Patients Attending ART Centre Research Articles

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Human immunodeficiency virus HIV infected individuals on national AIDS control organization NACO India based highly active antiretroviral therapy (HAART) regimen often continue experiencing neurological complications referred to as HIV associated neurocognitive disorders (HAND).The cognitive impairment is attributed to HIV replication in the brain and liberation of inflammatory neurotoxins leading to neuronal dysfunction.The American academy of neurology task force on the acquired immune deficiency syndrome AIDS defined two level of neurological impairment in HIV patients: 1.HIV associated dementia(HAD)and 2.minor cognitive motor disorder (MCMD).A core difference between the two is the degree of functional impairment present . Patient with HAD have more impairment than those with MCMDTimely detection of Cognitive dysfunction in patients with HIV infection is very crucial as HAND could affect patient’s activities of daily living such as medication adherence, employment; driving and so on this worsens disease indirectly.Methods:A Cross sectional Study on Patients with immune compromised states infected by HIV/AIDS was the main aim. The study includes 75 HIV infected patients attending ART centre in Victoria hospital. Patients taken into study were aged above 18years, of both sexes, then MINI Screening for Psychiatric diagnosis will be applied to rule out Axis I Psychiatric illnessIHDS scale will be applied to know the neurocognitive severity (score less than <=10) patients will be considered.Results:More than half of the HIV patients had scored less in IHDS SCALE, reported.Conclusion:the results show that patients with HIV states have the high prevalence of prevalence of HIV associated neurocognitive impairment.Introduction:Electrolyte abnormalities are common in chronic alcoholics as a result of chronic alcohol consumption, acute alcohol intoxication. They are especially significant during alcohol withdrawal. We should be aware of these clinically important disturbances caused by alcohol abuse for their appropriate management.Material and methods:A cross-sectional observational study was conducted for a period of 18 months and 126 patients of alcohol dependence in withdrawal state were included. Diagnosis of alcohol withdrawal were confirmed using ICD-10 and patients were evaluated using CIWA-Ar. Venous blood was obtained for the determination of serum potassium, sodium and magnesium, calcium, phosphates, bicarbonates concentrations and LFT.Results:The prevalence of electrolyte imbalance was 71%. Hyponatraemia was noted in 28.6% and hypernatremia in 11.9% of individuals with alcohol dependence syndrome. Hypokalemia was noted in 42.1% and hyperkalemia was noted in 1.6% of individuals with alcohol dependence syndrome. 14.3% of the individuals have decreased magnesium levels and 15.1% have increased magnesium levels. 67.5% of individuals have normal calcium levels and hypocalcaemia was noted in 31.7%, while hypercalcaemia was noted in only one patient. Hypophosphatemia was present in 15.1% of individuals while in rest the serum phosphorous levels were normal. Metabolic acidosis was found in 19.8% and metabolic alkalosis in 3.2% patients.Conclusion:The prevalence of electrolyte imbalance in patients of alcohol dependance in alcohol withdrawal state was 71%. The most frequent electrolyte disturbances in these patients were hypokalemia (42.1%) followed by hypocalcemia (31.7%), hyponatremia (28.6%), and hypomagnesemia (14.3%). The metabolic disturbances ware present in 23% patients. The patients consuming 7/weeks were significantly more likely to have electrolyte imbalance and deaarranged liver function tests than in individuals consuming 4/weeks or less.

Hemoglobin and CD4 count in HIV patients initiating antiretroviral therapy at a tertiary care hospital in Goa

Background: Hematological abnormalities are known to be independent predictors of morbidity and mortality in HIV-infected patients. The current study was conducted to evaluate the hemoglobin levels and CD4 count at the time of initiation of highly active antiretroviral therapy (HAART) of newly diagnosed HIV/AIDS patients attending ART centre at Goa Medical College.Methods: A hospital based observational retrospective study was carried out in Department of Medicine of Goa Medical College in collaboration with ART centre from October 2015 to January 2016. Patient’s relevant data about the infection was collected from patient’s treatment record card at the ART centre using preformed questionnaire.Results: The prevalence of anaemia in study participants was 66.35%. The prevalence of severe anaemia and mild-moderate anaemia was 9% and 57.3% respectively, while 33.65% of participants were not anaemic. Significant difference was observed in the prevalence of anaemia among immune deficient male participants (CD4 count &lt;500 cells/mm3) and participants with no significant immune deficiency (CD4 count ≥500 cells /mm3) (77.5% versus 50%). Significant difference was also seen in the prevalence of anaemia among immune deficient female participants (CD4 count &lt;500 cells/mm3) and participants with no significant immune deficiency (CD4 count ≥500 cells /mm3) (93.5% versus 56%).Conclusions: The current study revealed high prevalence of anemia in HIV patients prior to the initiation of ART in both males as well as females. Mild to moderate anemia was predominant in the study participants than severe anemia. There was significant difference observed in the prevalence of anemia among immune deficient population and participants with normal CD4 count. Prompt diagnosis of anaemia, identification of the underlying cause of anaemia in HIV patients as well as the implementation of appropriate treatment is essential.

Trend of HIV-TB co-morbidity?in north-west region of Uttarakhand

Tuberculosis (TB) is the commonest opportunistic infection and the number one cause of death in HIV patients in developing countries. HIV co-infection is the most powerful known risk factor for progression of M. tuberculosis infection to active disease, increasing the risk of latent TB reactivation. The study was carried out to study the trend of Tuberculosis in HIV seropositive patients and determine HIV-TB co-morbidity in Dehradun, Uttarakhand. A retrospective study of standardized patient records was conducted from December 2017 to November 2018 of all HIV sero-positive patients registered to ART PLUS Centre Govt. Doon Hospital Dehradun. TB suspected patients were referred to RNTCP. Data was taken and analyzed by Microsoft Excel. Among total of 18319 HIV positive patients attending ART centre (ART and Pre- ART enrolled) during the study period, 585 patients were suspected of TB and were referred from ART to RNTCP. Total 128 (21.9%) patients were diagnosed with TB, of which 71(55.46%) patients were diagnosed for pulmonary TB and 57(44.5%) were Extra-Pulmonary TB. In our study Male predominance was seen and most of the cases were of age group 19-40 years, mostly belonging to rural areas. Keywords: HIV/AIDS, Tuberculosis, Co-infection.

TO DETERMINE THE PREVALENCE OF RENAL DISEASES IN HIV/AIDS PATIENTS AT AIMS, DEWAS

Method: HIV positive patients registered in ART centre of AIMS, Dewas. The study will be carried out on HIV positive patients attending ART centre, General medicine OPD, and those admitted in Medicine wards of AIMS, Dewas.&#x0D; Result: Among 136 patients included in our study, 81 (59.3 %) were males and 55(40.3%) were females. Among those patients with renal dysfunction, 83.1% patients were diagnosed within past 3 years. 15.3% patients had duration of illness 3 to 6 years and only 1.6% patients had duration of illness more than 6 years. The influence of duration of illness on the risk of renal dysfunction was analyzed using One way ANOVA and Tukey pair wise analysis and found to be non significant.&#x0D; Conclusion: Prevalence of renal dysfunction in our study was 14.3%. Among them, 18 patients were having acute kidney injury and recovered normal renal functions. This study shows that the risk of renal dysfunction is higher in inpatients compared to outpatients. This study shows that the risk of renal dysfunction is higher in advanced stages of the disease.&#x0D; Keywords: Prevalence, Renal Diseases, HIV &amp; AIDS.

TO DETERMINE THE IMPACT OF ART ON RENAL DISEASES IN HIV PATIENTS

The study will be carried out on HIV positive patients attending ART centre, General medicine OPD, and those admitted in Medicine wards of Bundelkhand Medical College, Sagar.&#x0D; In this study, among those patients with renal dysfunction, 83.3% patients were on ART since less than 3 years. 16.7% patients were started on ART 3 to 6 years back. The influence of duration of antiretroviral therapy on risk of renal dysfunction was analyzed using One way ANOVA and Tukey pair wise analysis and found to be non significant.&#x0D; This study shows that there is no significant association between the regimen of HAART and the risk of renal dysfunction. This was contrary to the commonly available data47-57 which revealed that the choice of ART may have predilection for causing renal damage especially from NNRTI group like Tenofovir, which was found to cause renal toxicity. This finding needs to be reanalyzed by further continuation of the study.&#x0D; Keywords: Impact, ART, Renal &amp; HIV patient.

A study of demographic profile of HIV positive patients attending ART centre SGMH Rewa, Madhya Pradesh

Background: Caused by Human Immuno-deficiency virus, leading the patient’s immune system vulnerable to various infections and neurological disorder, AIDS have transformed into a socioeconomic and developmental concern. With the increasing population of India, the HIV epidemic will soon be a major cause of concern. The objective of the present study was to observe the demographic profile of HIV positive patients attending ART Centre at the Department of Medicine at Sanjay Gandhi Memorial Hospital & Shyam Shah Medical College, Rewa (M.P.) in year 2012-2014. Material & Methods: This was a data-based study. In this study total 1224 cases of all age group were taken, these patients were registered in ART center in between Jan. 2010 to Dec.2012. A pre-formed questionnaire (proforma) was made to enquire about socio-demographic-economic variables. The patient and their spouse were interviewed, examined and investigated according to pre-designed proforma with special reference to their occupation, spouse HIV status and high-risk behaviour. Results: In this study total number of ART attendees (patients) were 1224 and out of these total patients, 7.27% (n=89) were children ( 15 years). Out of 89 children, 5.15% (n=63) were male and 2.12% (n=26) were female and out of 1135 adult patients, 53.26% (n=652) were male and 39.46% (n=483) were female. M/F ratio in children was 2.4/1 and M/F ratio in adult patients was 1.3/1. Conclusion: As the present study was done in rural area, where hygiene was poor and sanitation was bad and environment was dusty, that is why infectious complications were more common in the present study.

Prevalence of HIV +ve Cases With AIDS Defining Opportunistic Infections Among ART Naive Patients Attending ART Centre

Prevalence of HIV +ve Cases With AIDS Defining Opportunistic Infections Among ART Naive Patients Attending ART Centre

Anti retroviral therapy adherence and its determinants among patients attending ART centre, Bhopal

Background: Antiretroviral drugs delay progression of HIV disease and improve the quality of life in the HIV infected people. A very high levels of adherence is required for ART to be effective long term and to prevent the emergence of resistant viral strains. The objectives were to assess the adherence of anti-retro viral treatment and its determinants and to estimate the status of CD4 count before and after ART in HIV patients.Methods: The study was a cross sectional study conducted in ART center Hamidia hospital at Bhopal, Madhya Pradesh. 256 participants with HIV who had registered in the center and receiving ART for the past 6 months were included in the study. A predesigned questionnaire was used for the study. Data was analysed using Epi Info. The significance of proportion were calculated using chi square test (p&lt;0.05).Results: All the respondents knew that unprotected sexual contact, contaminated Blood transfusion and infected syringes were the major modes of transmission of HIV. About 60 (41.96%) in 143 patient with CD4 count &lt;200 improved to &gt;350. Majority of respondents 195 (76.17%) missed the dose often and 61 (23.83%) did not miss the dose at all. The major reasons for missing dose of ART regimen were forgot to take medicines (57.95%), alcoholic state (26.15%) and long duration of treatment (47.17%).Conclusions: The majority of patient missed the doses due to socio demographic and treatment related factors. A good treatment adherence is linked with the good quality drug and better environment in the clinics throughout the treatment period.

Dermatological manifestations of acquired immunodeficiency syndrome: an observational study among HAART naive patients from an ART centre of excellence

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; &lt;span lang="EN-GB"&gt;Dermatological manifestations can be a window to the clinical and immunological status of patients with HIV infection. Introduction of HAART has dramatically shifted the pattern of HIV associated dermatoses. The present study has been carried out to find out the same among HIV infected patients not started on HAART therapy&lt;/span&gt;&lt;span lang="EN-IN"&gt;.&lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Two hundred (200) HIV-positive, HAART-naïve patients attending ART centre of excellence were examined between November 2005 to July 2007, for the presence of mucocutaneous manifestations, correlation with CD4 count and analyzed using SPSS software&lt;/span&gt;.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Out of the 200 patients examined, 64.5% (n=129) were found to have mucocutaneous manifestations. Out of those 129 patients 70 (54.3%) were male and 59 (45.7%) were females. Age of the patients ranged from 5 to 62 years with a mean±S.D of 32.08±11.48 yrs. Fungal infections (n=67, 51.9%) were the most common infectious dermatoses, followed by viral infections (n=35, 27.1%), scabies infestations (n=17, 13.2%) and bacterial infections (n=2, 1.6%). Of all the fungal infections, candidiasis (43.28%) was the commonest. Majority (64.5%) of the mucocutaneous manifestations were seen in patients with CD4 count &amp;lt;200 cells/mm&lt;sup&gt;3&lt;/sup&gt; and difference in CD4 count was significantly associated with cutaneous penicilliosis and oral hairy leukoplakia (p&amp;lt;0.044). &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Infectious dermatoses remain as the far most common skin manifestations in HAART naïve patients. Lower the CD4 higher will be the incidence. Rare endemic infections like penicilliosis should be considered in differentials of umbulicated lesions in this part of the country.&lt;/span&gt;&lt;/p&gt;

Asymptomatic urinary tract infection with multidrug resistant pathogens in retro positive patients on ART

Introduction: Asymptomatic urinary tract infection refers to occurrence of bacteria in urine without causing symptoms. UTI is more prevalent among retro positive patients compared to people without HIV. Objectives – The study was done to determine prevalence of UTI, common etiologies and antibiotic susceptibility pattern of urinary isolates among HIV seropositive patients attending ART centre for CD4 counts. Materials & Methods: –A total of 109 patients without any symptoms of UTI were included in the study. AST was done using Kirby Bauer disk diffusion method.CD4 count was done using FACS counter. Results: Out of the 109 cases tested, 55 were males, and 54 cases were females. No growth was seen in 60 (55.04%) samples, insignificant bacteriuria in 9(8.26%) samples. Significant growth was seen in 40 samples (36.7%). Among the 54 females, 44% had significant growth. Among 55 males, significant growth was seen in 29.1%. The isolated organisms included Escherichia coli - 9(22.5%), Staphylococcus aureus - 7(17.5%), Candida albicans - 7(17.5%). Bacterial isolates showing resistance to three or more categories of antibiotics were considered Multidrug resistant (MDR). Multidrug resistance was seen among 16 bacterial isolates (48.5%). HIV positive patients with CD4 counts of <200 had higher rates of asymptomatic bacteriuria. Conclusion: Screening of HIV seropositive patients with lower CD4 counts for asymptomatic UTI helps in early diagnosis and appropriate, early management of MDR will reduce morbidity.

Socio-demographic correlates of HIV-TB Co-infected Patients Attending ART Centre of Jharkhand

Socio-demographic correlates of HIV-TB Co-infected Patients Attending ART Centre of Jharkhand

Clinical and Laboratory Profile of Newly Diagnosed HIVInfected Patients Attending ART Centre, Government Thiruvannamalai Medical College Hospital, Thiruvannamalai

Introduction: Indian subcontinent has one of the highest HIV prevalence rates globally as per WHO. The HIV has reached epidemic proportions in our country and characterised by high rates of morbidity and mortality. Aim of the study: To document, the clinical profile, the laboratory profile, clinical staging and immunological staging based on CD4 count, in 100 randomly selected newly diagnosed HIV infected patients attending ART centre, Government Thiruvannamalai Medical College Hospital, Thiruvannamalai from January 2016 to July 2016. Materials: 100 randomly selected newly diagnosed HIV infected patients attending the ART centre, Government Thiruvannamalai Medical College Hospital, Thiruvannamalai Duration of the study:7 MONTHS Type of study: Descriptive study Sample size: 100

P16.04 Clinico-epidemiological profile of elderly hiv patients attending anti retro-viral therapy (art) centre of a teaching hospital in south india

Introduction Human Immunodeficiency Virus (HIV) infection was previously thought as a disease of the young. Clinicians are now encountering increasing numbers of older HIV patients in routine practice. Management elderly HIV can be challenging as they may present with advanced disease and they may also have multiple co-morbidities. There is a dearth of research in this field from India. The aim of our study was to determine the clinico-epidemiological profile of elderly ART naive HIV patients attending a tertiary care institution. Methodology This cross-sectional study was done in the ART centre attached to a tertiary care hospital of Southern India. Data of 120 patients who were diagnosed to be HIV-positive at or after age of 50 years (elderly HIV) from 2009 to 2014 was analysed after approval from the ethics committee. Sociodemographic and clinical characteristics were described using descriptive statistics. Results Among 786 HIV patients detected from 2009 to 2014, 120 (15.27%) were elderly HIV. Majority of them 82 (68.33%) were males. The mean age of males and females was 56.12 ± 6.88 and 55.34 ± 4.23 years. Heterosexual mode was the commonest mode of acquiring HIV 74 (61.67%). Majority of them 77 (64.17%) were in WHO stage 1. Tuberculosis was seen in 32 (26.6%) The common co-morbidities seen were hypertension 93 (77.5%) and diabetes 8 (6.6%). The median CD4 count (n = 112) at presentation was 245 cells/mm3 (IQR 145–426.2). Late presenters (CD4 less than 200 cells/mm3) were 47 (41.96%). Conclusion In our study 15% of patients attending ART centre were elderly. Majority of them had co morbidities. A significant proportion of them were late presenters. Physicians should have a high index of suspicion in diagnosing HIV in this age group as most of the symptoms of this disease may simulate the process of normal ageing. National programmes and policy makers must focus their attention on geriatric HIV.

A COMPARATIVE STUDY OF ANTIRETROVIRAL THERAPY INDUCED CD4 T-CELL CHANGES AMONG HIV INFECTED PATIENTS

The main objective of the study was to assess the CD 4 induced T - cell changes after initiation of first - line ART in patients attending ART centre, Palakkad, Kerala , India . This study was designed as a hospital based combined prosp ective and retrospective st udy. The data collection was carrie d out from January to July 2014. A total of 261 who were naive to ART w ere included in the study. The majority of the patients were betwe en the age group of 28 - 47 years. The male (49.43 %) and female (50.57 %) populations were almost in similar proportion. 63.60 % were married. 47.12 % of the patients had completed the secondary education. Heterosexual was the major cause for transmission for about 81.23 %. After 24 months of tre atment, CD 4 T - cell increased to 471.52 cells /mm 3 in ZLN/E and increase d up to 514.43 cells/mm 3 in TLN/E. The body mass index was increased to 1.76 kg/m 2 in TLN/E and 1.13 kg/m 2 in ZLN/E. ZLN/E and TLN/E had 82 and 68 HIV infected patients who had acute resp iratory infection, followed by oral candida sis accounting for 53 and 44 . Zidovudine induced anaemia were more common adverse drug reaction followed by nevirapine rashes . The study documented the efficacy of ART regimens and provides information about the improvement of immunological status in HIV i nfected popul ation, who were under the first - line regimen of antiretroviral therapy. The study shows TLN/E is safer than ZLN/E and the efficacy is relatively similar in both the regimens. K e ywords: HIV, ART, ZLN/E, TLN/E.

Scoring the medical outcomes among HIV / AIDS patients attending antiretroviral therapy center at Zonal Hospital, Hamirpur, using patient satisfaction questionnaire (PSQ-18)

To study level of satisfaction among patients attending ART centre using Patient Satisfaction Questionnaire (PSQ - 18). A cross-sectional interview based technique was used to study the level of satisfaction. A total of 59 patients attending ART centre were included in the study. The mean score for general satisfaction was 3.22 (SD 0.86), for technical quality 3.03 (SD 0.92), for the interpersonal manner 3.25 (SD 0.93), for communication (SD 0.90), for financial aspects was 2.38 (SD 1.00) and for time spent during the visit, the mean score was 2.97 (SD 0.98) Patient satisfaction is the key in planning and formulating guidelines for treatment and care.

Scoring the medical outcomes among HIV / AIDS patients attending antiretroviral therapy center at Zonal Hospital, Hamirpur, using Patient Satisfaction Questionnaire (PSQ-18)

Aim:To study level of satisfaction among patients attending ART centre using Patient Satisfaction Questionnaire (PSQ - 18).Materials and Methods:A cross-sectional interview based technique was used to study the level of satisfaction.Results:A total of 59 patients attending ART centre were included in the study. The mean score for general satisfaction was 3.22 (SD 0.86), for technical quality 3.03 (SD 0.92), for the interpersonal manner 3.25 (SD 0.93), for communication (SD 0.90), for financial aspects was 2.38 (SD 1.00) and for time spent during the visit, the mean score was 2.97 (SD 0.98)Interpretation:Patient satisfaction is the key in planning and formulating guidelines for treatment and care.

A Profile Of Patients Registered At Art Centre At Surat Municipal Institute Of Medical Education &amp; Research In Surat City, Gujarat, India

Introduction: An estimated 2.4 million Indians are currently living with HIV. In India, the antiretroviral treatment program started with a free ART treatment in 2003. This study was conducted in order to understand the clinico-epidemiological profi le of patients attending ART centre and the effectiveness of the therapy. Methodology: A cross sectional study was conducted at an ART center of Surat Municipal Institute of Medical Education and Research (SMIMER), in Surat city of Gujarat State. The data of 2357 PLHAs (People Living with HIV/ AIDS) registered at ART centre in one year time duration starting from 21st January 2010 was included in the study. Results: Among the total 2357 subjects, 1483 (63%) were males. In our study 42.3% of patients were between 31 to 40 years of age. Among the employed subjects, 32.9% of patients were laborer. Voluntary Counseling and Testing Centre (VCTC) was most common entry point of patient with 50% followed by private practitioner with 23% and NGOs with 6.2%. Other entry points are self referred, RNTCP etc. Tuberculosis and diarrhoea were the most common opportunistic infections. There was signifi cant improvement in CD4 count, bodyweight and functional status of the subjects after receiving the ART for an average duration of 6 months. Conclusion: The economically productive &amp; sexually active people and those with lesser education are at higher risk of becoming sero-positive. The subjects showed signifi cant improvement after receiving ART with respect to the CD4 count and average body weight. DOI: http://dx.doi.org/10.3126/saarctb.v8i2.5895 SAARCTB 2011; 8(2): 11-16