Viral Characteristic of HIV Infected Patients Naïf of Anti-Retroviral Therapy with CD4+ T Lymphocytes Rate Greater than 350 per Microliter of Blood in LoméTogo

Objective: To evaluate the virological status of ineligible HIV patients for anti-retroviral therapy based on the criterion of CD4+ T lymphocytes rate over than 350/μl of blood. Method: This is a prospective study which was conducted from November 2011 to July 2012 in the tropical and infectious disease department of CHU Sylvanus Olympio of Lomé. All HIV-1 infected patients whose CD4+ T lymphocytes rate was ≥350/μl of blood were retained. The count of CD4+ T lymphocytes was made by cytometer FACSCalibur? flow of BD biosciences and the determination of viral load was achieved by NASBA laboratory method of Biomérieux. Results: We have recruited 102 PLWHA aged between 19 and 58 years with a median of 35 years. Biologically, 102 patients had a T-CD4 rate between 355 and 432/μl of blood. The determination of viral load showed a very high viral replication more than 10,000 copies/ml among all patients and 28 (27.5%) patients had a viral load > 100,000 copies/ml of blood. Conclusion: Our results argue for a reconsideration of the criteria for starting antiretroviral therapy in Togo by including virological data if necessary in patients with T-CD4 rate below 500/μl of blood.

Factors That Influence Anti-Retroviral Therapy Adherence among Women in Lilongwe Urban Health Centres, Malawi

Introduction: Sub-SaharanAfricaremains most severely affected, with nearly1 inevery 20 adults (4.9%) living with HIV and this is accounting for 69% of the people worldwide. Although the regional prevalence of HIV infection is nearly 25 times higher in sub-Saharan Africa than in Asia, almost 5 million people are living with HIV in South, South-East and East Asia combined. Purpose: The purpose of this study was to find out the factors that influence anti-retroviral therapy adherence among women in Lilongwe Urban,Malawi. Methods: a descriptive cross-sectional design was used to study multi sites using quantitative methods. The sites were ART clinics at Area 18 health centre, and Area 25 health centre. A questionnaire was used to a convenient sample of 118 HIV positive women. Quantitative data from close-ended questions were coded and analyzed using the Statistical Package for Social Science (SPSS), version 16. Logistic regression model was used to execute the potential covariates. Findings: ART adherence among women is influenced by knowledge levels on: perceived importance and consequences for not adhering to ART;Short waiting time;good relationships with the next of kin and service providers;trust and effective coping mechanisms to stressful events. Source of information was highly associated with adherence in the logistic regression OR ≤ 2.89;CI (1.66 ± 5.38);p (0.039). Moreover, Short waiting time of the women at the hospital during the ARV refill period is highly associated with ART adherence level OR ≤ 4.11;CI (2.05 ± 6.12);p (0.021). On the other hand, factors that contribute to non-adherence are reduced knowledge level p0.002;Side effects of ART;bad relationships with service providers and relationship with the next of kin as well as occupation of the clients (women). Conclusion: Despite stressful events to HIV positive living women, this study revealed that the majority of these participants would continue taking ART if the factors are very minimal. Encouraging the women who stop taking ART particularly in urban health centres due to such factors like religious beliefs that God is superior and will heal them would influence the ART survival rate in Malawi.

Efficacy of integrated Traditional Chinese Medicine and anti-retroviral therapy on immunological nonresponse in patients with human immunodeficiency virus/acquired immunodeficiency syndrome: a Meta-analysis of randomized controlled trials

OBJECTIVE:To explore the efficacy of integrating Traditional Chinese Medicine(TCM)and anti-retroviral therapy(ART),a customized combination of different classes of medications which was also called cock-tail treatment,on the immunological nonresponse(INR)in people living with human immunodeficiency virus(HIV)(PLWH).METHODS:Relevant literature in databases such as China National Knowledge Infrastructure Database(CNKI),Wanfang Digital Journal,Chinese Medical Journal Database(CMJD),Chinese Biomedical Literature Database(CBM),Pub Med,Cochrane,and Embase was reviewed by two independent investigators.Data were extracted from the studies according to the eligible criteria and analyzed using Review Manager 5.3.RESULTS:Nine randomized controlled trials(RCTs)with 1078 patients were analyzed.Our analyses showed that CD4 T cell counts in the treatment group improved compared with that in the control group[mean difference(MD)=13.51,95%confidence interval(CI):7.42-19.60,P<0.0001].There was no significant difference between the treated and control groups after 3 months(MD=25.31,95%CI:-2.78 to 53.41,P=0.08).However,after 6 and 12 months,the response of the treatment group was superior to the control group(MD=27.45,95%CI:7.09-47.81,P=0.008 and MD=27.34,95%CI:6.31–48.37,P=0.01,respectively).The clinical efficacy of the treatment group was also higher than that of the control group(RR=1.75,95%CI:1.16-2.65,P=0.007).However,CD45 RO and CD45 RA T cell counts did not differ significantly between the two groups(MD=12.37,95%CI:-6.71 to 31.45,P=0.20 and MD=5.67,95%CI:-3.00 to14.35,P=0.20,respectively).CONCLUSION:The combined treatment strategy of integrated TCM and Western Medicine promotes long-term reconstitution of the immune system and thus,is beneficial and has potential use for improving INR in PLWH.However,large-scale RCTs are required to provide evidence for optimal intervention strategies.

Profiles of HIV-infected anti-retroviral therapy naïve children from Mumbai,India

Background:This study aimed to investigate the demographic profiles of human immunodifficiency virus(HIV)infected anti-retroviral therapy(ART)naïve children in our hospital and their relations to the clinical,immunological and nutritional status.Methods:A cross-sectional study was conducted in an Integrated Counselling and Testing Center(ICTC)at a tertiary care hospital in Mumbai.ART naïve HIV positive children were enrolled in the study.The demographic profiles,clinical features,immunological(CD4%/CD4 count)and nutritional status of these children were recorded.The agreement between clinical,immunological and nutritional staging was determined using Cohen’s kappa test.Results:In 192 HIV-infected ART naive children enrolled with a median age of 9 years(range 3 months-14 years),97.4%acquired infection through vertical transmission.The most common clinical presentation was fever(39.6%),followed by generalized lymphadenopathy(32.3%),cough(22.4%)and diarrhoea(9.9%).Tuberculosis was seen in 22.9%of the children.The agreement was fair between clinical and immunological staging,and slight between nutritional,immunological and clinical staging.Conclusion:Perinatal transmission is the most common mode of acquiring HIV infection in children.The Prevention of Parent to Child Transmission(PPTCT)program should be strengthened for lowering the transmission rate by providing extended ART to mothers during pregnancy and breast-feeding.Tuberculosis remains a major concern in HIV-infected children.The poor correlation between WHO clinical and immunological staging emphasizes the importance of making CD4 facilities available in HIV prevalent areas.Malnutrition cannot be used as a surrogate marker for predicting stage or severity as it is common at all stages of HIV disease.

Colorectal cancer screening in human immunodeficiency virus population:Are they at average risk?

AIM:To evaluate if human immunodeficiency virus (HIV) population is getting adequate screening for colon cancer in the highly active anti-retroviral treatment (HAART) era with improved longevity, and the prevalence of polyps and adenomas in this population, when compared with the general population. METHODS:We conducted retrospective chart review of average-risk HIV population for colon cancer attending our infectious disease clinic. Individuals who underwent diagnostic colonoscopy were excluded. We extracted various demographic, HIV disease-specific and colonoscopy data including histo-pathological reports in the last 10 years. Total population was divided into a study group, who underwent screening colonoscopy and a control group who did not. We analyzed data using standard statistical methods and software. RESULTS:We found that 25% of average-risk HIVinfected population was screened for colon cancer using colonoscopy. There was no difference in gender and ethnic distribution between the groups. We foundwider distribution of age (50-84 years with mean 56 years) in the control group when compared to (50-73 years with mean 58 years) the study group. However, there were 89% of subjects with well-controlled HIV disease measured by HIV RNA copies of < 75 in the study group when compared with 70% in the control group (P < 0.0001). We noticed polyp detection rate of 55% and adenoma detection rate of 32% in HIV population. CONCLUSION:It is unclear whether HIV or HAART medications play a role in increased prevalence of adenomas. We suggest that when estimating the risk for colonic neoplasms, HIV population should be considered as a high-risk group and screened accordingly.

Hepatitis C in human immunodeficiency virus co-infected individuals: Is this still a “special population”?

A substantial proportion of individuals with chronic hepatitis C virus(HCV) are co-infected with human immunodeficiency virus(HIV). Co-infected individuals are traditionally considered as one of the "special populations" amongst those with chronic HCV, mainly because of faster progression to end-stage liver disease and suboptimal responses to treatment with pegylated interferon alpha and ribavirin, the benefits of which are often outweighed by toxicity. The advent of the newer direct acting antivirals(DAAs) has given hope that the majority of co-infected individuals can clear HCV. However the "special population" designation may prove an obstacle for those with co-infection to gain access to the new agents, in terms of requirement for separate pre-licensing clinical trials and extensive drug-drug interaction studies. We review the global epidemiology, natural history and pathogenesis of chronic hepatitis C in HIV co-infection. The accelerated course of chronic hepatitis C in HIV co-infection is not adequately offset by successful combination antiretroviral therapy. We also review the treatment trials of chronic hepatitis C in HIV co-infected individuals with DAAs and compare them to trials in the HCV mono-infected. There is convincing evidence that HIV co-infection no longer diminishes the response to treatment against HCV in the new era of DAA-based therapy. The management of HCV co-infection should therefore become a priority in the care of HIV infected individuals, along with public health efforts to prevent new HCV infections, focusing particularly on specific patient groups at risk, such as men who have sex with men and injecting drug users.

Antiretroviral therapy improves neurocognitive impairment in people living with HIV? A meta-analysis

Objectives:Although effective antiretroviral therapy(ART)has been used for more than two decades,HIV-associated neurocognitive disorder remains prevalent.Thus,whether ART can improve neurocognitive impairment is controversial.This review aims to explore the effects of ART on cognitive impairment in people living with HIV(PLWH).Methods:A systematic literature search was conducted in eight databases(PubMed,Embase,Web of Science,Cochrane Library,CNKI,VIP,China Biology Medicine disc,and WanFang)to identify studies that compare cognitive function between study groups who are administered and not administered ART.We searched for articles published up to April 2019.Article evaluation and data extraction were independently conducted by two reviewers.Results:Sixteen articles(6,694 participants)-14 cross-sectional studies and 2 cohort studies—were included in this meta-analysis.The cross-sectional studies demonstrated that ART group did not perform better than the non-ART group(OR=1.16;95%CI,1.03-1.30).However,the cohort studies reported a significant improvement in cognitive function at three months(OR=4.01;95%CI,2.35-6.85)and six months(OR=9.24;95%CI,1.71-49.96)after ART initiation compared with the baseline data.No significant cognitive improvement was found in participants younger than 55 years old,but the two crosssectional studies showed that ART may improve cognitive function in PLWH under 65 years old with poor physical condition and immune status.Conclusions:ART could improve cognitive function in PLWH with poor physical condition and immune status,but it does not considerably improve cognition in the entire PLWH population.

Antiretroviral Therpay Induced Liver Toxicity among Immunecompromised HIV Patients at Chu Brazzaville

Introduction: Human immunodeficiency virus (HIV) infection is a public health problem of concern. Anti-retroviral therapy (ART) is associated with multiple side effects. This study aimed at identifying the different hepatic manifestations of antiretroviral therapy and the responsible molecules. Patients and Methods: This was an eight months period prospective descriptive study, from January 1st to August 31st, 2015, conducted in the Department of Gastroenterology and Internal Medicine at the Brazzaville University Teaching Hospital. Study participants were treatment-na?ve HIV patients who were initiated on ART treatment during the study period. Patients with liver disease, liver cytolysis prior to initiation of therapy, and those with alternative therapy that may cause hepatotoxicity were excluded. The sample size was 110 patients. Results: The age was ranging from 25 to 70 years with a mean age of 47.5 ± 7.5 years. During the six months of follow-up, the alarming hepatic signs were observed in 26.36% of cases (n = 29) in the 3rd month of treatment. There was no observed alarming sign in the 6th month of follow-up. The cytolytic pattern was observed in 54.55% of cases (n = 60) in the 3rd month. The cholestatic pattern was observed in 6.36% of cases (n = 7) in the 3rd month. Triple therapy combination of Zidovudine, Lamivudine and Nevirapine (AZT + 3TC + NVP) was the most used in 57.27% (n = 63) with a statistically significant p value to the occurrence of cytolytic pattern (p Conclusion: Drug induced liver toxicity occurs in a significant number of patients starting ART. The prevalence of hepatic events was high at the third month of treatment and the triple therapy of Zidovudine, Lamivudine and Nevirapine (AZT + 3TC + NVP) was the most incriminated.

Foilized pouches can prevent the transmission of HIV from mother to child using multi-drug therapies

Children can become HIV positive (HIV+) from their mother during home birth. If the infant ingests antiretroviral (ARV), medications immediately after birth, the risk of transmission can be dramatically reduced. We have previously proposed the use of foilized, polyethylene-lined pouches to store ARV’s. Using the pouch, the mother receives the medication at an antenatal care visit, months before delivery, and if she delivers at home, tears open the pouch and drips the medication into her child’s mouth. In this work, we extend the use of the pouch to store a modern ARV, Lamivudine (3TC), often used in multi-drug regimens. Under laboratory conditions, pouches were filled with 3TC and stored at 25?C/60% relative humidity (RH) for twelve months. We found that the 3TC was stable throughout the year (maximum 5.6% of labeled concentration change). The preservatives were somewhat degraded by the act of repackaging the medicine, but sufficient preservatives remained to maintain the medication. The same impurities were identified in the 3TC stored in the pouches and the samples removed from the bottles indicating that the pouches do not introduce new impurities (impurities that are not already introduced by the bottle). We conclude that the pouch can preserve this modern ARV for up to twelve months.

Successful Treatment with Triple Therapy of Amphotericin B, Voriconazole and Flucytosine on an AIDS Patients with Severe Cryptococcal Meningitis

A 35-year-old man(body weight=63 kg)with AIDS complaining fever and headache after having commenced anti-retroviral therapy(ART)for a week was admitted to our hospital.Five lumbar punctures performed during38 days could not confirm a cryptococcal meningitis(CM)based on staining or culture methods for cerebrospinal fluid(CSF).The disease quickly progressed with serious hearing/vision impairment and frequent onset of seizure and coma after being treated with corticosteroids for five days,and then CM was confirmed.Subsequent lumbar puncture showed elevated intracranial pressure as high as 870 mm H2O,even though treated with standard antifungal regimens for CM.His disease was finally controlled by a new triple therapy with amphotericin B(0.7mg?kg-1?day-1,intravenously),flucytosine(100 mg/kg perday,orally in four divided doses),and voriconazole(200mg every 12 hours)and ART containing lamivudine(300 mg/day),stavuding(30 mg,twice a day)and efavirenz(300 mg,orally every night).Although it is rare,negative CSF stain or culture for cryptococci in AIDS patients with CM can persist for a long time.Corticosteroids should be used cautiously when an effective anti-fungal therapy is not administered.Triple therapy with amphotericin B,flucytosine and voriconazole may be selectively applied in severe CM.Voriconazole can be co-administered with efavirenz with modified dosing.

Risk Factors for Viral Non-Suppression among People Living with HIV and Major Depressive Disorder in Uganda

Background: Several studies indicate that depression is associated with non-viral suppression among persons living with HIV (PLWH) using antiretroviral therapy (ART) worldwide. However, among PLWH with major depressive disorder, factors associated with non-viral suppression remain uncertain. We determined the prevalence and identified the factors associated with viral non-suppression among PLWH with major depressive disorder using ART in Northern Uganda. Method: A total of 30 primary care HIV clinics across three northern districts (Gulu, Kitgum, Pader) participated in the study. Using baseline data from the SEEK-GSP study, a cluster-randomized trial in northern Uganda (2016-2019) that involved 1140 PLWH with mild to moderate major depressive disorder;we examined the demographic, clinical, and psychosocial factors using standardized questionnaires. Data on viral load was abstracted from clinic records and dichotomized into suppressed (Results: We recruited 1140 PLWH. The viral non-suppression prevalence was 12.2%. In multivariable analysis, the only baseline psychosocial variable independently associated with non-viral suppression was suicide risk (PRR = 1.56, 95% CI: 1.05 - 2.32, p-value = 0.029). The prevalence odds for non-viral suppression were 56% higher among depressed PLWH with moderate to high suicide risk than those with low suicide risk. Among clinical variables, duration on ART ≥ 4 years was independently associated with non-viral suppression (PRR = 1.62, 95% CI: 1.09 - 2.32, p-value = 0.015). Conclusions: Suicide risk and longer duration on ART are associated with non-viral suppression among anti-retroviral therapy users with mild to moderate major depressive disorder in Uganda. As ART is scaled up across Sub-Saharan Africa, first-line psychological care for depression and its complications is urgently needed in established HIV treatment centers.

Gynaecological Cancers in HIV Positive and Negative Women—A Single-Center Retrospective Study (2008-2017)

Background/Objective: The association between Human Immunodeficiency Virus (HIV) and invasive cervical carcinoma is fully recognized. However, the effect of HIV and antiretroviral therapy on the morbidity and mortality of other gynaecological cancers have not been conclusively determined. Our study objective was to examine the effects of HIV on patient age at presentation, prevalence, and severity of the illness of various gynaecological cancers diagnosed in University of Nigeria Teaching Hospital (UNTH), Enugu over the period 2008-2017. Methods: This was a retrospective cross-sectional study of 224 patients who were managed in UNTH for different gynaecological malignancies. Ethical clearance was obtained from the Research Ethics Committee of the UNTH, Enugu. Data analysis was done with SPSS software with results expressed in descriptive statistics of simple frequency and percentage, and p-value set at Results: A total of 224 patients were studied. Twenty-five percent of HIV positive patients were aged 31 - 40 years at presentation compared to 12% of HIV negative patients. The commonest gynaecological cancer was cervical cancer with a higher proportion among the HIV-positive patients. While 32% of HIV negative patients presented at FIGO stages 1 - 2 Versus 8.3% of HIV positive patients, 58.3% and 33.3% of HIV positive patients presented at stages 3 and 4 respectively. Only 8.3% of HIV positive patients presented with ovarian cancer compared with 31% of HIV negative patients. A higher proportion of HIV positive patients presented with vulvar cancer (16.7%), but no endometrial or choriocarcinoma/GTD, compared with HIV negative patients. Conclusion: HIV positive clients present at an earlier age with more advanced disease, mostly cervical cancer of the squamous cell variety, with minimal non-AIDS defining cancers over the study period in UNTH, Enugu.

Overview of antiretroviral treatment in China： advancement and challenges

As the severity of the HIV epidemic in China grew, National Free Antiretroviral Treatment （ART） Program was announced since 2003. Even though there still were many difficulties, China had obtained great achievements in fighting against HIV.Over 52 000 adult patients had received first-line HAART thus far and the mortality of AIDS in China decreased significantly. This paper presents an overview of the HIV/AIDS epidemic in China; the status of national free ART program,the difficulties suffered and the achievements made since the initiation of program and the challenges ahead for continued progress for China. This paper also provides suggestions to overcome these challenges.