Antiretroviral Therapy Center Research Articles

Covid-19 Escaled Ongoing Injustices: Voices of Women Living With HIV in Nepal

The first HIV case in Nepal was reported in 1988. As of July 2020, the total number of PLHIV was 29,503 PLHIV whereas the numbers for male and females were respectively 17, 587 and 11, 916 (UNAIDS, 2021.). More than 72% of People Living with HIV (PLHIV) are of age group 25 to 49 years (Ministry of Health National Centre for AIDS and STD Control, 2020). There are 80 ART (Anti-Retroviral therapy) centres providing services to PLHIV in seven Provinces and a number of community-based organizations to provide services to PLHI (Ministry of Health National Centre of AIDS and STD Control, 2020). The current knowledge on this area are maninly the reports from HIV Service Agencies that do not capture the silenced voices of PLHIV on intersectional oppression. By acknowledging the need of a evidence-based study, a Participatory Action Research (PAR) project was developed in 2019 to understand the challenges of the Women Living with HIV in Kathmandu, Nepal (Dhungel, 2020; Dhungel & Lama, 2020). This understanding was reached through a variety of means, including photovoice, individual interviews and street dramas. Four major intersectional challenges were identified including discriminations against WLHIV at workplace, violations of privacy in health sectors, excluding from parental's property and discriminations against their children at school. The same study suggested the need for a further study, focusing on intersectional oppressions and public health services and programs available for WLHIV with a focus on Mental Health Services. Therefore, this study was initiated to bridge the gaps in current knowledge with a foucs on COVID-19 policies/programs. Keywords: COVID-19, HIV community, injustice, intersectional oppression

Stigma, Social Support, Illicit Drug Use, and Other Predictors of Anxiety and Depression Among HIV/AIDS Patients in Pakistan: A Cross-Sectional Study.

Introduction: Anxiety and depression in people living with HIV/AIDS (PLWHA) can lead to non-adherence to antiretroviral therapy (ART), morbidity, and mortality. Therefore, assessing the stigma, social support, and other determinants of anxiety and depression in PLWHA are important for developing further interventions.Methods: An institution-based cross-sectional study was conducted in 505 PLWHA, approached through systematic sampling, who paid routine visits to the ART center, Pakistan Institute of Medical Sciences (PIMS), Islamabad. Data was collected by pretested validated hospital anxiety and depression scale (HADS). Version 26 of the SPSS was used to apply Logistic regression analysis to identify determinants, and the 95% confidence interval (CI) adjusted odds ratio (AOR) was calculated to assess the magnitude of the relationships.Results: In PLWHA, the prevalence of co-morbid depression and anxiety was 80%. Separately, 89.9% had depression, and 80.3% had anxiety. Use of illicit drugs [AOR = 1.87, 95% CI (1.01, 3.27)], low social support [AOR = 1.21, 95% CI (1.02, 2.25)], being male [AOR = 2.21, 95% CI (1.11, 5.49)], and HIV related stigma [AOR = 2.48, 95% CI (1.25, 6.02)] were significant predictors of depression. Having detectable viral load [AOR = 3.04, 95% CI (1.04, 8.86)], young age [AOR = 5.31, 95% CI (1.19, 29.39)], no formal education [AOR = 21.78, 95% CI (4.03, 117.62)], low [AOR = 1.70, 95% CI (1.12, 6.93)] or moderate [AOR = 2.20, 95% CI (1.79, 6.09)] social support, illicit drugs addiction [AOR = 1.17, 95% CI (1.03, 2.55)], and HIV stigma [AOR = 54.3, 95% CI (21.20, 139.32)] had a remarkable association with anxiety.Conclusions: Given the high prevalence of anxiety and depression among PLWHA, the Pakistan Ministry of Health should focus more on monitoring mental health, expanding mental health services, and developing interventions based on identified factors to treat depression and anxiety among PLWHA.

Peripheral neuropathy in people living with human immunodeficiency virus and acquired immunodeficiency syndrome on antiretroviral therapy

Background: Peripheral neuropathy is a common neurological complication in people with human immunodeficiency virus (HIV) infection. HIV-associated sensory neuropathy (HIV-SN) is defined as the presence of neuropathic symptoms and at least an abnormal perception of vibrations of a 128 Hz tuning fork on the great toe or abnormal ankle reflexes or both. Brief peripheral neuropathy screening (BPNS) tool is employed in identifying HIV-SN based on a directed symptom questionnaire and limited clinical examination. The present study was conducted to determine the prevalence and drug regimens related to peripheral neuropathy in people living with HIV and Acquired immunodeficiency syndrome (AIDS) on antiretroviral therapy (ART) so as to help improve the care for those on ART. The objective was to study the prevalence of peripheral neuropathy in people living with HIV and AIDS on ART using AIDS clinical trials group validated BPNS tools.Methods: Cross-sectional study on 198 HIV-seropositive cases aged above 18 years on ART attending centre of excellence (CoE) ART centre, RIMS Imphal. The presence of peripheral neuropathy was examined by using a BPNS among the participants.Results: Peripheral neuropathy was found in 46 (23.2%) out of 198 participants using BPNS. In this study a positive association between the duration of treatment with ART and use of protease inhibitor regimes with the development of peripheral neuropathy was significant.Conclusions: Peripheral neuropathy in patient with HIV and AIDS on ART had significant association with duration of treatment with ART and use of protease inhibitor combination in the ART regime.

COVID-19 Vaccine Hesitancy Among PLWH in South India: Implications for Vaccination Campaigns.

Background:The global effort to end the Severe Acute Respiratory Syndrome - Coronavirus 2 pandemic will depend on our ability to achieve a high uptake of the highly efficacious vaccines in all countries. India recently experienced an unprecedented transmission surge, likely fueled by a premature reopening, the highly transmissible delta variant, and low vaccination rates. Indian media have reported high degrees of vaccine hesitancy, which could interfere with efforts to prevent future surges, making it crucial to better understand the reasons for such reluctance in vulnerable populations, such as people living with HIV.Methods:We conducted telephone interviews with 438 people living with HIV who were participants in a longitudinal cohort, designed to examine and validate novel antiretroviral therapy ART adherence measures. Interviews were conducted in January and February 2021 and covered COVID-19–related questions on confidence in vaccine safety and efficacy, worries of vaccine side effects, trust in COVID-19 information from specific sources, and intent to get vaccinated.Results:Over one-third of participants (38.4%, n = 168) met our definition of “vaccine hesitant” by reporting being either unlikely to get vaccinated at all or wanting to wait. Vaccine hesitancy was associated with lack of confidence in vaccine safety, concerns about side effects and efficacy, and distrust in common sources of vaccine-related information.Discussion:These results highlight several challenges for vaccination efforts. Campaigns may benefit from using trusted sources, including antiretroviral therapy center staff, providing clear information about safety and efficacy and emphasizing the role of vaccines in preventing severe disease, hospitalizations and death, and the reduction of forward transmission to unvaccinated household members.

Retrospective cohort analysis of survival of children living with HIV/AIDS in Mumbai, India

ObjectivesTo understand the survival in a cohort of children living with HIV/AIDS (CLHAs) and to study the factors associated with survival in CLHAs in government antiretroviral therapy (ART) centres in...

Effectiveness of Highly Active Anti-retroviral Therapy (HAART) in the Adult Population in the Ashanti Region of Ghana

AIDS is the late stage of infection with the Human Immunodeficiency Virus (HIV). Even though the Highly Active Antiretroviral Therapy (HAART) for the management of HIV/ AIDS has been in existence in Ghana since 2003, there is still limited data on their effectiveness. This study therefore sort to ascertain the effectiveness of HAART used at Anti-retroviral therapy (ART) Centres in the Ashanti region of Ghana by assessing its effects on immunological and haematological markers as well as some significant indicators such as body temperature and blood pressure changes. The study was a retrospective cross sectional study which reviewed medical record folders of 156 HIV infected patients who had attended the selected ART centres in the Ashanti region of Ghana between 2010 and 2014. About 49% of the study population had a significant rise in their CD4 counts after six months strict adherence to specific HAART regimen. HAART effectively reduced viral loads and increased CD4 counts in most of the patients whose medical record folders were reviewed. Socioeconomic factors, formal education and lack of health literacy had a significant effect on adherence to the HAART regimen, however; marital status of patients did not have any significant effect on adherence, CD4 counts and the haemoglobin concentration of patients. Based on results obtained from this study, HAART could be considered as effective in the adult population in the Ashanti region of Ghana provided there is a high level of adherence. Immunological and haematological markers for the assessment of effectiveness could also improve with high adherence recommended HAART regimen

Dermatological Opportunistic Infections in HIV Seropositive Patients: An Observational Study.

Background and objectiveIn developing countries, the dermatological manifestation of the human immunodeficiency virus (HIV) has a high prevalence. Apart from the systemic infection that ensues HIV, skin manifestations form a major part of the disease burden. They can present with atypical forms, and necessary tools for diagnosis may not be available in rural and remote parts of the country. Hence, they can stay misdiagnosed or undiagnosed, contributing to the morbidity of the patients. We attempted to enumerate the dermatologic opportunistic infections (OIs) in Rajkot city, Gujarat, India, in order to disseminate knowledge regarding the same. Material and methodsIt is a retrospective observational study. A total of 253 patients under treatment for HIV/acquired immunodeficiency syndrome (AIDS) at the ART Center (anti-retroviral therapy center) from 2011 to 2019 were included. The data recorded in the registry during the above-mentioned period were utilized in the study. The diagnoses of OIs were made clinically by multiple health care providers experienced in the field.ResultTwo hundred twenty-seven (227) of 253 (89.72%) of the patients had some form of dermatologic OI during the course of their treatment. Overall, fungal infections (33.03%) were most common, followed by bacterial infections (28.18%) and viral (14.55%) infections. Among the non-infectious causes, cheilitis/angular stomatitis topped the list. Among the STDs, herpes was the most common skin manifestation seen with a 10.57% prevalence. The CD4+ cell count for fungal infection ranged from 353-467 and was seen in stage 2 of the disease course. Bacterial infections were seen mainly during the early and middle stages of the disease while viral infections were most prevalent in stage 2 of the disease.ConclusionSkin manifestations can be useful clinical predictors of the disease stage, especially in resource-limited settings and in developing countries. They can present with unusual and atypical forms. Hence, knowledge about the prevalence of these OIs in a particular geographical area can be very useful for physicians in treating them and decreasing the disease burden.

Awareness, Availability and Accessibility of Pre-Exposure Prophylaxis (PREP) and Post Exposure Prophylaxis (PEP) in Health Institutions in Ekiti State, Nigeria

The study was conducted to determine the level of awareness, availability and accessibility of both pre-exposure prophylaxis (PrEP) and post exposure prophylaxis (PEP) in health institutions in Ekiti State. Five major health facilities providing Antiretroviral Therapy (ART) cutting across the three senatorial districts of the state were purposefully selected based on number of patients accessing the facilities for different reasons and been a functional ART centre in the state. Key informant interview (KII) was employed to collect information from the respondents. The result shows that PrEP is not available with the state as none of the Centres visited had provided PrEP services in the last one year. Though PEP is available in all the facilities visited but accessibility is low. Mostly PEP is provided to Health Workers who got exposed in the course of their duty and victims of sexual violence (mostly rape). There is no comprehensive programing for discordant couples who could have benefited from PrEP programing. Awareness of PEP services where available is low thereby leading to low service uptake. Only one centre reported external access (an individual with accidental condom bust) to PEP over two years ago. Disclose is still a big issue within the state, most PLHIV have partners that are not aware of their status (Probably because of stigma) therefore creating a barrier for effective programing. Recommendations focused on the ways to address the issues raised in the result above.

Virological failure among HIV infected individuals on antiretroviral therapy in Pune, India: a cross-sectional study

Background: It is important to identify and manage determinants of virological failure among HIV infected individuals on treatment for achieving viral suppression. This study aimed to identify proportion and factors associated with virological failure among HIV infected individuals receiving first line antiretroviral therapy (ART).Methods: A total of 2670 adult HIV infected individuals attending ART centre at ICMR-National AIDS Research Institute, between January 2005 and June 2019 and having their recent viral load done after implementation of guidelines on routine viral load testing were included. Data were reviewed and analysed.Results: Of the 2670 people living with HIV (PLHIV) on first line antiretroviral therapy, 48% were male and 69% were more than 40 years of age. Mean baseline CD4 count at ART initiation was 252 cells/mm3 (SD:210, IQR 116-313) Overall, 13% (340/2670) of the participants showed virological failure. In multivariate analyses, participants with younger age and males retained significant association. Those with baseline CD4 counts of less than or equal to 500 cells/mm3 at treatment initiation (adjusted OR 1.71; 95% CI 1.08-2.70; p=0.022) and ART adherence ≤95% within last three months of recent viral load determination (adjusted OR 1.55, 95% CI of AOR 1.04-2.32; p=0.031) had higher risk for virological failure as compared to others. PLHIV with ART substitution due to various reasons were almost twice as likely to have virological failure (adjusted OR 1.83, 95% CI 1.44-2.33; p<0.001).Conclusions: It is crucial to focus on factors leading to virological failure among HIV infected individuals attending ART centre. Early linkage to treatment and ART initiation along with adherence counselling at every follow up visit play an important role in mitigating virological failure.

English

BACKGROUND Globally the number of people living with human immunodeficiency virus/ acquired immunodeficiency syndrome (HIV/AIDS) has been rising steadily since 2011 nearing more than 33 million whereas in developing countries like India it is 2.4 million with a prevalence of 0.3%. The purpose of this study was to assess the association of CD4 counts with cardiovascular dysfunction among HIV/AIDS patients. METHODS This was a hospital-based study conducted at the Vijayanagara Institute of Medical Sciences, Bellary. Convenience sampling was used and patients admitted to the wards of the internal medicine as well as those attending anti-retroviral therapy (ART) centre out-patient department (OPD) were included in the study. A total of 200 cases of seropositivity of HIV patient diagnosed by Elisa technique were assessed after obtaining informed consent. Clinical profile and laboratory investigations were carried out on the patients such as CD4 counts and analyzed with various cardiac dysfunction. RESULTS Commonest affected with HIV infection were young male (26 – 40 years) 77.5 % followed by young female 60 % Commonest symptoms were fever, cough 82 % each and breathlessness 44 %. Commonest clinical findings were pallor 80 %, pedal oedema 68 %, and lymphadenopathy 32 %. 26 % of patients had electrocardiography (ECG) abnormalities with commonest being sinus tachycardia 18 %, low voltage complex 4 %, IHD (ischemic heart disease) 2 %, LVH (left ventricular failure) 2 %. 34 % had chest x-ray abnormalities such as cardiomegaly 14 %, pleural effusion 12 % and PTB (pulmonary tuberculosis) 2 %. Abnormal CD4 counts were noted in 94 % of patients, with 12 % having very low CD4 counts that is less than 50. Statistically significant pericardial effusion was noted with low CD4 counts on 2D ECHO cardiography. CONCLUSIONS The study concludes that decrease in CD4 count is statistically associated with increased pericardial effusion among HIV/AIDS patients. KEYWORDS CD4 Counts, HIV/AIDS Patients, Cardiovascular Dysfunction, Pericardial Effusion

To assess the adherence to antiretroviral therapy among HIV positive patients attending ART centres in Haryana and its effect on their quality of life

Background: Acquired immune deficiency syndrome (AIDS) is now considered as a manageable chronic illness with the availability of ART. A high level of adherence (>95%) is required for antiretroviral therapy to be effective. It is a syndrome that builds a vacuum in a person affecting his/her quality of life (QOL) as a whole. Aim& Objective: The aim of our study was to determine adherence and its effect on their quality of life among HIV/AIDS patients attending FIART (Facility Integrated Anti-retroviral therapy) clinic. Materials and Methods: Using a cross-sectional study design, 257 HIV positive patients receiving antiretroviral therapy at Facility integrated anti-retroviral therapy centre Ambala Haryana. QOL of patients taking ART was assessed using WHO-QOL-BREF questionnaire. Results: Of 257 participants, 88.3% were found to be adherent, adherent to ART therapy and ambulatory had better QOL (p < 0.05) than their counterparts from other socio-clinical strata. Mean scores of physical (70.89±7.384), psychological (47.37±9.174), social (51.97±11.119) & environmental domains (52.33±9.081), were having highest in patients those who were adherent (adherence rate >95%) to ART therapy. Conclusion: Adherence to antiretroviral therapy in Haryana India is suboptimal. Intensive adherence counselling should be provided to all patients before initiation of antiretroviral therapy and on every visit to FIART centre.

Effectiveness of HIV Intervention Package (HIP) on HIV Infected Adolescents: Pilot Study Report

Background: Adolescents are the fulcrum of the population. HIV affects this precious population, which faces many barriers in achieving optimal adherence to Anti Retroviral Therapy (ART) as compared to the children and adults living with HIV. The aim of the study is to evaluate the effectiveness of HIV Intervention Package (HIP) on HIV infected adolescents.Methods: Randomised controlled trial was conducted in the ART Centre, Institute of Child Health and Hospital for Children, Egmore. By simple random technique, 40 (10% from total sample size) samples were selected and divided equally into experimental and control groups. Relevant structured questionnaires were used to collect the data through face-to-face interview methods. The experimental group received HIP including asana demonstration along with routine care and the control group received only the routine care as conventional management. Results: At the end of the 6thmonth after the intervention, data were interpreted in the improvement of HIP components in the experimental and control groups and the results were recorded as follows: adherence rate: 6.4% in the experimental group and 2.2% in the control group, and Quality of life (QOL) 7.2% in the experimental group and 0.4% in the control group; it was significant at 95% Confidence Interval (CI). The other component of nutritional gain score increased by 4.5% in the experimental group and by 0.8% in the control group.Conclusion: Our study report revealed that HIP is more effective in achieving the targets of optimal adherence, increasing nutritional status, and enhancing QOL among HIV infected adolescents.

Function of Serum Adenosine Deaminase as an Indicator of Immune Status in HIV Patients treated with Combination Antiretroviral Therapy

Acquired immunodeficiency syndrome (AIDS) is one of the greatest public health and social problems threatening the human race. The trend of annual AIDS deaths is showing a steady decline since the implementation of the free Anti-Retroviral Therapy (ART) program in India (2004). HIV infection is characterized by replication of virus by abnormal non specific immune activation and persistent inflammation. Adenosine deaminase (ADA) has a cytokine-like co-stimulatory role in T cell proliferation which is independent of catalytic activity. Therefore, we decided to study the role of ADA as an indicator of immune status in HIV patients treated with combination antiretroviral therapy (cART). Adenosine deaminase activity (ADA) in HIV patients was estimated before and after 3 months interval of antiretroviral therapy (ART) up to 9 months. The study included 150 HIV positive patients between age group of 20-50 years from ICTC (Integrated Counseling and Testing Centre) and ART centre. Venous blood samples were collected in plain bulb to estimate serum ADA activity before and after 3 months interval upto 9 months of ART. Serum ADA activity was estimated using colorimetric method of Giusti and Galanti. Activity of serum ADA was significantly raised before and after 3 months interval of ART with decrease in CD4 cell count. After 6 months, increased ADA activity started declining and comes to near normal after 9 months of ART (p<0.001). Elevated serum adenosine deaminase activity in HIV patients is an indicator of T-cell activation. Serum ADA activity along with other markers can be used as a prognostic marker to monitor response to antiretroviral therapy and immunocompetence in HIV patients.

Prevalence of cervical abnormalities amongst HIV-positive women

To study the prevalence and variety of cervical squamous intra-epithelial lesions (SIL) by Pap smear screening as an indicator of suspected HPV infection among HIV-infected women in Surat, Gujarat, India.All consecutive asymptomatic HIV seropositive women 18 years and older and attending the Anti-Retroviral Therapy Centre at New Civil Hospital, Surat, India between October 2009 to September 2011 were eligible for inclusion in the study. Participants constituted 439 asymptomatic HIV seropositive women receiving care at the ART centre underwent detailed history taking, physical examination and Pap smear screening. The incidence of SIL was 8.7% (38/439) in the participants. Further, statistical significance (p value > 0.05) was observed in parity more than two, lost their husband, duration of marriage more than 10 years and CD4 count greater than 250.An association between HIV infection with pre-invasive changes in the cervical epithelium is noted. Early detection and prompt treatment of these changes after a thorough understanding of the natural history of disease in these women would go a long way in improving the survival as well as the quality of life in this increasing seropositive younger population.

Implementation status of national airborne infection control guidelines in the health care facilities of a North Indian State: A mixed method study

ObjectiveHealthcare-acquired infection (HCAIs), have become a significant cause of morbidity as well as mortality among the hospitalized patients and health care workers. The implementation of air-borne infection control measures play an important role in prevention of health care acquired infections (HCAIs). Hence, this study was planned to assess the implementation status of National Airborne Infection Control Guidelines in the health care settings of a North Indian State. Study designA mixed method study was planned in all the 13 health facilities of Himachal Pradesh having both the Anti-Retroviral Therapy (ART) Centre and Directly observed Treatment Short course (DOTS) for TB center in the same facility. MethodsThe implementation of airborne infection control measures was evaluated using a Standardized Health Care Facility Airborne Infection Risk Assessment Tool and an observational checklist. In-depth interviews are conducted with hospital staff. At all health facilities, risk assessment and implementation of airborne infection control was evaluated by using a pretested semi-structured questionnaire. The qualitative data was analyzed manually and transcripts prepared from hand written notes and audio tape records were analyzed thematically. ResultsOnly 5 out of 13 health facilities were having specially designated airborne infection control committee. The incidence of tuberculosis among hospital staff was 2.32% at secondary level health care facilities and 0.35% at tertiary care level health facilities. Among the tuberculosis cases, maximum were nursing staff (59.5%) as compared to other categories of health care workers. Improper functioning of health care system and individual factors were main reasons for deficiencies in the implementation of air-borne infection control measures. ConclusionThe health care facilities were not implementing the infection control measure to the fullest both at secondary and tertiary care health facilities. There is a need to set up the surveillance of airborne infections in the hospital and especially the passive surveillance of tuberculosis among health care workers.

Hematological Profile of HIV-Infected Patients on First-Line Highly Active Antiretroviral Therapy and Its Correlation With CD4 Count

Abstract Introduction Human immunodeficiency virus (HIV) infection is a state of profound immunodeficiency. Disorders of hematopoietic system are a common but often overlooked complication of HIV infection. This can manifest at any stage of the disease but more commonly in the advanced stage with low CD4 count. Anemia is the most common hematological abnormality in HIV patients and prevalence ranges from 1.3 to 95%. As HIV disease progresses, the prevalence and severity of anemia also increase. Hence, this study was undertaken to assess the hematological parameters of HIV-infected patients on highly active antiretroviral therapy (HAART) at different treatment durations with the hope to improve the HAART outcome in HIV patients and its correlation with CD4 count. Methods This prospective longitudinal study enrolled 134 HIV-infected patients admitted to or attending the OPD in the Department of Medicine or Antiretroviral Therapy (ART) Center (Center of Excellence), Regional Institute of Medical Sciences (RIMS), Imphal, Manipur, from 2018 to 2020. Complete hemogram, CD4 count, and other related-blood investigations were studied. Results The mean age of the study population was 39.9 ± 11.04 years. Of the 134 patients, 75 (56%) were males and 59 (44%) were females. Twelve (9%) patients had a history of injecting drug use (IDU). TLE (tenofovir, lamivudine, efavirenz) regimen was started on 112 (83.6%) patients and the majority of them (69/134 [51.5%]) had a CD4 count of 200 to 499 cells/mm3, which increased significantly 6 months after HAART to 99 to 1,149 cells/mm3, with a mean of 445 ± 217 cells/mm3. There were significant improvements in hemoglobin (Hb) levels, total leukocyte count (TLC), absolute neutrophil count (ANC), and absolute lymphocyte count (ALC) after HAART indicating a positive correlation with CD4 count (p < 0.05). Thrombocytopenia was observed higher after HAART when compared to baseline. There was a positive correlation between platelet count and CD4 count. However, the mean corpuscular volume (MCV) and erythrocyte sedimentation rate (ESR) had a negative correlation with CD4 count. Conclusion The study inferred a strong positive correlation between CD4 and Hb levels, TLC, ANC, ALC, and platelet count after HAART with improvement in these values as CD4 count increases. Specific treatment intervention based on the changes in the immunohematological profile trends can help prevent most of the adverse effects on HIV patients in our community.

Hepatitis B and C infections in HIV-1 patients on combination antiretroviral therapy (cART) in Ghana: implications for immunologic recovery, clinical response to treatment, and hepatotoxicity

BackgroundViral hepatitis could have an impact on the treatment response in HIV patients. In this study, we sought to determine the prevalence of hepatitis B and C infections and examine the effect on the treatment response in HIV-1 patients attending antiretroviral therapy (ART) centers in the Volta and Oti Regions of Ghana. MethodA longitudinal study design was employed. A cohort of 200 newly diagnosed HIV-1 positive adults who met the inclusion criteria (CD4 count ≤350 cells/μl) were enrolled at three ART Centers and initiated on the combination Antiretroviral Therapy (cART) from January 2014 to December 2015. Blood samples obtained from each participant were subsequently screened for the presence of hepatitis B surface antigen (HBsAg) and hepatitis C antibody. Out of the 200 study respondents recruited, 93 HIV mono-infected were randomly selected plus all 17 HIV co-infected were prospectively followed for twelve months. Using standard methods, three consecutive measurements of CD4 cells, haemoglobin, and liver enzymes [(aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase (ALP)] as well as weight measurements were performed at baseline, six months and twelve months, respectively, after treatment initiation. ResultThe overall HIV-viral hepatitis sero-positivity was 8.5%. HBV and HCV co-infections were 7.0% and 1.5% respectively. Among HIV mono-infected CD4 cell count, haemoglobin, and weight significantly increased from baseline to the twelfth month while levels remained statistically comparable in the HIV co-infected patients. The levels of AST, ALT, and ALP were more pronounced (hepatotoxicity) in the HIV co-infected compared to the HIV mono-infected at various time points within the twelve month. ConclusionThe frequency of HIV-hepatitis co-infection was high. This correlates with poor immunological outcome, clinical response to treatment and pronounced hepatotoxicity. The findings, therefore, underscore the need for regular screening of HIV patients for early detection and appropriate management.

Assessment of quality of life among HIV infected people on antiretroviral therapy in a tertiary hospital, Karnataka

Background: With the availability of highly effective antiretroviral treatment, HIV is transforming into a chronic condition, whose management is now experiencing problems of other chronic diseases, where quality of life (QOL) has become an important component of overall assessment of health care and management. This study was conducted with the objective of assessing the QOL and factors influencing it in HIV infected people on antiretroviral therapy (ART).Methods: A cross-sectional study was conducted at district ART center, Hassan. Purposive sampling was used to identify 148 HIV infected people on antiretroviral therapy, who were interviewed using a pretested questionnaire, assessing QOL with the World Health Organization (WHOQOL) HIV‑BREF.Results: The average age of the study population was 37.69 years. Majority of them were males 54.7% compared to 45.3% of females. Most of them resided in rural areas (87.8%). The educational status of the subjects was poor with 33.8% of them being illiterates. The mean score was highest for spirituality and social relationships domain and least for psychological domain. Age, education and socioeconomic status did not have any influence on the QOL. There was significant difference between QOL scores and clinical stages. Individuals in stage I and II had better scores compared to stage 3 and 4. QOL scores decreased with decreasing CD4 count.Conclusions: Our findings suggest that patient-reported measures of health status and related concepts may help provide a feasible, reliable and valid method to assess the impact of HIV/AIDS improve patient outcomes.

Adherence to antiretroviral therapy among HIV positive men who inject drugs in Pakistan.

People who inject drugs (PWID) living with HIV have poorer adherence to HIV antiretroviral therapy (ART) and elevated mortality compared to other populations. Little is known about factors associated with adherence among PWID in low-and middle-income countries, including in countries where opioid agonist therapy (OAT) is unavailable. We aimed to estimate ART adherence among men who inject drugs (MWID) living with HIV in Pakistan and identify factors independently associated with adherence. Nai Zindagi Trust (NZT) provides a range of HIV prevention, testing and treatment services to PWID in Pakistan. This study utilized data from HIV positive MWID who received ART refill/s from public sector ART Centres via NZT's Social Mobilizer Adherence Support Unit between September 2016 and December 2018. Multivariable logistic regression modelled factors independently associated with ART adherence. Among 5,482 HIV positive MWID registered with NZT who had attended the AAU and were supplied with ART refills between September 2016 and December 2018., 55% were adherent to ART. Independent predictors of adherence were being married (AOR 1.38, 95% CI:1.23-1.55, p<0.001) and >5 years of education compared to those with no education (AOR 1.19, 95% CI:1.05-1.35, p=0.005). MWID living on the street at night had lower adjusted odds of ART adherence (AOR 0.75, 95% CI:0.62-0.91, p=0.003). Findings indicate that MWID living with HIV continue to face barriers to ART adherence in Pakistan. Despite considerable evidence supporting the impact of OAT in increasing ART adherence among PWID, OAT remains illegal and inaccessible in Pakistan. Evidence-based interventions, including OAT, are needed to increase adherence and improve clinical outcomes, health equity and survival among PWID living with HIV in Pakistan.

Usability of mobile phones for personal health care by people living with HIV/AIDS

Mobile phones are necessary information tools for people in all walks of life, and people use it to meet their general and special needs. People living with human immunodeficiency virus and acquired immune deficiency syndrome (HIV/AIDS) use the technology to meet their health information needs. The aim of this study was to examine the use of mobile phone to support personal health care management by HIV/AIDS clients in three selected Antiretroviral Therapy Centres in South Western Nigeria. Data was collected from 362 PLWHA aged 18 years and above using a questionnaire. Very often, many respondents used mobile phones to encourage and comfort another HIV/AIDS client that they know, learn new HIV/AIDS services and get health educational materials. They also use mobile phones very often to seek advice on health issues from any sources. Most of the phone calls cited by the respondents include calls with nurse (61.0%). The largest proportion of phone calls received by the people living with HIV/AIDS came from their families/relatives (82.9%), while treatment partners were next (62.4%). Dedicated mobile applications to connect PLWHA with health care givers will contribute immensely in strengthening interaction between health care providers and PLWHA.