Journal of AIDS & Clinical Research

Background: The AIDS epidemic heralded an expanded spectrum of Kaposi sarcoma (KS) variants but to date KS masquerading as an abscess on clinical and histopathological assessment is undocumented. Methods: This 3 year retrospective study re-appraised the clinicopathological profile of all biopsies of KS that presented as abscesses clinically and demonstrated abscessing or suppurative microscopic features. Results: 10 males and 9 females form the study cohort. The clinical diagnosis in 11 patients was exclusively that of an abscess. Tuberculosis and abscess were clinical differential diagnoses in 8 patients. The average CD4 count was 261 cells/mm3. Abscessing KS was a sentinel of HIV infection and AIDS in 4 patients. Of 11 patients on HAART, 3 were virally suppressed. The pathology appeared within 3 months of HAART commencement in 5 patients; repeat CD4 counts and viral load assessments were not available for scrutiny. Microscopically, 17/19 initial biopsies with abscessing morphology demonstrated typical features of KS at least focally, while 2/19 had an exclusive abscess-like morphology. Spindle cell heterogeneity was present with co-existence in all biopsies of myofibroblasts and malignant spindle cells, the latter were HHV8-LANA-1 positive. Special stains and polymerase chain reaction investigation for infections were negative and were crucial in excluding an infective cause. Sequestrum was noted focally in the exudate of one biopsy but the patient’s demise precluded assessment of underlying osteitis. Folliculitis was not present. Conclusion: HHV8-LANA-1 immunostaining underpins the identification of KS that masquerades as an abscess clinically and may mimic a spectrum of infections microscopically. Heightened awareness of this inflammatory response is pivotal to its diagnosis. The exact cause of the abscessing morphology was unconfirmed in the present study, but on-going investigation is critical to determine the pathogenesis of this, hitherto undescribed, clinicopathological profile of KS, that may predicate altered therapeutic approaches.

HIV positive patients with sustained viral load <50 copies/mL are defined as elite controls in the absence of antiretroviral therapy and normal CD4+ values. The occurrence of this type of infections in only 1 of every 300 people infected by HIV. Elite control patients (EC) account for 0.5 to 1% of all HIV-1 infected persons, who are able to control viral replication and maintain immune function over prolonged periods of time without antiretroviral therapy. The following situations have been postulated to understand the primary mechanism of viremia control: low susceptibility of CD4 cells to infection, infection with defective replication, viral control by the patient's immune system and low availability of CD4 cells susceptible to infection. Most data on viral control in elite controls suggest that HIV-specific CD8+ T cell responses are probably crucial in elite control. These can be conferred by the protective HLA alleles in some patients. Our objective is to communicate a rare case of daily presentation of external consultation in this pathology.

Background: An Immune Reconstitution Inflammatory Syndrome (IRIS) event is a presentation or a paradoxical worsening of a pre-existing infection following initiation of anti-retroviral therapy in the presence of a decreasing viral load and features consistent with an inflammatory process. This study was conducted to find out the significance of different clinical parameters like hemoglobin, albumin, viral load, erythrocyte, body mass index in the people living with HIV/AIDS with IRIS in Nepalese population. Methods: The study was descriptive with control group. The study included patients who experienced IRIS after initiation of highly active antiretroviral therapy (HAART) with control group as patients who were HIV positive without HAART treatment. This study was carried out on 44 HIV infected individual who initiated HAART and then suffered from IRIS and compared with 56 control HIV infected person without IRIS visiting National Public Health Laboratory (NPHL) for routine HIV viral load testing and CD4 count between April and August, 2014. Results: The patients were categorized into highly active antiretroviral therapy (HAART) naïve (n=56) and on HAART with immune reconstitution inflammatory syndrome (IRIS) (n=44). Among 56 individuals naive HAART, viral load <1000 copies/ml was found in 44 individuals, among which 14 were female (34 ± 1.953 years) and 28 were male (39.40 ± 1.290 years) whereas 12 individual had viral RNA>1000 copies/ml among which 02 were female (34.83 ± 2.030 years) and 10 were male (41.34 ± 1.462 years). The comparison of CD4 count between the naïve and patients enrolled for HAART; the risk of having CD4 count <200 cell/mm3 is significantly greater in male than that of female. The BMI ratio of HAART to naïve patients (19.88 ± 0.7290) was lower than that of HAART enrolled patients (21.78 ± 0.3546). The hemoglobin value showed significant (P value<0.0001) difference among PLHIV having CD4 level less than 200 (9.9 ± 2.156), between 200-500 (11.63 ± 1.946) and more than 500 CD4 level (12.71 ± 1.850). Significant (P<0.0001) viral load suppression showed among HAART initiated female patients with IRIS when compared with naïve female patients without IRIS. BMI, hemoglobin level, total leukocyte count, albumin level, HDL level, ESR value, CRP level and absolute eosinophil level less than 351 cells/mm3 showed significant (P<0.05) difference among HAART naïve and on HAART female patients with IRIS. Significant (P<0.0001) viral load suppression showed among HAART initiated male patients with IRIS when compared with naïve female patients without IRIS. BMI (18-26), hemoglobin level below 8 g/dl, TLC, serum albumin level below 5 g/dl, HDL level below 61 mg/dl, ESR level, CRP value and absolute eosinophil count showed significant (P<0.05) difference between HAART naïve and on HAART male patients with IRIS. Hemoglobin level, HDL, TLC, ESR, CD8, AEC, viral load, BMI and serum albumin level showed significant (P<0.0001) difference among HAART initiated patients with IRIS when compared to different level of CD4 T cell count. Conclusion: Prevalence of anemia was high in HAART naïve patients while leucopenia prevalence was higher in patients on HAART and their prevalence increased as the CD4 count decreased. HIV Patients should be investigated for hematological and immunological changes following with appropriate therapeutic interventions. The study findings reemphasize the importance of nutritional and immunological parameters to assess the stage of the disease, initiate antiretroviral therapy and monitor the response in disease progression.

Since 1981, AIDS remains one of the alarming issues in public health. It kills more than 39 million people globally. In this silent killer disease, patients not only suffer physiologically and economically but psychologically too. Their psychological well-being, mental health and quality of life also affected. The cardinal objective behind the present research was to investigate the effect of social support on quality of life of AIDS patients. Further, the study strived to find the level of social support and quality of life among male and female; married and unmarried AIDS patients. This study consisted sample of 60 AIDS patients with equal number of male and female patients selected through purposive sampling technique. Quality of Life was measured by Quality of Life Scale and for assessment of Social Support among patients Enriched Social Support Inventory was applied. For statistical analysis Mean, t-Test, Pearson Correlation and One Way ANOVA was applied by using SPSS 16.0 version. The findings show that male and married AIDS patients have a better level of quality of life than female and unmarried AIDS patients; they also receive more social support than female and unmarried patients. The results also revealed that two demographical variables gender and marital status are negatively significant correlated with Social Support and Quality of Life. Concurrently Social Support was found positively significant correlated with quality of life. On the basis of the findings in the present study we may conclude that gender, marital status as well as Social support are influential variables in quality of life. All these three variables have their impact on quality of life.

Background: Pre-Exposure Prophylaxis (PrEP) use has remained low among US women while significantly increasing among men who have sex with men. Besides lack of awareness, women face several social and structural barriers in gaining access to and using PrEP. Methods: Four focus group discussions with 20 HIV-negative women who live in the Washington DC metropolitan area. Results: The women expressed concerns about social and structural barriers to PrEP use. They were afraid that stigma related to using “HIV medicines” could affect PrEP use as well. They are worried that family and friends may question their reasons for taking anti-retrovirals and suspect that they were HIV-positive. They expected hostile reactions from male partners, including accusations of infidelity and introducing mistrust in their relationships. Communicating with health care providers about sexual matters in general and their need for PrEP in particular were identified as further barriers. Women reported that providers rarely ask about risk behaviors related to HIV acquisition; that short visits hinder establishing a trusting relationship to discuss sensitive matters. They were concerned that disclosure of risk behaviors may result in judgmental responses and harsh treatment from providers. Lastly, women were concerned that PrEP costs, including insurance coverage and copays, would keep PrEP out of their reach. While cognizant of the potential barriers, women were unwavering in their determination to find ways to circumvent challenges to PrEP access. Conclusion: Social and structural barriers may impede women’s access to PrEP despite their own reported interest. Continued efforts to reduce HIV stigma, improve patient-provider relationships and ensure affordability of PrEP may increase the likelihood that women will use this important prevention modality.

Background: Adherence assessment in HIV-infected individuals under antiretroviral therapy (ART) is essential. The assessment tool should be reliable and easy to apply in routine clinical practice. The goal of this study was to evaluate a pictogram-enhanced visual analog scale (VAS) suitable for illiterate patients to assess self-reported adherence in ART-treated HIV-infected individuals in a resource-limited setting. Methods: Adherence of 299 HIV-infected individuals on ART for ≥ 6 months attending an HIV-clinic in rural Tanzania was prospectively assessed 1-3 months (visit V1) and 6-9 months (V2) after a healthcare provider training in patient-centered communication by various measures: 1) 1-10 pictogram-combined Likert VAS, 2) standardized questionnaire, 3) therapeutic drug monitoring (TDM) of ART-compounds and 4) plasma HIV-RNA. Results: 94% of the study population had no formal or only primary education. Individuals with non-adherence were detected in 17.2% by VAS (score ≤ 9) and in 10.7% by questionnaire (≥ 1 missed ART-dose/4weeks) at V1. The detection rate declined to a lesser extent with VAS (11.7%, p=0.06) compared to the questionnaire (5.7%, p=0.016) at V2. VAS strongly correlated with the questionnaire (kappa>0.50, p<0.0001). Test agreements between TDM and VAS (kappa ≤ 0.200) and between HIV-RNA and VAS (kappa ≤ 0.220) were weak to fair, but slighly superior compared to the questionnaire (kappa ≤ 0.180 and ≤ 0.060, respectively). Conclusion: The VAS is a valuable tool for assessing self-reported adherence in illiterate HIV-infected individuals. It is inexpensive, rapid, and easier to apply than the questionnaire. Its use should be considered in resource-limited countries where more complex measures may not be feasible.

Using FWSS in Nigeria as a case study, this research develops a novel risk equation for estimating new infections among FWSS, their clients and communities. It uses a hybrid SUDT and SIT structural model. It considers number of contacts, number of protected and unprotected sexual acts, population and other existing values as base inputs. Simulation of the model was done using python programming. The model also estimates the impacts of these interventions on the clients of the sex workers, their female partners and the general population. The levels of the program implementation, needed on each scenario, to achieve the required number of averted new infections are also modelled. This model can be used to estimate the risk of a population set to a sexually transmitted disease. Public health workers can use the model to prepare a fit for- purpose intervention program for specific community members.

Background: HIV/AIDS and malnutrition effects are interrelated and exacerbate one another in a vicious cycle. HIV specifically affects nutritional status by increasing energy requirements, reducing food intake and adversely affecting nutrient absorption and metabolism. In spite of the number of People Living with HIV ever enrolled on ART increases significantly in Ethiopia. Nutritional care and other supports which help for the success of treatment received insufficient attention. The aim of this study was to assess the prevalence of undernutrition status and its determinants among adult HIV/AIDS Clients enrolled on ART at Nigest Elleni Mohammed Memorial Hospital in Hosanna Town, Southern Ethiopia. Method: Institution based cross-sectional quantitative study was conducted using systematic random sampling technique with sample size of 234. From each sampled patient, interview and anthropometric data were collected. Bivariate and multivariate logistic regression analysis was used and the variables which had significant association were identified on the basis of p-value ≤ 0.05 and AOR, with 95% CI. Results: Among adult HIV/AIDS Clients in rolled in ART, 32.5% of them were under nourished (BMI<18.5 Kg/m2). ART patients had no nutritional supports (AOR=2.22), patients who feed less than 3times in a day (AOR=3.29) and had smoking habit (AOR=6.06) were more likely to be under nourished and those patients in WHO Clinical stage 3 (AOR=0.12) were less likely to be under nourished. Conclusion: This study revealed that under nutrition among adult HIV/AIDS Clients in rolled in ART was high prevalent problem in the study area. WHO clinical stage, daily food intake, nutritional support, smoking status was identified as the determinants of under nutrition. Current study identified that there is a need to design and implement nutritional interventions including nutritional support in items or financially together with healthy habit counselling as part of integrated ART service for effective patient treatment outcome.