Human Immunodeficiency Virus Serostatus Research Articles

The epidemiology of HIV seropositive malaria infected pregnant women in Akure Metropolis, Southwestern Nigeria

Background: HIV increases the risks of malaria in pregnant women, while maternal human immunodeficiency virus (HIV) viral load also facilitates perinatal transmission to neonates. Malaria and HIV coinfection has been shown to exacerbate adverse pregnancy complications. Our study was designed to determine the HIV prevalence of pregnant women at an antenatal clinic in Akure in southwestern Nigeria, investigate the relationship between dual HIV and malaria infection and HIV viral load and CD4+ T cell counts. The study also estimated the risks of adverse pregnancy outcomes in a selected cohort of 74 pregnant women. Materials and Methods: We evaluated the HIV serostatus of 3,225 pregnant women, who attended the antenatal clinic between August 2012 and April 2013. A cohort of 74 pregnant women was selected for the investigation of the relationship between coinfection of HIV and malaria and HIV viral load and CD4+ cell counts. Their HIV status was determined during three trimesters of pregnancy by both HIV-1/2 strips and confirmatory enzyme-linked immunosorbent assay (ELISA) method. Malaria parasitemia was determined by Giemsa-stained thin and thick blood smears. CD4 cell count was by flow cytometry using the CyFlow Counter (Partec, Germany). Viral load estimated by Amplicor HIV-I monitor assay. Results: We found 3.53% prevalence of HIV serostatus among the 3,225 pregnant women who were screened. Forty-four of the 74 subjects were HIV positive and 30 were HIV negative controls. The results show HIV infection among the pregnant women reduced the CD4 cells from a mean of 750 cells/ml for HIV negative women to a mean of 363 cells/ml for HIV seropositive women. Additionally the presence of malaria more than doubled the HIV viral load from a mean of 7,270 ribonucleic acid (RNA) copies/ml for HIV positive women without malaria to 15,148 RNA copies/ml for HIV positive women with malaria. Conclusion: In this study, HIV infection significantly increased risk of acquiring malaria in pregnant women (odds ratio (OR) = 2.27). Dual HIV/malaria infections exacerbated adverse pregnancy outcomes

Anogenital Lesions: Kaposi's Sarcoma and Its Mimicks

Kaposi's sarcoma (KS) is a low-grade vascular neoplasm associated with human herpes virus-8 (HHV-8) infection, and, in the epidemic form, with the human immunodeficiency virus (HIV). Although HHV-8 is present in all body fluids and is sexually transmitted, there are surprisingly few reports of anogenital KS. Clinically, especially in HIV/KS endemic areas, dark stained skin patches or nodules are prone to misdiagnosis, especially in dark-skinned individuals. Therefore, a biopsy is recommended. The histologic appearance spans a broad spectrum of KS and non-KS lesions; therefore, the final diagnosis should be confirmed by HHV-8 immunohistochemistry. We report a series of 36 anogenital biopsies from a group of 16 documented HIV-positive patients; in 20 the HIV serostatus was unknown. There were ten KS (five in HIV-positive patients), and 26 non-KS (11 in HIV-positive subjects) lesions. In the era of HIV/AIDS, anogenital lesions may be the first manifestation of KS in immunocompromised individuals and should be biopsied. The histological diagnosis should be confirmed by HHV-8 immunohistochemistry.

Effect of Aging and Human Immunodeficiency Virus Infection on Cognitive Abilities

To explore the combined effects of aging and human immunodeficiency virus (HIV) infection on cognitive decay. Cross-sectional, single-cohort study. Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy. One hundred fifty-three asymptomatic HIV-positive (HIV+) outpatients (20% aged ≥ 60) and an age- and education-matched control population of 39 HIV-negative individuals. A neuropsychological investigation was conducted to compare four groups of participants classified on the basis of HIV serostatus and age (<60 vs ≥ 60). The effects of age and HIV infection on neuropsychological performance were analyzed using a two-by-two factorial analysis of variance. Demographic and clinical variables associated with neuropsychological performance were identified using linear regression analysis in the HIV+ population. HIV infection and aging had significant negative effects on cognitive performance, but no significant interaction was observed between these two factors. Although older HIV+ participants had worse cognitive performance, they showed no distinct cognitive pattern from younger HIV+ participants. Moreover, younger HIV+ participants' performance on memory tasks was qualitatively and quantitatively comparable with that of older HIV- participants, despite the dramatic age difference. Aging and HIV might be additive factors in the expression of cognitive decline. As the HIV+ population ages, routine neuropsychological examinations could help clinicians better understand and manage the expression of cognitive impairment.

Prevalence of Urethral Trichomonas vaginalis in Black and White Men Who Have Sex With Men

To the Editor: Trichomonas vaginalis (TV) is a common nonulcerative sexually transmitted infection (STI) that has been associated with increased acquisition of human immunodeficiency virus (HIV) infection in women.1,2 Nucleic acid amplification testing for TV is more sensitive than traditionally used methods of detection, such as wet preparation or culture, and can facilitate the diagnosis of TV infection in both men and women.3 The prevalence of TV is estimated at 3.1% for US women, with black women being disproportionately affected by TV with a prevalence of 13.3%.4 Prevalence estimates among men are variable and reported between 3% and 17% for men attending STI clinics and as high as 72% for male partners of females diagnosed with vaginal TV.5–8 However, data on racial disparities among men are lacking. The incidence of HIV among black men who have sex with men (MSM) is at least 2 to 3 times that of white MSM, and differences in the prevalence of STIs are thought to contribute to disparities in HIV incidence among black and white MSM.9,10 However, the limited data available suggest that TV is a rare cause of urethral and rectal infection in MSM.8,11,12 Given its potential implications for disparities in HIV transmission among MSM, we assessed TV prevalence among community- recruited black and white MSM in the southeast. The Emory InvolveMENt study is currently enrolling a longitudinal cohort with plans to eventually enroll approximately 1000 MSM. The study is designed to examine individual-, dyadic-, and community-level factors that may explain disparities in HIV and STI incidence between black and white MSM. MSM aged 18 to 39 years, regardless of HIV serostatus, who reported having sex with another male in the previous 3 months and not being in a mutually monogamous relationship were recruited from community-based venues and via the internet in Atlanta, GA, surveyed, and tested for urethral TV as part of a standard battery of STI tests. MSM were not queried for symptoms of STI before testing. The presence of TV in urine specimens was assessed using a real-time polymerase chain reaction test that was developed and validated in our Center for AIDS Research Clinical Virology Core laboratory with sensitivity and specificity of 100% and 99.6%, respectively, and a limit of detection of <0.2 organisms per reaction or 40 copies/mL.13 Between July 2010 and February 2012, a total of 319 black MSM (42.0% HIV positive) and 281 white MSM (14.6% HIV positive) were tested for urethral TV at their first InvolveMENt study visit. No man refused TV testing, and 100% of urine specimens were adequate for analysis. None of the urine specimens from black (exact 95% confidence interval, 0%–0.94%) or white (exact 95% confidence interval, 0%–1.06%) MSM tested positive for urethral TV. Given these results, we have discontinued all TV testing in our study. Our data confirm previous studies that suggested TV is not a common cause of urethral infection in MSM. Furthermore, our data add to existing data by showing that clinically important racial disparities in TV prevalence reported among heterosexuals are likely not present among MSM.8,11,12 Our data are limited in that our study was conducted in 1 geographic area (Atlanta, GA) among community-recruited MSM aged 18 to 39 years and may not be generalizable. For example, older MSM or MSM attending STI clinics may have a higher prevalence of TV infection. In addition, we did not assess men for symptoms of urethritis before testing for TV, and TV prevalence could be higher among MSM with symptomatic urethritis. Nonetheless, our data show that differences in TV prevalence by race are not likely to be an important driver of disparities in HIV transmission among black and white MSM. In addition, the inclusion of routine TV screening in asymptomatic, sexually active MSM for clinical or research purpose is likely to be of very low utility.

Demographic Predictors of HIV Serostatus among HIV Counseling and Testing Clients in Rural Nigeria

Nnewi is a rural Nigerian town with a human immunodeficiency virus (HIV) counseling and testing center which tests about 120 clients/d. The objective of this study is to determine the factors predicting positive HIV status at Nnewi. Review of records was done with age, gender, marital status, and occupation as variables. Logistic regression analysis was used to identify factors linked to a positive HIV test. Overall HIV prevalence was 31.14%. Drivers and married clients had a high risk of being HIV+ (odds ratio [OR], 3.59; 95% confidence interval [CI], 2.17-5.96 and OR, 2.78; 95% CI, 2.42-3.19). Housewives were 2 times more likely to be positive (OR, 2.11; 95% CI, 1.35-3.29). After adjustment, females had 22% higher risk (OR, 1.22; 95% CI, 1.03-1.45) with the highest chance found in married females (OR, 6.70; 95% CI, 4.45-10.09). The study succeeded in panning out an unexpected risk group: married women. Drivers have been known to be a risk group. Preventive methods must be tailored to and acceptable by each risk group.

Human papillomavirus infection in human immunodeficiency virus-positive Taiwanese women incarcerated for illicit drug usage

The number of female injection drug users infected with human immunodeficiency virus (HIV) is increasing in Taiwan. Their human papillomavirus (HPV) infection has not been fully discussed. A cross-sectional study was conducted in a prison for women. Both HIV-positive and HIV-negative women were enrolled voluntarily. All patients answered self-administered questionnaires, had a Pap smear, and underwent linear array HPV genotype tests. A total of 72 female patients infected with HIV and 76 women who were not infected with HIV were enrolled in this cross-sectional study (mean age, 33.4 years). HPV infection was detected in 63.9% of patients infected with HIV and 47.4% of HIV-negative counterparts (p=0.043). Oncogenic HPV was detected in 41.6% of patients infected with HIV and 28.9% of their counterparts (p=0.10). A mean of 2.41 types of HPV were detected in HIV-positive women and 1.53 types were detected in the HIV-negative counterparts (p=0.014). HPV 52 was the most commonly encountered oncogenic type. Only 10.2% of the patients (10.9% of HIV-positive patients) had vaccine-preventable HPV types. Patients with abnormal cytology (81.3%) tended to have oncogenic types of HPV infection. HIV serostatus was the significant factor associated with oncogenic HPV infection (odds ratio=2.583, 95% confidence interval 1.071-6.231, p=0.0347). Drug-using women infected with HIV had significantly higher rates of HPV infections, justifying the aggressive screening for cervical dysplasia.

Do Chinese parents with HIV tell their children the truth? A qualitative preliminary study of parental HIV disclosure in China

With the extended lifespan of people living with human immunodeficiency virus (HIV) due to the advent of antiretroviral therapy, the disclosure of HIV serostatus to their uninfected children is becoming more critical. However, limited data are available regarding parental HIV disclosure to children in China. We explore patterns of parental HIV disclosure and the reasons for disclosure or non-disclosure to children. A preliminary study was conducted using open-ended questions in Guangxi, China in 2011 with 39 parents living with HIV. A majority of participants (77%) had not disclosed their HIV serostatus to their children. Participants who voluntarily disclosed tended to be older and were more likely to disclose to their adult children. Among parents who disclosed, reasons included a need for emotional and financial support, as well as feelings of obligation to their children. Among non-disclosing parents, primary reasons included concerns that children were too young to understand, fear of being stigmatized, and fear of increased psychological burden to children. Few parents with HIV disclosed their HIV status to their children. These data indicate the need for future research to explore disclosure issues in relation to children's age and the implementation of developmentally appropriate interventions and support systems for parents and children affected by HIV in China.

Development of multiplex serological assays to detect oncoviral infections

Serological markers of infection (antibodies or antigens) of viruses that cause cancer are most often detected using ELISA-based methodologies. In many cases, multiple markers of infection must be assessed to determine a final sero-status. Volume requirements and costs of reagents for single analyte ELISAs are high and studies which include multiple viruses can require milliliters of plasma, often not available from archived cohorts. Thus, we sought to develop a Luminex® bead-based customizable panel initially including Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), Epstein-Barr Virus (EBV) and often the concomitant infection, Human Immunodeficiency Virus (HIV) to reduce sample volume requirements, overall cost and increase flexibility. Peptides, antigens and antibodies were sourced from multiple manufacturers and tested for suitability in this platform. Where necessary, suitable reagents were designed and produced in-house. The HCV assay multiplexes four HCV peptides designed to detect antibodies raised to HCV Core (2), HCV NS4, HCV NS5 gene regions. The HBV assay multiplexes a HBV early antigen peptide, a recombinant HBV core protein and either a recombinant HBV surface antigen or an antibody specific for HBV surface antigen to assess HBV infection. The EBV assay multiplexes peptides specific to viral capsid antigen, EBNA-1 and early antigen (Cyto-Barr, Zuidhorn, The Netherlands). HIV-1 assay development is ongoing and the list of antigens to be included in the assay has not been finalized. These assays can be run singly or with any combination (multi-plex) of the above listed targets. Each target has been independently validated using samples of known molecular and serological status to determine specificity (false positive versus false negative) and re-evaluated under multiplex conditions to confirm assay performance. In addition, where possible, samples were assayed on commercial testing platforms as well as our multiplex assay to assess concordance (94-99%). Dependent on the panel selected and the expected antibody titers in a particular population, plasma or serum volumes in the range of 10 µL to 125 µL per subject would be required to determine the HBV, HCV, EBV and/or HIV serostatus of a subject. This assay platform is inherently flexible and the benefits include amenability to expansion to include other oncogenic viruses as well as screening large epidemiological cohorts or smaller subsets of samples in an economical and high throughput manner.

Systemic Shigellosis in South Africa

Systemic disease due to shigellae is associated with human immunodeficiency virus (HIV), malnutrition, and other immunosuppressed states. We examined the clinical and microbiologic characteristics of systemic shigellosis in South Africa, where rates of HIV infection are high. From 2003 to 2009, 429 cases of invasive shigellosis were identified through national laboratory-based surveillance. At selected sites, additional information was captured on HIV serostatus and outcome. Isolates were serotyped and antimicrobial susceptibility testing performed. Most cases of systemic shigellosis were diagnosed on blood culture (408 of 429 cases; 95%). HIV prevalence was 67% (80 of 120 cases), highest in patients aged 5-54 years, and higher among females (55 of 70 cases; 79%) compared with males (25 of 48 cases; 52%; P = .002). HIV-infected people were 4.1 times more likely to die than HIV-uninfected cases (case-fatality ratio, 29 of 78 HIV-infected people [37%] vs 5 of 40 HIV-uninfected people [13%]; P = .008; 95% confidence interval [CI], 1.5-11.8). The commonest serotype was Shigella flexneri 2a (89 of 292 serotypes [30.5%]). Pentavalent resistance occurred in 120 of 292 isolates (41.1%). There was no difference in multidrug resistance between HIV-infected patients (33 of 71 [46%]) and uninfected patients (12 of 33 [36%]; 95% CI, .65--3.55). Systemic shigellosis is associated with HIV-infected patients, primarily in older girls and women, potentially due to the burden of caring for sick children in the home; interventions need to be targeted here. Death rates are higher in HIV-infected versus uninfected individuals.

Prevalence of HBsAg, HCV and HIV Antibodies Among Infertile Couples in Ahvaz, South-West Iran

: Background: Without doubt the problem of infertility is important not just for the individual couple, but in many cases it has a wider effect on human life which may lead to social disorganization if not addressed in the future if not addressed in the future.Objectives: Since the screening of the hepatitis B surface antigen (HBsAg), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) antibodies of infertile couples has not been studied in our area; this study was conducted to determine the prevalence of HBsAg, HCV & HIV antibodies among infertile couples.Patients and Methods: This was a retrospective cross sectional study and its setting was an in vitro fertilization (IVF) ward. The population study included all of the couples (712) admitted to the infertility center of Ahvaz Imam Khomeini Hospital in 2007-2008 (12 month period). Intervention was an analysis of the data containing the patients’ demographic characteristics and included their HBsAg, HCV and HIV serostatus, which were routinely screened during this period. The main outcome measure was the prevalence of HBsAg, HCV and HIV antibodies among the infertile couples referred to the infertility center.Results: The age range of the men and women was 18 to 62 years and 16 to 46 years respectively. 11 (0. 77 %) of the infertile couples, including 6 (0. 8) women and 5 (0. 7%) men were HBsAg positive. 9 (0. 63 %) infertile couples, 6 (0. 8) women and 3 (0. 4%) men were HCV antibody positive. No cases of HIV were observed in this study.Conclusions: Although the frequencies of hepatitis B and C infections found in this study were small, it still seems logical from the statistical analysis to screen for both viruses as well as for HIV, while a future study using a larger sample size of infertile couples is also recommended. Implication for health policy/practice/research/medical education:The present study determined some critical information about the prevalence of HBsAg, HCV & HIV antibodies among infertile couples in southern Iran. Please cite this paper as:Nikbakht R, Saadati N, Firoozian F. Prevalence of HBsAg, HCV and HIV Antibodies Among Infertile Couples in Ahvaz, South-West Iran. Jundishapur J Microbiol. 2012;5(2):393-7. DOI: 10.5812/jjm.2809 Copyright © 2012 Kowsar Corp. All rights reserved.

Multidrug-resistant tuberculosis today

The World Health Organization (WHO) and its partners have long conducted efforts to improve tuberculosis (TB) case surveillance and programme monitoring and evaluation. WHO’s 2011 report on global TB control1 provided the most reliable information ever generated on the burden of disease and death caused by TB and multidrug-resistant TB (i.e. disease marked by in vitro resistance to at least isoniazid and rifampicin), treatment outcomes, financing mechanisms and new TB diagnostics, drugs and vaccines. The Global Project on Anti-tuberculosis Drug Resistance Surveillance, launched in 1994, has generated reliable drug resistance estimates for 127 countries based on representative studies that followed standard methods and separately looked at resistance among new and retreatment cases.2 The article by Zignol et al. in this issue of the Bulletin3 draws on those estimates to portray the best of current knowledge on anti-TB drug resistance, multidrug-resistant TB (MDR-TB) and extensively-drug-resistant TB (XDR-TB) (i.e. MDR-TB disease marked by additional in vitro resistance to at least one fluoroquinolone and one injectable drug). Zignol et al.’s report confirms that a belt of MDR-TB exists in eastern Europe and central Asia, as suggested by a recent study describing record rates of MDR-TB in Minsk, Belarus,4 where about half of all TB cases harbour MDR-TB strains. The finding that many countries in the same area still lack reliable MDR-TB surveillance systems is therefore highly worrisome. Efforts to understand how MDR-TB is evolving in African countries, India and the Russian Federation are also critically important. XDR-TB has been identified wherever it has been studied. In countries reporting nationally representative data, 10% of MDR-TB cases are extensively drug-resistant. The availability of good data for multiple years from 51 countries has finally made it possible to study trends in anti-TB drug resistance and to objectively examine why MDR-TB is increasing in some parts of the world and decreasing in others. We must now explore the determinants of these trends, learn from model programmes and delve into poorly understood areas and into the factors that influence how fast MDR-TB is declining in different places – slowly in Russian Federation oblasts, moderately fast in Estonia and Latvia, and fast in the United States of America. Furthermore, Zignol et al.’s suggestion that in the Republic of Korea therapeutic practices within the private sector may explain the increase in MDR-TB raises challenging questions. Finally, Zignol et al.’s report shows that MDR-TB surveillance is improving and is a useful source of data for investigating the basic determinants of MDR-TB. Sex did not emerge as an important determinant, and the long-feared association between MDR-TB and human immunodeficiency virus (HIV) infection was not supported by the study findings. However, the unavailability of data on HIV serostatus for many countries – not surprising since only 34% of the world’s confirmed TB cases are tested for HIV1 – dictates caution in interpreting this finding. It also reminds us of how difficult it is to incorporate HIV testing in TB drug resistance surveys and of how far away we are from fully implementing the 12 activities for collaborative control of TB and HIV infection recommended by WHO.5,6 The mismanagement of non-drug-resistant TB cases, which leads to drug resistance, is a continuing problem everywhere, even in high-income European countries with low TB incidence.7 The resulting growing reservoir of difficult-to-treat cases poses a challenge to national TB programmes and health systems all over the world.8 The number of incurable XDR-TB cases is on the rise in several countries, and properly caring for these cases, and especially for those experiencing treatment failure, is difficult and has obvious logistical, ethical and economic implications.8 Zignol et al.’s lucid report paves the way for targeted public health action in MDR-TB prevention and control. Although new molecular technologies, including line probe assays and Xpert® MTB/RIF, can allow the rapid diagnosis of thousands of MDR-TB cases, not all countries will be ready to treat those cases in compliance with appropriate guidelines. This obviously poses some risk of generating new super-resistant strains. On the positive side, at least two new forthcoming drugs – bedaquiline and delamanid – will reinforce our treatment armamentarium. The data presented by Zignol et al. should prompt us to make every effort to ensure their proper use.

Adolescents Living with HIV: An Indian Profile

Purpose. Although there have been studies on the presence of Human Immunodeficiency Virus (HIV) among the adult and even pediatric population, the adolescent population has been neglected. The main objective of this study was to understand and describe the profile of adolescents accessing the Integrated Counseling and Testing Centre (ICTC) at a tertiary healthcare centre in north India. This was a retrospective analysis of the data collected where, in addition to the analysis of the presence of HIV among the target population, a comparative analysis of HIV-positive and negative individuals was also carried out. Methods. Counselors at the ICTC of All India Institute of Medical Sciences recorded responses of the patients, and pre- and posttest counseling was performed appropriately. Also, HIV testing was performed using rapid tests (EIA) and ELISA. Both pre- and posttest counseling was performed for most of the patients. Also, the data collected from 2005 to May, 2011 was then retrospectively analyzed using various statistical tests, such as, Chi-square test and odds ratios. Results. Out of 979, 84 tested HIV positive. Discrimination at multiple levels was observed.The 10–14 years age group was 0.56 times more likely to be HIV positive than 15–19 year old. HIV serostatus was strongly associated with risk behavior (P = 0.003) with heterosexual transmission being the most common. Conclusion. These findings highlight the profile of adolescents in India and their equation with HIV on demographic and psychosocial levels.

Human Immunodeficiency Virus Seroprevalence among Patients Attending a Sexually Transmitted Disease Clinic in West Bengal, India

Sexually transmitted infections (STIs) such as human immunodeficiency virus (HIV) infection have become a major public health problem globally as well as in India. Prevalence of STIs varies across different high risk groups including the population with sexually transmitted diseases (STDs). Individuals with STDs are at a higher risk of acquisition of HIV through the sexual route than the other routes. The tendency of HIV infection was studied in attendees aged 15-49 years in an STD clinic in West Bengal from 2004 to 2008. Blood samples were collected consecutively from 250 attendees per year (a total of 1,250 samples over 5 years) from an STD clinic during 12 weeks (October-December) every year. HIV sero-status was screened using ELISA, and positive samples were subjected to rapid assay and confirmed by Western blot. Overall HIV seropositivity in STD patients was 1.28% (women, 1.04%; men, 1.48%). Data from 5 consecutive years showed a prominent decline from 2.40% (2004) to 0.0% (2007) and a minor increase (1.6%) in 2008, which was not statistically significant (χ(2) = 4.6, df = 4, P > 0.05). The highest seroprevalence (1.66%) was observed in the 25-29 age group, and the lowest (0.87%) was observed in the 40-44 age group. The overall decreasing tendency of HIV infections signifies the efficiency of current interventions. Focused intervention for the 25-29 age group may help in decreasing HIV infections further.

HIV serostatus disclosure: Experiences and perceptions of people living with HIV/AIDS and their service providers in Gujarat, India

Background:Human immunodeficiency virus (HIV) disclosure offers important benefits to people living with HIV/AIDS. However, fear of discrimination, blame, and disruption of family relationships can make disclosure a difficult decision. Barriers to HIV disclosure are influenced by the particular culture within which the individuals live. Although many studies have assessed such barriers in the U.S., very few studies have explored the factors that facilitate or prevent HIV disclosure in India. Understanding these factors is critical to the refinement, development, and implementation of a counseling intervention to facilitate disclosure.Materials and Methods:To explore these factors, we conducted 30 in-depth interviews in the local language with HIV- positive individuals from the Integrated Counselling and Testing Centre in Gujarat, India, assessing the experiences, perceived barriers, and facilitators to disclosure. To triangulate the findings, we conducted two focus group discussions with HIV medical and non-medical service providers, respectively.Results:Perceived HIV-associated stigma, fear of discrimination, and fear of family breakdown acted as barriers to HIV disclosure. Most people living with HIV/AIDS came to know of their HIV status due to poor physical health, spousal HIV-positive status, or a positive HIV test during pregnancy. Some wives only learned of their husbands’ HIV positive status after their husbands died. The focus group participants confirmed similar findings. Disclosure had serious implications for individuals living with HIV, such as divorce, maltreatment, ostracism, and decisions regarding child bearing.Interpretation and Conclusion:The identified barriers and facilitators in the present study can be used to augment training of HIV service providers working in voluntary counseling and testing centers in India.

Recent enhancement of the immunity in AIDS and other immunocompromised patients by hyperforin an antibiotic from &amp;lt;i&amp;gt;Hypericum perforatum&amp;lt;/i&amp;gt; L. (&amp;lt;i&amp;gt;in vitro&amp;lt;/i&amp;gt; model) part I

Today, Hypericum perforatum L. is probably one of the best-characterized medicinal plants, and hyperforin is its best-characterized constituent. Extracts from H. perforatum are widely used as antidepressants; however, less attention has been given to other properties of hyperforin, such as antitumor, fungicidal, antiviral and antibacterial action, or its possible use as a substance with immunomodulation properties. The present study summarizes results that describe the influence of hyperforin as an immunomodulation agent on phagocytosis and the breakdown of Escherichia coli by human polymorphonuclear neutrophils (PMNs). Hyperforin at 1 - 100 μg/mL concentrations was found to have a major influence on phagocytosis and the breakdown of E. coli by PMNs in vitro. A 100 μg/mL solution of hyperforin increased the uptake of non-opsonized E. coli almost 50-fold, and the uptake of IgG-opsonized E. coli more than threefold; on the other hand, the uptake of serum-opsonized bacteria was reduced to approximately 60% of that of the control. Hyperforin seems to bind to both PMNs and E. coli and acts like an opsonin. The elimination of remnants of IgG-opsonized E. coli from the PMNs was stimulated by hyperforin, while the elimination of remnants from non-op-so nized and serum-opsonized material was unaffected by the drug. Hyperforin exhibited clear immunomodulation ability as a phagocytosisstimulating agent. Hyperforin is probably inactive against human immunodeficiency virus (HIV) and most Gram-negative bacteria. However, it can protect acquired immunodeficiency syndrome (AIDS) patients and other immunocompromised patients by its antibacterial activity against Gram-positive bacteria and by enhancement of phagocytosis of Gram-positive and Gram-negative bacteria; some Gram-negative bacteria, such as Neisseria, are sensitive to hyperforin. Hyperforin has the ability to penetrate the blood-brain barrier (BBB) and blood-testis barrier (BTB) and is a valuable antibacterial agent against meningitis and gonorrhea. These properties of hyperforin are important for an antibiotic with immunomodulation activity in the struggle against the growing mortality in AIDS patients as a result of opportunistic bacteria, as recently shown by Bekondi et al. (2006, Int. J. Infect. Dis. 10, 387-395). It could also help to combat primary and opportunistic pathogens associated with meningitis in adults' relation to HIV serostatus.

Factors Influencing Persistence or Recurrence of Cervical Intraepithelial Neoplasia After Loop Electrosurgical Excision Procedure

The purpose of this study was to determine the predictors of persistent or recurrent cervical intraepithelial neoplasia (CIN) after a loop electrosurgical excision procedure (LEEP) procedure in an urban population of low socioeconomic status. A database was created using information about LEEPs done between October 2004 and December 2008 at John H. Stroger Jr. Hospital, Cook County. This information was then analyzed using χ2 test to determine the predictors of persistent or recurrent CIN. A total of 769 LEEPs were performed during the study period, and 52 were excluded secondary to ineligible entries, index cytology report not recorded, or incorrect medical record numbers. Persistent or recurrent disease was defined as cytology of atypical squamous cells cannot rule out high grade lesion (ASC-H) or worse without a histology, or histology of CIN 1 or worse, at any time after the LEEP was performed. Of our study population, 64.7% had a follow-up cytology or biopsy performed. Of these women, 24.7% had persistent or recurrent disease. The preoperative factors, namely positive human immunodeficiency virus serostatus (p < .0001) and a preoperative endocervical curettage that was positive for neoplasia (p < .0001), and postoperative factors, namely positive margin status (p < .0001) and high-grade pathology on the LEEP specimen (p < .0001), were significantly associated with persistent or recurrent disease. A high-grade preoperative cytology, a high-grade preoperative cervical biopsy, or the type of procedure performed (single specimen or separate endocervical pass) was not significantly associated with persistent or recurrent disease. In our population, adherence with follow-up was poor, and the rate of persistence or recurrence was high. In a limited resource setting such as ours, patients with significant predictors of persistence/recurrence such as human immunodeficiency virus seropositivity, endocervical disease, and high-grade pathology or positive margins on LEEP specimens should be targeted for closer surveillance.

Sexual partner characteristics, serodiscordant/serostatus unknown unprotected anal intercourse and disclosure among human immunodeficiency virus-infected and uninfected black men who have sex with men in New York City.

Black men who have sex with men (MSM) are disproportionately infected with human immunodeficiency virus (HIV) in the United States. This study describes sexual partner characteristics and disclosure of HIV serostatus and evaluates factors associated with sexual risk behaviors during last sex among black MSM. Between 2008 and 2009, 328 black MSM who reported recent unprotected anal intercourse were enrolled in an HIV behavioral intervention study in New York City. Factors associated with serodiscordant/serostatus unknown UAI (defined as having UAI with a partner of different or unknown HIV serostatus) with a male partner during last sex were assessed using logistic regression. A total of 205 HIV-infected and 123 uninfected men were enrolled in this study. Almost all men (91.6%) reported having a black male partner during last sex. About half (47.3%) of men used alcohol and 38.7% used other substances before or during last sex. About two-thirds (68.8%) of participants disclosed their HIV status to their last sex partner, while 57.2% of partners disclosed. In multivariate analysis, meeting a partner on the internet or chat line was associated with serodiscordant/serostatus unknown UAI during last sex among HIV-infected men. The only factor associated with serodiscordant/serostatus unknown UAI during last sex among HIV-uninfected men was the partner being a non-main partner. A significant proportion of black MSM in this study did not disclose their HIV status. Our data highlight the need for more data on dyadic variables and sexual risk behaviors among black MSM, as well as interventions to encourage communication between partners.

Tuberculosis-HIV co-infection among patients admitted at Muhimbili National Hospital in Dar es salaam, Tanzania

Data on the clinical presentations and magnitude of tuberculosis (TB)-human immunodeficiency virus (HIV) co-infection is limited. The objective of this study was to describe the clinical presentation and prevalence of TB-HIV co-infection among patients admitted at Muhimbili National Hospital between August 2008 and July 2009 in Dar es Salaam, Tanzania. Of 387 TB patients included, 117 (30.2%) were in the age group 30-39 years. The overall mean age of patients was 38.1 years (range 8 to 86 years) and 216 (55.8%) were male. Two hundred and five (53%) had pulmonary tuberculosis (PTB), 58 (15%) had extra pulmonary tuberculosis (EPTB) and 124 (32%) had both PTB and EPTB. Common sites of EPTB were pleural cavity 80 (44%), lymph node 31 (17%) and 30 (16.5%) abdomen. Of the 300 TB patients tested for HIV, 175 (58.3%) were HIV-infected and 97 (55.4%) of these were already on antiretroviral therapy (ART) at time of admission. Overall, 104 (26.9%) of the TB patients admitted died. About two thirds of patients who died had PTB. About three quarters (73.1%; N=283) of the patients were discharged home to continue with anti-TB treatment. There was significantly higher proportion of deaths among HIV-infected TB patients (29.1% versus 15.2%) than in the HIV uninfected TB patients (P=0.005). Age was a significant predictor for PTB (OR 0.946, 95% CI 0.917-0.976) while age (OR 1.019, 95% CI 1.002-1.036) and HIV serostatus (OR 2.143, 95% CI 1.313-3.497) were significant risk factors for EPTB. It is concluded that more than half of the patients had PTB and pleural cavity was the most common site of EPTB. TB-HIV co-infected patients had significantly higher mortality than the TB-HIV- uninfected patients. It is recommended to emphasize on the provision of HIV counselling and testing to all TB patients to ensure proper management and timely initiation of ART in TB-HIV co-infected patients in order to improve the outcome and reduce mortality.

Depression, alcohol abuse, and disclosure of HIV serostatus among rural HIV-positive individuals in western Uganda

Depression, alcohol abuse, and disclosure of HIV serostatus among rural HIV-positive individuals in western Uganda E Nakimuli-Mpungu1,2, G Munyaneza3,41Mental Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; 2Department of Psychiatry, Makerere College of Health Sciences, School of Medicine, Kampala, Uganda; 3Butabika School of Psychiatric Clinical Officers, Ministry of Education, Kampala, Uganda; 4Rushere Community Hospital, Rushere, UgandaIntroduction: Research into psychological factors associated with disclosure of human immunodeficiency virus (HIV) serostatus in low resource settings is limited. The primary aim of this study was to determine the relationship between depression, alcohol abuse, and disclosure of HIV serostatus to social networks.Methods: We performed a cross-sectional study in which 244 HIV-positive individuals were examined for disclosure of HIV-positive serostatus and assessed for DSM-IV (Diagnostic Statistical Manual, fourth edition)-defined major depression and alcohol abuse disorder. Multiple regression models were used to determine factors independently associated with major depression, alcohol abuse, and disclosure of HIV serostatus.Results: Of the 244 study participants, the majority 210 (86%) had disclosed their HIV serostatus. Among those who disclosed their HIV serostatus, 48 (23%) regretted this disclosure. The majority (40%) met DSM-IV criteria for depression, while (7.8%) met DSM-IV criteria for alcohol abuse. Disclosure was protective against alcohol abuse (odds ratio [OR] = 0.21; P = 0.016) but not depression (OR = 0.68; P = 0.38); and was associated with time since HIV diagnosis (OR = 1.39; P = 0.007) and HIV pretest counseling (OR = 3.9; P = 0.045).Conclusion: Disclosure of HIV serostatus was protective against alcohol abuse but not depression, while regret of disclosure was significantly associated with depression.Keywords: alcohol abuse, HIVstatus, depression, disclosure

Opt-out provider-initiated HIV testing and counselling in primary care outpatient clinics in Zambia

To increase case-finding of infection with human immunodeficiency virus (HIV) in Zambia and their referral to HIV care and treatment by supplementing existing client-initiated voluntary counselling and testing (VCT), the dominant mode of HIV testing in the country. Lay counsellors offered provider-initiated HIV testing and counselling (PITC) to all outpatients who attended primary clinics and did not know their HIV serostatus. Data on counselling and testing were collected in registers. Outcomes of interest included HIV testing coverage, the acceptability of testing, the proportion testing HIV-positive (HIV+), the proportion enrolling in HIV care and treatment and the time between testing and enrolment. After the addition of PITC to VCT, the number tested for HIV infection in the nine clinics was twice the number undergoing VCT alone. Over 30 months, 44,420 patients were counselled under PITC and 31,197 patients, 44% of them men, accepted testing. Of those tested, 21% (6572) were HIV+; 38% of these HIV+ patients (2515) enrolled in HIV care and treatment. The median time between testing and enrolment was 6 days. The acceptability of testing rose over time. The introduction of routine PITC using lay counsellors into health-care clinics in Lusaka, Zambia, dramatically increased the uptake and acceptability of HIV testing. Moreover, PITC was incorporated rapidly into primary care outpatient departments. Maximizing the number of patients who proceed to HIV care and treatment remains a challenge and warrants further research.