Human Immunodeficiency Virus Treatment Centers Research Articles

Perceived barriers and opportunities for implementing an integrated psychological intervention for depression in adolescents living with HIV in Tanzania

BackgroundAdolescents living with Human Immunodeficiency Virus (HIV) have an increased risk of depression, negatively affecting their adherence to antiretroviral therapy (ART) and treatment outcomes. Integrating mental health care in HIV care and treatment settings improves comprehensive care. However, integration remains challenging in Tanzania, like in other high-burden and low-resource settings. The overall objective of this work is to inform the development of a psychological intervention for depression in adolescents living with HIV (ALWHIV). We describe perceived barriers and opportunities for implementing an integrated, evidence-based psychological intervention to manage adolescent depression in HIV care and treatment centers (HIV-CTC) from the perspectives of adolescents, caregivers, and healthcare providers (HCPs) in Dar es Salaam, Tanzania.MethodsTo inform intervention development and implementation, this study utilized a qualitative design through a phenomenological approach informed by the Consolidated Framework for Implementation Research (CFIR) to explore implementation barriers and facilitators in ALWHIV, HCPs, and caregivers. Forty-five in-depth interviews were conducted in three HIV-CTCs in Kinondoni Dar es Salaam. Audio records were transcribed verbatim and analyzed deductively through NVIVO software.ResultsBarriers to implementing an integrated psychological intervention to address depression in ALWHIV included (A) poor mental health awareness among caregivers, adolescents, HCPs, and policy-makers, (B) high level of stigma against mental health care, (C) poor communication between adolescents and HCPs concerning mental health care, (D) lack of contextualized intervention of proven effectiveness and guidelines of mental health care, and (E) inadequate mental health care supportive supervision and mentorship. Facilitators for implementation included supportive infrastructure, positive pressure from HIV implementing partners, tension for change, and participant’s perception of the advantage of a psychological intervention as compared to just usual HIV care and treatment counseling.ConclusionDespite several modifiable barriers to implementing a psychological intervention in HIV CTC, there were encouraging facilitators and opportunities for implementing an integrated, evidence-based psychological intervention to address depression in ALWHIV in Kinondoni Dar es Salaam, Tanzania.

Prevalence of Malnutrition and Associated Factors among HIV Seropositive Adults on Antiretroviral Therapy at the Regional Hospital, Buea, Cameroon

Introduction: Malnutrition refers to deficiencies, excesses, or imbalances in a person’s intake of energy and/or nutrients and HIV which infects CD4 cells causes immune suppression which can further be worsened by poor nutrition. More than 37.7 million people are living with HIV in the world out of which about 36 million are adults. Aims: The study aimed to determine the prevalence of malnutrition and associated factors among human immunodeficiency virus (HIV) seropositive adults on antiretroviral therapy at the HIV care and treatment center of the Buea Regional hospital, Cameroon. Study Design: A Hospital-based Cross sectional study design. Place and duration of study: Buea regional hospital at the HIV care and treatment centre, South West Region of Cameroon between April 2022 to June 2022. Materials and method: We included 139 HIV seropositive individuals (17 men, 177 women age range 26 to 59 years). Nutritional status was assessed using anthropometric and clinical methods. A 24-hour dietary diversity was assessed using a questionnaire. Data was analyzed using SPSS version 25.0. Results: The prevalence of underweight, overweight and obesity among the participants were 1.4 %, 38.8%, and 24.4% respectively. In the bivariate analysis, sex of the participants (χ2 = 4.715, p = 0.030) and attendance to HIV-related counseling sessions (χ2 = 4.512, p = 0.034) were significantly associated with malnutrition. The mean dietary diversity score of the study respondents was 4.97±1.6 with only 37% of the respondents achieving a minimum dietary diversity. In the multivariate logistic regression analysis, the odds of those who received HIV-related counselling being malnourished(overweight) was 3.29 times more than those who did not receive HIV-related counselling (AOR=3.29, p=0.036). Conclusions: There is a high burden of overweight and obesity in the HIV population of the Regional Hospital Buea. The only factor independently associated to malnutrition(overweight) was uptake of nutrition related counselling. Majority of the HIV seropositive patients in the Regional Hospital Buea had a poor dietary diversity. Nutritional counseling should be an important part of persons living with HIV/AIDS (PLWHA) routine follow-up.

Outcome and barriers to cervical cancer screening amongst human immunodeficiency virus-positive women attending Aminu Kano Teaching Hospital, Kano State, Nigeria

Sub-Saharan Africa carries the overwhelming share of the global burden of human immunodeficiency virus (HIV) infection and of HIV-associated cervical cancer. Screening is an effective strategy for the prevention, early diagnosis and prompt management of cervical precancerous lesions among HIV-positive women. This study assessed the outcome and barriers to cervical cancer screening among HIV-positive women attending Aminu Kano Teaching Hospital, Kano. Using a cross sectional study design, a pro forma was used to collect data and screen 740 HIV-positive women. Screening was done using visual inspection with acetic acid and Lugol’s iodine and the data were analysed using SPSS version 24.0. The age of the patients ranged from 25 to 49 years with a mean age of 30.7 ± 2.4 years. Majority (n=698; 94.3%) were  30 years and married (n=592; 80.0%). Almost half (n=362; 48.9%) had secondary level of education and many (n=520; 70.3%) were unemployed. A few (n=42; 5.7%) had positive results on visual inspection with acetic acid and a lesser proportion (n=26; 3.5%) had positive screening results on visual inspection with Lugol’s iodine. Lack of awareness of screening services for cervical cancer was found to be a barrier to cervical cancer screening and treatment among two-thirds (n=565; 76.4%) of the patients while a substantial proportion (n=592; 80.0%) reported that their personal belief which was strengthened by their religion prevented them from accessing cervical cancer screening services. Also, two-thirds (n=493; 66.6%) agreed that their culture which considers cervical screening a taboo was a barrier to screening. There is a need for targeted and enhanced education with counselling to optimize the uptake of screening for cervical cancer among HIV-positive women in HIV treatment centers. The generated data can guide in the provision of evidence-based policy and decision-making.

Incident Kaposi sarcoma during the expansion of antiretroviral therapy eligibility in Nigeria: a retrospective cohort study

IntroductionThe expansion of antiretroviral therapy (ART) eligibility could lead to earlier initiation of Human Immunodeficiency Virus (HIV) treatment and consequently reduce the risk of HIV-associated Kaposi Sarcoma (KS). We investigated the impact of changes in the Nigerian HIV treatment guidelines on KS incidence among adults enrolled in HIV care in Nigeria.MethodsWe analyzed data of adults who enrolled for HIV care from January 2006 to December 2016 at one of Nigeria’s largest HIV treatment centers. Based on changes in HIV treatment guidelines, we classified 2006–2009 as the pre-expansion period and 2010–2016 as the post-expansion period. We used Kaplan Meier curves to compare the incidence of KS in the pre-expansion to the post-expansion period. We used Cox regression models to assess the hazard for incident KS between the two periods after adjusting for potential confounders.ResultsAmong 14,479 patients with HIV, the overall KS incidence was 2.35; 95% CI 2.01–2.74/1,000 person-years. The incidence of KS decreased from 2.53 to 1.58 per 1,000 person-years from 2006 to 2009 to 2010–2016. In models adjusting for age, sex, CD4-T cell count, and ART use, the risk for KS remained lower in 2010–2016 compared to 2006–2009. In analyses restricted to time on ART, there was no significant difference in KS incidence between HIV patients who enrolled in 2006–2009 and 2010–2016 after adjusting for age, sex, and CD4 T-cell count.ConclusionThe expansion of ART eligibility was associated with a reduced incidence of HIV-associated KS among adults initiating HIV care in Jos, Nigeria. The reduction was likely driven by earlier enrollment for HIV care and ART initiation.

HIV Replication Increases the Mitochondrial DNA Content of Plasma Extracellular Vesicles.

Extracellular vesicles (EVs) and their cargo have been studied intensively as potential sources of biomarkers in HIV infection; however, their DNA content, particularly the mitochondrial portion (mtDNA), remains largely unexplored. It is well known that human immunodeficiency virus (HIV) infection and prolonged antiretroviral therapy (ART) lead to mitochondrial dysfunction and reduced mtDNA copy in cells and tissues. Moreover, mtDNA is a well-known damage-associated molecular pattern molecule that could potentially contribute to increased immune activation, oxidative stress, and inflammatory response. We investigated the mtDNA content of large and small plasma EVs in persons living with HIV (PLWH) and its implications for viral replication, ART use, and immune status. Venous blood was collected from 196 PLWH, ART-treated or ART-naïve (66 with ongoing viral replication, ≥20 copies/mL), and from 53 HIV-negative persons, all recruited at five HIV testing or treatment centers in Burkina Faso. Large and small plasma EVs were purified and counted, and mtDNA level was measured by RT-qPCR. Regardless of HIV status, mtDNA was more abundant in large than small EVs. It was more abundant in EVs of viremic than aviremic and control participants and tended to be more abundant in participants treated with Tenofovir compared with Zidovudine. When ART treatment was longer than six months and viremia was undetectable, no variation in EV mtDNA content versus CD4 and CD8 count or CD4/CD8 ratio was observed. However, mtDNA in large and small EVs decreased with years of HIV infection and ART. Our results highlight the impact of viral replication and ART on large and small EVs' mtDNA content. The mechanisms underlying the differential incorporation of mtDNA into EVs and their effects on the surrounding cells warrant further investigation.

Barriers to timely disclosure of HIV serostatus: A qualitative study at care and treatment centers in Dar es Salaam, Tanzania

Disclosure of Human Immunodeficiency Virus (HIV) status is important to prevent the spread of HIV and maintain the health of people living with HIV, their spouses, and the community. Despite the benefits of disclosure, many people living with HIV delay disclosing their status to those close to them thereby increasing the risk for disease transmission. This study aimed to determine the barriers to timely disclosure of HIV serostatus for people living with HIV in Dar es Salaam, Tanzania, and identify what motivated disclosure. A qualitative descriptive study using in-depth individual interviews was conducted with10 participants attending HIV care and treatment centers in Dar es Salaam. The participants were people living with HIV who had delayed disclosing their serostatus for more than one month after diagnosis. Data was analyzed using qualitative content analysis. Three categories emerged from the analysis: Barriers hindering timely disclosure, motivation for disclosure of serostatus, and consequences of delayed disclosure. Barriers to timely disclosure included denial of one's status, the fear of stigmatization, fear of being separated or divorced, the need to protect loved ones, and lack of adequate knowledge about the disease. Reasons that motivated disclosure included gaining social support, preventing disease transmission and wanting to be at peace. Timely disclosure is hindered by stigma because HIV is negatively perceived by the public. People living with HIV prefer not to disclose to avoid the negative consequences of disclosure, especially because of fear of being discriminated against and losing their social status, which plays a major role in social status in Tanzania. Trust and adequate counseling from health care workers helps prompt disclosure.

PIN80 Understanding Real-World Utilization of Pre-Exposure Prophylaxis (PrEP): Data from Trio Health HIV Research Network

In February 2019, the US Department of Health and Human Services proposed a strategic initiative to end human immunodeficiency virus (HIV) epidemic in the US by reducing new HIV infections by 90% in 2020–2030. One of the 4 pillars of the initiative is protecting persons at risk for HIV infection using HIV PrEP (antiretrovirals proven effective at preventing infection among persons at risk). We investigated PrEP uptake, adherence, and discontinuation among patients in care at 11 large geographically distributed US HIV treatment centers. Trio Health HIV Research Network containing electronic medical records for over 130,000 HIV and non-HIV patients was used for the study. PrEP patient registry contains nearly 9,000 patients with PrEP prescriptions and over 5,000 with PrEP dispenses. Of 5,223 adults with PrEP dispensing data, 66% were male, 4% female, <1% transgender, and 30% unspecified gender; 59% were white, 12% black, 10% other race, 19% unknown; 86% were age <50 at PrEP initiation. Emtricitabine/tenofovir disoproxil fumarate (FTC/TDF) was dispensed to 81% of patients, FTC/tenofovir alafenamide (TAF) to 47%. Average PrEP duration was 10.2 mo (SD 9.9): 12 mo (11.6) FTC/TDF, 7.2 mo (4.4) FTC/TAF. Average medication possession ratio was 88%: 87% for FTC/TDF, 93% for FTC/TAF. Trio Health HIV Research Network is dynamic data collection that provides insight into patterns of PrEP prescribing and dispensing, patient experience and adherence, longitudinal changes in comorbidities and laboratory values, frequency and time to seroconversion. Continued collection and analyses of patient data will broaden PrEP awareness and optimize patient outcomes.

Prevalence of Vitamin B12deficiency in antiretroviral therapy naïve adults with human immunodeficiency virus infection in a human immunodeficiency virus treatment center in Lagos, Nigeria

Background: Vitamin B12 deficiency is reportedly higher in human immunodeficiency virus (HIV) infection, according to reports from developed countries and is associated with worsening anemia, progressing immunodeficiency (reduced CD4 count), and reduced survival rates. The status in Nigerians with HIV has not been extensively studied. The objective of the study was to determine the frequency and correlates of Vitamin B12 deficiency in HIV-positive antiretroviral therapy (ART) naive patients attending an outpatient HIV clinic in Lagos, Nigeria. Specifically, the study compared HIV-positive ART-naïve patients to age- and gender-matched HIV-negative controls and determined the relationship between B12 status and HIV disease severity (CD4 count) and hemoglobin (Hb). Methodology: The study was a descriptive study of the prevalence of Vitamin B12 deficiency and its correlation with disease severity in HAART-naïve newly diagnosed HIV infection. Seventy-five ART naïve, HIV-positive patients and 75 controls fulfilling the study criteria were included. Baseline hematologic (Hb, white blood cell, platelets, and CD4 count) and Vitamin B12 levels were measured. Vitamin B12 levels were measured using urine methylmalonic acid (MMA) on spot urine normalized for urine creatinine. B12 deficiency was defined as urine MMA >3.6 mmol/mol urinary creatinine. CD4 count (cells/μL) was categorized as <200, 200–499, and >500. Results: The frequency of B12 deficiency was 29.3% (22/75) in HIV-positive cases and 0% (0/75) in controls (P < 0.001). There was no difference in the frequency of anemia in HIV cases with or without B12 deficiency (54.5% vs. 58.5%; P = 0.75). There was no significant difference in the proportions of HIV cases with or without B12 deficiency in the CD4 categories 1 (>500), 2 (200-499) and 3 (<200), (1: 31.8% vs. 24.5%; 2: 40.9% vs. 50.9%; 3: 27.5% vs. 24.5%, respectively; P = 0.71). Neither severity of HIV infection nor Hb levels was found to be associated with B12 status (P > 0.05). Conclusion: Vitamin B12 deficiency was more prevalent in HIV-positive ART naïve cases compared to age- and gender-matched HIV-negative controls. However, the presence of B12 deficiency was not associated with anemia or the severity of HIV infection in this study.

Effects of exercise training on bone mineral density and some health-related outcomes in HIV conditions: A randomized controlled trial.

Introduction:Human Immunodeficiency Virus (HIV) infection remains prevalent co-morbidity, and among fracture patients. Few studies have investigated the role of exercise interventions in preventing bone demineralization in people who have fractures and HIV. If exercise exposed, HIV-infected individuals may experience improved bone health outcomes (BMD), function, quality of life (QoL). The study will aim to assess the impact of home based exercises on bone mineral density, functional capacity, QoL, and some serological markers of health in HIV infection among Nigerians and South Africans.Methods and design:The study is an assessor-blinded randomized controlled trial. Patients managed with internal and external fixation for femoral shaft fracture at the study sites will be recruited to participate in the study. The participants will be recruited 2 weeks post-discharge at the follow-up clinic with the orthopaedic surgeon. The study population will consist of all persons with femoral fracture and HIV-positive and negative (HIV-positive medically confirmed) aged 18 to 60 years attending the above-named health facilities. For the HIV-positive participants, a documented positive HIV result, as well as a history of being followed-up at the HIV treatment and care center. A developed home based exercise programme will be implemented in the experimental group while the control group continues with the usual rehabilitation programme. The primary outcome measures will be function, gait, bone mineral density, physical activity, and QoL.Discussion:The proposed trial will compare the effect of a home-based physical exercise-training programme in the management of femoral fracture to the usual physiotherapy management programmes with specific outcomes of bone mineral density, function, and inflammatory markers.Trial registration:The study was prospectively registered with the Pan African Clinical Trials Registry (Reference number – PACTR201910562118957) on October 21, 2019. (https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=9425).

PP289 Impact Of Regional Human Immunodeficiency Virus Therapeutic Pathway On Prescriptions: The Experience Of The Lazio Region In Italy

IntroductionIn 2017, the Lazio Region (Italy) published a care and therapeutic pathway (Percorso Diagnostico Terapeutico Assistenziale [PDTA]) to guide the choice of treatments for human immunodeficiency virus (HIV) patients. Recommendations were based on clinical and economic criteria to guarantee the most appropriate care and sustainability of the regional National Health Service. Our pilot study was conducted to assess how the PDTA impacts clinical decisions and expenditure. Organizational and economic analyses were based on four HIV treatment centers at the regional level.MethodsAn ad hoc data collection was conducted. Each center provided data on the volume of prescriptions for each treatment option for the first semester of 2017 and 2018. The period January-June 2017 (H1-2017) represents the scenario pre-PDTA, while January-June 2018 (H1-2018) provides evidence on the first impact of the PDTA. Expenditure was estimated considering prices reported in the PDTA document. For each center, a semi-structured survey collected evidence on which factors influence treatment decisions.ResultsBetween H1-2017 and H1-2018 the number of experienced patients increased 10.1 percent (6,580 versus 7,249, respectively), while that of naive patients decreased 3 percent (227 versus 220). More than 80 percent of naive patients were treated with regimes recommended by the PDTA versus 36 percent in H1-2017 and 62 percent in H1-2018 of experienced patients. Regimes with a monthly cost &gt; EUR 700 were preferred. The survey showed that the PDTA is a useful tool for supporting clinical decisions.ConclusionsOur pilot study provides a snapshot on the impact of a regional HIV PDTA and identifies key aspects for its future update. Personalization of HIV therapies for an aging (5–29% of patients were &gt;65 years in the four centers) and complex (&gt;65% of patients had at least one comorbidity) population should be discussed for a PDTA update. Posology and treatment adherence should be further investigated.

Knowledge, Attitude and Utilization of HIV Post-Exposure Prophylaxis among Health Care Workers at HIV Treatment Centers in Port-Harcourt Metropolis

Background: Human Immunodeficiency Virus (HIV) is one of the world's top causes of death. New HIV infections emerge every day, leading HIV patients to seek care at health facilities and prompting health care professionals to undertake risky invasive procedures. And notwithstanding the mediation of science, this poses a risk of occupational exposure among health care workers (HCWs), hence the need for the effective use of HIV post-exposure prophylaxis (PEP). The aim of this study was to assess the knowledge, attitude and utilization of PEP among health care workers at HIV treatment centers in Port-Harcourt metropolis.&#x0D; Methodology: This descriptive cross-sectional study utilized a pre-tested, structured, self-administered questionnaire on a sample of 204 HCWs chosen by multi-stage sampling method. Data were analyzed and presented using descriptive and analytical statistics.&#x0D; Results: The study revealed that 39.7% of the respondents had good knowledge of HIV PEP and 96.5% had good attitude towards HIV PEP. Additionally, 22.1% had previously encountered possible occupational exposure to HIV, and only 45.5% of them took PEP. This translates to an overall PEP use of 10.1%. Significant associations were observed between knowledge and attitude towards PEP (p=&lt;0.001), source of information and knowledge (p=&lt;0.001), and source of information and attitude (p=0.02). The study also showed that sex, marital status and designation was associated with utilization of PEP (p=0.01; p=0.04; p=0.02).&#x0D; Conclusion: The study revealed low utilization of PEP despite the level of good and fair knowledge and a generally positive attitude towards PEP. There exists a gap between knowledge and utilization of PEP, hence the need for periodical retraining of HCWs. This should be supplemented by ensuring the consistent availability and accessibility of PEP at treatment centers.

Epidemiology of Opportunistic Infections in HIV Infected Patients on Treatment in Accredited HIV Treatment Centers in Cameroon.

Background:The African continent accounts for over 70% of people infected with Human Immunodeficiency Virus (HIV). The HIV sero-prevalence rate in Africa is estimated at 4.3%. In developed countries, such as France, pneumocystis is indicative of AIDS in 30% of patients; however, in Africa, pulmonary tuberculosis (TB) is the most-documented opportunistic infection (OI) and the leading cause of death in HIV-infected patients. In 2016, Cameroon had 32,000 new cases of OI and 29,000 deaths as a result of these infections. However, there is little existing data on the epidemiological profile of OIs in Cameroon, which is why we conducted this study in accredited HIV treatment centers and care/treatment units in the two cities of Douala and Yaounde, Cameroon.Methods:This was a retrospective descriptive and analytical study carried out in 12 accredited HIV treatment centers in the cities of Yaoundé and Douala, Cameroon, over a period of seven months from October 2017 to April 2018. A stratified sampling method was used with three sampling levels: the city, type of health facility and size of active files. Ethical clearance and administrative authorization were obtained from the appropriate authorities and data were collected using a pre-tested survey form. The data collected was entered and analyzed using Epi Info version 3.5.4.Results:Out of a total of 1,617 HIV-infected patients sampled, 419 (25.9%) had at least one OI. Of these patients with an OI, 246 or 65% had a baseline CD4 count of <200/mm3. There was a significant relationship between the male gender and the onset of OI (OR = 1.47; p = 0.01). Age ≥ 50 years was associated with the occurrence of OI (OR = 2.57; p = 0.01). A CD4 count of <200/mm3 was also associated with the risk of developing an OI (OR = 3.12; p = <0.01).Conclusion and Global Health Implications:The prevalence of OI is high among people living with HIV (25.9%). Shingles was the most common OI found followed by pulmonary tuberculosis. Male gender, age ≥ 50 years, and CD4 <200/mm3 were the most common factors associated with the occurrence of these OI. These findings suggest that public health interventions for reducing HIV related co-morbidities (and implicitly mortality) should especially target the male gender for greater impact in addition to other measures.

Issues Surrounding HIV Status Disclosure: Experiences of Seropositive Women in Lagos, Nigeria.

Background:Disclosure of human immunodeficiency virus (HIV) seropositivity by infected women is crucial in HIV control. To determine the rates, patterns, effects, and determinants of disclosure of status among HIV-positive women in Lagos, Nigeria.Methods:This was a descriptive cross-sectional study. Simple random sampling method was used to select 364 HIV-positive women accessing care in HIV treatment centers in Lagos Island. Data were collected using interviewer-administered questionnaires and analyzed with Epi Info (version 3.5.3). Inferential statistics done was Chi-square test and level of statistical significance was set at <5%.Results:Mean age of respondents was 37.3 ± 3 years, and most were married or cohabiting in monogamous families. The disclosure rates were 81.9% to anyone (excluding a health care professional); 60.4% to spouse/sexual partners; and 67.7% disclosed on the same day of diagnosis. Main reasons for disclosure were failing health (49.3%) and a sense of responsibility to the spouse/sexual partner (33.6%). Major reasons for nondisclosure were negative public opinion (84.8%) and fear of losing relationships (40.3%). Positive reactions following disclosure were mostly acceptance: 75.2% (family member) and 72.3% (spouse/sexual partner) while blame was the main negative outcome. Longer duration of diagnosis significantly improved disclosure to anyone (P < 0.001). Older age (P < 0.001) and awareness of spouse/sexual partner's HIV status (P < 0.001) significantly improved disclosure to spouse/sexual partner.Conclusions:Many respondents had not disclosed their status and require support and counseling to do so. Community education regarding stigmatization should be intensified.

Pakistan needs to speed up its human immunodeficiency virus control strategy to achieve targets in fast-track acquired immune deficiency syndrome response.

In last fifteen years remarkable success in the fight against human immunodeficiency virus (HIV) is achieved globally. The number of HIV infections has decreased and the number of people on antiretroviral therapy is increased. This all is possible by strong political commitments and heavy investments in the fight against HIV. Pakistan is among few Asian countries in which HIV cases are increasing year by year since 1990. There are 94000 cases of HIV in Pakistan and only 14000 are registered with government. The main source of HIV infection in Pakistan is the use of contaminated injection equipment among people who inject drugs (PWID). The overall prevalence of HIV among PWID in Pakistan is 27.2%. There are five cities in Pakistan in which HIV prevalence is above 40% in PWIDs. In June 2016, United Nations political declaration on acquired immune deficiency syndrome (AIDS) provided a global mandate to fast-track the AIDS response over the next five years to achieve the targets in Sustainable Development Goals. To achieve the targets in fast-track AIDS response, the global leaders showed strong commitments to invest $ 26 billion per year by 2020. Pakistan needs to speed up its HIV control program. There is a dire need to locate all HIV positive people and enroll them in the treatment program. Pakistan also needs to calculate exact number of people living with HIV, increase HIV treatment centers and increase HIV awareness. Recently, Global Fund invested handsome money in the fight against HIV. Let’s hope the country will have effective HIV control strategy to achieve the HIV elimination target by 2030.

Comparative analysis of some hematological and immunological parameters of HIV-positive patients at a tertiary HIV treatment center in Zaria, Nigeria

Background: Human immunodeficiency virus (HIV) infection is a major public health problem in sub-Saharan Africa. In addition to immunological complications of the disease, hematological abnormalities have been documented as strong independent predictors of morbidity and mortality in HIV-infected individuals. Objectives: To determine the effect of antiretroviral therapy (ART) on hematological and immunological parameters in HIV-positive patients. Materials and Methods: This was a retrospective cross-sectional analytic study involving 90 HIV-positive treatment naive patients aged 18 years and above attending a tertiary hospital over a 6-month period. Frequencies, proportions, and paired t test were performed using SPSS version 20.0 and the level of significance was set at ≤0.05. Results: The mean (±SD) age of the study participants was 35.6 ± 9.65 years with females comprising of 56 (62%). The mean (±SD) values of the hematological parameters (at baseline and 6 months after initiation of ART) were: hemoglobin concentration [10.9 ± 1.95 vs 11.8 ± 1.83 g/dL, 95% Confidence Interval (CI); −1.1938, −0.5218, P value Conclusion: Anemia, neutropenia, and immunosuppression were the predominant findings in this study at recruitment. However, an improvement of these parameters was observed 6 months after commencement of ART among the HIV-positive treatment naive patients. This showed that ART has improved both the hematological and immunological parameters in HIV-positive treatment-naive patients.

Incidence and Risk Factors for Venous Thrombosis in Human Immunodeficiency Virus (HIV) Infection, Data from the Dutch Athena Cohort Study

Incidence and Risk Factors for Venous Thrombosis in Human Immunodeficiency Virus (HIV) Infection, Data from the Dutch Athena Cohort Study

Virological and Social Outcomes of HIV-Infected Adolescents and Young Adults in The Netherlands Before and After Transition to Adult Care.

As a result of effective combination antiretroviral therapy (cART) and advanced supportive healthcare, a growing number of human immunodeficiency virus (HIV)-infected children survive into adulthood. The period of transition to adult care is often associated with impaired adherence to treatment and discontinuity of care. We aimed to evaluate virological and social outcomes of HIV-infected adolescents and young adults (AYAs) before and after transition, and explore which factors are associated with virological failure. We included 59 HIV-infected AYAs from the Netherlands who had entered into pediatric care and transitioned from pediatric to adult healthcare. We used HIV RNA load and cART data from the Dutch Stichting HIV Monitoring database (1996-2014), and collected social and treatment data from patients' medical records from all Dutch pediatric HIV treatment centers and 14 Dutch adult treatment centers involved. We evaluated risk factors for virological failure (VF) in a logistic regression model adjusted for repeated measurements. HIV VF occurred frequently during the study period (14%-36%). During the transition period (from 18 to 19 years of age) there was a significant increase in VF compared with the reference group of children aged 12-13 years (odds ratio, 4.26 [95% confidence interval, 1.12-16.28]; P = .03). Characteristics significantly associated with VF were low educational attainment and lack of autonomy regarding medication adherence at transition. HIV-infected AYAs are vulnerable to VF, especially during the transition period. Identification of HIV-infected adolescents at high risk for VF might help to improve treatment success in this group.

Willingness and acceptability of cervical cancer screening among women living with HIV/AIDS in Addis Ababa, Ethiopia: a cross sectional study

BackgroundIn Ethiopia, cervical cancer (CC) ranks the 2nd most frequent cancer and the country had 27.19 million women at risk of developing the disease though only 0.6 % women age 18-69 years was screened every 3 years. Nearly a quarter (22.1 %) of southern Ethiopia HIV (Human Immunodeficiency Virus) infected Women were positive for precancerous cervical cancer. Doing regular screening can prevent the disease by around half (45 %) of the cases in age of 30s and three quarter (75 %) cases in 50s and 60s.In the presence of high risk for acquiring cervical cancer among HIV patients, willingness and acceptance of the screening is low in Addis Ababa, Ethiopia thus the current study was aimed to assess willingness and acceptability of cervical cancer screening and its determinants among women living with HIV/AIDS in Addis Ababa, Ethiopia.MethodA facility based cross sectional study was conducted among HIV positive women attending HIV treatment centers in Addis Ababa. The respondents were identified using systematic random sampling method. Data was collected using pretested questionnaire and were entered in to Epi-info version 3.5.1 software and exported in to SPSS version 20 statistical package for analysis. The criterias for entering independent variables into multivariate analysis were having p-value 0.05 or less at bivariate analysis and not co-linear.ResultOne third (34.2 %) of participants knew cervical cancer and two third (62.7 %) were willing for the test though only a quarter (24.8 %) were accepted the test. The independent variables significantly associated with acceptance of screening were educational level, source of information, awareness for the test and preventability of the disease.ConclusionIn current study willingness and acceptance of CC (cervical cancer) were low thus organizations working on cancer and HIV/AIDS should establish cervical cancer screening program and further enhance awareness creation.

Incidence and risk factors for invasive pneumococcal disease in HIV-infected and non-HIV-infected individuals before and after the introduction of combination antiretroviral therapy: persistent high risk among HIV-infected injecting drug users.

Invasive pneumococcal disease (IPD) is an important cause of morbidity among individuals infected with human immunodeficiency virus (HIV). We described incidence and risk factors for IPD in HIV-infected and uninfected individuals. Nationwide population-based cohort study of HIV-infected adults treated at all Danish HIV treatment centers during 1995-2012. Nineteen population-matched controls per HIV-infected individual were retrieved. The risk of IPD was assessed using Poisson regression. The incidence of IPD was 304.7 cases per 100 000 person-years of follow-up (PYFU) in HIV-infected and 12.8 per 100 000 PYFU in HIV-uninfected individuals. After adjusting for confounders, HIV infection (relative risk [RR], 24.4 [95% confidence interval [CI], 23.7-25.1]), male sex (RR, 1.20 [95% CI, 1.16-1.24]), increasing age (per year) (RR, 1.03 [95% CI, 1.03-1.04]), and calendar period (pre-cART RR, 2.80 [95% CI, 2.70-2.91] compared with late cART) were significantly associated with an increased risk of IPD. Among HIV-infected individuals, male sex (RR, 1.57 [95% CI, 1.49-1.66]), smoking (RR, 1.34 [95% CI, 1.26-1.42]), and injecting drug use (RR, 2.51 [95% CI, 2.26-2.67]) were associated with an increased risk of IPD. Detectable viral loads (RR, 1.88 [95% CI, 1.79-1.98]) and a relative fall in CD4 T-cell counts were also associated with an increased risk (≥500 to 350-500 CD4 T cells/µL: RR, 1.29 [95% CI, 1.21-1.37] and <100 cells/µL: RR, 7.4 [95% CI, 6.87-8.02]). The risk of IPD declined over time, although this was not the case for IDUs where the risk remained unchanged. The incidence of IPD in HIV-infected individuals remained significantly higher than the incidence observed in non-HIV-infected subjects, despite the widespread use of cART. IDUs have a persistently high risk of IPD. Injecting drug use, smoking, and the receipt of cART are suitable targets for preventive measures in the future.

Pharmaceutical care outcomes in an outpatient human immunodeficiency virus treatment center in Jos, Nigeria

Rationale:Pharmacotherapy for patients infected with human immunodeficiency virus (HIV) is complex and increases the potential for drug therapy problems (DTPs). We described the frequency and type of DTPs in a Nigerian cohort of HIV infected patients on antiretroviral therapy (ART), as well as the changes in HIV clinical outcomes after pharmacists’ intervention.Methods:A prospective 1-year descriptive study was conducted from July 2010 to June 2011, at the adult HIV clinic of Jos University Teaching Hospital, Nigeria. DTPs and the associated pharmacist-initiated interventions were documented. Chi-square and Wilcoxon signed ranks test was used as appropriate, to compare the main outcome measures of pre- and post-intervention levels of viral load and CD+ cell count.Results:A total of 64,839 prescriptions were dispensed to 9320 patients. Interventions were documented for 85 unique patients (incidence of 1.31 interventions/1000 prescriptions), of which 62 (73%) and 3 (3.5%) were on first- and second-line ART, respectively, while 20 (23.5%) were yet to commence ART. Reasons for pharmacist intervention included failure to initiate therapy for HIV or hepatitis B infection; therapeutic failure (25.9%); and drug toxicity (24.7%). After intervention, the percentage of patients with HIV ribonucleic acid level <400 copies/mL rose from 29.4% to 67.1% (P < 0.001), while median (interquartile range) CD4+ cell count increased from 200 (123–351) to 361 (221–470) cells/mm3 (P < 0.001).Conclusion:Pharmacist intervention resulted in clinically significant improvements in patients HIV virological and immunological outcomes. This highlights an important role for the pharmacist in the treatment and care of HIV-infected patients, in a multidisciplinary team.