Number Of HIV-positive Patients Research Articles

The Health Education on Adolescent Reproductive Health Through a Festival Competition for Indonesia's Independence Day Celebration

In 2030, Indonesia is projected to experience a 37% increase in the number of HIV-positive patients, marking an addition of approximately 13,576 cases over 11 years. East Java, particularly among the 25-49 age group, predominantly males, stands out with the highest HIV prevalence. Factors such as inadequate knowledge among adolescents about reproductive health, exposure to pornography, and parental disempowerment contribute to risky sexual behaviors. The Activity aims to enhance adolescent reproductive health awareness, reduce HIV/AIDS cases, and supports preventative efforts at SMPN 15 Surabaya, Kenjeran, Surabaya. The community service activities encompass smart quiz seminars, educational role-playing, and informational posters. A questionnaire with 15 questions serves as metric for the success of the outreach. To analyze the methods' outcomes and effectiveness Descriptive and inferential statistics are applied. The community service initiatives successfully garnered participation from 108 students out of a total of 900 at SMPN 15 Surabaya. The seminar quiz activity with ρ-value ≤ 0.05 significantly increased students' knowledge by 14%, while role-playing and poster competitions showed no significance. Hence the festival has positively contributed to students' knowledge enhancement, particularly through the smart quiz seminar.

Impact of COVID-19 pandemic on the utilization of ART Centre Services of a teaching hospital

Background- COVID-19 pandemic has had a huge impact on the collateral health system. It made access to essential health services difficult. Such an essential service is a service provided to HIV patients. This study was planned to assess the effect of the current COVID-19 pandemic on Anti-Retroviral therapy (ART) center services. Methods -Pre-recorded epidemiological data from an ART center of a teaching hospital was used to answer the research question. Data was collected for retrieving 4 parameters i.e. number of registrations, number of HIV-positive patients kept on ART, number of deaths, and loss to follow up of the COVID-19 year and non-COVID-19 year then comparison was made between both. Data analysis was done with the help of SPSS. Independent t-test, one-way ANOVA test, and multiple comparison Tuckey’s test were applied. Results- Statistically significant difference was noted in the total number of registrations, the number of patients kept on ART, death, and loss to follow-up in non- COVID-19 & COVID-19 years. After appling above mentioned statistical test the p-value came out to be <0.05. Conclusion-COVID-19 pandemic has adversely affected the auxiliary non-COVID-19 health services and health programs. The current study gives evidence that ART functioning is negatively affected by the COVID-19 pandemic.

1835. Factors impact Longevity in Persons Living with HIV

Abstract Background In contrast to high mortality including young patient in 1990’s, persons living with HIV (PLWHIV) can expect a near-normal life expectancy of 77 years. Recent mortality data suggests significant number of HIV positive patients pass before the age of 70 years. There is a current paucity of literature looking at characteristics of the elderly PLWHIV when comparing to patients who died from HIV at a younger age. The goal of this study was to compare factors between the current HIV population living longer than age 70 and the population that did not survive until age 70 at the Positive Health Clinic (PHC). PHC is an urban city Ryan White funded HIV Care Medical Home Clinic, at Pittsburgh, PA, that provides care to ∼920 PLWHIV Methods A retrospective chart review of patient records at PHC; with patients from period between 2015 -2022 was queried for HIV viral load, recent CD4 counts, and social history. Smoking, alcohol, and drug use were used as primary social measures due to their known impact in early development of prevalent chronic comorbidities. A Chi squared test was then employed to analyze for statistical significance of these factors (P < 0.05) between the cohort of patients that are living beyond the age of 70 (longevity) and the cohort of patients who died prior to age of 70 Results A total of 149 records were obtained (122M/ 27F, 95W/54B). The median age of HIV diagnosis and death was 44 and 60, respectively. There was no statistical difference between two groups in gender, race, and initial HIV transmission route, but being diagnosed with HIV after the age of 40 was associated with longevity. Unsurprisingly, patient with last viral load above 500 or CD4 below 200 were less likely to survive past age 70. HIV viral load < 200, persistently, in past 5 years and absence of smoking in last 15 years were the 2 factors most strongly associated longevity. Alcohol abuse and drug use were less likely to survive age 70. Statistical data between the two groups are listed in Table attached. Comparing factors associated with living beyond 70 versus dying before 70 Conclusion Common comorbidities such as diseases of heart, lung, kidney and cancer are impacted by substance misuse, and as a result may serve as a barrier to reaching old age in PLWHIV. Counseling against tobacco use, treatment of alcohol and drug addiction while sustaining viral control with HAART can promote the longevity of PLWHIV. Disclosures Chiu-bin hsiao, MD, Gilead: Grant/Research Support|ViiV: Advisor/Consultant|ViiV: Grant/Research Support|ViiV: Honoraria

Trends Analysis of HIV Infection and Antiretroviral Treatment Outcome in Amhara Regional from 2015 to 2021, Northeast Ethiopia.

The persistent efforts of HIV/AIDS epidemiology remain one of the world's most important community health threats. To avoid becoming an epidemic, UNAIDS has set three 90% fast-track targets for 2020, and Ethiopia has also changed its implementation since 2015. However, the achievement targets in the Amhara region have yet to be evaluated at the end of the programme period. The aim of this study was to assess the Trends of HIV Infection and Antiretroviral Treatment outcome in Eastern Amhara Regional from 2015 to 2021, Northeast Ethiopia. A retrospective study was conducted by reviewing the District Health Information System from 2015 to 2021. The collected data includes the trend of HIV testing services, the trend of HIV positivity, the yield of HIV testing approaches, the number of HIV positive patients linked to HIV care and treatment or access to lifelong antiretroviral therapy, viral load testing coverage, and viral suppression. A descriptive statistic and trend analysis were computed. A total of 145,639 people accessed antiretroviral therapy. The trend of HIV test positivity has been declining since 2015, peaking at 0.76% in 2015 and declining to 0.60% in 2020. A high level of positivity was reported in volunteer counselling and testing as compared with provider-initiated testing and counselling services. Following an HIV positive, there was an increase in linkage to HIV care and treatment. High suppression rates of viral load indicate testing coverage grew over time. The viral load monitoring coverage was 70% in 2021, with a viral suppression rate of 94%. The trend in achievement in the first 90s was not consistent with predefined goals (90%). On the other hand, there was good achievement in the second and third goals. Hence, intensified case-finding approaches to HIV testing should be strengthened.

The aggressive tendencies in HIV-positive persons with concomitant mental disorders

Hostility and aggressiveness can be a marker of individual psychological vulnerability to stressors leading to reduced social adjustment and the risk of mental disorder manifestation. The aggressive tendencies prevalence is believed to be high among people living with HIV. With an increase in the incidence of HIV infection, the number of HIV-positive patients with concomitant mental disorders is increasing.Aim: to evaluate the intensity and the structure of aggressive tendencies in HIV-infected persons with concomitant mental disorders. Material and Methods. 78 HIV-positive persons and 24 HIV-negative psychiatric patients. The Bass-Darkie Aggressive Level Questionnaire (BDHI) and Short Psychiatric Assessment Scale (BPRS) were used. Nonparametric statistics, dispersion analysis was performed with p≤0.05, Cohen’s d calculated (effect size).Results. We examined 102 people, 51 (50.0%) men, 51 (50.0%) women, the average age — 35.5 ± 9.7 years. 58 (74.4%) HIV-infected respondents had mental disorders. HIV-positive persons with schizophrenia had higher values of most aggressive tendencies (p<0.05) in the group of HIV-infected subjects. In comparison with HIV-negative patients, HIV-positive persons with schizophrenia had higher mean values of «Physical aggression» (p<0.001, Cohen’s d=1.0), «Verbal aggression» (p <0.001, Cohen’s d = 1, 0), and «Aggressiveness» (p=0.004, Cohen’s d=0.86). 4B clinical stage of HIV infection was associated with higher scores of «Physical aggression», «Indirect aggression», «Verbal aggression», «Negativism», «Aggressiveness» (p<0,05).Conclusion. The study findings contribute to the understanding of the features of aggressive tendencies in HIV-positive persons and call for further research to improving the quality and personalization of medical care for patients with concomitant mental disorders.

824. Analysis of Comorbidities and Use of Co-medications in 28,089 HIV-positive Patients: A Nationwide Cohort Study From 2009 to 2019 in Japan

Abstract Background Comorbidities are associated with a high burden of disease in human immunodeficiency virus (HIV)- positive patients. The objective was to investigate the prevalence of chronic comorbidities and the use of co-medications in HIV-positive patients in Japan. Methods This longitudinal cohort study retrospectively analyzed clinical information from HIV-positive patients using antiretroviral therapy (ART) between April 2009 and April 2019. Demographic characteristics, numbers and types of chronic comorbidities and numbers and types of co-medications, were described by age groups. This is the first report to analyze comorbidities and the polypharmacy of all patients in the cross-sectional National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB), which contains data on the largest number of HIV-positive patients in Japan, available to date. Results Overall, 28,089 HIV-positive patients (male 91·9%) who used ART were identified. About 40% of 28,089 patients had at least one chronic comorbidity. The number of acquired immunodeficiency syndrome (AIDS)-defining cancers and non-AIDS-defining cancers in this Japanese cohort was 2,432 (8·7%) and 2,485 (8·8%), respectively. The incidence of AIDS-defining cancers was 6·4% for non-Hodgkin lymphoma and 2·5% for Kaposi’s sarcoma, with bronchus or lung cancer being the most common of the non-AIDS-defining cancers. Syphilis was the most common infection (47·2%). The cumulative burden of vascular disease and AIDS-free cancer increased with age. The most common therapeutic categories of co-medications were systemic antibacterials (42%) and antacids, antiflatulents and antiulcerants (38·8%). Most of the patients used at least one co-medication (71·4%), and the numbers of co-medications used were greater in the older age groups. Conclusion The burden of chronic comorbidities and co-medication were found to be greater in older than younger patients, among 28,089 HIV-positive patients in a nationwide study in Japan. This finding suggests the need to identify elderly persons living with HIV and to appropriately manage their HIV and comorbidities. Disclosures All Authors: No reported disclosures

Retro-Viral Disease Status of Patients on DOTS Tuberculosis Treatment Strategy in a South-East Nigeria Teaching Hospital

Introduction: Tuberculosis is associated with HIV/AIDS and it has been recognized as one of the most frequent opportunistic infections in persons with HIV. Tuberculosis is the leading cause of death in people with HIV having an adverse effect on HIV progression. Objectives: The objective is to determine the retroviral disease status of patients on the DOTS strategy. Materials and Methods: A retrospective study of patients was seen at the University of Nigeria Teaching Hospital from January 2013 to April 2015. Relevant information was collected from patients’ folders. Statistical analysis was done with the SPSS and results were represented in tables. Results: 171 patients (77%) were HIV negative while 51 (23%) were positive giving an HIV negative/HIV positive ratio of 3.35:1. 97 patients (43.7%) had 6 months duration of treatment. The least was 2 patients (0.9%) that complied with their medication for 7 months. The 61 - 70 years age group accounted for the least number of HIV-positive patients. Conclusion/Recommendations: There is strong tuberculosis/HIV co-infectivity among the studied population. Strategies to reduce the burden of TB/HIV co-infection should be strengthened.

Forecasting future HIV infection cases: evidence from Indonesia

ABSTRACT Countries throughout the world, including Indonesia, are facing a complex problem with regards to HIV infection incidences and its prevalence. This is despite some local governments in some provinces of Indonesia working together with the Social Ministry of Indonesia to eradicate prostitution. There are high numbers of HIV sub-types in Indonesia such as HIV-1 (CRF01_AE and B). The forecast was conducted with the Autoregressive Integrated Moving Average model. The ARMA (1,1) was observed to be the best model for forecasting the number of HIV patients in Indonesia. This forecasting has been done since March 2019. Based on its dynamic forecasting with ARMA (1,1), this study proved the number of HIV-positive patients, from 2019 to 2030, had increased from 22,679 to 36,255, by almost 37% within 12 years. Indonesia is facing a growing trend in the number of new HIV cases, until 2030 which caused by stopped their follow-up treatments or they have ceased in consuming the Antiretroviral drugs even though the Indonesian government was provided national health insurance which covers the Antiretroviral drug and a limited number of health-care services providing the Antiretroviral therapy. Therefore, investigations focusing on estimate the number of HIV patients in Indonesia is an important finding. The information can be used as a resource for policy and decision making for plans and programs.

Homocysteine Levels in Patients with Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome in Ibadan

Introduction: Homocysteine is produced from the conversion of methionine to cysteine. Conditions resulting in hyper homocysteinemia leads to an increased risk of both arterial and venous thromboembolisms by about 2 fold. 20% of HIV infected patients with objective evidence of venous thromboembolism are found to be thrombophilic with higher homocysteine levels. We enquired into homocysteine levels prior to the development of a clinical evidence of a venous thrombus in both HAART naïve and those on HAART of HIV /AIDS population. We evaluated the association between homocysteine, CD4 lymphocyte count and ART use in order to identify possible risk factors for hyper homocysteinemia in HIV population.
 Method: Employing a cross sectional design; we compared mean plasma levels of homocysteine, full blood count parameters and CD4+ lymphocytes counts in HIV positive patients and HIV negative controls. One hundred and twenty patients with HIV infection attending the APIN clinic at the University College Hospital Ibadan and St Mary’s Catholic Hospital Eleta Ibadan and one hundred and twenty-six HIV negative healthy controls were compared in the study.
 Results: Fifty-nine point one percent of the HIV positive patient had hyperhomocysteinemia i.e. homocysteine levels of >18µmol/l. The mean plasma homocysteine levels were significantly higher at 24.4µmol/l (SD=13.8) (CI -2 to -8; p=0.002) in the HIV positive group compared with 19.5µmol/L (SD=10.6) in the control group. The use of Anti-retroviral drugs was not associated with higher homocysteine level in the seropositive group and neither were factors like age, gender or the use of combined oral contraceptive pills. There was no correlation between CD4 cell count and homocysteine levels (r= -0.01; p=0.9).
 Conclusion: Homocysteine levels are elevated in HIV positive patients and hyperhomocysteinemia was found in a significant number of HIV positive patients. None of the patients investigated had features of thromboembolism or outright deep venous thrombosis. Neither CD4 cell counts nor traditional risk factors were associated with the higher homocysteine levels.

Innovative Multimodal Training Program for Family Physicians Leads to Positive Outcomes Among Their HIV-Positive Patients

CME programs can increase physicians' uptake and adherence to clinical guidelines for chronic diseases. We developed an intensive multimodal training program for family physicians to increase their competency in the management and treatment of HIV, through group learning and via close interactions with expert clinicians in HIV. We trained 51 physicians from September 2010 to June 2015 and compared their adherence to clinical guidelines 1 year before and 1 year after the program. We observed significant increases in the physicians' HIV-related clinical competencies, in accordance with clinical guidelines, and an increase in the number of HIV-positive patients seen by these physicians and the number of combination antiretroviral therapies prescribed by these physicians. By combining various pedagogical approaches, as well as creating and encouraging communities of practice, we were able to make a durable impact on physician performance and patient-specific outcomes.

Predictors of unfavorable outcome in neurosyphilis: Multicenter ID-IRI Study.

Neurosyphilis (NS) has different clinical manifestations and can appear during any stage of syphilis. We aimed to identify the factors affecting poor outcome in NS patients. Patients with positive cerebrospinal fluid Venereal Disease Research Laboratory test, and positive serological serum treponemal or nontreponemal tests were classified as definite NS. The data of 141 patients with definite NS were submitted from 22 referral centers. Asymptomatic NS, syphilitic meningitis, meningovascular syphilis, tabes dorsalis, general paresis, and taboparesis were detected in 22 (15.6%), 67 (47.5%), 13 (9.2%), 10 (7%), 13 (9.2%), and 16 patients (11.3%), respectively. The number of HIV-positive patients was 43 (30.4%). The most common symptoms were headache (n= 55, 39%), fatigue (n= 52, 36.8%), and altered consciousness (50, 35.4%). Tabetic symptoms were detected in 28 (19.8%), paretic symptoms in 32 (22.6%), and vascular symptoms in 39 patients (27.6%). Eye involvement was detected in 19 of 80 patients (23.7%) who underwent eye examination and ear involvement was detected in eight of 25 patients (32%) who underwent ear examination. Crystallized penicillin was used in 109 (77.3%), procaine penicillin in seven (4.9%), ceftriaxone in 31 (21.9%), and doxycycline in five patients (3.5%). According to multivariate regression analysis, while headache was a protective factor in NS patients, double vision was significantly associated to poor outcome. We concluded that double vision indicated unfavorable outcome among NS patients. A high clinical suspicion is needed for the diagnosis NS. As determined in our study, the presence of headache in syphilitic patients can help in early diagnosis of central nervous system disease.

Acceptance situation of HIV patients in Japanese dialysis facilities\u2014questionnaire survey by the Infection Survey Subcommittee

BackgroundA newspaper article in August 2016 reported that about 40 medical facilities refused dialysis to a human immunodeficiency virus (HIV) patient. Infection Survey Subcommittee in the Japanese Society for Dialysis Therapy investigated this situation.MethodsAn anonymous questionnaire survey about the acceptance of HIV-positive patients was sent to 4039 dialysis institutions. The questionnaire included a number of HIV-positive patients on dialysis currently and in the last 5 years, details on whether the institution received requests to perform dialysis on HIV-positive patients, the responses to these requests, the preparation system for acceptance, the reasons for refusal of dialysis of HIV-positive patients, knowledge of HIV-related guidelines in use, and the considerations for the acceptance of dialysis for HIV-positive patients. We evaluated answers to these questions from the institutions.ResultsTwo thousand five hundred eighty-three facilities (64.0%) responded to the survey questions. In the past 5 years, 215 facilities (8.3%) were requested to accept HIV patients for dialysis and 40.1% of these refused acceptance. Although manuals, written policy and procedure, for a needle piercing accident existed in most of the facilities that accepted the patients, many facilities did neither prepare the stocks of anti-HIV drugs nor cooperate with HIV core hospitals. Principal reasons for the refusal were listed as the lack of medical experience with HIV patients, anxiety of healthcare providers with regard to HIV infection risk, lack of stocks of anti-HIV drugs for needle piercing accidents, and the lack of cooperation with HIV core hospitals. The proportion of facilities expected to accept HIV patients in the future was as low as 16.9% among all facilities that responded to the survey.ConclusionsThe Japanese Society for Dialysis Therapy will need to strengthen the cooperation with other academic societies and disseminate basic knowledge on HIV and infection control measures to develop and establish the acceptance system of maintenance dialysis for HIV patients.

Predictors of attrition in patients on anti-retroviral treatment in Ghana an analysis of National HIV Programme data

Introduction: the availability and use of antiretroviral treatment (ART) has made great progress in reducing the burden of HIV across the world. In view of this, countries have adopted strategies that will increase enrollment and retention of HIV positive individuals on ART. However, a good number of HIV positive patients drop out of treatment along the continuum of care which adversely affects national goals of reducing the disease burden. This study aimed at determining predictors of attrition in patients after initiating ART.

The importance of assessing out-of-pocket payments when the financing of antiretroviral therapy is transitioned to domestic funding: findings from Vietnam.

To assess out-of-pocket payments and catastrophic health expenditures among antiretroviral therapy (ART) patients in Vietnam, and to model catastrophic payments under different copayment scenarios when the primary financing of ART changes to social health insurance. Cross-sectional facility-based survey of 843 patients at 42 health facilities representative of 87% of ART patients in 2015. Because of donor and government funding, no payments were made for antiretroviral drugs. Other health expenditures were about $66 per person per year (95% CI: $30-$102), of which $15 ($7-$22) were directly for HIV-related health services, largely laboratory tests. These payments resulted in a 4.9% (95% CI: 3.1-6.8%) catastrophic payment rate and 2.5% (95% CI: 0.9-4.1%) catastrophic payment rate for HIV-related health services. About 32% of respondents reported, they were eligible for SHI without copayments. If patients had to pay 20% of costs of ART under social health insurance, the catastrophic payment rate would increase to 8% (95% CI: 5.5-10.0%), and if patients without health insurance had to pay the full costs of ART, the catastrophic payment rate among all patients would be 24% (95% CI: 21.1-27.4%). Health and catastrophic expenditures were substantially lower than in previous studies, although different methods may explain some of the discrepancy. The 20% copayments required by social health insurance would present a financial burden to an additional 0.6% to 5.1% of ART patients. Ensuring access to health insurance for all ART patients will prevent an even higher level of financial hardship.

Häufigkeiten antiretroviraler Therapie in Sekundärdaten von gesetzlichen Krankenkassen in Deutschland

The objective of this study is to determine the number of patients who receive anti-retroviral medicinal products (ARMs) and to assess the frequency of prescriptions depending on age, gender and treatment regimen by evaluating German statutory health insurance data. We analysed a number of databases of several million customers of various nationwide statutory sickness funds and extrapolated the results to the overall population of the statutory health insurance. The number of HIV-positive patients with ARMs varied considerably between the statutory sickness funds analysed. The number of patients with HIV diagnosis receiving ARMs that are exclusively approved for HIV increased from about 23,262 in 2008 to 30,200 in 2010. For ARMs labelled for both, HIV and HIV/chronic hepatitis B, indications, we calculated about 34,032 patients for the year 2011. In about 24.2% of the cases with HIV-only and HIV plus HIV/chronic hepatitis B-approved ARMs no HIV-diagnosis was documented. Patients in this group were significantly younger and more often female as compared to patients with documented HIV diagnosis who received prescriptions of ARMs. 16.5% of the patients received treatment within the label for chronic hepatitis B. In 7.7% of the patients ARMs were used off-label for prophylaxis (10.0%), for hepatitis (65.0%) or for unknown reasons (25.0%). Hence, the number of people under ARMs was estimated to be below the 44,000 patients calculated for statutory sickness funds patients on the basis of prescription data in 2011. According to our analysis only 39,000 of those could have a documented HIV diagnosis.

Profile and mortality outcome of patients admitted with cryptococcal meningitis to an urban district hospital in KwaZulu-Natal, South Africa.

IntroductionCryptococcal meningitis (CCM) is one of the leading causes of early mortality among HIV-infected patients. This study was a part of clinical audit [1] aimed at improving care for patients with CCM at an urban district hospital in South Africa.MethodsClinical records of all patients (age>13 years) admitted to the hospital with a diagnosis of CCM (based on a positive India ink, positive cryptococcal latex agglutination test (CLAT) or a positive culture of Cryptococcus neoformans) between June 2011 and December 2012 were retrospectively reviewed. Descriptive statistics and Chi-square analysis were generated with Epi Info 7.1.2.0. 95% confidence intervals were reported where appropriate.ResultsOf the 127 patients admitted with CCM, only 97 (76.4%) knew their HIV status. Only 44.8% (43/96) of those who knew they were HIV positive were on antiretroviral therapy (ART). Seventeen out of 25 patients (68%) previously treated for CCM had defaulted fluconazole and only 60% (15/25) were on ART. Acute mortality (death within 14 days of CCM diagnosis) was 55.9% (71/127). The median time to death from diagnosis was four days (IQR 2–9). The association between CSF WBC count<20cells/mL and increased risk of death within 14 days was statistically significant (OR 2.2; 95% CI 1.1–4.6, p=0.03). Patients with heavy cryptococcal burden (reported as numerous yeasts seen on microscopy) at diagnosis were three times more likely to die within 14 days of diagnosis of CCM (OR 3.2; 95% CI 0.9–10.7, p=0.06). Even though a CD4 count<100cells/mm3 was associated with a 1.6 times increased acute mortality risk, the association was not statistically significant (OR 1.6; 95% CI 0.6–4.6, p=0.3). The role of elevated CSF opening pressure at diagnosis was not assessed because only two (1.6%) patients had their baseline opening pressure measured.ConclusionsAcute CCM-related mortality remains high. The number of patients who do not know their HIV status, the number of HIV positive patients not on ART, the high level of non-adherence to fluconazole and the proportion of patients not on ART after at least one previous CCM episode all point to the need of developing comprehensive strategies aimed at encouraging HIV testing and improving patient's retention in HIV care and support.

Neurocognitive dysfunction among HIV positive patients using International HIV dementia scale

Background: HIV associated neurocognitive dysfunction (HAND) ranges from asymptomatic neurocognitive impairment (ANI) to mild neurocognitive disorders (MND) to HIV associated dementia (HAD). Cognitive impairment may impact medication adherence which will ultimately affect morbidity and mortality. Aim: This study was undertaken to evaluate neurocognitive dysfunction among HIV positive patients using the International HIV Dementia scale(IHDS). Materials and Methods: This cross sectional study was conducted in a tertiary care hospital attached to a medical college that caters to a large number of HIV positive patients. The subjects for this study included HIV positive patients belonging to WHO stage 1 or 2. Data collection was done using a pre tested questionnaire. The International HIV Dementia scale(IHDS) was used to assess HAND. Results: Out of the 101 patients studied, 69(68.3%) were males and 32(31.7%) were females. Among these patients, 88 (87.1%) were receiving antiretroviral therapy (ART), 84 (83.2%) were in WHO stage 1. 91 (90.1%) patients had HAND. There were statistically significant differences in the gender and educational level between patients with or without HAND. As age advanced the percentage of patients having HAND also increased. Conclusion: There was high prevalence of HIV associated neurocognitive dysfunction among HIV positive individuals in our study. Also there was an increase in HIV associated neurocognitive dysfunction with increase in age. DOI: http://dx.doi.org/10.3126/ajms.v5i4.8724 Asian Journal of Medical Sciences 2014 Vol.5(4); 61-64

Immunological response after initiation of second line anti-retroviral therapy in HIV patients

Introduction Treatment with second line ART is initiated when the first line therapy fails. There is less experience with the immunologic response for second-line ART for adults. Hence this study was done to find out the immunological response after initiation of second line ART by analysis of CD4 counts. Methods This retrospective study was conducted in a tertiary level hospital attached to a medical college that caters to a large number of HIV positive patients. The study population for this analysis included all HIV positive individuals who were undergoing second line ART treatment.The data was collected using semi-structured pre-tested proforma from the hospital records of HIV positive individuals. The immunological response after the initiation of second line ART was analyzed using the CD4 cell counts taken at intervals of 3 months and 6 months after the initiation. Results Out of the 32 patients studied, 27(84.4%) were males and only 5(15.6%) were females. Mean age of the patients was 40.56±6.78 years. The mean CD4 value at initiation was 152.35±142.89cells/μL, which significantly increased to 324.43 ±163.65cells /μLby 3 months after initiation (p value= .000) and to 348.21± 253.57cells /μLby 6 months after initiation.Around 91.3% of patients had a baseline CD4 T cell count <350 cells L-6. After 3 months of therapy, 65.2% of patients and after 6 months 46.2% had a baseline CD4 T cell count <350 cells /μL.The mean weight at initiation was 50.548± 11.37 kg, which very significantly increased to 53.30± 11.1 kg by 3 months of therapy (p = .001, table 1) and to 54.63 ± 10.29kg at the end of 6 months. Conclusion The CD4 counts increase very significantly within the first 3 months of initiation of second line therapy.The rise in CD4 count between 3 months and 6 months is not as statistically significant as the earlier one. Also, there is significant gain in weight within 6 months of initiation of second line therapy.

Condyloma Acuminate and Increase in the Number of Human Immunodeficiency Virus-Positive Patients

See Article on Page 294-298 Condyloma acuminata arising from human papillomavirus (HPV) infection may cause anal squamous cell cancer and can have a recurrence rate of up to 50% of patients after surgical treatment because surgery cannot control latent HPV infection in surrounding tissue [1]. Therefore, trials using interferon, imiquimod, 5-fluorouracil, vaccine and natural products have been performed to reduce the recurrence rate. That the immune function of the host is important to the recurrence of condyloma is supported by the higher recurrences in patients with immune-suppressants and with human immunodeficiency virus (HIV) infection and by condyloma acuminate being a viral infection [2]. The incidence of HPV infection is more than twice in homosexual man than in others, and anal condyloma increases the incidence of anal cancer; hence, anal cancers are increasing in men who have sex with men [3]. With the increases in homosexuality and homosexual marriage, anal condyloma has become a disease deserving attention. Anal condylomas have more dysplasia in homosexual man and a more frequent neoplastic process in HIV-positive patients [4, 5]. Moreover, frequent multiple infections of oncogenic HPV strains such as HPV-type 16 or 18 are seen in HIV-positive patients [6]. Highly active antiretroviral therapy is thought by some researchers to contribute to reduce morbidity and mortality due to HIV infection, resulting in a decreased incidence of HPV infection and anal cancer while other researchers suggest that prolonged survival of HIV-positive patients may increase the prevalence of anal cancers [7]. Few data exist on the incidence of anal condyloma and associated anal squamous cell cancer in Korea. However, the increases in the number of HIV-positive patients and in their survival [8] will eventually make condyloma acuminata and associated anal cancer an important issue. As uterine cervical cancer, a typical cancer caused by HPV infection, diminishes in incidence and mortality because of publicity and education, the time to start surveillance and to increase education to prevent and to reduce the incidence of anal cancer due to HPV infection has arrived.

Missed opportunities for earlier HIV testing and diagnosis at the health facilities of Dessie town, North East Ethiopia

BackgroundFor patients in all health-care settings HIV screening is recommended after the patient is notified that testing will be performed unless the patient declines. The nation's physicians and other health care providers should assume a much more active role in promoting HIV testing. The aim of this study was to investigate the extent to which missed opportunities for earlier HIV testing and diagnosis occur in the health facilities of north east Ethiopia.MethodsA confidential client exit interview and medical record review was made on 427 clients who attended health facilities of Dessie town between November-December 2008. Data collection was done by counselors trained on Provider Initiated Counseling and Testing (PICT) and data collection tool included demographics, reason for visit to health facilities, HIV test initiation by service providers, clients self risk perception, clients willingness and acceptance of HIV test, HIV test result and review of client medical records.ResultsAmong 427 clients, missed opportunities for HIV testing were found in 76.1% (325) of clients. HIV test initiation was made by data collecting counselors during interview period and 80.0% (260) of clients not initiated by service providers were found to be willing to have HIV test. Large number, 43.0% (112), of the willing clients actually tested for HIV. Of the tested clients, 13.4% (15) were found to be HIV positive. Most, 60% (9), of HIV positive clients who lost the opportunities of diagnosis felt themselves as having no risk for HIV infection. Missed opportunities for HIV diagnosis of 51.7% (15), overall HIV test acceptance rate of 36.5% (154) and positivity rate of 6.9% (29) were found.ConclusionsThe missed opportunities for earlier HIV test and diagnosis of patients attending health facilities were found to be high and frequent. Testing only clients with HIV risk misses large number of HIV positive patients. Asking clients' willingness for HIV testing should be conducted by all service providers irrespective of the clients' risk behaviors for HIV infection or the type of services they need.