Journal of AIDS & Clinical Research

Introduction: Benefits of early Highly Active AntiRetroviral Therapy (HAART) to reduce infant mortality and morbidity have been demonstrated in resource-limited and rich settings. However, immunovirological data collected in Sub-Saharan Africa are scarce. This study describes the long-term outcome of South African children who started HAART before one year of age (Early Starters Cohort or ESC) and compare their immunovirological outcomes to children who started their therapy after two years of age (Late Starters Cohort or LSC). Immunovirological results will be compared in order to evaluate the long-term non-inferiority of early treatment initiation. Methods: Fifty-five children were included in the ESC (mean follow-up period 7.9 years) and 96 children were included in the LSC (mean follow-up period 6.3 years). Children from the ESC and the LSC were subdivided into three subgroups according to CD4+% at HAART initiation (<15%, between 15-24% and ≥ 25%). Results: All children included in the ESC achieved normal CD4% at least once during the entire follow-up period, contrary to the LSC where 89.6% children achieved normal CD4% (p=0.014). Furthermore, mean CD4+% became higher in the ESC six years after treatment initiation. Children with CD4+% between 15 and 24% at HAART initiation reached higher CD4+% in the ESC, three years after treatment initiation. The proportion of children who experienced virological failure (>100 cp/ml) was comparable in both cohorts but persistent undetectable viral load (<50 cp/ml) after initial virological suppression was more frequent in the ESC (p=0.008). Finally, the proportion of children with detectable viral loads (50 to 1000 cp/ml) at least one time during the entire follow-up period was higher in the LSC (p=0.0022). Conclusion: HAART appeared highly effective in terms of immunovirological outcomes both in children treated before one and after two years of age. The results of this study demonstrate that early treated children more often achieved normal CD4+%, tended to have higher mean CD4+% and more sustained virological suppression. These results encourage the current international recommendations to initiate HAART as soon as possible in RLS.

Background: Admission rates to intensive care unit (ICU) remains high in AIDS patients, although data in lowincome countries are scarce. The aim of this study was to evaluate the epidemiology, morbidity and mortality risk factors of HIV/AIDS patients admitted to the ICU of a university hospital in southern Brazil. Methods: Retrospective cohort study with all patients aged >18 years in the ICU from 2004 to 2014 with a diagnosis of HIV/AIDS (previous or newly diagnosed). Results: 1.7% of ICU patients had HIV/AIDS; of these, 67.1% were male, with an average of 40 years. 91.8% of hospitalizations were due to clinical causes, and most patients (83.6%) had no comorbidities. Mean APACHE 25.1, 95.1% required invasive mechanical ventilation (MV), ICU stay 13.9 days, mortality 51.4%. Among AIDS patients, incidence of complications was high: 41.7% acute respiratory distress syndrome (ARDS), 45.8% acute renal failure (ARF), 37.5% pneumonia. Approximately 1/3 had diagnosis during hospitalization and 27.5% were on antiretroviral therapy. Mortality has progressively reduced over the years. Conclusion: The prevalence of HIV/AIDS was 1.7%. This group had a high incidence of complications, which were related to higher mortality. The mortality of this group has decreased in recent years in this population.

Background: AIDS is associated with a number of malignancies, which in turn carry a high burden of mortality and morbidity in affected patients. This article was developed as an initiative of the High-Cost Diseases Office (CAC in Spanish) to provide the Colombian health system with evidence on the incidence of Cancer in patients diagnosed with AIDS in the country. Methods: The CAC compiled the National Cancer and Human Immunodeficiency Virus (HIV) administrative registries, which identify unique patients diagnosed with both Cancer and AIDS from 1983 to 2015. For the 736 cases found, we considered only those diagnosed with Cancer five years before a diagnosis of AIDS and all cases after the diagnosis. A final sample of 238 individuals, with age ranging from 17 to 84 years, diagnosed with AIDS between 1998 and 2015, was analyzed using Stata Software to compute Standardized Incidence Ratio (SIR) of cancers. Results: Results show that patients with AIDS display an elevated risk of developing the following specific types of cancer: Kaposi’s sarcoma’s (male SIR 301.12; female SIR 252.67) Invasive cervical cancer (female SIR 5.09); Non- Hodgkin Lymphoma (male SIR 20.65; female SIR 9.10). The following non-AIDS-defining cancers were also more common in patients with the disease: in men, anal cancer (SIR 51.52), eye and related malignancies (SIR 27.24), and Hodgkin’s Lymphoma (SIR 20.96); in women: anal (SIR 24.82); vaginal and vulvar (SIR 10.36); and in situ cervical cancer (SIR 5.83). Conclusion: There is an increased incidence of specific types of cancers in a population of patients diagnosed with AIDS in Colombia, in accordance with data from other regions of the world. The National Cancer and AIDS registries provide local information, which can be used for health care policy planning.

Background: Across the Asian continent, the issue of sexual behavior of men who have sex with men (MSM) has become a subject of significant interest in human immunodeficiency virus infection (HIV) Infections among the MSM population. This study aims to see how knowledge, attitude, behavior of MSM with HIV/AIDS. Results: Age of respondents from 17 to 40 years gay 45.9%, bisexual 24.7%, heterosexual 25%. The majority of MSM have heard of HIV / AIDS, know about HIV, anal sex, the use of needle-sharing syringes are at risk of transmitting HIV, and social relationships can not transmit HIV. MSM often had anal sex of 50%, not frequent anal sex 34.3%. Always use a condom 24.3%, sometimes using a condom 27.1%, and not at all wearing a condom 48.6%. MSM who had tested HIV 32.9%, was never tested 61.4%. Conclusions: Knowledge, attitudes, and behavior of MSM are particularly at risk for contracting HIV.

Objective: Mycoplasma genitalium has been recognized as a cause of male urethritis, and there is now evidence suggesting it causes cervicitis and pelvic inflammatory disease (PID) in women. Methods: Prevalence, risk factors and co-infections with other sexually transmitted pathogens were collected in a cross-sectional study looking at 400 women at the gynecologic clinics of a university medical center in the United States. Bacterial vaginosis and trichomoniasis were diagnosed using Amsel’s criteria, gram stain and trichomonas culture respectively. Cervicitis and PID were clinically diagnosed. After testing for Chlamydia trachomatis and Neisseria gonorrhoeae, the residual cervical swab transport medium (Gen-Probe/Hologic®) was stored at -70°C. Stored samples were later analyzed for M. genitalium by a research use only transcription-mediated amplification assay using procedures similar to those established for APTIMA Combo2 assay for C. trachomatis and N. gonorrhoeae (Gen-Probe/Hologic®). Results: The overall prevalence of infection with C. trachomatis, N. gonorrhoeae, T. vaginalis and M. genitalium was found to be 7.8%, 1.8%, 10.43% and 8.9%, respectively. Prevalence of M. genitalium was comparable to that of C. trachomatis and greater than the prevalence of N. gonorrhoeae. Univariate analysis of M. genitalium status showed that participants with lower condom use had an increased probability of M. genitalium (p=0.037). Conclusion: Prevalence of M. genitalium was comparable to C. trachomatis in our study, but more research is needed to clarify pathogenicity.

Introduction: Early infant diagnosis (EID) of Human immunodeficiency virus (HIV) infection by Polymerase Chain Reaction (PCR) on Dry Blood Spot (DBS) has started in Togo since 2009 with difficulties about geographic accessibility and durability of the test. The aim of this study is to analyze the timeframes of implementation and the results of the PCR in Togo. Methodology: This was a cross-sectional study from 22 July to 15 August 2014 on PCR registers and application forms in the two reference laboratories in Togo (Lomé and Kara) and on clinical records of exposed children in 26 sites of Prevention of mother-to-child transmission (PMTCT). The analysis focused on the sampling, performance and test results. Results: The number of collected samples increased from 450 in 2011 to 920 in 2013, representing only 13% of the expected PCRs. However, 97% of these samples were sent to laboratories. The average age at PCR samples varied from 3.3 to 8.5 months. The main gateway was PMTCT (99.5%); the majority of children were breastfed (80.8%). The proportion of results returned to parents ranged from 12% to 52% between 2011 and 2013. The average duration between the dates of the sample’s withdrawal and the return of the result to the mother, calculated on clinical record, was 68 days (n=62) but could reach 105.5 days according to the health service providers. The rate of vertical transmission of HIV was 4.5%. Conclusion: The timeframes for the implementation of PCRs are long in Togo. Scaling up and creating an emergency fund will improve the early diagnosis of the child.

The good practice case study was undertaken in 2015 and mostly focussed on out of school youth with regard to adolescent sexual reproductive health and rights and HIV and Aids prevention. This study used a mixed method where both the quantitative as well as the qualitative research method were utilised and where the latter was the dominant method. The research focus on the target beneficiaries between the ages 15-24 and the services they received from Partners in Sexual Health (PSH). The findings indicate that this group are very early sexual active. The research has further established that when it comes to Sexual Reproductive Health and Rights (SRHR) there is a huge need for youth friendly services and cognisance need to be taken of the needs of young people, which is not being identified and addressed fully. While the exact impact on beneficiaries of the Out of School Project has not been measured, there is considerable evidence of a positive impact on beneficiaries as reflected by the respondent’s comments. According to observations made by the key informants the uptake of the Out of School Project was excellent. The study concluded by presenting a list of recommendations.

Background: Human immunodeficiency virus (HIV) remains a global health problem disproportionately distributed across Nigeria. Cross River State (CRS), a tourist state, located in the Niger delta, has one of the highest prevalence rates. There is evidence that poor knowledge and stigmatization are obstacles to achieving universal access to HIV prevention programs. Objective: The aim of this study was to determine the Knowledge, Attitude and Practice (KAP) of HIV among adults resident in CRS, Nigeria. Methods: A cross sectional descriptive survey design was employed. A total of 1,620 healthy adults were recruited. KAP towards HIV was assessed using a structured pre-tested questionnaire. Categorical variables were described as frequencies and continuous variables as median and interquartile range. Kruskal-Wallis test was used to determine relationship between variables and median KAP scores. P value<0.05 was considered significant. All analyses were performed using Stata 12 statistical package. Results: A total of 1,465 respondents completed the questionnaire correctly giving a response rate of 91%. The M: F ratio was 1:1.8. The median age was 38 years. Majority was married and had formal education. Knowledge of HIV and common routes of transmission was high (>80%). However, misconception that HIV can be transmitted through hugging, hand shake, mosquito bites and witch craft was also common (>60%). The overall attitude and practice towards persons living with HIV infection was poor. Conclusion: This study showed misconceptions in the knowledge and consequences of HIV infection which is associated with negative attitude towards persons living with HIV.