Suppression of human immunodeficiency virus type 1 viral load with selenium supplementation: a randomized controlled trial.

BACKGROUND: Despite findings that selenium supplementation may improve immune functioning, definitive evidence of its impact on human immunodeficiency virus (HIV) disease severity is lacking. METHODS: High selenium yeast supplementation (200 mug/d) was evaluated in a double-blind, randomized, placebo-controlled trial. Intention-to-treat analyses assessed the effect on HIV-1 viral load and CD4 count after 9 months of treatment. Unless otherwise indicated, values are presented as mean +/- SD. RESULTS: Of the 450 HIV-1-seropositive men and women who underwent screening, 262 initiated treatment and 174 completed the 9-month follow-up assessment. Mean adherence to study treatment was good (73.0% +/- 24.7%) with no related adverse events. The intention-to-treat analyses indicated that the mean change (Delta) in serum selenium concentration increased significantly in the selenium-treated group and not the placebo-treated group (Delta = 32.2 +/- 24.5 vs 0.5 +/- 8.8 microg/L; P<.001), and greater levels predicted decreased HIV-1 viral load (P<.02), which predicted increased CD4 count (P<.04). Findings remained significant after covarying age, sex, ethnicity, income, education, current and past cocaine and other drug use, HIV symptom classification, antiretroviral medication regimen and adherence, time since HIV diagnosis, and hepatitis C virus coinfection. Follow-up analyses evaluating treatment effectiveness indicated that the nonresponding selenium-treated subjects whose serum selenium change was less than or equal to 26.1 microg/L displayed poor treatment adherence (56.8% +/- 29.8%), HIV-1 viral load elevation (Delta = +0.29 +/- 1.1 log(10) units), and decreased CD4 count (Delta = -25.8 +/- 147.4 cells/microL). In contrast, selenium-treated subjects whose serum selenium increase was greater than 26.1 microg/L evidenced excellent treatment adherence (86.2% +/- 13.0%), no change in HIV-1 viral load (Delta = -0.04 +/- 0.7 log(10) units), and an increase in CD4 count (Delta = +27.9 +/- 150.2 cells/microL). CONCLUSIONS: Daily selenium supplementation can suppress the progression of HIV-1 viral burden and provide indirect improvement of CD4 count. The results support the use of selenium as a simple, inexpensive, and safe adjunct therapy in HIV spectrum disease. Trial Registration isrctn.org Identifier: ISRCTN22553118.

Economic analysis of an educational human security model in southwestern bateyes of the Dominican Republic / Análisis económico de un modelo educativo de seguridad humana en los bateyes del suroeste de la República Dominicana

Objetivos: realizar un análisis económico para evaluar los costos de una intervención educativa, utilizando los principios de un modelo de seguridad humana en Bateyes del suroeste de la República Dominicana. Métodos: se consideraron cuatro recursos de intervención, incluyendo la capacitación del personal, los incentivos mensuales, la supervisión de las actividades de campo y el costo total asociado al tratamiento anual de la diarrea aguda. El gasto se comparó entre el programa estándar de atención (Batey Control) y la intervención con el modelo de seguridad humana (Batey Caso). Resultados: el ahorro del costo total anual para el Ministerio de Salud de República Dominicana asociado con la reducción de la incidencia de episodios de diarrea aguda fue de US$252,399. Si se extrapolan a los 300 Bateyes de República Dominicana, se podría ahorrar aproximadamente US$75 millones en prevención de enfermedades infecciosas. Conclusiones: el modelo de seguridad humana luce ser un método eficaz para mejorar el conocimiento sobre la prevención de enfermedades y aumentar el empoderamiento de la comunidad para la movilización de recursos. Aplicada a otros entornos, la intervención podría tener una incidencia beneficiosa en las poblaciones de refugiados e indocumentados bajo el impacto de la violencia estructural.

Objectives: To conduct an economic analysis to evaluate the costs of an educational intervention, using the human security model, and potential sources of economic benefits, in Southwestern Bateyes in the Dominican Republic. Methods: Four intervention resources were considered, including staff training, monthly incentives, supervision of field activities, and total cost associated with annual treatment for acute diarrhea. The expenditure was compared between the standard program of care and the intervention using the human security model. Results: The total annual cost saving to the Dominican Republic Ministry of Health, associated with reducing the incidence of acute diarrhea episodes, was US$252,399. If this is extrapolated to the 300 Bateyes of the Dominican Republic, the Ministry of Health could save approximately US$75 million in infectious disease prevention by implementing this intervention model in these isolated rural communities. Conclusions: The educational intervention, which incorporated a human security approach, appeared to be an effective method to enhance knowledge about disease prevention and to increase empathy among community members for resource mobilization and local empowerment. Applied to other settings, the intervention could have a beneficial impact on refugee and undocumented populations under the

Impact of a massage therapy clinical trial on immune status in young Dominican children infected with HIV-1.

PURPOSE: The effectiveness of massage therapy on immune parameters was evaluated in young Dominican HIV+ children without current access to antiretroviral therapies. METHODS: Eligible children, who were followed at the Robert Reid Cabral Hospital (San Domingo, Dominican Republic), were randomized to receive either massage treatment or a control/friendly visit twice weekly for 12 weeks. Blood was drawn at baseline and following the 3-month intervention for determinations of CD4, CD8, and CD56 cell counts and percentage, along with activation markers (CD25 and CD69). RESULTS: Despite similar immune parameters at baseline in the two groups, significantly more of the control group exhibited a decline in CD4 cell count (>30%, p = 0.03), postintervention. The decrease was particularly evident in older (5-8 years) children in the control arm, who demonstrated a significant reduction in both CD4 and CD8 cell counts compared to massage-treated older children who remained stable or showed immune improvement. Additionally, a significant increase in CD4+CD25+ cells was observed over the 12-week trial in the massage-treated older children (p = 0.04) but not in the control group. In younger massage-treated children, (2-4 years old), a significant increase in natural killer cells was shown. CONCLUSION: Together these findings support the role for massage therapy in immune preservation in HIV+ children.

Increased risk of Pneumocystis carinii and community-acquired pneumonia with tobacco use in HIV disease.

OBJECTIVES: Tobacco smoking-related diseases continue to be of great health concern for the public, in general, and may be particularly deleterious for immunosuppressed HIV-positive individuals, who exhibit widespread tobacco use. METHODS: A total of 521 HIV-infected subjects consecutively admitted to Jackson Memorial Hospital between 2001-2002 were enrolled in the study. Research data included a medical history, details of tobacco and illicit drug use and complete computerized hospital information. Blood was drawn to obtain T lymphocyte profiles and viral load levels. Statistical analysis methods included Pearson, Student's t- and Chi-square tests and SAS Proc CATMOD. RESULTS: Tobacco use was prevalent, with 65% of the 521 HIV-positive hospitalized patients being current smokers. Overall, current tobacco users reported smoking an average of 15+/-13 cigarettes per day for an average of 15+/-14 years, with 40% smoking more than one pack per day. Pulmonary infections accounted for 49% of the total hospital admissions: 52% bacterial pneumonias, 24% Pneumocystis carinii pneumonia (PCP), 12% non-tuberculous mycobacterial diseases (NTM), 11% tuberculosis and 1% bronchitis. Many of the respiratory patients (46%) had been on highly active antiretroviral therapy (HAART) for over six months and 42% had received PCP and/or NTM prophylaxis. After matching the cases by HAART and CDC stage, the hazardous risk of being hospitalized with a respiratory infection was significantly higher for smokers than non-smokers (95% CI 1.33-2.83; p=0.003). Respiratory infections were noted in (37%) of the HAART-treated patients, and most (67%) occurred in smokers. CATMOD analyses controlling for HAART, viral load and CD4, indicated that HIV-infected smokers were three times more likely to be hospitalized with PCP and twice as likely to be hospitalized with community-acquired pneumonia than non-smokers, with increased risk related to the number of cigarettes/day in a dose-dependent manner. CONCLUSIONS: Tobacco use, which is widespread among HIV-infected subjects, increases the risk of pulmonary diseases, particularly PCP and CAP, two respiratory infections with high prevalence and morbidity risks even in the era of HAART.

Hypocholesterolemia is associated with immune dysfunction in early human immunodeficiency virus-1 infection.

PURPOSE: Patients with the acquired immunodeficiency syndrome exhibit marked disturbances in lipid metabolism. Because altered lipid metabolism may affect immune processes, this study characterized the lipid profile of asymptomatic individuals infected with the human immunodeficiency virus (HIV-1), in relationship to immune function. PATIENTS AND METHODS: Serum levels of triglycerides and cholesterol were determined in 94 asymptomatic HIV-1-infected (Centers for Disease Control stage II, III) homosexual men and 42 healthy seronegative control subjects. Immune assessment included measurements of lymphocyte subpopulations (CD4), immune activation (beta 2-microglobulin), natural killer cell function, and lymphocyte proliferation in response to mitogens phytohemagglutinin and pokeweed. Dietary intake was determined using a semiquantitative food frequency questionnaire. RESULTS: Despite greater consumption of saturated fat and cholesterol, significantly lower levels of total, high-density, and low-density lipoprotein cholesterol were observed in HIV-1-seropositive men, relative to seronegative controls (p < 0.05), with 40% of the HIV-1-infected group demonstrating hypocholesterolemia (less than 150 mg/dL). Low values of total, high-density, and low-density cholesterol were associated with elevated levels of beta 2-microglobulin in HIV-1-seropositive men. No difference between the groups was noted for serum triglycerides. HIV-1-infected subjects did not demonstrate the significant inverse relationship between cholesterol and mitogen response observed in seronegative controls. CONCLUSIONS: These findings indicate that low levels of cholesterol are prevalent during the early stages of HIV-1 infection and associated with specific alterations in immune function, suggesting that hypocholesterolemia may be a useful marker of disease progression.

Impact of a selenium chemoprevention clinical trial on hospital admissions of HIV-infected participants.

PURPOSE: To evaluate the impact of selenium chemoprevention (200 microg/day) on hospitalizations in HIV-positive individuals. METHOD: Data were obtained from 186 HIV+ men and women participating in a randomized, double-blind, placebo-controlled selenium clinical trial (1998-2000). Supplements were dispensed monthly, and clinical evaluations were conducted every 6 months. Inpatient hospitalizations, hospitalization costs, and rates of hospitalization were determined 2 years before and during the trial. RESULTS: At enrollment, no significant differences in CD4 cell counts or viral burden were observed between the two study arms. Fewer placebo-treated participants were using antiretrovirals (p <.05). The total number of hospitalizations declined from 157 before the trial to 103 during the 2 year study. A marked decrease in total admission rates (RR = 0.38; p =.002) and percent of hospitalizations due to infection/100 patients for those receiving selenium was observed (p =.01). As a result, the cost for hospitalization decreased 58% in the selenium group, compared to a 30% decrease in the placebo group (p =.001). In the final analyses, selenium therapy continued to be a significant independent factor associated with lower risk of hospitalization (p =.001). CONCLUSION: Selenium supplementation appears to be a beneficial adjuvant treatment to decrease hospitalizations as well as the cost of caring for HIV-1-infected patients.

Evaluation of HIV prevention and counseling practices of obstetrician/gynecologists in Bogota, Colombia: impact on women's knowledge and risk practices.

The present community-based study in Bogotá, Colombia, investigated risk assessment and preventive counseling practices of obstetrician/gynecologists (ob/gyn n = 34) and their impact on women's (n = 230) knowledge and risk behaviors. The data indicate that physician education has a significant and positive impact on women's knowledge and behavior. After controlling for sociodemographic variables, women instructed by their ob/gyn were 11 times more likely to correctly identify preventive measures (p = 0.0001) and high-risk sexual practices for the HIV /sexually transmitted diseases (STDs) transmission (4x; p = 0.05) and were less likely to engage in high-risk sexual practices (OR = 2; p = 0.05). Few ob/gyns (17%), however, assess risk behaviors and provide risk reduction counseling, and only 6% frequently encouraged HIV testing. These findings highlight the potential public health impact of ob/gyn physicians and underscore the need to increase their involvement in halting the HIV/STD epidemic in Colombia.

"I will miss the study, God bless you all": participation in a nutritional chemoprevention trial.

Randomized controlled clinical trials are often considered to be the "gold standard" for health research. Consequently, understanding the reasons people participate in these trials, especially minority groups who are often under-represented in clinical trials, or populations who have chronic illnesses or abuse drugs, is salient for successful recruitment, retention, and project design. This paper describes the results of a study that was designed to examine some of the ways in which participants in a randomized double blind clinical trial perceived their participation in the clinical trial, and the reasons they gave for continuing in the study. All of the participants were individuals who were using drugs and were infected with the HIV-1 virus, and had participated in a chemoprevention trial. The data from an exit interview were analyzed thematically in order to reveal units of meaning concerning participation and continuation in the clinical trial. The analysis revealed 3 higher-level concepts, or themes, that guided participation: increased health awareness, personal enhancement, and sociability. The data clearly indicated that involvement and retention in the trial were directly related to the ways in which the participants interpreted the study, perceived the benefits they derived from participating, and imbued their participation with value so that it was important and relevant to their own perceptions of health, as well as personal and social well being.

Continued high risk behaviors in HIV infected drug abusers.

To characterize current risk behaviors of HIV drug abusers in the highly active antiretroviral therapy (HAART) era, socio-demographic, medical and behavioral information were obtained and immune measurements determined. High-risk sexual practices were prevalent. Participants diagnosed before 1995 were 6 times more likely to have unprotected sex with HIV+ partners (p = 0.05) and 11 times more likely to use contaminated needles (p = 0.05) than participants with later diagnosis. Consistent condom use was reported by only 7% of the cohort. Many (43%) of the participants reported multiple HIV+ and HIV- concurrent partners. Most (65%), particularly women (OR = 3, p = 0.02), did so for drugs or money. Despite detectable viral loads, 36% reported unprotected anal sex. Antiretroviral-treated men, compared to non-treated, tended to have unprotected anal sex (OR = 2, p = 0.07). The continued high-risk behaviors of HIV drug users, particularly those diagnosed before 1995 and/or on antiretroviral therapy, indicates an urgent need for new public health strategies.

Massage treatment in HIV-1 infected Dominican children: a preliminary report on the efficacy of massage therapy to preserve the immune system in children without antiretroviral medication.

OBJECTIVES: More than 1.4 million children are living with HIV and global access to antiretrovirals is not yet readily available. Massage therapy, which has been shown to improve immune function in HIV+ adults and adolescents, may provide an important complementary treatment to boost immune status in young children living with HIV disease, especially those without access to antiretroviral medications. No studies have been conducted, however, that specifically target massage therapy to enhance immune function in HIV+ children. DESIGN: Clinical trial with eligible, consented HIV+ children randomized to receive either massage therapy or a friendly visit (controls). SETTINGS/LOCATION: CENISMI/Robert Reid Cabral Hospital, Santo Domingo, Dominican Republic. SUBJECTS: HIV+ children ages 2-8 years. INTERVENTION: Massage therapy sessions (20 minutes, twice weekly, for 12 weeks), conducted by trained nurses, following a structured protocol of moderate pressure stroking and kneading of muscles, using a non-scented oil. The friendly visit control group, (reading, talking, playing quiet games), met with the nurse twice weekly for 12 weeks. OUTCOME MEASURES: At the initial evaluation, and following the 12-week intervention, blood was drawn to determine absolute helper (CD4/T4) and suppressor (CD8/T8) counts. RESULTS: Children in the control arm had a greater relative risk of CD4 count decline (>20%) than massage-treated children (RR = 5.7, p = 0.03). Lymphocyte loss was also more extensive in the controls (p < 0.02), and more of the control group than the massage group lost >50 CD8 lymphocytes (p = 0.03). CONCLUSIONS: The efficacy of massage therapy in maintaining immunocompetence may offer a viable alternative to the thousands of children worldwide without antiretroviral access.

HIV/AIDS knowledge and health-related attitudes and behaviors among deaf and hearing adolescents in southern Brazil.

HIV/AIDS knowledge and health-related attitudes and behaviors among deaf and hearing adolescents in southern Brazil are described. Forty-two deaf students attending a special nonresidential public school for the deaf and 50 hearing students attending a regular public school, ages 15-21 years, answered a computer-assisted questionnaire. (There was simultaneous video translation of questions to Brazilian Sign Language.) A branched decision-tree structure was used to determine level of sexual experience and hearing status. Deaf participants scored lower on HIV/AIDS knowledge, demonstrating a need to improve school-based instruction and develop campaigns tailored to this group's requirements. Though the hearing students reported more sexual activity than the deaf students, no other significant differences were found in health-related attitudes and behaviors. Two findings of concern are the high rate of sexual abuse reported by deaf participants and the large number of deaf adolescents reporting having a friend with AIDS.

Dominican Children with HIV not Receiving Antiretrovirals: Massage Therapy Influences their Behavior and Development.

Forty-eight children (M age = 4.8 years) infected with HIV/AIDS and living in the Dominican Republic were randomly assigned to a massage therapy or a play session control group. The children in the massage therapy group received two weekly 20-min massages for 12 weeks; the children in the control group participated in a play session (coloring, playing with blocks) for the same duration and length as the massage therapy group. Overall, the children in the massage therapy group improved in self-help abilities and communication, suggesting that massage therapy may enhance daily functioning for children with HIV/AIDS. Moreover, the HIV infected children who were six or older also showed a decrease in internalizing behaviors; specifically depressive/anxious behaviors and negative thoughts were reduced. Additionally, baseline assessments revealed IQ equivalence below normal functioning for 70% of the HIV infected children and very high incidences of mood problems (depression, withdrawn) for 40% of the children and anxiety problems for 20% of the children, suggesting the need for better monitoring and alternative interventions in countries with limited resources to improve cognition and the mental health status of children infected with HIV/AIDS.

The relationship between nutritional and sociodemographic factors and the likelihood of children in the Dominican Republic having a BCG scar.

OBJECTIVES: To critically assess the prevalence among schoolchildren 6 to 9 years of age throughout the Dominican Republic of a bacille Calmette-Guérin (BCG) vaccination scar, and to examine the relationship between nutritional and sociodemographic factors and the likelihood of having a BCG scar. METHODS: This correlational study used the database of the Second National Census on Height and Weight of Elementary School First Grade Students, which was conducted in the Dominican Republic August 2001-May 2002, to provide a critical assessment of BCG coverage nationwide. The Census information for the children included the presence of BCG scar, their nutritional status, and basic demographic data. We developed a new sociodemographic indicator, the "Rosa Index," to examine the potential influence of poverty and other environmental characteristics on scar presence. We used logistic regression models to predict the presence of a BCG scar. RESULTS: An overall BCG scar prevalence of 55.3% (85,644/154,887) was found. Malnourished children were less likely to have a BCG scar than were children with adequate nutritional status (odds ratio = 0.91; 95% confidence interval: 0.87, 0.95, P < 0.05). Children who were 7-9 years old were less likely to have a BCG scar than were children 6 years old. Children in the areas of the country more than two hours' driving distance from the capital city of Santo Domingo more often exhibited lower BCG scar prevalence levels than did children in Santo Domingo. A higher Rosa Index (better level of socioeconomic characteristics) was correlated with higher BCG scar prevalence values (r = 0.54, P < 0.05). CONCLUSIONS: Our study findings indicate that BCG coverage appears to be inadequate for schoolchildren in the Dominican Republic. Nevertheless, the presence of a scar in a higher proportion of younger children suggests that coverage has improved in recent years. More programmatic and economic emphasis needs to be placed on extending early BCG vaccination coverage to the areas of the country where vaccination coverage is lower, and on examining the potential role that poverty may have on vaccination effectiveness.

Actitud de los estudiantes en tres facultades de odontología en Santiago de Cali, Colombia, frente a pacientes con VIH / Atitude dos estudantes em três faculdades de odontologia em Santiago de Cali, Colômbia, frente a pacientes com HIV / Attitudes of students at three dental schools in Santiago de Cali, Colombia, toward HIV+ patients

Objetivos: Conocer la actitud de estudiantes de odontología de Cali respecto del manejo de personas con diagnóstico de VIH/SIDA. Método: Estudio observacional descriptivo mediante aplicación de una encuesta aplicada en 1.173 estudiantes de tres facultades de odontología de Cali, clasificados en tres grupos (preclínica, clínica inicial y clínica final). Resultados: participó un 63,4 por ciento; 50 por ciento tenía menos de 20 años, 68 por ciento mujeres. 92 por ciento solteros y 82 por ciento católicos. Se encontró actitud positiva entre 86 por ciento y 92 por ciento, la disposición de atender pacientes fue más favorable en preclínica (p=0.03). Aunque 88,7 por ciento mostró disposición de atender pacientes VIH+; entre los que pensaban que sería difícil hacerlo para su personal auxiliar, se encontró 33 por ciento de estudiantes con probabilidad de hacerlo, (p= 0.03). Cuando se interrogó sobre conocimientos acerca del VIH/SIDA, 66,7 por ciento (clínica final) y 82,2 por ciento (preclínica) percibían que no habían recibido entrenamiento previo (p<0,001). Conclusiones: Se evidenció que la intención de atender pacientes VIH+ era similar a lo reportado en otros países americanos e Irlanda. Los estudiantes necesitan recibir un mejor entrenamiento con el fin de disminuir sus temores y mejorar su actitud para atenderlos.

Objective: To know attitude of students at three dental schools in Santiago de Cali, Colombia, toward HIV+ patients. Methods: This is a cross-sectional study with using a questionnaire to 1173 invited to attend students from three dental schools in Cali. Students were classified in three groups (Pre-clinic: semester I-IV; initial clinic: V to VII and last clinical: VIII to X). Results: Participation rate was 63.4 percent. 50 percent under 20 years old, 68 percent female, 92 percent single, and 82 percent Catholics. Between 86 percent and 92 percent had positive attitudes; when asked about their willingness to care patients being more favorable preclinical students (p=0.03). Although, 88.7 percent of all students showed a willingness to address HIV patients. Among those who believed that it would be difficult for assistant staff to accept treating such patients there was a 33 percent chance of doing so (p=0.003). When we asked about training to manage, between 67 percent (clinical) and 82 percent (preclinical) perceive not receiving any. Conclusions: The intention to dental care was similar to that reported in the other American countries, and Ireland. Dental students need better training, because they do not perceived adequate training, to reduce their fear and increase positive attitudes to care for HIV/AIDS patients.

Objetivos: Conhecer a atitude de estudantes de odontologia de Cali a respeito do manejo de pessoas com diagnóstico de HIV/AIDS. Método: Estudo observacional descritivo mediante aplicação de um questionário aplicado em 1.173 estudantes de três faculdades de odontologia de Cali, classificados em três grupos (pré-clínica, clínica inicial e clínica final). Resultados: participaram 63,4 por cento; 50 por cento tinham menos de 20 anos, 68 por cento mulheres. 92 por cento solteiros e 82 por cento católicos. Foi encontrada atitude positiva entre 86 por cento e 92 por cento; a disposição de atender pacientes foi mais favorável na pré-clínica (p=0.03). Ainda que 88,7 por cento mostraram disposição de atender pacientes HIV+; entre os que pensavam que sería difícil fazê-lo para o seu pessoal auxiliar, foram encontrados 33 por cento de estudantes com probabilidade de fazê-lo, (p= 0.03). Quando se interrogou a cerca de conhecimentos sobre HIV/AIDS, 66,7 por cento (clínica final) e 82,2 por cento (pré-clínica) perceberam que não haviam recebido treinamento prévio (p<0,001). Conclusões: Foi evidenciado que a intenção de atender pacientes HIV+ era similar ao reportado em outros países americanos e Irlanda. Os estudantes necessitam receber um melhor treinamento com a finalidade de diminuir seus temores e melhorar sua atitude para atendê-los.

VIH y vulnerabilidad: una comparación de tres grupos en Cali, Colombia / HIV and vulnerability: a comparison of three groups in Cali, Colombia

OBJETIVO: determinar las características socio-demográficas, comportamientos de riesgo para VIH/Sida y presencia de VIH en tres grupos de participantes de diferentes grupos socio-económicos en Cali. METODOLOGIA: entre 2005 y 2007, Durante campañas de búsqueda activa focal integral de VIH, 4055 participantes dieron voluntariamente su consentimiento informado, respondieron un cuestionario estructurado, recibieron asesoría de VIH pre-prueba y post-prueba, así como prueba para diagnóstico presuntivo de VIH. Los participantes fueron agrupados en tres categorías: personas de bajo nivel socio-económico, baja escolaridad y alto desempleo (N1=1217); trabajadores empleados con escolaridad técnica-superior y de estrato medio-alto (N2=899); y estudiantes de universidades de carácter privado, de estrato medio-alto (N3=1939). Se determinaron características socio-demográficas, comportamientos sexuales y auto percepción de conocimientos sobre VIH. Análisis estadístico: uso de Chi-Cuadrado y prueba de muestras independientes t-student, significancia<0.05 e intervalos de confianza al 95%. RESULTADOS: prevalencia global de VIH 0.62%; para el grupo N1 la prevalencia fue 1.97%, mayor que en los otros grupos (p<0.0001). CONCLUSIONES: una alta prevalencia de VIH en el grupo N1 fue evidente, junto con una historia previa más frecuente de Enfermedad de Transmisión Sexual (ETS) y pobre auto-percepción de conocimientos sobre VIH, destacando la necesidad de fortalecer las estrategias de prevención y tamizaje de ETS y VIH dirigidas a este grupo.

OBJECTIVE: to identify socio-demographical characteristics and risk behaviors for HIV /Aids and HIV status in three groups of participants from different socio-economic background in Cali. METHODOLOGY: between 2005 and 2007, an active surveillance campaigns was done and included 4055 voluntary participants who gave informed consent, answered a structured questionnaire, and received pre- and post-test counseling and HIV testing. The participants were grouped in three categories: a total of 1217 from low socio-economic status (lse), with low education and high unemployment (N1), 899 employed workers with technical-professional schooling and upper-middle socio-economic status (N2), and 1939 students of private universities and upper-middle socio-economic status (N3). Socio-demographic characteristics, sexual behaviors and HIV knowledge self-perception were assessed. Statistical analyses: Chi Square, and independent T tests with significance <0.05, 95% confidence intervals. RESULTS: overall prevalence of HIV was 0.62%; in the N1 group prevalence was 1.97%, significantly higher than in the other two groups, (p<0.0001). CONCLUSIONS: a higher prevalence of HIV in the N1 (lse) group was evident, along with a more frequent history of previous Sexual Transmision Disease (std), and poorer self-perception of HIV knowledge, highlighting the need to strengthen std and HIV prevention and testing strategies targeting this group.

HIV knowledge and risk behaviors among women in law enforcement in Bogota, Colombia: potential role as community educators.

As HIV infection is increasing among women, evaluation, prevention, and education campaigns need to target this vulnerable population. Because of their frequent and accepted contact with members of the community, female law officers, if knowledgeable, could be well suited to provide information/education related to HIV/STD transmission. A survey of HIV/AIDS knowledge and risk behaviors was administered to 120 law enforcement women (LEW) and 60 women from the general population (GPW) in Bogotá, Colombia. LEW indicated a very high (90%) understanding of basic HIV knowledge. Although most (52%) of the LEW did not report high-risk behaviors, 29% indicated having unprotected sex during menses, and 17% had unprotected anal sex. This contrasts, however, with GPW, who were of similar age, but had a significantly higher prevalence (73%) of risky behaviors (P=.004). Moreover, 52% of the GPW reported having unprotected anal sex, and approximately half of this group (55%) indicated having unprotected sex during menses. Alcohol and drug users were also more prevalent in the GPW: 14% frequently used alcohol and 3% inhaled drugs during sexual encounters, contrasted to 2% of LEW reporting alcohol use. GPW were four times more likely than LEW, to engage in high-risk sexual practices [95% confidence interval (CI)=1.9-10.4, P=0.034]. Multivariate analyses indicated that alcohol and/or drug use were significantly associated with high-risk sexual practices [odds ratio (OR)=4.7, 95% confidence intervals (CI)=1.3-18.4, P=.02). Improved educational HIV/AIDS programs are needed, particularly for women in the general population, who use alcohol/drugs during sexual encounters, which account, at least in part, for their high-risk behaviors. Women in law enforcement, who appear knowledgeable and exhibit safer behaviors, could be useful educators for GPW. Because of their professional role in the community, training for LEW in HIV/AIDS education/prevention programs should be considered.

HIV treatment in drug abusers: impact of alcohol use.

Studies of alcohol use in HIV-1 infected patients have resulted in conflicting and limited information regarding prevalence, as well as impact on HIV replication, disease progression and response to antiretroviral therapy. Alcohol, drug abuse and past medical information, including antiretroviral treatment, were obtained using research questionnaires and medical chart review in 220 HIV-1 infected drug users. A physical examination was conducted and blood was drawn to evaluate immune measures and nutritional status. Heavy alcohol consumption, defined as daily or 3 - 4 times per/week, was reported in 63% of the cohort. Men (odds ratio (OR) = 2.6, 95% CI 1.13 - 5.99, p = 0.013), and participants between 35 and 45 years of age were three times more likely to be heavy alcohol users (p = 0.006 and 0.0009, respectively). Low serum albumin levels were more evident in heavy alcohol users than non-drinkers (p = 0.003). Heavy alcohol users receiving antiretroviral therapy were twice as likely to have CD4 counts below 500 than light or non-drinkers (95% CI, 1 - 5.5, p = 0.03), and highly active antiretroviral therapy (HAART)-treated heavy alcohol users were four times less likely to achieve a positive virological response (95% CI, 1.2 - 17, p = 0.04). Alcohol consumption is prevalent in our HIV-1 infected drug user cohort and significantly impacts both immunological and virological response to HAART treatment.

Neuroprotection in HIV-positive drug users: implications for antioxidant therapy.

Impaired neuroprotection resulting from oxidative stress has been implicated in neurodegeneration in a number of pathologic conditions of the brain, including both subcortical and cortical type dementias. Production of excessive oxidative stress, moreover, can lead to elevated levels of certain proinflammatory cytokines that are considered to be contributing factors to neuronal injury and are evident in HIV-related dementia as well as in other neurodegenerative conditions. Inhibitors of oxidative damage could thus be promising therapeutic agents for preventing progressive nerve cell death and slowing the advance of neurodegenerative disease. The potential of antioxidant therapy to provide neuroprotection is substantiated by studies demonstrating reduced oxidative stress with supplementation and lower risk for cognitive impairment with higher plasma antioxidant levels.