Immunological effect and influencing factors of HAART on HIV/AIDS with baseline CD4 below 350 cells/mm3 / 公共卫生与预防医学

Objective To analyze the immunological effect and its influencing factors of HAART on HIV/AIDS with a baseline CD4 of less than 350 cells/mm3 in Hubei Province during 2011-2020. Methods The treatment information of people living with HIV/AIDS (PLWH) was collected through China Disease Control and Prevention Information System, and the change of CD4 mean value was analyzed by Wilcoxon sign rank sum test. Chi square test and multivariate logistic regression were used to analyze the factors influencing the immunological effect. Results The mean value of CD4 cell count at baseline was (172.78±107.65) cells/mm3 before treatment and (398.85±206.71) cells/mm3 in the fifth year after treatment. Patients with baseline CD4<50 /mm3 had the largest increase in CD4 mean value after treatment (P<0.05). Multivariate logistic regression analysis showed that Age ≥35 years, heterosexual transmission, time interval from diagnosis to treatment≥1 month, baseline CD4<50 /mm3, treatment time 7-<18 months, and drug failure were the risk factors for the success of antiviral therapy(P<0.05). Conclusion The immunological effect of HIV/AIDS antiviral therapy in Hubei Province is affected by many factors. It is necessary to strengthen the implementation of early detection and early treatment strategy and promote treatment compliance education for patients aged ≥35 years.

A retrospective cohort study on blood lipid changes and their influencing factors in HIV/AIDS patients after receiving antiretroviral therapy in Wuhan / 公共卫生与预防医学

Objective To investigate the prevalence and influencing factors of HIV/AIDS patients with hyperlipidemia before and after receiving antiviral therapy in Wuhan. Methods A retrospective cohort study was used to analyze the data of HIV/AIDS patients in Wuhan from 2004 to 2021. Elevated levels of either TG or TC were determined as hyperlipidemia. Logistic regression model was used to analyze the influencing factors of baseline hyperlipidemia, and Cox proportional risk model was used to analyze the influencing factors of new-onset hyperlipidemia after receiving antiviral therapy. Results A total of 7 562 HIV/AIDS patients were enrolled, 30.61% (2 315/7 562) with hyperlipidemia at baseline and 69.39% (5 247/7 562) without hyperlipidemia. The mean person-years of follow-up for those patients without hyperlipidemia at baseline were 3.48, of whom 33.14% (1 739/5 247) developed hyperlipidemia during follow-up, with an overall density of 9.53/100 person-years. Multivariate logistic regression analysis showed that age ≥30 years and BMI ≥24 kg/m2 were positively correlated with baseline hyperlipidemia, while CD4 cell count ≥ 200 μL was negatively correlated with baseline hyperlipidemia. Multivariate Cox model analysis showed that new-onset hyperlipidemia after receiving antiviral therapy was significantly positively correlated with BMI between 18.5-23.9 and ≥24 kg/m2, the initial antiviral treatment regimen containing LPV/r, efavirenz and other factors A baseline CD4 cell count of 200 to 349 cells /μL was negatively correlated with new-onset hyperlipidemia. Conclusion HIV/AIDS patients with high BMI and an initial antiviral regimen including Kaletra or efavirenz have a significantly higher risk of hyperlipidemia. Follow-up monitoring of blood lipid in these patients should be strengthened.

CCR5 Polymorphisms and its Relationship with HIV Susceptibility, Viral Load and CD4 Count in Early Antiretroviral Therapy among HIV Patients in Selangor and Terengganu

@#Introduction: Early studies have suggested the role of C-C chemokine receptor type 5 (CCR5) polymorphisms in influencing HIV pathogenesis and phenotypes, including the protection against HIV infection and delaying disease progression to AIDS. This study aimed to further determine the impact of CCR5 variants (CCR5-Δ32 and CCR5- R223Q) on HIV susceptibility, viral load suppression and CD4 recovery during highly active antiretroviral therapy (HAART) among Malaysian HIV patients. Methods: This cross-sectional study involved 182 HIV-infected who were recruited from three out-patient clinics, and 150 non-HIV subjects from Malay, Chinese and Indian ethnicities. CD4 count and viral load data at 4-6 months (t1) and 8-12 months (t2) after starting HAART were gathered from hospital records. Chi-square test was used to analyse the correlation between CCR5 variants with dependent variables. Results: Heterozygous CCR5-Δ32 and CCR5-R223Q occurred in a percentage of 0.5% (1/182) and 1.7% (3/182) among HIV patients respectively, while none of homozygous mutant for CCR5-Δ32 and CCR5-R223Q were found. CCR5-R223Q was found more frequently in non-HIV as compared to the HIV group (P=0.018). However, both polymorphisms were not found to be correlated with CD4 recovery to ≥500 cells/mm3 (P>0.05) and viral load suppression ≤50 copies/mL (P>0.05). Conclusion: CCR5-R223Q and CCR5-Δ32 alleles probably have no modifying effects on HIV susceptibility virological and immunological recoveries in the first 12 months of HAART, partially due to the low prevalence of these mutations in the studied population.

Quality of life of people living with HIV and AIDS attending Irrua Specialist Teaching Hospital, Edo State, Nigeria

Background: With the use of highly active antiretroviral therapy (HAART), life expectancy of HIV-infected persons had increased and the disease is now managed as a chronic one, but the quality of life (QOL) of the patients is now a concern. Social support enhances QOL of patients with chronic illnesses. However, no study has been done to determine the QOL of people living with HIV and AIDS (PLWHA) in our environment. This study therefore assessed the QOL of PLWHA attending antiretroviral therapy (ART) clinic of Irrua Specialist Teaching Hospital (ISTH), Edo State of Nigeria Methodology: A descriptive cross-sectional study design was used. Two hundred and thirty PLWHA attending the ART clinic of ISTH, Irrua, Edo State, Nigeria, were systematically selected for the study. A structured questionnaire was interviewer-administered to collect data on sociodemographic and clinical profiles of selected participants, and the WHOQOL-HIV BREF questionnaire was used to collect data the QOL of each participant. Data were analyzed with IBM SPSS version 20.0. Results: The overall mean QOL score for the participants was 89.13±1.18 (95% CI=87.95-90.31). The scores in three of the six life domains in the WHOQOL-HIV BREF instrument were similar and high; spirituality/ religion/personal beliefs (16.33±0.36), physical health (15.83±0.28) and psychological health (15.07±0.24). Lower mean QOL scores were observed in the social relationships (13.49±0.28) and environment (13.45±0.20) domains. Clinical HIV stage, marital status, educational status and gender were significantly associated with mean QOL scores in bivariate analysis while only HIV stage 1 and 2 were significantly associated with good QOL in multivariate logistic regression analysis. Conclusion: It is pertinent that PLWHA are kept in early stages of HIV disease through combination of efforts such as prompt enrolment, commencement and monitoring compliance of HAART, and treatment of opportunistic infections, as well as public health measures including education, de-stigmatization, early diagnosis by extensive accessible screening/testing of at-risk population, social supports and economic empowerment, psychotherapy and social integration of affected individuals especially in a functional home.

Predictors of Adherence to Highly Active Antiretroviral Therapy among HIV Patients attending Selected Comprehensive Care Centres in Kericho County, Kenya

Highly Active Antiretroviral Therapy (HAART) is undoubtedly the only proven remedy known to improve the health outcomes and reduce AIDS-related mortality. However, just like other chronic diseases, HIV presents significant challenges in achieving and maintaining adherence to medication. The effectiveness of HAART solely depends on adherence. For maximum medication benefits, a nearperfect adherence levels of >95% is required yet data from different studies indicate that few, if any patients have achieved perfect adherence. The main objective of the study was to the determine predictors of adherence to Highly Active Antiretroviral Therapy among HIV patients attending selected comprehensive care centres in Kericho County. MATERIALS AND METHODS A descriptive cross-sectional study was adopted, involving 280 HIV patients (≥ 15 years) on HAART from three selected Comprehensive Care Centres in Kericho County, Kenya. Quantitative and qualitative data were collected using interviewer administered semi-structured questionnaires and key informant interviews, respectively. Purposive sampling was used to select the three health facilities while systematic sampling was used for participant selection. Adherence was measured using viral load. Data was analyzed using SPSS version 25. Logistic regression analysis was used to determine the association between adherence to HAART and various independent variables. Results were considered to be significant at p < 0.05). RESULTS AND CONCLUSION Seventy six percent (76%) of the respondents had optimal adherence while 24% had sub-optimal adherence. More females than males were on treatment. Use of HAART alternatives was a risk factor for sub-optimal adherence (p=0.011). Having someone/tool to remind of when to take medication and disclosure of HIV positive status to spouse were found to significantly promote adherence to HAART with p=0.034) and p=0.048, respectively. African Journal of Health Sciences Volume 34, Issue No.4, July- August 2021 465 RECOMMENDATIONS Several studies have been done on the socio-demographic and socio-economic factors associated with adherence to HAART. Findings from this study indicate that attitudes and practices towards HAART have significant effects on adherence hence more research should be done on attitudes and practice aspects of adherence

Prevalence and components of metabolic syndrome in HIV-infected patients at the Tiko Central Clinic and Cottage Hospital in Cameroon

Background: HAART and HIV related metabolic syndrome (MS) is associated with increased cardiovascular risk in aging HIV patients. This study was aimed at comparing the prevalence of MS between HIV-infected patients on HAART and apparently healthy HIV-uninfected individuals and identifying key MS components in these groups of subjects.Methods: This was a hospital-based case-control study. The cases were HIV sero-positive individuals on HAART for at least 6 months and controls were HIV sero-negative individuals.Results: 74/135 (54.8%) participants were females amongst which 53/75 (70.7%) and 21/60 (35%) were in the test and control groups respectively. The prevalence of MS was insignificantly higher in HIV-infected patients on HAART than in control subjects according to the IDF (22.7% versus 20%, p=0.834) and NCEP ATP III criteria (18.7% versus 18.3%, p=1.000) respectively. The most prevalent components of MS in HIV-infected patients on HAART were low HDL-c (100%), abdominal obesity (IDF: 68%, ATP III: 32%), and hypertension (28%). Multivariate analysis of MS components in HIV-infected patients on HAART revealed that hypertension (OR: 15.996, 95% CI: 3.385-75.585; p≤0.001) and high blood glucose (OR: 10.760, 95% CI: 1.642-70.505; p=0.013) were associated with MS. Significantly more HIV-infected females were seen with abdominal obesity than HIV-infected males (86.8% versus 4.5%, p≤0.001).Conclusions: Abdominal obesity is a driving component of MS in HIV-infected patients particularly among females and hypertension is a prevalent and predictor component of MS among HIV patients.

Factors Associated With Quality Of Life Among People Living With Hiv/Aids On Highly Active Anti Retroviral Therapy: A Cross-Sectional Study

Objective: To assess Quality of life (QoL) and its associated factors in people living with HIV/AIDS (PLWHA) who taking highly active antiretroviral therapy (HAART) in Wangaya Hospital in Denpasar, Bali, Indonesia. Methods: A cross-sectional study was conducted during February 2019 to January 2020 at Wangaya Hospital in Denpasar, Bali, Indonesia. QoL was assessed using the five-level version of the EuroQol five-dimensional questionnaire (EQ-5D-5L), EQ-5D index value, and the EuroQol visual analogue scale (EQ-VAS). The data was analyzed using Statistical Package for Social Science (SPSS) software package version 26.0. Bivariate analysis was tested using the cross-tabulation Gamma, Kruskal-Wallis and post hoc Mann-Whitney test. P value<0.05 was considered as statistically significant. Results: A total of 584 PLWHA took HAART for at least 3 mo. The median index value and EQ-VAS were 1.0 (range-0.514–1.0) and 100.00 (range 30-100), respectively. Most patients had problems in ‘anxiety/depression’ and ‘pain/discomfort’ domains. Predictors of better QoL included men, married, good adherence, and treatment duration>24 mo (p<0.05). Predictor of poorer QoL included an advanced HIV clinical stage(p=0.001). Conclusion: The QoL scores of PLWHA receiving HAART in our study were high; hence the QoL of PLWHA was good. The good QoL can be taken as the goal for HIV treatment in order to have a successful HAART therapy.

A rare case of gastroduodenal artery aneurysm in a highly active antiretroviral therapy induced acute pancreatitis case presenting with lump in abdomen

Gastroduodenal artery (GDA) aneurysm is a rare but potentially fatal vascular disease, with chronic pancreatitis being reported as the commonest etiological factor. Rupture, which is not uncommon, carries a high risk of mortality. The typical patient with palpable epigastric mass, upper gastrointestinal bleeding and pain, may not present in the emergency and the lesion is often picked up incidentally on abdominal ultrasound or a computed tomography. We describe a critical case presenting with lump in abdomen which was found out to be gastroduodenal artery aneurysm on scanning, developing in a patient with recurrent highly active antiretroviral therapy (HAART) induced pancreatitis managed with transfemoral catheter embolization. The patient in question succumbed due to post procedure hepatic failure. The management of aneurysms since historic times have been challenging, the open procedures are being gradually replaced by endovascular techniques, which are yielding better results.

Haart Therapy In Ghana: Comparative Assessment Of The Effectiveness Of Different Haart Combinations At Komfo Anokye Teaching Hospital

Objective: Although all marketed antiretrovirals (ARVs) have proven efficacy, genetic differences can result in varied effectiveness. This study was conducted to determine the effectiveness of different Highly Active Antiretroviral Therapy (HAART) combinations among patients attending HIV clinic at a Major Teaching Hospital in Ghana. Methods: The study was a retrospective study involving 500 patients at an HIV clinic in the Ashanti Region of Ghana. Results: Twelve major antiretroviral combinations for HAART were prescribed at the study center. The most prescribed drug combinations were AZT+3TC+EFV and AZT+3TC+NVP. The study identified that HAART, irrespective of the kind of drug combination used, was effective at increasing CD4 count within the first 6 mo of therapy initiation in the study population. However, the magnitude of the increases differed from combination to combination. All HAART combinations with zidovudine as one of the drugs resulted in higher CD4 counts compared with combinations containing stavudine. HAART with nevirapine also resulted in a higher CD4 count than those with efavirenz. However, efavirenz-based combinations appeared to be more effective in critically ill patients and patients with mean CD4+T helper cells count below 100 cell/mm3. More importantly, efavirenz was common among all HAART combinations that resulted in treatment failure. Conclusion: There was significant variation in response to different HAART combination among Ghanaian HIV patients. However, there was no statistically significant difference in mean CD4 count between the two most predominately used HAART i. e AZT+3TC+EFV and AZT+3TC+NVP.

Predictive value of baseline CD4+ Cell Counts and CD4/CD8 ratio in immune reconstitution in HIV/AIDS patients receiving highly effective antiretroviral therapy / 公共卫生与预防医学

Objective To explore the predictive value of baseline CD4+ cell counts and CD4/CD8 ratio in immune reconstitution among HIV/AIDS patients receiving highly effective antiretroviral therapy (HAART). Methods A total of 90 HIV/AIDS patients who had received over 24 months of HAART regimen and had viral road s) (s) (200~500 cells/μl) and immunological responders (IRs) (>500 cells/μl) according to the CD4 cell counts after two-year HAART regimen. The characteristics and dynamic CD4+ cell counts among the three groups were compared, and the factors of immune reconstitution were analyzed. Results The CD4+ cell counts in the immunological responders (IRs) were significantly higher than those in the immunological non-responders (INRs) and immunological inadequate responders (IIRs) (P+ cells reached the highest predictive value at 1 year of HAART. Conclusion Our findings suggested that early initiation of HAART could reduce the failure of immune reconstitution. The combination of baseline CD4+ cell counts and baseline CD4/CD8 ratio may serve as a valid predictor of immune reconstitution prognosis after HAART.

Genotyping analysis of drug resistance related gene mutations in HIV-1 patients who failed in antiviral therapy in Hubei Province,2017-2018 / 公共卫生与预防医学

Objective To analyze HIV-1 drug resistance gene mutations in AIDS patients who failed first-line antiviral therapy in Hubei Province from 2017 to 2018, and to provide references for clinical treatment. Methods Plasma samples of HIV patients who had received first-line antiviral treatment for more than 12 months and had a viral load greater than 103 copies / ml were collected in Hubei Province, and drug resistance genotypes were detected. The prevalence and characteristics of drug resistance were analyzed. Results A total of 198 patients were selected, and 182 target gene sequences were successfully detected. The gene subtypes were mainly CRF01_AE, with a total drug resistance rate of 69.23%. The proportion of NRTIs, NNRTIs and PIs resistance mutations was 46.15%, 65.38% and 0.55%, respectively. The occurrence of cross resistance mutations of NRTIs and NNRTIs reached 40.66%. The mutation sites related to NRTIs were mainly M184V and K65R, while the mutation sites related to NNRTIs were mainly V179D, K103N and Y181C. There was only one case of PIs related mutation at the site of M46I. Conclusion HIV-1 genotyping demonstrated a high proportion of drug resistance in the HAART failure population in Hubei Province, and multi-drug resistance occurred frequently. It is necessary to strengthen the monitoring of drug resistance, implement timely adjustments to antiviral treatment programs, and reduce the occurrence and spread of drug-resistant strains.

Immunological status and virological suppression among HIV-infected adults on highly active antiretroviral therapy

BACKGROUND@#World Health Organization (WHO) recommends that viral load ([VL) is a primary tool that clinicians and researchers have used to monitor patients on antiretroviral therapy (ART), an antiviral drug against retroviruses. Whereas, CD4 cell counts can only be used to monitor clinical response to ART in the absence of VL testing service. Therefore, this study is aimed to assess the level of immunological status and virological suppression, and identify associated factors among human immunodeficiency virus ([HIV)-infected adults who were taking antiretroviral drugs of combination regimen know as highly active antiretroviral therapy (HAART).@*METHODS@#A hospital-based cross-sectional study was conducted at the University of Gondar comprehensive specialized referral hospital from February to April 2018. A total of 323 adult participants on HAART were selected using a systematic random sampling technique and enrolled into the study. Blood samples for viral load determination and CD4 cell count were collected. Binary logistic regression analysis was used to determine factors associated with immunologic status and virological suppression in HIV patients on HAART. Odds ratio with 95% CI was used to measure the strength of association.@*RESULTS@#Virological suppression (VL level  499 cells/mm (AOR = 7.71; 95% CI 3.48, 17.09) at VL testing and current age > 45 years old (AOR = 5.99; 95% CI 2.12, 16.91). Similarly, favorable immunological status (≥ 400 cells/mm for male and ≥ 466 cells/mm for female) was observed in 52.9% (95% CI 47.4, 58.8) of the study participants. Baseline CD4 cell count of > 200 cells/mm, age at enrollment of 26 through 40 years old, and urban residence were significantly associated with favorable immunological status.@*CONCLUSION@#Though the majority of HIV-infected adults who were on HAART had shown viral suppression, the rate of suppression was sub-optimal according to the UNAIDS 90-90-90 target to help end the AIDS pandemic by 2020. Nonetheless, the rate of immunological recovery in the study cohort was low. Hence, early initiation of HAART should be strengthened to achieve good virological suppression and immunological recovery.

Widespread use of anti-retroviral therapy elevated the prevalence of dyslipidemia in HIV-infected Chinese patients

With the widespread use of high-efficiency antiretroviral therapy (HAART), the life expectancy of HIV-infected patients has been significantly extended. However, the metabolic complications among HIV-infected patients treated with HAART have become the most common problem in the world. It is very important to explore the incidence of dyslipidaemia and studies on the role of potential risk factors in HIV-infected Chinese patients treated with HAART are sparse. Therefore, we designed current study, to investigate the effects of therapeutic intervention and continuous information support on the lifestyle of HIV/AIDS patients with dyslipidaemia. Three hundred and six HIV/AIDS patients admitted to the AIDS clinic in Beijing from January 2016 to January 2017 were recruited and assigned into two groups: the treatment group (n=64) and the control group (n=64). The median age of the participants was 38.8±11.0 years (range 20-75 years). The prevalence of dyslipidemia in control and treatment group was (59/64) 92.2% and (53/64) 82.8%, respectively. In this study, low HDL-cholesterol (HDLC) led to abnormalities 47/64 (73.3%) in the control group and 35/64 (54.7%) in HAART-treatment group. Additionally, HAART group showed higher triglyceride, total cholesterol, and low-density lipoprotein (246.1±171.8, 1.73±1.61 mmol/L, 4.46±1.1 mmol/L, 2.54±0.74 mmol/L). In multivariate analysis, gender, marital status, high BMI, dietary habits and physical activity were potential risk factors for dyslipidemia in HIV-infected Chinese patients. In this study, we reported high prevalence dyslipidemiain two HIV infected groups. We suggest that the appropriate diagnosis should be performed for analyzing the metabolic complications in HIV-infected Chinese patients. Further studies are very important to understand the role of potential risk factors in metabolic complications.

Alteración del metabolismo de glucosa y lípidos en los pacientes con virus de inmunodeficiencia humana

Introducción: El virus de inmunodeficiencia humana (VIH) es un retrovirus, de la subfamilia Lentiviridae, asociada con la dislipidemia y la resistencia a la insulina. Asimismo con el tratamiento antirretroviral de gran actividad (TARGA) se ha logrado una reducción de la morbimortalidad y como efecto secundario se ha presentado desbalance metabólico en cuanto a la glicemia y perfil lipídico. Objetivo: Relacionar los niveles de glucosa y lípidos en los pacientes con VIH con TARGA en la consulta de infectología del Servicio Autónomo del Hospital Central de Maracay (SAHCM) período mayo ­ julio 2016. Materiales y Métodos: Estudio clínico, diagnóstico, analítico, transversal, correlacional, no experimental. Se incluyeron pacientes con VIH mayores de 18 años que acudieron a la consulta de infectología en el SAHCM mayo ­ julio de 2016. Resultados: Se analizaron 30 pacientes con predominio de sexo masculino (66,7 %) y edad promedio de 41,13 años. El índice de masa corporal <25 Kg/m2 prevaleció (66,67 %), la circunferencia abdominal tuvo una media de 80,53 cm. Las personas con inhibidores de la transcriptasa reversa análogo de nucleósido más inhibidores de la transcriptasa reversa no análogo de nucleósido (ITRN/ITRNN) demostraron mayor proporción de sobrepeso (13 %). El 10 % presentaron hipercolesterolemia, la mayoría con ITRNN/ITRN; el 10 % tuvo hipertrigliceridemia y VLDL >100 mg/dL en tratamiento con ITRN/IP (Inhibidores de proteasa). El 63,3 % presentó LDL elevado asociado a ITRNN/ITRN; solo el 3,3 % presentó el HDL <50 mg/ dL y glicemias >100 mg/dL en 13,3 % de los pacientes. Conclusión: El VIH y los TARGA producen alteración metabólica.

Introduction: Human Immunodeficiency Virus (HIV) is a retrovirus, Lentiviridae subfamily, associated with dyslipidemia and insulin resistance. Antiretroviral therapy (HAART) has achieved a reduction in morbidity and mortality as a result, it has been presented metabolic imbalance related to glycemia and lipid profile. Objetive: Relate glucose and lipid levels in HIV patients on HAART in infectology's consultation the Autonomous Service of the Central Hospital of Maracay (SAHCM) period from May to July 2016. Materials and Methods: Clinical, diagnostic, analytical, transversal, co-relational, not experimental study. HIV patients over 18 years old, attended in the Infectology's consultation in May SAHCM, were included Results: 30 patients predominantly male (66.7 %) and average age of 41.13 years were analyzed. The body mass index <25 kg / m2 prevailed (66.67 %), abdominal circumference had an average of 80,53 cm. People treated with nucleotide reverse transcriptase inhibitor plus non nucleotide reverse transcriptase inhibitor (NRTIS/ ITRNA) showed higher proportion of overweight (13 %). Hypercholesterolemia was founded in 10 %, almost patients with ITRNN / ITRN; 10 % had hypertriglyceridemia and VLDL> 100 mg/dL treated with NRTIS /ITRNN / PI (protease inhibitors) with P = 0.00. The 63.3 % had elevated LDL associated with ITRNN / ITRN; only 3.3 % had HDL <50 mg/dL; the blood glucose> 100 mg/dL (13.3 %) was evident in most of HAART. Conclusion: HIV and HAART produce metabolic disorder.

Práticas de uma equipe multiprofissional para pessoas vivendo com HIV/AIDS: um estudo de caso em um município da Foz do Rio Itajaí-Açu, Santa Catarina ­ Brasil / Practices of a multiprofisional group for people living with HIV/AIDS: a case study in a city of Foz do Rio Itajaí-Açu, Santa Catarina state - Brazil

A incidência da Síndrome da Imunodeficiência Adquirida (AIDS) continua a aumentar em nosso país, mesmo com o avanço da Terapia antirretroviral (TARV) e a diminuição da mortalidade. Assim, aspectos relacionados ao cuidado destes pacientes tornam-se relevantes, especialmente quanto ao papel das equipes de saúde provedoras da atenção. O objetivo deste trabalho foi identificar particularidades relacionadas ao cuidado das pessoas com HIV/AIDS em um centro de referência de um município da Foz do Rio Itajaí-Açu, Santa Catarina ­ Brasil. Foi realizado um estudo qualitativo com coleta de dados por meio de grupo focal e utilizada a técnica de análise de conteúdo temático para avaliação e apresentação dos resultados. Identificaram-se duas grandes categorias, com suas respectivas subcategorias sendo: aspectos promotores de cuidado (acolhimento no serviço de saúde, trabalho em equipe, entendimento/aceitação da doença, presença de rede de apoio, existência de grupos nos serviços, atenção individual do profissional e tratamento medicamentoso) e aspectos dificultadores do cuidado (baixo número de profissionais; falta de ambiência/espaço físico adequado no serviço; sigilo/estigma do local e gestão dos serviços). Conclui-se que o cuidado do paciente com HIV/AIDS apresenta dimensões que extrapolam o conhecimento técnico sobre a doença, devendo considerar aspectos relacionados à vida da pessoa, na qual a organização do serviço de saúde apresenta papel determinante. Aspectos estruturais e de gestão também foram identificados como importantes na adesão ao tratamento e no cuidado desses pacientes.

The incidence of Acquired Immunodeficiency Syndrome (AIDS) continues to increase in our country in despite of theadvanceof antiretroviraltherapy (ART) anddecreasedmortality. Thus, related aspects to the care of these patients become relevant, especially about the role of health careproviders. The objective of this study was to identify aspects related to the care of people with HIV/AIDS, in a reference center of a city of Foz do Rio Itajaí-Açu, Santa Catarina - Brazil. A qualitative study was conducted with data collection with a focus group, and the thematic content analysis technique wasused for analysis and presentation of results. Two major categories related to the care of people with HIV/AIDS were identified, with their respective subcategories: care-promoting aspects (health service reception, teamwork, understanding / acceptance of the disease, presence of support network, existence of groups in this service, individual professional attention and drugtreatment) and aspects that hinder the care (low number of professionals; missing ambience/suitable physical space in the service; confidentiality / stigma of the placeand management of the services. It is concluded that the care of patients with HIV/AIDS hás dimensions which go beyond the technical knowledge about the disease, and aspects related to the person's life should be considered, which the organization of the health service plays a determining role. Structural and management aspects were also identified as important aspects that interfere in the patient adherence and care.

Comparative Study on the Electrolyte Levels of HIV/AIDS Patients on High Active Antiretroviral Therapy (HAART) in Owerri Metropolis, South Eastern Nigeria

(baseline) demographic andclinical information, with initial full blood count results were retrieved from the medical records of the participants. Post HAART administration blood sample (5mLs) was taken from each participant into an EDTA vacutainer tube andcomplete blood count (CBC) performed usingURIT 5250 haematology analyser.Participants transfused with blood overthe last 4 months were excluded from the study.Results: The study recorded significant decreases in WBCand Neutrophil (%)post HAART administration. Lymphocyte (%),Haemoglobin, Haematocrit, MCV, MCHC, RDW-SD were all significantly higher post HAART administration. Total Platelets count, MPV, PDW-SD, PCT and P-LCR were significantly lower post-HAART administration.A comparison of the effects of EFV and NVP administered with AZT/3TC backbone yielded the following results. The NVP group recorded a significantly higher HCT compared with the EFV group (p-0.0073). A significantly higher mean PCT, MPV, P-LCR,PLCC, PDW-SD were recorded in the EFV group comparedto the NVP group respectively.Conclusion: The administration of HAART is associated with significant improvements in erythroid and lymphoid lineages, reduce anaemia, improves immunity and general patient well-being. NVP improve erythroid cell indices while EFV ameliorate platelet indices. HAART regimen should be chosen based on the pre-HAART laboratory tests conducted on the individual normal ranges. Decreased levels (mmol/L) of serum Cl-(3.90±0.54) and Na (31.70±0.10) were observed. Between the male and female patients, K+level (mmo/L) (3.70±0.54 and 4.0±0.54 respectively) was observed to be within the normal value of 3.5 –5.0mmo/L. Na+concentration (mmol/L) was observed to be decreased in both male and females with the values of 130.80 ±6.40 and 131.4±6.50 respectively. The Cl-concentration (mmol/L) was observed to be increased in females (98.40±7.60) and decreased in males (97.20±8.90) when compared with the normal range (98.00-105.00mmol/L). The male patients showed an observed significant increase in the concentration (mmol/L) of their HCO3-(38.20±15.70) than the females (25.10±2.60) when compared with the normal value of 24.00-30.00mmol/L. The concentration (mmol/L) of Na+of all the ages (10-59years) was observed to be decreased when compared with the normal range (135.00-150.00mmol/L) while K+for all the ages was observed to fall within the normal range. Only the age range of 30 -39years had an increased level of Cl-(145.90±48.10) while the other age ranges were decreased. The concentration (mmol/L) of HCO3-of all the age ranges were observed to be within the normal range except for the age range of 20-29years which was observed to show a decreased concentration (mmol/L) of 22.30±4.00 when compared with the normal range of 24.00-30.00mmol/L. Findings from this study has led to the recommendation that strict monitoring of the serum electrolytes in HIV/AIDS patients on HAART is important as early detection and treatment of these abnormalities will enhance the quality of life of patients.

HIV in pregnancy: a 9 year study of the seroprevalence, sociodemographic factors and pregnancy outcomes of seropositive women at a tertiary care hospital in Mumbai, Maharashtra, India

Background: HIV can cause considerable morbidity and mortality in those affected. An effective PPTCT programme helps in reducing the spread of HIV by vertical transmission and improving the life of the women and her baby.Methods: A retrospective study was done at a tertiary care hospital, including pregnant women registered and delivered at the hospital during a period of 9 years from January 2010 to December 2018. Pretest counseling, HIV testing, Post-test counseling were done and antiretroviral prophylaxis given as per the NACP guidelines. Sociodemographic characteristics, obstetric and maternal-foetal outcome of seropositive women and efficacy of PPTCT services were analyzed.Results: Out of the 58,205 antenatal mothers included, 55,256 (94.93%) accepted HIV testing. 171 of these tested positive (0.31%). 70 spouses of the 171 seropositive women tested positive, 53 tested negative and 48 did not undergo the HIV test. Majority of seropositive women were primigravidas; housewives from urban areas, from low income and educational background and with no history of any contraceptive use. 7.6% had an MTP, 1.75% a spontaneous abortion and 0.58% an ectopic pregnancy. Of the 154 births, 35.71% underwent caesarean sections. There were 96.7% live births in our study and the perinatal mortality rate was 5.19%. After 2013, all mother-baby pairs were given ARV prophylaxis.Conclusions: Utilization of PPTCT services has increased through the years, decreasing the vertical transmission and seroprevalence rate. Increasing the acceptance rates of HIV testing, both by patients and partners may further help in curbing the spread of this condition.

A prevalence study of ocular manifestations in HIV positive patients on highly active anti-retroviral therapy

Background: Among 40 million cases worldwide, 50-75% of patients have at least one ocular manifestation in their lifetime. Many of ocular infections are treatable with therapeutic agents. Ocular manifestations invariably reflect systemic disease and can be the initial manifestations of HIV in many cases. Understanding of ocular sequel of HIV infection can lead to the early diagnosis and effective treatment. This study emphasizes on the need of developing a specific ophthalmic examination for the management of ocular manifestations in HIV infected patients.Methods: Cross sectional and observational study of 100 HIV positive participants on HAART were done irrespective of presence or absence of ocular symptoms. Participants were examined for complete ocular examination. Prevalence find out using chi-square test, find p values and ensuring statistical significance.Results: In our study, prevalence of ocular manifestation in HIV positive patients receiving HAART was 39%. Out of them, 20% adnexal involvement, 28% anterior segment involvement, 33% posterior segment involvement, 11% neuro-ophthalmic abnormality, 4% orbital involvement were present. 76% patients belonged to WHO clinical stage 2 and 3. 51% had CD4+ T cell counts <200 cells/µl.Conclusions: Posterior segment followed by anterior segment are the most commonly encountered ocular manifestations of HIV infection. Low CD4 count is good predictor for ocular manifestations in HIV positive patients. Higher WHO stage is also directly related with the severity of the ocular symptoms. Routine baseline ophthalmic screening to all HIV positive patients are necessary to prevent ocular morbidity.

Frecuencia y etiología de la enteroparasitosis en pacientes con virus inmunodeficiencia humana en un hospital de Lambayeque, Perú / Frequency and etiology of enteroparasitosis in patients with human immunodeficiency virus at a hospital of Lambayeque, Peru

RESUMEN Introducción: A pesar de terapia antiretroviral aún es común encontrar la presencia de infecciones oportunistas, tales como enteroparásitos que causan un gran impacto en salud y economía de los pacientes. Objetivos: Determinar la frecuencia, etiología y factores asociados a las enteroparasitosis en pacientes con VIH, en un hospital referencial de Lambayeque, Perú. Material y Métodos: Se realizó un estudio prospectivo tipo observacional en pacientes diarreicos con infección por VIH de un hospital de Lambayeque desde enero a junio del 2016. Tanto la recolección y transporte, como el análisis de las muestras siguieron las recomendaciones del Manual de procedimientos para el diagnóstico de las parasitosis humanas del Instituto Nacional de Salud. Resultados: La mediana de edad fue 28 años, predominó el sexo masculino y el porcentaje de parasitismo fue de 73,08%. Pacientes con carga viral > 1000 fueron 69,2% y pacientes en TARGA fueron 55,8%. Blastocystis hominis fue el parásito más frecuente (30,77%), seguida de Cryptosporidium spp. y Cystoisospora belli con el 21,2% y 11,5% respectivamente. El análisis bivariado entre carga viral y TARGA con parasitismo, demostró asociación con el parasitismo. Conclusiones: La enteroparasitosis es frecuente en pacientes con VIH y diarrea, predominando las infecciones oportunistas por encima de las no oportunistas.

ABSTRACT Introduction: Despite antiretroviral therapy, it is still common to find the presence of opportunistic infections such as enteroparasites, which cause a big impact on the health and economy of patients. Objetive: To determine the frequency, etiology and factors associated with enteroparasitosis in patients with HIV at a reference hospital in Lambayeque, Peru. Material and Methods: A prospective observational study was conducted in diarrheic patients with HIV infection in a hospital in Lambayeque from January to June, 2016. The study was a census. Both the collection and transport as well as the analysis of the samples followed the recommendations of the Manual of procedures for the diagnosis of human parasitosis of the National Institute of Health. Results: The meadian age was 28 years, the male sex predominated, and the percentage of parasitism was 73.08%. Patients with viral load >1000 were 69.2% and patients with HAART were 55.8%. Blastocystis hominis was the most frequent parasite (30.77%), followed by Cryptosporidium spp. and Cystoisospora belli with 21.2% and 11.5%, respectively. The bivariate analysis between viral load and HAART with parasitism, demonstrated an association with parasitism. Conclusions: Enteroparasitosis is frequent in patients with HIV and diarrhea, predominating opportunistic infections over non opportunistic ones.

The Role of HAART and CD4 Count in HIV Retinopathy

Introduction: Human immunodeficiency virus (HIV)infection and Aquired Immuno-Deficiency Syndrome (AIDS)is a global pandemic. Study aimed to record the retinalmanifestations in patients with HIV according to their CD4count and HAART status.Material and methods: A total of 100 patients with HIVwere examined over a period of 7 months. The patientswere selected on the basis of confirmed sero-positive HIV.They were thouroghly examined under mydriasis withindirect ophthalmoscope and fundus photographs were takenwhenever possible.Results: 32 patients (32%) were found having fundusmanifestations. Out of which majority had hiv microangiopathyand few had retinitis or choroiditis.Conclusion: There is higher incidence of retinal findings innon-HAART group and in patients with CD4<100/ml in bothgroups and HAART associated with reduced incidence ofretinal manifestations.