Human Immunodeficiency Virus Life Research Articles

Contemplation of smoking cessation and quit attempts in human immunodeficiency virus–infected and uninfected veterans

ABSTRACTBackground: As antiretroviral treatments prolong life in human immunodeficiency virus (HIV)-infected patients, smoking cessation is now a top priority. However, studies of HIV-infected smokers have not been conducted with uninfected controls. In this study, researchers determined factors associated with contemplating smoking cessation and making a prior quit attempt among HIV-infected and uninfected smoking veterans. Methods: Between 2005 and 2007, 1,027 HIV-infected and 794 uninfected smokers were identified as part of the Veterans Aging Cohort Study (VACS). Stratifying by HIV status, adjusted odds ratios (AORs) were calculated using logistic regression to identify factors associated with contemplating smoking cessation and making a prior quit attempt. Results: Most participants (66 % of HIV-infected vs. 68 % of uninfected; P = .46) were contemplating cessation, and 56 % of both groups (P = .99) had attempted to quit in the last year. In stratified multivariable analyses, HIV-infected smokers with recent pulmonary disease diagnoses were more likely to have made a quit attempt (AOR = 4.93, 95 % confidence interval [CI] = 1.41–17.17). Both HIV-infected and uninfected patients with unhealthy alcohol use were less likely to be contemplating cessation (AOR = 0.66, 95 % CI = 0.49–0.90 and 0.71, 95 % CI = 0.50–1.00). HIV-infected smokers who reported unhealthy alcohol use were also less likely to have made a quit attempt in the last year (AOR = 0.68, 95 % CI = 0.51–0.91). Conclusions: Patient-level interest and motivation are not major barriers to smoking cessation among HIV-infected veterans. Targeting HIV-infected smokers with a recent pulmonary disease diagnosis may improve sustained smoking cessation. Unhealthy alcohol use appears to be a key modifiable risk factor. Smoking cessation rates may be improved by combining interventions for smoking and alcohol use for HIV-infected patients.

Quality of life in HIV/AIDS patients: A cross-sectional study in south India

With developing countries on the wave of a HIV epidemic, issues like quality of life (QOL) have come to fore. We aimed to assess the quality of life in human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) patients at antiretroviral therapy (ART) clinic in a tertiary healthcare centre in South India. The study was conducted on 60 HIV/AIDS patients attending ART clinic at a tertiary health hospital, Chennai, South India. QOL was evaluated using the WHO QOL-BREF (Field trial version) instrument using 26 items grouped under 4 domains, namely physical health, psychological well-being, social relationships, and environment on 60 HIV/AIDS patients. Standard error of the difference between means was employed to find out significant difference between domain scores and clinical categories. QOL scores were highest for environmental domain which is 46.19 (0-100 scale). QOL scores were significantly lower among persons with lower CD4 counts (<i> P </i> < 0.001). Women had lower QOL scores than men despite having less advanced disease. Patients with better educational background had significantly higher psychological domain scores. Also, a supportive family kept environmental domain scores better (<i> P</i> < 0.001). A need for good healthcare support system was perceived. Better education helps the patient to cope with the disease well. Family support is essential for healthier environment.

Diarrhea-associated HIV-1 APIs potentiate muscarinic activation of Cl- secretion by T84 cells via prolongation of cytosolic Ca2+ signaling.

Aspartyl protease inhibitors (APIs) effectively extend the length and quality of life in human immunodeficiency virus (HIV)-infected patients, but dose-limiting side effects such as lipodystrophy, insulin resistance, and diarrhea have limited their clinical utility. Here, we show that the API nelfinavir induces a secretory form of diarrhea in HIV-infected patients. In vitro studies demonstrate that nelfinavir potentiates muscarinic stimulation of Cl(-) secretion by T84 human intestinal cell monolayers through amplification and prolongation of an apical membrane Ca(2+)-dependent Cl(-) conductance. This stimulated ion secretion is associated with increased magnitude and duration of muscarinically induced intracellular Ca(2+) transients via activation of a long-lived, store-operated Ca(2+) entry pathway. The enhanced intracellular Ca(2+) signal is associated with uncoupling of the Cl(-) conductance from downregulatory intracellular mediators generated normally by muscarinic activation. These data show that APIs modulate Ca(2+) signaling in secretory epithelial cells and identify a novel target for treatment of clinically important API side effects.

The impact of anemia on quality of life in human immunodeficiency virus-infected patients.

Anemia is the most commonly encountered hematologic abnormality in human immunodeficiency virus (HIV)-positive patients, occurring with increasing frequency as the disease progresses. Several factors play a role in the development of anemia in patients with HIV, including chronic disease, opportunistic infections, and certain nutritional deficiencies. Despite the high prevalence of anemia in this population, the symptoms of anemia are frequently overlooked, although anemia can significantly affect a patient's ability to carry on even normal activities of daily living. Therefore, approaches--including the treatment of causative infections, discontinuation of certain drugs, or use of recombinant human erythropoietin (epoetin alfa)--aimed at increasing hemoglobin levels to normal or near-normal levels would be expected to improve quality of life (QOL). The purpose of this article is to describe the effects of anemia on QOL and to provide an overview of several studies showing that QOL improves with the alleviation of anemia.

Pain and depression in HIV illness.

The purpose of this study was to examine the relationship among pain and depression, hopelessness, and quality of life in human immunodeficiency virus (HIV)-infected gay men, taking into account the role of HIV symptoms. One hundred sixty-one HIV+ gay men were assessed, with 40 men endorsing HIV-related pain. The HIV+ men with pain had a modal rating of pain within the mild range. They had significantly more advanced disease, more physical and depressive symptoms, and reported less life satisfaction than the men without pain. However, when HIV illness variables are accounted for, the higher depression scores in the men with pain were largely accounted for by somatic rather than cognitive symptoms. While pain is associated with greater physical distress in this cohort of HIV-seropositive gay men, it does not appear to be independently associated with cognitive symptoms of depression. These findings apply to HIV-infected men with mild pain and may not apply to those who experience more severe pain. Nonetheless, these observations highlight the overlap between symptoms of depression and pain and the challenge that clinicians face in assessing patients suffering from pain.

Impact of Human Immunodeficiency Virus on Medical and Surgical Residents

Background.— Previous surveys of resident physicians on human immunodeficiency virus (HIV) matters have tended to focus on urban programs serving a patient population with an expected high prevalence of HIV infection. The objective of this study was to survey a community hospital residency program in a nonurban area with a perceived low HIV patient seroprevalence. Methods.— A 32-question survey was completed on an anonymous basis by the entire 74 member multidisciplinary resident physician group at a two-campus university-affiliated hospital program in southeastern Pennsylvania in May 1991. Results.— Residents perceived their patient population's HIV seroprevalence rate to be low although they believed their personal risk of occupational exposure to blood-borne infection was moderate to high. House staff most often complied with universal precautions for fear of acquiring a blood-borne illness and most often did not comply because of time constraints. Not perceiving the exposure as a health risk was the primary reason for nonreporting of exposures. Occupational exposure rates were alarmingly high, with suturing using a curved needle being the most common exposure method. Most residents were unfamiliar with HIV legislation. A majority of the house staff wanted improved HIV patient management training and life and disability insurance against occupationally acquired HIV. Many other important issues were addressed in this survey. Conclusion.— Residents even in low seroprevalence environments do fear occupationally acquired HIV. A great need exists for improved training in universal precautions, acquired immunodeficiency syndrome legislation, and HIV patient management as well as for insurance against occupationally acquired HIV. ( Arch Intern Med . 1992;152:1788-1796)