Two Highly Variable Vpr₈₄and Vpr₈₅Residues within the HIV-1-Vpr C-Terminal Protein Transduction Domain Control Transductionnal Activity and Define a Clade Specific Polymorphism

The virally encoded HIV-1 viral protein R (VPR) is a multifunctional factor that is required for induced HIV-1 pathogenesis. VPR is also a cell-penetrating protein found in biological fluids from HIV-1 infected individuals. In this regard, we previously published that the C-terminal VPR77-92 sequence from HIV-1 89.6, but not from pNL4.3 strain, is a new pro-apoptotic and protein transduction domain (PTD). Here we report on a sequence analysis of VPR77-92 domain using the Los Alamos HIV-1 sequence database. The analysis showed that the two residues of the domain VPR84 and VPR85 are highly variable and differently biased in HIV-1 clade B and HIV-1 clade C. Furthermore, when Jurkat lymphoblastoid cells or PBMC were incubated with chemically synthesized peptides containing distinct VPR77-92 C-terminal sequences from clades B or C, we found that a clade-dependent polymorphism in VPR84 and VPR85 residues controlled the transducing activity of the C-terminal HIV-1 VPR77-92 domain. Together our data indicate that clade-dependent polymorphism in the VPR84 and VPR85?residues defines the transducing properties mediated by the C-terminal domain of HIV-1 VPR. Identification of this VPR polymorphism suggests new approaches to understand the HIV-1 biology and/or pathogenesis.

Impact of TI Programmes Intervention under National AIDS Control Programme among Female Sex Workers in India: Evidence from Integrated Biological and Behavioural Survey, 2014-15

Background: A better understanding of the impact of Targeted Interventions (TI) services on Female Sex Worker (FSW) behaviours can help in informing and strengthening future TI efforts under National AIDS Control Programme (NACP). Methods: National Integrated Biological and Behavioural Survey (IBBS) 2014-15 has been analysed in the paper. Descriptive statistics and logistic regression analysis were used to understand factors affecting condom use. Propensity score matching (PSM) was done to understand the impact of the TI services on condom use at the last act and consistent condom use in the last three months among FSWs. Results: Younger FSWs aged 15 - 25 years were 1.4 times (95% CI: 1.04 - 1.77) more likely to use consistent condoms in the last three months compared to older over 45 years after controlling for other socio-economic and programme variables. The matched samples estimate ATET i.e. the average treatment effect on treated for consistent condom use in the last three months shows that a 6.0% (CI: 4.7 - 7.3) increase in consistent condom use in the last three months in the FSWs who received information on STI/HIV from peer educator and outreach worker. There is also a 6.0% (4.7 - 7.2) increase in condom use in the last act for FSWs who received the referral services at STI clinics, HIV testing, and detox centres. Conclusions: It is evident that the TI programme has a positive impact on behavior change among FSWs which can prove beneficial to curtail the spread of HIV to the partners and onward transmission to the general population.

Characterization of Candida Species Isolated from Cases of Lower Respiratory Tract Infection among HIV/AIDS Patients in Calabar, Nigeria

This study was designed to identify and characterize the Candida species isolated from lower respiratory tract infections among HIV positive patients and to determine the prevalence rates of Candida infections among these subjects. Two early morning expectorate sputum samples were collected from 272 HIV positive subjects visiting the ART clinics and DOTS centre with cases of lower respiratory tract infection, over a period of 14 months from May 2009 to July 2010 in Calabar. Subjects were recruited for this study upon approval by the Ethical Research Committee of the University of Calabar Teaching Hospital and obtaining written informed consent from the patients. Samples were processed by standard methods for isolation of Candida. Speciation was done by a germ tube test, chlamydospore production on corn meal agar and sugar fermentation and assimilation tests using the Microexpress Candida identification kit (Tulip, India). Out of the 544 sputum samples collected from 272 subjects, Candida species were isolated from 40 (14.7%) and identified after confirming the growth in the second sample. The majority of Candida species among the Candida isolates were Candida albicans (80%) followed by Candida tropicalis 5 (12.5%), Candida dubliniensis 2 (5.0%) and Candida guilliermondii 1 (2.5%). The isolation rate of Candida species from sputum samples was found to be highest among subjects aged 25 - 34 years, followed by those aged 15 - 24 years. Twenty (7.3%) HIV seropositive subjects had bacterial infections, while 4 (1.5%) subjects had mixed fungal and bacterial infections. This study is the first of its kind to be carried out in Calabar and the South-South geopolitical region of Nigeria, and has shown that pulmonary candidiasis is a health problem among HIV positive patients in Calabar.

Strategies for Good Retention Rates in HIV Exposed Sero-Negatives (HESN) Individuals: Important Consideration for HIV Biomedical Prevention Trials in Nigeria

Background: Retention in clinical trials is critical for the accumulation of data over time and retaining enough power for comprehensive analysis. We document for the first time the retention rates and factors associated with retention among a cohort of HIV exposed seronegative (HESN) person in a discordant relationship. Understanding these factors will provide valuable cues for maintaining high retention rates in future HIV biomedical prevention studies in this cohort. Aim: We aimed to document retention rates and associated factors relevant in conducting future HIV prevention studies using a cohort of HIV exposed sero-negative individuals. Method: We conducted a prospective cohort study to enroll HESN persons in discordant relationship based on established inclusion criteria that includes: Established sero-discordance with at least 3 months in the relationship;above 18 years and willingness to be followed up. Relevant ethical approvals were obtained. Following informed consent at enrollment, standardized questionnaires on risk behavior and factors that may affect retention were administered at enrollment and during the 2 years follow-up. This was spread over 10 follow-up visits to mimic phase a 2b HIV vaccine clinical trial follow up and duration. In addition, clinical examinations were done and samples collected for safety lab during the follow up visits. Estimation of CD4 and viral load was also done for the HIV+ partners of HESN study participants. Results: Six hundred and sixty HESN persons were screened and 534 (81%) enrolled (i.e. month 0) and followed up. There was a decline in retention from 96% at month 1 (visit 1) to 78% at month 24 (Visit 10). Sharpest drop out from the study occurred at month 1 (20%) and month 15 (14%) follow-up visits. Inability to reach study participants, unwillingness of study participants to continue study, and mortality of the HIV+ partners of HESN participants were the commonest reasons for participant study termination. Furthermore, no or low level of formal education, (AOR 2.79;95% CI 1.29 - 6.02, p = 0.06), being unemployed (AOR 1.96;95% CI 1.18 - 3.29, p < 0.01) and inconsistent use of condoms (AOR 1.83;95% CI 1.16 - 2.91, p Conclusion: Retention rates decline especially during month 1 (visit 1) and month 15 (visit 7) mainly due to participants’ inability to locate study participants and death of HIV+ partners of HESN enrollees. One unexpected finding from our study is that those who were more consistent in their use of condom were more likely to stay in the study. This is a possible indication of commitment or an incentive for giving free condoms at study visits. This is encouraging for combined biomedical prevention strategies where consistent condoms use is desired. On the other hand, factors such as unemployment, poor formal education and never/occasional condom use were predictors of study drop out. Retention strategies should consider these barriers and predictors of drop out as exclusion criteria in preparation for future HIV biomedical prevention trial.

The Role of Religiosity in HIV Prevention in Uganda: A Case-Control Study among Muslim and Christian Youth in Wakiso District

Background: In Uganda's HIV prevention strategy religious institutions are encouraged to deliver HIV prevention messages to the general public and to integrate HIV prevention into faith-based activities such as worship, funerals and marriage ceremonies. However, there is limited data on the relationship between religiosity and HIV prevalence. Objectives: The main objective was to assess the association between religiosity, HIV-risk behaviors and HIV prevalence. Methods: A case-control study was done among Muslim and Christian youth. Cases were defined as HIV positive youth and controls were HIV negative youth. Respondents were interviewed and then tested for HIV. A religiosity index was constructed to assess the association between religiosity, HIV-risk behaviors and HIV infections. Results: Higher levels of religiosity were significantly associated with abstaining from sex, avoiding drinking alcohol and avoiding narcotics. Higher levels of religiosity were also associated with lower HIV-infections. HIV infections were significantly associated with low religiosity, having one or both parents dead, and having multiple sexual partners. Conclusions: Religiosity appears to have an important role in HIV prevention among many Ugandans. These should be encouraged and made to feel proud of using religiosity in their HIV prevention efforts. Their numbers should also be increased. Religious leaders should be energized by the study findings and they should be supported to take the lead in the efforts of using religiosity for HIV prevention. All Ugandans should use the power of God within each of them for HIV prevention in line with their motto: 'For God and my country'. Religiosity for HIV prevention is readily available, accessible and affordable to the majority of Ugandans. This option should be supported by all stakeholders including government, non-governmental organizations, faith-based organizations and external support agencies, by mobilizing appropriate human, technical and financial resources to accelerate its implementation.

Biological Profile of HIV-Positive Patients in Bangui, Central African Republic, in 2017

Background: The biological profile of HIV-positive patients is essential for diagnosing treatment failure and the prognosis of infection. We determined the virological and immunological profiles and biological anomalies of HIV-positive people on antiretroviral therapy (ART) in Bangui, Central Afri-can Republic. Methods: We conducted an analytical, descriptive study be-tween 4 April and 30 September 2017 of all patients who had received ART for more than 12 months and who attended the Medical Analysis Laboratory of the Institut Pasteur in Bangui for a complete biological work-up, including viral load. A blood sample was taken for quantification of RNA HIV-1, CD4 lymphocytes and blood count in two tubes containing ethylenediamine te-traacetic acid, and another sample was taken in a dry tube for measurement of creatinine and transaminases. Results: The total population comprised 1748 patients, with a mean age of 38.7 years (±14.3;median, 41 years;range, 2 - 79 years);33.3% of patients were between 40 and 49 years old. Females predo-minated (71.3%), for a sex ratio of 0.4. Immunological failure was observed in 20.2% of patients (CD4 Conclusion: The abnormalities observed in this study concerned the haematopoietic system, the liver and the kidneys. As other or-gans and systems may be affected, periodic multidisciplinary biological and clinical follow-up is necessary for people living with HIV in order to improve their management.

When Does Drug Resistant TB Strike HIV/TB Patients?—A South India Experience

Background: India is a high TB (tuberculosis) burden country. The advent of HIV (Human immunodeficiency virus) and DR-TB (drug resistant TB) has worsened the ongoing TB control efforts. A study was conducted to (a) to determine the duration for developing drug resistant TB after diagnosis of HIV (b) to ascertain the patients status after one year of DR-TB treatment in Karnataka, India. Methods: It is a retrospective cross-sectional study involving review of records and reports at ART (Anti-retroviral treatment) centres and DR-TB centres in Karnataka during the period 2013-2014. Results: The median time from being known as HIV positive to being diagnosed as DR-TB was 1168 days (IQR: 571 - 1955). At the end of 14 months, nearly 39% of patients had died and 49% of patients were on treatment. Conclusion: The National Health programmes should prioritize monitoring of the HIV/TB patients and develop appropriate novel strategies for community involvement.

Graves’ Disease as a Late Manifestation of Immune Reconstitution Syndrome after Highly Active Antiretroviral Therapy in an HIV-1 Infected Patient

Context: Highly active antiretroviral therapy (HAART) inhibits the HIV replication and consequently increases CD4 levels and decreases viral load. This immune system improvement can trigger various immunological phenomena, entity called Immune Reconstitution Syndrome (IRS). Graves’ disease is a late Immune Reconstitution consequence. Patient: We report the case of a 48 years old man with HIV infection who developed Graves’ disease three years after he was on effective HAART because of the Immune Reconstitution Syndrome. At presentation he had a very low CD4 T-cell count (17 cells/μL). When he started HAART he presented a lipodystrophy syndrome. HAART was changed because of the persistent low CD4-T cells count (less than 100 cell/μL). Afterwards serum lipid levels began to decrease and that was the first manifestation of Graves’ disease, which was diagnosed when CD4 T-cells increased up to 343 cell/μL. Our patient developed Graves’ disease 36 months after initiating effective HAART with protease inhibitors which was coincident with viral suppression and a rise of CD4 T cells. Conclusion: The most immunosuppressed patients with a CD4 T cell count less than 100 cells/μL are at greatest risk for the development of Immune Reconstitution Syndrome after HAART initiation. We conclude that clinicians will have to consider the importance of the early diagnosis of thyroid disease to bring an adequate treatment.

Trends of HIV Viral Load in Patients under Combined Antiretroviral Treatment in Bangui, Central African Republic

Background: The success of antiretroviral therapy requires better virological monitoring. We described the virological profile of patients on combined antiretroviral therapy (cART) for HIV/AIDS in Bangui, Central African Republic (CAR). Methods: In this prospective cohort study of patients who had been on combined antiretroviral therapy treatment (cART) for at least 12 months in Bangui, only one HIV plasma viral load per patient was realized at the Institut Pasteur of Bangui, between April 4th and November 28th, 2017. Sociodemographic and biological data were collected. Blood samples were taken for viral load. The biocentric generic human immunodeficiency virus (HIV) load test was used to quantify a ribonucleic acid (RNA) HIV-1. Data were analyzed with Stata software version 14. Chi-squared test was used to analyse viral load according to sex and age. The level of significance was set at P ≤ 0.05. Results: A total of 3569 patients were recruited, with a mean age of 40 years (median, 42 years;range, 1 - 84), patients aged 40 - 49 predominating (34.2%). The sex ratio was 0.4. No virus was detectable in plasma from 49.2% of patients, while 42.4% had virological failure (viral load, ≥1000 copies/mL) according to WHO criteria. The risk for virological failure decreased with age (P = 0.001) and was higher among females than males (P = 0.001). Conclusions: The rate of virological failure among patients on cART is very high in the CAR, despite the availability of and access to monitoring of HIV plasma viral load in Bangui. Therefore, adherence to treatment should be evaluated and reinforced in Bangui, CAR.

Psychometric Properties of the Greek-University of California, Los Angeles Loneliness Scale-Version 3 in a Sample of People with Human Immunodeficiency Virus

Aims: The aim of this study was to validate the Greek translation of the University of California, Los Angeles Loneliness Scale (UCLA) in Greek adults with HIV. Methods: The UCLA Loneliness scale (version 3) was administered to 140 people with HIV. Participants also completed the Greek Hospital Anxiety and Depression Scale (G-HADS). Validity and reliability analyses were performed. Results: The Cronbach’s α coefficient for the total UCLA score was 0.9. Test-retest reliability analysis in a subgroup of patients (n = 40) revealed good short-term stability over a 2-week interval (ICC 0.8 - 0.9, p < 0.0005). Exploratory factor analysis generated a three factors structure for the Greek translation. Convergent validity was supported through the scale’s high correlations with G-HADS anxiety (0.382, p < 0.01) and depression (0.524, p < 0.005). Conclusion: The Greek UCLA Loneliness scale (version 3) is a valid and reliable instrument that can be usefully implemented into clinical practice in order to diagnose and treat loneliness among the Greek HIV positive patients.

Peer Pressure Is the Prime Driver of Risky Sexual Behaviors among School Adolescents in Addis Ababa, Ethiopia

Background: Understanding ecological factors that influence risky sexual behavior of adolescents is vital in designing and implementing sexual risk reduction interventions in specific contexts. Interventions undertaken without understanding the critical factors may not produce the desired results. Objective: The objective of this study was to identify the factors associated with adolescent risky sexual behavior among school adolescents in Addis Ababa, Ethiopia. Methods: This cross-sectional study was done among randomly selected school adolescents in Addis Ababa, Ethiopia. Data were collected by an anonymous self administered questionnaire. Risky sexual behavior was assessed by asking question about sexual activity, consistent condom use and faithfulness to a single partner. Logistic regression analysis was done to identify factors related to sexual behavior using the ecological framework. Result: Overall 377(10.6%) of the 723 sexually active students were involved in risky sexual practices. Risky sexual behavior was significantly and very strongly associated with perception of peers' involvement in sexual intercourse [AOR = 11.68 (95% CI: 8.76 - 15.58)]. Conclusion: This study demonstrated that peer pressure is the most important factor associated with risky sexual behavior among school adolescents in Addis Ababa. Interventions aimed at reducing sexual behavior among school adolescents should target adolescents as a group rather than individually.

Zinc Status in Virological Controlled Human Immunodeficiency Virus Type 1 Infected Patients

Zinc (Zn) is a key micronutrient for correct immune function and its deficiency correction has been shown to be useful in HIV-infected but most of the studies included a significant proportion of patients without adequate virological control. It would be interesting to establish the prevalence, associated factors and clinical repercussions of Zn deficiency in patients with good virological to assessing the usefulness of Zn monitoring in the routine follow-up of well controlled HIV-infected patients, based on the colorimetric techniques commonly used in daily clinical practice. We included the first 100 patients that met the requirements of HAART and viremia levels under 200 copies for at least 6 consecutive months, with no active illicit drug use, active infections or weight loss of any cause during the previous 6 months. Serum Zn concentration was measured using a colorimetric assay (Sentinel Diagnostics?) adapted to the Cobas 8000 analyzer (Roche Diagnostics). The Zn values showed a normal distribution with a mean concentration of 88.7 μg/dl (SD 23.3) and were found to be decreased in 13 patients and in 6 subjects were below 61 μg/dl. Both the simple statistical analysis and the multivariate regression model only identified a significant effect for age and alcohol consumption. In sum an important number of HIV-infected with effective and prolonged HAART and no evidence of active infections or other associated factor show diminished serum Zn concentrations. The inclusion of at least occasional Zn determinations should be considered in the regular follow-up evaluations of HIV-infected patients.

COVID-19 and HIV Treatment Interruption: A Case Study of the AIDS Support Organization (TASO) Mbale Clinic

Introduction: COVID-19 pandemic caught many HIV programs completely unprepared, leading to massive interruptions in HIV treatment. Fear and anxiety caused by another infectious and potentially deadly virus kept many PLHIV away from accessing ART services. Besides, the COVID-19 control measures imposed by the Government of Uganda, such as restrictions on movement due to the ban on both private and public transport, shortened travel hours due to the curfew imposed from 7 p.m. local time and limited resources at The AIDS Support Organization (TASO) Mbale clinic further frustrated access to ART services. The actual burden of treatment interruption in Uganda remains unclear. As such, this paper provides the magnitude of treatment interruption in TASO Mbale clinic during the April-June 2020 quarter—the COVID-19 pandemic peak period in Uganda. Methodology: We analyzed secondary and routine program data for all PLHIV on scheduled appointment in the quarters of January-March 2020 and April 2020-June 2020. We abstracted data from Uganda Electronic Medical Records (EMR) and linked with that from TASO Management Information system to make one dataset. This was then exported for final analysis in STATA version 15. Results: Out of 6744 PLHIV scheduled on appointment during April-June 2020 quarter, 1710 (25.3%) individuals missed their appointments, with the facility-based clients more affected than community-based (56.1% vs 43.9%) (p < 0.001), individuals with up-to-date viral load (VL) status were less likely to miss their appointment (p < 0.001) while sex was not associated with missed appointment (p-value = 0.269). Overall, there was a 356% increase in rate of missed appointment compared with that of January-March 2020 quarter (25.3% vs 7.1%) before COVID-19 pandemic hit Uganda. Moreover, PLHIV who received six-month’s drug refills were less likely to miss their appointment (p < 0.001) compared to those who received less. Conclusions: The COVID-19 pandemic significantly disrupted provision of ART services, leading to increased rate of missed appointment from 7.1% in the pre-COVID-19 quarter to 25.3%.

Changing HIV Epidemic in North-Eastern India and Its Relationship with Development and Programmatic Indicators

Background: Although there has been significant reduction in HIV prevalence and new HIV infections in India, some of the low/moderate prevalence states have been showing long term increase in HIV prevalence and new HIV infections. Assam, a state in northeast India is one such low HIV prevalence state where HIV prevalence and new HIV infections have almost doubled in the last few years. This study examined the trend of HIV prevalence across districts/regions of Assam and its association with developmental and program indicators. Materials and Methods: A retrospective descriptive analysis of secondary data from the National AIDS Control Program, Census of India-2011, and District Level Household and Facility Survey-3 was conducted. The time period covered under the secondary data analysis was 2007 to 2012. Correlation and Chi-square for trend tests were also used in this paper. Results: During 2007 and 2012, HIV positivity (%) increased relatively in North Assam (46.9%) followed by South Assam (11.5%) while there has been a relative decline in West Assam (﹣51.5%). Correlation analysis showed statistically significant association between HIV prevalence and female literacy, population using mobile phone, population using internet, women (15 - 49 years) seeking treatment for any STI/RTI, proportion of brothel based FSWs, FSWs having <5 clients per week and proportion of condom utilized annually. Conclusion: Program efforts in the state should be focus on the districts with increasing HIV prevalence. Emphasis should be given in planning strategies to address the program gaps among the high risk and vulnerable populations in the state.

Validity and Reliability of Total Lymphocyte Count as Alternative Biomarker for CD4 Count in the Management of HIV Positive Patients on HAART in Osogbo, Nigeria

Introduction: To determine the possibility of utilizing total lymphocyte counts (TLC) instead of CD4 counts in the initiation and management of patients with HIV on highly active antiretroviral therapy (HAART). The commencement of HAART CD4 lymphocytes has been employed in the management HIV. However it has been found that determination of CD4 counts is expensive and somewhat laborious to perform in already overburdened healthcare systems especially in the developing countries. Methodology: Five hundred and three (503) consenting patients already on HAART (commenced at CD4 count < 350 cells/μl) who attended our HIV clinic between February 2014 and February 2015 were enrolled into the study. The patients had already been diagnosed as HIV positive. Kappa statistic was computed as a measure of reliability of TLC. Various cut-off marks for TLC in respect of the CD4 counts were determined in addition to the computation of both sensitivity and specificity. Receiver operating curves (ROC), showing area under the curve indicating agreement in classification, were plotted. Results: Majority of patients were female (73.8%). Most of the patients were in the age range of 25 - 34 years (37.2%). Males were found to be significantly older than females (P < 0.05). Area under the receiver operating curves (ROC) revealed that 4 out of 10 patients would be missed using total lymphocyte count (TLC) as the indicator for commencement of HAART. A low correlation coefficient and Kappa statistic r = 0.18, and K = 0.20 respectively, were observed between TLCs and CD4 counts. Conclusion: Total lymphocyte count is not a suitable alternative to CD4 counts in the management of HIV/AIDS.

The Effects of Treatment on Serum Hepcidin and Iron Homeostasis in HIV-1-Infected In-dividuals

Background: Hepcidin is the principal regulator of iron absorption and its tissue distribution. Its correlation with iron homeostasis in individuals infected with human immunodeficiency virus type-1 (HIV-1) treated with different regimens of highly active antiretroviral therapy (HAART) was investigated. Methods: Serum hepcidin levels were determined in 448 volunteers. Of these, 372 were HIV-1-infected individuals, and 93 did not receive HAART (ART-na&iuml;ve) while 279 received HAART consisting of a non-nucleoside reverse transcriptase inhibitor (NNRTI-based) and protease inhibitors (PI-based);both were used in association with a nucleoside reverse transcriptase inhibitor (NRTI). Seventy-six additional HIV-1 seronegative individuals were enrolled in the study. The following parameters were quantified: hematological parameters, iron biomarkers and markers of infection (CD4+ and CD8+ T-cells), and HIV-1 RNA (viral load). Results: Serum hepcidin, iron and ferritin levels, as well as the marker of infection, CD4+ T-cells, were significantly lower in the ART-na&iuml;ve group compared with other groups. Additionally, transferrin saturation, iron binding capacity, hemoglobin level and erythrocyte level were not significantly different, and anemia was not observed in the different groups. Conclusions: HIV-1 infection affected serum hepcidin, iron and ferritin levels in the ART-na&iuml;ve group, and the different HAART regimens restored the levels of hepcidin and iron homeostasis in HIV-1-infected individuals who have undetectable HIV-1 RNA levels.

Missed Opportunities for Prevention of Mother-to-Child Transmission of HIV (PMTCT) in Ibadan, Southwest Nigeria

Background: Nigeria has the largest paediatric HIV-infected population in the world. Missed opportunities for prevention of mother-to-child transmission of HIV (PMTCT) compromise efforts at eliminating new pediatric HIV infections. Methods: Six hundred children, aged < 15 years, presenting to the pediatric units of the University College Hospital (UCH), Ibadan Southwest Nigeria between June to December 2007 were studied. The demographics, HIV status and socioeconomic status of mothers and their children were studied. A 4-step hierarchy was used to assess the missed opportunities for PMTCT. Step 1: utilization of a health facility for antenatal care and delivery;Step 2: maternal HIV status determination during pregnancy;Step 3: provision of antiretroviral medication to HIV-infected mother and baby;and Step 4: avoidance of mixed feeding in HIV-exposed children. The rates of missed opportunities for PMTCT services at different steps in the PMTCT cascade, perinatal transmission rates, and associated factors were reported. Results: There were 599 mothers and 600 children (one set of twins), 60 (10%) were HIV infected and 56 (93.3%) of these were adjudged perinatally infected. Of 78 HIV-infected women, 7 (9.0%) accessed all interventions in the PMTCT cascade and 71 (91.0%) had missed opportunities for PMTCT. Missed opportunities for PMTCT occurred 42.9% in cascade Step 1, 64.2% in Step 2, 52.6% in step 3 and 73.7% in Step 4. All mother-baby pairs who accessed complete PMTCT interventions received care at a teaching hospital. Among infants with perinatal HIV infection, 53 (94.6%) were born to mothers who had missed opportunities for PMTCT. Most women with missed opportunities attended antenatal care outside the teaching hospital setting and belonged to low socioeconomic status. Conclusion: It is imperative to expand PMTCT access to women who receive antenatal care outside the teaching hospitals and to those of low socioeconomic status.

Self-Corporal Image among People Living with HIV/AIDS with Lipodystrophy Syndrome in Brazil

Currently, with the increase in life expectancy of people living with HIV (PLHIV), it is essential to analyze the biopsychosocial aspects involved in satisfaction with quality of life and its multidimensionality, because although HAART produces hope for the control of HIV, can have important emotional consequences. Thus, the aim of the present study was to evaluate the effects of lipodystrophy (LDS) on self-esteem and body image of PLHIV in Brazil. It is a psychoanalytic method by semi-structured interview, a body image scale and two drawings that represent the patients’ body image before and after. The diagnosis of LDS was by self-report. Sixteen patients 8 (eight men and 8 women), with a mean age of 43 years, were invited to the HIV-Out ADEE 3002 outpatient clinic of the Dermatology Clinic of the Central Institute of a University Hospital in S&#227;o Paulo. It was noted that 50% of patients reported physical problems and 25% consequences in the family and social sphere. There were increased bodily changes, family problems and social prejudices after HAART and the self-esteem of 88% of patients were shown to be “little adjusted” to their condition. For 63%, physical appearance was a concern and 87% of them reported body dissatisfaction. Patients also reported impact on their sexuality (75% felt less attractive and 88% with reduced libido after starting LDS). The interviews, drawings and body image scale showed important changes in the lives of patients with lipodystrophy, where negative changes in appearance and effects on self-image were observed. This diagnosis seems to influence other aspects of social life, which can lead to prejudice in relation to illness and, therefore, isolation.

Diversity of Human Immunodeficiency Virus Type-1 Subtypes in Western Kenya

Background: HIV/AIDS is the principal pandemic in the world today.?Two viral types (HIV-1 and HIV-2), with numerous groups (M, N and O for HIV-1 and A through H for HIV-2) have emerged. These have further proliferated into numerous subtypes, sub-subtypes and circulating recombinant forms (CRF) over the last 30 years.?HIV-1 variants circulate together within a geographical region providing an opportunity for recombination of viral strains within infected individuals.?In Kenya, at least nine different genetic HIV-1 subtypes and several recombinant forms have been defined within group M, which accounts for the majority of cases in the AIDS pandemic. Objective:?To determine the genetic diversity of HIV-1 in the western region of Kenya bordering Uganda. Methodology: A cross sectional study was carried out at Busia District Hospital between 2007 and 2009. A total of 75 patients were sampled randomly from a cohort of 1000 clients on antiretroviral therapy. Blood samples were analysed at the HIV Laboratory, Kenya Medical Research Institute, Nairobi, Kenya. PCR was carried out on the?Pol?region of HIV, sequenced and analysed by BLAST for subtypes. Results: BLAST analysis revealed the following circulating subtypes: 40/75 (53.30%) were HIV-1 group M subtype A1;21/75 (28.0%) were subtype D;5/75 (6.7%) were subtype G;4/75 (5.30%) were subtype C;and 2/75 (2.70%) were subtype A2. Only one isolate was identified for the other subtypes?viz: 1/75 (1.30%) resembled subtype B;1/75 (1.30%) was A1/C, and 1/75 (1.30%) was A1/D. Conclusion: The study showed increasing HIV-1 diversity along the Kenya-Uganda border with the emergence of A1/C and A1/D recombinants. Such HIV-1?diversityvis a vis?the recent expanded access to antiretroviral therapy in resource limited settings calls for continuous evaluation of anti-HIV regimens. There?is need therefore, for regular surveillance and monitoring for mutations that are likely to lead to drug resistance if we have to achieve successful treatment outcomes.

Impact of Age on CD4 Response to Combination Antiretroviral Therapy: A Study in Tehran, Iran

Background: This study was undertaken to address the controversy regarding immunologic response to combination antiretroviral therapy (cART) among older patients. Methods: In a cross-sectional study all patients attending the HIV Clinic at Imam Khomeini Hospital (Tehran) from 2010 to 2011 were evaluated. Immunologic response was investigated using consecutive CD4+ T-cell counts in a one-year interval and outcomes were analyzed for older (>=50 yrs) and younger (<50 yrs) patients using SPSS version 16.0. Results: A total of 714 patients were actively enrolled in the clinic while 24 were 50 years or older, and had initiated ART;a similar random group of younger patients was selected as the control. Hepatitis C was the most prevalent co-infection in both groups. Patients with no serologic evidence of hepatitis B and C had significantly higher CD4+ T-cell counts than HIV/HBV co-infected patients after 12 months (p = 0.04). The average increased CD4+ T-cell counts in 6, 9, and 12 months of cART initiation were lower among older patients but the difference was not significant (50.75 vs. 123.08;p = 0.37, 132.87 vs. 710.58;p = 0.25, 271.27 vs. 500;p = 0.65). Conclusion: About 11% of the registered HIV-positive patients at our clinic were 50 years or older while their immunologic response to cART showed to be different. Specific needs of older HIV infected patients are highly recommended to be addressed in future treatment and care programs.