Journal of AIDS & Clinical Research

Study background:Poor CD4 T-lymphocyte responses to anti-retroviral treatment (ART) are associated with increased HIV disease progression and mortality. In sub-Saharan Africa a substantial proportion of HIV infected patients are co-infected with TB. This study evaluated the effect of active TB presenting after ART initiation on immunological responses to ART.

Methods: A retrospective cohort study was conducted of patients initiated on ART in a South African academic hospital between 1 January 2004 and 15 May 2008. Changes in CD4 T-lymphocyte count, virological suppression and incident TB episodes occurring in the fi rst year of ART were assessed. Sub-optimal CD4 responses were defi ned as ‘failure to increase CD4 T-lymphocyte count by 50cells/μl at 6 month on ART’.

Results:The cohort for analysis included 691 patients. 141 (20.4%) had sub-optimal CD4 responses at 6 months on ART. 49 patients (7.1%) developed incident TB within the fi rst 12 months of ART. After adjustment for age, sex, baseline CD4 count and detectable viral load, patients with incident TB were found to have a 2.20 times greater odds of a sub-optimal CD4 response at 6 month of ART as compared to those who were TB free (95%CI: 1.14-4.23).

Conclusion:Incident TB was associated with a poor CD4 response during early ART in this cohort. Although the direction of causality cannot be determined from these data, these fi ndings provide additional support for the initiation of ART at higher CD4 counts.

Background: HIV/AIDS remains a major health problem in Sub-Saharan Africa. Co-infection with intestinal parasites has been suggested to worsen the outcome of infection by polarizing the immune response towards Th2. This study investigated the IgE profile in patients with diarrhea and with or without HIV and/or intestinal parasites co-infection at the time of diagnosis.

Methods and Materials: A cross-sectional study was conducted among diarrheic patients with and without HIV/AIDS attending at the outpatient Department of the University of Gondar teaching hospital, in Gondar, Ethiopia. Stool samples were examined using standard parasitological procedures. The presence of HIV antibodies was determined by an enzyme linked immunosorbent assay following the manufacturer’s instruction.

Results: Among tested diarrheic patients, 109 (52.9%) of them were seropositive for HIV. Chronic and acute diarrheas were diagnosed in 114(55.3%) and 92(44.7%) of the patients, respectively. Intestinal parasites were detected in 30(27.5%) among HIV seropositive and 36(37.1%) of HIV seronegative diarrheic patients. Diarrhea and marked weight loss were found to be significantly associated with HIV infection (P<0.05). Median IgE concentration found in HIV positive diarrheic patients (618 IU/ml, IQR 107.25-971.25 IU/ml) was not significantly (P>0.05) higher than in HIV negative diarrheic patients (618 IU/ml, IQR 304.50-739 IU/ml). Significantly higher association of median total IgE level was obtained in diarrheic male patients (624 IU/ml, IQR 325.50-857.25 IU/ml) than diarrheic female patients (490 IU/ml, IQR 39-835 IU/ml), P<0.001. Adjusted estimates of the effects of HIV, age, and helminth infection on IgE concentration, estimated using linear regression did not showed significant associations.

Conclusion:There was a remarkably elevated IgE response in diarrheic patients irrespective of HIV and/or intestinal parasitic infection. The correlation of IgE levels with parasitic infection with or without HIV co-infection as well the immunological and molecular mechanisms of IgE overproduction and its role in HIV infection needs further investigation.

The rationally designed novel anti-HIV drug candidate Stampidine exhibited (a) remarkable subnanomolar to low nanomolar in vitro ARV potency against genotypically and phenotypically NRTI-resistant primary clinical HIV isolates, non-nucleoside reverse transcriptase inhibitor (NNRTI)-resistant HIV-1 isolates, clinical non-B subtype HIV- 1 isolates (subtypes A, C, F, and G) originating from South America, Asia, and sub-Saharan Africa with resistance to stavudine, adefovir and tenofovir, as well as recombinant HIV clones containing common patterns of RT mutations responsible for NRTI resistance such as multiple TAMs plus M184V, multiple TAMs plus T69 insertion, and Q151 complex (b) favorable, safety profile in mice, rats, dogs, and cats, and (c) promising prophylactic in vivo anti-retroviral activity in Hu-PBL-SCID mice as well as therapeutic anti-retroviral activity in FIV-infected domestic cats. Notably, in a placebo-controlled Phase I study involving 30 therapy-naïve adult HIV-infected adult patients, formulated GMP- grade oral Stampidine capsules did not cause dose-limiting toxicity at single dose levels ranging from 5 to 25 mg/kg. Taken together, the presented favorable preclinical and early clinical safety/activity profile of Stampidine warrants its further development as a new anti-HIV drug candidate.

We analyzed the role of cholesterol as a potential mediator of alcohol-increased risk of respiratory infections that required hospitalization in People Living with HIV (PLWH). Using a longitudinal clinic-based design, 346 PLWH were consecutively admitted and followed at Jackson Memorial Medical Center(enrolled in the study). Following national guidelines, PLWH were stratified according to cholesterol levels: <150 mg/dl (Hypocholesterolemia= HypoCHL), 151-200, and >200 mg/dl Hypercholesterolemia =HyperCHL), and compared on the basis of clinical outcomes, lymphocyte phenotypes and behavioral risks. Analyses indicated that compared to HyperCHL participants, HypoCHL subjects were more likely to be hospitalized, particularly for lower respiratory tract infections (LRTI). Excessive admissions were associated with more deviant lymphocyte profiles, particularly limited NK cells. In logistic regression analyses, smoking (OR=1.5), HypoCHL (OR=7.7), and alcohol (OR=1.2) were predictors of LRTI. These findings warrant further investigation of the potential use of HypoCHL as a risk marker, and the cost-effectiveness of switching prevention gears towards HypoCHL, alcohol and tobacco in PLWH.

Purpose: This study examined the social and contextual factors associated with continued high risk sexual behaviors among male-to-female transgender (MTFTG) adolescents living with HIV/AIDS. The study is part of a larger qualitative study of 59 racial/ethnic minority adolescents living with HIV/AIDS. Methods: In-depth focused interviews were conducted with five MTFTG adolescents (16-24 years) living with HIV. Content analysis was conducted to identify themes related to continued sexual risk behaviors. Results: Four out of five of MTFTG adolescents reported inconsistent condom use since their HIV diagnosis. Transgender stigma contributed to financial vulnerability leading to the adoption of sex work to support themselves. Sex and drugs were used to manage transgender stigma and sexual risk-taking with sex work partners was influenced by financial vulnerability. Conclusions: MTFTG adolescents with HIV have unique psychosocial needs related to transgender stigma and structural needs to decrease financial vulnerability that contribute to risky sexual behavior.

Adolescent and young adult minority women account for approximately 20% of new cases of HIV in this age group each year in the United States. It is vital to understand factors that influence sexual risk behavior in this population in order to prevent secondary transmission of HIV. As part of a larger qualitative study of youths living with HIV, in- depth interviews were conducted with 26 Black and Latina young women aged 16 to 24 years, infected with HIV through heterosexual transmission. The study explored factors related to continued unprotected sex with male partners. Since learning of their HIV infection, 23% reported multiple episodes of unprotected vaginal and/or anal sex, 27% reported condom use for some but not all of the time, 42% reported condom use all of the time and 7% were not sexually active. Among the highest risk participants partner refusal to use a condom, having the same HIV sero-status as partner, negative attitudes toward condoms, beliefs about HIV transmission, and fear of disclosure to new partners were associated with risky sex. The data suggests that more research is needed to develop more intensive interventions that address the role of gender power inequity for this sub-set of young women living with HIV

Background and purpose: HIV/AIDS prevalence among Asian-American Pacific Islanders (APIs) is low yet rapidly increasing. Prior research from other populations indicates that HIV risk behaviors are associated with specific adverse/risk factors including depression, drug use, history of child sexual abuse, and forced sex. However, no studies have explored the attitudes about sexual risk behaviors and condom use between API women with adverse experiences versus women without such experiences. This qualitative study compares descriptions of sexual history and condom use between the two groups of women. Methods: A random sample of 24 sexually active API women (16 in the adverse group and 8 in the nonadverse group) was selected for in-depth interviews from a larger study, which included 501 Korean, Chinese, and Vietnamese survey participants. Findings: 14 out of the 16 women in the adverse group described complex sexual histories, with greater number of partners, more casual partners, and the combined use of alcohol/drugs and sex. The 8 women in the nonadverse group had fewer partners who were more long term. However, for both groups of women, condom use was inconsistent. Also, the majority of the women in both groups reported that either they themselves or they together with their partners had decided whether or not to use condoms. Yet 4 women in the adverse group showed lower gender power, with their partners being the primary decision-maker for condom use. Conclusion: Given the inconsistent condom use for both groups, all women in this study were at risk for HIV/ AIDS. Consistent with prior research, a sub-group of the women in the adverse group with lower gender power seemed particularly at higher risk. Future HIV prevention interventions need to target all API women while screening for lower gender power to identify those with the highest risk of HIV.

Background: Alcohol plays a role at the different points in the natural history of HIV/AIDS: This article focuses on the health implications of harmful alcohol consumption in the era of antiretroviral therapy. Aim: To explore the role of alcohol in HIV disease progression, in order to improve HIV patient management and overall better HIV prognosis. Methods: An examination of studies pertaining to the behavioral, biological and bio-chemical aspects of alcohol consumption on the pathogenesis of HIV. Findings: Alcohol consumption impacts on HIV progression resulting in increased morbidity and mortality. Alcohol consumption reduces compliance with ARV regimens, resulting in additional premature mortality. Both alcohol and HIV modulate innate and adaptive immunity and alcohol consumption for HIV-positive individuals increases the likelihood of viral replication and leads to increased susceptibility to contract opportunistic infections and other co-morbid conditions. The situation is further compounded by drugs used for the treatment of the opportunistic infections and other co-morbid conditions and their potential interactions with alcohol. The liver also metabolizes both alcohol and ARV drugs and alcohol-related liver toxicity results in compromised liver function with ARVs not working optimally and an increased risk of serious toxicity from antiretroviral therapy. Discussion: Very diverse measures of alcohol consumption have been used in studies on interactions between alcohol and HIV, making it difficult to compare studies and draw definitive conclusions. It is essential to acquire clear evidence-based guidelines on alcohol consumption for HIV-positive patients and their health-care providers. The variables alcohol, HIV and ART and their myriad interactions have not been clearly delineated. The multiple effects from HIV, alcohol and ART may compound each other, making it difficult to disentangle presenting adverse reactions and specifically the associations with alcohol. Furthermore findings in this arena are particularly relevant for prevention and treatment of HIV in countries such as South Africa that have high HIV and alcohol health burdens and have committed to an extended ARV rollout.

Bleaching of syringes has been advocated to prevent HIV transmission among injection drug users (IDUs). In this paper, a simple mathematical model is developed to assess the role of bleaching and individual withdrawal on controlling HIV among intravenous drug users. A threshold dimensionless quantity known as the reproductive number ( R 0 ) has been derived and qualitatively used to assess the impact bleaching and individual withdrawal of symptomatic HIV carriers (from drug injection misuse activity) on controlling HIV epidemic among intravenous drug users. Latin Hypercube Sampling has been used to assess the amount and type of change inherent in the model as captured by the terms that define the ( R 0 ). At best this study suggests that bleaching is more effective on controlling HIV among intravenous drug users compared to withdrawal of symptomatic HIV carriers from drug injection misuse activity. Furthermore, the study suggest that, the use of antiviral drugs can substantially reduce the rate at which individuals progress to full blown AIDS, thereby increasing the life expectancy of individuals within the community.

South Africa has one of the fastest growing rates of new HIV infection in the world. It is estimated that 5.7 million people in South Africa were infected with HIV. A combination of poverty, illiteracy, migrant labour, commercial sex workers and disruption of family and communal life has increased the individual’s risk of infection. The purpose of this study was to explore and describe the psychological experiences of HIV/AIDS by infected persons in Hospital A in the Vhembe district of Limpopo Province. The research design was qualitative, exploratory and descriptive, using the phenomenological approach. The target group for this study were males and females who visited the institution seeking health care, whose blood samples were found to be HIV positive, between the ages of 18 and 49 years at Hospital A in the Vhembe district of Limpopo Province. A convenience sampling method was used. Data was collected through in-depth unstructured one-to-one interview. Three phases suggested by Miles and Huberman were used which are: data display; in data reduction and lastly during data interpretation. Measures to ensure trustworthiness and ethical issues were ensured. The effects of HIV/AIDS on the infected persons were identified and the following theme and sub-theme: Psychological experiences, factors contributory to psychological imbalance and observations. Living with HIV/AIDS poses tremendous psychological and physical challenges to those who are infected. The experience of HIV-related symptoms is a significant part of that challenge. The physical and psychological symptoms are profoundly disruptive and impact on almost every aspect of daily life.

China has a growing HIV/AIDS epidemic mostly among intravenous drug users. The purpose of this study was to examine the HIV/AIDS related knowledge and risk behaviors among a group of former intravenous drug users utilizing services at a methadone clinic in Guangxi Zhuang Autonomous Region. A sample of 140 methadone care recipients was surveyed on their demographic characteristics, drug-using behaviors, sexual behaviors, and factors related to risk behaviors including HIV/AIDS related awareness and knowledge. Although HIV/AIDS related knowledge was high, respondents reported that they did not use condoms, they shared needles, and they participated in commercial sex. Additionally, the respondents’ perception of their risk for HIV infection was not always in accordance with their reported risk behaviors. This research suggests that methadone care recipients could act as a bridge population for HIV transmission to populations not involved with intravenous drug use. Further research on former intravenous drug users in China and their risk behaviors is warranted.

Background: HIV prevention has rarely explored the impact of childhood sexual abuse (CSA) across health domains among African American men who have sex with men and women (MSMW). Early sexual experiences may influence perceptions of gender roles, sexual identity, and risks for HIV/AIDS. The attribute of masculinity is commonly associated with strength and success. However, a legacy of racism and oppression may pose challenges for African American men in achieving gender-based milestones. Instead, proxies for success may include masculinity constructs with hypersexual posturing and prowess that contradict sexual health messages. Methods: Two groups, each meeting twice for 90-minutes, of HIV-positive African American MSMW participated in discussions focusing on masculinity and sexual experiences. Participants were bisexual HIV-positive African American men who engaged in unprotected sex and had histories of CSA. Discussions were recorded, transcribed, and analyzed using consensual qualitative research and a constant comparison qualitative method. Results: Participant mean age was 40.5 years (n=16). Majority had a high school education (69%), half were unemployed, and almost two-thirds earned less than $20,000 annually. Three themes, each with two subthemes, emerged that described the sociocultural context for engaging in high-risk sexual behaviors, and included: 1) the importance of inhabiting a "traditional" masculine gender role with: a) general and b) sexual masculine traits; 2) the influence of conceptions of masculinity on sexual identity with the associations: a) between being gay and being effeminate and b) between being gay and being HIV-positive, and; 3) CSA experiences with: a) appraisal of CSA and b) early sexual experiences as rites of passage. Conclusion: Attempts to be masculine may contribute to high-risk sexual behaviors. Research needs to explore how early sexual experiences shape perceptions of masculinity and masculinity\'s influence on receiving health messages for African American MSMW who may prioritize a specific image over sexual risk reduction

Background: Over the last decade, the incidence of positive HIV test reports within the Saskatoon Health Region (SHR), Saskatchewan, and Canada has been rapidly rising. Injection drug use (IDU) has been widely recognized as the major etiological factor for this increase. This study sought to assess the prevalence, characteristics, and risk indicators of higher risk injection drug use (HR IDUs) in comparison to lower risk injection drug use (LR IDUs) within the SHR, Saskatchewan, and Canada. Methods: This is a cross sectional study. Study participants were selected over an eight month period spanning from 2009 to 2010. During that time period current IDUs (n = 603) were interviewed and stratified into either the HR IDUs (n = 182) or LR IDUs (n = 421) categories depending on their drug use behaviours and needle and paraphernalia sharing practices. Results: This study found that HR IDUs were more often engaged in giving sex to get drugs and giving drugs to get sex than LR IDUs. HR IDUs also had significantly more sexual partners and a higher frequency of injection than LR IDUs. Logistic regression analysis, determined three covariates that independently predicted being a HR IDU including homelessness, having experienced sexual assault as a child, and lack of knowledge related to HIV/AIDS. Conclusions: The findings of the present study provide valuable information to health care professionals and a useful context based on which public health initiatives can be designed to specifically target IDUs, who are most at risk in developing HIV and subsequently transmitting the disease.

This paper reports on a feasibility study that examined contingency management among out-of-treatment, heterosexual methamphetamine users and the reduction of drug use and HIV risk. Fifty-eight meth users were recruited through street outreach in Denver from November 2006 through March 2007. The low sample size reflects that this was a pilot study to see if CM is feasible in an out-of-treatment, street-recruited population of meth users. Secondary aims were to examine if reductions and drug use and risk behavior could be found. Subjects were randomly assigned to contingency management (CM) or CM plus strengths-based case management (CM/SBCM), with follow-up at 4 and 8 months. Participants were primarily White (90%), 52% male and averaged 38 years old. Eighty-three percent attended at least one CM session, with 29% attending at least fifteen. All participants reduced meth use significantly at follow-up. Those who attended more sessions submitted more stimulant-free urines than those who attended fewer sessions. Participants assigned to CM/SBCM attended more sessions and earned more vouchers than clients in CM. Similarly, participants reported reduced needle-sharing and sex risk. Findings demonstrate that CM and SBCM may help meth users reduce drug use and HIV risk.

This paper is the first in mainland Tanzania to report on sexual practices and HIV perceived risk of Men who have Sex with Men (MSM). A total of 150 MSM with a mean age of 21.3 were recruited using a respondent-driven sampling. Their median age at first anal sex was 12.2 and their median number of lifetime sexual partners was 35. The majority (94.0%) of the respondents reported more than two sex partners in the three months preceding the survey, and 32.0% reported involvement in heterosexual relationships. Two-thirds of the participants had low HIV perceived risk, which was associated with involvement in heterosexual relationships (AOR, 3.6, 95% CI: 1.015.0), lower condom use (AOR, 0.3, 95% CI: 0.2-0.7), alcohol consumption (AOR, 6.0, 95% CI: 2.3-16.9) and lower likelihood of ever having been tested for HIV (AOR, 0.3, 95% CI: 0.1-0.9). Focuses in HIV prevention have excluded MSM and our results indicate the need to consider this group in HIV programming in Tanzania.