Current Issue : January - March Volume : 2013 Issue Number : 1 Articles : 6 Articles
In 2009, Government of Kenya with key stakeholders implemented an integrated multi-disease prevention campaign for waterborne\r\ndiseases, malaria and HIV in Kisii District,Nyanza Province. The three day campaign, targeting 5000 people, included testing\r\nand counseling (HTC), condoms, long-lasting insecticide-treated bednets, and water filters. People with HIV were offered on-site\r\nCD4 cell counts, condoms, co-trimoxazole, and HIV clinic referral. We analysed the CD4 distributions from a district hospital\r\ncohort, campaign participants and from the 2007 Kenya Aids Indicator Survey (KAIS). Of the 5198 individuals participating in the\r\ncampaign, all received HTC, 329 (6.3%) tested positive, and 255 (5%) were newly diagnosed (median CD4 cell count 536 cells/�µL).\r\nThe hospital cohort and KAIS results included 1,284 initial CD4 counts (median 348/L) and 306 initial CD4 counts (median\r\n550/�µL), respectively (campaign and KAIS CD4 distributions P = 0.346; hospital cohort distribution was lower P < 0.001 and\r\nP < 0.001). A Nyanza Province campaign strategy including ART <350 CD4 cell count could avert approximately 35,000 HIV\r\ninfections and 1,240 TB cases annually. Community-based integrated public health campaigns could be a potential solution to\r\nreach universal access and Millennium Development Goals....
Since the introduction of antiretroviral treatment, HIV/AIDS can be framed as a chronic lifelong condition, requiring lifelong adherence\r\nto medication. Reinforcement of self-management through information, acquisition of problem solving skills, motivation,\r\nand peer support is expected to allow PLWHA to become involved as expert patients in the care management and to decrease the\r\ndependency on scarce skilled medical staff.We developed a conceptual framework to analyse how PLWHA can become expert patients\r\nand performed a literature review on involvement of PLWHAas expert patients in ART provision in Sub-Saharan Africa. This\r\npaper revealed two published examples: one on trained PLWHAin Kenya and another on self-formed peer groups inMozambique.\r\nBoth programs fit the concept of the expert patient and describe how community-embedded ART programs can be effective and\r\nimprove the accessibility and affordability of ART. Using their day-to-day experience of living with HIV, expert patients are able to\r\nprovide better fitting solutions to practical and psychosocial barriers to adherence. There is a need for careful design of models in\r\nwhich expert patients are involved in essential care functions, capacitated, and empowered to manage their condition and support\r\nfellow peers, as an untapped resource to control HIV/AIDS....
Objective: The purpose of this study was to document the outcome of HIV-infected children receiving the Highly Active Antiretroviral Therapy (HAART) in Togo.\r\n \r\nPatients and method: It was a retrospective and descriptive multicentric national survey based on records of HIV-infected children who started receiving the HAART before the 31st of June 2010. The study was conducted in 14 sites throughout the country.\r\n \r\nResults: 854 children (under 15 years old) out of 1257 monitored in Togo were included in the survey. During the study period, 715 (84%) of those children were stable patients, always watched over at selected sites. To be noted also, 56 deaths (6%), 69 follow-up lost (8%) and 14 transfers to other sites (2%). Death and follow-up losses rates were higher in children under one year with respective percentages 11.9% and 18.6%. The rate of death was 13.7% in the cohort of 2007, 10.8% in the cohort of 2008, 6.5% in the cohort of 2009 and finally 5% in the cohort of 2010. The survival rate at 12 months was greater than 90% in all the cohorts.\r\n \r\nConclusion: This study shows a gradual improvement in the survival rate of HIV-infected children receiving the HAAART from 2007 to nowadays. The survival rate of children receiving the HAART at 12 months is not different from that of adults. So, it is important to improve qualitative and quantitative care of HIV-infected children in public health programs in sub-Saharan Africa....
Background: Despite reports of an increasing incidence of asthma in HIV-infected children, exploration of pulmonary function by spirometry has never been reported in this population in the HAART era.\r\n \r\nObjective: The aim of this study was to determine the prevalence of spirometric abnormalities in HIV-1 infected children. We conducted a cross-sectional study of pulmonary function tests (PFT) in HIV-1 vertically infected children.\r\n \r\nMethods: Spirometric values were measured in 17 HIV-1 chronically infected children and compared to matched healthy children. In HIV-1 infected children, the correlations between PFT and the determination of the single breath carbon monoxide diffusing capacity of the lung (TLCO) and immunological and virological values were assessed.\r\n \r\nResults: Overall, 11 of the 17 PFT were normal. Four showed mild distal obstruction. Two were considered restrictive. When compared with matched healthy children, the only difference was the FEV1/FVC ratio that was significantly lower in the patients� group (91.9% of predicted value versus 97.1%, p<0.0001). We found a positive correlation between TLCO and the CD4/CD8 T-cell ratio (p=0.012) and viral load (p=0.05). We observed that FEF25-75 values increased with age and weight in healthy children (p= 0.006 and p=0.007 respectively), but not in infected patients.\r\n \r\nConclusions: Our results showed that chronic HIV-1 infection and/or continuous HAART exposure induce a specific response of the pulmonary immune system which may compromise its function with time. If confirmed, it may justify a careful follow-up of pulmonary function in vertically infected children....
The predominant route of human immunodeficiency virus type 1 (HIV-1) transmission is across the vaginal and rectal epithelia during sexual intercourse. Yet the development of safe and clinically effective vaginal and rectal antiretroviral microbicides remains an unmet challenge despite more than 25 years of accelerated product development. The clinical failure of seven microbicide candidates points to major unresolved challenges associated with target specificity, safety, potency as well as drug-delivery of validated candidates undergoing preclinical and clinical development as anogenital microbicides. Currently, additional antiretroviral agents are sought as anogenital microbicides to provide potential anti-HIV protection by directly inactivating HIV-1, preventing HIV-1 from attaching, entering or replicating in susceptible target cells, and/or by hindering the dissemination of HIV-1 to the host cells that line the vaginal/rectal walls along with targeting novel HIV-host dependency factors. Among the several types of anti-HIV microbicides currently in preclinical and clinical development, only one clinical trial of an HIV-1 reverse transcriptase inhibitor has shown clinical promise as a potential microbicide. This article reviews the preclinical/ clinical efficacy and safety profiles of current antiretroviral microbicide candidates (Tenofovir, Stampidine, UC-781, Dapivirine/TMC120, MIV-150, HI-443, CCR5 antagonists, neutralizing antibodies, targeted RNA interference, RNAbased aptamers, Aptamer-siRNA-chimeric RNA), as well as advances in multimodal microbicide delivery systems (nanocarriers - liposomes, dendrimers, polymeric, solid lipid and metal nanoparticles, nanospheres, nanocapsules, intravaginal rings and recombinant lactobacilli delivery strategies). The clinical failure of first-generation antiretroviral gels is spearheading efforts to evaluate new mechanism-based antiretrovirals with a rational design and engineering of long-acting and novel delivery systems more appropriate to curb anogenital HIV transmission....
Many HIV-positive pregnant women and infants are still not receiving optimal services, preventing the goal of eliminating motherto-\r\nchild transmission (MTCT) and improving maternal child health overall. A Rapid Results Initiative (RRI) approach was utilized\r\nto address key challenges in delivery of prevention of MTCT (PMTCT) services including highly active antiretroviral therapy\r\n(HAART) uptake for women and infants. The RRI was conducted between April and June 2011 at 119 health facilities in five\r\ndistricts in Nyanza Province, Kenya. Aggregated site-level data were compared at baseline before the RRI (Oct 2010ââ?¬â??Jan 2011),\r\nduring the RRI, and post-RRI (Julââ?¬â??Sep 2011) using pre-post cohort analysis. HAART uptake amongst all HIV-positive pregnant\r\nwomen increased by 40% (RR 1.4, 95% CI 1.2ââ?¬â??1.7) and continued to improve post-RRI (RR 1.6, 95% CI 1.4ââ?¬â??1.8). HAART uptake\r\nin HIV-positive infants remained stable (RR 1.1, 95% CI 0.9ââ?¬â??1.4) during the RRI and improved by 30% (RR 1.3, 95% CI 1.0ââ?¬â??1.6)\r\npost-RRI. Significant improvement in PMTCT services can be achieved through introduction of an RRI, which appears to lead to\r\nsustained benefits for pregnant HIV-infected women and their infants....
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