Journal of AIDS & Clinical Research

Considering higher morbidity and mortality associated with HIV/HBV coinfected patients compared to monoinfected patients, it is imperative to determine the prevalence of occult HBV (OHB) infection, in such population.630 unique HIV-infected patients, during the defined study period, were screened for evidence of occult HBV infection serology. 82 patients (13%) were found to have evidence suggestive of OHB infection of which 57 had HBV DNA testing available and comprised the final study population. Data on demographic variables, Hepatitis C antibody status, antiretroviral therapy (ARV), CD4 count and HIV viral load was also collected. Among the final study population, 7% (n=4) patients met the OHB definition. All 4 (100%) with OHB had HIV RNA levels > 50 copies/ml. OHB was found in 4 (22%) of 18 patients not on ARV, but in none of 39 patients on ARV (p=0.007). All patients on ARV were on a regimen with anti HBV activity. 75% of patients with OHB tested positive for HCV compared to 47% in isolated anti HBc positive but HBV DNA negative population (p= 0.58). With an OHB prevalence of 7% in our community clinic, clinicians should have a high index of suspicion for OHB among HIV patients whose hepatitis panel is positive only for anti HBc only and start them on HAART regimen containing ARVs with anti-HBV activity.

Introduction: In Nigeria, gaps between uptakes of Prevention of Mother To Child Transmission of HIV (PMTCT) interventions by HIV-infected women continue to exist with its consequent increase in perinatal HIV epidemic. This study aims to determine the predictors and HIV infection rates among infants and children of mothers of PMTCT Gaps in a major Nigerian city.

Methods: It is a retrospective study that involved infants and children seen at the Federal Medical Centre, Makurdi, between June 2009 and June 2011. The bivariate and multivariable logistic regression models were used to identify risk factors that may predict MTCT of HIV.

Results; A total of 224 subjects comprising 121 males (M) and 103 females (F) with a M: F ratio of 1:0.9 was seen. The median age was 150 days with a range from 4 days to 690 days. MTCT of HIV was 34.4% (77/224). In multivariate analyses and after adjusting for other factors: absence of episiotomy at delivery (Adjusted Odd Ratio –AOR 0.063, 95%CI 0.005-0.773, p=0.031), partial PMTCT interventions involving antiretroviral given to mothers and their babiesafter 72 hours of life, (AOR 0.050, 95%CI 0.005-0.512, p=0.031), mixed feeding (AOR 4.017, 95%CI 1.030-15.665, p=0.045), maternal HIV viral loads of 1001-10,000 copies/ml (AOR 3.207, 95%CI 1.158-8.882, p=0.025) and children presenting at older than 12 months of age (AOR 26.331, 95%CI1.244-557.230, p=0.036) remain independently associated with HIV transmission.

Conclusion: The high prevalence of MTCT of HIV in the present study can be prevented if access, uptake and PMTCT interventions are improved.

Mitochondrial dysfunction is linked to disease, but it remains unclear whether accumulation of random mutations in the mitochondrial genome is the cause of dysfunction. Using digital or near-digital LATE-PCR with Lights-On/Lights- Off probes we have measured the mutational load in mitochondrial genomes. Exposure of HepG2 and CCD-1112Sk cells to AZT for thirty days caused a significant increase in mutations in the three mitochondrial loci examined. These results demonstrate the utility of our method for analysis of mutational load without sequencing and reinforce the fact that mitochondrial DNA damage due to drugs, aging, and disease should be studied in detail.

Background: Depressive disorders are a significant public health issue. They are prevalent, disabling, and often chronic, with a high economic burden to the society. Although depression is common, determining its prevalence across studies and within different segments of the HIV population is not easy, given the variety of methodological issues that warrant consideration. This study estimates the prevalence of depressive disorders and its correlates.

Objectives: The study sought to determine the prevalence of depression among adults, HIV/AIDS respondents, attending HIV/AIDS clinic in Kwara State specialist Hospital, Sobi, Ilorin, Nigeria.

Methods: This was a hospital based, cross sectional, descriptive study of three hundred adult HIV/AIDS patients attending the HIV clinic of Kwara State specialist hospital, Sobi, Ilorin from 1st of March to 30th July, 2013. Informed consent was obtained from the respondents. The PHQ-9 was administered to the respondents to screen for depression. A pre-tested PHQ-9 questionnaire was used to collect data. Subject who scored one and more were assessed clinically for depression. The severity of the depression was further classified as minimal, mild, moderate and severe. The three keys of social determinants of depression (SDS) were assessed and the association with depression sought. Results: One hundred and seventy (56.7%) satisfied the criteria for a depressive disorder using the PHQ-9 score. Depressive symptoms were strongly related to gender, below average year of schooling, poor economic status, low social cohesion, and stressful life events.

Conclusion: Clinicians should assess HIV-infected subjects for depression, to ensure early detection and treatment. Failure to recognize depression may endanger both the subjects and others in the community. This result calls for improved public health education and awareness programme, to highlight the health impact of depressive symptoms among People Living with HIV/AIDS (PLWHA).

Background: HIV infected children who started highly active antiretroviral therapy in antiretroviral therapy clinics have survived to older age, and disclosure has become an essential part of their care. Hence, this study tried to (a) estimate the prevalence of HIV disclosure among school-aged children in Bahir Dar, North West Ethiopia, and (b) assess caregivers’ barriers to disclose their children’s HIV positive status receiving highly active antiretroviral therapy in pediatric antiretroviral therapy clinics.

Methods: Institution based cross sectional study were conducted among 231 caregivers of pediatric antiretroviral therapy children on highly active antiretroviral therapy aged 6-14 years in four centres in Bahir Dar, North West Ethiopia. Caregivers were obtained proportionally and interviewed consecutively with convenience to respond for the structured pre-tested questionnaire. Data were entered into Epi Info version 3.5 and analyzed by using SPSS version 20 software for windows. Bivariate and multivariate logistic regression analyses were done.

Results: The prevalence of disclosure of children’s HIV positive status on highly active antiretroviral therapy was 31.5%. Religion of caregivers (AOR = 4.27 [95% CI = 1.24, 14.73]), family number (AOR = 3.73 [95% CI = 1.11, 12.48]), age of child (AOR = 9.87 [95% CI = 3.47, 28.07]), child age when ART started (AOR = 6.15 [95% CI = 1.76, 21.50]), and children time on ART (AOR = 5.40 [95% CI = 1.87, 15.55]) were found to have statistically significant association with disclosure of HIV positive status to HIV infected children.

Conclusion: Addressing and scaling up efforts on stigma and discrimination in neighbourhood, communities, and school settings; and developing guideline for disclosure of children with HIV/AIDS in Ethiopian context will increase the rate of disclosure of children’s HIV positive status on highly active antiretroviral therapy.

Background: Among women living with HIV infection in the District of Columbia (DC), African American women are disproportionately affected, comprising > 90% of reported cases. Sociostructural exploration of local HIV epidemics among African American women has been understudied. We explored sociostructural correlates of health for HIVinfected African American women in DC to inform local HIV prevention and intervention efforts.

Methods: HIV surveillance data from the District of Columbia Department of Health for African American women living with HIV were reviewed. We analyzed data for sociostructural correlates for progressing to acquired immune deficiency syndrome (AIDS) (CD4 counts < 200 cells/ml) among African American women. Data were analyzed using SAS 9.2 and mapped by census tracts using ArcGIS.

Results: Of 4,619 women living with HIV, 4,204 (91%) were African American; 3,050 (72.5%) had census tract information available and were included. Median age at diagnosis was 36.6 years. Among these 3,050 African American women, 1,814 (59.4%) had ever progressed to AIDS, 1,109 (36.4%) had CD4 counts < 200 cells/μl (AIDS) at most recent clinical visit, and 208 of 1,109 (18.8%) had progressed to AIDS within 12 months of their HIV diagnosis (late testers). Women who progressed to AIDS had a higher probability of being diagnosed at private facilities compared with public facilities (PR=1.1, 95% CI=1.1-1.3) and of being exposed through injection drug use (IDU) compared to being exposed through heterosexual contact (PR=1.3, 95% CI=1.2-1.5). In multivariate and geomapping analyses, poverty, education levels and census tracts were not associated with an AIDS diagnosis.

Conclusion: Progression to AIDS is prevalent among HIV-infected African American women in DC. Increased, early routine HIV screening and intensified treatment efforts with African American women living with HIV infection in DC, regardless of socioeconomic status, are warranted, to improve outcomes and decrease disparities.

Astrocytes play an important role in maintaining an optically suited milieu for neuronal functionality, and are involved in the progression and outcome of many neuropathological conditions. It becomes increasingly evident that astrocytes are significant contributors to HIV-1 associated neurological disorders by modulating the microenvironment in the central nervous system and releasing proinflammatory cytokines. Recent studies have revealed direct metabolic interactions between neurons and astrocytes observed particularly in HIV-1-associated neurological disorders by which astrocytic dysfunctions disregulate extracellular K+ homeostasis, intracellular calcium concentration, glutamate clearance, and blood brain barrier integrity and permeability. Such dysfunctions are amplified via gap junctions, directly or indirectly impacting surrounding neurons and significantly contributing to the pathogenesis of HIV-1-associated neuropathology. In this review, we tentatively address recent progresses on the roles astrocytes may play in HIV-1- associated neurotoxicity.

The engagement of patients with their health care providers (HCP) improves patients' quality of life (QOL), adherence to antiretroviral therapy, and life satisfaction. Engagement with HCP includes access to HCP as needed, information sharing, involvement of client in decision making and self-care activities, respect and support of the HCP for the client's choices, and management of client concerns. This study compares country-level differences in patients' engagement with HCP and assesses statistical associations relative to adherence rates, self-efficacy, self-esteem, QOL, and symptom self-reporting by people living with HIV (PLHIV). A convenience sample of 2,182 PLHIV was enrolled in the United States, Canada, Puerto Rico, Namibia, and China. Cross-sectional data were collected between September 2009 and January 2011. Inclusion criteria were being at least 18 years of age, diagnosed with HIV, able to provide informed consent, and able to communicate in the local language with site researchers. In the HCP scale, a low score indicated greater provider engagement. Country comparisons showed that PLHIV in Namibia had the most HCP engagement (OR 2.80, p < 0.001) and that PLHIV in China had the least engagement (OR -7.03, p < 0.0001) compared to the PLHIV in the Western countries. Individuals having better HCP engagement showed better self-efficacy for adherence (t = -5.22, p < 0.0001), missed fewer medication doses (t = 1.92, p ≤ 0.05), had lower self-esteem ratings (t = 2.67, p < 0.01), fewer self-reported symptoms (t = 3.25, p < 0.0001), and better overall QOL physical condition (t = -3.39, p < 0.001). This study suggests that promoting engagement with the HCP is necessary to facilitate skills that help PLHIV manage their HIV. To improve ART adherence, HCPs should work on strategies to enhance self-efficacy and self-esteem, therefore, exhibiting fewer HIV-related symptoms and missing less medication doses to achieve better QOL.

Approximately 65,000 people live with HIV/AIDS (PLWHA) in Canada and around 82% of declared cases (52,932 cases) of HIV and AIDS are men. Without evidence-based specific interventions, HIV will continue to spread. This scoping review aims to identify evidence on best practice programs for sexual and reproductive health promotion (i.e. HIV/AIDS) targeting men, and to document the best channels for reaching men. English and French language literature indexed in relevant electronic databases was systematically searched. This was complemented by a manual search through five periodicals specializing in men's health. A total of 6608 articles were identified and 39 articles that met all inclusion and exclusion criteria were retained in the synthesis. Three reviewers independently extracted information on: health topic (i.e. HIV/AIDS), design of services (structure and resources), modes of delivery, content of intervention and main outcomes. The preventive practices with the strongest supportive evidence included, just in time information available through electronic channels (website or cell phone). Interventions designed for men only, showed significantly greater effectiveness compared to interventions targeting both men and women. We derived practical recommendations to design an integrated evidence-based preventive intervention targeting men.