HIV-positive Woman Research Articles

Awareness on HIV/AIDS and prevention of mother to child transmission of HIV/AIDS among stake holders and people living with HIV/AIDS in Dharan municipality, Sunsari, Nepal

PMTCT (prevention of mother to child transmission) is a commonly used term for an intervention programme designed to reduce the risk of mother to child transmission of HIV. In 2008, there were more than 40 million people living with HIV/AIDS worldwide out of which, 2.5 million were children under 15 years old. Mother to child transmission is the largest source of HIV infections in Nepal. Out of the estimated 900,000 annual pregnancies, 1,800 pregnancies are estimated to occur in HIV positive woman (0.2% HIV prevalence) leading to as annual cohort of about 450 to 810 infected new born. Creating awareness about PMTCT services among stake holders and people living with HIV/AIDS is helpful in initiating and communicating the information about PMTCT services to the pregnant women. The objective of this study is to assess the awareness of stake holders and PLWHA regarding prevention of mother to child transmission of HIV/AIDS. Cross sectional study was done including 100 stake holders and 50 people living with HIV/AIDS of attending Dharan municipality and Dharan positive centre respectively. Semi structure questionnaire was used to assess the awareness. The study findings show that 61% of the stake holders and PLWHA had inadequate knowledge on HIV/AIDS and PMTCT, only few pregnant women referring by stakeholder and people living with HIV/AIDS for utilization of PMTCT services. Age and religion are associated with overall knowledge of HIV/AIDS and PMTCT, where p value is 0.024, 0.012, respectively. Education, family size and training are not associated with overall knowledge of HIV/AIDS and PMTCT. In General, inadequate knowledge was found 61% of the respondents. Thus it is important that need to conduct more awareness programme among different stake holders will be worthwhile, as they directly and indirectly contact with pregnant women and can inform and motivate them to utilize these services. Key words: Awareness, HIV/AIDS, prevention of mother to child transmission (PMTCT), stakeholders/PLWHA.

Tuberculous syringomyelia in an HIV-infected patient: a case report

A 37-year-old HIV-positive Gambian woman presented with spastic weakness of the right leg six years after receiving treatment for tuberculous meningitis (TBM). Magnetic resonance imaging (MRI) of the spine showed a multiloculated syrinx in the thoracic spinal cord extending from the T2 to the T11 level. Syringomyelia and syringobulbia have been reported as complications of TBM. We describe the first case of syringomyelia as an uncommon late complication of treated TBM in the setting of HIV infection. Early recognition of this rare entity may avoid irreversible neurological sequelae.

HIV and Reproduction: Fertility, Contraception, and Preconception Issues and Interventions

HIV and Reproduction: Fertility, Contraception, and Preconception Issues and Interventions

Contraception for the HIV-positive woman: a review of interactions between hormonal contraception and antiretroviral therapy.

Background. Preventing unintended pregnancy in HIV-positive women can significantly reduce maternal-to-child HIV transmission as well as improve the woman's overall health. Hormonal contraceptives are safe and effective means to avoid unintended pregnancy, but there is concern that coadministration of antiretroviral drugs may alter contraceptive efficacy. Materials and Methods. We performed a literature search of PubMed and Ovid databases of articles published between January 1980 and February 2012 to identify English-language reports of drug-drug interactions between hormonal contraceptives (HCs) and antiretroviral drugs (ARVs). We also reviewed the FDA prescribing information of contraceptive hormone preparations and antiretrovirals for additional data and recommendations. Results. Twenty peer-reviewed publications and 42 pharmaceutical package labels were reviewed. Several studies of combined oral contraceptive pills (COCs) identified decreased serum estrogen and progestin levels when coadministered with certain ARVs. The contraceptive efficacy of injectable depot medroxyprogesterone acetate (DMPA) and the levonorgestrel intrauterine system (LNG-IUS) were largely unaffected by ARVs, while data on the contraceptive patch, ring, and implant were lacking. Conclusions. HIV-positive women should be offered a full range of hormonal contraceptive options, with conscientious counseling about possible reduced efficacy of COCs and the contraceptive implant when taken with ARVs. DMPA and the LNG-IUS maintain their contraceptive efficacy when taken with ARVs.

Implanon failure in an HIV-positive woman on antiretroviral therapy resulting in two ectopic pregnancies

This letter to the editor describes Implanon failure in an HIV-positive woman on antiretroviral therapy resulting in two ectopic pregnancies to provide information on antiretroviral drug interactions and contraceptive options. The author recommends that a more cautious approach should be taken in advising all women on long-term treatment with an enzyme-inducing drug to change to an unaffected contraceptive method such as the progestogen-only injectable copper or levonorgestrel-releasing intrauterine methods or the combined oral contraceptive pill. Furthermore the author recommends that due to the complexity of antiretroviral drug interactions and constant changes in the fields of HIV medicine and contraception clinicians may need to continually check various sources of information for current advice.

Gross Tumour of Minor Salivary Glands in HIV Sero-Positive Patient

Tumours of minor salivary glands are rare. We report the case of a 58-year-old HIV positive woman with a palatal adenocarcinoma evolving for 15 years, followed by a literature review. The case enlightens on the deleterious effect of delayed specialist consultation, which in our context is multifactorial in origin.

Immune reconstitution inflammatory syndrome: A therapeutic paradox

A 41-year-old HIV positive woman was started on highly active antiretroviral therapy when her CD4 count was 54/cu mm. Three weeks later, she developed erythematous to skin-colored plaques over the face. Investigations revealed a moderate eosinophilia, raised ESR, elevated 24-hour urinary calcium and hyperglobulinemia. Skin biopsy of the facial plaque revealed prominent epithelioid cell granulomas in the dermis. Reticulin stain showed reticulin fibers within the granulomas. Five months later, all the facial lesions regressed with continuation of HAART, with no specific treatment for facial plaques. Repeat CD4 count was 104/cu mm. A diagnosis of cutaneous sarcoidosis occurring as a part of immune reconstitution inflammatory syndrome was made. Although systemic sarcoidosis has been reported, the occurrence of cutaneous sarcoidosis as part of immune reconstitution inflammatory syndrome has not been elucidated conclusively.

Unusual Presentation Of Giant Condylomata Acuminata Of The Vulva- A Case Report And Review Of Literature

Context: The lesion of condyloma acuminata, popularly known as venereal warts is a sexually transmitted disease generally diagnosed based on their appearance. Giant condyloma acuminata also named Buschke- Lowenstein tumour (BLT) is a slow growing cauliflower-like tumour, locally aggressive and destructive, with possible malignant transformation. The mode of treatment range from application of podophyllin to surgical excision by cauterisation. Case report: A case of unusual presentation of giant condyloma in a 26 year old, single, nulliparous, HIV positive woman is presented and the literature reviewed. She had an18 month’s history of rapidly progressive growth of vulval tumour and associated itching, contact bleeding, malodorous vaginal discharge and difficulty in walking. She had previously been treated with podophyllin without success. The tumour measured 40 x 30 cm and was successfully excised with no evidence of malignancy. Conclusion: BLT is still seen in low resource countries like Nigeria, due to late presentation. Wide excision with histological margins examination is the best surgical choice in the treatment of BLT as it was performed in our patient. Small condylomas must be very carefully treated, including with surgical excision, in order to prevent further developing of BLT.

Left Hemibody Swelling in an HIV-Positive Patient with Congenital Heart Disease

We report the case of a 50-year-old HIV-positive woman with a congenital cyanotic heart disease who developed left axillary, subclavian, and brachiocephalic vein thrombosis and left lower aortopulmonary collateral arterial thrombosis, presenting as left hemibody swelling. We also briefly overview the literature regarding upper extremity deep vein thrombosis (UEDVT). Given the absence of other risk factors, it was our firm believe that our patient's UEDVT was due to a hypercoagulable state associated with congestive heart failure (CHF) and HIV infection.

Tinea capitis in the form of concentric rings in an HIV positive adult on antiretroviral treatment

Dermatophyte infection may present in the form of concentric rings caused by Trichophyton concentricum, known as Tinea Imbricata. In immunosuppressed patients, there are reports of lesions in the form of concentric rings caused by dermatophytes other than Trichophyton concentricum too, mostly by Trichophyton tonsurans, known as Tinea indesiciva or Tinea pseudoimbricata. We report a case of tinea capitis in a HIV-positive adult woman on antiretroviral therapy, who presented with concentric rings of papules and pustules with slight scaling on the scalp along with diffuse thinning of hair. Both Potassium hydroxide mount and culture showed the presence of Dermatophytes. Tinea capitis is considered rare in adults, but new cases are being reported in immunocompromised as well as in immunocompetent patients. The pertinent features of this case are: HIV-positive adult female on antiretroviral therapy, presenting with tinea capitis in the form of concentric rings; culture from the lesion grew Microsporum audouinii; responding to oral Terbinafine.

Fertility Responses to Prevention of Mother-to-Child Transmission of HIV

Prevention of mother-to-child transmission (PMTCT) interventions reduce the cumulative probability of transmission from a HIV positive woman to her child by as much as 40 percentage points. This paper is the rst economic analysis of the behavioral e ects of PMTCT. I examine fertility responses to the scale-up of PMTCT in Zambia, a country where approximately 15 percent of adults age 15-49 are HIV positive. My results suggest that the local introduction of PMTCT reduced pregnancy rates by up to 20 percent, that the fertility response was greater among women who were more likely to be HIV positive, and that PMTCT substantially increased breastfeeding rates.

Gynaecological and Reproductive Health Issues in HIV-Positive Women

Women constitute over 60 percent of the HIV-infected population in sub-Saharan Africa. Highly active antiretroviral therapy (HAART) has improved the life span of people living with human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS). Advances in scientific knowledge and management of the HIV-positive pregnant woman have also led to reduction in the risk of mother-to- child transmission (MTCT) of HIV. The gynaecological and reproductive health needs and care of the HIV-positive woman are poorly appreciated, suboptimal and largely neglected, with potential to negatively affect their quality of life and efforts at control of the HIV epidemic. To review the contemporary gynaecological and reproductive health problems and management of the HIV-positive woman. A review of local and international publications on gynaecology / reproductive health and HIV from indexed / online journals and relevant websites using Pubmed and Google search in the period between 1980 and March 2009. The HIV-positive woman suffers increased frequency and severity of pelvic infections and cervical premalignant and malignant lesions. Relapses and treatment failures of these conditions are common among these patients. Infertility and contraception are also challenges to the HIV-positive woman. Gynaecological and reproductive health care is an integral part of the comprehensive health care needs of the HIV-positive woman. In addition to antiretroviral treatment, HIV positive women should be provided regular screening for sexually transmitted infections (STIs), cervical cytology, counselling and services for infertility and contraception. Appropriate attention to the gynaecological and reproductive health needs of the HIV-positive woman will improve her general health status and quality of life and contribute to reduction in the incidence of HIV infection.

Implanon® failure in an HIV-positive woman on antiretroviral therapy resulting in two ectopic pregnancies

Since its introduction in 1999, Implanon® remains one of the preferred contraceptive choices for many women as it offers a highly effective means of long-term contraception for three years that does not rely on adherence. Like all hormonal contraceptives, certain hepatic enzyme-inducing drugs may reduce its efficacy. We present an interesting case of an HIV-positive woman on antiretroviral therapy having tubal pregnancies on two separate occasions with Implanon in place.

Hypoprolactinaemic galactorrhoea in long-term methadone treatment.

Although hyperprolactinaemia is associated with galactorrhoea, galactorrhoea often occurs without any hyperprolactinaemia. This has been well established, and it has been documented in women prescribed/using methadone and other opiates. One case series described amenorrhoea and galactorrhoea in 'female heroin addicts', but it has not before been described in a patient with hypoprolactinaemia. We report a case of a 30 year old non-pregnant, non-puerperal, opioid-dependent, HIV positive woman on long-term methadone maintenance programme, who presented with bilateral, milky nipple discharge, associated with painful breast lumps, but with serum prolactin levels below the normal range. She was not prescribed any other medications likely to have effect on the endocrine system. This case highlights the need for prescribers to be alert to the implications of long-term use of opioids.

Disseminated Histoplasma capsulatum and Cryptococcus neoformans Co-Infection in Patients with AIDS

Histoplasmosis and cryptococcosis are the most prevalent systemic mycoses in HIV-infected patients. The authors report a 20-year-old Brazilian HIV-positive woman with concomitant disseminated histoplasmosis and cryptococcosis. In addition, we review the reported cases described in the medical literature.

Múltiples abscesos cerebrales por Listeria monocitogenes en un paciente con infección por el virus de inmunodeficiencia humana, primer caso descrito en Colombia

The manifestations of Listeria monocytogenes central nervous system infection are wide, ranging from meningitis to cerebral abscesses. Those are clinically indistinguishable from other forms of cerebral abscesses. We are describing a HIV positive woman who presented with generalized tonicclonic seizures, progressive alter mental status, evidence of lymphocytic pleocytosis and multiple hypodense lesions that enhanced with contrastae on imaging studies (CT and MRI) Listeria monocytogenes was isolated of cefaloraquid liquid cultures. After a specific antibiotic treatment regimen associated with steroids, improved neurological symptoms and concomitant documented a progressive decrease until disappearance of the lesions in the CNS imaging follow. Listeria monocytogenes is a cause of brain abscesses in immunosuppressed patients especially HIV patients without antiretroviral therapy and without prophylaxis with trimethoprim / sulfamethoxazole.

Primary effusion lymphoma associated with Human Herpes Virus-8 and Epstein Barr virus in an HIV-infected woman from Kampala, Uganda: a case report

IntroductionPrimary effusion lymphoma is a recently recognized entity of AIDS related non-Hodgkin lymphomas. Despite Africa being greatly affected by the HIV/AIDS pandemic, an extensive MEDLINE/PubMed search failed to find any report of primary effusion lymphoma in sub-Saharan Africa. To our knowledge this is the first report of primary effusion lymphoma in sub-Saharan Africa. We report the clinical, cytomorphologic and immunohistochemical findings of a patient with primary effusion lymphoma.Case presentationA 70-year-old newly diagnosed HIV-positive Ugandan African woman presented with a three-month history of cough, fever, weight loss and drenching night sweats. Three weeks prior to admission she developed right sided chest pain and difficulty in breathing. On examination she had bilateral pleural effusions.Haematoxylin and eosin stained cytologic sections of the formalin-fixed paraffin-embedded cell block made from the pleural fluid were processed in the Department of Pathology, Makerere University, College of Health Sciences, Kampala, Uganda. Immunohistochemistry was done at the Institute of Haematology and Oncology "L and A Seragnoli", Bologna University School of Medicine, Bologna, Italy, using alkaline phosphatase anti-alkaline phosphatase method. In situ hybridization was used for detection of Epstein-Barr virus.The tumor cells were CD45+, CD30+, CD38+, HHV-8 LANA-1+; but were negative for CD3-, CD20-, CD19-, and CD79a- and EBV RNA+ on in situ hybridization. CD138 and Ki-67 were not evaluable. Our patient tested HIV positive and her CD4 cell count was 127/μL.ConclusionsA definitive diagnosis of primary effusion lymphoma rests on finding a proliferation of large immunoblastic, plasmacytoid and anaplastic cells; HHV-8 in the tumor cells, an immunophenotype that is CD45+, pan B-cell marker negative and lymphocyte activated marker positive. It is essential for clinicians and pathologists to have a high index of suspicion of primary effusion lymphoma when handling HIV positive patients who have effusions without palpable tumor masses. Basic immunohistochemistry is essential for definitive diagnosis.

Postpartum Endometritis Caused by Herpes and Cytomegaloviruses

Postpartum endometritis is usually a polymicrobial infection caused by organisms that are part of the normal vaginal flora. A pathologically confirmed case of postpartum endometritis secondary to herpes and cytomegalovirus in a human immunodeficiency virus (HIV)-positive patient is reported. A 29-year-old, HIV-positive woman presented 6 days postpartum with abdominal pain and foul-smelling vaginal discharge. Pelvic ultrasonography revealed retained products of conception. Dilation and evacuation was performed, and antibiotics were started. Despite adequate antibiotics and laparoscopic drainage of a pelvic collection, fevers and pain continued. A total abdominal hysterectomy, salpingectomy, and appendectomy were performed. Pathology reported herpes and cytomegalovirus infection of the uterus. Herpes simplex virus (HSV) and cytomegalovirus need to be considered as a potential cause of postpartum endometritis. When antibiotic therapy fails, an antiviral regimen should be considered.

Patella Infera in an HIV Positive Patient Following Total Knee Arthroplasty

A lowering of the patella after total knee arthroplasty is accompanied by pain and a restriction of the range of motion. With its etiology being unclear at present, a multifactorial genesis is under discussion. For the first time, we present a case report describing an HIV infection as a possible cause of patella infera.A 54-year-old HIV-positive woman developed patella infera (Insall-Salvati ratio 0.6) with a painful restriction of motion 18 months after implantation of a bicondylar surface prosthesis. By changing to a partially coupled endoprosthesis, distalization of the joint line and partial patellar resection, the patient was free of symptoms with a ROM of 0°/0°/110°.All risk factors known from the literature could be excluded in this case, so that the presence of an HIV infection has to be discussed as a possible cause.

An apple-core lesion in the colon: An infectious etiology

Gastrointestinal involvement occurs in about 70% to 90% of histoplasmosis cases but is usually not the initial manifestation. We present the case of a 52-yearold HIV-positive woman who presented with gastrointestinal symptoms and an apple-core lesion on CT scan of the abdomen. The patient had been diagnosed with histoplasma colitis eight months earlier and was started on long-term itraconazole therapy. However, she prematurely discontinued treatment. A colonoscopy during the present hospitalization revealed a 3.5-cm mass, biopsies of which revealed Histoplasma capsulatum. In the present report, we discuss the differential diagnosis of apple-core lesions in the colon and the importance of keeping histoplasmosis on the differential diagnosis, especially in endemic areas like the Ohio River valley. It is equally important to ensure compliance with treatment of histoplasmosis, as well as close follow-up, as progression to colonic obstruction while on medical management has been reported.