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Quarterly published in print and online "Inventi Impact: Preventive & Social Medicines (Formerly Inventi Impact: AIDS)" publishes high quality unpublished as well as high impact pre-published research and reviews catering to the needs of researchers and professionals. This journal focuses on all the aspects related to HIV/AIDS that help in better understanding of disease and improve the quality of patient care. Articles from following areas are given special emphasis, diagnosis, epidemiology, prevention, treatment, virology & immunology of HIV/AIDS, opportunistic infections and pathogenicity. Articles from social perspective like political economy are also welcome.
Background: South Africa implements variations of second generation suveilance\nsurveys to monitor human immunodeficiency virus (HIV) epidemic.\nObjective : This paper compares HIV estimates from two design variations:\ntake all approach and sub-sampling approach to ascertain if any changes in\nHIV epidemic are due to methodological changes or inherent evolution of the\nepidemic. Methods : A multi-stage stratified cluster sample of 1000 census\nenumerator areas was implemented with 15 households systematically sampled\nwithin each census enumerator area. In each household, every member\nwas invited to participate (take all approach). To compare to the previous\nsurvey designs, a sub-sampling approach of at most four people from each\nhousehold was implemented by randomly sampling one person from each\nage group: <2 years, 2 - 14 years, 15 to 24 years and 25 years and above. Results\n: HIV estimates were comparable with no systematic pattern. Prevalence\nestimates were slightly higher 12.2% [11.4% - 13.1%] in the take all compared\nto 11.6% [10.6% - 12.6%] in the sub-sampling approach. Estimates from\nsub-sampling approach were more variable. The design effects in the take all..................
A number of antiviral agents used against Human Immunodeficiency Virus (HIV) infection and hepatitis B virus\n(HBV) mono or co-infection have been associated with real nephrotoxicity (including tenofovir disoproxil fumarate\n(TDF), atazanavir, indinavir and lopinavir) or apparent changes in renal function (e.g. cobicistat, ritonavir, rilpivirine\nand dolutegravir). Patients with HIV are at higher risk of acute and chronic renal dysfunction, so baseline assessment\nand ongoing monitoring of renal function is an important part of routine management of patients with HIV.\nGiven the paucity of evidence in this area, we sought to establish a consensus view on how routine monitoring\ncould be performed in Australian patients on ART regimens, especially those involving TDF. A group of\nnephrologists and prescribers (an HIV physician and a hepatologist) were assembled by Gilead to discuss practical\nand reasonable renal management strategies for patients particularly those on TDF-based combination regimens\n(in the case of those with HIV-infection) or on TDF-monotherapy (in the case of HBV-mono infection). The group\nconsidered which investigations should be performed as part of routine practice, their frequency, and when\nspecialist renal referral is warranted. The algorithm presented suggests testing for serum creatinine along with\nplasma phosphate and an assessment of urinary protein (rather than albumin) and glucose.\nHere we advocate baseline tests of renal function at initiation of therapy. If creatinine excretion inhibitors (e.g.\ncobicistat or rilpivirine) are used as part of the ART regimen, we suggest creatinine is rechecked at 4 weeks and this\nvalue used as the new baseline. Repeat testing is suggested at 3-monthly intervals for a year and then at least yearly\nthereafter if no abnormalities are detected. In patients with abnormal baseline results, renal function assessment\nshould be performed at least 6 monthly. In HBV mono-infected patients advocate that a similar testing protocol\nmay be logical....
Background\nThree national HIV household surveys were conducted in South Africa, in 2002, 2005 and 2008. A novelty of the 2008 survey was the addition of serological testing to ascertain antiretroviral treatment (ART) use.\n\nMethods and Principal Findings\nWe used a validated mathematical method to estimate the rate of new HIV infections (HIV incidence) in South Africa using nationally representative HIV prevalence data collected in 2002, 2005 and 2008. The observed HIV prevalence levels in 2008 were adjusted for the effect of antiretroviral treatment on survival. The estimated Ã¢â?¬Å?excessÃ¢â?¬Â HIV prevalence due to ART in 2008 was highest among women 25 years and older and among men 30 years and older. In the period 2002Ã¢â?¬â??2005, the HIV incidence rate among men and women aged 15Ã¢â?¬â??49 years was estimated to be 2.0 new infections each year per 100 susceptible individuals (/100pyar) (uncertainty range: 1.2Ã¢â?¬â??3.0/100pyar). The highest incidence rate was among 15Ã¢â?¬â??24 year-old women, at 5.5/100pyar (4.5Ã¢â?¬â??6.5). In the period 2005Ã¢â?¬â??2008, incidence among men and women aged 15Ã¢â?¬â??49 was estimated to be 1.3/100 (0.6Ã¢â?¬â??2.5/100pyar), although the change from 2002Ã¢â?¬â??2005 was not statistically significant. However, the incidence rate among young women aged 15Ã¢â?¬â??24 declined by 60% in the same period, to 2.2/100pyar, and this change was statistically significant. There is evidence from the surveys of significant increases in condom use and awareness of HIV status, especially among youth.\n\nConclusions\nOur analysis demonstrates how serial measures of HIV prevalence obtained in population-based surveys can be used to estimate national HIV incidence rates. We also show the need to determine the impact of ART on observed HIV prevalence levels. The estimation of HIV incidence and ART exposure is crucial to disentangle the concurrent impact of prevention and treatment programs on HIV prevalence....
This case report describes an HIV-positive patient with recurrent tuberculosis in Uganda. After several failed courses\r\nof treatment, the patient was diagnosed with multi-drug resistant tuberculosis (MDR-TB). As adequate in-patient\r\nfacilities were unavailable, we advised the patient to remain at home, and he received treatment at home via his\r\nfamily and a community nurse. The patient had a successful clearance of tuberculosis. This strategy of home-based\r\ncare represents an important opportunity for treatment of patients in East Africa, where human resource\r\nconstraints and inadequate hospital facilities exist for complex patients at high risk of infection to others....
Background: Despite progress in the development of combined antiretroviral therapies (cART), HIV infection\r\nremains a significant challenge for human health. Current problems of cART include multi-drug-resistant virus\r\nvariants, long-term toxicity and enormous treatment costs. Therefore, the identification of novel effective drugs is\r\nurgently needed.\r\nMethods: We developed a straightforward screening approach for simultaneously evaluating the sensitivity of\r\nmultiple HIV gag-pol mutants to antiviral drugs in one assay. Our technique is based on multi-colour lentiviral\r\nself-inactivating (SIN) LeGO vector technology.\r\nResults: We demonstrated the successful use of this approach for screening compounds against up to four HIV\r\ngag-pol variants (wild-type and three mutants) simultaneously. Importantly, the technique was adapted to Biosafety\r\nLevel 1 conditions by utilising ecotropic pseudotypes. This allowed upscaling to a large-scale screening protocol\r\nexploited by pharmaceutical companies in a successful proof-of-concept experiment.\r\nConclusions: The technology developed here facilitates fast screening for anti-HIV activity of individual agents from\r\nlarge compound libraries. Although drugs targeting gag-pol variants were used here, our approach permits\r\nscreening compounds that target several different, key cellular and viral functions of the HIV life-cycle. The modular\r\nprinciple of the method also allows the easy exchange of various mutations in HIV sequences. In conclusion, the\r\nmethodology presented here provides a valuable new approach for the identification of novel anti-HIV drugs....
Background: Chemokines can block viral entry by interfering with HIV co-receptors and are recognised mediators\r\nof atherosclerosis development. A number of experimental drugs that inhibit HIV entry arrest the development of\r\natherosclerosis in animal models. We hypothesised that the expression of chemokine receptors in circulating\r\nleukocytes is associated with the rate of atherosclerosis progression in HIV-infected patients.\r\nMethods: The increase in intima-media thickness during a 2-year follow-up was used to classify HIV-infected\r\npatients (n = 178) as progressors (n = 142) or non-progressors (n = 36) with respect to atherosclerosis. Logistic\r\nregression was used to assess variables associated with atherosclerosis progression. Mutations in the CCR5?32,\r\nCCR2 64I, and CX3CR1 (T280M and V249I) co-receptors as well as the levels of CCR5, CXCR4, CX3CR1, and CCR2\r\nmRNA expression in circulating leukocytes were analysed as independent variables.\r\nResults: Among the baseline variables, only genetic variants explained the dichotomous outcome. The expression\r\nof CCR2 and CXCR4 did not discriminate between progressors and non-progressors. Conversely, CCR5 and CX3CR1\r\nexpression was higher in not only progressors but also patients with detectable viral load. The logistic regression,\r\nhowever, demonstrated a significant role for CCR5 expression as a predictor of atherosclerosis progression\r\n(B = 2.1, OR = 8.1, p = 0.04) and a negligible effect for CXC3R1 and CCR2 expression.\r\nConclusions: Available CCR5 antagonists should be investigated for their potential to delay the course of\r\natherosclerosis in HIV-infected patients....
Background. In Nigeria, various sociocultural and economic factors may prevent women from being retained in HIV care. This
study explores the factors associated with retention in care among women with HIV in a large HIV clinic in Lagos, Nigeria, under
the Test and Treat policy. Methods. Women living with HIV/AIDS (n 24) enrolled in an HIV study at the AIDS Prevention
Initiative in Nigeria (APIN) clinic in Lagos, Nigeria, were interviewed from April 1 to October 31, 2021, using a semistructured
interview guide. Interviews were audio-taped, transcribed verbatim, and the themes were analyzed using the framework of
Andersen and Newman’s Behavioural Model for Healthcare Utilization. Results. The mean age of the respondents was 37.4 ± 9.27
years. The identified themes were as follows: being aware of the antiretroviral medications and their benefits, the household’s
awareness of the respondents’ HIV status, and the presence of social support. Other themes were the presence of a dependable
source of income and the ability to overcome the challenges encountered in obtaining income, ease of travel to and from the clinic
(length of travel time and transportation costs), securing support from the clinic, challenges encountered in the process of
accessing care at the clinic, and the ability to overcome these challenges. Also mentioned were self-perception of being HIV
positive, motivation to remain in care, linkage to care, and intention to stay in care. Conclusion. Several deterring factors to
retention in HIV care, such as nondisclosure of status, absence of social support, and clinic barriers, persist under the Test and
Treat policy. Therefore, to achieve the “treatment as prevention” for HIV/AIDS, especially in sub-Saharan Africa, it is essential to
employ strategies that address these barriers and leverage the facilitators for better health outcomes among women with HIV/
The amruthum nutrimix is a health supplement provided by ICDS to satisfy nutritional requirements of the children of Kerala between the age group of 6 months to 3 years. Under nutrition in children is a wide spread health problem in our country. ICDS address the problem of malnutrition has been unsuccessful even after three decades of implementation. Amruthum nutrimix given to underfive children is not utilized due to tedious mode of preparation and unlikable taste. During the period of community health nursing posting, the researcher visited an anganwadi in Pallithottam where majority of the student children will come to anganwadi at morning with pre processed food packets like bingo, lays and kurkure though each student was the benefactor of amruthum nutrimix. Many parents do not have enough knowledge concerning the nutritive value of it. They use them as poultry feed or wasting the product without knowing its utility. So researcher felt the need to provide awareness regarding the proper use amruthum nutrimix. Quantitative research approach, pre experimental one group pretest posttest design was used in research. The results of the study showed that, the mean pretest score of experimental group is 6.15Â±1.90 and posttest score of experimental group is 12.73Â±2.01. And calculated â??tâ?? value 23.87 is greater than table value at 0.05 level of significance. There was no significant association between levels of knowledge and demographic variables such as age of mother, religion, occupation, education, type of family and annual income. Since the tabulated values were more than calculated value at 0.05 level of significance. The study concluded that, the calculated â??tâ?? value 23.87 is greater than table value at 0.05 level of significance. So there is a significant difference in posttest knowledge scores before and after intervention. This shows that the interventional programme is effective in improving knowledge regarding use of amruthum nutrimix among mothers of under five children in selected urban anganwadis. There was no significant association between levels of knowledge and demographic variables such as age of mother, religion, occupation, education, type of family and annual income. Since the tabulated values were more than calculated value at 0.05 level of significance....
Background: Analytical treatment interruptions (ATI) are commonly used clinical endpoints to assess interventions
aimed at curing HIV or achieving antiretroviral therapy (ART)-free HIV remission. Understanding the acceptability of
ATI amongst people living with HIV (PLHIV) and their HIV healthcare providers (HHP) is limited.
Methods: Two online surveys for PLHIV and HHP assessed awareness and acceptability of ATI, and understanding of
the prospect for HIV cure in the future. Responses were collected from July 2017–January 2018. A descriptive analysis
was performed and similar questions across the two surveys were compared using χ squared test.
Results: 442 PLHIV and 144 HHP completed the survey. 105/400 (26%) PLHIV had ever interrupted ART, 8% of which
were in a clinical trial. Altruistic motivations were drivers of participation of PLHIV in cure related research. 81/135
(60%) HHP would support their patients wishing to enrol in an HIV cure-focused trial, but fewer would promote and
allow such participation (25% and 31% respectively). Compared to HHP, PLHIV were more likely to believe that an HIV
cure would be achievable within 10 years (55% vs. 19%, p < 0.001), had less awareness of ATI (46% vs. 62%, p < 0.001)
and were less likely to have had experience of either participation or enrolment in an ATI study (5% vs. 18%, p < 0.001)
Conclusion: PLHIV were more optimistic about the potential for HIV cure. HHP had more direct experience with HIV
cure-focused studies. Educational strategies are required for both groups to increase understanding around ATIs in
HIV cure research but should be tailored specifically to each group....
Despite the goal of eliminating new human immunodeficiency virus (HIV) infections
in children, mother-to-child transmission is still common in resource-poor countries. The aims of
this study were to assess the occurrence of mother-to-child transmission of HIV (MTCT) by age 18
months, risk factors for transmission, and the implementation of the national prevention of MTCT
(PMTCT) program in a rural hospital in Tanzania. Data were collated from various medical registers
and records. We included 172 children and 167 HIV-infected mothers. Among 88 children (51%)
with adequate information, 9 (10.2%) were infected. Increased risk of MTCT was associated with late
testing of the child (>2 months) [OR = 9.5 (95% CI: 1.8–49.4)], absence of antiretroviral therapy during
pregnancy [OR = 9.7 (95% CI: 2.1–46.1)], and maternal CD4 cell count <200 cells/mm3 [OR = 15.3
(95% CI: 2.1–111)]. We were unable to determine the occurrence of MTCT transmission in 84 children
(49%). The results from this study highlight that there is an urgent need for enhanced efforts to
improve follow-up of HIV-exposed children, to improve documentation in registries and records,
and to facilitate ease of linkage between these....
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