Young HIV Research Articles

Transitioning behaviourally infected HIVpositive young people into adult care: Experiences from the young person’s point of view

Background. There is limited literature on the transition of young people living with HIV/AIDS (YPLHIV) from adolescent/young adult HIV care to adult HIV care in sub-Saharan Africa. Objective. We aimed to share the experiences of HIV-seropositive young adults transitioning into adult care, to inform best practice for such transitioning. Methods. We conducted a retrospective evaluation of the transition of 30 young adults aged ≥25 years from our adolescent/young adult HIV clinic at the Infectious Diseases Institute, Makerere University, Kampala, Uganda, to adult HIV healthcare services between January 2010 and January 2012. Results. Six major themes emerged from the evaluation: (i) adjustment to adult healthcare providers, (ii) the adult clinic logistics, (iii) positive attributes of the adult clinic, (iv) transfer to other health centres, (v) perceived sense of stigma, and (vi) patient-proposed recommendations. A model for transitioning YPLHIV to adult care was proposed. Conclusion. Th ere is a paucity of evidence to inform best practice for transitioning YPLHIV to adult care in resource-limited settings. Ensuring continuity in HIV care and treatment beyond young adult HIV programmes is essential, with provision of enhanced support beyond the transition clinic and youth-friendly approaches by adult-oriented care providers. S Afr J HIV Med 2013;14(1):20-23. DOI:10.7196/SAJHIVMED.885

Transitioning behaviourally infected HIVpositive young people into adult care: Experiences from the young person’s point of view

Background. There is limited literature on the transition of young people living with HIV/AIDS (YPLHIV) from adolescent/young adult HIV care to adult HIV care in sub-Saharan Africa.
 
 Objective. We aimed to share the experiences of HIV-seropositive young adults transitioning into adult care, to inform best practice for such transitioning.
 
 Methods. We conducted a retrospective evaluation of the transition of 30 young adults aged ≥25 years from our adolescent/young adult HIV clinic at the Infectious Diseases Institute, Makerere University, Kampala, Uganda, to adult HIV healthcare services between January 2010 and January 2012.
 
 Results. Six major themes emerged from the evaluation: (i) adjustment to adult healthcare providers, (ii) the adult clinic logistics, (iii) positive attributes of the adult clinic, (iv) transfer to other health centres, (v) perceived sense of stigma, and (vi) patient-proposed recommendations. A model for transitioning YPLHIV to adult care was proposed.
 
 Conclusion. Th ere is a paucity of evidence to inform best practice for transitioning YPLHIV to adult care in resource-limited settings. Ensuring continuity in HIV care and treatment beyond young adult HIV programmes is essential, with provision of enhanced support beyond the transition clinic and youth-friendly approaches by adult-oriented care providers.
 
 S Afr J HIV Med 2013;14(1):20-23. DOI:10.7196/SAJHIVMED.885

Proximal Tubule Function and Free Water Clearance: Comparison between Healthy Elderly and Young HIV+ Patients

In previous studies it was documented that proximal tubule sodium reabsorption capability was preserved in healthy elderly, while Thick Ascending Loop of Henle (TALH) one was reduced. Aim: Since, it has also been documented that senile changes are accelerated in HIV patients, we performed a prospective study in order to evaluate if there was a significant difference in proximal and TALH function between healthy elderly and HIV patients. Methods: Proximal and TALH was analyzed by performing hyposaline infusion test in 10 young (≥ 18-≤ 40 years old) HIV volunteers under treatment with tenofovir, free of viral charge, and normal renal function: serum creatinine, urinary sediment, and renal ultrasound), with the control group made up of 10 healthy old volunteers (≥ 65 years old). Results: During the test, it was observed that the HIV group had a significant reduction of natremia (HIV: 133 ± 1 mmol/l vs. healthy elderly: 139 ± 1 mmol/l, p=0.03), serum osmolarity (HIV: 276 ± 4 mOsm/l vs. elderly: 288 ± 3 mOsm/l, p=0.03) and free water clearance (HIV: 3.5 ± 3 ml/min/1.73 m² vs. elderly: 5 ± 8 ml/min/1.73 m², p ≤ 0.01). Besides, HIV patients showed an inadequate and significant increase in their urinary tonicity in comparison with the healthy elderly group: HIV: 170 ± 18 mOsm/l vs. elderly: 90 ± 10, p ≤ 0.01. Regarding proximal tubular function, it was found that it was preserved in both groups. Conclusion: Proximal tubule sodium reabsorption was normal, while free water clearance was significantly reduced in young HIV patients in comparison with healthy elderly volunteers.

The prevalence of anal human papillomavirus among young HIV negative men who have sex with men

Men who have sex with men (MSM) especially those who are HIV positive are at risk for HPV-associated anal cancer. We systematically reviewed studies with data on the prevalence of vaccine preventable anal HPV among men who have sex with men aged 25 or younger and identified 6 studies. None of these studies were specifically designed to determine the prevalence of HPV in this population. Available data, albeit limited, suggest many young MSM may not already be HPV infected. Further studies using representative sampling focused on teenage MSM are required to confirm this.

Palliation in Adolescent and Young Adult HIV Medicine—An Emerging Need

Journal of Palliative MedicineVol. 15, No. 11 Letters to the EditorPalliation in Adolescent and Young Adult HIV Medicine—An Emerging NeedChristine KatusiimeChristine KatusiimeSearch for more papers by this authorPublished Online:1 Nov 2012https://doi.org/10.1089/jpm.2012.0318AboutSectionsView articleView Full TextPDF/EPUB ToolsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Palliation in Adolescent and Young Adult HIV Medicine—An Emerging Need." , 15(11), pp. 1167–1168FiguresReferencesRelatedDetailsCited byEarly Use of the Palliative Approach to Improve Patient Outcomes in HIV Disease: Insights and Findings From the Care and Support Access (CASA) Study 2013-201927 August 2020 | American Journal of Hospice and Palliative Medicine®, Vol. 38, No. 4Young Adult Palliative Care6 November 2013 | American Journal of Hospice and Palliative Medicine®, Vol. 32, No. 1 Volume 15Issue 11Nov 2012 InformationCopyright 2012, Mary Ann Liebert, Inc.To cite this article:Christine Katusiime.Palliation in Adolescent and Young Adult HIV Medicine—An Emerging Need.Journal of Palliative Medicine.Nov 2012.1167-1168.http://doi.org/10.1089/jpm.2012.0318Published in Volume: 15 Issue 11: November 1, 2012PDF download

Axillary Tuberculous Lymphadenitis: a Case Report and a Literature Review

INTRODUCTION: Tuberculosis (TB) still accounts for a high burden disease. It has been estimated that one third of the world population is infected with M. tuberculosis, the most residing in developing countries. In Brazil, according to literature, about twenty five percent of population is infected by Koch s bacillus and approximately 100, 000 new cases per year are registered. Extra-pulmonary TB accounts for 7-30 percent of all TB cases, and Seventeen to forty-three percent of that cases are lymphadenitis. The lymph node tuberculosis is the second most common manifestation of extra-pulmonary TB. The Cervical lymph nodes are most commonly affected, and axillary lymph nodes are involved in only 3. 8-20. 3 percent of TB lymphadenitis. Axillary tuberculous lymphadenitis is rare and has major prevalence between 20 and 50 years old. It can be confused with Breast carcinoma or can exist both at the same time. REPORTING: M. D. S. R. , 66 years old, female, reported the appearance of a hardened nodule in the right axillary for six months. In the physical check-up, it was found a hardened nodule and a skin thickening in the right axillary extension. A mammography and ultrasonography were made on both Breast and the findings of they showed two high density lymph nodes and 2 images with heterogeneous texture in the right axillary extension. Also, a Tomography of the chest was made and it showed a residual lesion in the right lung. The patient was submitted to an excisional biopsy of the right axillary lymph nodes. The Histopathologic evaluation demonstrated the presence of lymph node tuberculosis, presence of chronicle granulomatous lymphadenitis and presence of central caseous necrosis, favoring tuberculous etiology. The treatment for the axillary tuberculous lymphadenitis was conducted with rifampin, isoniazid and pyrazinamide for one year. DISCUSSION: Our patient was from Paraiba, Northeast of Brazil. In 2011, 1. 087 new cases of TB were diagnosed in the state. Risk factors of TB lymphadenitis include young age, female, and HIV infection, but it can occur in patients of old ages without HIV infection, as we have seen in this patient. Mammographic and ultrasonography features of the axillary lymph node in our patient were not as helpful in diagnosis as the biopsy of the lymph node. Axillary tuberculous lymphadenitis diagnosis depends on the complete pathological examination. TB was supposed to be considered in the differential diagnosis of patients who present with axillary lymphadenopathy, especially in the endemic areas of TB. KEYWORDS: Tuberculosis, Lymphadenitis, Axillary.

High prevalence of ECG variations and abnormalities in young and healthy TaMoVac 01 HIV vaccine trial volunteers from Tanzania

Vaccinia immunizations have caused peri-/myocarditis. As a result, volunteers receiving Modified Vaccinia Ankara (MVA) are monitored with ECGs. Early Repolarization Syndrome(ERS) has been reported in 1-2% and Left Ventricular ypertrophy(LVH) in <10% of young, healthy populations across different ethnicities. These changes have been described as normal ECG variations, and according to early reviews, are more frequent in African and Asian populations. A prevalence of 90% has been reported for ST-Elevation in young males in several studies from industrialized and developing countries. ECG was performed in healthy HIV negative volunteers during screening for the Phase II ”TaMoVac01” HIV Vaccine Trial in DarEsSalaam and Mbeya, Tanzania. ECG variations that could potentially interfere with the later interpretation of myocarditis/pericarditis were confirmed by a panel of international cardiologists and led to exclusion from the study. These were ST-segment elevation, T-wave abnormalities, signs of LVH and ERS. 263 Volunteers (mean age 24.4 years, 63.5% males) had a baseline ECG evaluation performed. 19% of ECGs showed ERS, 20.3% showed LVH and 77% showed ST-elevation. 22.1% of volunteers were screened out due to ECG findings, none of whom had a history of cardiac disease, although one participant had a systolic murmur which led to echocardiogram. Dilation of the left ventricle was diagnosed. Although the prevalence of ST elevation was no higher than expected in young males, ERS and LVH was far more common than the literature suggested in this cohort of clinically healthy, young Tanzanians.Exclusions were due to the presence of more than one abnormality. None had symptoms that were clinically relevant, although a significant cardiac finding was revealed through chocardiogram in one participant. The clinical benefit of ECG screening in the context of vaccine studies in healthy volunteers remains to be determined, but it is clear from this study that it added considerably to the number of screenouts.

Vitamin D status in young HIV infected women of various ethnic origins: Incidence of vitamin D deficiency and possible impact on bone density

Decreased bone mineral density (BMD) was reported in HIV infected patients. Mechanisms leading to this decrease are poorly understood. To assess factors relating to BMD in young HIV infected Israeli women of Ethiopian and Caucasian origin. 75 young HIV infected women aged 34.5 ± 8.5 followed up at the Institute of Allergy, Clinical Immunology & AIDS filled a questionnaire about sun exposure, daily calcium intake and dress habits. Data about HIV status and treatment regimens were collected from the patients' charts. Serum hydroxyvitamin D [25(OH)D] levels, bone turnover markers and bone densitometry were evaluated. 28 (65%) of Ethiopians and 2 (6.25%) of Caucasians had 25(OH)D serum levels <10 ng/ml (vitamin D deficiency), p = 0.001. 21 (67.7%) Ethiopians and 16 (39%) Caucasians avoided sun exposure, p = 0.019. Mean daily calcium intake was 491 ± 268.6 mg and 279 ± 252.6 mg, respectively, p = 0.001. Z scores < -1 found at Lumbar spine in 26 (89.7%), at Femoral neck in 20 (69%) at Total hip in 17 (58.6%) of vitamin D deficient patients compared to 20 (48.8%), 17 (41.5%), 9 (22%), in patients with 25(OH)D > 10 ng/ml, p < 0.01, <0.03, <0.001, respectively. Significantly more Ethiopian than Caucasian women covered their face (32.3% and 9.5%, p = 0.003) and hands (58.1% and 30.9%, p = 0.03). There was no difference in bone turnover markers levels. Poorer vitamin D status was observed in Ethiopian women might be one of the important factors related to lower BMD in this group.

Source Credibility and Evidence Format: Examining the Effectiveness of HIV/AIDS Messages for Young African Americans

Using experimental methodology, this study tests the effectiveness of HIV/AIDS prevention messages tailored specifically to college-aged African Americans. To test interaction effects, it intersects source role and evidence format. The authors used gain-framed and loss-framed information specific to young African Americans and HIV to test message effectiveness between statistical and emotional evidence formats, and for the first time, a statistical/emotional combination format. It tests which source—physician or minister—that young African Americans believe is more effective when delivering HIV/AIDS messages to young African Americans. By testing the interaction between source credibility and evidence format, this research expands knowledge on creating effective health messages in several major areas. Findings include a significant interaction between the role of physician and the combined statistical/emotional format. This message was rated as the most effective way to deliver HIV/AIDS prevention messages.

A Tale Of Two Epidemics Within TWO Countries

A Tale Of Two Epidemics Within TWO Countries

STD and HIV Testing Behaviors Among Black And Puerto Rican Young Adults

Given the high rates of infection among urban young adults, STD and HIV testing promotion is a public health priority. To inform future testing efforts, lifetime and recent testing behaviors of this population within casual and serious relationships should be better understood. Data from a 2007-2008 study conducted in select neighborhoods in Hartford and Philadelphia were used to examine self-reported STD and HIV testing behaviors and attitudes among 483 sexually active black and Puerto Rican young adults aged 18-25. Multivariate ordered logit regression analyses were conducted to assess characteristics associated with lifetime number of STD tests. More than eight in 10 participants reported having been tested for STDs, and a similar proportion for HIV, most of them multiple times. Nineteen percent had ever had an STD diagnosis. A majority-86%-perceived their risk of STD infection in the next year as "not at all likely." Sixty-one percent of those in serious relationships reported that both partners had been tested, compared with 25% of those in casual relationships. Characteristics associated with higher lifetime number of STD tests were being female (odds ratio, 2.2), being from Philadelphia (2.5), being black (1.5), having lived with two or more serious partners (1.7) and having ever received an STD diagnosis (2.3). Despite their risks, participants did not perceive themselves to be at risk of STDs. However, they did report testing repeatedly. Testing was highly acceptable, particularly within serious relationships. Questions about the timing of testing initiation and repeat testing merit attention for the benefits of widespread testing to be fully realized.

P2-352 Youth HIV prevalence and sexual behaviour indicators: evidence from Nigeria

IntroductionYouths are particularly vulnerable to HIV/AIDS, sexual and reproductive health problems, which are major challenges to their health and development. There is a need to estimate HIV prevalence and understand...

Pharmacokinetics of Ethionamide in Children

Ethionamide (ETH), a second-line antituberculosis drug, is frequently used in treating childhood tuberculosis. Data supporting ETH dose recommendations in children are limited. The aim of this study was to determine the pharmacokinetic parameters for ETH in children on antituberculosis treatment including ETH. ETH serum levels were prospectively assessed in 31 children in 3 age groups (0 to 2 years, 2 to 6 years, and 6 to 12 years). Within each age group, half received rifampin (RMP). Following an oral dose of ETH (15 to 20 mg/kg of body weight), blood samples were collected at 0, 1, 2, 3, 4, and 6 h following 1 and 4 months of ETH therapy. The maximum serum concentration (C(max)), time to C(max) (T(max)), and area under the time-concentration curve from 0 to 6 h (AUC(0-6)) were calculated. Younger children were exposed to lower ETH concentrations than older children at the same mg/kg body weight dose. Age correlated significantly with the AUC after both 1 month (r = 0.50, P = 0.001) and 4 months (r = 0.63, P = 0.001) of therapy. There was no difference in the AUC or C(max) between children receiving concomitant treatment with RMP and those who did not. Time on treatment did not influence the pharmacokinetic parameters of ETH following 1 and 4 months of therapy. HIV infection was associated with lower ETH exposure. In conclusion, ETH at an oral dose of 15 to 20 mg/kg results in sufficient serum concentrations compared to current adult recommended levels in the majority of children across all age groups. ETH levels were influenced by young age and HIV status but were not affected by concomitant RMP treatment and duration of therapy.

Young caregiving and HIV in the UK: caring relationships and mobilities in African migrant families

AbstractRecent research in Sub‐Saharan Africa has revealed the importance of children's caring roles in families affected by HIV and AIDS. However, few studies have explored young caregiving in the context of HIV in the UK, where recently arrived African migrant and refugee families are adversely affected by the global epidemic. This paper explores young people's socio‐spatial experiences of caring for a parent with HIV, based on qualitative research with 37 respondents in London and other urban areas in England. In‐depth semi‐structured interviews were conducted with young people with caring responsibilities and mothers with HIV, who were predominantly African migrants, as well as with service providers. Drawing on their perspectives, the paper discusses the ways that young people and mothers negotiate the boundaries of young people's care work within and beyond homespace, according to norms of age, gender, generational relations, and cultural constructions of childhood. Despite close attachments within the family, the emotional effects of living with a highly stigmatised life‐limiting illness, pressures associated with insecure immigration status, transnational migration, and low income undermined African mothers' and young people's sense of security and belonging to homespace. These factors also restricted their mobility and social participation in school/college and neighbourhood spaces. While young people and mothers valued supportive safe spaces within the community, the stigma surrounding HIV significantly affected their ability to seek support. The paper identifies security, privacy, independence, and social mobility as key dimensions of African young people's and mothers' imagined futures of ‘home’ and ‘family’. Copyright © 2009 John Wiley &amp; Sons, Ltd.

“Get Them While They’re Young”: Reflections of Young Gay Men Newly Diagnosed With HIV Infection

Thirty years into the epidemic, young men who have sex with men (YMSM) continue to be the largest at-risk group for HIV infection in the United States. In this qualitative study, face-to-face confidential interviews were conducted with 10 recently diagnosed YMSM. The purpose of the study was to explore the factors that may have contributed to each young man's recent HIV diagnosis and to solicit his perspectives on the design and efficacy of existing HIV prevention programs. Content analysis of the interview data revealed four major themes: personal risks, lack of relevant education, accessing the Internet, and the need for mentors. The informants in this study recommended the formulation of age-specific education interventions and the development of HIV prevention interventions that match the sophistication level and needs of today's gay youth to reduce the number of new HIV infections in YMSM.

Young people, sex and HIV

This article reflects on the challenges faced by HIV positive and negative young people becoming sexually active in the UK and introduces the idea that clinical psychologists may be well placed to encourage the development of ‘sexual competence’.

Atypical Meningioma in a Young HIV Patient

Although intracranial lymphoma is the most common primary intracranial tumor among AIDS patients, we report a 25 years old HIV positive patient with a recent onset of seizures for which he was evaluated with brain scan and was found to have a left frontal lesion with cystic necrotic appearance. Pathological examination confirmed an atypical meningioma WHO grade II. This would be the seventh case in the literature of a meningioma in an HIV positive patient. doi:10.4021/jmc40w

Young Women's Marital Status and HIV Risk in Sub-Saharan Africa: Evidence from Lesotho, Swaziland and Zimbabwe

Abstract This paper examines whether marriage increases the risk of HIV infection among women aged 15-24 in Lesotho, Swaziland and Zimbabwe. We find that in all the three countries, the risk of infection is significantly lower for never-married young women than ever-married young women; however, the difference in risk disappears when we control for age, educational attainment, household wealth, and area of residence. Thus, our result highlights the importance of socio-economic and demographic factors in analyzing the link between marital status and HIV risk among young women. Particularly, our findings show that age and education play a crucial role in determining the level of HIV/AIDS risk for young women. The result also implies that marriage as an institution does not necessarily elevate the risk of HIV infection among young women.

High Prevalence of Pneumocystis jiroveci Colonization Among Young HIV-Infected Patients

Pneumocystis colonization in young HIV-infected patients has been poorly studied. The aim of this study was to analyze the prevalence of P jiroveci colonization in a cohort of young HIV-infected patients. We designed a basal cross-sectional study in 20 young HIV-infected patients to determine the prevalence of P jiroveci colonization in oropharyngeal wash samples studied by nested polymerase chain reaction (PCR). Subsequently, patients were followed up during 50 weeks to observe the development of Pneumocystis pneumonia (PCP). P jiroveci colonization was detected in eight (40%) of the 20 oropharyngeal wash samples. Genotype 85C/248C was the most frequent. After 50 weeks of follow-up, one colonized patient with advanced immunodepression developed PCP. We have found a high prevalence of P jiroveci colonization in young HIV-infected patients with a major prevalence of genotype 1 (85C/248C). Further studies are necessary to clarify if Pneumocystis colonization could be a potential risk factor of developing PCP in young HIV infected patients.

“I look forward. I feel insecure but I am ok with it”. The experience of young HIV+ people attending transition preparation events: a qualitative investigation

Transition programmes which prepare young people with HIV to manage the medical, social and psychological consequences of the condition can provide clinical benefits for both young people and their families. The London-based Looking Forward Project (LFP) is embedded within a National Health Service HIV family clinic. The project uses a group work approach and aims to equip HIV+ young people over the age of 12 years who know their status with the emotional, psychological and behavioural skills necessary to face the challenges of living with HIV. This small scale qualitative study investigated the experience of attendance, explored factors which facilitated participation in the groups and investigated the impact on their lives as a result of participation. Participants reported that the LFP events were educational but different to school-like activities, being with other young people reduced isolation and that receiving a voucher was an incentive to attend. Participation was facilitated through family support. Attendance at the LFP facilitated a positive attitude towards medication and hope for the future.