral, histoplasmosis cutánea, candidiasis y herpes oral; recibió tratamiento y falleció 27 días después por criptococosis diseminada. Se le practicó autopsia y se observó en sustancia blanca del sistema nervioso central numerosos nódulos microgliales, linfocitos perivascular y células gigantes multinucleadas sin formación de granulomas, característicos de la encefalitis por VIH. Este paciente es un ejemplo de la historia natural por VIH en estadío avanzado con compromiso del sistema nervioso central.

Étiologie des pneumonies BAAR négatives chez les patients infectés par le VIH hospitalisés à Dakar (étude ANRS 1260)

A prospective study was carried out in two tertiary hospitals in Dakar to determine the main causes of sputum acid-fast bacillus (AFB) smear-negative pneumonia in HIV-infected patients. All clinical and microbiological records were reviewed by experts. Seventy patients were finally enrolled. Most of them were hospitalized at an advanced stage of AIDS. The median CD4 cell count was 62/mm(3) and the median body mass index (BMC) was 18 kg/m(2). Thirty-one patients (44 %) were known as seropositive for HIV infection prior to admission. Radiological opacities were localized in 70 % of patients and diffuse in 21 %. Fiberoptic bronchoscopy was performed in 50 patients (71 %). A definite or probable diagnosis was obtained in 55 patients (79 %). Bacterial pneumonia (usually due to Enterobacteriaceae and Pseudomonas aeruginosa), tuberculosis, Pneumocystis pneumoniae and other causes (Kaposi's sarcoma, atypical mycobacteria) were diagnosed in 67 %, 24 %, 5 %, and 13 % of these patients respectively. In conclusion, pneumonia of bacterial origin and tuberculosis can be incriminated in the majority of cases of AFB negative pneumonia observed in HIV patients in Dakar.

The Successful Treatment of Mania Due to Acquired Immunodeficiency Syndrome Using Ziprasidone: A Case Series

Secondary causes of mania need to be considered when atypical features of mania are manifested. These would include those patients with a later onset and without a prior psychiatric history. This case series investigates the use of ziprasidone for the treatment of mania due to HIV, a complication that could develop in those patients with advanced stages of AIDS.

Relationship between sex steroid hormone levels and CD4 lymphocytes in HIV infected men.

The serum concentrations of the steroid, androgens and estrogens, in the HIV-positive male patients were studied. These men belonged to one of the three main behaviour groups: heterosexual (He), drug addicts (DA) and homosexual (Ho) at early stages (II and III) or at advanced stage of AIDS (IVC), classified according to the Centers for Disease Control (CDC). The circulating concentrations of sex steroids were then analysed with reference to the risk factors, absolute CD4 cell count and the progression of HIV infection. Regardless of risk factors, the stage II and III HIV-infected patients had serum dehydro-epiandrosterone sulfate (DHEAs) (+37%, p < 0.03), testosterone (T) (+24%, p < 0.006) and estrone (E1) (+170%, p < 0.0001) levels higher than those of controls. The patients IVC stage had low serum DHEAs (-48%, p < 0.0001) and elevated estradiol (E2) (+200%, p < 0.0001). According to risk factors, there were no significant differences in androgen and estrogen concentrations between the behaviour groups. There were significant positive correlations between the CD4 cell count and the serum concentrations of DHEAs (p < 0.0001), DHEA (p < 0.01) and E1 (p < 0.006). This suggests that there is a relationship between the circulating sex hormone levels, particularly DHEAs, and the progression of immune depression in HIV, whatever the risk factor. The observed association between DHEAs and the progression of HIV infection suggests that this androgen may play a role in the normal function of the immune system.

Gatekeeper role of 14-3-3τ protein in HIV-1 gp120-mediated apoptosis of human endothelial cells by inactivation of Bad

HIV-1-associated dementia (HAD) is a major neurological complication often observed in the advanced stages of AIDS. We have reported that 14-3-3 proteins in cerebrospinal fluid, reflecting neuronal cell destruction, is a real-time marker of HAD progression. This study was designed to examine the role of 14-3-3 proteins in HAD. An in-vitro human umbilical vein endothelial cells (HUVEC) model of gp120 protein-induced apoptosis to study the protective role of 14-3-3 in HIV-1 gp120/CXCR4-mediated cell death. The alpha-chemokine receptor-mediated cell death by HIV-1 envelope protein, gp120, the critical event that causes neuron loss and endothelial cell injury, was evaluated in HUVEC undergoing gp120-induced apoptosis through the CXCR4 receptor. We studied the effects of siRNA for each 14-3-3 isoform on the death of HUVEC treated with CXCR4-preferring gp120 (IIIB). Gp120 increased the expression of 14-3-3tau in HUVEC. The binding of Gp120 to CXCR4 induced apoptosis of HUVEC through decreased binding of 14-3-3tau to the pro-apoptotic molecule, Bad. Treatment of the cells with dsRNA against 14-3-3tau enhanced the gp120-mediated dephosphorylation of Bad and its association with Bcl-XL in mitochondria, accelerating the gp120-induced apoptosis, whereas suppression of Bad by RNAi rescued the cells from apoptosis triggered by gp120. The specific up-regulation of 14-3-3tau in HUVEC negatively regulated gp120/CXCR4-mediated cell death by protecting Bad dephosphorylation.

Frequency, causes, and new challenges of indeterminate results in Western blot confirmatory testing for antibodies to human immunodeficiency virus.

More than 2 decades of developments in the field have led to a wide variety of test kits available for addressing the different needs of surveillance, diagnosis, and monitoring of human immunodeficiency virus (HIV) infection and antiretroviral therapy ([20][1], [23][2]). These test kits are based on

Risk factors for treatment denial and loss to follow‐up in an antiretroviral treatment cohort in Kenya

To evaluate risk factors for treatment denial and loss to follow-up in an antiretroviral treatment (ART) cohort in a rural African setting in western Kenya. Sociodemographic and clinical data of patients enrolled in an ART cohort were collected within 18 months of an observational longitudinal study and analysed by logistic and Cox regression models. Of 159 patients with treatment indication 35 (22%) never started ART. Pregnancy [adjusted odds ratio (AOR) 3.60, 95% confidence interval (CI) 1.10-11.8; P = 0.035] and lower level of education (AOR 3.80, 95% CI 1.14-12.7; P = 0.03) were independently associated with treatment denial. The incidence of total loss of patients under therapy was 43.2 per 100 person years (pys) (mortality rate 19.2 per 100 pys plus drop out rate 24 per 100 pys). Older age [adjusted hazard ratio (AHR) 1.06, 95% CI 1.01-1.12; P = 0.04], AIDS before starting treatment (AHR 5.83, 95% CI 1.15-29.5; P = 0.03) and incomplete adherence to treatment (AHR 1.05, 95% CI 1.03-1.07; P < 0.001) were independent risk factors for death. Incomplete adherence also independently predicted drop out because of other reasons (AHR 1.06, 95% CI 1.04-1.09; P < 0.001). Pregnancy and lower level of education, higher age, advanced AIDS stage and impaired compliance to ART were identified as risk factors for treatment denial and death, respectively. Adequate counselling strategies for patients with these characteristics could help to improve adherence and outcome of treatment programmes in resource-limited settings.

Prevalence of mycobacteremia in patients with AIDS and persistant fever

In the advanced stages of AIDS, characterized by severe immunodepression, tuberculosis (TB) may present with a clinical picture of septic shock, due to typical bacteremia. Hematogenic dissemination of mycobacteria is frequent in immunodepressed patients with TB or disseminated mycobacteriosis, leading to increased positivity in detection by automated blood culture. The objective of our study was to determine the prevalence of mycobacteremia in patients with AIDS and with prolonged fever seen at the Emilio Ribas Institute of Infectology. Patients with a history of daily fever (> or = 37.8 degrees C), lasting more than 30 days, and with CD4+ helper lymphocyte counts below 200 cells/mL, were selected from February 2001 to March 2002. A 5 mL peripheral blood sample was collected from each patient for mycobacterial blood culture by an automated method, using the BACTEC 9000 MB and MB/BACT techniques. Forty-five patients aged on average 35 years, most of them males, were included in the study. The mean T CD4+ lymphocyte count was 58 cells/mL. Among the samples submitted to blood culture, 30% gave M. tuberculosis growth, with 62% sensitivity. Among the patients with a negative blood culture, nine had received a diagnosis of TB by another method. Automated blood culture proved to be a technique of relevant diagnostic value for M. tuberculosis in patients with prolonged fever in advanced stages of AIDS. The method is simple, and it helps the physician to select the best therapeutic option.

Hospital-Acquired Candidemia in HIV-Infected Patients. Incidence, Risk Factors and Predictors of Outcome

A retrospective case-control study was performed to analyze hospital-acquired candidemia in HIV-positive patients. To understand the impact of Highly Active Antiretroviral Therapy (HAART) on the incidence of nosocomial candidemia, two time periods were compared: A (1992-1996) and B (1997-2001). 32 out of 38 (84%) cases of candidemia were hospital-related. A significant reduction in the incidence of all cases of hospital-acquired candidemia has been observed in the post-HAART in respect to pre-HAART period (0.09 episodes vs. 1.1 per 100/py). Multivariate analysis showed that the presence of central venous catheter was the only variable independently associated with the development of nosocomial can-didemia. The overall mortality rate was 59%. Univariate analysis indicated three prognostic indicators: presence of concomitant opportunistic infections, isolation of non-albicans Candida species; neutropenia. Multivariate analysis of prognostic indicators showed that isolation of non, -albicans Candida species is the only independent variable. Despite the use of HAART, this disease still represents a severe complication of advanced stage of AIDS.

Alterações dermatológicas em crianças com Aids e sua relação com categorias clínico-imunológicas e carga viral

FUNDAMENTOS: Desde o início da epidemia da Aids as dermatoses têm sido freqüentemente descritas em pacientes com essa doença, com relatos de casos atípicos e estudos de séries de pacientes adultos; no entanto, há poucas publicações sobre alterações cutâneas em pacientes pediátricos com Aids. OBJETIVOS: Estudo prospectivo para avaliar a presença de dermatoses em 40 pacientes pediátricos com Aids. MÉTODOS: Quarenta pacientes, com idade inferior a 13 anos e portadores de Aids, foram estudados por um período de seis meses para avaliação de: número de alterações dermatológicas; suas características clínicas; distribuição conforme as categorias clínico-imunológicas e o valor da carga viral. RESULTADOS: A prevalência de dermatoses foi de 82,4%, na primeira consulta, e, no acompanhamento longitudinal, 92,5% dos pacientes tiveram alterações dermatológicas, com proporção de cinco diagnósticos por doente. As crianças com classificação clínico-imunológica grave e carga viral acima de 100.000 cópias/ml apresentaram maior número de alterações dermatológicas quando comparadas àquelas das categorias clínico-imunológicas leves. A proporção de diagnósticos por paciente na categoria clínica C foi de 6,8 e na A de 3,6; na categoria imunológica grave, de sete, e na leve de 3,7; e na carga viral &gt; 100.000 de 7,3, e na &lt; 100.000 de 4,2 (todos com significância estatística). CONCLUSÃO: As dermatoses foram freqüentes nas crianças com Aids e ocorreram em maior número nos pacientes pertencentes às categorias graves. A elevada freqüência de alterações da pele nos pacientes pediátricos com a doença indica ser imprescindível sua avaliação dermatológica minuciosa e freqüente.

Is HIV involved in the pathogenesis of non-infectious pulmonary complications in infected patients?

Pulmonary complications of AIDS are one of the major causes of morbidity and mortality in HIV-infected individuals, and are often direct indicators of enhanced progression to an AIDS-defining illness. HIV can be detected in the lung during asymptomatic disease, as well as during the advanced stages of AIDS. With prolonged survival of HIV-infected patients, non-infectious pulmonary complications are becoming more common and can lead to respiratory compromise and failure. The pathogenesis of non-infectious pulmonary complications, following HIV infection is not fully understood, and the role that HIV-induced immunosuppression plays in the development of these complications is not known. In this review, we will discuss non-infectious pulmonary complications of HIV infection, focusing on HIV-associated malignancies of the lung, inflammatory disorders, pulmonary hypertension and the effect of antiretroviral therapy on the incidence of these diseases. The possible role that HIV plays in the pathogenesis of these pulmonary disorders is also addressed.

Determination of genetic subtypes of HIV type 1 isolated from Korean AIDS patients.

To determine HIV-1 subtypes in Korean patients, we analyzed the nucleotide sequences of the HIV-1 env gene isolated from 19 Korean patients. DNA was extracted from cultured lymphocytes and the proviral V3 env gene was amplified by nested polymerase chain reaction. DNA sequences were determined using a cycle sequencer with fluorescence-labeled dye terminators, and aligned using a set of reference sequences. The phylogenetic tree was constructed by the neighbor-joining method. Most of the enrolled patients were in the advanced stage of AIDS with CD4+ lymphocyte counts ranging from 10 to 560 (median 50) per mm3. Eighteen of the nineteen patients' sequences fall into subtype B (95%) and one was subtype A (5%). The tetrameric motifs at the tip of the V3 loop were comprised of GPGR (10 cases, 53%), GPGS (5 cases, 26%), and GPGQ, GPGG, GQGR, and APGS (one case each, 5%). Subtype B was found to be the most predominant clade of HIV-1 in our AIDS patients.

The experience of HIV reactive patients in rural Malawi--Part I.

Malawi has a population of 9 million people with AIDS the leading cause of death in the 20-40 age group. The HIV positive prevalence rate, estimated at 23% in urban areas and 8% in rural areas, is one of the highest in the world (AIDSEC, 1994:1). Evaluation of counselling practices showed poor results with counsellors feeling ineffective and inadequate. Patients are mostly tested on medical indication but patients who do not see the benefit of knowing their HIV status increasingly refuse testing. The counselling practise as it is known in the Western world is a foreign concept for patients living in rural Malawi. The high stigma of AIDS complicates support of the patients. The goal of the research study was to describe a model of counselling that would meet the needs of an AIDS patient in rural community in Malawi. A qualitative research design that was explorative, descriptive and contextually specific to rural Malawi was used for the study. In order to describe a counselling model it was important to understand the illness experience of HIV reactive patients. The patients are seen in group context congruent with the African culture and therefore the experience of the primary care giver of AIDS patients is explored as the other major factor in the phenomenon examined. One phase of the research is described in this article namely exploring and describing the experience of the HIV reactive patient in rural Malawi. Results show that patients are in an advanced stage of AIDS when they are diagnosed and complain of weakness and an inability to do work, including an inability to do their daily chores. This causes a feeling of desperateness that is worsened by the perception that support systems are inadequate. Support systems are mostly identified as parents, partners and siblings to assist mainly with the physical care and financial support. Despite the fact that the family is very important to patients there is a reluctance to acknowledge their HIV status. Patients fear being rejected once it is known that they have AIDS--not only because AIDS is a sexually transmitted disease, but also because it is perceived that financial and other support will be withheld if it is known that patients have AIDS and will therefore die and not be able to return the support provided. Patients feel they have no future once a diagnosis of AIDS has been made which results in refusal of testing, as they do not see the benefit of knowing their HIV status. Assessing the coping ability of the patient within the household as part of an overall assessment is one proposed strategy that could be taken. Secondly the patient is encouraged to take a more active role in the counselling process, which could be achieved by narration. The family should be incorporated into the counselling process as early as possible.