Management and Outcome of Pregnant Women with HIV Acquired by Vertical Transmission

The majority of children with perinatally acquired human immunodeficiency virus (HIV) do not survive beyond childhood but this is changing due to the benefit of antiretroviral therapy for the perinatally infected cohort, so affected children are now approaching the age to be mothers. The aim of this article is to evaluate the outcomes of pregnant women with HIV acquired by vertical transmission in our centre and encourage the results obtained in “Thirty Years Later: Pregnancies in Female Perinatally Infected with Human Immunodeficiency Virus-1”, a review article published in this journal in 2012 [2]. We report 6 patients with eight pregnancies with HIV acquired by vertical transmission. They delivered a total of nine newborns between 2004 and 2013. In any case, mother-to-child transmission was reported. The management of pregnant women with HIV acquired by vertical transmission is complicated, since the patients are the most of the cases young and the compliance to the treatment may be poor. The prematurity was the more frequent complication and the cesarean section was the more frequent form of ending. In our case series, mother-to-child transmission was absent.

Testing Point of Care Portable Data Capture in a Hospital HIV Transmission Prevention Programme and Experience from Computerized Patient Management in a Sub-Saharan Clinic Setting

Clinicians involved in HIV/AIDS （Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome） prevention of mother to child transmission （PMTCT） programme and research activities can benefit from the advantages that computerized systems add to medical practice even in resource constrained sub-Saharan clinic settings. Their continued use of paper based systems presents clinical data management and patient care challenges. A portable point of care data capture electronic system and a computerized clinic patient management system （CCPMS） were implemented to remedy these challenges. PMTCT report compilation was easier with the portable data collection system whose data were found to be more complete and accurate with a 0.83% error rate compared to a 4.1% error rate in the paper registers. A resounding majority of clinicians preferred using the new CCPMS with many of the view that it improved drug inventory and general clinic management with a positive effect on patient care.

Impact of HIV on the health-related quality of life in youth with perinatally acquired HIV

Background Studies investigating health-related quality of life(HRQoL)in youth with perinatally acquired HIV(PHIV+)are scarce.This study aimed to compare HRQoL of PHIV+to sociodemographic-matched youth not living with HIV(HIV-),Spanish general youth population,and to explore associations between sociodemographic variables,drug consumption,and HRQoL.Methods PHIV+youth were randomly selected from CoRISpe database(Cohort of the Spanish Pediatric HIV Network).HRQoL was evaluated by SF-12v2.Results Thirty-nine PHIV+youth(mean age:23.36 years,SD=3.83)and thirty-nine HIV-youth(mean age:22.97 years,SD=3.80)participated in this study.PHIV+obtained lower scores in SF-12 physical health subscale(PCS)than HIV-(P=0.001)and Spanish general youth population(P=0.006).PHIV+had lower scores on the mental health subscale(MCS)than the Spanish general youth population(P<0.001).PHIV+who were at school obtained better scores than those were not at school.PHIV+youth who had used cocaine and cannabis had lower scores in MCS(P=0.002).Conclusions There is a need for HRQoL management in the associated medical follow-up.

Survival of people living with HIV after treatment with Traditional Chinese Medicine in Henan province of China: a retrospective cohortstudy

OBJECTIVE: To provide survival estimates of people living with human immunodeficiency virus(PLHIV) after treatment with Traditional Chinese Medicine(TCM) in rural China, to identify the prognostic factors at enrollment, and to explore the effectiveness of TCM intreating PLHIV.METHODS: PLHIV who enrolled in national TCM HIV treatment trial program in October 2004 were analyzed in this study and followed up to October 2010. Survival time was estimated by the Kaplan-Meier curve and hazard ratios, and identifying prognostic factors were computed through Cox proportional hazard models.RESULTS:A total of 1666 PLHIV were included with 102 591 person-months of follow-up. Overall, 312(18.7%) patients died. The total mortality rate over the study period was 3.6 per 100 person-years,which was lower than the worldwide rate. The cumulative survival rate was 95.9% at 1 year[95% confidence interval(CI)(94.8-96.8)] and 80.4% at 6years [95% CI(78.4-82.3)]. Elevated death risks emerged among males, older individuals, and thosewithlowerCD4+T-cellcounts.CONCLUSION: TCM could increase survival and lengthen the life span of PLHIV in Henan province of China, as shown by our retrospective cohort study. Factors such as sex, age, education, and CD4+ T-cell counts correlated to survival. However,retrospective cohorts bias the data, so more prospective studies should be performed to confirm our primary results.

Fuzhengpaidu granule regulates immune activation molecules CD38 and human leukocyte antigen-D related on CD4+ and CD8+ T cells in patients with acquired immunodeficiency syndrome/human immunodeficiency virus

OBJECTIVE: To evaluate the effect of Fuzhengpaidu granule (FZPDG) on immune activation molecules CD38 and human leukocyte antigen-D related (HLA-DR) on CD4+ and CD8+ cells in HIV/AIDS patients, and to explore the underlying mechanism of this therapy. METHODS: Plasma changes in CD3+, CD4+, CD8+, CD3+CD4+CD38+, CD3+CD4+HLA-DR+, CD3+ CD8+CD38+, and CD3+CD8+HLA-DR+levels in HIV/ AIDS patients treated with FZPDG for six months were examined by flow cytometry and compared with levels in healthy controls. RESULTS: The clinical trial included 34 outpatients with HIV/AIDS. Before treatment, plasma levels of CD38+ and HLA-DR+ on CD4/CD8 cells were higherthan those in 28 health controls (P<0.05). There were no significant changes in serum levels of CD3+, CD4+, and CD8+ T cells between pretreatment baseline versus after treatment, which were 82.85% ± 5.41% , 14.57% ± 10.31% and 54.55% ± 11.43% before treatment and 79.15% ± 8.21% , 19.96% ± 9.58% and 56.36% ± 11.67% after treatment, respectively (P>0.05). Plasma levels of CD3+ CD4+CD38+and CD3+CD4+HLA-DR+were 2.3%± 2.2% and 7.8%±5.5% before treatment and 1.2%± 0.8% and 2.6%±1.0% after treatment, respectively. Plasma levels of CD3+CD8+CD38+ and CD3+CD8+ HLA-DR+ were 41.4%±13.4% and 17.8%±11.3% beforetreatment,whichchangedto27.1%±10.2%and 3.8%±2.4%aftertreatment,respectively(P<0.05). CONCLUSION: HIV/AIDS patients exhibited an immune activation profile following FZPDG treatment. A potential mechanism of action for FZPDG appears to lie in its ability to up-regulate CD38 and HLA-DR levels on CD4+ T cells, and down-regulate them on CD8+ cells, thereby modulating immune activation of CD4+and CD8+T cells.

Reliability and validity of dermatology life quality index: assessment of quality of life in human immunodeficiency virus/acquired immunodeficiency syndrome patients with pruritic papular eruption

OBJECTIVE: To test the reliability and validity of dermatology life quality index(DLQI) in simplified Chinese language by assessing the quality of life(QoL) in HIV(human immunodeficiency virus)/AIDS(Acquired immunodeficiency syndrome) patients with pruritic papular eruption(PPE). METHODS: A study of simplified-Chinese-versiond from10 questions with the principal component analysis and the contribution rate of the 3 common factors was 59.95%. CONCLUSION: The simplified-Chinese-version DIQL is an acceptable and valid scale for HIV/AIDS patients with PPE. It can be used to evaluate the QoL of HIV/AIDS patients with PPE in China.

Effectiveness of Xielikang capsules in treating HIV-related diarrhea by increasing the plasma concentration of interleukin-17

OBJECTIVE: To evaluate the efficacy of Xielikang capsules(XLKC) in the treatment of HIV-related diarrhea(HRD) and its effect on the plasma concentration of interleukin-17(IL-17).METHODS: This was a randomized, open-label, pos-itively-controlled clinical trial. Sixty-seven HRD patients were randomly assigned to two groups: one group was treated with XLKC(n = 35), the other with diosmectite(Smecta~?, n = 32). All patients were treated for 4 weeks. The HRD symptom scores were evaluated in each patient based on the frequency of diarrhea, and the quality and shape of the stool according to the Chinese Medicine Clinical Treatment of AIDS Program. The plasma concentration of IL-17 before and after treatment was measured with ELISA.RESULTS: Compared with the Smecta~? group, the XLKC group had a significantly reduced frequency of diarrhea and HRD symptom score regarding the quality and shape of stools(P < 0.05). The IL-17 concentration in the peripheral blood of the XLKC group was significantly increased after treatment,while the IL-17 concentration in the Smecta~? group significantly decreased after treatment.CONCLUSION: XLKC improves the symptoms of patients with HRD, and increases the plasma concentration of IL-17.

Health related quality of life:is it another comprehensive evaluation indicator of Chinese medicine on acquired immune deficiency syndrome treatment?

Health related quality of life(HRQOL) can better reflect changes in acquired immune deficiency syndrome(AIDS) patients and inform economic evaluation of AIDS treatment services,and the assessment of HRQOL can help us to detect problems that may influence the progression of the disease,hence HRQOL has become a particularly important assessment indictor for HIV comprehensive interventions.Being a multi-angle,multi-level,and diversified complex intervention,roles of Chinese medicine(CM) in AIDS treatment have been recognized and accepted by more and more patients,and HRQOL has been widely used to evaluate the comprehensive management effects of CM on AIDS.In this article,the authors analyze the definition and measurement of HRQOL,measurement of HRQOL of HIV/AIDS patients and effects of CM on AIDS,and give some reasonable advices for the usage of the scale of HRQOL.The authors hold that some new HRQOL instruments specific for CM treatment of AIDS should be developed and further prospective studies should be carried out to demonstrate the practicality,reliability and validity of HRQOL as an evaluation indictor for CM treatment of AIDS.

Reliability and validity of Persian version of Medical Outcome Study-HIV health survey in Iranian people living with HIV

OBJECTIVE: To evaluate the psychometric properties of the Persian version of the medical outcome study human immunodeficiency virus(MOS-HIV)health survey among people living with HIV or acquired immune deficiency syndrome(HIV/AIDS) in Iran is our main goal in this study.METHODS: The MOS-HIV questionnaire was translated into Persian using backward translation and the Persian version was filled by 100 HIV infected patients. Reliability of the questionnaire was estimated using Cronbach's alpha coefficient for the total questionnaire and for each dimension. Convergent, discriminant and construct validity were performed. Comparisons were performed between the subscales of the questionnaire in Iran and some other countries with t-test.RESULTS: The overall Cronbach's alpha in this study was 0.90 and the range of this coefficient was from 0.71 to 0.86 across the subscales with two exceptions, general health perception and role functioning, which were at 0.65 and 0.61. Convergent and discriminant validity were excellent in all domains. The two factor confirmatory factor analysis showed a good fit based on standardized estimates of factor loading, incremental and absolute fit indices.CONCLUSION: The Persian version of the MOS-HIV had good reliability and validity in measuring health related quality of life in people living with HIV in Iran. Furthermore, quality of life for HIV infected patients was very low in comparing with the people in some other countries.

Cutaneous Manifestations of HIV/AIDS in the Era of Highly Active Antiretroviral Therapy: Evidence from Bangladesh

Objective:Skin diseases are common and striking features of patients with human immunodeficiency virus/acquired immunodeficiency syndrome(HIV/AIDS)and may vary considerably by ethnic and geographic regions and by the influence of highly active antiretroviral therapy(HAART).However,little information exists regarding the cutaneous manifestations of patients with HIV/AIDS in Bangladesh.This study was performed to elucidate the spectrum of cutaneous disorders in patients with HIV/AIDS in the era of HAART.Materials:This descriptive cross-sectional study was carried out in Chittagong Medical College Hospital,Bangladesh from January 2017 and December 2020.Diagnosed case of HIV/AIDS for HAART therapy and all cases of HIV/AIDS who are already on HAART therapy were included in this study.Descriptive statistical analysis was carried out by using frequencies and percentages.Results:Of 40 patients with HIV/AIDS,22(55.0%)were male and 18(45.0%)were female.The patients ranged in age from 8 to 60 years,with a mean age of 38±0.966 years.Among all age groups,the highest 19(47.5%)patients were in the 31-to 40-year age group.Most of the patients were migrant workers[22/40(55.0%)]with low socioeconomic status[32/40(80.0%)],and the most common transmission mode was heterosexual activity[36/40(90.0%)].Most of the patients[32/40(80.0%)]had mucocutaneous disorders,30/40(75.0%)had infective dermatoses,and 21/40(52.5%)had non-infective inflammatory dermatoses.Eight of forty(20.0%)patients presented with three or more skin disorders.The most common infective dermatoses were fungal infections[15/40(37.5%)],followed by viral infections[8/40(20.0%)],bacterial infections[4/40(10.0%)],and scabies[3/40(7.5%)].The most common non-infective dermatosis was generalized pruritus[6/40(15.0%)],followed by prurigo simplex[4/40(10.0%)],psoriasis[4/40(10.0%)],eczema[3/40(7.5%)],pruritic papular eruption[1/40(2.5%)],seborrheic dermatitis[1/40(2.5%)],urticaria[1/40(2.5%)],and xerosis[1/40(2.5%)].Patients treated with HAART had decreased rates of oral candidiasis and herpes simplex but increased rates of drug reactions[19/40(47.5%)].The most common drug eruption following HAART was a morbilliform rash[11/40(27.5%)],and the most common offending agent was nevirapine.The prevalence of mucocutaneous disorders was higher in patients with a CD4 cell count of<200 cells/mm3.Conclusions:A wide range of mucocutaneous disorders is observed in Bangladeshi patients with HIV/AIDS,and HAART has an impact on the spectrum of HIV/AIDS-associated mucocutaneous disorders.Skin and mucocutaneous disorders are seen at every stage of HIV/AIDS and are the initial presentation in most patients in Bangladesh.There is a need for increased attention to the diagnosis and treatment of skin diseases affecting the quality of life of patients withHIV/AIDS.