Journal of AIDS & Clinical Research

Despite the wide access to anti-retroviral medications to combat HIV/AIDS, the Dominican Republic (DR) has the second highest numbers in HIV prevalence in the Caribbean and Latin American region. Knowledge gained from previous research still struggles to explain how socio-cultural factors effect prevention and treatment. Few studies rigorously examine the manner in which Dominicans face unique social and cultural challenges with diagnosis. Syndemic theory frames this paper in order to capture the importance of socio-cultural interconnections within the HIV/AIDS population in the DR. Particularly, this paper focusses on the social and behavioral difficulties of HIV/AIDS prevention and treatment. This study took place in Boca Chica, Dominican Republic, at a small HIV/AIDS clinic near the tourist quarter. Qualitative methodologies are employed with in-depth interviews, memos, and participant observation of group charlas (educative talk sessions), and visits the community medical center and patients' neighborhoods. A syndemic was confirmed of neighborhood effects, malnutrition, and HIV/AIDS diagnosis. Particular attention was paid to disparities of gender, economic class, and employment.

The incidence of anal dysplasia in HIV-positive men who have sex with men (MSM) is increasing. This dysplasia is described as either high-grade anal intraepithelial (HAIN) or low-grade anal intraepithelial (LAIN). Anal squamous cell carcinoma (ASCC) is more frequent in HIV-positive patients and is related to human papillomavirus (HPV) infections, conditions of low systemic immunity and long use of highly active antiretroviral therapy. The anal Pap smear protocol and high-resolution anoscopy seem to be effective for screening for anal dysplasia and early anal cancer. The aim of this study was to identify some factors that could raise the risk of HAIN and LAIN among HIV-positive patients. We evaluated 134 HIV-positive and HIV-negative patients who had previously had anal intercourse, at CRT/AIDS São Paulo from October 2011 to March 2012. HIV-negative patients and HIV-positive patients without recent CD4 lymphocyte counts were excluded. All of the patients underwent the anal Pap smear protocol and high-resolution anoscopy. The anal lesions were treated with 90% trichloroacetic acid (TCA) and 5% imiquimod for 12 weeks. The patients with residual lesions were operated. The statistical analysis was performed using Student’s t test and the significance level was set at less than 5%. 101HIV-positive patients were evaluated (91 males and 10 females), among whom 31 had warts and 3 had LAIN and warts. One patient was operated after the treatment with 90% TCA and 5% imiquimod. In conclusion, HIV-positive patients with anal warts presented low CD4 lymphocyte counts and anal dysplasia.

Objective: Primary aim is to compare contraception practices between adolescent females aged 15-25 years with perinatally vs. behaviorally acquired HIV infection

Design: A retrospective, pilot, chart review of 33 HIV positive adolescent females 15-25 years old, with one or more clinic visits at the Maternal Child and Adolescent Center for Infectious Diseases and Virology from January 1, 2010 to December 31, 2012 was conducted. Secondary outcomes included number of pregnancies, changes in contraceptive method, and condom use. Adolescents with perinatally and behaviorally acquired HIV infection were compared; and both groups were compared to the United States Centers for Disease Control national statistics.

Results: Eighteen (55%) perinatally and 15 (45%) behaviorally HIV infected adolescents were studied. Depo medroxyporgesterone Acetate (DMPA) was the most commonly used contraceptive by the perinatal group (n=7, 39%) and the second most common method in the behaviorally infected group (n=4, 27%). Condoms were the second most commonly used method among perinatally infected adolescents (n=4, 22%). Condoms in addition to a hormonal contraceptive was used by 5 (28%) perinatal and 5 (33%) of the behavioral adolescents. None of the behavioral group used condoms as the exclusive method of contraception. Long Acting Reversible Contraception (LARC) was the most commonly used method by the behavioral group (n=5, 33%). The average number of pregnancies was 2.8 (range 1-5) among adolescents with behaviorally acquired HIV and. 0.4 (range 0-2) among adolescents with perinatally acquired infection (P<0.001).

Conclusion: In this small pilot study, perinatally infected adolescents were more likely to use DMPA or condoms as compared to behaviorally infected adolescents, who were more likely to use LARC or DMPA though these differences were not statistically significant given the small sample size. Future larger studies should explore pregnancy and contraception in these distinct populations

Introduction: In an expanding HAART era, obesity has become a health problem among persons living with HIV (PLWH). Whereas the rising level of obesity has been largely attributed to poor nutrition and exercise habits, differences in biological factors may explain why some individuals gain more weight than others. Thus, our main goal is to prospectively determine in PLWH whether plasma brain-derived neurotrophic factor (BDNF), and hazardous alcohol use (HAU), two overlooked but highly prevalent conditions among PLWH, correlate with an adverse anthropometric profile. Also to test whether these relationships varied in men and women

Methods: The Platelets mediating Alcohol and HIV Damage Study (PADS) is an ongoing multiethnic study of 400 PLWH receiving regular medical care in South Florida (37% females and 63% males). Semi-annual visits consisted of a medical exam, including anthropometrics to assess both general (body mass index: BMI) and central obesity (waist and hip circumferences). Participants also completed health history questionnaires, and provided a fasting blood sample to obtain BDNF and immune and biochemical assessments.

Results: A sizable proportion of participants met the National Institutes of Health definition of overweight (BMI = 25-29.9 kg/m2; 26%) and obese (BMI ≥ 30 kg/m2; 35%). Women were more likely to be obese than men (OR=4.9, 95% CI=2.9-8.2, p=0.0001). Compared to men, women also exhibited the highest mean plasma BDNF levels (9,959 ± 6,578 vs. 7,470 ± 6,068 pg/ml, p=0.0001). Additional analyses indicated that HAU, particularly heavy drinkers, had the smallest waist and hip circumferences if they were males, but the opposite if they were females. High BDNF levels were positively correlated with BMI. Linear regression analysis revealed that gender, BDNF, and HAU were the best predictors of BMI.

Conclusion: In summary, our findings offer novel insights into the relationships between BDNF, and alcohol use among overweight and obese PLWH. Our results also suggest that these relationships may be inherently different by gender.

Background: Treatment options for HIV-infected children failing combination antiretroviral therapy (ART) are limited. We describe lamivudine monotherapy (LM) as a holding strategy for ART-experienced virologically-failing children where a definitive suppressive regimen was not possible.

Methods: A retrospective review of data collected until the end of July 2010 from four sites in Johannesburg, South Africa was performed. Inclusion criteria were age ≤16 years with documented HIV-1 infection and use of LM for at least three months.

Results: Twenty three patients (52% female) were identified. Median age at LM was 8.02 years (IQR: 4.07–11.80). LM was initiated for intractable adherence issues in 20/23 children (87%) and for multi-drug resistance precluding construction of an active new regimen in 3/23 (13%). The median duration of LM was 6.13 months (IQR: 3.93–9.31). At six months post LM initiation, CD4 count decreased by 23% but did not reach pre-ART levels. Neither nadir CD4 (p=0.35) nor pre-LM ART regimen (p=0.50) predicted CD4 count decline. LM was stopped in nine children, seven of whom restarted combination ART. Reasons to restart ART were: immunological progression n=3, disease progression n=1 and adherence issues resolved n=3. The other 14 (60.9%) children were continuing LM at time of data collection. No deaths occurred during follow-up.

Conclusion: LM should be investigated through clinical trial as a short-term holding strategy in paediatric patients, where suppressive ART is challenging due to adherence or drug availability problems.

Point-of-care technologies are a cornerstone for effective HIV care of patients in resource poor settings. They greatly reduce loss to follow up as the patients receive their results immediately and obtain appropriate treatment and other care. There are 593,000 people in urgent need of antiretroviral therapy in Zimbabwe for whom point-of-care technology may be a benefit. The PointCare NOW device was evaluated in order to assess systematic errors between it and conventional flow cytometry and haematology devices, such as the Becton Dickinson FACS Calibur Single Platform and the Sysmex XT-1800i. There being no calibration method for CD4 count on any platform, large systematic errors could affect therapy enrollment decisions. Specimens were collected from 104 patients from the Harare Central Hospital Opportunistic Infection clinic by venipuncture using EDTA tubes. Three samples were automatically excluded as unsuitable for analysis by the PointCare NOW internal control software flag system; for a rejection rate of 2.9%. No other samples were excluded. Each device performed within manufacturer’s replicate precision specifications for all parameters. There was a small but statistically insignificant difference in mean absolute CD4 cell count (+8.6 cells/ μl), mean CD4% (+0.76%) and mean total lymphocyte count (+0.054×103 cells/μl) between the PointCare NOW and the central laboratory systems. There was a small but statistically significant difference in mean total white cell count (+0.28×103 cells/μl) and mean total haemoglobin (-0.74g/dl) measurements and Sysmex XT1800i. We compare two methods for qualifying patients for therapy and show that there was no statistically significant difference between PointCare NOW and FACSCalibur qualifications for either method. One method uses a conventional sharp cut-off and the other uses a newer idea based on patient variability. Our results indicate that the systematic errors determined in our study would not produce disparity in therapy enrollment action taken for a patient receiving results from a PointCare NOW and a FACSCalibur. Our study was completed in 2011 and when compared to other studies carried out in 2009, it suggests that there have been improvements in the PointCare NOW systematic error performance.

Our objective has been the investigation of possible cardiovascular or renal organ damage in HIV patients with confirmed high blood pressure by means of instrumental cardiovascular investigation and renal function evaluation. A total of 265 consecutive patients accessing our outpatient facility were enrolled in the study. Patients with confirmed pathological pressure values or high normal values were submitted to clinical and instrumental monitoring by 24-hour ambulatory blood pressure monitoring (ABPM), to derivation of 12-lead ECG registration, to echocardiography and to epi-aortic vessel echo-color-Doppler. The ECG and echocardiographic data were compared to a control group of 40 hypertensive HIV-negative subjects. Renal damage was evaluated by means of the microalbuminuria/creatininuria ratio on a spot urine sample, plus 24-hour albuminuria and proteinuria measurements. 61 (23.0%) of the subjects examined were hypertensive: 24 (39.3%) had a previous hypertensive diagnosis but had never been treated for this condition, and 37 (60.7%) had a new diagnosis; In 100% of cases, 24-hour ABPM confirmed the hypertension and 27.8% of the patients resulted non-dippers. The ECG showed left ventricle overload, V4-V6 strain, or left ventricular hypertrophy in 64.3% of cases compared to 35.7% in the control group. Echocardiography demonstrated increasing in left ventricle parietal thickness with concentric remodeling and hypertrophy in 85.2% of patients. HIV-positive patients showed a statistically significant tendency to concentric remodeling and concentric hypertrophy, even in presence of mild hypertension. Echocolor-Doppler examination detected intima-media thickness > and/or carotid plaques in 72.1% of patients. Renal function seems spared in these subjects. Our data highlights the importance of investigating arterial hypertension among our patients as it is a frequently undiagnosed condition, and illustrates the utility of 24- hr ABPM to confirm hypertension and to identify the non-dipper subject. Moreover, the ECG, echocardiography and echocolor-Doppler examinations evidenced a premature tendency to organ damage in these patients that showed altered cardiac remodeling compared to those without HIV. This stresses the need for an early diagnosis, including a complete instrumental evaluation to properly identify organ damage even at a subclinical level.