Journal of AIDS & Clinical Research

Inter-individual variations in HIV infection outcome indicate a role of host genetic variations in the HIV disease progression and response to therapy. Cytokines are early key players in HIV infection, which influence the infection outcome by regulating viral replication, persistence and eradication of its reservoirs as well as host immune response. Genetic variations in cytokine genes can alter protein expression resulting in differential infection outcome. In this review we have summarized the available literature on cytokine and receptor variations in HIV infection outcome and response to therapy. A better understanding of cytokine genetic variation in HIV disease progression and response to therapy will help clinicians in better management of HIV infected individuals.

Polymorphonuclear eosinophils are source of chemokines such as RANTES and IL-16. These chemokines suppress the in vitro viral replication of HIV primary strains and so could contribute to the resistance of infection in HIV seronegative patients despite their belonging to risk groups. Hypothesis considering eosinophilia as a protective factor against HIV infection by overexposing RANTES was tested. Therefore we studied the impact of co-infections of human T lymphotropic virus-1 (HTLV-1) and Strongyloïdes stercoralis (Ss), infectious agents potentially eosinophylogenic, on the eosinophilic reaction in HIV patients and on the patients' survival. From 1983 to 1996, 445 HIV infected patients had a follow-up for at least one year of whom 52% developed AIDS, 13% presented with HTLV-1, 15% with Ss coinfection and 23% showed eosinophilia superior to 1.10x9/L. Our results indicate that eosinophilia provoked by Ss was not altered by HTLV-1. Furthermore the reactive ability of eosinophils was not affected by the drastic decrease of CD4-T observed in HIV patients. HIV patients co-infected by HTLV-1 presented higher amounts of CD4-T as compared to patients only infected by HIV, but no effect on CD8-T and eosinophils amount was observed. The median age superior in HTLV-1/Ss co-infected HIV patients suggested an asymptomatic period lengthened because of later diagnostic and a protective effect of these co-infections. However patients' survival in AIDS phase was neither changed by eosinophilia nor by the HTLV-1 and Ss co-infections.

Background: Literature consistently shows dearth of published data from developing countries on effect of exercise on HIV infected persons.

Objective: The study was aimed at determining effect of aerobic exercise on CD4 cell counts and lipid profile of HIV infected persons in Northeastern Nigeria.

Methods: Sample of convenience was employed to enroll volunteer and willing 91 HIV infected persons attending antiretroviral clinic at a tertiary hospital in Northeastern Nigeria. Eighty two met the inclusion criteria and participated in the study. Participants were randomly assigned to experimental and control groups. Baseline values of the variables were determined. Experimental group participated in moderate intensity treadmill aerobic exercise for 12 weeks. Control group participated in weekly lectures on nutrition, adherence to therapy among others. At the end, the study recorded 22% attrition rate, leaving 32 participants in each group (64 participants in both). After the 12 weeks, the variables were re-evaluated. Descriptive statistic summarized the socio-demographic characteristics of the participants. Paired and unpaired Student t-tests analyzed the significant difference in mean values of the variables.

Results: Mean ages in years of the 64 participants, the control and experimental groups were 39.57 ± 10.13, 39.38 ± 10.03 and 40.84 ± 10.05 respectively. There was significant improvement (p < 0.05) in the variables between pre- and post-tests in the experimental group. In the control group, there was either no significant change (p > 0.05) or significant deterioration (p < 0.05) in lipid profile between pre- and post-tests, while in CD4 cell counts, significant improvement was observed. Significant difference (p < 0.05) existed in the variables at the end of the study between both groups.

Conclusion: CD4 cell counts and lipid profile of HIV infected persons who participated in the 12 weeks moderate intensity treadmill aerobic exercise significantly improved. Proper nutrition and adherence to antiretroviral therapy may enhance immune function in HIV population

Background: Men who have sex with men (MSM) remain a hidden and hard-to-reach high-risk group. MSM experience stigma, discrimination and criminalization in India. The organized participation of MSM in “public spaces” --through which they openly identify themselves as MSM, address social stigma, and demand their rights and entitlements-- is an indicator of their empowerment process against structural barriers. This paper assesses MSMs’ “public participation” and the contextual factors that influence them.

Method: Data were drawn from a cross-sectional Integrated Behavioral and Biological -Assessment survey conducted during 2009-2010 in Tamil Nadu, India. Information was collected on the socio-demographic characteristics, public participation, community mobilization, vulnerability and risk status of 1757 MSM. Two set of measures thought to influence MSMs’ public participation were considered-- “push” factors and “pull “factors. Pull factors were related to MSMs’ community mobilization status and push factors were related to MSMs’ risk and vulnerability.

Results: Almost half of the MSM (48%) reported public participation in the past six months. Univariate and Multiple regression analysis shows that pull factors [exposure to peer education (OR 8.2 (4.0-16.6); AOR-6.1(1.9-19.4); p<0.05), collective membership (OR 10.2 (6.4-16.3); AOR 9.7 CI 5.9-15.9; P<0.05) and collective agency (OR 3.2 (2.0-5.2); AOR 4.3 (2.3-8.1 P<0.05)] influence MSMs’ likelihood of participating in public spaces. Experience of police arrest was a push factor that influenced MSMs’ likelihood of participating in public places (AOR-3.7 CI 1.6-8.4 P<0.05).

Conclusion: The community mobilization strategy is effective in fostering MSMs’ “public participation;” through this strategy MSM can address structural barriers and the program can be upscale. Public participation of MSM can serve as a key indicator of the empowerment process in a stigmatized society.

Objective: A level of 95% adherence to antiretroviral therapy (ART) has been found to benefit HIV/AIDS patients. Low adherence may lead to treatment failure, and may subsequently result in treatment change. The main objective of this study was to evaluate the effect of ART adherence on treatment change

Methods: Data were extracted from available written clinical and pharmacy records, and the electronic database at the Korle-Bu Teaching Hospital. Cases comprised all those (≥15 years) who experienced a first treatment change after starting first-line ART between 1/1/2004 and 31/12/2009. Controls (who did not change treatment) were sampled from the same cohort of ART starters and matched to cases on date ART was started. Adherence was determined using the proportion of days covered (PDC) approach and poor adherence was defined as PDC levels below 95%. Measures of effect were calculated using conditional logistic regression.

Results: The 298 cases and 298 matched controls were similar in most baseline characteristics. Among cases 20.1% (60/298) switched to second-line therapy and the rest had treatment substitutions. Overall, 88.9% of controls compared with 79.9% of cases had adherence levels greater than or equal to 95% (p=0.003). After adjusting for possible confounders, an adherence level below 95% was associated with almost four times (ORadj=3.56 (95% CI 1.60 to 7.88)) the likelihood of having a treatment change.

Conclusion: This study showed that insufficient ART adherence was associated with about four times the likelihood of treatment change. Policy makers must partner researchers to engage patients more often, to unravel the causes of non-adherence, and make the necessary interventions for patients to achieve maximum benefits from dispensed medicines.

The study explored the knowledge and use of Voluntary Counselling and Testing (VCT) services by a stratified random sample of 609 older adults from four purposively selected districts in Botswana. Only 76.8% of the older adults had taken an HIV test and 51.6% of this number actually requested the test (client initiated). More than 20% have engaged in a sexual relationship with a person whose HIV status they did not know. While 91% of older adults indicated that everyone should undergo HIV test and 96.2% know where to get the HIV test but less than 16% of them know that people who have unprotected sex, people who think they have sex with HIV infected persons and people who have direct dealings with needles and tattoos should be tested. The identified main barriers to taking HIV test were not feeling at risk of HIV infection (76.8%), fear of testing positive because of the reactions of partner(s) (10.9%), and fear of testing positive because others will judge / treat them badly (8%) were. The study shows that being educated, older than 59 years, married, female, coming from a rural location and having a negative HIV status increase the likelihood of intention to use VCT services. The study recommends that education, which targets the needs of older adults, about HIV and AIDS and VCT needs to be improved in order to enhance the uptake of VCT services, an essential step for the initiation of treatment. In addition, home-based, door-to-door HIV testing, which will increase the number of older adults to be tested, and create opportunities for increased knowledge of HIV transmission, prevention and care through provision of correct information to older adults in their homes should be instituted.

The Eye is a vital sense organ and much like any other organ in the body can be afflicted by HIV. An ophthalmic referral at the time of presentation must be ensured by the treating physician. The ophthalmologist must take utmost care while examining and treating such patients to avoid patient to patient and patient to healthcare provider spread of HIV. A detailed ophthalmic examination for the various manifestations must be done and timely intervention for the same must be carried out which is critical to prevent ocular morbidity. Highly Active Anti Retroviral Therapy (HAART) is safe and has been instrumental in lowering sight threatening complications of HIV such as CMV retinitis.

Background: As we strive to reduce disparities in the implementation of the US National HIV/AIDS Strategy, we must understand HIV disparities as they exist in all US populations, including the foreign-born. We evaluate disparities in HIV prevalence in a US and foreign-born cohort in Philadelphia.

Methods: Comparative analyses were conducted using data from questionnaires paired with HIV test results for individuals undergoing HIV testing in Philadelphia between 2007 and 2011. Descriptive analyses were conducted by gender and world region of origin.

Results: Of 14,216 participants, 76.2% were US-born and 59% female. Caribbean men, 3.6% of the cohort, constituted 11.4% of the HIV- positive. Among women, Africans, 3.0% of the cohort constituted 4.5% of the HIVpositive. No disparities by race/ethnicity were found in the US-born cohort.

Conclusions: In this global population in Philadelphia, HIV disparities were found to occur by world region of birth and gender. The foreign-born must be included in analyses of the domestic epidemic that drive prevention strategies, policy and resource allocation

Background: Although prenatal Human Immunodeficiency Virus (HIV) infections are declining in the United States, many women of child bearing age are unaware of their HIV status. HIV testing before or during the early stages of pregnancy is a critical first step to reduce the risk of mother-to-child transmission.

Objective: The aim of this study was to estimate prevalence of women with unknown HIV status and to explore the associations between socio-demographic characteristics, health care access and HIV testing among pregnant women in the United States.

Methodology: Data from the 2013 Behavior Risk Factors Surveillance System (BRFSS) were used to calculate estimates of HIV testing prevalence among pregnant women in the United States (n=2,722). Pregnant women who never had an HIV test or had not been tested for HIV within the past year were considered as pregnant women with unknown HIV status. Descriptive statistics, Chi-square tests and logistic regression were done using SAS Proc Survey procedures, to account for BRFSS’s multistage complex survey design and sample weights.

Results: Overall, 30.3% of pregnant women had never been tested for HIV and among these women, only 24% had past-year HIV testing. Non-Hispanic whites (p<0.0001), those aged 18-24 years (p=0.02), married women (p=0.02), those with no insurance (p<0.001) and no personal doctor (p=0.02) had significantly higher rates of no lifetime HIV testing. Pregnant women aged 35-44 years (39.2%), those with annual income of $50,000 or more (32.9%) and those who were married (31.4%) had significantly higher rate of no past-year HIV testing. Multiple logistic regressions showed that the likelihood of having never been tested for HIV was greater among non-Hispanic whites (aOR=2.1; 95% CI:1.3– 3.4; reference=other races), married women (aOR=1.7; 95% CI:1.1–2.3; reference=unmarried), those aged 18-24 years (aOR=2.1; 95% CI:1.4–3.3; reference=35 years old or more), and those who had no insurance (aOR=2.2; 95% CI: 1.3–3.7; reference=covered by insurance). Among those who ever had an HIV test, married women were two times more likely to have no past-year HIV testing than unmarried women (aOR=2.0; 95% CI:1.3–3.1; reference=unmarried); while, younger women (18-24 years old) were less likely to have no past-year HIV testing (aOR=0.3; 95% CI: 0.2–0.7 reference=35-44 years old).

Conclusion: Our findings indicated that prevalence of unknown HIV status (lifetime and recent) was high, raising concerns about the prenatal HIV testing approaches in the United States. The likelihood of having never been tested for HIV was greater among non-Hispanic whites, married and younger (18-24 years old) women, and those who had no insurance after controlling for covariates. In addition, the results showed that married women had higher likelihood of having no recent HIV test; while, younger women (18-24 years old) were less likely to have no past-year HIV testing. Our findings highlight the need to continue and strengthen efforts to prevent perinatal HIV transmission in the United States through increasing HIV testing awareness. Health care providers should recommend HIV testing to all women of childbearing age, regardless of sociodemographic characteristics to reduce this mode of transmission.