Journal of AIDS & Clinical Research

Background: Human immunodeficiency virus/acquired immunodeficiency syndrome is among the leading causes of infectious diseases morbidity and mortality worldwide. A common manifestation of enteric involvement of HIV is diarrhea. Diarrhea affects approximately 90% of patients with AIDS in developing countries and 30-60% of AIDS patients in developed countries. The purpose of the study is to identify potential factors associated with occurrence of diarrheal diseases among adult peoples living with HIV who are currently attending ART clinics in Jimma town. Methods: Institutional based unmatched case control study was conducted in Jimma town. A 95% confidence interval is desired with 80% statistical power and 1:1 ratio of controls to cases. Samples were taken consecutively and data were collected using a interviewer-administered structured questionnaire. Bivariate analysis was done to identify candidates for multivariate analysis and multivariate analysis was done to identify potential risk factors of diarrheal diseases among adult peoples living with HIV/AIDS. Results: Male sex (AOR=2.276; 95% CI:1.079, 4.800), public water point (AOR=4.972; 95% CI: 2.408, 10.266), absence of squat hole cover (AOR=2.763; 95% CI: 1.276, 5.980), waste disposal in garbage container (AOR=7.676; 95% CI: 1.776, 33.188), pets/animals in the house (AOR=2.260; 95% CI: 1.153, 4.427), not having refrigerator (AOR=3.343; 95% CI: 1.274, 8.774), previous GIT disorder (AOR=4.254; 95% CI: 1.647, 10.987) and history of diarrhea (AOR=3.966; 95% CI: 1.896, 8.295) were potential risk factors of diarrheal diseases. Conclusions: Diarrheal disease were associated with gender, environmental and clinical factors such as public water point, non-use of latrine covers, presence of pets in the house, solid waste disposal in garbage container, absence of refrigerator, history of clinically diagnosed GIT disorder and previous history of diarrhea which suggested that hygiene and sanitation should be the core of basic preventive care package to prevent diarrheal disease.

Background: Healthcare providers are in constant risk of exposure to Human Immunodeficiency Virus (HIV)during their routine practice. This makes it paramount to evaluate their knowledge, attitude and practice of Post-Exposure Prophylaxis (PEP). Since this will determine their likely line of action if exposed to HIV. Therefore, this study aimed to determine their level of knowledge, altitude and practice of PEP among Primary health care workers in Enugu State.
Method: The study was a descriptive cross sectional study conducted in Enugu state, South East Nigeria. Data were collected from 129 health workers in 10 primary health centers using questionnaire adopted from the US guideline for the management of occupational exposure. Data was analysed using SPSS
Result: About 86% (111/129) had knowledge of PEP, 92.2% (119/129) agreed that PEP reduces the risk of occupational HIV and 29% (38/129) treated themselves with PEP on exposure aggressively, while 71% (91/129) were not serious with PE treatment. On their practice of PEP, 17.8% (23/129) were frequent, 26.4% (34/129) practice is sometimes, 27.9% (36/129) were regular and 27.9% (36/129) do not practice PEP.
Conclusion: The gap between the impressive knowledge or attitude on PEP by the healthcare workers and their poor practices is unacceptable. A study to determine factors that contribute to the poor practices can provide solution on how to improve on their practice and therefore, reduces the risk of getting infected when exposed to HIV.

Reproductive age women proportion with HIV-infection increasing, but relationship of antioxidant deficiency and reproductive disorders in this category of patients remain unclear. Objective: To identify antioxidant vitamins deficiency and frequency of reproductive disorders interrelations in women with HIV-infection. 53 women of reproductive age with HIV-infection were divided for 4 groups according to blood serum vitamins concentration: 36 women - α-tocopherol level less than 12 μmol/L; 17 women - α-tocopherol level in the range 12-24 μmol/L; 35 women with retinol level less than 1.05 μmol/L and 18 women - retinol level in the range 1.05-2.8 μmol/L. Spectral fluorofotometric methods were used. Statistical analysis was performed by parametric and non-parametric methods High incidence of menstrual disorders (63%), infertility (36.1%), and luteal phase deficiency was found in the group
of women with HIV-infection and α-tocopherol deficiency. Elevated levels of primary lipid peroxidation (LP) products- diene conjugates, with the absence of significant differences in the content of the thiobarbituric acid reactants in this group were registered. The results obtained showed a close relationship of α-tocopherol deficiency and disorders of the reproductive system in women with HIV-infection. It is a significant reason to recommend including of antioxidant drugs in HIV-women patients of complex pathogenetic therapy to regulate adequately their reproductive function and possibly to preserve reproductive ability in these women.

Reducing viral-load measurements to annual testing in virologically suppressed patients increases the estimated mean time those patients remain on a failing regimen by 6 months. This translates to an increase in the proportion of patients with at least one Thymidine Analogue Mutation from 10% to 32% over one year.

Background: Prevention and control of HIV/AIDS among Muslim communities using religious principles and practices helps to prevent HIV/AIDS epidemic. Therefore, monitoring and evaluation of outcome achievements will shape policy implications.
Methods: A mixed method design using both qualitative and quantitative data collection methods was performed to verify the project achievements, best practices on strategic campaign and strengthening partnership and networking for project management among Muslim communities.
Results: A total of 60 trainees were selected from 10 communities as peer educators in a training of trainer program to conduct training activities on HIV/AIDS prevention and control among Muslim communities. Best practices focused on people’s perceptions that HIV/AIDS reflects the morals and ethics of community members, using the Noble Al Quran to teach people on appropriate sexual behaviours, to sacrifice themselves for others, and to strengthen partnership and networking through religious leaders, community leaders, housewives, village health volunteers and teenagers as a change agent for sustainable project management. Regarding 84% of returned questionnaires from the target communities, the respondents had their knowledge on HIV/AIDS prevention and transmission and their awareness on HIV/AIDS severity in a moderate to high level. There mean scores of knowledge and awareness between male and female respondents were not significant different. Around 59.5% of them reported on sexual experiences and preventive behaviours. In all, 30% had sexual experiences and100% denied having sex with HIV patients but only 20% always used condoms when having sex. Among 70% who never have sexual experience, 56.7% will always use condom when having sex.
Conclusions: The Noble Al Quran helped Muslims to realize appropriate sexual behaviours. Religious leaders are the catalysts of HIV/AIDS prevention and sex education that can be expanded as a nationwide program in every Islamic school.

As globalization progressively connects and impacts the health of people across the world, collaborative research partnerships provide mutual advantages by sharing knowledge and resources to address locally and globally relevant scientific and public health questions. Partnerships undertaken for scientific research are similar to business collaborations in that they require attention to partner systems, whether local, international, political, academic, or non-academic. Scientists, like diplomats or entrepreneurs, are representatives of their field, culture, and country and become obligatory agents in health diplomacy. This role significantly influences current and future collaborations with not only the immediate partner but with other in country partners as well. Research partnerships need continuous evaluation of the collaboration’s productivity, perspectives of all partners, and desired outcomes for success to avoid engaging in “research tourism”, particularly in developing regions. International engagement is a cornerstone in addressing the impact of infectious diseases globally. Global partnerships are strategically aligned with national, partner and global health priorities and may be based on specific requests for assistance from the partnering country governments. Here we share experiences from select research collaborations to highlight principles that we have found key in building long-term relationships with collaborators and in meeting the aim to address scientific questions relevant to the host country and strategic global health initiatives.

Objective: To evaluate the safety and tolerability of RAL therapy and the rapidity with which RAL decreases viral load in HIV-infected pregnant women.
Methods: Women were considered for inclusion in the study if they were HIV-seropositive, ≥18 years of age, and received RAL during pregnancy. Men, non-pregnant women, or those that did not meet the inclusion criteria were not considered. HIV viral load, CD4 count (absolute), pregnancy demographics, antiretroviral regimens, adverse events, liver function enzymes, and APGAR scores were collected.
Results: Eight HIV-infected RAL-naïve pregnant women presented between 6 to 39.4 weeks gestational age with a median RNA viral load of 41,083 copies/mL at the initiation of RAL. From the initiation of RAL until delivery, the median decline in RNA viral load was 1.60 log. At delivery, two patients reached <48 copies/mL and two had <500 copies/mL. The median RNA viral load at delivery was 911 copies/mL. No adverse events in the mother or neonate due to RAL therapy were noted during this study.
Conclusions: These results support the safe and efficacious addition of RAL to HAART regimen to decrease RNA viral load late in pregnancy if a patient is not yet virologically suppressed. Further prospective study is needed.

Introduction: Iceland is well suited for epidemiological research due to well-kept patient records, easy followup of patients and nation-wide health care databases. This study provides a nationwide 30-year epidemiological overview of the HIV epidemic in the country.
Materials and methods: Retrospective study on all HIV positive individuals in Iceland, 1983-2012. Clinical data, CD4+ T-cell counts, plasma HIV RNA, proportion of late presenters and effectiveness of combined antiretroviral therapy (cART) were compared by different time intervals.
Results: In total, 313 were diagnosed with HIV in 1983-2012, thereof 222 (71%) men and 91 (29%) women. Most infections (65%) were acquired outside the country. Mean incidence of HIV was 3.7/100,000 inhabitants/year, with a significant increase in 2010-2012 (p=0.0113), related to misuse of the prescription drug methylphenidate among intravenous drug users. Official prescriptions for this drug increased from 3.5 in 2002 to 17.4 defined daily doses/ 1,000 inhabitants/day in 2012. Mortality decreased by 70% during the study period (p=0.0275). Proportion of late presenters decreased from 74% in the first decade to 36% during the third (p=0.0001). After 6 months of ART, CD4+ T-cells increased by only 26 cells/μl on average during the monotherapy era (1987-1995; p=0,174), by 107 cells/μl during the early-cART era (1996-2004; p<0.0001) and by 159 cells/μl during the late-cART era (2005-2012; p<0,0001). Similarly, progressively greater reductions in plasma HIV RNA were observed from 1996-2004 to 2005-2012 (p<0.0001).
Conclusions: HIV incidence remained relatively low in Iceland until 2010, when it increased significantly due to spread among IDUs. The majority of HIV infections diagnosed in Iceland were imported. With ever more effective drug treatments on CD4+ T-cells and plasma HIV RNA, the number of AIDS diagnoses and deaths has decreased dramatically.
 

Aim: To analyze HCV care and treatment in HIV-HCV coinfected patients and their evolution between 2006 and2013, in France.Patients and

methods: HIV-HCV consecutive seropositive patients were prospectively included in two crosssectional
studies from April 3 to 10, 2006 (n=416) and from April 8 to 15, 2013 (n=342). A standard data collection
form was used.
Results: Patients in 2013 compared to those in 2006 had undetectable HIV viral load and negative HCV viremia more often (82% vs. 69%, and 48% vs. 27%, respectively), with more frequent co-infection by HCV genotype 1 and 4. Liver biopsy was done less frequently (5% vs. 35%). Non-invasive liver damage assessment was done more frequently (42% vs. 22%), using serum biomarkers (37% vs. 67%) or liver-stiffness methods (69% vs. 11%). A sustained virological response to HCV treatment was more frequent (50% vs. 30%). In both surveys, patients who had received HCV treatment compared to those who had never been treated were more often of European origin, had better control of their HIV infection, had more frequent liver damage assessments and were less frequently infected by a genotype 4.
Conclusion: In comparison to 2006, more co-infected patients in 2013 had better control of their HIV infection, had liver damage assessment, received HCV treatment and more frequently had a sustained virological response. New anti-HCV combinations with greater efficacy and less toxicity should soon modify the present picture.

Objective: Just as HIV prevention programs need to be tailored to the local epidemic, so should evaluations be country-owned and country-led to ensure use of those results in decision making and policy. The objective of this paper is to describe the process undertaken in Ghana to develop a national evaluation plan for the Ghana national strategy for key populations. Methods: This was a participatory process that involved meetings between the Ghana AIDS Commission (GAC), other partners in Ghana working to prevent HIV among key populations, and MEASURE Evaluation. The process included three two-day, highly structured yet participatory meetings over the course of 12 months during which participants shared information about on-going and planned data and identified research questions and methods. Results: An evaluation plan was prepared to inform stakeholders about which data collection activities need to be prioritized for funding, who would implement the study, the timing of data collection, the research question the data will help answer, and the analysis methods. The plan discusses various methods that can be used including the recommendation for the study design using multiple data sources. It has an evaluation conceptual model, proposed analyses, proposed definition of independent variables, estimated costs for filling data gaps, roles and responsibilities of stakeholders to carry out the plan, and considerations for ethics, data sharing and authorship. Conclusion: The experience demonstrates that it is possible to design an evaluation responsive to national strategies and priorities with country leadership, regardless of stakeholders’ experiences with evaluations. This process may be replicable elsewhere, where stakeholders want to plan and implement an evaluation of a large-scale program at the national or subnational level that is responsive to national priorities and part of a comprehensive monitoring and evaluation system.

The authors report a case of histoplasmosis in an Aids patient who took HAART irregularly for the past 10 years. He presented pulmonary symptoms and cutaneous lesions on the face. Therapy with amphotericin B followed by itraconazol controlled the fungal infection. Physicians who deal with Aids patients must be aware of the possibility of this mycosis especially when there is a low CD4 count.

Currently, AIDS represents the most common risk factor for the development of cryptococcosis. Despite of rapid scale-up of antiretroviral therapy programs and global investement in HIV care over the past decade, the decline in incidende and mortality rates associated with cryptococcosis has not been commensurate. This article puts into context recent diagnostics studies and morphologies - with special attention to laboratory diagnosis based on classical mycology: (a) histopathology through the histochemical techniques of hematoxilin and eosin, periodic acid-Schiff, and Grocott’s silver, as well special histochemical techniques such as Mayer’s mucicarmine and Fontana-Masson; (b) cultures by Sabouraud’s medium, brain-heart infusion agar, canavanineglycine- bromothymol blue agar, in addition to niger seed agar medium and lysis-centrifugation blood-culturing technique; (c) serology by cryptococcal antigen test and cryptococcal antigen lateral flow assay. In this paper, we also discussed the new rapid point-of-care lateral flow assay to be used to screening HIV-infected person with CD4 counts of less than 100 cells /μL. It is noteworthy that laboratory findings should be interpreted considering the clinical and epidemiological history of all patients. Consequently, diagnostic tools are only properly used, if the treating physician is aware of the propensity of patients to acquire a fungal infection

Background: Sexual risk behaviour is a global health concern. Unsafe sex practices increase the risk of HIV transmission to sex partners. This study assessed the knowledge of HIV transmission and sexual risk behaviours of patients accessing antiretroviral therapy (ART) in secondary health facility in Nigeria. Methods: In a cross sectional study, a study-specific questionnaire was self-administered to randomly selected 350 out of 5770 patients accessing ART. A midpoint of Likert-type scale was determined; and values above were positive while below were negative. Chi square was used for inferential statistics at 95% confidence interval. Results: Of participants, 57.1% were female and 28.6% aged ≥ 40years old. Knowledge of routes of HIV transmission and risk reduction associated with condom use was negative. Participants had positive attitudes to non-disclosure of HIV sero-status, multiple sex partners and unprotected sexual intercourse. Majority (63.7%) had one sex partner, 16% had >1 sex partners and 12.6% had none. Number of sex partners was associated with sex, marital and occupational status (P<0.05) unlike educational status; 66.2% of those who had one sex partners were married; 56.9% and 46.7% of those who had >1 sex partners were males and retirees respectively. Majority (66.3%) disclosed HIV sero-status to sex partners but only 62.6% knew HIV sero-status of their sex partners. Disclosure was associated with marital status (P<0.05) unlike sex and educational status. Only 28.9% consistently used condom during sexual intercourse; and 67.6% of them were aged >30 years old, while 55.7% were married. Consistent use of condom was associated with marital status and age (P<0.05) unlike educational status. Conclusion: There were poor knowledge of routes of HIV transmission and benefits of condom use. Few participants consistently used condom during sexual intercourse. Majority had one sex partner and disclosed HIV sero-status to sex partners. Ongoing counselling and education should be integrated into HIV prevention strategies

Abstract Introduction: There is a growing concern about the increasing rates of Loss to Follow up (LTFU) among people who are on HIV/AIDS treatment programs. It is more common in resource-poor settings. However little is known about the time to LTFU and predictors after Antiretroviral Therapy (ART) initiation in low resource settings including Ethiopia. Method: Retrospective cohort study was employed among a total of 520 records of patients who were enrolled on antiretroviral therapy in Aksum St. Marry hospital. Baseline patient records were extracted from electronic and paper based medical records database and analysed using Kaplan Meier survival and Cox proportional hazard model to identify the independent predictors of loss to follow up of patients on ART. Result: of 520 patients, 51(9.8%) were loss giving a LTFU rate of 8.2 per 100 person- years. From these LTFU, 21(41%) occurred within the first Six months of ART initiation. The independent predictors of LTFU of patient were being smear positive pulmonary TB [Adj.HR (95% CI)=(2.05 (1.02, 4.12)], male gender [Adj. HR (95%CI)=(2.73 (1.31, 5.66)], regiment AZT-3TC-NVP [Adj. HR (95%CI)=(3.47 (1.02,11.83)] and weight ≥60kg [Adj. HR (95% CI)=(3.47 (1.02,11.83)]. Conclusion: Substantial magnitude of loss to follow up has been found among patients on ART which significantly affect the overall outcome of HIV/AIDS program of treatment. The independent predictors identified were TB smear positive, male gender, regiment AZT-3TC-NVP and lower weight. So, continuous and comprehensive follow up is necessary to minimize loss to follow up and optimize treatment outcome of people on ART.

Introduction: HIV infection leads to a decrease in the CD4 count ultimately leading to the development of AIDS. Under this condition, within the body of the host several OIs manifest their pathological effects. With progressive decrease in CD4 count and with HIV disease progression, the pathogenic effects of these OIs increase several folds. Under this condition, dissemination of multiple infections is extremely common. Report of case: A 28 year old male patient presented with complaints of weakness, fever, weight loss, dry cough, respiratory distress and dimness of vision. He was HIV sero positive with CD4 count of 0.1 cells/μl of blood. Indirect opthalmoscopic investigations revealed Cytomegalovirus (CMV) retinitis. Treatment with wide spectrum antibiotics could not improve his respiratory distress. Broncoscopy or lung biopsy could not be performed due to his poor general condition. CMV PCR revealed high titre (5.1×107 copies of DNA/ml serum). In anticipation that his respiratory distress might be caused due to infiltration of CMV into the lungs and also to combat retinitis, i.e. Ganciclovir was started. On treatment, patient became afebrile and there was significant radiological improvement of pneuomonitis. He later developed urinary tract infection of Pseudomonas aeruginosa and was treated with Cotrimoxazole (800 mg). With HAART, CD4 increased to 66. Patient’s visual acuity improved slightly in left eye. Discussion: Early detection and prompt treatment of HIV and associated OIs is of utmost importance. The symptoms of Cytomegalovirus Retinitis are subtle and nonspecific. So, the clinician must have a high index of suspicion for diagnosing CMV retinitis. At extremely low CD4 counts, a disseminated cytomegalovirus infection should always be considered as a likely etiology of Pneumonitis. A CD4 Count of 0.1 cells/μl has made the case more novel. The initiation of HAART at extremely low CD4 counts may boost the immune system with rapid increase in CD4 coun

HIV pathogenesis is extremely complex and involves both immunodeficiency that leads to opportunistic infections and AIDS as well as excessive inflammation and systemic immune activation. Generalized chronic immune activation and the progressive loss of the balance between T-helper 17 (Th17) and T-regulatory (Treg) cells have been demonstrated as leading events in HIV pathogenesis. Recent studies have investigated interactions between Th17 and Treg cells in relation to HIV infection. Th17 cells are perturbed during HIV infection in humans and SIV infection in nonhuman primates. Studies of Th17 cells in humans and nonhuman primates has shown that depletion of these cells is associated with the dissemination of microbial products from the infected gut, increased systemic immune activation, and disease progression. Treg cells, another small sub-population of T-cells involved in preventing or inhibiting autoimmune and inflammatory disorders has also been associated with HIV infection. Treg cells have been associated with the reduced antiviral T-cell responses but not with the suppression of generalized Tcell activation. In HIV patients, a profound depletion of peripheral blood Th17 cells, contrasted with a gradual decline in Treg cells, has also been documented. Both T-cell subsets influence innate immune responses and, in doing so, may shape the progression of HIV infection. Therefore, the relative balance between these two subsets rather than the function of either alone is critical for disease progression following HIV infection. This review provides updates and discussions on the relationship between Th17 and Treg cells subsets and HIV infection and disease progression. Further, the impact of antiretroviral therapy (ART) on these cellular subsets will be reviewed. Finally, unanswered questions relating to Th17/Treg cells and HIV progression and future perspectives for achieving effective therapeutic strategies for HIV infection will be highlighted.

Background: Every day, more than 1,800 babies worldwide contract HIV from their mothers. Many of these cases occur in Africa including Ethiopia. The transmission of HIV from infected mothers to babies could occur during pregnancy, delivery and breastfeeding. For women to take advantage of measures to reduce transmission, they need to know about Mother To Child Transmission (MTCT) of HIV and their HIV status. The aim of this study was to assess the knowledge on MTCT and utilization of services designed for Prevention of Mother-To-Child Transmission (PMTCT) of HIV/AIDS among pregnant women. Methods: Community based cross-sectional study was conducted at Hossana town from March 3-28/2014 using pre-tested questionnaire and structured interviews. The collected data were analyzed using SPSS version 16. Descriptive statistics and logistic regression analysis were done. Result: Out of the 417 pregnant women interviewed, 370 (88.7%) responded that they know MTCT of HIV, 377 (90.4%) mothers tested for HIV during current pregnancy and 354 (93.9%) shared test result to their husband. Few, 23 (6.1%) did not disclose test result due to fear of divorce. The main reason for HIV testing, according to this study, is to know self-status. Knowledge of Mother to child transmission was the independent predictor of utilization of the services rendered for PMTCT of HIV/AIDS. Conclusions: More than three-fourth of pregnant women knew about MTCT of HIV. Nine women in every ten tested for HIV during current pregnancy and shared test result to their husband. Knowledge of mother to child transmission of HIV/AIDS was the independent predictor of utilization of PMTCT services. Thus, improving awareness of pregnant women about MTCT of HIV/AIDS and its prevention strategies by means of health care providers in maternal and child health service units should be strengthened.

Introduction: Antiretroviral Treatment (ART) has led to an improvement in survival of HIV infected individuals. Some of them will develop cancer during the course of their infection and will require radiation therapy. HIV positive cancer patients have presented with adverse side effects of radiotherapy and elevated chromosomal radiosensitivity. This study investigated if ART has an influence on chromosomal radiosensitivity of HIV positive individuals. Methods and materials: Blood samples from 60 HIV positive individuals were in vitro exposed to doses of X-rays of 0, 2 and 4Gy and chromosomal radiosensitivity was assessed with the micronucleus assay. The micronucleus assay was also performed on lymphocytes of a group of non HIV-infected health care workers taking prophylactic post-exposure ART to measure the effect of these ART drugs on chromosomal radiosensitivity without HIV as a confounding factor. Results: All HIV patients (those on ART and without ART) had significantly higher radiation induced Micronuclei (MN) than healthy controls. The MN yields increased in the HIV patients taking ART compared to HIV patients not on treatment. The evaluation of chromosomal radiosensitivity of health care workers on ART revealed no effects of ART. Conclusions: HIV positive individuals show an increased chromosomal radiosensitivity. Antiretroviral treatment given to HIV positive individuals can lead to enhanced chromosomal radiosensitivity and therefore impose higher risks for radiotherapy side effects in these patients.

Introduction: Sexual dysfunction in HIV positive women is highly prevalent and it is often associated with
psychosocial distress. Not much scientific attention has been dedicated to this important aspect of the life of the HIVpositive woman especially in Nigeria and in the West African sub region at large, where issues pertaining to sexuality are hardly ever discussed even in routine clinic visits due to cultural restrictions.
Objectives: To determine the prevalence, psychological status, and socio demographic/clinical factors
associated with sexual dysfunction in HIV-positive women.
Methods: This was a hospital based cross-sectional study conducted over six months. Data were collected from 370 respondents using a structured questionnaire. The General Health Questionnaire (GHQ12) was used to assess their psychological status while the modified Female Sexual Function Index Questionnaire (FSFI) was used to assess female sexual dysfunction. Questionnaire was interviewer administered by and the data was analysed using Epi-info 2011 package.
Results: It showed that the prevalence of Sexual Dysfunction in HIV positive women was sixty one (61%). Thirty five (35%) of the respondents had significant psychological distress. The presence of psychological distress was significantly associated with Female Sexual Dysfunction (FSD). There was no association between FSD and religion, ethnicity, duration of marriage or presence of other chronic diseases. Increasing age, multiple sex partners, non-disclosure of HIV status, stigma, on-going stressful event, being underweight or obese were significantly associated with FSD. High level of education, being married, monogamy, WHO clinical stage I disease and higher CD4 count were associated with better sexual functioning.
Conclusion: This study brings to the fore the need for physicians and healthcare workers who render
comprehensive care as frontline doctors to acquire skills that is needed to attend to and alleviate the sexual problems of women in an African setting.

It is of paramount importance that sensible and prudent public policies for the introduction and management of genetic research, technologies and therapies be adopted for countries on the African continent. The author agrees with Buchanan et al. when they claim that it is “unwise to consider the ethics of genetics only at the individual level. What matters is not merely the ethics of the individual scientist, physician or counsellor, but the broader questions of justice, of claims for freedom and for protection from harm, and our obligations towards future generations”. What is therefore important, is the development of a “public and institutional policy on genetics” (Ibid.) that is adopted for the needs of, specifically, the people of Africa. The author delineates three such issues, and indicates some moral aspects that accompany their understanding as well as the challenges that they pose. The three issues are: (i) The kinds of genetic technologies that are appropriate for African needs, (ii) The lessons about public health policy to be learned from (especially South African) policymakers’ appropriation of scientific expertise, (iii) Concerns about informed consent of patients and the competence of health care professionals in administering appropriate genetic remedies in African societies

Chronic use of 3′-Azido-3′-deoxythymidine (AZT) to treat HIV/AIDS causes mitochondrial dysfunction and the accumulation of mitochondrial mutations. These toxicities have been attributed to increased oxidative damage, among other mechanisms. Palm fruit juice (PFJ), also known as oil palm phenolics (OPP), is a water soluble byproduct of oil extraction from the fruit of the oil palm (Elaeis guineensis) that is rich in antioxidants and other phytochemicals. The capacity of PFJ to mitigate AZT mitochondrial genotoxicity (mutagenesis) as well as dosedependent cytotoxicity were measured in cultured HepG2 cells. In the presence of PFJ, AZT-induced mutations were 35% the number of mutations observed in samples treated with AZT alone in the three regions of the mitochondrial genome examined (HV2, CO2, and ND1). Co-treatment with PFJ increased cell survival in the presence of increasing doses of AZT by up to 350%. These effects were not due to degradation or inactivation of AZT by PFJ. The discovery of the mitigating effects of PFJ provides a potential means of ameliorating AZT-induced mutations and possibly other long-term negative side effects of long-term AZT use.

Background: Depression is common in HIV-infected patients and may affect response to Antiretroviral Therapy (ART). We analyzed anonymized data from the DR’s major non-governmental ART clinics to estimate the prevalence of and characteristics associated with Clinically-significant Depressive Symptomatology (CSDS) in Dominican Republic (DR) ART patients, and its impact on response to ART. Methods: We performed a cross-sectional analysis of data obtained by questionnaires screening for CSDS, ART adherence, and food insecurity in a convenience sample of non-acutely ill ART patients seen in the collaborating clinics in 20 workdays in May-June 2013. Demographic characteristics and most recent CD4+ T-lymphocyte counts and plasma HIV-RNA levels (“viral loads”) were obtained by medical record review. Factors associated with CSDS and poor ART response were identified by comparing prevalence of CSDS and ART failure by patient characteristics. Results: Of 205 patients, 61 (29.8%) met criteria for CSDS. CSDS prevalence was higher among residents in bateyes (sugarcane plantation-worker barracks) (100%) than in those residing elsewhere (26.9%; p<0.001) and in patients reporting food insecurity (52.2%) than in those denying it (18.8%); p<0.001). Patients taking ART for less than 36 months were more likely to have CSDS (38.6%) than those with longer ART duration (23.8%; p=0.02). Proportions of patients with viral suppression were higher in: females (64.9%) than males (48.8%; p=0.02); patients with ART for over 36 months (66.0%) versus those with shorter ART duration (47.0%; p=0.009); patients reporting perfect (63.4%) versus imperfect adherence (42.3%; p=0.009), and; patients without CSDS (64.0%) versus those with CSDS (40.0%; p=0.002). When controlled for perfect ART adherence, ART duration, and gender in logistic regression, CSDS was independently associated with decreased likelihood of viral suppression (OR=0.4; 95% confidence interval=[0.2-0.8]; p=0.006). Conclusions: CSDS is associated with ART failure even when controlled for adherence. Depression treatment may improve ART response and patients’ quality of life.

Life expectancy of HIV-infected patients has improved in the recent decade with the use of antiretroviral therapy. Hence, more HIV-infected patients with chronic co-morbidities are being followed by different specialities. Diabetes and obesity are two of the co-morbidities. We looked at the outcome of bariatric surgery for 3 HIV-infected patients. We concluded that bariatric surgery is safe and can reduce pill burden. However, a multi-disciplinary team approach is needed to ensure that the right patients are selected and on-going support available to achieve the best outcome.

Background: Mortality among Human Immunodeficiency Virus-1 (HIV-1) infected children initiated on Antiretroviral Therapy (ART) though on a decline still remains high in resource-limited countries. Identifying baseline factors that predict mortality could allow their possible modification in order to improve pediatric HIV care and reduce mortality. Methods: We conducted a retrospective cohort study analyzing data on 691 children, aged 2 months-15 years, diagnosed with HIV-1 infection and initiated on ART between July 2005 and March 2013 at the pediatric HIV clinic of Jos University Teaching Hospital. Lost to follow-up children were excluded from the analyses. A multivariate Cox proportional hazards model was fitted to identify predictors of mortality. Results: Median follow-up time for the 691 children initiated on ART was 4.4 years (interquartile range (IQR), 1.8-5.9) and at the end of 2752 person-years of follow-up, 32 (4.6%) had died and 659 (95.4%) survived. The mortality rate was 1.0 per 100 child-years of follow-up period. The median age of those who died was about two times lower than that of survivors [1.7 years (IQR, 0.6-3.6) versus 3.9 years (IQR, 3.9 - 10.3), p<0.001]. On unadjusted Cox regression, the risk of dying was about three and half times more in children <5 years of age compared to those >5 years (p=0.02) Multivariate modeling identified age as the main predictor of death with mortality decreasing by 24% for every 1 year increase in age (Adjusted Hazard Ratio (AHR)=0.76 [0.62-0.94], p=0.013. Conclusion: The lower mortality rate for our study suggests that even in RLCs, mortality rates could be reduced given a good standard of care. Early initiation of ART in younger children with close monitoring during follow-up could further reduce mortality.

Objective: The aim of this pilot study was to identify HIV/AIDS care delivery gaps from both caregiver and patient perspectives, in a high risk region of the Dominican Republic. Furthermore, the study hopes to establish baseline data on psychosocial issues of HIV/AIDS in the Dominican Republic. The study further analyzed these factors in the context of current national policies. Methods: The study, conducted at Boca Chica HIV/AIDS Clinic in the Dominican Republic, consisted of two parts: 1) a retrospective review of 300 patient clinical charts and 2) personal interviews with 52 patients, 15 physicians, 7 nurses, 5 social workers and 11 hospital administrators. Results: Major barriers to accessing care identified were patient education, training for healthcare professionals, lack of funds, transportation and inconvenient clinic hours. Over half of patients believed that supernatural means to healing could be utilized as a sole path to disease management. Only 21% indicated they had continuous access to medication. Although patients trusted the clinic in terms of confidentiality, 60% expressed a fear of inappropriate information. Social workers, physicians, and nurses identified stigmatization as a major healthcare barrier, but this view was held by only 17% of patients. Administrators identified documentation and equipment as major areas that need improvement. All 300 records were missing follow-up dates for appointments, medication histories, social histories, income information, or psychiatric histories, and 33% had no record of a physical exam. Only 62% of physicians, nurses, social workers, and medical administrators were aware of national programs that collect HIV/ AIDS information and how they function. Conclusion: Our results warrant new programs and development of a robust and coherent multidisciplinary approach to HIV/AIDS care delivery as a capacity-building national policy. Furthermore, our observations indicate that the lack of effective implementation programs add to the complexity of HIV/AIDS care services.