Journal of AIDS & Clinical Research

Objectives: Intra-hepatic cholestasis of pregnancy (ICP) is uncommon, but has severe effects on pregnancy outcomes. ICP is characterized by elevated serum bile acids and liver enzymes and preferentially affects women with liver disorders. We compared bile acids and pregnancy outcomes of HIV-infected pregnant women, who commonly have elevated live enzymes, with uninfected controls.

Methods: Twenty-four HIV-infected, including 2 co-infected with hepatitis C virus (HCV), and 25 uninfected women were tested during early and late pregnancy and postpartum.

Results: After exclusion of the HCV-infected women, serum bile acids were similar in HIV-infected and uninfected participants. -glutamyl transpeptidase was elevated in HIV-infected compared with uninfected women during pregnancy and postpartum. Bilirubin and aspartate transaminase were higher in uninfected compared with HIV-infected women in early pregnancy, but subsequently similar. Bile acids in late pregnancy correlated with bile acids in the baby at birth. An HIV- and HCV-co-infected pregnant woman with active hepatitis developed ICP complicated by fetal distress. Another co-infected participant without active hepatitis had an uneventful pregnancy and delivery.

Conclusion: In the absence of HCV co-infection, bile acid metabolism appeared to be similar in HIV-infected and uninfected pregnant women. Both HIV-infected and uninfected pregnant women had mild liver enzyme elevations.

Background: Pregnancies in HIV positive women may or may not be desired. Family planning methods can be provided as an option to avoid undesired pregnancies. However, the prevalence of unmet need for family planning methods and its determinants among reproductive age women in HIV/AIDS care is not well known. This research assessed the prevalence and determinants of unmet need among HIV positive reproductive age women in HIV/AIDS care at Hawassa referral hospital, Southern Ethiopia.

Methods: A quantitative cross sectional study was done on HIV positive reproductive age women in HIV/AIDS care antiretroviral treatment (ART) clinic Hawassa referral hospital. Married or cohabiting with partner women, who were sexually active one year prior to survey, were included. A total of 658 women were studied. Data were entered and cleaned using computer software. Logistic regression analysis was done to select determinants of unmet need for family planning.

Results: The prevalence of unmet need for family planning was 19.1%, of whom 5.9% had unmet need for limiting and 13.2% for spacing. Women who were aged between 15-24 years [AOR, 2.86, 95%CI 1.09-7.48] and 25-34 years [AOR, 2.56, 95%CI, 1.18-5.57], illiterate [AOR, 2.76, 95%CI, 1.48-5.15] and completed primary education [AOR, 1.89, 95%CI, 1.05-3.40], had high unmet need for family planning. Women who desired children [AOR, 1.67, 95%CI, 1.01- 2.76], did not use family planning previously [AOR, 2.75, 95%CI, 1.07-7.06], did not receive family planning on day of interview at HIV/AIDS care [AOR, 6.82, 95%CI 2.73-17.06] and were not on ART [AOR, 1.71, 95%CI 1.06-2.74] had high unmet need.

Conclusions: The prevalence of unmet need for family planning among women in HIV/AIDS care at Hawassa is high. Integration of family planning services at ART clinic and increased attention to women who are less educated, young adults, naïve to family planning and not on ART is recommended.

The efficacy of daily oral antiretroviral (ARVs), even when combined with supplemental adherence strategies, remains limited by non-adherence. Resistance and treatment failure resulting from missed ARV doses continue to hamper efforts to curb the epidemic. This commentary argues that we must simplify ARV regimens even further, and highlights the potential for long-acting injectable (LAI) formulations to facilitate weekly, monthly, and multi-month ARV regimens in both resource rich and resource poor settings. We summarize the latest progress in LAI development and reflect on the potential of LAIs to revolutionize HIV management and define the next frontier of HIV medicine.

Objective: Throughout most of sub-Saharan Africa (SSA), prevention of mother-to-child transmission (PMTCT) services are readily available. However, PMTCT programs in SSA have had suboptimal performance compared to other regions of the world. The main objective of this study is to explore the socio-ecological and individual factors influencing the utilization of PMTCT services among HIV-positive pregnant women in western Kenya using a social ecological model as our analytical lens. Methods: Data were collected using in-depth interviews with 33 HIV-infected women attending government health facilities in rural western Kenya. Women with HIV-infected infants aged between 6 weeks to 6 months with a definitive diagnosis of HIV in the infant, as well as those with an HIV-negative test result in the infant were interviewed between November 2012 and June 2013. Coding and analysis of the transcripts followed grounded theory tenets. Coding reports were discussed in a series of meetings held among the authors. We then employed constant comparative analysis to discover dominant individual, family, society and structural determinants of PMTCT use. Results: Barriers to women’s utilization of PMTCT services fell within the broad constructs of the socio-ecological model of individual, family, society and structural determinants. Several themes cut across the different steps of PMTCT cascade and relate to different constructs of the socio-ecological model. These themes include: self-motivation, confidence and resilience, family support, absence or reduced stigma, right provider attitude and quality of health services provided. We also found out that these factors ensured enhanced maternal health and HIV negative children. Conclusion: The findings of this study suggest that a woman’s social environment is an important determinant of MTCT. PMTCT Interventions must comprehensively address multiple factors across the different ecological levels. More research is however required for the development of multi-component interventions that combine strategies at different ecological levels.

Despite the importance of continuous care, a large proportion of persons with HIV are not engaged or retained in care at any one time, leading to poor outcomes. Identifying the risk factors associated with lack of engagement and retention in HIV care is needed in order to target patients for interventions. While both engagement and retention in care have been studied using multiple measures, the observation period for the majority of studies is less than one year, few studies have examined both initial engagement and retention, and the effect of comorbidities has typically not been included. This study extends the literature by examining how comorbidities, in addition to demographics, HIV clinical indicators and transmission risk factors, were associated with engagement and retention in a cohort study of 485 HIV-infected persons seen for an initial HIV visit at an urban safety-net hospital. Using the electronic medical record, demographic, risk factor, health status and comorbidity data were gathered at the time of initial visits. To measure engagement and retention, appointment data were obtained for a 24-month period following the initial visit. Key findings were that unknown HIV transmission risk factor and being homeless at initial visit were associated with both lack of engagement and retention. Conversely being diagnosed with a psychiatric disorder was predictive of retention. Our findings have important implications for program structure, including the integration of care, as well as regarding key components to be addressed holistically in early clinic visits.

Background: Pregnancies in HIV positive women may or may not be desired. Family planning methods can be provided as an option to avoid undesired pregnancies. However, the prevalence of unmet need for family planning methods and its determinants among reproductive age women in HIV/AIDS care is not well known. This research assessed the prevalence and determinants of unmet need among HIV positive reproductive age women in HIV/AIDS care at Hawassa referral hospital, Southern Ethiopia.

Methods: A quantitative cross sectional study was done on HIV positive reproductive age women in HIV/AIDS care antiretroviral treatment (ART) clinic Hawassa referral hospital. Married or cohabiting with partner women, who were sexually active one year prior to survey, were included. A total of 658 women were studied. Data were entered and cleaned using computer software. Logistic regression analysis was done to select determinants of unmet need for family planning.

Results: The prevalence of unmet need for family planning was 19.1%, of whom 5.9% had unmet need for limiting and 13.2% for spacing. Women who were aged between 15-24 years [AOR, 2.86, 95%CI 1.09-7.48] and 25-34 years [AOR, 2.56, 95%CI, 1.18-5.57], illiterate [AOR, 2.76, 95%CI, 1.48-5.15] and completed primary education [AOR, 1.89, 95%CI, 1.05-3.40], had high unmet need for family planning. Women who desired children [AOR, 1.67, 95%CI, 1.01- 2.76], did not use family planning previously [AOR, 2.75, 95%CI, 1.07-7.06], did not receive family planning on day of interview at HIV/AIDS care [AOR, 6.82, 95%CI 2.73-17.06] and were not on ART [AOR, 1.71, 95%CI 1.06-2.74] had high unmet need.

Conclusions: The prevalence of unmet need for family planning among women in HIV/AIDS care at Hawassa is high. Integration of family planning services at ART clinic and increased attention to women who are less educated, young adults, naïve to family planning and not on ART is recommended.

Objective: In Europe, during the last years the proportion of foreign migrants among AIDS and HIV cases is growing. In Italy, the number of new cases of HIV represented by foreign migrants has progressively increased, but the new HIV diagnoses incidence among foreign migrants has decreased, because of the increase in the total number of foreign migrants in recent years. Nevertheless, the new HIV diagnoses incidence among foreign migrants is still high if compared to that among Italians. The aim of the study was to analyze the characteristics of foreign migrants with a new HIV diagnosis and the new HIV diagnoses incidence among foreign migrants diagnosed in Italy between 2006 and 2013.

Methods: The new diagnoses incidence was calculated as the ratio between the number of new HIV diagnoses among foreign migrants and the number of foreign migrants residing in Italy. The new HIV diagnoses incidence was compared with that among Italians using the standardized incidence ratio (SIR) adjusted by age and gender.

Results: During the study period (2006-2013), of the 25,545 new diagnoses reported by the HIV surveillance system, 28.8% were among foreign migrants. The incidence of new HIV diagnoses among foreign migrants for the entire study period was 26.7 cases per 100,000 foreign migrant residents, compared to 5.1 per 100,000 among Italians. The incidence of new HIV diagnoses decreased over time for foreign migrants: from 42.5 per 100,000 foreign migrant residents in 2006 to 20.0 per 100,000 foreign migrant residents in 2013, whereas for Italians it remained stable. The SIR confirmed the marked difference between the two populations: specifically the overall incidence of new diagnoses was more than four times higher among foreign migrants, compared to Italians.

Conclusion: The results stress the need to reinforce the efforts aimed at reducing the circulation of HIV in this population.

HIV/AIDS knowledge has been rated as the most important factor for HIV prevention. However, studies have also shown that knowledge alone does not always translate into reduced risky sexual behavior (RSB). Health locus of control (HLC) categorized as perceived control over health status (internal locus of control) or attribution of health status to chance or fate (external health locus of control) is a psychological construct that has been shown to impact health outcomes including RSB. This study thus investigated the relationship between HLC and RSB among Nigerian adolescents.

A cross-sectional survey design was employed among 361 adolescents from nine senior secondary schools selected through stratified random sampling from Jos, Plateau State Nigeria. Data were collected between August and October of 2008. Health Locus of Control Scale was used to categorize individuals into having either an internal or external HLC. RSB was assessed using the Brief HIV Screener (BHS). Descriptive statistics were computed and Mann-Whitney U test was used to determine differences in BHS scores by HLC categories. Odds ratios and adjusted odds ratios were calculated for individual BHS question responses based on HLC.

Participants were 169 males (46.8%) and 192 females (53.2%) with a mean age of 16.9. When grouped into HLC categories, 141 were internal and 220 were external. The mean score on the BHS showed statistically significant difference based on HLC (p=0.01). Odds for using a condom during sexual intercourse were higher for adolescents with an internal HLC while adolescents with an external HLC had significantly higher RSB scores. Prevention programs targeted at adolescents should also aim to internalize their HLC.

Human Immunodeficiency Virus (HIV) and Non Communicable Diseases (NCD) are now the major chronic diseases of public health concern, especially in low- and middle-income countries. This joint burden has major adverse effects on the quality of life of an affected individual; causes premature death; creates adverse economic effects on families in general. The purpose of this paper is to highlight extent of the problem and various approaches that can address the threat posed by NCD among people living with HIV based on evidence and best practices in health interventions. The paper is based on the non-systematic review of policies, programs, health interventions and published research articles. In addition, recommendations of expert consultations and workshops organized in various countries were also reviewed. Review indicates that there are emerging developments to bridge the gap between the NCD and HIV, however, no focused strategy is available to address NCD in PLHIV. Some of the key suggested approaches are; build evidence for planning and management of NCD in PLHIV, increase allocation of financial resources for investigation and treatment of common NCDs in PLHIV, strengthening governance structure for improved efficiency and effectiveness of systems to address NCD in HIV and non-HIV services, reconfiguration of primary health care, routine screening of PLHIV for NCD and promoting healthy lifestyle to reduce PLHIV’s susceptibility to NCD, multi-/ inter-sectoral cooperation, public private partnership and community participation for sustained efforts. Although context-specific factors vary from place to place, the feasibility and cost-effectiveness of different approaches tackling NCD in PLHIV is needed.

Background: Depression HIV/AIDS and are projected to be the world's two leading causes of disability by 2030. Depression among people with HIV/AIDS is very high also affects 121 million people globally. The study was aimed at estimating prevalence of depression and associated factors among adult patients seeking ART treatment in Harar, East Ethiopia

Method: An institutional based cross-sectional study was carried out in March 2013. A total of 740 study subjects were included in the study. Proportionate stratified random sampling technique was used to select participants. Data was collected using pre-tested structured questionnaire by trained data collectors. Bivariate and multivariate logistic regression analyses were undertaken to identify predictors of depression. The association between explanatory and dependent variable was reported using odd ratio and its 95% confidence interval.

Results: prevalence of depression among HIV patients was 45.8%. In multivariate models, independently associated with sex being male (AOR 1.633; 95% CI 1.138, 2.342) and Marital status being widowed (3.128; 95% CI 1.700, 5.757) and Monthly income earning 500-1000 (1.924; 95% 1.159, 3.195) the last scheduled clinic visit in a month (AOR 22.729; 95% 2.450, 210.873) and last time missed any of medication (5.274; 95% CI 2.583, 10.768) and Teased, insulted or sworn at (AOR 2.286; 95% CI 1.216,4.297) Gossiped about (AOR 2.990; 95% CI 1.682,5.313) had significant association.

Conclusion: From findings of this study, it emerged that depression is high among people living with HIV who participated in the study. Being male and lack of social support were statistically associated with depression. On the other hand, depressive morbidity is hence challenges to uptake of medical recommendations among PLWHA accessing care and treatment services, with potential implications for HIV treatment outcomes.

Background: In patients presenting with lymphadenopathy, evaluation of the biopsy specimen of accessible lymph nodes provides specific information to establish an early diagnosis which is important in the management of these patients.

Method: The study is a four–year (2010-2013) retrospective audit of all histologically diagnosed lymph node biopsies of 141 cases received at the Federal Medical Centre Owerri, Eastern Nigeria.

Results: Nearly one third 46(32.6%) of the 141 patients had reactive hyperplasia. Tuberculous lymphadenopathy 40(28.3%) and metastasis 27(19.7%) were other common causes. Non Hodgkins lymphoma was seen in 17(12%), while Hodgkins lymphoma was seen in 7(5%). Other cases seen were onchocerciasis 3(2.1%) and Rosai – Dorfman’s disease 1(0.7%). Acid–fast bacilli was demonstrated in 12/40(30%) of Tuberculous adenitis. All the patients with TB were screened for HIV and 14/40(35%) of them were HIV positive. Six patients had generalized lymphadenopathy and 4/6(66.6%) of them were HIV positive.

Conclusion: The differential diagnoses of lymphadenopathy are many. Tuberculosis and reactive hyperplasia have remained the predominant causes in our environment; followed by malignancy and lymphoma. Accurate diagnosis and early intervention is the key to good treatment outcome. Definitive histological classification using modern techniques like immunohistochemistry and cytogenetics should be made available in our tertiary hospitals.