Care For HIV-positive Patients Research Articles

Perception of Clinical Students on the Care of HIV Positive Patients: A Study of Federal Medical Centre, Yenagoa, Bayelsa State

Background: Perception of (Nursing, Medicine and Medical Laboratory) Students on the care of HIV positive patient is a concern for nurse educators and staffs in facilities where students are posted to and it has the potential to greatly influence the quality of patient care and thus the overall image of the profession and even health workers, thus this is a study on the perception of students on the care of HIV positive patients in Federal Medical Centre, Yenagoa, Bayelsa State. Objectives: The purpose of this study is to show the importance of student’s perception and care for HIV positive patients which will either lead to facilitating the healing of the HIV positive patient. As promulgated by the American Journal of health promotion since 1986. Therefore, it is essential that health workers, including students in training who are agents of health promotion to patients including HIV positive patients have a role to play in facilitating the healing process of HIV positive patients and at such should be well informed about the disease and measures of caring for patients with the disease. Hence the need for this study. Methodology: the study utilized questionnaire of 21 questions which is sectioned into four (i.e. A-D) with section A consisting of 6 questions, section B, 9 question, section C, 3 questions and section D, 5 questions. These questions was distributed to 120 respondents comprising of nursing, medicine and medical Laboratory students doing their posting at Federal Medical Centre, Yenagoa, Bayelsa State. Data were collected and analysed using tables with a simple calculation of frequencies and percentages. Results: The results from the study revealed that student nurses, medicine students and medical laboratory students have a variety of perception about HIV and AIDS problem. Majority of the students stigmatize AIDS patients as they felt uncomfortable and afraid when caring for patients with HIV/AIDS. They fear infection through accidental pricks. Conclusion: Hospitals should also provide adequate protection for students and staff so that students do not fear handling HIV and AIDS patients. There is need for continuous and particularly HIV and AIDS awareness programs to inculcate in them the importance of taking precautionary measures to avoid been infected with the virus. Keywords: Clinical students, HIV/AID, FMC, Questionnaire, perception.

Predictors of Viral Non-Suppression among Patients Living with HIV under Dolutegravir in Bunia, Democratic Republic of Congo: A Prospective Cohort Study.

The Democratic Republic of the Congo adopted the integrase inhibitor dolutegravir (DTG) as part of its preferred first-line HIV treatment regimen in 2019. This study aimed to identify predictors of viral non-suppression among HIV-infected patients under a DTG-based regimen in the context of ongoing armed conflict since 2017 in the city of Bunia in the DRC. We conducted a cohort study of 468 patients living with HIV under DTG in all health facilities in Bunia. We calculated the proportion of participants with an HIV RNA of below 50 copies per milliliter. About three in four patients (72.8%) in this cohort had a viral load (VL) of <50 copies/mL after 6–12 months. After controlling for the effect of other covariates, the likelihood of having non-suppression remained significantly lower among the 25–34 age group and self-reported naïve patients with a baseline VL of ≥50 copies/mL. The likelihood of having non-suppression remained significantly higher among those who were at advanced stages of the disease, those with abnormal serum creatinine, those with high baseline HIV viremia over 1000 copies/mL, and the Sudanese ethnic group compared to the reference groups. This study suggests that we should better evaluate adherence, especially among adolescents and economically vulnerable populations, such as the Sudanese ethnic group in the city of Bunia. This suggests that an awareness of the potential effects of DTG and tenofovir is important for providers who take care of HIV-positive patients using antiretroviral therapy (ART), especially those with abnormal serum creatinine levels before starting treatment.

Burnout mediates the relationship between coping strategies and self-perceived health in healthcare providers working with HIV/AIDS patients

Burnout syndrome is conceptualized as a particular type of distress mainly occurring among healthcare providers. Burnout syndrome has been shown to identify a serious and spe-cific problem in providing care for HIV-positive patients, in this context health professionals are very sensitive to burnout syndrome not only because of the specific patients' physical needs, but also because of other factors such as HIV-related discrimination, stigma, sexuality, intellectual disability, drugs and fear of HIV contagion during health professionals medical practice. Research studies have often focused on burnout syndrome, coping strategies and psychological and physical health in health professionals employed in the health system show-ing that coping strategies significantly predict burnout syndrome. Despite these premises, no previous study explored the possible role of burnout syndrome in mediating the relationship between coping strategies and mental health in health professionals. A sample of 85 health professionals working in HIV/AIDS units of two Italian hospitals were enrolled in this study. The results showed that emotional exhaustion is a partial mediator of the relationship between emotional coping and mental health status; so, we can assume that structured interventions aimed to improving both emotional coping and burnout syndrome could improve mental health status. All these results underline the importance of health promotion and disease prevention initiatives for health professionals.

Análise da conduta dos acadêmicos de Odontologia no atendimento de pacientes soro positivo

Objetiva-se avaliar o conhecimento e as condutas adotadas pelos acadêmicos de odontologia acerca do atendimento de pacientes soropositivo. Trata-se de um estudo transversal, quantitativo, realizado entre junho a dezembro de 2020. O trabalho foi aprovado pelo Comitê de Ética do Centro Universitário UNIFACID sob o número de parecer 075913/2020. Os dados foram coletados por meio da aplicação de um questionário aos acadêmicos de odontologia do 6° ao 10° período de um Centro Universitário de Teresina. Os dados foram tabulados no Excel® e analisados de forma descritiva. Participaram 97 alunos, predominantemente feminino (73,2%, n=71), com idade entre 20-29 anos (93,8%, n=91), que fazem o uso da máscara e touca (79,4%, n=77), avental cirúrgico (86,6%, n=84) e luvas (82,5%, n=80). A maioria (85,6%, n=83) confirmou atender os pacientes soro positivo, mesmo mostrando preocupação quanto ao risco de infecção (96,9%, n=94). Uma parte (18,6%; n=18) acusou ter sofrido lesão com material perfurocortante, contudo, apenas 8,2% (n=8) realizaram a testagem anti-HIV. Quanto aos cuidados adotados: 94,8% (n=92) conduziriam higienizando com água e sabão e o uso de antissépticos (81,4%, n= 79). Não houve consenso quanto ao direito de negar o atendimento, valor cobrado e ambiente indicado ao atendimento, porém todos se mostram seguros e preparados ao manejo do paciente soro positivo, com insegurança aos procedimentos cruentos (59,8%, n=58) e diagnóstico das lesões bucais (51,5%, n=50). Os acadêmicos têm preocupação quanto aos riscos, porém mostram ter conhecimento científico e técnico sobre a doença, o que faz com que mostrem segurança no atendimento dos pacientes soro positivo.

Knowledge and clinical practices of orthodontists regarding the treatment of patients with AIDS

Aim: To evaluate orthodontists’ knowledge and clinical practices regarding the treatment of patients with HIV/AIDS. Methods: Cross-sectional study performed with 655 Brazilian orthodontists based on a previously calculated sample size. Self-administered questionnaires were sent to orthodontists to collect information on knowledge and clinical conduct regarding the care of patients with HIV/AIDS. The study evaluated the awareness of possible risk factors for contamination, oral manifestations of HIV, need for more information on the care of HIV-positive patients, whether orthodontic treatment is indicated in HIV-positive patients, and whether they had knowingly performed orthodontic treatment in HIV-positive patients. Simple regression models were adjusted, and crude Odds Ratios estimated the associations with 95% confidence intervals. The variables with P &lt; 0.20 in the crude analysis were tested in multiple logistic regression models, and those with P ≤ 0.05 were maintained in the final model. Magnitudes were estimated by adjusted Odds Ratios values, with 95% confidence intervals. Results: Orthodontists who were aware of the oral manifestations of HIV/AIDS, those having work experience of more than 20 years, and those who believed that orthodontic treatment could be indicated for these patients were 3.30 (1.79-6.10), 2.74 (1.36-5.52) and 1.92 (1.13-3.24) times more likely to perform orthodontic treatment in HIV-positive patients, respectively. Most orthodontists (92.9%) reported they needed to obtain more information about orthodontic care in patients with HIV/AIDS. Conclusion: Although orthodontists reported feeling able and qualified to provide dental care to patients with HIV/AIDS, gaps in their knowledge need to be addressed with further training.

A survey of the involvement of primary care doctors in HIV prevention and care in a low-prevalence, high-income setting

BackgroundIn high-income countries with a low HIV prevalence, primary care doctors are likely the first point of medical contact for people at high risk of HIV. One of the key factors for successful implementation of preventive measures is the cooperation of primary healthcare providers. Hong Kong’s population mostly seek primary care in the private sectors. Our study evaluated the involvement of private primary healthcare providers in HIV prevention and care.MethodsA cross-sectional postal structured questionnaire was administered to 1102 private primary care doctors in Hong Kong in December 2017. Responses were received via postal mail, fax or online. Non-respondents received a phone-call reminder to complete the survey. Descriptive analyses were performed for all the question items. Chi-square test was used to assess the association between participants’ level of involvement in HIV prevention and care and their demographics and medical practice characteristics.ResultsThe response rate was 17.9% (197/1102). Most of the respondents were Chinese (95%) and have obtained their primary medical qualifications in Hong Kong (72%). More than half of the doctors have practiced in the private sector for more than 20 years (54%). Six aspects were used to evaluate practices or involvements in HIV prevention or care: Most of the responding doctors had offered advice (61%) and/or HIV test (76%) to patients with high-risk behaviors. However, fewer doctors had diagnosed HIV (27%), provided care for HIV positive patients (21%), reported HIV cases (19%) or prescribed antiretrovirals (4%). Nine (4.5%) did not answer all six questions on their practices or involvements in HIV prevention or care. The remaining respondents were then categorized into no/low involvement group and high involvement group. Overall,71% had no/low involvement (133/188) compared to 29% who had high involvement (55/188). Factors associated with high involvement included being in the 50–59 age group (OR: 2.48, 95% CI: 1.12–5.5), and belonging to a large practice (OR: 3.16, 95% CI: 1.4–7.12).ConclusionsOverall, most private primary care doctors in Hong Kong have no or low involvement in HIV prevention and care. However, most were willing and experienced in providing general preventive services, such as HIV testing and advice.

Compassion Fatigue among Nurses: The Cost of Having a Relationship with HIV-Positive Patients

In the public healthcare sector in South Africa, nurses treat a large number of patients who are infected with the human immunodeficiency virus (HIV) on an outpatient basis. Many patients consult the nurses only when they experience symptoms due to the delayed onset of antiretroviral (ARV) treatment. The large number of patients and often poor outcome of treatment could result in compassion fatigue in the nurses. The aim of the current study was to describe the cost of having a relationship with HIV-positive patients on nurses who work in outpatient ARV clinics. A qualitative, single, embedded case study design was used, and six registered nurses (RNs) and one enrolled nurse (EN) were individually interviewed. The data analysis revealed two themes, namely: (1) the risk of developing compassion fatigue; and (2) the manifestation of compassion fatigue. The themes were discussed with reference to the extant literature. Many research reports have focused on compassion fatigue in nurses in hospital-based settings, but few on the manifestation of compassion fatigue in nurses who work in outpatient settings. The authors concluded that nurses who take care of HIV-positive patients on an outpatient basis are at risk of developing and do manifest compassion fatigue, and it is thus recommended that programmes be instituted to support them.

HIV treatment and monitoring patterns in routine practice: a multi-country retrospective chart review of patient care

Background: A study of patient records in four HIV clinics in three sub-Saharan African countries examined routine clinical care patterns and variations. Methods: Clinic characteristics were described, and patient data extracted from a sample of medical records. Data on treatment, CD4 count and viral load (VL) were obtained for the last visit in the records, dates mainly between 2015 and 2017, patient demographic data were obtained from the first clinic visit. Results: Four clinics, two in Nigeria, one in Zambia and one in Uganda, all public facilities, using national HIV treatment guidelines were included. Numbers of patients and health professionals varied, with some variation in stated frequency of testing for CD4 count and VL. Clinical guidelines were available in each clinic, and most drugs were available free to patients. The proportion of patients with a CD4 count in the records varied from 84 to 100 percent, the latest median count varied from 269 to 593 between clinics. 35% had a record of a VL test, varying from 1% to 63% of patients. Lamivudine (3TC) was recorded for more than 90% of patients in each clinic, and although there was variation between clinics in the choice of antiretroviral therapy (ART), the majority were on first line drugs consistent with guidelines. Only about 2% of the patients were on second-line ARTs. In two clinics, 100% and 99% of patients were prescribed co-trimoxazole, compared with 7% and no patients in the two other clinics. Conclusions: The wide variation in available clinic health work force, levels and frequency of CD4 counts, and VL assessment and treatment indicate sub-optimal adherence to current guidelines in routine clinical care. There is room for further work to understand the reasons for this variation, and to standardise record keeping and routine care of HIV positive patients.

Assessment of knowledge level about acquired immune deficiency syndrome and patient approaches of dental students

The aim of this study was to evaluate the level of knowledge about HIV, and intraoral signs that can be seen in HIV positive patients and the interpretation of attitudes toward HIV positive patients of fourth- and fifth-grade students at Marmara University Faculty of Dentistry, İstanbul, Turkey. In our study, a questionnaire consisting of 23 questions was applied to 100 fourth- and 100 fifth-grade students totalling 200 dental students who are educated in Marmara University Faculty of Dentistry. Besides the knowledge level of the students, their attitudes were evaluated using the survey conducted. Chi-square (or Fisher's exact test at appropriate locations) was used to examine the relationship between categorical variables. Statistical significance level was determined as P < 0.05. Of the 200 participants, 46 (23.0%) were males and 154 (77.0%) were females. One hundred people (50%) are fourth grade, 100 people (50%) are fifth grade. The rate of fifth grade agreements for the question "Treatment of HIV positive patient increases the risk of transmission of HIV infection to dentist" was statistically higher than that of fourth-grade students (Fisher's exact P < 0,05). Fifth-grade knowledge of oral symptoms of HIV/AIDS was statistically higher than fourth grades (Fisher's exact P < 0.05). As the grade level increases, the knowledge about HIV/AIDS raises portraying a relevant approach to patients with AIDS. Comprehensive training and motivation for improving dentistry students' awareness against HIV-positive patients will also improve knowledge and attitudes of the students that enable them to take better care of HIV-positive patients.

HIV treatment and monitoring patterns in routine practice: a multi-country retrospective chart review of patient care

Background: A study of patient records in four HIV clinics in three sub-Saharan African countries examined routine clinical care patterns and variations. Methods: Clinic characteristics were described, and patient data extracted from a sample of medical records. Data on treatment, CD4 count and viral load (VL) were obtained for the last visit in the records, dates mainly between 2015 and 2017, patient demographic data were obtained from the first clinic visit. Results: Four clinics, two in Nigeria, one in Zambia and one in Uganda, all public facilities, using national HIV treatment guidelines were included. Numbers of patients and health professionals varied, with some variation in stated frequency of testing for CD4 count and VL. Clinical guidelines were available in each clinic, and most drugs were available free to patients. The proportion of patients with a CD4 count in the records varied from 84 to 100 percent, the latest median count varied from 269 to 593 between clinics. 35% had a record of a VL test, varying from 1% to 63% of patients. Lamivudine (3TC) was recorded for more than 90% of patients in each clinic, and although there was variation between clinics in the choice of antiretroviral therapy (ART), the majority were on first line drugs consistent with guidelines. Only about 2% of the patients were on second-line ARTs. In two clinics, 100% and 99% of patients were prescribed co-trimoxazole, compared with 7% and no patients in the two other clinics. Conclusions: The wide variation in available clinic health work force, levels and frequency of CD4 counts, and VL assessment and treatment indicate sub-optimal adherence to current guidelines in routine clinical care. There is room for further work to understand the reasons for this variation, and to standardise record keeping and routine care of HIV positive patients.

Molecular identification of tick-borne pathogens in asymptomatic individuals with human immunodeficiency virus type 1 (HIV-1) infection: a retrospective study

BackgroundThe studies on the occurrence and diversity of tick-borne infections in HIV-infected individuals have been few, and the subject has been relatively neglected when compared with other common infections associated with HIV. In HIV-positive patients in whom a serological diagnostics is complicated due to reduced positive predictive value, a method where the microorganism is detected directly is of great value. Therefore, we performed a molecular study to ascertain the prevalence and incidence of tick-borne infections in HIV-infected persons in Poland, an endemic area for Ixodes ricinus ticks.MethodsGenomic DNA was isolated from whole blood of tested patients. Detection of tick-borne pathogens was performed by amplification and sequencing of different loci. Molecular and phylogenetic analyses of obtained nucleotide sequences were performed. Serum samples were analyzed for antibodies against tick-borne pathogens by using commercial tests in all patients.ResultsAmong 148 studied blood samples from HIV-infected patients, two cases (1.4%) of infection with tick-borne pathogen were reported. No symptoms of tick-borne infection were observed in these cases. In one case a patient was infected with Anaplasma phagocytophilum – the agent of human granulocytic anaplasmosis (HGA) and in the other with Borrelia garinii.ConclusionsOur study revealed the first case of HIV positive patient infected with A. phagocytophilum. Asymptomatic tick-borne infection can occur in HIV-positive patients. The detailed history of tick bites, especially in endemic tick areas, should be considered as part of anamnesis in routine clinical care of HIV-positive patients.

HIV Citizenship in Uneven Landscapes

The HIV/AIDS epidemic has taken on a new course in recent years with expanded access to antiretroviral therapy in the Global South. Although this transition is extending the lives of individuals for years or even decades, it is also creating new relationships between citizens and the state that are driven by resource needs specific to HIV management. This article details findings from an ongoing research project in northeast South Africa that is examining the social and ecological impacts of HIV/AIDS. Qualitative interviews are combined with ethnographic observations of a rural primary care clinic to document the ways in which residents and health care institutions are managing HIV. While initiating care for HIV-positive patients on antiretroviral therapy, clinics and other health care agencies advocate behavioral practices that challenge existing cultural norms and spatial economies, particularly in the realm of nutrition and food access. The importance of accessing certain foods is advocated as necessary for maintaining bodily health, yet this therapeutic citizenship confronts historical systems of inequality produced through spatial segregation. The consequence is that the coupling of drug provision with public health interventions produces uneven opportunities for health management that are mediated by cultural, ecological, and political systems in the era of managed HIV. Key Words: health, health and environment, HIV/AIDS, political ecology of health, South Africa, therapeutic citizenship.

Impact of Patient Navigators in Linkage to Care for HIV-Positive Patients in an Urban Emergency Department in Newark, NJ

Abstract Background Despite CDC recommendations, areas with high HIV prevalence have not implemented routine HIV testing, stating among other concerns, inability to effectively link them to care. We implemented a routine HIV testing program in the Emergency Department (ED) at University Hospital in Newark, NJ that had 46,164 visits from July 2015 to November 2016 and looked at the impact of patient navigators (PN) on linkage to care (LTC) rates. Methods This was a retrospective study of all patients newly diagnosed (ND) with HIV or previously positive (PP) but lost to follow-up (LTFU) in select areas of the ED from July 2015 to November 2016. We collected information on demographics, HIV risk factor, and looked at the impact of PN on LTC by comparing months the PN was able to make personal contact compared with months when the PN was unavailable for substantial periods of time. Results A total of 9,511 individuals were screened, and 151 (1.6%) had a positive HIV test; 8 died and 2 were incarcerated. Of the remaining 141, 102 (72%) were LTC. The mean age was 49, 57% Male, 77% Black, 14% Hispanic, and 6% White. The reported HIV risk factors were 67% Heterosexual, 9% MSM, 6% IV drug use (IDU) and 18% Other. Of the patients with a positive HIV test, 60 (43%) were ND and 81 (57%) were PP. Only 52% ND patients were LTC, while 88% PP patients were LTC. Black and Hispanic patients tended to be PP (60% of both groups), while White patients tended to be ND (75% of white patients were ND). The risk factors for ND were 44% Heterosexual, 39% MSM, and 25% IDU. Average LTC while the PN was unavailable decreased from 78% to 56%. There were no demographic differences in the LTC group compared with the LTFU group. IDU had the highest rate of being LTFU at 37% followed by MSM and Heterosexual at approximately 23% each. The primary reason for LTFU was incorrect contact information in the medical record such as wrong address or phone number. PN would make 3 phone calls, send 2 letters and 1 outreach attempt. If all of those failed, the PN notified the state health department. Conclusion PN have a positive impact on LTC even in busy ED settings. Given limitations of staffing a busy ED 24/7, we need to develop strategies to link patients even if the PN is not present. To address this limitation, we plan on looking at the impact of involving medical residents to help with linkage to care after business hours. Disclosures S. Swaminathan, Gilead Sciences: Grant Investigator and Scientific Advisor, Consulting fee and Research grant

Improving retention in HIV care among adolescents and adults in low- and middle-income countries: A systematic review of the literature.

IntroductionAdolescents living with HIV are an underserved population, with poor retention in HIV health care services and high mortality, who are in need of targeted effective interventions. We conducted a literature review to identify strategies that could be adapted to meet the needs of adolescents living with HIV.MethodsWe searched PubMed, Web of Science, Popline, USAID’s AIDSFree Resource Library, and the USAID Development Experience Clearinghouse for relevant studies published within a recent five-year period. Studies were included if they described interventions to improve the retention in care of HIV-positive patients who are initiating or already receiving antiretroviral therapy in low- and middle-income countries. To assess the quality of the studies, we used the NIH NHLBI Study Quality Assessment Tools.Results and discussionOf 13,429 potentially relevant citations, 23 were eligible for inclusion. Most studies took place in sub-Saharan Africa. Only one study evaluated a retention intervention for youth (15–24 years); it found no difference in loss to follow-up between a youth-friendly clinic and a family-oriented clinic. A study of community-based service delivery which was effective for adults found no effect for youths. We found no relevant studies conducted exclusively with adolescent participants (10–19 years). Most studies were conducted with adults only or with populations that included adults and adolescents but did not report separate results for adolescents. Interventions that involved community-based services showed the most robust evidence for improving retention in care. Several studies found statistically significant associations between decentralization, down-referral of stable patients, task-shifting of services, and differentiated care, and retention in care among adults; however, most evidence comes from retrospective, observational studies and none of these approaches were evaluated among adolescents or youth.ConclusionsInterventions that target retention in care among adolescents living with HIV are rare in the published literature. We found only two studies conducted with youth and no studies with adolescents. Given the urgent need to increase the retention of adolescents in HIV care, interventions that are effective in increasing adult retention in care should be considered for adaptation and evaluation among adolescents and interventions specifically targeting the needs of adolescents must be developed and tested.

Cascade of Care for HIV Positive Patients in a Rural Health Region in the North-Central Region of Ivory Coast: A Follow-up Study

Objective: To describe the cascade of care for HIV positive patients in the health region of Worodougou-Béré, North-Central Region of Ivory Coast. Methods: Cross-sectional study which included patients diagnosed HIV positive between January 2009 and December 2012 was conducted. The analysis focused on different steps of care, from HIV screening to antiretroviral treatment (ART) initiation. Results: A total of 1659 people were diagnosed HIV positive and 992 (60%) of them were included in HIV care. Their median age and CD4 count were 33 years [27-41 years] and 311 cells/mm3 [162-548/mm 3 ], respectively. Overall, 55% of them were female and 62% were symptomatic. The proportion of eligible patients was 52%, and 81% of them started ART. Conclusion: The cascade of HIV care in Worodougou-Béré Region had high attrition rate. A change in strategy, included point of care CD4 and viral load, is needed to increase access to ART and retention in care in these rural areas.

Analysis of inpatient care for HIV-positive patients with malignant lymphomas and hepatitis over 5 years (2011-2015) at the A.S.Loginov Moscow Clinical Research Center, Moscow Healthcare Department

The authors give their own data in the first Russian publication on 170 patients with lymphomas and hepatitis concurrent with HIV infection, on the distribution of therapy regimens by nosological entities and the number of deaths. Conventional protocols and programs were used for diagnosis and treatment. All the patients received highly active antiretroviral therapy. Lymphoma was treated according to the conventional programs using rituximab in people without hepatitis B. Aggressive lymphomas, such as diffuse large B-cell lymphoma, Burkitt lymphoma, and plasmablastic lymphoma, were identified in most patients. Hodgkin's lymphoma is the matter of a separate study; it differs in its pathogenesis from other lymphomas. The rate of coinfection with hepatitis was high in the entire group of patients with lymphomas. The major prognostic indicators included low CD4 T-cell counts (less than 50), stage IVB lymphoma, and hepatitis. Complete remissions were achieved in 40% of patients. Forty-one (24%) patients died.

P165 HIV inpatient experience

Introduction‘Standards of care for people living with HIV 2013’ provides recommendations for the clinical care of HIV positive patients, including inpatients. We conducted an audit to describe patterns of service use with particular reference to time to diagnosis of HIV, presenting illness, medication, length of stay and follow up.MethodsData was collected retrospectively from notes of 36 inpatients from 1stJanuary to 31stDecember 2014.Results4 patients were newly diagnosed with HIV, of which, 3(75%) presented with an AIDS defining illness. HIV test was performed in MAU on 2 patients (50%). In the remaining 32 patients, 8 presented with AIDS defining illness. 11% had evidence of drug-drug interactions. 37% had no evidence of HIV Team inpatient review. 25 patients were discharged within 7 days, however, 4 stayed for more than 28 days. Only 41% were seen in HIV Outpatients within 4 weeks after discharge. After admission with AIDS defining diagnosis, all patients were alive at 30 days and 72% alive at 6 months.DiscussionComplex care accounted for a sizeable proportion of our inpatient work. Current BHIVA recommendation of immediate commencement of HAART will significantly reduce disease progression and inpatient admission. This audit highlights the need for continued effort to raise awareness of HIV testing among non-HIV specialists and GP’s.

Are we doing enough preventive primary care for older HIV positive patients? A survey in a third level hospital in Mexico City

Are we doing enough preventive primary care for older HIV positive patients? A survey in a third level hospital in Mexico City

Tailoring HIV testing in a setting of late HIV diagnosis: is the tide turning?

Routine HIV testing in areas of high HIV prevalence has been shown to be both cost effective and to avert downstream morbidity and mortality from 'late' HIV diagnosis (defined as CD4 cell count<350 cells/ml). In the London borough of Waltham Forest in 2010, late HIV diagnoses were resulting in high morbidity with associated lengthy and costly hospital admissions. A retrospective analysis of all new HIV diagnoses was undertaken within a two-phased quality improvement project 2010-13. Newly diagnosed patients in 2010 were characterized, including immunological state, presence of HIV-related illness and department where they presented. After an intervention to set up an opt-out, walk-in rapid HIV testing service in outpatients, an analysis was conducted of numbers of tests, prevalence and immunological state of newly diagnosed patients in 2013. A total of 91 patients were diagnosed with HIV, January-December 2010, 70% of which were a late diagnosis, including 48% defined as 'very immunosuppressed' (CD4 count<100 cells/ml). Of these, 51 out of 91 patients (56%) had attended hospital services in the 5 years before diagnosis, including 204 outpatient department attendances. After the intervention, rates of late diagnosis in 2013 had reduced to 46%, and rates of those diagnosed 'very immunosuppressed' had reduced from 48% to 8%. HIV testing in outpatients is feasible and acceptable to patients and can be offered alongside routine outpatient care. The rate of positive HIV tests in this group of patients in the authors' setting has been much higher than the HIV positivity rate of larger scale HIV testing interventions in other hospital settings. This approach also provides a model for more integrated care of HIV-positive patients.

Deep Vein Thrombosis Following Enteric Fever &amp; Immunological Failure in HIV Positive Soldier: Case Report

Incidence of deep vein thrombosis (DVT) is 2–10 times more in human immunodeficiency virus (HIV)-infected persons than non-HIV cohort. Risk factors involved with DVT in HIV-infected patients are age older than 45 years, use of protease inhibitor in highly active antiretroviral therapy (ART), most common indinavir, hospitalization and presence of AIDS-defining opportunistic infections such as cytomegalovirus, Pneumocystis jiroveci (is a yeast like fungus particularly in immune-compromised host), and Mycobacterium-intracellular. Others well known thrombogenic risk factors include are such as immobility, cigarette smoking, advanced age, pregnancy, pelvic surgery, and personal or family history of DVT may be absent in HIV-infected patients presenting with DVT. Inflammation and venous thrombosis are related to each other, and the associations between them are strong when the inflammation or the infection has occurred recently, or the inflammation is active. A 29-year-old HIV-positive soldier on first line ART with poor adherence presented with fever pain abdomen and diarrhea and was diagnosed to have an enteric fever with immunological and clinical failure. He was treated for enteric fever but during treatment of enteric fever he complains of painful left lower limb swelling after 4 weeks and was suspect to have DVT of left lower limb based on Doppler studies. After confirmation of DVT by Doppler images, thrombolytic therapy was started, and gradually improvement was seen in the condition. Recent Infection or inflammation has a strong association with the development of thrombosis in HIV-positive patients, absent with classical predisposing factors of DVT. Physicians involved in the care of HIV-positive patients should be aware of this condition and the associated aggravating risk factors in them so as to provide timely management.