Current Issue : October - December Volume : 2015 Issue Number : 4 Articles : 8 Articles
Background: Estimates of the interval from HIV-1 infection to disease progression may be affected by selection\nbias, and data concerning asymptomatic early seroconverters are limited. We examined the interval until disease\nprogression in HIV-1 seroconverters in whom the timing of infection could be estimated within 1 year before\ndiagnosis.\nMethods: Subjects included newly diagnosed patients at Osaka National Hospital between 2003 and 2010 who\nhad either (1) symptomatic acute HIV-1 infection with a negative or intermediate reaction on Western blotting\nand a positive reaction on an HIV RNA test (symptomatic acute group) or (2) a positive reaction on Western\nblotting at diagnosis and a <1-year interval from the last negative HIV test until the first positive test. The latter\nwas divided into symptomatic recent or asymptomatic recent groups based on the presence or absence,\nrespectively, of any transient fever between the last negative and first positive tests. Disease progression was\ndefined as a fall in the CD4 count to <350 cells/microL on 2 consecutive tests, the start of anti-HIV therapy, or the\nonset of AIDS-indicator diseases. Information was retrospectively collected from medical records.\nResults: Subjects included 210 patients: 91 in the symptomatic acute group, 72 in the symptomatic recent group,\nand 47 in the asymptomatic recent group. In the symptomatic acute (0.8 years) and symptomatic recent\n(2.2 years) groups, the Kaplan-Meier estimate of median interval until disease progression was significantly shorter\nthan that in the asymptomatic recent group (2.9 years). Multivariate analysis by Coxââ?¬â?¢s proportional hazards test\nshowed that the symptomatic acute group (vs. asymptomatic recent group: hazard ratio: 1.93; 95% confidence\ninterval: 1.14ââ?¬â??3.36; p = 0.0140) and a baseline CD4 count of <400 cells/microL (hazard ratio: 3.88; 95% confidence\ninterval: 2.57ââ?¬â??5.96; p < 0.0001) were independent prognostic factors associated with early disease progression.\nConclusions: Symptomatic seroconversion was associated with early disease progression. Furthermore, the\nestimated median interval until the CD4 count was <350 cells/microL was only 2.9 years even in patients with\nasymptomatic seroconversion. These results suggest the importance of early diagnosis in early seroconverters...
Objective\nTo determine the levels of NT-pro BNP in HIV patients over 40 years who are receiving highly active antiretroviral therapy (HAART) and investigating potential independent clinical or laboratory factors.\n\nMethod\nWe determine levels of NT-pro BNP in peripheral blood of HIV patients from Costa del Sol Hospital, over 40 years.\n\nWe collected epidemiological, classical cardiovascular risk factors and variables associated with HIV infection status. The qualitative variables were compared using the ?2 test. NT-proBNP levels were taken as the dependent variable. The association between these levels and the quantitative variables were studied by analysis of variance (ANOVA), and the association with the qualitative variables, using Student�s t test.\n\nResults\nNt-pro BNP levels were determined in 146 HIV patients. We assess the 10-year cardiovascular risk calculated by the Framingham equation, 59 (41.5%) were classified as low risk, 46 (32.4%) as a moderate risk and 37 (26.1%) as a high risk. The higher levels of NT-pro BNP were found in women, and in those patient with lower filtration rate and high levels of triglycerides. An association was also observed between higher levels of NT-proBNP and the recent use of lamivudine and fosamprenavir. After a multivariate analysis we found an association between higher levels of NT-proBNP and the current use of fosamprenavir and a lower glomerular filtration rate.\n\nConclusions\nWe found, with the limitations of a small serie, that higher levels of NTproBNP in HIV patients could be linked to the occurrence of cardiovascular events, this fact suggest that NTpro BNP could be used in patients at moderate or high vascular risk in order to optimise the primary prevention of vascular events....
New evidence has emerged regarding when to commence antiretroviral therapy (ART), optimal treatment\nregimens, management of HIV co-infection with opportunistic infections, and management of ART failure. The 2014\nguidelines were developed by the collaborations of the Department of Disease Control, Ministry of Public Health\n(MOPH) and the Thai AIDS Society (TAS). One of the major changes in the guidelines included recommending to\ninitiating ART irrespective of CD4 cell count. However, it is with an emphasis that commencing HAART at CD4 cell\ncount above 500 cell/mm3 is for public health, in term of preventing HIV transmission and personal benefit. In\ntuberculosis co-infected patients with CD4 cell counts ?50 cells/mm3 or with CD4 cell counts >50 cells/mm3 who\nhave severe clinical disease, ART should be initiated within 2 weeks of starting tuberculosis treatment. The\npreferred initial ART regimen in treatment na�¯ve patients is efavirenz combined with tenofovir and emtricitabine\nor lamivudine. Plasma HIV viral load assessment should be done twice a year until achieving undetectable results;\nand will then be monitored once a year. CD4 cell count should be monitored every 6 months until CD4 cell\ncount ?350 cells/mm3 and with plasma HIV viral load <50 copies/mL; then it should be monitored once a year\nafterward. HIV drug resistance genotypic test is indicated when plasma HIV viral load >1,000 copies/mL while on\nART. Ritonavir-boosted lopinavir or atazanavir in combination with optimized two nucleoside-analogue reverse\ntranscriptase inhibitors is recommended after initial ART regimen failure. Long-term ART-related safety monitoring\nhas also been included in the guidelines....
Background: Little evidence exists on the connections between nutrition, diet intake, and quality of life (QoL)\namong people living with HIV (PLHIV). The study aimed to estimate the prevalence of under-nutrition among\nPLHIV in Nepal, and identify risk factors and assess correlations with PLHIVs� QoL and nutritional status.\nMethods: This quantitative cross-sectional study used Body Mass Index (BMI) as an indicator for nutritional status, and\nadditional information on opportunistic infections (OIs), CD4 count, and World Health Organization (WHO) clinical\nstaging was collected from medical records. Participants were asked to complete surveys on food security and QoL.\nDescriptive analysis was used to estimate the prevalence of under nutrition. To assess associations between nutrition\nstatus and independent variables, bivariate and multivariate analysis was completed. Spearman�s rank correlation test\nwas used to assess the association between nutritional status and QoL.\nResults: One in five PLHIVs was found to be under nourished (BMI <18.5 kg/m2). Illiteracy, residence in care homes,\nCD4 cells count <350 cells/mm3, OIs, and illness at WHO clinical stages III and IV were found to be significant predictors\nof under nutrition. BMI was significantly correlated with three domains of QoL (psychological, social and\nenvironmental).\nConclusion: Nutrition interventions should form an integral part of HIV care programs. Understanding the presence of OI,\ndecline in CD4 count, and advancing WHO clinical stages as risk factors can be helpful in preventing under nutrition from\ndeveloping. Longitudinal research is necessary to further explicate associations between nutritional status and QoL....
We report a rare case of osteonecrosis of the jaw following necrotizing gingivitis in a Japanese AIDS patient.\nIntraoral examination showed exposed necrotic bone in the left mandible and spontaneous loss of teeth. This\npatient was successfully treated with highly active anti-retroviral therapy combined with minimally invasive surgical\nprocedures to remove the osteonecrosis of the jaw....
Codes of confidentiality play an essential role in the intimate discourses in many learned professions. Codes with\nvarious prescriptions exist. The Hippocratic Oath for example, prescribes rewards to the secret keeper, for keeping\nsecret what ought to be kept secret, and punishments for failing. In public health practice, partner notification,\narguably is one endeavor that tests the durability of this secret keeping doctrine of the health professional. We\npresent an interest-analysis of partner notification in the context of HIV service rendition. Using principles-based\nanalysis, the interests of the individual, the state/public health, and the bioethicist�s are discussed. The public health\ninterests in partner notification, which are usually backed by state statutes and evidence, are premised on the\ntheory that partners are entitled to knowledge. This theory posits that knowledge empowers individuals to avoid\ncontinuing risks; knowledge of infection allows for early treatment; and that knowledgeable partners can adapt their\nbehavior to prevent further transmission of infection to others. However, persons infected with HIV often have\ncounter interests. For instance, an infected person may desire to maintain the privacy of their health status from\nunnecessary disclosure because of the negative impacts of disclosure, or because notification without a matching\naccess to HIV prevention and treatment services is detrimental. The interest of the bioethicist in this matter is to\nfacilitate a resolution of these conflicted interests. Our analysis concludes that governmental interests are not\nabsolute in comparison with the interests of the individual. We reiterate that any effort to morally balance the\nbenefits of partner notification with its burdens ought to first recognize the multivalent nature of the interests at play....
Sporotrichosis is an infection caused by a dimorphic fungus of the Sporothrix schenckii complex. Host immunity is an\nimportant factor in the clinical manifestations of the disease. Deeply immunocompromised individuals, especially\nthose infected with the Human Immunodeficiency Virus (HIV) and T CD4 counts < 350 cells/ul lymphocytes, may\npresent with the systemic form of sporotrichosis. This report describes a case of disseminated sporotrichosis caused\nby S. brasiliensis in a patient with advanced AIDS. The skin, lungs, bones and central nervous system were affected.\nMedical treatment involved the administration of amphotericin B, terbinafine, itraconazole and posaconazole.\nPosaconazole was associated with the best clinical response and clearing of the fungus from the central nervous\nsystem....
Background: Trends in prevalence of opportunistic infections (OIs) associated with the human immunodeficiency\nvirus (HIV) in resource poor settings have previously not been well documented. The objective of this study was to\ndescribe the trends in prevalence of Diarrhoea, Bacterial pneumonia, Kaposiââ?¬â?¢s sarcoma, Malaria and Geo helminths\namong HIV positive individuals over a 12 year period in Uganda.\nMethods: Observation data for 5972 HIV positive individuals enrolled with the AIDS support organisation (TASO) in\nUganda were analysed. Study participants were drawn from three HIV clinics located in different geographical areas\nof Uganda and followed from January 2002 to December 2013. The prevalence trends for the above OIs were\nplotted using the Box Jenkins moving average technique. X2-test for trend was used to test for the significance of\nthe trends and Pearsonââ?¬â?¢s correlation coefficient used to test for the strength of linear relationship between OI\nprevalence and calendar time. Mixed effect linear regression was used to estimate average monthly change in\nprevalence with monthly variation modelled as a random effect.\nResults: A total of 204,871 monthly medical reports were retrieved and analysed. 73 % (4301/5972) were female\nwith a median age of 32 years (inter-quartile range 26ââ?¬â??39). Overall, significant decreasing mean annual prevalence\ntrends (p < 0.05, X2\ntrend) were observed for Diarrhoea (<1 month) with Pearsonââ?¬â?¢s correlation coefficient (r = ?0.89),\nMalaria (r = ?0.75), Bacterial Pneumonia (r = ?0.52), and Geo helminth (r = ?0.32). Non-significant increasing mean\nannual prevalence trend was observed for Kaposis sarcoma (p = 0.20, X2\ntrend; r = +0.26). After adjusting for age, sex\nand clinic in a mixed effects linear regression model, average monthly prevalence declined significantly at a rate of\n0.4 % for Kaposis sarcoma, 0.3 % for Geo helminths, 2 % for Malaria, 1 % for Bacterial Pneumonia and 3 % for\nDiarrhoea(<1 month). However, the rate of decline per month differed significantly (p < 0.05) by HIV clinic for\nDiarrhoea (<1 month), and age, sex and clinic for malaria....
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