AIDS Clinic Research Articles

Retrospective Study on Genetic Diversity and Drug Resistance among People Living with HIV at an AIDS Clinic in Beijing.

(1) Background: The objective of this study was to investigate the prevalence of genetic diversity and drug resistance mutations among people living with HIV (PLWH) attending clinics in Beijing. (2) Methods: A retrospective analysis was conducted on PLWH admitted to the Fifth Medical Center of People's Liberation Army (PLA) General Hospital between 1 March 2013 and 31 July 2020. The participants were analyzed for pretreatment drug resistance (PDR) and acquired drug resistance (ADR). Nested polymerase chain reaction (PCR) was utilized to amplify the pol gene from plasma RNA samples obtained from the participants. Genotypic and HIV drug resistance were determined using the Stanford University HIV Drug Resistance Database. Univariate and multifactorial logistic analyses were used to assess the risk factors for PDR. (3) Results: The overall prevalence rates of PDR and ADR were 12.9% and 27.8%, respectively. Individuals treated with non-nucleoside reverse transcriptase inhibitors (NNRTIs) exhibited the highest prevalence of mutations. Specific mutation sites, such as V179D for NNRTIs and M184V and K65R for nucleoside reverse transcriptase inhibitors (NRTIs), were identified as prevalent mutations. Individuals treated with efavirenz (EFV) and nevirapine (NVP) were found to be susceptible to developing resistance. The multifactorial regression analyses indicated that the factors of circulating recombination form (CRF) genotype CRF07-BC and a high viral load were associated with an increased risk of PDR. CRF01-AE and CRF07-BC were the most prevalent HIV genotypes in our study. (4) Conclusions: The distribution of HIV genotypes in Beijing is complex. There is a need for baseline screening for HIV drug resistance among ART-naive individuals, as well as timely testing for drug resistance among ART-experienced individuals.

Clinical and immunological characteristics of HIV/syphilis co-infected patients following long-term antiretroviral treatment.

This study aims to analyze the efficacy of anti-syphilis treatment and the impact of syphilis events on HIV virology and immunology in HIV/syphilis co-infected patients on long-term antiretroviral therapy (ART) and to investigate the incidence and factors of syphilis recurrence/re-infection/serofast state. The insights derived from this investigation can potentially guide strategies for preventing and managing syphilis and AIDS. A retrospective case-control study was conducted at the AIDS clinic of Peking Union Medical College Hospital from January 2003 to December 2022. The study involved 86 HIV/syphilis co-infected patients and 86 HIV mono-infected patients matched based on age, baseline CD4 + T cell counts, and viral load. We examined the clinical characteristics of HIV/syphilis co-infected patients, evaluated the efficacy of anti-syphilis treatment, and analyzed the dynamic changes in HIV virology and immunology. The Generalized Estimating Equations (GEE) model investigated the factors associated with HIV/syphilis co-infection and syphilis recurrence/reinfection/serofast state. Syphilis serofast state was observed in 11.6% (10/86) of HIV/syphilis co-infected patients after treatment, and 33.7% (29/86) had syphilis recurrence or re-infection. The overall effectiveness of syphilis treatment stood at 76.8% (63/82). Notably, the effectiveness of syphilis treatment displayed a significant correlation with baseline syphilis titers exceeding 1:128 (p = 0.003). Over the 10-year follow-up period on ART, the HLA-DR + CD8+/CD8 + % levels in the HIV/syphilis co-infected group were markedly higher than those in the HIV mono-infected group (p < 0.05). However, no significant differences were observed between the two groups regarding HIV viral load, CD4+ T cell counts, CD8+ T cell counts, CD4/CD8 ratio, and CD38 + CD8+/CD8 + % (p > 0.05). GEE analysis model revealed that elevated HLA-DR + CD8+/CD8 + % levels were associated with HIV/syphilis co-infection (OR = 1.026, 95% CI = 1.007-1.046; p = 0.007) and syphilis recurrence/reinfection/serofast state (OR = 1.036, 95% CI = 1.008-1.065; p = 0.012). While HIV/syphilis co-infected patients typically receive adequate treatment, the incidence of syphilis recurrence and reinfection remain notably elevated. A heightened HLA-DR + CD8+/CD8+ % is a notable risk factor for HIV/syphilis co-infection and syphilis recurrence/reinfection/serofast state. Therefore, it is advisable to reinforce health education efforts and ensure regular follow-ups for people living with HIV undergoing ART to monitor syphilis infection or increased risk of syphilis infection.

Predictors and Barriers Associated with Non-Adherence to ART by People Living with HIV and AIDS in a Selected Local Municipality of Limpopo Province, South Africa

Introduction: The partial success of Anti-Retroviral treatment remains a challenge, therefore, contributory factors need to be addressed for treatment success. For instance, issues leading to ART non-adherence, that can be prevented, must be identified and addressed. Prevention of HIV has remained the best approach to controlling the spread of HIV, as there is no definitive cure yet. This study aimed at identifying predictors and barriers associated with ART non-adherence amongst HIV patients attending an adult antiretroviral clinic in Makhado Municipality, Limpopo Province, South Africa Methods: A cross-sectional study was conducted with patients who were on antiretroviral treatment, were attending HIV and AIDS clinics, and whose ages ranged from 18 years and above; structured questionnaires were distributed to these respondents. Results: A total of 225 respondents participated in the study. There were more female (68%) respondents; most respondents (72%) were unemployed. They travelled more than 15 km to the treatment centers and over half (65%) of the respondents have been on ART treatment for less than five years. The financial cost, the long distance travelled, and forgetfulness were identified as some of the barriers to ART adherence. Respondents mentioned the provision of health education as one of the strategies that might assist in improving adherence. Conclusion: Non-adherence to ART poses a significant challenge in the study area. The study concluded that lack of knowledge regarding the urgency of follow-up and financial constraints were contributing to ART non-adherence, therefore, HIV education should form part of the curriculum in the basic education syllabus.

1489. CD4+ T Cell Count and Associated Mortality in PLWHIV and Cancer at an Oncologic Center in Mexico over a 10-year Period.

Abstract Background PLWHIV and cancer have an increased risk of mortality. Previous studies show that a 100 cells/mm3 drop in CD4+ T cells following chemotherapy increases the risk of mortality by up to 30%. In Mexico almost 40% of patients have a late diagnosis. The aim of this study is to measure the mortality association between the CD4+ T cell count nadir in PLWHIV and cancer. Methods We conducted a retrospective study involving PLWHIV and cancer ≥18 yo treated at the cancer and AIDS clinic of the Instituto Nacional de Cancerología in México City from January 01, 2005, to December 31, 2015, that received chemotherapy, immunotherapy, radiotherapy and/or oncologic surgery. The baseline CD4+ T cell count, nadir during treatment, first CD4+ T cell count after treatment, one year and five years after the end of oncologic treatment were evaluated. A logistic regression (LR) model was performed considering CD4+ T cell count at baseline, nadir during oncologic treatment and the association with all-cause mortality. Institutional Review Board (IRB) of INCan approved the study (Ref/INCAN/CI/0049/2022). Results A total of 445 patients were included, median of nadir CD4+ T cell count was 122 cells/µL (IQR 48-232), 147 (32.89%) had baseline CD4+ T cell ≤100 cells/µL. Kaposi Sarcoma (46%) and non-Hodgkin lymphoma (27%) were the most frequent diagnosis. One-year mortality occurred in 72 patients (16%), from them, the cause of death was cancer in 54 (75%). Descriptive analysis by mean difference showed significant difference in CD4+ T cell count between patients who died vs. those who survived 117.7 vs 175.4 (p=0.01). In the LR model, a significant association was found between stage IV of cancer and higher mortality at 1 year (OR 2.39; CI 1.27- 4.52) and at 5 years (OR 2.21; CI 1.21-4.02). At five years, mortality was higher in patients with a second AIDS defining event (OR 2.17; CI 1.12-4.17). At one year after completed cancer treatment having a CD4+ T cell nadir &amp;gt;200 cells/ µL was associated with lower mortality (OR 0.29; CI 0.08 – 0.92). Conclusion This study found that having other AIDS defining events and advanced neoplastic disease was associated with higher mortality; while having a nadir ≥200 cd4+ cells/ml showed lower mortality after one year of treatment. Disclosures All Authors: No reported disclosures

Independent predictors of forecasting the course of congenital HIV infection in children

The purpose is to characterize the clinical and laboratory parameters in children with different rates of congenital HIV infection progression and, based on the data obtained, to develop independent predictors of forecasting the course of the disease.Research methods. The comparison of clinical, immunological and virological parameters in 91 children with HIV infection with rapid (26%) and slow progression of the disease (74%) was carried out. The criterion for the rapid progression of HIV infection was considered the development of the AIDS clinic in the first two years of life.Results. Testing of clinical, immunological and virological parameters in a multivariate logistic regression model revealed independent predictors of rapid progression in children aged 6 months — HIV blood viral load more than 1 00 000 cop./ml (odds ratio OR 23.9; 95% confidence interval 95% CI 4.6—71.8; P &lt; 0.001) and a decrease of blood CD4-lymphocytes less than 25% (OR 6.3; 95% CI 1.2—33.4; P = 0.029). The predictor «HIV blood viral load more than 100 000 cop./ml» was characterized by a higher sensitivity (91.3%), specificity (97.1 %) compared to the indicator «CD4 lymphocyte count less than 25%» (88.2% and 86.9%).Conclusion. In 26% of children with HIV infection, there is a rapid progression of the disease with the development of AIDS clinic during the first two years of life. The independent predictors of forecasting an unfavorable course of the disease are HIV blood viral load of more than 1 00 000 cop./ml and a decrease in CD4 lymphocytes in the blood of less than 25% at the age of 6 months. The level of viremia seems to be more preferable for predicting the course of HIV infection in children due to its high sensitivity and specificity.

Investigating the effect of social support, social capital, and coping on the positive state of mind of Iranian older people with human immunodeficiency virus/acquired immunodeficiency syndrome.

BACKGROUND:Social resources help to adapt to stress and might positively affect the well-being of individuals with severe conditions like human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). The present study investigates the effect of social support, social capital, and coping in a positive state of mind of Iranian older people with HIV/AIDS.MATERIALS AND METHODS:This cross-sectional study was conducted on 160 older people with HIV referred to AIDS clinics in Tehran in 2019. Samples were randomly selected from patients aged 50 years and older. Data were collected using a questionnaire, a positive state of mind, social capital, coping, social support, and a checklist of demographical variables. Data analysis was performed using SPSS software version 21.RESULTS:A significant positive correlation was found between social support, social capital, coping, education, and a positive state of mind. A significant negative correlation was also found between age, several chronic diseases of the patient, and a positive state of mind. The linear regression results showed that social support, social capital, coping, and education improved the positive state of mind.CONCLUSIONS:Based on our findings, we believe that social and psychological interventions effectively enhance patients' positive state of mind with HIV and ultimately, improve their quality of life.

From Silos to Solidarity: Case Study of a Patient-Centered, Integrative Approach to Opioid Tapering and Chronic Pain Mitigation in a Multidisciplinary AIDS Clinic

Background:People with HIV (PWH) are at a disproportionate risk for experiencing both chronic pain and opioid use disorder (OUD). Prescription opioid tapering is typically addressed within the “silo model” of medical care, whereby attention is focused solely on opioid addiction rather than also addressing chronic pain management, and limited communication occurs between patient and providers.Objective:This descriptive case study examined an integrative, collaborative care model consisting of Provider, Physical Therapist (PT), and Patient aimed at decreasing chronic pain and opioid use within a multidisciplinary HIV/AIDS clinic.Method:A physical-therapy based model of chronic pain mitigation and physician-driven opioid tapering was implemented. The Provider, PT, and Patient worked collaboratively to address physiological pain, pain coping skills and opioid tapering. A patient case example was used to illustrate the implementation of the model for a future, larger study in the same patient population.Results:This model was feasible in this case example in terms of clinic workflow and acceptability to both the Patient and Providers in this clinic. After the intervention, the Patient’s pain was fully eliminated, and he had ceased all opioid use.Conclusion:Results of this case study suggest that utilizing an integrative, patient-centered approach to both chronic pain management and opioid tapering may be feasible within the context of a multidisciplinary HIV/AIDS clinic. Generalizability is limited by case study model; however, this gives insight into the value of a collaborative alternative compared to a “silo” model of opioid tapering and chronic pain management in preparation for a larger study.

Internalized homophobia and sexual risk behavior among HIV-infected men who have sex with men in Israel

ABSTRACT Sexual risk behaviors among men who have sex with men (MSM) have been linked to diverse demographic, psychosocial, and behavioral factors. This study assessed the association between internalized homophobia and sexual risk behavior among HIV-infected MSM and the mediating effects of safe-sex self-efficacy and depression on this association, using a theoretical framework based on the Theory of Social Action. Data were collected from 124 HIV-infected MSM attending an AIDS clinic in Israel. No significant association was found between internalized homophobia and sexual risk behavior (unprotected anal intercourse). Examination of mediation effects revealed full mediation by depression, but not by self-efficacy. Depression and self-efficacy were the only significant explanatory variables of sexual risk behavior. Diverse social work interventions with HIV-infected MSM aimed at reducing sexual risk behaviors should include routine screening of IH and its association with depression, and address depression and self-efficacy in CBT and other interventions.

Development and Validation of a HIV Disease–Specific Nutrition Screening Tool

The Rapid Nutrition Screening for HIV disease (RNS-H) was developed and used by case managers to screen for nutrition risk status at an AIDS clinic. A registered dietitian nutritionist (RDN) completed a comprehensive nutritional assessment on all clients screened and assigned a nutrition risk status. A total of 96 clients participated. Analyses showed a very high degree of association between the dietitians' and case mangers' nutrition risk ratings (Kendall τ = 0.973, P &lt; .00008

Widespread use of anti-retroviral therapy elevated the prevalence of dyslipidemia in HIV-infected Chinese patients

With the widespread use of high-efficiency antiretroviral therapy (HAART), the life expectancy of HIV-infected patients has been significantly extended. However, the metabolic complications among HIV-infected patients treated with HAART have become the most common problem in the world. It is very important to explore the incidence of dyslipidaemia and studies on the role of potential risk factors in HIV-infected Chinese patients treated with HAART are sparse. Therefore, we designed current study, to investigate the effects of therapeutic intervention and continuous information support on the lifestyle of HIV/AIDS patients with dyslipidaemia. Three hundred and six HIV/AIDS patients admitted to the AIDS clinic in Beijing from January 2016 to January 2017 were recruited and assigned into two groups: the treatment group (n=64) and the control group (n=64). The median age of the participants was 38.8±11.0 years (range 20-75 years). The prevalence of dyslipidemia in control and treatment group was (59/64) 92.2% and (53/64) 82.8%, respectively. In this study, low HDL-cholesterol (HDLC) led to abnormalities 47/64 (73.3%) in the control group and 35/64 (54.7%) in HAART-treatment group. Additionally, HAART group showed higher triglyceride, total cholesterol, and low-density lipoprotein (246.1±171.8, 1.73±1.61 mmol/L, 4.46±1.1 mmol/L, 2.54±0.74 mmol/L). In multivariate analysis, gender, marital status, high BMI, dietary habits and physical activity were potential risk factors for dyslipidemia in HIV-infected Chinese patients. In this study, we reported high prevalence dyslipidemiain two HIV infected groups. We suggest that the appropriate diagnosis should be performed for analyzing the metabolic complications in HIV-infected Chinese patients. Further studies are very important to understand the role of potential risk factors in metabolic complications.

Trouble

Trouble Mariah Garnett (bio) When I began making Trouble (2019), I wrote down what happened every day for the first six weeks of shooting. This is when I was staying in my dad's art studio in Vienna. I wasn't sure what would come of it, but about a year later when I made Other & Father (2016), this text was exhibited alongside a two-channel projection of my shot for shot remake of archival news footage of my dad from 1971. And in 2019, all of these elements ended up in the final cut of Trouble as onscreen text. What began as research, or as a playful exercise, or a means of recording information for posterity, often ended up sitting alongside material specifically crafted for the film. This is true in most of my work. [End Page 92] Day 1 I arrive at the airport. It's David's birthday. I decide not to ask about filming. Click for larger view View full resolution Day 3 I ask David about filming. He tentatively says yes but feels uncomfortable. He talks at length about Belfast. I wish I had my camera. I meet with a collector for lunch and I'm wearing a Raiders sweatshirt. He is wearing a suit. I feel embarrassed about my clothes. I meet Anne at a bar David used to drink at in his wilder days. I can't tell if I have a crush on her. She tells me I walk as fast as she bikes. Click for larger view View full resolution [End Page 93] Day 5 Get AIDS test at the free clinic. Kill time looking at Tinder and feel like a monster. Later, I go to a gallery where I am supposed to meet some people. I see at least two people from the waiting room for the AIDS clinic at the opening. I tell my new "friends" this. Wonder if it is appropriate. Click for larger view View full resolution Day 6 I have a dream that I am a piece of paper floating above the rooft ops. I float over the whole city and I am on fire. The pain is so excruciating I beg god to kill me and put me out of my misery. Click for larger view View full resolution [End Page 94] Day 8 Supposed to go to the countryside but David says it's too gloomy so we don't go. I try not to take this personally but am not entirely successful. We go to see an art show and he starts coming up with ideas for ways we could shoot stuff together. I am elated. At home, I watch Se7en with German dubbing. The neighbors scream at each other. I turn my sound recorder on and fall asleep. Click for larger view View full resolution [End Page 95] Day 11 David takes me to the Osteopath. She tells me my uterus has shifted. I feel nervous about videoing even though she said its ok. I don't record the good part, only the stuff that comes right after. Afterwards we meet some of my new friends at the gay Christmas market. My uterus hurts from her moving it around. David worries he'll have to take me to the hospital. He is jumpy around my friends. Astrid asks if the Osteopath was expensive and he replies in German and walks off. Astrid asks me "do you know what he just said?" I don't. "He said 'I never gave her anything so I figured this was the least I could do.'" Click for larger view View full resolution [End Page 96] Day 12 Joanna and I meet Kevin and David at the natural history museum and all bomb around like children. We lick the salt rock. Afterwards, we hang out on the steps outside. We talk about composing images. I feel like I haven't composed a single one since I've been here, just turned the camera on and off. Click for larger view View full resolution [End Page 97] Day 15 In my dream, my dog runs away because I left the door wide open. I spend hours looking for...

Prevalence and risk factors for erectile dysfunction in HIV-infected patients in Salvador, Brazil

BackgroundEffective antiretroviral therapy (ART) has increased life expectancy for HIV patients to levels close to that observed for general population. Comorbidities are also increasing, due to ageing of such population. Erectile dysfunction (ED) has been a frequent finding in men living with HIV. ObjectivesThe goals of the present study were to define the prevalence of ED and associated factors in HIV-infected men, in a referral center of Salvador city, Brazil. MethodsHIV-infected men ≥18 years of age, receiving care at the AIDS Clinics of Complexo Hospitalar Professor Edgard Santos (C-HUPES), Universidade Federal da Bahia were consecutively included in the study until the estimated sample size (N=134) was reached. Patients filled a structured questionnaire on clinical-epidemiological characteristics, as well as the International Index on Erectile Function to assess ED. ResultsMost (55%) were black and single (79%), mean age 44.8 years. ED was detected in 29 (21.6%) patients; 86% of ED cases were classified as severe. The only factors associated with ED were low income (p=0.02) and unemployment (p=0.01). No association was found between ED and frequency of comorbidities, age, or ART used by patients. ConclusionIn a referral center in Salvador city, socio-economic problems were the main factors associated with ED. Psychological impact of poor social conditions should be routinely assessed in patients with ED to implement preventive measures for ED.

Risk factors of syphilis co-infection among HIV-infected men who have sex with men in Tel-Aviv, Israel

ABSTRACTSyphilis incidence in Israel and other industrialized countries has increased in the past decade, mainly among men who have sex with men (MSM) who were co-infected with HIV. This study aimed to assess the demographic characteristics and behavioral risk factors for syphilis infection among HIV-infected MSM in the Tel-Aviv region, Israel. This cross-sectional study compared HIV-infected MSM who were co-infected with syphilis since 2005 with HIV-infected MSM without syphilis, using an anonymous self-administered questionnaire distributed at the AIDS treatment clinic in central Israel in 2016. This study included 75 HIV-infected MSM who were diagnosed with syphilis after their HIV diagnosis and 99 HIV-infected MSM without syphilis. Variables associated with syphilis infection included inadequate adherence to antiretroviral therapy (ART) (OR = 1.8 [1.2–2.4]), frequent unprotected receptive anal intercourse (UAI) with casual sex partners (OR = 2.2 [1.5–8.2]), especially with HIV-infected partner (OR = 3.2 [1.1–7.9]).In conclusion, HIV and syphilis co-infection were associated with frequent UAI with casual sex partners, inadequate adherence to ART and limited partner notification. In order to minimize syphilis transmission among HIV-infected MSM, AIDS clinics should encourage HIV-infected MSM to use condoms, ensure that patients perform periodic syphilis serology testing and improve partner notifications.

\u2018Virus Carriers\u2019 and HIV testing: navigating Ukraine\u2019s HIV policies and programming for female sex workers

BackgroundThere are an estimated 80,100 female sex workers (FSWs) in Ukraine, of whom 7% are living with HIV. Early HIV diagnosis continues to be a public health priority in Ukraine as only approximately 54% of people living with HIV are diagnosed nationwide. This study aims to analyse the content, context and discourse of HIV testing policies among female sex workers in Ukraine and how these policies are understood and implemented in practice.MethodsTo analyse past and current national policies, we searched the database of the Ukrainian Parliament and the Ministry of Health for relevant policy documents (e.g. legislation and orders). To analyse the day-to-day practice of those involved in the implementation of these HIV programmes, we conducted face-to-face semi-structured interviews with key stakeholders. All data were coded using deductive thematic analysis initially guided by the Policy Triangle, a framework which addresses policy content, the process of policy-making, the health policy context, actors involved in policy formulation and implementation.ResultsHIV testing policies are formed and implemented in the post-Soviet context through a vertical system of AIDS clinics, resulting in the separation of key affected populations from the rest of the health system. Successive testing policies have been strongly influenced by international donors and non-governmental organisations. Furthermore, a lack of government funding for HIV prevention created a gap that international donors and local non-governmental organisations covered to ensure the implementation of testing policies. Their role, however, had limited influence on the Ukrainian government to increase funding for prevention, including testing of FSWs. Since the early 1990s, when stigmatising and discriminatory forced/mandatory HIV testing was applied, these approaches were slowly replaced with voluntary testing, self-testing and assisted HIV testing, yet stigma was found to be a barrier among FSWs to access testing.ConclusionPoor governance and the fragmentation of the health system, ongoing health sector reforms, shrinking international funding, and persisting stigma towards people living with HIV and sex workers might impede the continuity and sustainability of HIV testing programmes. Local civil society may now have the opportunity to contribute to the development and further implementation of HIV testing policies in Ukraine.

PENGETAHUAN DAN SIKAP WANITA RAWAN SOSIAL EKONOMI (WRSE) TENTANG PENCEGAHAN PENANGGULANGAN HIV/AIDS DI KOTA PEKALONGAN TAHUN 2014

Human Immunodeficiency Virus (HIV) is the virus that causes Acquired Immunodeficiency Syndrome &#x0D; (AIDS), which is a global health problem in both developed and developing countries. HIV / AIDS is a sexually &#x0D; transmitted disease that can be transmitted throughout society from infants to adults both male and female. &#x0D; Women's socio-economic prone included into the vulnerable groups because of poor health status, durability and &#x0D; family welfare would have the potential to perform high-risk of HIV infection and AIDS. The purpose of the &#x0D; research is to analyze the knowledge and attitudes of women's socio -economic prone on the prevention of &#x0D; transmission of HIV / AIDS in Pekalongan.&#x0D; This research method is quantitative and qualitative. The samples of this research are 47 WRSE in &#x0D; Pekalongan, taken 4 WRSE study subjects aged 18-50 years with criteria, are married and have children, widows &#x0D; live / dead widow who becomes the primary breadwinner families or married to a husband who worked at sea for &#x0D; long periods (return 3 months or more), working as a bus driver Inter-City Inter-Province (AKAP), truck drivers, &#x0D; or work outside the city without clarity, have dependents by more than 3 people, stay in Pekalongan. Collecting &#x0D; data through in-depth interviews and analysis with content-analysis.&#x0D; The results showed WRSE knowledge about STDs, HIV / AIDS as well as an overview of HIV disease &#x0D; AIDS is still very limited, limited knowledge society is due to the lack of dissemination to the public of &#x0D; information relating to HIV / AIDS and VCT clinics presence in Pekalongan by the Government. Negative &#x0D; attitudes towards PLHIV community committed (People Living with HIV / AIDS) is caused by ignorance of the &#x0D; community clearly.&#x0D; It is recommended to promote coordination among agencies in providing public education, socializa tion &#x0D; expanded, the type of information plus, especially socialization related to the prevention of disease transmission, &#x0D; forming an organization engaged in the protection and prevention of HIV/AIDS.&#x0D; &#x0D; Keywords: HIV / AIDS, WRSE, Knowledge, Attitude

POLA PENGGUNAAN OBAT ANTIRETROVIRAL (ARV) PADA RESEP PASIEN RAWAT JALAN DARI KLINIK HIV/AIDS SALAH SATU RUMAH SAKIT SWASTA DI KOTA BANDUNG

ABSTRACT&#x0D; The Human Immunodeficiency Virus (HIV) continues to be a major global public health issue, which targets the human immune system. The using of ARVs in the treatment of HIV / AIDS increased life expectancy for PLHIV (People With HIV / AIDS). This study aims to determine the description of the using of ARV drugs in outpatients of the HIV / AIDS Clinic and assessed their suitability with established treatment standards. This research was carried out in a descriptive non-experimental manner, with data collection carried out retrospectively, used patient prescription data from April to December 2017. The results of quantitative studies showed 87% were male patients, and the largest age group was 20-29 years (39%) . Class of antiretroviral drugs used were Nucleoside / Nucleotide Reverse Transcriptase Inhibitors (NRTIs), Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs), and Protease Inhibitors (PI), with a combination of antiretroviral drugs most was the combination of first-line tenofovir + lamivudine + efavirenz (69%) while the second-line drug zidovudine + lamivudine + lopinavir / ritonavir was 1%. The most commonly used comorbid drug was cotrimoxazole. For qualitative data, the accuracy of combination and dose of ARV drugs was 100% in accordance with Permenkes No. 87/ 2014, with 79% of patients adhered to antiretroviral treatment every month. The potential for most ARV drug interactions with other drugs for the moderate category was zidovudin + cotrimoxazole (11%) which occured pharmacokinetically by decreasing renal clearance of zidovudine and glucuronide metabolites. In conclusion, the pattern of used of ARV drugs had met the standard of Permenkes No.87/2014, with the most used were the first line combination of tenofovir + lamivudine + efavirenz.

Chronic Pain Mitigation and Opioid Weaning at a Multidisciplinary AIDS Clinic: A Case Report.

Chronic pain has emerged as a treatment priority among people living with HIV (PLHIV). Recent studies indicate the use of physical therapy (PT) for chronic pain mitigation among PLHIV, however there is a paucity of literature regarding PT as part of multidisciplinary collaboration to address the intersection of HIV, chronic pain and opioid use. This case report examined the effect of a 24-session PT intervention aimed at decreasing chronic pain and opioid weaning for a 64 year-old patient at a multidisciplinary AIDS clinic in Atlanta, Georgia. The PT intervention focused on pain mitigation, utilizing using pain-relief techniques such as a home TENS unit, home stretching regimen, diaphragmatic breathing techniques. In addition, the physical therapist communicated regularly with the patient's primary HIV provider regarding patient progress. After the intervention, outcomes included: decreased pain from 10/10 to 0/10, independent pain management, and increased independence in functional activities. In addition, the patient decreased opioid usage from 15 to 2.5 mg Hydrocodone, an 83.3% decrease. In a complex chronic pain case with a patient on chronic opioid therapy, multidisciplinary communication is key in successful management. To truly address opiate weaning in the context of pain management, physical therapists' expertise in pain management should ideally be complemented by close communication with the patient's primary medical provider. This allows for open dialogue, and acknowledges the importance of various specialty areas committed to a joint effort of not simply opioid weaning, but of patient-centered, multidisciplinary chronic pain control.

Dietary intake of HIV-seropositive clients attending Longisa County Hospital Comprehensive Care Clinic, Bomet County, Kenya

Background: Dietary intake of HIV-seropositive persons remains a major concern across various settings around the globe. Inadequate dietary intake, infections and stage of disease progression elicit malnutrition among HIV-seropositive individuals, which hastens progression of HIV to full-blown AIDS. Aim: The study sought to determine the dietary intake of HIV-seropositive clients attending Longisa County Hospital Comprehensive Care Clinic, Bomet County, Kenya. Methods: A cross-sectional analytical study design was administered on a comprehensive sample of 210 patients. A 24-hour dietary recall questionnaire and Food Frequency Questionnaire (FFQ) were used by the researcher to collect data on the dietary intake of the respondents. The 24-hour dietary recall data were analysed using NutriSurvey whereas data obtained from the FFQ were analysed manually. Results: Study respondents comprised more females (61.6%) than males (38.6%). Adequacy in energy intake amongst the respondents was average as males attained 47.4% of recommended energy intake, whereas females attained 50.0%. Intakes for selected nutrients, vitamin A, B1, B2, C, were adequate for males and females. Iron intake was significantly low among female respondents as 89.3% did not meet the RDA. Similarly, zinc intake among male respondents was low as only 28.9% met the RDA. The mean number of meals consumed by the respondents was 3.8 ± 0.1. Consumption frequency of legumes, fruits, other vegetables, meats, eggs and fish was irregular. Conclusion: The dietary intake of the respondents was not satisfactory as evidenced by inadequacies in intake of certain nutrients and low number of meals consumed on a daily basis. Inadequate dietary intake is detrimental to HIV and AIDS management and treatment modalities, hence resulting in poor treatment outcomes. Care and treatment modalities at HIV and AIDS clinics should encompass provision of clear and concise information on the importance of adequate dietary intake as a means of optimising positive treatment outcomes.

Dermatological conditions associated with HIV medication in a cohort of Greek patients initiating antiretroviral therapy: 1988–2013

Objectives: Treatment of HIV infection has evolved from a single antiretroviral agent to combination therapy, which has dramatically improved both the quality of life and life expectancy of affected patients. The aim of this study was to review HIV treatment-associated dermatological conditions observed in adult patients receiving antiretroviral therapy (ART) in a single tertiary care referral centre over time.Methods: We reviewed the files of HIV-positive patients seen at the Dermatology Department, AIDS Clinic of the Andreas Syggros Hospital, Athens, Greece who had initiated ART from 1988 to 2013, for evidence of dermatological conditions commonly associated with HIV-related medication.Results: Among a cohort of 1329 HIV-positive patients (1155 men and 174 women), 352 (299 men and 53 women) presented with at least one dermatological condition, with a total of 423 conditions diagnosed that could be attributed to HIV-related medication. Lipodystrophy (47.42%), and maculopapular (MP) rash (40.6%) were most commonly diagnosed. There were three incidence peaks for these reactions, which reflected the different types of ART and HIV-related drugs commonly used at the time. After 2006, the number of these dermatological conditions declined (15.1% of cases) with the availability of newer ART regimens.Conclusions: Early ART was accompanied with a high incidence of adverse skin reactions, which have decreased over time in association with overall better tolerated treatment regimens for HIV infection

Burden of sleep disturbances and associated risk factors: A cross-sectional survey among HIV-infected persons on antiretroviral therapy across China

This study evaluated the prevalence and factors associated with sleep disturbance in a large cohort of HIV-infected patients across China. A cross-sectional study was conducted among HIV-infected patients on antiretroviral therapy at 20 AIDS clinics. The Pittsburgh Sleep Quality Index was self-administered by subjects. Socio-demographic characteristics, medical history and HIV-related clinical data were collected. 4103 patients had complete data for analysis. Sleep disturbances were observed in 43.1% of patients. Associated factors in multivariable analysis included psychological factors: anxiety (odds ratio [OR], 3.13; 95% confidence interval [CI], 2.44–4.00; P < 0.001), depression (OR, 2.09; 95% CI, 1.70–2.57; P < 0.001), and both anxiety and depression (OR, 5.90; 95% CI, 4.86–7.16; P < 0.001); sociodemographic factors: MSM (OR, 1.26; 95% CI, 1.04–1.52; P = 0.018), being single (OR, 1.45; 95%CI 1.21–1.74; P < 0.001), higher education (OR, 1.25; 95% CI, 1.03–1.53; P = 0.025); and clinical factors: suboptimal adherence (OR,1.51; 95% CI,1.23–1.85; P < 0.001), regimen-switching (OR, 1.94; 95% CI, 1.12–3.35; P = 0.018), and antidepressant use (OR, 1.98; 95% CI, 1.47–2.67; P = 0.044). Prevalence of sleep disturbance is high in this large Chinese cohort. Associated factors appear related to psychological and social-demographic factors. Health workers may consider routinely assessing sleep disturbances among HIV-infected patients, especially in the first three months after HIV diagnosis, and referring for mental health services, which may positively impact adherence to treatment.