Antiretroviral Treatment Center Research Articles

A Prospective Study of the Medication Regimen Complexity Index and Hospitalization Due to Adverse Drug Reactions Among People Living with HIV.

Background and Objective: The complexity of antiretroviral therapy (ART) regimens in people living with HIV (PLHIV) poses significant challenges for medication management, impacting adherence and overall health outcomes. The Medication Regimen Complexity Index (MRCI) is a tool that quantifies regimen complexity, yet its correlation with hospitalization rates and adverse drug reactions (ADRs) in PLHIV remains underexplored. Materials and Methods: This prospective study, which was conducted at a government-funded antiretroviral treatment center, investigated the relationships among MRCI scores, hospitalization due to ADRs, and the ADR rates in 285 PLHIV participants over 18 months. Results: The study revealed a significant association between higher baseline MRCI scores and hospitalization due to ADRs, with a threshold MRCI score of 8 indicating increased risk. There was no significant association between average MRCI scores and overall ADR rates or non-ADR-related hospitalizations. Conclusions: These findings emphasize the importance of monitoring medication regimen complexity in PLHIV, particularly in the context of preventing hospitalizations related to ADRs. Further research is needed to understand the multifactorial influences on ADR occurrence and to optimize ART regimens for better patient outcomes.

Factors associated with tuberculosis among PLHIV: An observational study in a Government Medical College in West Bengal, India

BackgroundTuberculosis (TB) is one of the leading causes of significant morbidity and mortality among the People Living with Human Immune-deficiency Virus (PLHIV) in India. Reducing TB burden among PLHIV is a priority area under the National TB Elimination Program (NTEP). MethodologyWe analyzed the routinely collected data from an Anti-Retro-viral Treatment Centre (ARTC) of Malda Medical College, West Bengal with an aim of identifying the factors associated with TB prevalence among the PLHIV. All 739 PLHIV who attended the ARTC during 2020–2022, were included in this study. ResultsMean age of the study participants was 34 years (SD:13). 47.9 % PLHIV received Co-trimoxazole Prophylaxis Treatment (CPT) whereas 67.7 % PLHIV received TB preventive treatment (TPT). Transgender [2.9 (1.4–6)], Males [3.7 (1.8–7.9)], Widow/Separated [2.5 (1.2–5.4)], Living with 2–4 Family members [1.6 (1–2.7)], CD4 count less than 200 [1.9 (1.1–3.2)], those who received CPT [17 (7.1–40.8)] and those who didn't receive TPT [1.6 (1–2.6)] were independently associated with increased risk of developing TB. There was no significant association of Age with TB diagnosis among the PLHIV. ConclusionsIt is evident from this study, that introduction of TPT and improving CD4 count by Anti-retroviral Treatment is the key intervention to reduce TB burden among PLHIV. The study found significant association of CPT with TB. Further study may be conducted to determine the actual reason for such association.

Magnitude of intestinal parasitic infections and its determinants among HIV/AIDS patients attending at antiretroviral treatment centers in East and West Gojam Zones, Northwest, Ethiopia: institution based cross-sectional study

BackgroundIntestinal parasitic infections (IP) are a major source of morbidity in people living with Human immunodeficiency virus (HIV), particularly in resource-limited settings, mostly as a result of high viral load. Hence, this study aimed to investigate the magnitude of intestinal parasitic infections and its determinants among patients with HIV/AIDS attending public health facilities in East and West Gojam Zones in Ethiopia.MethodsInstitution-based cross-sectional study was conducted on 327 people living with HIV visiting public health facilities from December 2022 to May 2023. A simple random sampling technique was used to recruit participants. Face-to-face interviews were used to collect socio-demographics and determinants. The fresh stool was collected from each patient, transported, and tested in accordance with laboratory standard operating procedures of wet mount, formol-ether concentration technique, and modified acid-fast staining. Data were entered and analyzed in the statistical package for Social Science (SPSS) version 20. A 95% CI with p-value < 0.05 was considered statistically significant.ResultsThe overall prevalence of IP in patients with HIV/AIDS was 19.3% (63/327). Hookworm was the most identified parasite 33.3% (21/63) followed by E.histolytica 17% (11/63) and G.lamblia 14.3% (9/63). Parasitic infections were significantly higher among viral load > 1000cps/ml (p = 0.035), WHO stage 4 (p = 0.002), CD4 < 200 cell/mm3 (p = 0.001), and bare foot walking (p = 0.001).ConclusionIP infections are moderately high among patients with HIV/AIDS in the study area. The proportion of parasites was greatly affected by high viral load, WHO stage 4, CD4 < 200 cell/mm3, and being barefoot; this gives valuable insight to health professionals, health planners and community health workers. As a result, viral load monitoring, and WHO stage controlling were periodically assessed in patients with HIV/AIDS. Health education, awareness creation, routine stool examination, and environmental hygiene were regularly advocated to increase the life of patients with HIV/AIDS.

Tuberculosis Co-infection among HIV/AIDS Cases Attending an Anti-retroviral Therapy Center: A Retrospective Cohort Study from Pakistan

Objective: The co-occurrence of tuberculosis (TB) and human immunodeficiency virus (HIV) results in heightened morbidity and mortality, placing an increased burden on healthcare systems. This study aims to assess the incidence and identify associated risk factors for TB/HIV co-infection, with the objective of enhancing the survival rates of co-infected patients in Pakistan. Methods: This retrospective cohort investigation took place at the Anti-Retroviral Treatment Center in Islamabad, Pakistan. Data spanning a decade (January 2006 to December 2016) were extracted from 2,542 people living with HIV using a pre-tested data extraction tool. Results: Following the exclusion of 156 ineligible participants, records of 2,386 individuals were analyzed over 4,433 person-years. The cumulative incidence and incidence rate of TB among HIV/AIDS patients were 446 (18.7%) and 0.001 cases/10,000 person-years, respectively. The majority (81%) of incident TB cases occurred within one year, predominantly manifesting as pulmonary TB. Of the TB-infected individuals, 98.6% received TB medication, with 0.7% prescribed Isoniazid prophylaxis. Significant associations with TB were identified in relation to work abroad history, patient age, and current HIV stage (P&lt;0.05). Binary logistic regression indicated a 3.1 times higher likelihood of TB infection in the anemic group compared to the non-anemic group. HIV/AIDS infection emerged as a consistent TB risk factor irrespective of CD4 count and WHO HIV staging. Conclusion: This study highlights a substantial incidence of TB co-infection among HIV patients in Pakistan, emphasizing the need for comprehensive efforts by the National AIDS Control and National TB Control Programs to effectively manage co-infection.

Prevalence of HIV Drug Resistance Mutations among Treatment-Naive People Living with HIV in a Tertiary Care Center in India.

India has the third-largest number of people living with HIV (PLHIV) in the world. A national program provides free access to standard uniform antiretroviral therapy. However, the program is not monitored by comprehensive drug resistance surveys. The aim of this study was to determine the prevalence of HIV drug resistance mutations (DRMs) among treatment-naive PLHIV in a large antiretroviral treatment center of the national program. This cross-sectional study was done in 2017 and involved 200 consecutive treatment-naive PLHIV. A target fragment of 1,306 bp in the reverse transcriptase and protease regions was amplified. Identification of mutations and drug resistance interpretation was done by HIV Genotypic Resistance Interpretation and International Antiviral Society-USA list. Sequencing was successful in 177 samples. The majority (98.8%; 175/177) belonged to subtype C. Nineteen of 177 patients (10.7%; 95% CI: 6.2%-15.3%) had at least one major DRM. The prevalence of non-nucleoside reverse transcriptase inhibitor (NNRTI) mutations was 10.2% (18/177). The most frequent mutations were E138A/K, A98G, K103N, V179D, and K101H/E. The prevalence of nucleoside reverse transcriptase inhibitor (NRTI) mutations was 1.1% (2/177). None of the samples had major protease inhibitor resistance mutations. The prevalence of NNRTI mutations in this study was >10%, crossing the threshold recommended by the WHO to change the NNRTI-based first-line regimen to non-NNRTI based. In 2021, the national program replaced efavirenz with dolutegravir in the first-line regimen of tenofovir, lamivudine, and efavirenz. As the majority (64%) of PLHIV in India are accessing free ART from the national program, this study highlights the need for regular nationally representative drug resistance surveys for optimizing antiretroviral regimens in the program.

Depression and its role in adherence to anti-retroviral treatment in people living with HIV and AIDS in Chennai.

The AIDS epidemic has drastically reduced in India since it was first identified in 1986, largely due to the widespread availability of anti-retroviral treatment (ART). Management of HIV is currently more focussed on long term morbidities, including mental health. Depression is the most common co-morbidity seen in people living with HIV. Depression is found to negatively affect patient adherence to ART. Poor adherence to ART leads to drug resistance and susceptibility to opportunistic infections. The purpose of this study is to find the prevalence of depression among people living with HIV and to study the correlation between depression and adherence to ART. The study was conducted in the ART centre at Rajiv Gandhi Government General Hospital in Chennai, between August and October 2022. Patient health questionnaire-9 (PHQ-9) was used to identify depression, and the Adult AIDS clinical trials group (AACTG) questionnaire was used to identify adherence. Data were entered in MS Excel and were analysed using Statistical Package for Social Science (SPSS) Version 16. The association between categorical data were analysed using Chi-square and Fisher exact test. The correlation between adherence and depression was done using the Spearman correlation. The prevalence of depression was found to be 20.2%. A mild negative correlation was found between depression and adherence. Depression was found to have a significant correlation with women, unemployed, widowed, divorced individuals, and those with diabetes mellitus and tuberculosis. Depression is an important risk factor for adherence to ART. Though severe depression was not found in this study, mild and moderate depression was associated with reduced adherence to ART. Treating depression is likely to improve adherence and the overall wellbeing of patients with HIV and AIDS.

Trend of HIV Prevalence in Antenatal Women in a Tertiary Care Hospital in the Western Region of India.

Background The severity of AIDS and the social and personal implications of HIV makes the epidemiological study of HIV more difficult. Surveillance studies remain the mainstay of understanding thetrends of HIV infection. In this study, we aimed to determine the trend in the prevalence of HIV in the antenatal women attending our hospital situated in the western region of India over the period of the last nine years and theART adherence and the viral loads of the cluster of positive patients identified from this antenatal HIV testing. Methodology A retrospective study was conducted by collecting data fornine years from January 2015 to December 2023 from the PPTCT (Prevention of Parent to Child Transmission) Centre and ART (Anti-Retroviral Treatment) Centre of the hospital. All pregnant women attending antenatal clinics and being admitted to the labor room are counseled for HIV testing as per the National AIDS Control Organisation (NACO) guidelines of India. The data of the total antenatal women counseled for HIV testing and who tested HIV positivewere collected. The HIV prevalence rate was derived and the trend of HIV prevalence in antenatal women attending the hospital was determined over the study period. The data on ART adherence and the viral load of these HIV-positive women detected antenatally and their seropositive spouseand children were collected and analyzed. Results A total of 22,584 antenatal women were counseled for HIV testing during the study period. No women opted out and there was 100% testing of these 22,584 antenatal women for HIV. Fifty antenatal women tested positive for HIV, resulting in an overall HIV prevalence of 0.22% (50/22,584) during the study period. There was adeclining trend of HIV prevalence among antenatal women from 2020 to 2023 (from 0.37% to 0.19%). Of the 50 seropositive antenatal women, 42remained bookedat our ART Centre for treatment. Thirty (71%) women are still adhered to taking ART. Of their 20 seropositive spouses, 14 (70%) have remained adhered to ART. Twenty-eight (93%) female patients on ART and 13 (93%) spouses on ART have suppressed viral loads. Two children of these seropositive mothers had tested HIV positive. ART adherence and suppressed viral load were seen in both seropositive children. Conclusion The study reflects a decline in antenatal seroprevalence in recent years in our region. The antenatal HIV prevalence trends have major implications on mother-to-child transmission and these positive antenatal cases serveas index cases bringing the testing opportunity for the so-called identified as the non-high-risk population. ART adherence of positive female patients, after the completion of the antenatal period, remains the challenge in our region, which requires improvement in the outreach activities and increased motivation and awareness of these patients regarding the importance of taking lifelong ART.

A retrospective study on comparison of effects of older art regimen against Dolutegravir based art in PL-HIV

According to the WHO guidelines 2020, Dolutegravir-based antiretroviral treatment (ART) is a preferred first-line ART regimen for people living with HIV (PLHIV) because of its efficacy, tolerance, high barrier to resistance, and minimal drug interactions. The main aim of this study is to assess the safety and efficacy of a Dolutegravir based antiretroviral therapy regimen to that of older regimens. A retrospective observational study was conducted among the people who visited the ART center on an Out-Patient basis. One to One interview was taken with the patients who met the inclusion criteria and all the information was noted down in the demographic form. Adverse Drug Reactions were noted in the Suspected Adverse Drug Reaction (ADR) Form and then we assessed causality, severity, and Prevent-ability. All the data was entered into an excel sheet and analyzed using SPSS21 software. Out of the study population of 100, 63% are females and 36% are males. The paired T-test sampling statistics revealed a significant difference between an increase in CD4 count after transitioning to a Dolutegravir-based regimen in comparison with the older regimens (p&lt;0.001). 34 ADRs are reported before the transition and 54 ADRs are reported after the transition to Dolutegravir. The most common ADR found was rashes before the transition and blurred vision after the transition respectively. The comparison with various parameters like CD4 count, and viral load, proves that the Dolutegravir based drug regimen is quite more effective in reducing HIV load. So proper counseling and regular screening are advised to prevent the risks of the newer drug regimens.

Health system cost for providing antiretroviral therapy, family planning, and pregnancy-related services to women living with HIV in public health settings, Mumbai, India.

Integration of HIV care into family planning (FP) services would help in reducing unintended pregnancies among women living with HIV. This study focuses on determining the health system cost for providing the linked HIV-FP services per beneficiary for the year 2019-2020. Using mixed micro-costing approach costs were collected from two tertiary hospitals in Maharashtra, India. The economic costs collected from gynaecology department and anti-retroviral treatment center were combined and added with package, program, and intervention costs to obtain health-system costs. We conducted probabilistic sensitivity analysis. The unit cost and annual per-capita cost for providing HIV care (without considering cost of drugs and investigations) per beneficiary were INR 1033.8 (USD 13.6) and INR 9304.2 (USD 122.7), respectively. The unit cost was least for the outpatient services INR 197.5 (USD 2.6), followed by inpatient services INR 2735.92 (USD 36.21) and operation theater INR 4410 (USD 58.2). Cost was highest for dual-permanent (INR 13866.8 [USD 182.9]) followed by dual-reversible user (INR 2104.8 [USD 24.8]). It was the least for a person who only used condoms at INR 1674.1 (USD 22.1). In pregnancy-related services, cost for ante-natal services was least (INR 2043.6 [USD 27.96]), followed by vaginal delivery (INR 7120.5 [USD 93.93]), abortion (INR 11530.5 [USD 152.097]), and C-section (INR 18703.8 [USD 246.7]). We found no staggeringly additional costs for providing FP and pregnancy-related services to HIV-affected population, in comparison to general population. The findings could improve programs and insurance with a focus on this vulnerable population.

Patterns of Occupational Exposure to Human Immunodeficiency Virus and Post-Exposure Prophylaxis Among Health Care Personnel in a Tertiary Care Institute in South India - A Retrospective Case Series.

Post-exposure prophylaxis (PEP) for occupational human immunodeficiency virus (HIV) exposure involves the comprehensive measures used to prevent transmission of blood-borne pathogens such as HIV, hepatitis B virus, and hepatitis C virus through various strategies such as first aid, counseling, risk assessment, relevant laboratory investigations with informed consent, the provision of short-term anti-retroviral drugs, and follow-up testing. We sought to investigate the patterns and causes of occupational exposure in health care workers (HCWs) in our institute and the usage of PEP in our center, a tertiary care hospital in south India. The study involved a retrospective analysis of data extracted from the records of PEP usage from the anti-retroviral treatment (ART) center attached to the dermatology, venereology and leprosy out-patient department of a tertiary care center in south India. The data were extracted into a pre-designed proforma and analyzed using descriptive statistics. A total of 352 health care professionals reported to the ART center for PEP from 2010 to 2020. One hundred and thirty-four patients took only the first dose as the source patient later tested to be HIV-negative. Among the 218 remaining patients, 84 were male and 134 were female patients. Only 56 health care workers started the regimen within 2 hours. One hundred and thirty-four patients completed the full course of PEP. Most HCWs (n = 68, 31%) sustained the exposure while doing a procedure on the patient followed by re-capping a needle (n = 64, 29%). Gastritis and drowsiness were the most common adverse effects. The study was limited by the retrospective nature of data collection and the lack of detailed interviews with HCWs. Knowledge about PEP, needle safety training, and training of early first aid measures should be increased among health care workers.

Healthcare Utilization 12 Months Prior to Fatal and Non-fatal Suicidal Behaviour in Cape Town, South Africa

The purpose of this study was to characterize healthcare use for general care and mental health one year before suicidal behavior among individuals with fatal and non-fatal suicidal behavior (NFSB) in Cape Town, South Africa. We linked electronic health records of 484 participants from a case series of 93 completed suicides on whom forensic autopsies were performed at a mortuary in Cape Town, between August 2014 and January 2016; and 391 patients admitted to hospital following NFSB between June 2014 and March 2015, and between August 2015 and August 2017. Time from last healthcare visit to date of suicidal behavior (fatal or non-fatal) was calculated, and Kaplan Meier curves were used to compare the differences by psychiatric diagnoses and study group. Overall, 64.5% of completed suicides and 65.9% of NFSB patients sought general healthcare in the year before suicidal behavior. Most of these visits occurred at hospital outpatient clinics (40.8%) and primary healthcare facilities (31.3%). The prevalence of preexisting psychiatric diagnoses and the use of mental healthcare services was lower for individuals who completed suicide compared to NFSB patients. Common reasons for a healthcare visit among individuals who completed suicide were chronic disease and assault; and psychiatric illness (depression, bipolar, and/or substance use disorders), chronic disease and HIV among NFSB patients. A large proportion of individuals with fatal and NFSB interacted with the healthcare system before suicidal behavior. These findings suggest opportunities for suicide prevention at primary healthcare facilities, antiretroviral treatment centers and emergency departments. HIGHLIGHTS Healthcare access is common among individuals with fatal and NFSB in the year before suicidal behavior. The prevalence of mental disorder diagnoses is higher among NFSB patients than among individuals who completed suicide. A greater proportion of NFSB patients accessed mental healthcare services compared to individuals who completed suicide.

Prevalence of HLA-B*57:01 allele in HIV-positive and HIV-negative population of eastern India: An epidemiological study

IntroductionThe nucleoside analogue reverse-transcriptase inhibitor Abacavir has potent antiviral activity against HIV; however, 5–8% patients develop hypersensitivity reactions within six weeks of treatment. The presence of the HLA-B*57:01 allele is strongly associated with the risk of Abacavir-associated hypersensitivity reaction (ABC-HSR). Prevalence of HLA-B*57:01 allele varies in different populations. This observational study was performed to determine the prevalence of HLA-B*57:01 allele in the population of Eastern India which included both HIV-positive and HIV-negative subjects. MethodsWe screened 406 subjects attending the ART (antiretroviral treatment) centre and linked ICTC (Integrated counselling and testing centre), however 6 samples did not have adequate DNA. HLA-B*57:01 typing was done using direct sequence specific primer PCR (SSP-PCR). All PCR positive samples were sequenced using Sanger's method. ResultsThe prevalence of HLA-B*57:01 genotype in our cohort was 12.25% (49/400). Prevalence among men was 13.3% (33/248) and female was 10.5% (16/152). The prevalence was similar in HIV-positive subjects (13.5%) and in HIV-negative subjects (11%). ConclusionsPrevalence of HLA-B*57:01 in our eastern Indian population was high. Therefore, screening for HLA-B*57:01 before ABC administration would be useful to prevent ABC-HSR.

Evaluation of CD4 count response in HIV subjects with antiretroviral treatment protocol

The present study was undertaken to evaluate the CD4 count responses in subjects who are on long term first line antiretroviral treatment (ART).A total of 200 People Living with HIV/AIDS (PLHIV), on first line ART for five years seen in the ART centre were included in the study. Patients were interviewed and details entered as per the proforma. Proforma included various details such as serial CD4 counts and Opportunistic infection pre and post ART.Mean CD4 count pre ART was 171.32 ± 65.23 per mm and one year after ART was 374.56 ± 159.12. There was significant rise in CD4 count one year after the initiation of ART (p = 0.000) The mean CD4 count at the time of collection of data was 545.23 ± 259.11 as compared to mean CD4 count pre ART of 171.32 ± 65.23 per mm. The rise was significant.National AIDS Control. OrganizationNACO) suggested first line regimens outcome in vigorous immunologic response that is continued over a mean period of over six years in a majority (84%) of the subjects and consequence in significant decline in opportunistic infections.

Dietary diversity and impact of Moringa oleifera Lam. leaves supplemented – Diet on the nutritional status and CD4 cell counts of patients receiving antiretroviral therapy in Nigeria: A double - Blind randomized trial

BackgroundTo maintain an optimal nutritional status and immunological function in PLHIV, a diet with adequate nutrients is of utmost importance. This is a major challenge among poor populations in developing worlds like Nigeria, where malnutrition and food insecurity are endemic. This study aimed to assess the type of regular diet consumed and assess the impact of supplementation of the diet with Moringa oleifera Lam. leaves on the nutritional status and CD4 cell counts of PLHIV that are on ART in Nigeria. MethodA double-blind, randomized trial was conducted. Two hundred consented patients were randomly allocated to either the Moringa oleifera Lam. group (MOG) or the control group (COG). The FAO individual dietary diversity questionnaire was used. The regular diets of participants at baseline and six months were monitored. The measurements of weight, BMI, MUAC, and CD4 cell counts were obtained from baseline to six months of Moringa oleifera Lam. leaves supplementation. ResultsOne hundred and seventy-seven patients completed the six-month follow-up (89 MOG versus 88 COG). At both baseline and sixth month, the foods most commonly consumed by the participants in both MOG and COG were cereals, spices and condiments, oils, fats and palm oil, and dark green vegetables. At baseline, significantly higher consumption of legumes, nuts & seeds (p = 0.001) was observed in the MOG and higher consumption of other vegetables (p = 0.024) in COG. Consumption of cereals, roots, and tubers was significantly higher (p = 0.024; 0.045) in the COG in the sixth month. In both groups, participants were in the medium or low dietary diversity tercile. Throughout the study period, all the nutritional status variables observed were not significantly different between the two study groups [(p > 0.0001); weight; p = 0.5556; BMI; p = 0.5145; MUAC; p = 0.6456]. Over the study period, the treatment by time interaction shows a significant difference in CD4 counts by treatment group (p < 0.0001) and an estimate of fixed effects 10.33 folds greater in the MOG than COG. All tests were conducted at 95CI. ConclusionThis study revealed a poor dietary diversity amongst PLHIV. Supplementation of regular diet with Moringa oleifera Lam. leaves did not affect the nutritional status but could improve the immune response of HIV-positive adults attending the antiretroviral treatment centre in the present study area.

Study of Depression in People Living with HIV/AIDS Attending Antiretroviral Treatment Center

Background: Depression, being the most common neuropsychiatric complication of HIV, is also associated with increased healthcare utilization, decreased quality of life, and poor adherence to antiretroviral therapy (ART). Depression is a multidimensional disorder affected by a variety of biological, psychological, and social determinants, and this relation becomes more complicated in HIV patients. The current study therefore aimed to assess the prevalence of depression in adult people living with HIV/AIDS using Patient Health Questionnaire 12 (PHQ12) and to study the various sociodemographic factors and clinical variables associated with depression in adult people living with HIV/AIDS. Materials and Methods: A cross-sectional study was conducted at an ART center in a tertiary care hospital in HIV/AIDS patients of 20–60 years of age. Sociodemographic and clinical characteristics were studied, and PHQ12 was used to assess depression. The χ2 test was applied to test association among depression, sociodemographic variables, and clinical variables of study subjects. Results and Conclusion: Out of the 372 study subjects 169 (45.4%) suffered from depression. Female sex, nuclear family, rural residence, lowered socioeconomic class (lower middle and below), illiteracy, widowed person, and opportunistic infection were significantly associated with depression (P &lt; 0.05) in people living with HIV/AIDS. There was no significant association between prevalence of depression and age group, religion, CD4 count, and WHO staging.

Neurological manifestation with special reference to HIV-associated neurocognitive disorder (HAND) among people on anti-retroviral treatment in India.

The neurological manifestations and their severity in patients on antiretroviral treatment (ART) are currently unexplained. ‎We aimed at studying the prevalence of HIV Associated Neurological Disorders (HAND) among people on antiretroviral treatment, using the International HIV Dementia Scale (IHDS). A predesigned and pretested proforma including the International HIV Dementia Scale (IHDS) was administered to 100 HIV patients attending to ART center of KIMS teaching Hospital (Koppal, Karnataka) from January 2020 to March 2020. The data was analyzed SPSS version 15 software. Descriptive statistics were used for demographic characteristics. The Student's t-test and chi-square test methods were applied to determine the relationship between qualitative characteristics. The prevalence was found to be 59%. Out of 100, 57 HIV patients scored less than 10 whereas 43 HIV patients scored ≥10 on the IHDS scale. The mean age of the study population was 39.14 ±13.01 years; the total IHDS score was 9.96±1.53 and the CD4 count was 427.91±226.0. This study demonstrated that the patients with CD4 count more than 350 (i.e., 63.60%) had a better IHDS score. Neurocognitive disorder was found to be more common than anticipated. All ICTC Centers need to consider assessing HIV-associated neurocognitive disability (HAND), and the International HIV Dementia Scale (IHDS) as one instrument for such assessment.

Improving public health service delivery response to address contraceptive needs of socio-economically disadvantaged HIV positive people in Maharashtra, India

BackgroundPeople living with HIV (PLHIV) receive free antiretroviral treatment (ART) in public health facilities of India. With improved life expectancy, unmet sexual and reproductive health needs of PLHIV have to be addressed through a converged programmatic response strategy. Evidence shows that socioeconomically disadvantaged women are most vulnerable to high reproductive morbidities, especially HIV positive women with an unmet need of contraception.MethodsProgrammatic convergence by linking ART and family planning services were strengthened at two public health facilities (district hospitals) generally accessed by disadvantaged socio-economic sections of the society. Barriers to linking services including stigma and discrimination were addressed through analysis of existing linkage situation, sensitization and training of healthcare providers and system-level interventions. This facilitated provider-initiated assessment of contraceptive needs of PLHIV, counseling about dual contraception using a couple approach, linkage to family planning centers and maintaining data about these indicators. Six hundred eligible PLHIV seeking care at ART centers were enrolled and followed up for a duration of 6 months. Acceptance of family planning services as a result of the intervention, use of dual contraception methods and their determinants were assessed.ResultsEighty-seven percent HIV couples reached FP centers and 44.6% accepted dual methods at the end of the study period. Dual methods such as oral contraceptive pills (56.2%), IUCDs (19.4%), female sterilization (11.6%), injectable contraception (9.9%) and vasectomy (2.9%) in addition to condoms were the most commonly accepted methods. Condom use remained regular and consistently high throughout. The study witnessed seven unintended pregnancies, all among exclusive condom users. These women availed medical abortion services and accepted dual methods after counseling. Female index participants, concordant couples, counseling by doctors and women with CD4 count above 741 had higher odds of accepting dual contraception methods. Standard operating procedures (SOP) were developed in consultation with key stakeholders to address operational linkage of HIV and family programs.ConclusionThe study saw significant improvement in acceptance of dual contraception by PLHIV couples as a result of the intervention. Implementation of SOPs with supportive supervision can ensure efficient linkage of programs and provide holistic sexual and reproductive healthcare for PLHIV in India.

Mucocutaneous disorders in HIV/AIDS at a tertiary care hospital in Nepal: An observational study

Background: Mucocutaneous manifestations in HIV infections are common. However, they have not, so far, been studied in Nepal. The aim of this study was, therefore, to describe mucocutaneous manifestations in Nepalese HIV patients. Materials and Methods: The following is a hospital-based, descriptive, cross-sectional study conducted in the Department of Dermatology and Venereology and Antiretroviral Treatment (ART) Center of Tribhuvan University Teaching Hospital (TUTH) from May 2017, through October 2018. Patients aged 16 years and above diagnosed with HIV were included in the study, for whom history and clinical examinations were performed. The study variables were age, sex, a clinical diagnosis of dermatological problems, clinical stages of HIV/AIDS, as per the World Health Organization (WHO) classification criteria, and the CD4 count. Results: A total of 52 patients were included in the study. The mean age upon presentation was 38.77 ± 10.9 years. The mean CD4 count was 464.27 ± 255.13. Females were more affected than males (female:male = 1.4:1). Mucocutaneous manifestations were the following: fungal infections (10; 19.3%), viral infections (6; 11.6%), parasitic infestations (3; 5.8%), bacterial infections (4; 7.7%), sexually transmitted infections (2; 3.8%), seborrheic dermatitis (3; 5.8%), idiopathic pruritus (3; 5.8%), recurrent oral ulcers (3; 5.8%), urticaria (3; 5.8%), pruritic papular eruptions (2; 3.8%), eczemas (2; 3.8%), acne (2; 3.8%), angular cheilitis (2; 3.8%), xerosis cutis (2; 3.8%), and others (5; 9.6%). Conclusions: The study showed that fungal infections are common in HIV patients, followed by viral infections and parasitic infestations. Seborrheic dermatitis, idiopathic pruritus, recurrent oral ulcers, and urticaria were found to be common inflammatory skin diseases in HIV.

Assessment of Depression in HIV-Positive Patients Attending Antiretroviral Treatment Center of a Tertiary Care Institute in Eastern India: A Hospital-Based Cross-sectional Study

Assessment of Depression in HIV-Positive Patients Attending Antiretroviral Treatment Center of a Tertiary Care Institute in Eastern India: A Hospital-Based Cross-sectional Study

Assessment of self-reported adherence to ART and patient's virological/CD4 response in a tertiary care clinic and government free ART clinic.

Introduction:Treatment adherence to antiretroviral treatment (ART) is critical in reducing morbidity, mortality, and improving the survival in HIV patients. ART is a life-long commitment, and the variety of factors can influence treatment adherence. We studied the factors affecting treatment adherence in the private sector and public sector outdoor clinic in Ahmedabad, India. The primary objective of this study is to compare the level of adherence and factors that influence adherence to ART in patients attending government run free ART program and private setup.Methods:We conducted a cross-sectional study of 8 weeks among HIV-infected patients who were receiving ART from private clinic and free ART center from July 2019 to September 2019. We enrolled all consecutive patients >18 years of age attending both clinics. Statistical analysis was carried out using the SPSS software version 25.0. Multiple logistic regression was used to identify the factors that were independently associated with adherence to ART.Results:The study enrolled 306 patients, 151 (49.34%) from the outpatient department of private hospital, and 155 (50.65%) from the free ART center. Patients attending private clinics were more likely to have been diagnosed with HIV since ≥10 years compared to free ART center. Higher opportunistic infection rates were found in free ART center (64.51%). Treatment adherence was significantly lower in the patients attending free ART center (P = 0.004). Patients taking concomitant medications for other comorbid conditions (≥4 pills/day) were more likely to exhibit inadequate adherence ([odds ratio] 1.216, 95% confidence interval 1.0171–1.454). Univariate analysis showed that age, education, habits of alcohol, tobacco, number of pills, and duration of disease played a significant role in predicting adherence to ART (P < 0.05).Conclusions:Patients attending private clinic are surviving longer with HIV diagnosis, have fewer opportunistic infections, and have better treatment adherence compared to free ART clinic.