Current Issue : October - December Volume : 2017 Issue Number : 4 Articles : 7 Articles
HIV/AIDS affects the basic educational sector which is the most productive segment of the population and vital to the creation\nof human capital. The loss of skilled and experienced teachers due to the problem is increasingly compromising the provision of\nquality education in most African countries. The study was proposed to determine the magnitude of VCT utilization and assess\ncontributing factors that affect VCT service utilization among secondary school teachers in Awi Zone. A cross-sectional study\ndesign was conducted among 588 participants in 2014. Self-administered questionnaire was used to collect data. Data was analyzed\nusing SPSS version 16, presented as frequencies and summary statistics, and tested for presence of significant association with odds\nratio at 95% CI. More than half (53.6%) of study participants were tested for HIV. Those who had sexual intercourse, had good\nknowledge about VCT, were divorced/widowed, were in the age group of 20ââ?¬â??29 years, and were married utilized VCT services\ntwo, three, four, three, and two times better than their counterparts, respectively. Actions targeting unmarried status, increase of\neducational level, and teachers with age groups above 30 years are necessary to follow their counterparts to utilize VCT service in\norder to save loss of teachers....
Background: Abacavir and rilpivirine are alternative antiretroviral drugs for treatment-naÃ?¯ve HIV-infected patients.\nHowever, both drugs are only recommended for the patients who have pre-treatment HIV RNA <100,000 copies/mL.\nIn resource-limited settings, pre-treatment HIV RNA is not routinely performed and not widely available. The aims of\nthis study are to determine factors associated with pre-treatment HIV RNA <100,000 copies/mL and to construct a\nmodel to predict this outcome.\nMethods: HIV-infected adults enrolled in the TREAT Asia HIV Observational Database were eligible if they had an HIV\nRNA measurement documented at the time of ART initiation. The dataset was randomly split into a derivation data set\n(75% of patients) and a validation data set (25%). Factors associated with pre-treatment HIV RNA <100,000 copies/mL\nwere evaluated by logistic regression adjusted for study site. A prediction model and prediction scores were created.\nResults: A total of 2592 patients were enrolled for the analysis. Median [interquartile range (IQR)] age was 35.8 (29.9ââ?¬â??\n42.5) years; CD4 count was 147 (50ââ?¬â??248) cells/mm3; and pre-treatment HIV RNA was 100,000 (34,045ââ?¬â??301,075) copies/\nmL. Factors associated with pre-treatment HIV RNA <100,000 copies/mL were age <30 years [OR 1.40 vs. 41ââ?¬â??50 years;\n95% confidence interval (CI) 1.10ââ?¬â??1.80, p = 0.01], body mass index >30 kg/m2 (OR 2.4 vs. <18.5 kg/m2; 95% CI 1.1ââ?¬â??5.1,\np = 0.02), anemia (OR 1.70; 95% CI 1.40ââ?¬â??2.10, p < 0.01), CD4 count >350 cells/mm3 (OR 3.9 vs. <100 cells/mm3; 95%\nCI 2.0ââ?¬â??4.1, p < 0.01), total lymphocyte count >2000 cells/mm3 (OR 1.7 vs. <1000 cells/mm3; 95% CI 1.3ââ?¬â??2.3, p < 0.01),\nand no prior AIDS-defining illness (OR 1.8; 95% CI 1.5ââ?¬â??2.3, p < 0.01). Receiver-operator characteristic (ROC) analysis\nyielded area under the curve of 0.70 (95% CI 0.67ââ?¬â??0.72) among derivation patients and 0.69 (95% CI 0.65ââ?¬â??0.74) among\nvalidation patients. A cut off score >25 yielded the sensitivity of 46.7%, specificity of 79.1%, positive predictive value of 67.7%, and negative predictive value of 61.2% for prediction of pre-treatment HIV RNA <100,000 copies/mL among\nderivation patients.\nConclusion: A model prediction for pre-treatment HIV RNA <100,000 copies/mL produced an area under the ROC\ncurve of 0.70. A larger sample size for prediction model development as well as for model validation is warranted....
Background: Routine laboratory monitoring is part of the basic care package offered to people living with the\nHuman Immunodeficiency Virus (PLHIV). This paper aims to identify the proportion of PLHIVs with clinical and\nimmunological failure who are virologically suppressed and risk being misclassified as treatment failures.\nMethods: A retrospective analysis of patient viral load data collected between January 2013 and June 2014 was\nconducted. Of the patients classified as experiencing either clinical or immunological failure, we evaluated the\nproportion of true (virological) failure, and estimated the sensitivity and specificity of the immunological and clinical\ncriteria in diagnosing true treatment failure.\nResults: Of the 27,418 PLHIVs aged 2ââ?¬â??80 years on ART in the study period, 6.8% (n = 1859) were suspected of\ntreatment failure and their viral loads analysed. 40% (n = 737) demonstrated viral suppression (VL < 1000 copies/ml).\nThe median viral load (VL) was 3317 copies/ml (IQR 0ââ?¬â??47,547). Among the 799 (2.9%) PLHIVs on ART classified as\nhaving clinical failure, 41.1% (n = 328) of them had confirmed viral suppression. Of the 463 (1.7%) classified as having\nimmunological failure, 36.9% (n = 171) had confirmed viral suppression. The sensitivity of the clinical criteria in\ndiagnosing true failure was 61% (CI 58%ââ?¬â??65%) while that of the immunological criteria 38% (CI 35%ââ?¬â??42%). The\nspecificity of the clinical criteria was 34% (CI 30%ââ?¬â??39%) while that of the immunological criteria 66% (61%ââ?¬â??70%).\nAge below 20 years was associated with a high viral load (p < .001). Sex and ART regimen were not associated with\nthe viral load.\nConclusion: Clinical and immunological criteria alone are not sufficient to identify true treatment failure. There is need\nfor accurate treatment failure diagnosis through viral load testing to avoid incorrect early or delayed switching of\npatients to second-line regimens. This study recommends increased viral load testing in line with the Kenyaââ?¬â?¢s ART\nguidelines....
Background: CSF PCR is the standard diagnostic technique used in resource-rich settings to detect pathogens of\nthe CNS infection. However, it is not currently used for routine CSF testing in China. Knowledge of CNS opportunistic\ninfections among people living with HIV in China is limited.\nMethods: Intensive cerebrospiral fluid (CSF) testing was performed to evaluate for bacterial, viral and fungal etiologies.\nPathogen-specific primers were used to detect DNA from cytomegalovirus (CMV), herpes simplex virus (HSV),\nvaricella-zoster virus (VZV), Epstein-Barr virus (EBV), human herpesvirus 6 (HHV-6) and John Cunningham virus (JCV)\nvia real-time polymerase chain reaction (PCR).\nResults: Cryptococcal meningitis accounted for 63.0% (34 of 54) of all causes of meningitis, 13.0% (7/54) for TB, 9.3%\n(5/54) for Toxoplasma gondii. Of 54 samples sent for viral PCR, 31.5% (17/54) were positive, 12 (22.2%) for CMV, 2 (3.7%)\nfor VZV, 1 (1.9%) for EBV, 1 (1.9%) for HHV-6 and 1 (1.9%) for JCV. No patient was positive for HSV. Pathogen-based\ntreatment and high GCS score tended to have a lower mortality rate, whereas patients with multiple pathogens infection,\nseizures or intracranial hypertension showed higher odds of death.\nConclusion: CNS OIs are frequent and multiple pathogens often coexist in CSF. Cryptococcal meningitis is the most\nprevalent CNS disorders among AIDS. The utility of molecular diagnostics for pathogen identification combined with\nthe knowledge provided by the investigation may improve the diagnosis of AIDS related OIs in resource-limited\ndeveloping countries, but the cost-efficacy remains to be further evaluated....
Background. Prevalence and incidence of drug eruptions vary around the world and are influenced by some key factors including\nHIV infection. Objective. This study aimed to find the peculiarities of drug eruptions in people living with HIV (PLHIV) and on\nantiretroviral therapy (ART). Methods. This was a retrospective cross-sectional study including ART-taking PLHIV, aged 15+ years,\nfollowed up between January 2010 and December 2014 at the day-care unit of the Yaound�´e Central Hospital, and who presented\nwith drug eruptions after ART initiation. Results. Of 6,829 ART-experiencing PLHIV, 41 presented with drug eruptions, giving a\nprevalence of 0.6%.TheM/F sex ratio equaled 0.17.Themean age was 41.07 �± 11.36 years. Benign drug eruptions accounted for 83.3%.\nMilder forms were essentially maculopapular exanthema (36.6%), fixed pigmented erythema (7.3%), and urticaria (4.9%). Severe\nforms were represented by multiform erythema (4.9%), toxic epidermal necrolysis (2.4%), and drug hypersensitivity syndrome\n(2.4%). The Zidovudine + Lamivudine + Efavirenz ART-protocol was received by 48.8% of patients and 69% of patients were\nreceivingCotrimoxazole prophylaxis.Nevirapine, Efavirenz, Zidovudine, andCotrimoxazolewere suspected as the potential causes\nin 43.7%, 4.8%, 2.4%, and 26.8% of cases, respectively. Conclusion. Drug eruptions seem infrequent among ART-exposed HIV\ninfected adult Cameroonians....
Background: The XpertÃ?® MTB/RIF (XP) has a higher sensitivity than sputum smear microscopy (70% versus 35%) for\nTB diagnosis and has been endorsed by the WHO for TB high burden countries to increase case finding among HIV\nco-infected presumptive TB patients. Its impact on the diagnosis of smear-negative TB in a routine care setting is\nunclear. We determined the change in diagnosis, treatment and mortality of smear-negative presumptive TB with\nroutine use of Xpert MTB/RIF (XP).\nMethods: Prospective cohort study of HIV-positive smear-negative presumptive TB patients during a 12-month\nperiod after XP implementation in a well-staffed and trained integrated TB/HIV clinic in Kampala, Uganda. Prior to\ntesting clinicians were asked to decide whether they would treat empirically prior to Xpert result; actual treatment\nwas decided upon receipt of the XP result. We compared empirical and XP-informed treatment decisions and\nall-cause mortality in the first year.\nResults: Of 411 smear-negative presumptive TB patients, 175 (43%) received an XP; their baseline characteristics did\nnot differ. XP positivity was similar in patients with a pre-XP empirical diagnosis and those without (9/29 [17%]\nversus 14/142 [10%], P = 0.23). Despite XP testing high levels of empirical treatment prevailed (18%), although XP\nresults did change who ultimately was treated for TB. When adjusted for CD4 count, empirical treatment was not\nassociated with higher mortality compared to no or microbiologically confirmed treatment.\nConclusions: XP usage was lower than expected. The lower sensitivity of XP in smear-negative HIV-positive\npatients led experienced clinicians to use XP as a ââ?¬Å?rule-inââ?¬Â rather than ââ?¬Å?rule-outââ?¬Â test, with the majority of patients\nstill treated empirically....
Backgrounds: There are few studies focus on the factors underlying the late initiation of ART in China. We\nanalyzed the trends in the median CD4 cell counts among different patient groups over time and the risk factors\nfor the late initiation of ART in Shanghai, China.\nMethods: A retrospective cross-sectional survey was made in the Department of Infectious Disease of Shanghai\nPublic Health Clinical Center which is a designated diagnosis and treatment center for HIV-positive patients in\nShanghai during the period of January 1st, 2008ââ?¬â??June 30th, 2014. Late ART initiation was defined as a CD4 cell\ncount <200 cells/mm3 or having a clinical AIDS diagnosis prior to ART initiation. Trends in the median CD4 cell\ncount at ART initiation and the proportion of late ART initiation by year were evaluated using Spearmanââ?¬â?¢s\ncorrelations and Chi-squared methods, respectively. We used a logistic regression model to analyze the risk factors\nfor late ART initiation. The related factors collected in the multivariate model were the patientââ?¬â?¢s age, gender,\ninfection routes and marital status.\nResults: A total of 3796 patients were analyzed in this study, with a median baseline CD4 cell count of 205 cells/mm3\n[interquartile range: 75ââ?¬â??287]. The median CD4 cell counts of patients initiating ART late increased from 76 cells/mm3 in\n2008 to 103 cells/mm3 in 2014 (p < 0.001), and the proportion of late ART initiation decreased from 80% to 45%\n(p < 0.001). The risk factors for late ART initiation were male gender, heterosexual transmission and older age\n(>30 years) (p < 0.001).\nConclusions: Notable improvements were made in the median CD4 cell count at ART initiation and the proportion of\nlate ART initiation from 2008 to 2014. However, persons with high risk of HIV exposure who are male, older even\nheterosexual orientation should be given more opportunities to receive frequently screening, earlier diagnoses and\ntimely treatment....
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