Advanced Stage Of HIV Disease Research Articles

Cognitive functions in patients with Human Immunodeficiency virus. Infection in Nigeria: assessment using computer assisted neuropsychological test batteryhi7

AbstractBackgroundThere is paucity of information on the cognitive functions in patients with HiV infection in NigeriaMethodFifty patients with HIV infection were studied along age,sex and level of education matched 50 HIV negative controls subjects.The patients underwent general physical and neurologically examinations. Laboratory investigations such as blood glucose test, CD4 cell counts, Full blood counts,CXrays, HIV clinical staging were done for all patients Fepsy neuropsychological Test battery was used for cognitive asssessment in all the study participants.ResultThe patients with HIV infections performed worse on measures of psychomotor speed (auditory reaction times, visual reaction times, attention concentration(Binary choice reaction times and computerized visual searching tasks) than the controls The prevalence of sevvere cognitive infection in HIV patients was 20%.Presence of anaemia and advanced HIV disease stage were predictive of cognitive impairment in the patients with HIV infection.ConclusionHIV Associated Cognitive Disorder is common in patients with HIV in this study

Role of MMP-13-77A/G polymorphism in HIV-associated neurocognitive disorders patients

Many diseases including HIV-Associated Neurocognitive Disorder (HAND) are impacted by matrix metalloproteinases (MMPs). MMP-13 play a role to cleave the collagen. MMP-13 contributes to peripheral neuropathy and induces unmyelinated axon degeneration. MMP-13-77A/G polymorphism has been associated to a lower level of MMP-13. MMP-13 have been linked to increased expression in a number of diseases including neurological disease. Hence we analyzed the effect of MMP-13-77A/G polymorphism in pateints with and without HAND. The PCR-Restriction fragment length polymorphism approach was used to genotype MMP-13-77A/G polymorphism. The MMP-13-77AG genotype was shown to be more prevalent in HAND patients than in controls and showed a risk for severe HAND (44.4% vs. 34.8%, P = 0.16, OR = 1.79). When compared to healthy controls, the MMP-13-77AG genotype was found to be prevalent in HAND patients (44.4 %vs. 38.2%, P = 0.66, OR = 1.26). MMP-13-77AG genotype was overrepresented (51.5% vs. 38.2%, OR = 1.70, P = 0.29) in HAND patients who had advanced HIV disease. In without HAND patients, the MMP-13-77AG genotype was found be lessor in advanced stage of HIV disease when compared with healthy controls and it was associated with a reduced risk for advancement in disease (38.2% vs. 11.82%, P = 0.03, OR = 0.18). Smokers were more likely to have the MMP-13-77AG genotype than non-smokers, indicating an elevated risk of HAND severity (60.0% vs. 40.0%, P = 0.50, OR = 2.29, 95%). In patients with and without HAND, alcohol intake enhanced the risk for developing HAND and its severity when the MMP-13-77GG genotype was present (P = 0.78, OR = 2.10, P = 0.78, OR = 2.10). In conclusion, Individuals with alcohol usage and the MMP-13-77GG genotype may have additive effect on HAND development and its severity. Individuals of without HAND and MMP-13-77AG genotype showed reduced risk for advancement of HIV disease.

Factors Associated with Baseline CD4 Cell Counts and Advanced HIV Disease among Male and Female HIV-Positive Patients in Iran: A Retrospective Cohort Study

Despite the recommendation for early diagnosis and rapid initiation of HIV treatment, more than half of patients are in an advanced stage of HIV disease in Iran. This study aimed to investigate the factors related to baseline CD4 cell count and advanced HIV disease (AHD) in Southern Iran. The study comprised all adults between 15 and 87 years of age who were newly diagnosed with HIV in Southern Iran. Linear and logistic regressions were used to identify baseline CD4 cell count predictors and AHD, respectively. A total of 820 (53.9%) HIV-infected individuals over 15 years of age were at the AHD stage. Based on the results of the multiple logistic regression, older age at diagnosis (OR≥40/<30 = 2.68, 95% CI = 1.38–5.19), gender (ORfemale/male = 0.62, 95% CI = 0.44–0.85), HIV/TB coinfection (ORyes/no = 1.98, 95% CI = 1.29–3.02), HIV/HBV coinfection (ORyes/no = 1.58, 95% CI = 1.07–2.38), and hemoglobin (OR = 0.89, 95% CI = 0.85–0.92) were directly associated with AHD in HIV/AIDS patients. As suggested by a linear regression model, factors including gender (B Female = 44.12, 95% CI:17.86, 70.38), older age (B ≥ 40 = −111.99, 95% CI:−174.70, −49.27), higher education level (B = 35.65, 95% CI:5.34, 65.97), WHO clinical stage (BIV = −254.53, 95% CI−298.82, −210.24), and hemoglobin (B = 5.23, 95% CI:0.25, 10.20) were significantly associated with CD4 count.The prevalence of AHD in patients was high in Iran. Our results suggested that several demographic and clinical factors are significantly associated with the baseline CD4 cell count and AHD. Targeted HIV testing, implementation of screening programs for early detection, and access to care services to assure early ART are recommended to improve the clinical status and quality of life of the patients.

Predictors of Mortality among Adult People Living with HIV and Its Implications for Appointment Spacing Model Approach Care.

Ethiopia has been motivated to achieve a goal of "appointment spacing model approach care." However, little has been documented on the predictor of mortality and challenges of sustainable HIV care. Therefore, the aim of this study was to determine predictors of mortality among adult people living with HIV/AIDS on antiretroviral therapy (ART). A retrospective cohort study was conducted on 676 adult people living with HIV who enrolled to ART clinic from September 01, 2012 - August 30, 2016. Multivariable Cox Regression analysis was done where adjusted hazard ratio (AHR)with corresponding 95% confidence interval (CI) at P value ≤ 0.05 cut of point was used to identify predictors of mortality. The total person-time contributed was 28,209 person-months with an overall mortality incidence rate of 11 per 1000 person-months observation. The cumulative mortality incidence among females over the study period was 16.8% (64/382). Severe undernourishment and moderate malnutrition at baseline, younger age, female sex, single, divorced, illiterate, lack of disclosure, advanced WHO clinical stage, seeking treatment outside catchment area, rural residence and immunological failure were found to be independent predictors of mortality. Poor nutritional status at baseline, advanced stage of HIV disease, occurrence of treatment failure, female sex, substance abuse, lack of social support, immunological failure, clinical failure, and younger age, low level of education and poor physical access to healthcare facility were found to be important predictors of mortality. Intervening, those factors as routine and part of the appointment spacing model care can improve survival of PLWHA.

Machine learning-selected variables associated with CD4 T cell recovery under antiretroviral therapy in very advanced HIV infection

BackgroundA considerable portion of the HIV pandemic is composed of people under antiretroviral therapy, many of whom get a late diagnosis. Patients starting antiretroviral therapy (ART) at a very advanced stage of HIV disease attain a low recovery of CD4 T cells. Factors associated with poor recovery are incompletely described. This study aimed at finding variables associated with CD4 T cell recovery in late-presenting HIV patients.MethodsWe studied a cohort of HIV+ patients initiating ART with very low basal CD4 T cell counts. We defined immune recovery as the net increase in circulating CD4 T cell counts after one year on ART. We analyzed diverse routine laboratory determinations at different times using Least Absolute Shrinkage and Selection Operator (LASSO), adaptive LASSO and Conditional Inference Random Forest.ResultsCD4/CD8 ratio, % CD4 T cells and CD8 T cell counts at different times were the main recovery correlates, validated by all approaches. Unexpectedly, basal hematocrit was a consistent predictor. Additionally, week 24 creatinine had a high lasso coefficient, and alkaline phosphatase had a high conditional inference random forest coefficients, although neither was verified by other tests.ConclusionsCD4 T cell proportions are associated with CD4 T cell recovery, independently of cell counts. Inflammation-related variables could also affect reconstitution. These accessible variables may reflect underlying mechanisms and could improve the follow up of patients starting ART with an advanced HIV infection.

Social and structural factors and engagement in HIV care of sub-Saharan African migrants diagnosed with HIV in the Paris region

ABSTRACTMigrants from sub-Saharan Africa (SSA) are often diagnosed at an advanced stage of HIV, and many of them have harsh living conditions. We aimed to evaluate the entry into care after HIV diagnosis and examine the related social determinants. The ANRS PARCOURS study is a life-event survey conducted in 2012–2013 in the Paris region among. Time between HIV diagnosis of SSA migrants living diagnosed HIV positive in France and HIV care and the determinants was assessed yearly by using mixed-effects logistic regression models. Among a total of 792 participants, 94.2% engaged in HIV care within the year of HIV diagnosis, 4.3% in the following year and 2.5% beyond the second year after diagnosis. The participants were more likely to engage in HIV care during years when they were effectively covered by health insurance and if the HIV test was carried out at the initiative of the doctor. Immigration for economic reasons or owing to threats in his/her country of origin was associated with delayed engagement in HIV care. Additionally, 4.3% of treated participants discontinued HIV care at least once at the time of the survey and more often if diagnosed at an advanced HIV disease stage and financially dependent.

Polymorphisms in miRNAs Gene (146a, 149, 196a) and Susceptibility to ARV-associated Hepatotoxicity.

Background: Micro RNAs act as a regulatory layer for pharmacogenomics-related gene ex-pression. It could play a role in the efficacy and toxicity of the drug. The SNPs in miRNA genes are linked with different functional consequences. Methods: Hence, we examined the miR (146a G/C, 149C/T, and 196aC/T) polymorphisms in 34 pa-tients with hepatotoxicity, 123 patients without hepatotoxicity, and 155 healthy controls using a PCR-RFLP method.Results:In patients with hepatotoxicity, miR196aCT genotype and combined genotype GCT showed a risk for hepatotoxicity severity with borderline significance (OR=2.08, P=0.07; OR=2.88, P=0.06). While comparing between patients with hepatotoxicity and healthy controls, the combined genotypes CCC and GCT have shown a susceptibility to hepatotoxicity severity (OR=2.89, P=0.05; OR=2.60, P=0.09). The miR196TT genotype was associated with the individuals of advanced HIV disease stage (OR=3.68, P=0.04). In HIV patients who consumed alcohol and did not have hepatotoxicity, the miR 196aCT genotype showed susceptibility to acquisition of hepatotoxicity with borderline significance (OR=2.36, P=0.06).Discussion: The miR149TT and 196aTT genotypes showed a risk of acquisition of hepatotoxicity to nevirapine usage among HIV patients without hepatotoxicity (OR=4.19, P=0.07; OR=1.97, P=0.84). In HIV patients with and without hepatotoxicity, the miR 196aCT genotype showed a risk of acquisition of hepatotoxicity and its severity to the combined use of alcohol and nevirapine, respectively (OR=14.18, P=0.08; OR=2.29, P=0.08). In multivariate logistic regression, taking nevirapine, 196aCT genotype had an independent risk factor for hepatotoxicity severity (OR=5.98, P=0.005; OR=2.38, P=0.05).Conclusion: In conclusion, miR196aC/T polymorphism and combined genotypes GCT and CCC may facilitate the risk for acquisition of hepatotoxicity and its severity

Prevalence of CYP2D6*4 1934G/A polymorphism in Western Indian HIV patients.

Hepatic CYP2D6 enzyme metabolizes antiretroviral drugs (ARVs) including nevirapine. Polymorphism in CYP2D6 gene affects drug metabolism and displays distinctive phenotypes in the population. Hence, we investigated the prevalence of CYP2D6*4 1934G/A polymorphism in a total of 165 HIV patients that include 34 with and 131 without hepatotoxicity and 160 unrelated healthy controls by the PCR-RFLP method. The prevalence of CYP2D6*4 1934AA genotype was higher in total HIV patients as compared to healthy controls (1.81% vs 0.6%, OR=2.86). Similarly, CYP2D6*4 1934AA genotype was much more prevalent in HIV patients without hepatotoxicity as compared to healthy controls (2.3% vs 0.6%, OR=2.87). Likewise, CYP2D6*4 1934AA genotype was predominant in advanced HIV disease stage as compared to healthy controls (3.8% vs 0.6%, OR=6.15). CYP2D6*4 1934GA genotype was distributed higher in HIV patients taking tobacco and nevirapine as compared to non-users (23.3% vs 19.3%, OR=1.21, 21.0% vs 16.7%, OR=1.2). Likewise, CYP2D6*4 1934GA genotype was overrepresented in patients with hepatotoxicity taking alcohol+nevirapine as compared to alcohol non-users+nevirapine users (20.00% vs 16.67%, OR=1.25). Thus, there was no significant difference in genotype or allele frequencies of CYP2D6*4 1934G/A polymorphism between the patients with hepatotoxicity and those without or healthy controls.

Promoter polymorphism MMP-1 (-1607 2G/1G) and MMP-3 (-1612 5A/6A) in development of HAND and modulation of pathogenesis of HAND.

The pathogenesis of HIV-associated neurocognitive disorder (HAND) is modulated by host genetic susceptibility factors such as Matrix metalloproteinases (MMPs). Promoter polymorphism of MMP-1 and MMP-3 may modify the expression of the gene. Hence, we evaluated the association of MMP-1-16072G/1G and MMP-3-1612 5A/6A polymorphisms with development of HAND and the modulation of pathogenesis of HAND. We enrolled a total of 180 individuals, 50 HIVinfected individuals with HAND, 130 without HAND, and 150 healthy controls. Polymorphism of MMP-1 and MMP-3 were genotyped by PCR-RFLP. MMP-1-1607 2G1G, -16071G/2G-1G/1G genotypes and -1607 1G allele were associated with the development of HAND (OR = 1.64, P = 0.05; OR = 1.45, P = 0.04; OR = 1.69, P = 0.05). MMP-1- 16071G1G, MMP-3-16125A5A genotypes increased the risk for the development of HAND (OR = 1.78, P = 0.25; OR = 2.39, P = 0.13). MMP-3-1612 5A5A, -1612 6A/5A-5A/5A genotypes and -1612 5A allele were associated with the reduced risk of HAND (OR = 0.40, P = 0.05; OR = 0.53, P = 0.04; OR = 0.40, P = 0.01). Haplotype 5A1G increased the risk of development of HAND (OR = 1.93, P = 0.05). As observed in advanced HIV disease stage, MMP-1-1607 1G1G genotype enhance the risk for advancement of HIV disease (OR = 1.69, P = 0.89). MMP-3-1612 6A5A genotype showed higher risk for development of HAND in alcohol users (0R = 1.65, P = 0.44). MMP-1 genotype may have an influence on development of HAND whereas MMP3-1612 5A5A genotype may reduce risk for pathogenesis of HAND.

APOBEC3B deletion impacts on susceptibility to acquire HIV-1 and its advancement among individuals in western India.

APOBEC3B deletion polymorphism has been associated with risk of HIV-1 acquisition and its progression. Therefore, we aimed to investigate the association of APOBEC3B ins/del polymorphism with risk of acquisition of HIV-1 and its progression. In the present case-control study, we enrolled a total of 150 HIV-infected individuals and 150 healthy controls. Polymorphism for APOBEC3B gene was genotyped by PCR. APOBEC3B ID, DD genotypes, and D allele were associated with higher risk of acquisition of HIV-1 (p = 0.004, OR = 4.96; p = 0.03, OR = 3.55; and p = 0.004; OR = 1.60). The individuals with ID genotypes and combined genotype ID+DD of APOBEC3B in the presence of tobacco and alcohol showed the higher risk of advancement of HIV disease; however, risk could not reach statistical significance (OR = 1.14, 95% CI: 0.59-2.18; OR = 1.33, 95% CI: 0.83-2.15 and OR = 1.44, 95% CI: 0.77-2.69; OR = 1.50, 95% CI: 0.94-2.40). Individuals in advanced HIV disease stage and ID genotype and combined genotype ID + DD of APOBEC3B were more likely to be associated with advanced HIV disease stage but risk could not reach significant (OR = 1.50, 95% CI: 0.94-2.40; OR = 1.27, 95% CI: 0.88-1.84). Individuals with ID and DD genotype of APOBEC3B had influence on susceptibility to acquisition of HIV-1. This suggests that APOBEC3B deletion may attenuate innate cellular immunity against HIV-1 and thus confer the host persistence for HIV infection.

Prevalence and risk factors of cervical squamous intraepithelial lesions among HIV-infected women in Dar es Salaam, Tanzania.

To determine the prevalence and predictors of cervical squamous intraepithelial lesions (SIL) among HIV-infected women in Tanzania, a cross-sectional study was conducted among HIV-infected women at HIV care and treatment clinics. A Papanicolaou (Pap) smear was used as a screening tool for detection of cervical SIL. From December 2006 to August 2009, 1365 HIV-infected women received cervical screening. The median age was 35 (interquartile range [IQR]: 30-42) years, and the median CD4 + cell count was 164 (IQR: 80-257) cells/mm(3). The prevalence of cervical SIL was 8.7% (119/1365). In multivariate analysis, older age (≥50 versus 30-<40 years: prevalence ratio [PR], 2.36; 95% confidence interval [CI], 1.45-3.84, p for trend = 0.001), lower CD4 + cell counts (<100 versus ≥200 cells/mm(3): PR, 1.55; 95% CI, 1.01-2.36, p for trend = 0.03) and cervical inflammation (PR, 1.73; 95% CI, 1.16-2.60, p = 0.008) were associated with an increased risk of cervical SIL. Women with advanced WHO HIV disease stage (IV versus I/II: PR, 3.45; 95% CI, 1.35-8.85, p for trend = 0.01) had an increased risk for high-grade SIL. In resource-limited settings where it is not feasible to provide cervical cancer prevention services to all HIV-infected women, greater efforts should focus on scaling-up services among those who are older than 50 years, with lower CD4 cell counts and advanced HIV disease stage.

Correlates of HIV Transmission from Husband to Wife among Heterosexual Married Couples in ART-era in West Bengal, India

Objective: To identify factors associated with HIV-transmission from husbands to their wives within the existing HIV prevention and control program environment in West Bengal, India. Methods: In this cross-sectional study, information was collected from the study participants on socio-demography and various health issues including sexually transmitted diseases (STDs). They were also tested for blood borne and sexually transmitted infections. Women living with HIV were compared for behavioral and biologic markers against women who did not have the virus. Both these groups of women were married to HIV sero-reactive men. To detect recent HIV infection, HIV sero-negative women were tested by Polymerase Chain Reaction. Results: Of the 234 married couples, 29% (69/234) lived in HIV discordant relationship where wives were not infected with HIV and the rest were concordant for HIV infection. Six of the 165 women living in concordant relationship acquired HIV infection recently. Fifty six percent of the husbands were in advanced stage of HIV disease with CD4 count ≤200/μl while tested for the first time at ART center. Factors independently associated with HIV concordance were 'wives experiencing any STD-symptom after marriage' (Adjusted Odds Ratio (AOR) 2.05; 95% CI 1.09 - 3.83; p=0.02) and 'self-reported male condom use/reduced frequency of sex with spouse' (AOR 2.99; 95% CI 1.29-6.94; p=0.01). Although 'HSV-2 concordance' (Odds Ratio (OR) 2.46; 95% CI 1.32-4.59; p=0.004) and 'bacterial vaginosis' (OR 2.57; 95% CI 1.18-5.61; p=0.02) were associated with HIV infection in wives in uni-variate analyses, the strength of such associations weakened in multi-variate model. ART intake by husbands did not offer any protection against HIV infection in wives. Conclusions: Early initiation of ART among HIV discordant couples, strengthening of STD prevention and control and limitation of self-reported sexual risk reduction to inform HIV-program in India are underscored.

Hearing function in patients living with HIV/AIDS.

During the earlier years of the HIV/AIDS epidemic, initial reports described sensorineural hearing loss in up to 49% of individuals with HIV/AIDS. During those years, patients commonly progressed to advanced stages of HIV disease and frequently had neurological complications. However, the abnormalities on pure-tone audiometry and brainstem-evoked responses outlined in small studies were not always consistently correlated with advanced stages of HIV/AIDS. Moreover, these studies could not exclude the confounding effect of concurrent opportunistic infections and syphilis. Additional reports also have indicated that some antiretroviral medications may be ototoxic; thus, it has been difficult to make conclusions regarding the cause of changes in hearing function in HIV-infected patients. More recently, accelerated aging has been suggested as a potential explanation for the disproportionate increase in complications of aging described in many HIV-infected patients; hence, accelerated aging-associated hearing loss may also be playing a role in these patients. We conducted a large cross-sectional analysis of hearing function in over 300 patients with HIV-1 infection and in 137 HIV-uninfected controls. HIV-infected participants and HIV-uninfected controls underwent a 2-hr battery of hearing tests including the Hearing Handicap Inventory, standard audiometric pure-tone air and bone conduction testing, tympanometric testing, and speech reception and discrimination testing. Three-way analysis of variance (ANOVA) and logistic regression analysis of 278 eligible HIV-infected subjects stratified by disease stage in early HIV disease (n = 127) and late HIV disease (n = 148) and 120 eligible HIV-uninfected controls revealed no statistically significant differences among the three study groups in either overall 4-frequency pure-tone average (4-PTA) or hearing loss prevalence in either ear. Three-way ANOVA showed significant differences in word recognition scores in the right ear among groups, a significant group effect on tympanogram static admittance in both ears and a significant group effect on tympanic gradient in the right ear. There was significantly larger admittance and gradient in controls as compared to the HIV-infected group at late stage of disease. Hearing loss in the HIV-infected groups was associated with increased age and was similar to that described in the literature for the general population. Three-way ANOVA analysis also indicated significantly greater pure-tone thresholds (worse hearing) at low frequencies in HIV patients in the late stage of disease compared with HIV-uninfected controls. This difference was also found by semi-parametric mixed effects models. Despite reports of "premature" or "accelerated" aging in HIV-infected subjects, we found no evidence of hearing loss occurring at an earlier age in HIV-infected patients compared to HIV-uninfected controls. Similar to what is described in the general population, the probability of hearing loss increased with age in the HIV-infected subjects and was more common in patients over 60 years of age. Interestingly, HIV-infected subjects had worse hearing at lower frequencies and have significant differences in tympanometry compared to HIV-uninfected controls; these findings deserve further study.

144-week outcomes of lopinavir/ritonavir (LPV/r)-based first-line ART in 1,409 HIV-infected patients: data from the German STAR/STELLA cohort.

IntroductionSTAR/STELLA is a prospective[TS1] cohort of HIV patients initiated on LPV/r-based ART in routine clinical practice. Here, virologic/immunologic outcomes and safety data of LPV/r-based first-line ART over a period of 144 weeks are presented.MethodsAnalysis included ART-naïve patients who started on LPV/r before July 2011 (i.e. patients with ≥144 weeks since ART initiation). Safety evaluation included adverse events (AEs), discontinuations (disc.) due to AEs, and symptoms assessed with the self-report ACTG Symptom Distress Module (ASDM; high score=high distress).Results1409 patients were included (84% men; 76% on TDF+FTC), with a large proportion in advanced stages of HIV disease at ART initiation: 48% had a CD4 count <200/µL, 55% had HIV RNA levels >100,000 c/mL. 53% of patients (n=746) remained on LPV/r for at least 144 weeks. Time on drug was longer for patients initiated before 2008 than in subsequent years (HRadj, 1.2; 95% CI, 1.0–1.4; p=0.04; hazard ratio adjusted for CD4 <200/µL and HIV RNA >100,000 c/mL). Main reasons for d/c were: AEs (19.3%), patient wish (9.2%), virologic/immunologic failure (4.1%), and noncompliance (2.8%); 1.6% of patients died. By week 144, 33% of patients had >750 CD4/µL (Kaplan–Meier estimate): time to CD4 count >750 c/ µL, stratified by BL CD4 count, is shown in Figure 1.ITT snapshot analysis of HIV RNA <50 c/mL at week 144 showed 51% responders (failure=d/c due to virologic/immunologic failure, AEs, noncompliance, death). In patients on LPV/r for 144 weeks, median CD4 change was +314/µL (IQR, 205–440/µL), 87% had HIV RNA levels <50 c/mL. In patients who discontinued therapy prior to week 144, 56% had an HIV RNA level <50 c/mL. In 51% of patients, ≥1 AE was reported (most commonly diarrhoea, 35%); 11% of patients had ≥1 AE of grade 3 or 4 (diarrhoea, 4.5%). In patients who remained on LPV/r based ART through 144 weeks, median ASDM score decreased significantly from 9 at BL (IQR, 3–21) to 2.5 at Week 144 (IQR, 0–8.5, p<0.001).ConclusionIn the STAR/STELLA observational cohort, LPV/r-based ART demonstrated good virologic outcomes and immune recovery in ART-naïve patients over 144 weeks, with significant improvements in symptom distress. Over three years, <5% of patients discontinued LPV/r due to virologic/immunologic failure, and 19% of patients discontinued for tolerability reasons.

HIV-1 DNA concentrations and evolution among African HIV-1-infected children under antiretroviral treatment (ANRS 1244/1278)

The objectives of this study were to describe the pretreatment HIV-1 DNA concentrations in children infected with HIV and to evaluate the impact of antiretroviral therapy (ART) on HIV-DNA concentrations. This was a retrospective analysis of all children followed up in the 'Programme Enfant Yopougon' cohort, Abidjan, Côte d'Ivoire, from 2000 to 2004, who had cryopreserved peripheral blood mononuclear cells (PBMCs) and plasma samples. HIV-DNA was measured using a real-time PCR assay. Mixed-model analysis was used to analyse the factors associated with change in HIV-DNA concentration. The study included 121 children infected with HIV-1. The median age at inclusion was 6 years (IQR: 3.5-9) and children were at an advanced stage of HIV disease (46.6% and 20.3% presenting CDC stage B and CDC stage C, respectively). At baseline, the median HIV-DNA concentration was 3.4 log₁₀ copies/10(6) PBMCs (IQR: 3.1-3.6). Fifty-four children were initiated on ART during follow-up. After 24 months of ART, HIV-DNA load decreased by 0.32 (IQR: 0.08-0.57) log₁₀ copies/10(6) PBMCs. The only factor associated with the HIV-DNA decrease was a concomitant low HIV-RNA viral load result. Children with efficient ART had a 0.51 log₁₀ copies (IQR: 0.40-0.86) HIV-DNA decrease per million PBMCs. HIV-DNA concentrations decreased following ART initiation in a large African paediatric cohort. This decline was exclusively associated with the decrease in ongoing replication level achieved. Our study points out that a strong adherence is needed for ART to be efficient on the viral reservoirs, and further reinforces that adherence support is also essential to diminish the reservoir.

High burden of STIs among HIV-infected adults prior to initiation of ART in South Africa: a retrospective cohort study

ObjectivesTo assess the burden of sexually transmitted infections (STIs) among HIV-positive South Africans in the period prior to antiretroviral therapy (ART) initiation compared with the period once on ART.MethodsWe linked...

The pattern of mucocutaneous disorders in HIV infected children attending care and treatment in Tikur Anbesa specialized hospital, Addis Ababa, Ethiopia

BackgroundChildren with HIV infection may develop a wide variety of infectious and inflammatory diseases of the skin. These disorders are often more severe and more difficult to treat than in the immunocompetent child. In some cases, disorders of the skin or mucous membranes may provide an early clue to the presence of pediatric HIV infection.MethodsIt is a descriptive cross-sectional study which was conducted at the pediatric infectious disease unit, department of pediatrics and child health, Tikur Anbesa specialized Hospital. Clinical information was collected using a questionnaire. The data was analyzed using SSPS 16.0 version. Chi-squared was utilized where appropriate and a p-value of less than 0.05 was considered statistically significant.ResultsTwo hundred seventy HIV infected children were recruited in this study. Out of these females were 51.5% and males were 48.5%. Most of the children 196/270 (72.6%) were suffering from one or more mucocutanous disorders. The most prevalent mucocutanous disorders were infectious dermatosis. Overall, mucocutaneous disorders were more prevalent in advanced stages of HIV disease P < 0.001. Two or more mucocutanous disorders were found in moderate and sever immunosuppression. Seventy three percent of the HIV-infected children with mucocutaneous disorders were already on HAART.ConclusionsThe prevalence of mucocutanous disorders is high in HIV infected children. Advanced immunosuppression is highly associated with a wide spectrum of mucocutanous disorders.

The Problem of Late ART Initiation in Sub-Saharan Africa: A Transient Aspect of Scale-up or a Long-term Phenomenon?

Efforts to scale-up HIV care and treatment have been successful at initiating large numbers of patients onto antiretroviral therapy (ART), although persistent challenges remain to optimizing scale-up effectiveness in both resource-rich and resource-limited settings. Among the most important are very high rates of ART initiation in the advanced stages of HIV disease, which in turn drive morbidity, mortality, and onward transmission of HIV. With a focus on sub-Saharan Africa, this review article presents a conceptual framework for a broader discussion of the persistent problem of late ART initiation, including a need for more focus on the upstream precursors (late HIV diagnosis and late enrollment into HIV care) and their determinants. Without additional research and identification of multilevel interventions that successfully promote earlier initiation of ART, the problem of late ART initiation will persist, significantly undermining the long-term impact of HIV care scale-up on reducing mortality and controlling the HIV epidemic.

Multicenter epidemiological study to describe prevalence of advanced stage disease among newly diagnosed HIV‐infected patients in the Russian Federation

Purpose of the studyThe proportion of HIV‐infected persons diagnosed in an advanced stage of HIV disease (ASH) varies by country from 15 to 30%. Data are lacking on the proportion of new cases diagnosed in this late stage in Russia. The aim of this study was to estimate the proportion of and further characterize patients with ASH among newly diagnosed HIV‐1 infected persons in the Russian Federation.MethodsThis was a cross‐sectional, multicenter, epidemiologic study. Adult HIV‐1 patients that were newly diagnosed within 90 days and naïve to highly active antiretroviral therapy were included at twelve centers/regions (Moscow Region, St Petersburg, Leningrad Region, Ufa, Kazan, Ulyanovsk, Volgograd, Yekaterinburg, Kemerovo, Krasnoyarsk, Irkutsk and Vladivostok) of the Russian Federation. ASH was defined as a CD4+ cell count ≤200 cells/mm3. Pairwise, two‐tailed comparisons were conducted with an unadjusted 5% significance level. For comparison variables between patients with ASH and all other patients, Pearson's chi‐square test was used.Summary of results4540 patients were included. The overall proportion of ASH was 16.3% (95% CI; 15.3%, 17.4%). The median plasma HIV‐1 RNA was 4.48 (Q1, Q3; 3.81, 5.07) log10 copies/mL. The proportion of patients with CD4+ cell count by categories is presented in Figure 1.ASH was associated with male sex (62.3%), 26‐40 and &gt;40 years age groups, rural place of residence (18.9%), only primary and/or basic school education (complete or not complete) (39.4%), unemployment (40.5%), intravenous drug user as mode of HIV‐1 transmission (39.5%), patient with clinical signs of immunodeficiency or condition related to HIV/AIDS as reason for primary HIV‐1 testing (35.2%), HBV (5.4%), HCV (44.0%) as partly shown in Table 1.ConclusionsThe overall prevalence of ASH was 16.3%. At least 9 factors associated with ASH were revealed. Knowledge of these factors is valuable for planning, prevention and post‐diagnosis services for HIV‐infected patients presenting with advance stage disease.Proportion of newly HIV infected patients by CD4+ count categories, % (n=4540).image Descriptive statistics of newly HIV‐infected patients Total CD4+ cell count ≤ 200 cells/mm3 CD4+ cell count ≥ 200 cells/mm3 p‐value* 4540 741 3799 Age Mean (SD) 32.6 (8.7) 35.5 (8.9) 32.1 (8.6) &lt;0.0001 Median 31.0 33.0 30.0 Age group 18‐25 yr 901 (19.8%) 52 (7.0%) 849 (22.3%) &lt;0.0001 26‐40 yr 2921 (64.3%) 512 (69.1%) 2409 (63.4%) &gt;40 yr 718 (15.8%) 177 (23.9%) 541 (14.2%) Gender Male 2289 (50.4%) 462 (62.3%) 1827 (48.1%) &lt;0.0001 Female 2251 (49.6%) 279 (37.7%) 1972 (51.9%) HIV mode of transmission Heterosexual contact 2801 (61.7%) 390 (52.6%) 2411 (63.5%) &lt;0.0001 Homosexual contact 99 (2.2%) 21 (2.8%) 78 (2.1%) Intravenous drug user (IVDU) 1388 (30.6%) 293 (39.5%) 1095 (28.8%) Blood transfusion, organ transplant or healthcare contact 3 (0.1%) 1 (0.1%) 2 (0.1%) Unknown 249 (5.5%) 36 (4.9%) 213 (5.6%) Chronic hepatitis B No 4362 (96.1%) 701 (94.6%) 3661 (96.4%) 0.0235 Yes 178 (3.9%) 40 (5.4%) 138 (3.6%) Chronic hepatitis C No 3001 (66.1%) 415 (56.0%) 2586 (68.1%) &lt;0.0001 Yes 1539 (33.9%) 326 (44.0%) 1213 (31.9%) Analysis result of comparison of HIV‐1‐infected patients with advanced stage disease vs. all other patients. Tests resulting in p‐values less than or equal to 0.05 are reported as ‘statistically significant’.

Prevalence of Prolonged Amenorrhea in HIV-Infected Women

Prevalence of Prolonged Amenorrhea in HIV-Infected Women