Journal of AIDS & Clinical Research

Primary presentation of HIV/AIDS can be greatly varied, with continued emphasis on primary prevention and early detection of infection; there should be a decreasing number of atypical initial presentations. It has been shown that chronic disease results in an increased risk of people developing depression, and that psychiatric features may be the only symptoms of non-malignant brain lesions. These two points combined shows that there is a possibility that HIV, a chronic medical condition, could have a psychiatric presentation. This is atypical though, and therefore is an interesting teaching point, especially in the importance of ruling out organic conditions in the presentation of psychiatric diagnosis.

Background: The number of Nigerians infected with the HIV infection in 2016 was about 3 million, which was the second highest burden globally and accounted for 9% of the worldwide burden of the HIV/AIDS. The country ART (antiretroviral therapy) programme which commenced in 2001 had adult coverage of 48.3% in 2014. Effectiveness of the antiretroviral drug regimens requires a very good level of adherence (95%) to suppress viral replication. Despite all the strategies to address the adherence barriers to HAART (highly active antiretroviral therapy), the problems of poor adherence are ever-present. Factors determining adherence to HAART drug regimens have been studied in various population but little is known on this subject among PLHIV (people living with HIV) in Nigeria. Identifying and overcoming the factors that reduce adherence to combination antiretroviral agents is of utmost importance for prolonged viral load suppression. Very few of the strategies developed to mitigate the challenges of non-adherence were based on the theories of health behavior. However, behavioural theories, if adopted, could assist in the development of more effective interventions to improve treatment adherence. This cross-sectional study was conducted to explain the dynamics of HAART adherence among Nigerians living with HIV/AIDS; using behaviour change theories such as the Theory of Planned Behavior (TPB) and Health Belief Model (HBM). Methods: This was a questionnaire-based study using closed ended-questionnaires administered by the on the 225 participants. Findings: There were more female (181, 80.40%) than male (19.6%) living with HIV infection among the respondents. More than half, (139, 61.7%), of the respondents were married while less than a fifth (66; 29%) were singles About 96% of the respondents were literate with 2.7% illiteracy rate. Employment rate was also more than half (59%) while the unemployed rate was about 31.6%. Most (202, 89.8%) were of the Christianity faith TPB model factors such as the ability to set realistic goals and objectives with respect to medication adherence and meet such goals did not have any significant association with adherence (P 0.001) among the PLHIV. Likewise other TPB factors like determination and self-discipline to adhere to medications (HAART) did not have statistical association with HAART adherence. On the other hand, Health Believe Model (HBM) components such as the believes that adherence to HAART improves HIV patent's health condition (P=0.004),adherence to HIV medication is feasible in the Nigerian context (P=0.00), refusal to adhere to HAART is a serious health risk for the HIV patient (P=0.00), non-adherence to HAART is life threatening for the HIV patient(P=0.00), non-adherence to HAART can lead to AIDS faster (P=0.00) and the consequences of non-adherence to HAART are severe (P=0.00) all show significant statistical association with HAART adherence .Also significant statistical association was found between HAART adherence and other health believes like adherence to HAART is beneficial (P=0.00). Conclusion: Unlike the theory of planned behaviour, health believes Model was most suited to explaining or predicting patterns of HAART adherence behaviour among Nigerians PLHIV. However, for the model to be most effective it would need to be integrated with other models that take into account the environmental context and recommend strategies for change.

Objective: Vulval tuberculosis (TB) is reported rarely. The histomorphological spectrum and diagnostic mimicry thereof in patients with concomitant HIV infection/ AIDS is unreported to date. This study aimed to appraise the histopathologic spectrum of vulval TB in HIV co-infected patients and to identify histopathological diagnostic challenges, mimicry and pitfalls. Methods: Ten year retrospective study that reappraised the histomorphological features of vulval TB in HIV-infected patients. Results: The clinical descriptions of the biopsied lesions from 19 patients that form the study cohort encompassed nodules (9), ulcers (5), hypertrophy/edema (3) and abscesses (2). The main microscopic features included necrotizing and non-necrotizing granulomatous inflammation, ulceration with a zoned inflammatory response and chronic suppurative inflammation. The necrotizing component had the typical morphology of caseative necrosis or of suppuration/karyorrhexis or an admixture of both necrosis types. Vasculitis, of varied histomorphology, was present in 15 biopsies. Infective special stains were pivotal diagnostic tools. The presence of mycobacteria on Ziehl Neelsen stains (ZNs) and absence of nonmycobacterial infective agents on additional infective stains, underpinned TB diagnosis, especially in biopsies that lacked prototypical granulomatous inflammation or of infective mimickers that manifest with a granulomatous phenotype. ZNs also confirmed mycobacteria in vasculitic foci. The absence of mycobacteria on ZNs facilitated the diagnosis of tuberculids. Conclusion: Lesions with a common clinical appearance had heterogeneous histomorphological features, while lesions with common histopathological features demonstrated divergent clinical morphology. Infective, especially Ziehl Neelsen, stains are pivotal in the histopathological work-up of infective/inflammatory vulval biopsies. It is possible that the rarely reported anergic mononuclear or abscessing features, pseudotumoral spindle cell reactions, ulcers with a zoned inflammatory response and the presence of vasculitis of varied type, are clues to the HIV-TB tissue partnership. Increased clinicopathological investigation of and reporting on vulval TB in the HIV/AIDS afflicted population is pivotal to ascertain this.

Aims and objective: Current study is aimed to explore and observe adverse drug reactions occurrence of antiretroviral therapy and to examine the gender differences in treatment outcomes of HIV/AIDS patients during HAART therapy. Method: An observational retrospective study of all patients on HAART therapy diagnosed with HIV infection from January 2007 to December 2012 was conducted at infectious disease department of Hospital Pulau Pinang, Malaysia. Patients socio-demographic, clinical and laboratory data was retrieved via self developed validated data collection form. Results: Out of 743 patients 571 (76.8%) were male and 172 (23.1%) were female patients. A total number of 425 (57.2%) adverse drug reactions were reported among which 311 (73.1%) occurred in males and 114 (26.8%) in female patients, with a significant statistical relationship (p=0.02, OR=1.21). Out of total ADRs (57.2%) observed in both genders, a significant association was observed in Lipodystrophy (p=0.05), anemia (p=0.02), Peripheral Neuropathy (p=0.02) and pancreatitis (p=0.01). A total of 455 (79.6%) male and 139 (80.8%) female patients have improvement in CD4 cells count at the final follow up, a significant association (p=0.05) was observed among the mode of transmission and treatment outcome. Conclusion: Overall, the ADRs observed in both gender emphasize the importance of developing safer HAART regimens and managing these adverse effects in a timely manner in order to avoid long-term health consequences.

Introduction: Few studies in Iran have explored the potential impact of factors influencing the survival time of patients with HIV and AIDS. Therefore, this study was designed to estimate the time from the HIV to AIDS progression and the time from the AIDS to the AIDS-related death and non-AIDS-related death. The prognostic factors influencing this process were also investigated. Methods: This retrospective cohort study was conducted in Isfahan province, from 2000 to 2014.The outcome was three categories: alive or lost to follow up, and death due to AIDS related, non-AIDS-related. Cox proportional hazard and competing risks Cox model was employed to evaluate the effects of prognostic variables on the survival rate of progression to AIDS and from the AIDS to the AIDS-related death and non-AIDS-related death. Results: We identified 307 patients, 44 were ineligible. At the end of the study period, 197 (74.9%) patients were alive or lost to follow up, 28 (10.6%) died from AIDS-related causes, and 38 (14.4%) died from non-AIDS-related causes. Results showed there was a significant association between gender (P=0.04), increase in age (P=0.022), TB coinfection (P=0.004), and a decreased level of CD4 cell count (P=0.012) with progression to AIDS. Also there was a significant association between CD4 level (P=0.013) and antiretroviral therapy (P<0.001) and AIDS-related deaths. There was a significant association between a level of CD4 cell count (P=0.022) and TB coinfection (P=0.01) with non-AIDS-related deaths. Conclusion: A substantial proportion of the patients had progressed to AIDS in the first year because they were identified very late. This source of HIV infection had the chance to transmit the infection to others. Also patients who died from AIDS-related causes of death had poorer immunological status at recruitment.

Human immunodeficiency virus (HIV)/Acquired immune deficiency syndrome (AIDS) is the key public health concern particularly in sub-Saharan Africa including Kenya. Consistent condom use is crucial especially among HIV positive people to prevent HIV transmission as well as re-infection with different resistant virus strain. It is important to identify the obstacles of condom use among HIV positive individuals in order to constitute preventive measures. Thus, the study was conducted to explore barriers and challenges of condom use among women living with HIV attending Comprehensive Care Centre of Thika Level 5 Hospital, Kenya. We conducted qualitative method of data collection using three focus group discussions and ten key informant interviews. Purposive sampling was used to select participants. Descriptive quotes representing key themes were identified and then analysed thematically. The result indicated that the main barriers of condom use were inability to negotiate in condom use, fear of mistrust, nondisclosure of HIV positive status to partner, alcohol use, and reduced sexual pleasure. In addition, among the negative beliefs and misconceptions identified as barriers of condom use were feeling promiscuous for carrying condoms, religion (being Catholic) and perceived pores in condoms. HIV positive women face many challenges in using condoms and the specific areas of focus should include the barriers mentioned above.

Background: Liver diseases are among the most frequent causes of non-AIDS-related deaths in human immunodeficiency virus (HIV)-infected patients due to hepatitis B or C virus co-infections, and/or the toxicity of longterm treatment of some antiviral drugs. There are few cohort studies reported in China. Methods: All data from the clinic HIV/AIDS patients in the database of Tianjin Second People’s Hospital, a branch of the National Free Antiretroviral Treatment Program database, from April 1, 2010 to March 31, 2016 were retrospectively assessed and analyzed. Results: We analyzed 2270 HIV-positive, hepatitis B virus (HBV-), hepatitis C virus (HCV-) negative patients, who received cART and followed for 13334.8 person-years. A total of 67 patients (3.0%, or 5.0 per 1000 person-years) died of non-liver-related causes. The incidence of liver-related deaths in persons without HCV or HBV co-infections was zero percent during follow-up. Only 30 cases (1.3% or 2.2 per 1000 person-years) developed hepatotoxicity, but liver function of these patients improved after changing cART regimens. Conclusion: cART-related hepatotoxicity can be well-controlled and managed by modifying the therapeutic regimens. Liver-related mortality in HIV-positive, HBV-, HCV-negative patients is currently zero percent in Tianjin, China.

Introduction: The nevirapine is the most widely accused drug in toxidermias in patients living with HIV. It is responsible for toxic epidermal necrolysis called Lyell syndrome or Stevens Johnson syndrome, severe during pregnancy. We report five cases in pregnant women who are HIV-positive. Case reports: Five pregnant women aged 35 years on average with a mean gestational age of 29.6 weeks of amenorrhea were HIV1-positive.The mean CD4 count was 416/mm3. They had severe toxidermia such as Lyell syndrome or Stevens Johnson syndrome. These toxidermias appeared on average 26 days after taking antiretroviral triple therapy including nevirapine as part of the prevention of mother-to-child transmission of HIV (PMTCT). The outcome was favorable after discontinuation of antiretrovirals. Nevirapine was substituted with lopinavir/ritonavir. Newborns had received antiretroviral prophylaxis and were not infected with HIV. Conclusion: The nevirapine toxidermia is common during antiretroviral therapy. These toxidermia are severe during pregnancy related to maternal and fetal vital risks. The replacement of nevirapine with an anti-protease is a therapeutic alternative in our resource-limited countries.

Impoverished men have lower rates of facility-based HIV counseling and testing and higher unknown HIV-positive status than women. Economic theory suggests that individuals will obtain an HIV test if anticipated benefits are greater than anticipated costs. Yet, few studies have investigated the range of financial preferences of HIV self-testing (HIVST) among poor men who decline testing or do not test regularly. Twenty-three interviews were conducted to qualitatively assess perceived costs saved and costs incurred from use of HIVST kits in infrequently- or never-tested Tanzanian men. All men were shown an HIVST kit and video. They were then asked about the costs associated with providerled HIV testing, financial benefits and concerns of HIVST and willingness to pay for HIVST. Data were transcribed, coded and analyzed using inductive content analyses. We then grouped codes into perceived cost advantages and disadvantages and tabulated the range of prices men were willing to pay for a self-test kit. Perceived cost advantages of HIVST were avoidance of spending money to test in facilities, omission of follow-up fees, affordability relative to private clinics, and increased time for earning income and other activities. Men also discussed the imbalance of the financial benefit of accessing free, public HIV testing with the resources spent for transport, purchasing meals away from home and long wait lines. Perceived cost disadvantages of HIVST were prohibitive kit costs, required prior savings to purchase kits, expenditures relating to death and preferences for free provider-performed testing. Men were also concerned about the psychological costs of inaccurate results. HIVST willingness to pay varied among men. Men’s decisions to self-test for HIV takes into account expected financial gains and losses. Demand generation for HIVST among men should consider use of low fees or free HIVST, while emphasizing potential savings from reduced travel, clinical costs, or time way from work. Efforts are also needed to address anticipated emotional costs of HIVST, such as anxiety from kit errors, purchasing “death” or testing alone, which for some men was a substantial barrier.