Human Immunodeficiency Virus Positive Participants Research Articles

Cytomegalovirus (CMV) IgM antibodies among HIV-infected patients at a teaching hospital in Port Harcourt, Nigeria

Cytomegalovirus (CMV) is an important pathogen in HIV (Human Immunodeficiency Virus) patients, as it could drive accelerated disease progression leading to increased morbidity and mortality in the population. This cross-sectional study analyzed plasma samples from 93 HIV positive participants in the Rivers State University Teaching Hospital, Port Harcourt, Nigeria, to investigate the magnitude and associated factors of cytomegalovirus (CMV) infection. Plasma samples were screened serologically for the presence of specific CMV IgM antibodies using microwell ELISA kits. Demographic and behavioural risk factors were collected by the use of a structured questionnaire. Chi-square test was used to assess the statistical significance of different demographic and behavioural risk factors to CMV acquisition. Of the 93 subjects 3(3.2%) were seropositive for CMV IgM antibody. No statistical association existed between the prevalence of CMV IgM antibodies and the socio-demographic factors studied. Higher prevalence of CMV IgM antibody was found in age group 21-40 years (3.2%), female sex (3.9%), single marital status (6.0%), tertiary education (10.0%), students (6.7%) and Christians (3.7%). The observation from this study necessitates the need for serological evaluation in all HIV patients for CMV IgM antibodies for early diagnosis and preventive strategies.

The quality of life of HIV positive Transgender and homosexual population in Karachi, Pakistan.

To study the demographics and the quality of life of Transgenders and men who have sex with men (MSM) infected with Human Immunodeficiency Virus (HIV). A Cross sectional study conducted from 2019 to 2021 in the Indus Hospital Karachi. A 30 minutes interview was conducted among HIV positive homosexual participants. Out of 100 patients enrolled 58% were transgender, 39% uneducated, 76% not supported financially by family, 20% reported hospital misconduct, 50% were commercial sex workers and 64% had anxiety. Our results also showed that increasing patient knowledge does not guarantee safe sex habits (p-value=0.82). We found declining psycho-social wellbeing in this population. Education and family support may help establish a good standard of living in them. More studies are needed in the Pakistani transgender population in order to understand their needs better.

English

The Human Immunodeficiency Virus (HIV) is a neurotropic virus that is associated with cognitive, behavioral and motor deficits known as HIV Associated Neurocognitive Disorder (HAND). This was a prospective study aimed at determining the prevalence of cognitive impairment as well as comparing the performance of the HIV positive patients on a screening test, the International HIV Dementia Scale (IHDS), and subtests drawn from a neuropsychological test battery - WHO/UCLA. The screening test and neuropsychological test battery were administered to HIV positive patients while the HIV negative patients had only the test battery administered to determine the mean score of each test domain. Neurocognitive impairment was defined using the cut-off score of 10 for the International HIV Dementia scale and Z scores greater than 1 SD in at least two domains of the neuropsychological test battery. The mean performance on each domain of the test battery was determined after administration to the HIV negative individuals. Ninety-two HIV positive patients (57 females and 35 males) and ninety-two age, sex and education matched HIV negative subjects (46 females and 46 males) were enrolled into the study. The median age and interquartile range were 33(26-39) and 35(27-46) for the HIV positive and negative participants respectively. The prevalence estimates of cognitive impairment determined by the IHDS and the test battery were 42.4 and 76.1%, respectively. The IHDS in this study was found to have a sensitivity of 50% and a specificity of 81% for HAND. Neurocognitive impairment still persists in the combination anti-retroviral therapy (CART) era and is better accessed using neuropsychological testing than with screening tests although the former is cumbersome and require expertise and patience on the part of the subjects. Key words: HIV, neurocognitive disorder, sub-Saharan Africa, dementia tests, neuropsychology.

Isoniazid and Rifampicin Tuberculosis Drug Resistance in HIV Endemic Region of Western Kenya

Background: Tuberculosis drug resistance is often associated with inadequate anti-tuberculosis treatment regimen resulting to mutations that confers resistance to anti-tuberculosis agents. This is aggravated by synergetic relationship between Tuberculosis and HIV (Human Immunodeficiency Virus). Over 25% of Global Tuberculosis deaths occur in Africa and Kenya is one of the 30 high burden countries that together account for more than 80% of the world’s TB cases. According to World Health Organization, in 2018, Multi drug resistant Tuberculosis prevalence in Kenya was 1.3% in new cases and 4.4% in retreatment cases. Kisumu County recorded the second highest HIV prevalence at 18.6% against the national prevalence of 4.5% in 2020. The extent of regional burden of DR-TB and HIV co-infection has not been exactly well-defined in Western Kenya. Methods: This was a prospective cross sectional study that aimed to explore the association between Tuberculosis drug resistance and HIV status among new and previously treated pulmonary tuberculosis cases in Kisumu County, Kenya. Tuberculosis clinical suspects were recruited into the study and classified as HIV positive or negative based on their clinical data. Sputum samples from tuberculosis clinical suspects were subjected to fluorescent microscopy, phenotypic culture and line probe assay. Results: Out of a sample of 256, response rate was 216 of which HIV positive cases were 119(55.1%) and negative were 97 (44.9%). The study found that out of 11 that were phenotypic Isoniazid resistance 8(6.7%) were from HIV positive cases while 3 (3.2%) were from HIV negative cases. Phenotypic rifampicin resistance among the HIV positive were 8 (6.7%) while HIV negative were 2 (2.1%). All the 2(1.7%) MDR cases were from HIV positive participants. The study found out that HIV status and Tuberculosis cases were significantly associated at p<.05. HIV positive cases were more likely associated with retreatment cases (OR=1.4,95CI:1.00-1.90) compared to new cases. The study found out that the common mutant probe among the HIV positive was katG MUT1 4(2.6%), while mutant probes among the HIV negative were in hA MUT1 1(0.7%), katG MUT1 1(0.7%) and roB MUT2A 1(0.7%). Wild type gene deletion among the HIV positive cases were observed in probes katG WT 3(2.1%), roB WT7, katG WT 1(0.7%) while wild type gene deletion among the HIV negative cases were inhA WT1 1(0.7%), in hA WT1/inhAWT2 1(0.7%), katG WT 1(0.7%). Conclusion: Interventions specific to HIV-endemic areas are urgently needed to block tuberculosis drug resistance transmission. Development and improvement of the efficacy of interventions will require a greater understanding of the transmission of multidrug-resistant tuberculosis in HIV-endemic settings like Kisumu County, Western Kenya.

Prevalence and associated factors of sexually transmitted infections among methamphetamine users in Eastern China: a cross-sectional study

BackgroundThe reported incidence of sexually transmitted infections (STIs) in China has been increasing over the last decades, especially among drug users, which has become one of the main burdens of public health in China. This study was conducted to estimate the prevalence and associated factors of STIs among non-injecting methamphetamine (MA) users in Eastern China.MethodsA cross-sectional survey was conducted among 632 MA users in Eastern China in 2017. Demographic characteristics, sexual behaviors, behaviors of MA use and sexual health knowledge were collected through questionnaire. First pass urine specimens were collected and detected for deoxyribonucleic acid (DNA) of Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) with Nucleic Acid Amplification Technology (NAAT), while blood specimens were collected and detected for antibodies of Human immunodeficiency virus (HIV), Herpes simplex virus type-2 (HSV-2), and syphilis with enzyme-linked immune sorbent assay (ELISA).ResultsAmong the 632 MA users, 464 (73.42%) were males, 60.92% were < 35 years of age, 546 (86.39%) were Shandong residents. 317 (50.16%, 95% CI 46.26–54.06%) participants were tested positive for at least one kind of STIs, including 242 (38.29%, 95% CI 34.50–42.08%) for HSV-2, 107 (16.93%, 95% CI 14.01–19.85%) for active syphilis, 46 (7.28%, 95% CI 5.25–9.31%) for treated syphilis, 40 (6.33%, 95% CI 4.43–8.23%) for CT, 6 (0.95%, 95% CI 0.19–1.71%) for HIV, and 3 (0.47%, 95% CI 0.06–1.00%) for NG infection. 99 (15.66%, 95% CI 12.83–18.49%) participants were co-infected with two kinds of STIs, including 91 (14.40%, 95% CI 11.66–17.14%) participants were co-infected with HSV-2 and syphilis. 14 (2.22%, 95% CI 1.07–3.37%) participants were co-infected with three kinds of STIs, and 4 HIV positive participants were co-infected with both syphilis and HSV-2. In the multiple logistic regression analysis, the results showed that females (adjusted OR [AOR] = 7.30, 95% CI 4.34–12.30) and individuals ≥ 35 years of age (AOR = 2.97, 95% CI 2.04–4.32) were more likely to test positive for STIs among MA users, whereas participants who acquired sexual health knowledge primarily from the Internet (AOR = 0.57, 95% CI 0.40–0.82) and those whose regular partners did not use drugs (AOR = 0.59, 95% CI 0.37–0.94) were less likely.ConclusionsThis study found that the prevalence of HSV-2 and syphilis are alarming high among non-injecting MA users in Shandong Province in Eastern China. The prevention and control intervention of STIs among MA users in Shandong were needed, especially on females and MA users ≥ 35 years of age.

The Prevalence of Hepatitis B and C among HIV Positive Patients in Some Hospitals in Rivers State

Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HBV), and Hepatitis C Virus (HCV) are all blood borne pathogens that are still global health challenges and were known to be endemic in Nigeria. Little work had been done on Hepatitis-B and C co-infection among HIV positive patients in the three Senatorial Districts of Rivers State. A case- control, hospital- based study was conducted among subjects from Rivers state University Teaching Hospital (RSUTH), Zonal Hospital, Bori and Zonal Hospital, Ahoada to determine the prevalence of Hepatitis B and C co-infection in these areas. Three hundred and seventy-five subjects of (10-69 years) and both sexes were included in the study. A structured questionnaire was administered to obtain demographic parameters of the participants. The samples collected were screened and confirmed for hepatitis-B and C using standard techniques. The overall prevalence rates of HBV, HCV and HBV/HCV in this study are 4.5%, 2.1% and 0.8% respectively while the prevalence among HIV positive participants were; 4.6%, 2.8% and 1.1% respectively. Bori had the highest prevalence of HBV and HCV, (5.3% and 4.2%) while Ahoada had the highest prevalence of triple infection (2.1%). The prevalence of HIV/HBV, HIV/HCV and HIV/HBV/HCV infection was more among subjects within age range of 30-39 years (7.0%, 5.6% and 4.2%) and lowest within the age range of 20-29 years (2.3%, 0% and 0%). Conclusively, the research findings show that the prevalence of hepatitis B and C co-infection among HIV patients in these hospitals are high. Thus, every HIV positive patient should be screened and educated on the danger of co-infection for better management of the patient.

Prevalence and correlates of dyslipidemia in HIV positive and negative adults in Western Kenya: A cross-sectional study.

There is increasing morbidity and mortality from cardiovascular diseases (CVD) in sub-Saharan Africa (SSA). Dyslipidemia is a well-known CVD risk factor which has been associated with human immunodeficiency virus (HIV) infection and its treatment in high-income countries. Studies in SSA that have examined the relationship between HIV and dyslipidemia have reported mixed results. In this study, we sought to determine the prevalence of dyslipidemia in HIV positive and negative adults (>=30 years old) and evaluate for association in Western Kenya with a higher prevalence expected among HIV positive individuals.HIV positive adults receiving antiretroviral therapy (ART) and HIV negative individuals seeking HIV testing and counseling services were recruited into a cross-sectional study. Demographic and behavioral data and fasting blood samples were collected. Dyslipidemia was defined according to the National Cholesterol Education Program Adult Treatment Panel III. Associations between baseline demographic and clinical variables and dyslipidemia were analyzed using logistic regression.A total of 598 participants, 300 HIV positive and 298 HIV negative adults were enrolled. Dyslipidemia data was available for 564 (94%) participants. In total, 267 (47%) had dyslipidemia. This was not significantly different between HIV positive and HIV negative individuals (46% vs 49%, P = .4). In a multivariate analysis including both HIV positive and negative individuals, adults 50 to 59 years of age had a 2-fold increased risk of dyslipidemia (Odds ratio [OR] 2.1, 95% confidence interval (1.2–3.5) when compared to 30 to 39-years-old participants. Abdominal obesity (OR 2.5), being overweight (OR 1.9), and low fruit and vegetable intake (OR 2.2) were significantly associated with dyslipidemia. Among HIV positive participants, time since HIV diagnosis, ART duration, use of (PI) protease inhibitor-based ART, viral load suppression, current cluster of differentiation (CD4) count and nadir CD4 did not have significant associations with dyslipidemia.The prevalence of dyslipidemia is high in Western Kenya, with nearly half of all participants with lipid abnormalities. Dyslipidemia was not significantly associated with HIV status, or with HIV-specific factors. Older age, being overweight, abdominal obesity, and low fruit and vegetable intake were associated with dyslipidemia and may be targets for public health interventions to lower the prevalence of dyslipidemia and CVD risk in sub-Saharan Africa.

ASSOCIATION OF HIV INFECTION WITH CLINICAL AND LABORATORY CHARACTERISTICS OF SICKLE CELL DISEASE

Sickle cell disease (SCD) is a multisystem disorder characterized by a wide spectrum of clinical manifestations and severity. Studies investigating potential effects of co-morbid human immunodeficiency virus (HIV) and SCD have produced conflicting results, and additional investigations are needed to elucidate whether the interaction between the two disease states might impact both HIV and SCD clinical outcomes. The association of HIV infection with clinical and laboratory characteristics of patients with SCD was assessed. This nested case-control study included individuals with SCD with HIV treated at six Brazilian SCD centers. Clinical and laboratory data were abstracted from medical records. HIV positive participants were compared to age, gender, center, and SCD genotype matched HIV negative participants (ratio 1:4). Individual clinical outcomes as well as a composite outcome of any SCD complication and a composite outcome of any HIV-related complication were compared between the two groups. Fifteen HIV positive participants were included, 12 (80%) alive and 3 (20%) deceased. Most of the HIV positive patients had HbSS (60%; n = 9), 53% (n = 8) were female, and mean age was 30 ± 13 years. The frequency of individual SCD complications of acute chest syndrome/pneumonia, sepsis/bacteremia, pyelonephritis, ischemic stroke, hemorrhagic stroke, abnormal transcranial Doppler (TCD), and pulmonary hypertension was higher in HIV positive participants when compared to HIV negative, although analyzed individually none were statistically significant. HIV positive participants had significantly higher risk of any SCD complication and of a composite HIV-related complication compared to the HIV negative group (HR = 4.6; 95%CI 1.1–19.6; P = 0.04 and HR = 7.7; 95%CI 1.5–40.2; P = 0.02, respectively). There was a non-significant trend towards higher risk of any infections in participants with HIV positive (HR = 3.5; 95%CI 0.92–13.4; P = 0.07). Laboratory parameters levels were not significantly different in individuals with and without HIV. In summary, our study in SCD patients shows that those with HIV have an increased risk of any SCD complication and HIV-related complications, as well as a suggestive but not significantly increased risk of infections.

Association of HIV infection with clinical and laboratory characteristics of sickle cell disease

BackgroundSickle cell disease (SCD) is a multisystem disorder characterized by a wide spectrum of clinical manifestations and severity. Studies investigating potential effects of co-morbid human immunodeficiency virus (HIV) and SCD have produced conflicting results, and additional investigations are needed to elucidate whether the interaction between the two disease states might impact both HIV and SCD clinical outcomes. The association of HIV infection with clinical and laboratory characteristics of patients with SCD was assessed.MethodsThis nested case-control study included individuals with SCD with HIV treated at six Brazilian SCD centers. Clinical and laboratory data were abstracted from medical records. HIV positive participants were compared to age, gender, center, and SCD genotype matched HIV negative participants (ratio 1:4). Individual clinical outcomes as well as a composite outcome of any SCD complication and a composite outcome of any HIV-related complication were compared between the two groups.ResultsFifteen HIV positive participants were included, 12 (80%) alive and 3 (20%) deceased. Most of the HIV positive patients had HbSS (60%; n = 9), 53% (n = 8) were female, and mean age was 30 ± 13 years. The frequency of individual SCD complications of acute chest syndrome/pneumonia, sepsis/bacteremia, pyelonephritis, ischemic stroke, hemorrhagic stroke, abnormal transcranial Doppler (TCD), and pulmonary hypertension was higher in HIV positive participants when compared to HIV negative, although analyzed individually none were statistically significant. HIV positive participants had significantly higher risk of any SCD complication and of a composite HIV-related complication compared to the HIV negative group (HR = 4.6; 95%CI 1.1–19.6; P = 0.04 and HR = 7.7; 95%CI 1.5–40.2; P = 0.02, respectively). There was a non-significant trend towards higher risk of any infections in participants with HIV positive (HR = 3.5; 95%CI 0.92–13.4; P = 0.07). Laboratory parameters levels were not significantly different in individuals with and without HIV.ConclusionsIn summary, our study in SCD patients shows that those with HIV have an increased risk of any SCD complication and HIV-related complications, as well as a suggestive but not significantly increased risk of infections.

Malaria parasite prevalence and Haematological parameters in HIV seropositive patients attending the regional hospital Limbe, Cameroon: a hospital-based cross-sectional study

BackgroundMalaria and the human immunodeficiency virus (HIV) infection constitute public health problems in Cameroon including the South West Region (SWR). This study determined the prevalence of malaria parasites and haematological abnormalities in HIV positive patients in Limbe, Cameroon from April–July 2014.MethodsThe study was cross-sectional and involved 411 participants who were administered structured questionnaires to record socio-demographic and clinical data. Three hundred and nine (309) HIV positive patients and one hundred and two (102) HIV negative individuals were examined clinically and venous blood collected for malaria parasite detection, HIV infection diagnosis and full blood count analysis.ResultsOverall malaria parasite prevalence was 14.1% (58/411). This prevalence was significantly higher (P < 0.001) in the HIV negative participants (33.3%, 34/102) compared to the HIV positive patients (7.8%, 24/309). Amongst HIV positive participants, malaria parasite prevalence was significantly higher in female patients (P = 0.003), febrile patients (P < 0.001), anaemic patients (P = 0.015) and in patients who were not on antiretroviral treatment (ART) (P = 0.03) when compared with their respective counterparts. Among the HIV negative group, though not significant, malaria parasite prevalence was higher in females, febrile and anaemic patients when compared with their respective counterparts. Overall anaemia prevalence was 52.1% (214/309) and was significantly higher (P = 0.004) in HIV positive patients (56%, 173) than in HIV negative participants (40.2%, 41). Malaria/HIV co-infected patients had a significantly lower mean value of Hb (P = 0.002), RBC (P = 0.002) and Hct (P = 0.001) when compared with HIV-infected patients.ConclusionHIV negative participants had a higher prevalence of malaria parasites than their HIV positive counterparts. Anaemia prevalence was higher in HIV positive patients than in HIV negative participants. Malaria/HIV co-infected patients presented with more red blood cell abnormalities than HIV-infected patients.

Detection of human immunodeficiency virus among individuals presenting with febrile illness in Lagos, Nigeria

Introduction : The Human Immunodeficiency Virus (HIV) is the aetiological agent of Acquired Immunodeficiency Syndrome (AIDS), which is a chronic and potentially life-threatening condition. Fever is mostly associated with the early stage of virus replication known as acute HIV infection or syndrome; as such, determination of HIV status during this critical period is a good means of improving clinical outcome in those infected. Thus, this study aimed to determine the prevalence of HIV among febrile individuals in Lagos, Nigeria. Materials and Methods : A cross sectional study of 250 febrile individuals attending General Hospitals at Isolo, Mushin and Surulere, Lagos, Nigeria. Analysis was carried out at the Virology Research Laboratory, Central Research Laboratory, College of Medicine of the University of Lagos from July to October 2017. Sample analysis was done according to the Nigerian National Testing Algorithm to determine HIV status using Enzyme Immunoassay (EIA) and data analyzed using Statistical Package for Social Sciences (SPSS) version 20. Results : Out of the 250 febrile participants, 8 were positive for HIV, with an overall prevalence of 3.2%. Further analysis however showed that 90% of the HIV positive participants had four or more episodes of fever in a month. HIV infection was still majorly among the ages 15-24 and 25-34 for male and ages 25-34, 35-44 and 45-54 for females. Conclusion : This findings showed that different cohorts are significantly at risk of HIV infection. Hence, policies and all efforts to reduce the burden of HIV are paramount for a HIV free future for Nigeria. Keywords : Acute Retroviral Syndrome (ARS), Fever, Asymptomatic and Enzyme–Linked Immunosorbent Assay (ELISA).

Seroprevalence of Cytomegalovirus Infection and Associated Risk Factors among Human Immunodeficiency Virus Infected Patients Attending Thika Level 5 Hospital, Kenya

Cytomegalovirus (CMV) is an important pathogen in immunocompromised individuals. Coupled with Human Immunodeficiency Virus (HIV), it causes end organ diseases leading to increased morbidity and mortality in the population. The prevalence of Cytomegalovirus infection is above 93% in HIV infected children in Kenya. Despite, a high Cytomegalovirus seroprevalence found in children, few studies have documented CMV in adults. This study was done to determine the seroprevalence of CMV infection and its associated risk factors among HIV patients attending Thika level 5 Hospital in Kiambu County, Kenya. The study also evaluated the effect CMV infection on the immunity of HIV infected patients. A cross-sectional study involving 163 HIV positive participants from different age groups was carried out. A questionnaire was used to assess the socio-demographic and specific risk factors associated with cytomegalovirus. Blood was collected and analyzed for CD4 counts, CMV IgG and IgM. The seroprevalence of CMV was found to be 89% (CMV IgG) while the incidence was 10.4% (CMV IgM). The study found that CMV infection leads to more suppression of the immunity among the HIV infected patients. In addition, education, economic status, having other sexual transmitted infections, sharing drinks, immune status and blood transfusion were associated with CMV infection (p

Seroprevalence of Kaposi's sarcoma-associated herpesvirus among HIV-infected Uygurs in Xinjiang, China.

Kaposi's sarcoma-associated herpesvirus (KSHV) is the etiological agent of Kaposi's sarcoma (KS), which primarily affects human immunodeficiency virus (HIV)-infected adults with advanced immunodeficiency. Xinjiang province in China is an endemic area for Kaposi's sarcoma (KS), however, currently, only limited data for KSHV infection among HIV-infected individuals living in this endemic area is available. A cross-sectional study of 86 HIV positive participants was conducted in Xinjiang, China from 2014 through 2015. Plasma samples were collected and screened for KSHV and HIV infection. HIV pol gene and KSHV ORF-K1 gene were amplified and sequenced, genotypes were determined by phylogenetic analysis. Over all, prevalence was 48.9% (42/86; 95%CI 38.4-59.3%) for KSHV. Only CRF07_BC subtype has been identified among all these HIV positive individuals, while the subtype A and C of KSHV were detected in the participants. Meanwhile, we found that those with high CD4 counts (>500) showed a lower anti-KSHV titer, compared with other groups. Our study indicated a high prevalence of KSHV among HIV positive individuals in Xinjiang, China. Thus, management of HIV/AIDS patients should include KSHV screen and should consider the risk of KSHV-associated malignancies.

The Impact of Cultural Norms on HIV Transmission in Swaziland

The Impact of Cultural Norms on HIV Transmission in Swaziland

High levels of von Willebrand factor and low levels of its cleaving protease, ADAMTS13, are associated with stroke in young HIV-infected patients.

Stroke associated with human immunodeficiency virus infection may occur through a variety of mechanisms. Von Willebrand factor is a marker of endothelial dysfunction, and is elevated in human immunodeficiency virus infection. High levels of von Willebrand factor, a protein involved in platelet adhesion and aggregation, and low levels of ADAMTS13, a metalloproteinase that cleaves von Willebrand factor, have been associated with an increased risk of thrombosis. To investigate the role of von Willebrand factor and ADAMTS13 in the pathogenesis of human immunodeficiency virus-related stroke in young patients. A case-control study (n = 100) comprising three participant groups: human immunodeficiency virus-positive antiretroviral therapy-naïve young strokes (n = 20), human immunodeficiency virus-negative young strokes (n = 40), and human immunodeficiency virus-positive antiretroviral therapy-naïve nonstroke controls (n = 40). von Willebrand factor and ADAMTS13 levels were measured in plasma samples collected five- to seven-days poststroke. Human immunodeficiency virus-positive stroke participants had higher von Willebrand factor levels than human immunodeficiency virus-negative strokes (173·5% vs. 135%, P = 0·032). They tended to have higher levels of von Willebrand factor than human immunodeficiency virus-positive nonstroke controls (173·5% vs. 129%, P = 0·061). Human immunodeficiency virus-positive stroke participants had lower levels of ADAMTS13 than human immunodeficiency virus-positive nonstroke controls (0% vs. 23·5% P = 0·018) most likely due to the effect of the acute stroke. However, in the nonstroke group, these levels were significantly reduced compared with population norms. von Willebrand factor levels in all human immunodeficiency virus-positive participants were negatively correlated with CD4 counts. Stroke in human immunodeficiency virus infection is associated with a prothrombotic state, characterized by elevated von Willebrand factor and low ADAMTS13 levels.

Aflatoxin-related immune dysfunction in health and in human immunodeficiency virus disease.

Both aflatoxin and the human immunodeficiency virus (HIV) cause immune suppression and millions of HIV-infected people in developing countries are chronically exposed to aflatoxin in their diets. We investigated the possible interaction of aflatoxin and HIV on immune suppression by comparing immune parameters in 116 HIV positive and 80 aged-matched HIV negative Ghanaians with high (≥0.91 pmol/mg albumin) and low (<0.91 pmol/mg albumin) aflatoxin B1 albumin adduct (AF-ALB) levels. AF-ALB levels and HIV viral load were measured in plasma and the percentages of leukocyte immunophenotypes and cytokine expression were determined using flow cytometry. The cross-sectional comparisons found that (1) among both HIV positive and negative participants, high AF-ALB was associated with lower perforin expression on CD8+ T-cells (P = .012); (2) HIV positive participants with high AF-ALB had significantly lower percentages of CD4+ T regulatory cells (Tregs; P = .009) and naive CD4+ T cells (P = .029) compared to HIV positive participants with low AF-ALB; and (3) HIV positive participants with high AF-ALB had a significantly reduced percentage of B-cells (P = .03) compared to those with low AF-ALB. High AF-ALB appeared to accentuate some HIV associated changes in T-cell phenotypes and in B-cells in HIV positive participants.

Written medicines information for South African HIV/AIDS patients: does it enhance understanding of co-trimoxazole therapy?

Written information to promote patient education is being increasingly recognized as an integral part of quality health care. The main objective of this study was to evaluate the effect of distributing a patient information leaflet (PIL) on knowledge acquisition and recall. Two different PILs were designed for co-trimoxazole tablets: a simple, shorter PIL that incorporated pictograms and text and a text-only PIL that was longer and more complex. Human immunodeficiency virus-positive participants on chronic co-trimoxazole therapy were enrolled from five local primary health care clinics in Grahamstown, South Africa, and were randomly allocated to a Control Group (no PIL), Group A (text-only PIL) or Group B (simple PIL with pictograms). At the preliminary interview, demographic data were collected and the tablets dispensed according to normal clinic protocol. In a follow-up interview approximately 14 days later, participant medicines knowledge was investigated by asking a series of questions. The mean percentage for medicines knowledge was significantly higher in the group that received the simple PIL incorporating pictograms (76.3%), compared with both the Control Group (43.3%) and the group who received the longer, text-only PIL (50.9%). This study reinforces the value of providing patients with an appropriately designed PIL to inform appropriate medicine-taking behaviour.