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1.
Med. mycol. case rep ; 26: 64-66, Dec. 2019. ilus, tab
Artigo em Inglês | Sec. Est. Saúde SP, SESSP-IIERPROD, Sec. Est. Saúde SP | ID: biblio-1025285

RESUMO

The detection of cryptococcal capsular antigen (CrAg) is very sensitive and specific, however false-negative results have been reported, mostly in cerebrospinal fluid. We report the case of an HIV-infected patient with CD4=42 cells/mL, asthenic, negative serum CrAg lateral flow assay (LFA) and culture-proven cryptococcaemia. Despite the high accuracy of LFA, false-negative result is possible. Careful clinical evaluation and close follow-up are relevant


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Infecções por HIV , Criptococose , Reações Falso-Negativas , Antígenos de Fungos
2.
Mikrobiyol Bul ; 53(4): 374-387, 2019 Oct.
Artigo em Turco | MEDLINE | ID: mdl-31709935

RESUMO

Human immunodeficiency virus (HIV) comprises two genotypes, namely HIV-1 (group M, N, O and P) and HIV-2 (group A to H), which differ in their envelope glycoproteins and other antigenic epitopes despite their morphological and biological resemblance.Group M of HIV-1 responsible for 95% of HIV infections worldwide is composed of nine subgroups. In addition to subgroups, group M contains also two recombinant forms, known as circulating recombinant form (CRF) and unique recombinant form (URF). The first case of HIV/acquired immun deficiency virus (AIDS) in Turkey was reported in 1985 and the current number of cases reached a total of 18.557 including 1736 with AIDS based upon the surveillance data of Ministry of Health between October 1985 and November 2018. The aim of this study was to determine the prevalence of HIV-1 strains isolated from HIV positive autopsy cases detected by HIV polymerase chain reaction (PCR) and determine drug resistance. Twenty eight cases [17 males, 11 female: age ranged between 3 months and 66 years (median: 35 years)] found to be HIV positive among the autopsy cases sent for HIV1 PCR study and serological screening between 2011-2017 were recruited in the study. For identification of subtypes in HIV-1 isolates, most-preferred analysis tool was used [HIVdb Stanford University Genotypic Resistance Interpretation Algorithm (www.hivdb.stanford.edu)]. Phylogenetic tree was made according to direct sequencing of HIV-1 reverse transcriptase (pol) region and phylogenetic analysis was evaluated in 23 cases. Los Alamos National Laboratory were trimmed from full-length genomes. Phylogenetic analysis of the 870 base pair of the pol gene region was performed using CLC Sequence Viewer v8.0 (Qiagen Aarhus A/S, www.qiagenbioinformatics.com) software. The phylogenetic tree was obtained according to the neighbor-joining method and the Jukes-Cantor nucleotide distance scale and bootstrap value was set at 1000. In our study, subtype B was found to be most frequent type (39.3%; 11/28). Subtype A (17.9%; 5/28), CRF02_AG (14.3%; 4/28), subtype C (10.7%; 3/28), B+CRF02_AG recombinant (3.6%; 1/28), CRF01_AE (3.6%; 1/28), subtype D (3.6%; 1/28), as well as subtype F (3.6%; 1/28) and subtype G (3.6%; 1/28) strains were also detected in the circulation. Analysis of our results showed that 32.1% (9/28) of the samples exhibited resistance mutations. Detected mutations were as follows: M41L, T215C, K65R, M184V, responsible for nucleoside reverse transcriptase inhibitor (NRTI) resistance; K103N, Y181C, G190A, responsible for non-nucleoside reverse transcriptase inhibitor (NNRTI) resistance; D30N, M46I, responsible for protease inhibitor (PI) resistance. NRTI, NNRTI and PI mutation rates in the samples were found as 21.4%, 7.1% and 3.6%, respectively. Although number of samples analyzed in our study is low, we can propose that they resemble the strains circulating in Turkey. The results of our study; although the subtype B is still dominant in our country, it supports other studies reporting that there are non-B subtypes and an increase in CRF rates in recent years. Phylogenetic analysis is widely regarded as the gold standard technique to determine the subtypes of HIV-1. Molecular epidemiologic studies related to HIV may be important in monitoring HIV subtype patterns and spreading pathways in that country. As a result; the opportunity to collect postmortem HIV sequences in a database appears to have occurred, and as this database expands, its usability is available. Therefore, it is thought that HIV subtypes and mutation information may be useful.


Assuntos
Infecções por HIV , HIV-1 , Epidemiologia Molecular , Adolescente , Adulto , Idoso , Antivirais/farmacologia , Autopsia , Criança , Pré-Escolar , Farmacorresistência Viral , Feminino , Genótipo , Infecções por HIV/epidemiologia , Infecções por HIV/virologia , HIV-1/classificação , HIV-1/efeitos dos fármacos , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Mutação , Filogenia , Turquia/epidemiologia
3.
Mikrobiyol Bul ; 53(4): 388-400, 2019 Oct.
Artigo em Turco | MEDLINE | ID: mdl-31709936

RESUMO

Tuberculosis (TB) is the most common opportunistic infection in human immunodeficiency virus (HIV)-infected patients. Diagnosis and treatment of latent tuberculosis infection (LTBI) is the most important step in preventing the development of active TB. In our country where TB is moderately endemic, HIV-infected patients should be investigated for LTBI. Tuberculin skin test (TST) and interferongamma release assays (IGRA) are used in the diagnosis of LTBI but there isn't a standard practice. The aim of this study is to compare the TST and T-SPOT.TB test efficiency in the diagnosis of LTBI in HIVinfected patients. Patients who had no previous active TB infection, who were not treated for LTBI and who had no active tuberculosis infection at the time of admission were included in the study. A total of 100 HIV-infected patients who were admitted to the Infectious Diseases and Clinical Microbiology outpatient clinic between June 2015 and March 2016 were evaluated cross-sectionally. CD4+ T lymphocyte counts in the last one month were detected. All patients underwent chest radiography at the time of admission. Patients who are not considered as active TB infection with clinical and laboratory findings and who had no TST within the last one month were included in the study. TST was performed after the blood samples were taken for T-SPOT.TB test. In our study, 87% of the patients were male and the mean age was 40.2. The mean CD4+ T lymphocyte count was 605 cells/mm³ (26-1313). 16% of the patients had a history of encountring a person with tuberculosis and 81% had BCG vaccination scar. TST positivity and T-SPOT.TB positivity were 22.9% and 22%, respectively. The concordance between the two tests was found to be moderate (Kappa= 0.491). It was determined that BCG vaccination and the presence of a contact with a patient with TB did not affect TST and T-SPOT.TB test positivity (p> 0.05). There was a positive correlation between CD4+ T lymphocyte count and TST measurement values (r= 0.3, p= 0.003). Accordingly, as the number of CD4+ T lymphocytes increased, TST positivity increased (p= 0.007). T-SPOT.TB test was not affected by CD4+ T lymphocyte count (p= 0.289). Our study showed that TST was affected by CD4+ T lymphocyte count and patients' compliance with this test was also low. On the contrary T-SPOT.TB test was not affected by CD4+ T lymphocyte count. There was no statistically significant difference between T-SPOT.TB test positivity and CD4+ T lymphocyte count (p= 0.289). The concordance between the two tests was found to be moderate. It is thought that the main reason for the discordance between the tests is due to false negative or false positive results of TST. In conclusion, T-SPOT.TB was found more reliable in the diagnosis of LTBI in HIV-infected individuals. In the light of these findings, especially in HIV-infected patients with low CD4+ T lymphocyte counts, T-SPOT.TB test can be considered for LTBI diagnosis.


Assuntos
Infecções por HIV , Testes de Liberação de Interferon-gama , Tuberculose Latente , Teste Tuberculínico , Feminino , Infecções por HIV/complicações , Humanos , Testes de Liberação de Interferon-gama/normas , Tuberculose Latente/complicações , Tuberculose Latente/diagnóstico , Masculino , Teste Tuberculínico/normas , Turquia
4.
Mikrobiyol Bul ; 53(4): 401-407, 2019 Oct.
Artigo em Turco | MEDLINE | ID: mdl-31709937

RESUMO

Acquired Immunodeficiency syndrome (AIDS) is an important global public health issue. Increasing HIV/AIDS cases reported each year has become a serious health problem for our country. The fourth generation enzyme immunoassay (EIA) test is the first step in the laboratory diagnosis of human immunodeficiency virus (HIV) infection. When the EIA test is repeatedly reactive, antibody-based tests such as immuno blot (IB), line immunoassay (LIA), HIV 1-2 antibody differentiation immunoassay, and HIV RNA tests for the early period of infection are used as confirmatory tests. The aim of this study was to evaluate the results of three different methods for the diagnosis of HIV infection. HIV 1-2 IB and quantitative HIV-1 RNA PCR tests were performed in 199 patient samples. These samples were detected as the reactive or gray zone with HIV 1-2 Ab+Ag EIA test between 2010 and 2015 at Akdeniz University Hospital, Microbiology Laboratory. HIV 1-2 Ab+Ag determination in serum samples was performed with the EIA method (Elecsys HIV combi PT test, Roche Diagnostics, Germany). A commercial kit (INNO-LIA HIV I-II Score, Innogenetics, Belgium) was used for HIV 1-2 IB method. The presence of HIV-1 RNA was investigated by automated nucleic acid extraction and real-time PCR method (Ampliprep/COBAS Tagman HIV-1 Test, Roche Diagnostics, Germany) in plasma samples. For statistical analysis, SPSS, Mann Whitney U test was used, ROC analysis was performed and p<0.05 value was considered statistically significant. HIV 1-2 Ab+Ag EIA COI (cut-off index) median value was higher with positive HIV 1-2 IB and HIV-1 RNA results than negative HIV 1-2 IB and HIV-1 RNA results. These values were 394 (range: 11.5-2272) and 1.79 (range: 1.01-83.3) respectively and this difference was statistically significant (p< 0.001). HIV-1 RNA test results were positive in one patient with gray zone and two patients with negative HIV 1-2 IB result (viral loads were > 10.000.000, > 10.000.000 and 5.040.000 copies/ml, respectively). For the kit that we used for HIV 1-2 Ab+Ag EIA COI ratio of >16.45 had a sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 97.6%, 98.1%, 97.6% and 98.1%, respectively for the detection of HIV infection (r= 0.994, p< 0.001). HIV 1-2 Ab+Ag EIA S/CO ratio of < 9.26 had a sensitivity, specificity, PPV and NPV of 100%, 92.5%, 91.1% and 100% (p< 0.001). HIV infection is diagnosed if HIV 1-2 Ab+Ag EIA test result is repeatedly reactive and HIV 1-2 IB test and HIV-1 RNA tests are positive. In our study, HIV 1-2 Ab+Ag EIA COI median value was 394 (range: 11.5-2272) in this group of patients (p< 0.001). HIV-1 RNA PCR test was positive in three patients with > 10.000.000, 5.040.000 and > 10.000.000 copies/ml whose EIA tests were repeatedly reactive. HIV IB test was detected as the gray zone in one of them and as negative in the remaining two (HIV EIA S/CO values were 265, 9.5 and 131.8, respectively). These patients were diagnosed as acute HIV infection with clinical and laboratory findings. In conclusion, HIV RNA should also be performed and included in the diagnostic algorithm for acute HIV infection.


Assuntos
Infecções por HIV , Imunoensaio , Immunoblotting , Reação em Cadeia da Polimerase , Alemanha , Infecções por HIV/diagnóstico , HIV-1 , HIV-2 , Humanos , Imunoensaio/normas , Immunoblotting/normas , Reação em Cadeia da Polimerase/normas , RNA Viral/genética , Sensibilidade e Especificidade
5.
Expert Opin Drug Metab Toxicol ; 15(11): 927-935, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31668105

RESUMO

Introduction: Ritonavir and cobicistat are pharmacoenhancers used to improve the disposition of other HIV antiretrovirals. These drugs are, however, characterized by important pharmacokinetic differences.Areas covered: Here, the authors firstly update the available information on the pharmacokinetics of ritonavir and cobicistat. Subsequently, the review focuses on the description of drug-drug interactions (DDIs) involving cobicistat and comedications that might beneficiate from a shift-back to ritonavir. A MEDLINE Pubmed search for articles published from January 1995 to April 2019 was completed matching the term ritonavir or cobicistat with pharmacokinetics, DDIs, and pharmacology. Moreover, additional studies were identified from the reference list of retrieved articles.Expert opinion: Despite more than 20 years after its introduction on the market, ritonavir still represents a valid option for the treatment of selected HIV-infected patients. The large-scale switch to cobicistat may result in some unexpected DDIs not previously reported for ritonavir. Besides the issue of DDIs, additional advantage of ritonavir over cobicistat is its use in pregnancy, and its availability as single component of pharmaceutical formulations allowing the fine-tuning of antiretroviral regimens in patients with heavy polypharmacy when other unboosted-based therapeutic options cannot be used.


Assuntos
Fármacos Anti-HIV/administração & dosagem , Cobicistat/administração & dosagem , Ritonavir/administração & dosagem , Fármacos Anti-HIV/farmacocinética , Cobicistat/farmacocinética , Interações de Medicamentos , Quimioterapia Combinada , Infecções por HIV/tratamento farmacológico , Humanos , Ritonavir/farmacocinética
6.
Pan Afr Med J ; 33: 249, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31692764

RESUMO

Neuromeningeal cryptococcosis is a common and severe opportunistic fungal infection caused by the encapsulated yeast Cryptococcus neoformans. It commonly occurs in immunocompromised patients, in particular in subjects with advanced stage HIV while it is rare in immunocompetent patients. We report 40 cases of neuromeningeal cryptococcosis (NMC) diagnosed at the Mycology-Parasitology Department of the Ibn Sina hospital in Rabat, over a 21-year period (1993-2014). The diagnosis was based on nested-PCR-based assay for the detection of Cryptococcus neoformans after staining with China ink and culture on Sabouraud agar without actidione as well as on the identification of soluble cryptococcal antigens. Thirty-five patients had HIV infection, 2 patients were apparently immunocompetent and 3 were immunocompromised patients without HIV (30 men and 10 women). The average age of patients was 38 years; neuromeningeal cryptococcosis was indicative of HIV infection in 13 cases. In 22 cases it was a complication of AIDS. Twenty-seven patients of our series were treated with fluconazole monotherapy. Amphotericin B was used in 13 patients. Outcome was favorable in 13 patients (32.5%) while 3 patients had complications (7.5%). Eighteen patients died (45%) and 6 were lost to follow-up (15%). The tests to diagnose a Cryptococcus neoformans infection should be performed systematically in patients with neurological signs for early diagnosis.


Assuntos
Antifúngicos/administração & dosagem , Infecções por HIV/epidemiologia , Hospedeiro Imunocomprometido , Meningite Criptocócica/epidemiologia , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Adulto , Idoso , Anfotericina B/administração & dosagem , Cryptococcus neoformans/isolamento & purificação , Feminino , Fluconazol/administração & dosagem , Infecções por HIV/complicações , Humanos , Masculino , Meningite Criptocócica/diagnóstico , Meningite Criptocócica/tratamento farmacológico , Pessoa de Meia-Idade , Marrocos , Adulto Jovem
7.
Pan Afr Med J ; 33: 252, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692814

RESUMO

Introduction: HIV and syphilis are major public health problems in Morocco. The region of Souss-Massa, south-west of the country, hold more than 24% of HIV seropositive cases registered in Morocco during 2009. The aim of this study is to evaluate the seroprevalence of syphilis among HIV seropositive patients in the region of Souss-Massa, south-west of Morocco. Methods: To evaluate the seroprevalence of syphilis and neurosyphilis among HIV seropositive patients, we retrospectively investigated the medical records of HIV-infected patients attending the regional hospital located in the city of Agadir, during the period comprised between 2011 and 2016. Results: The population studied involved 1381 males (49.18%) and 1427 females (50.82%) HIV seropositive patients. Among them, 481 patients were seropositive for syphilis and three cases were diagnosed with neurosyphilis. The sex ratio distribution was 243 male (52.71%) and 218 female (47.29%). The prevalence of syphilis among the studied population was estimated to 16.42% with a slight dominance in male (17.63%) compared to female (15.28%). By contrast, neurosyphilis was only detected in male patients, with a prevalence estimated to 0.11%. Conclusion: Even if the prevalence of HIV and syphilis is stable in the region of Souss-Massa, the prevalence of syphilis among HIV seropositive patients remained high and correlated positively with that of HIV infection. We did not find a significant difference between the genders, in relation to the prevalence of HIV and syphilis. We concluded that it was essential to continue monitoring the population, in order to improve the prevention and the access to the medical care in the south-west of Morocco.


Assuntos
Infecções por HIV/epidemiologia , Neurossífilis/epidemiologia , Sífilis/epidemiologia , Feminino , Humanos , Masculino , Marrocos/epidemiologia , Prevalência , Estudos Retrospectivos , Estudos Soroepidemiológicos , Distribuição por Sexo
8.
Indian J Dent Res ; 30(4): 521-526, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31745046

RESUMO

Aims and Objective: Routine oral health care is essential for those living with HIV (human immunodeficiency virus) infection, especially in pregnant women. Hormonal changes during pregnancy, immunosupression in HIV along with bacterial load in periodontal infections strongly influence the pregnancy outcomes. The aim of this study was to evaluate the periodontal health status in HIV seropositive pregnant women in Andhra Pradesh, India. Materials and Methods: This study includes a sample of 90 divided into three groups; HIV seropositive pregnant women (group PH; n = 30), HIV seropositive nonpregnant women (group H; n = 30), and healthy pregnant women without HIV infection (group P; n = 30). Clinical examination includes the recording of probing depths (PD), clinical attachment level (CAL), plaque index (PI), gingival index (GI), and periodontal screening and recording index (PSR) were assessed in three groups. Statistical analysis was done by Mann-Whitney U-test and Wilcoxon paired test using the software SPSS version 17. Results: Clinical parameters do not show any significant variation between the three groups. But slightly higher mean PD and CAL levels was observed in HIV seropositive pregnant and nonpregnant women compared with healthy pregnant women without HIV infection. About 13% of severe gingivitis cases were observed in HIV seropositive pregnant group compared with 6% in HIV seropositive and 3% in healthy pregnant group. Conclusions: Presence of slightly higher percentage of severe gingivitis in HIV seropositive pregnant women strengthens the fact of extra need for preventive oral health services during the prenatal period and provides recommendations for promoting maternal oral health in regional antiretroviral therapy centers in India.


Assuntos
Infecções por HIV , Doenças Periodontais , Índice de Placa Dentária , Feminino , Nível de Saúde , Humanos , Índia , Índice Periodontal , Gravidez
9.
Pan Afr Med J ; 33: 326, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692828

RESUMO

Introduction: Human immunodeficiency virus (HIV) and tuberculosis (TB) are the leading causes of death from infectious disease worldwide. The prevalence of HIV among children with TB in moderate to high prevalence countries ranges between 10% and 60%. This study aimed to determine the prevalence of HIV infection among children treated for TB in Directly Observed Treatment Short-Course (DOTS) clinics in Lubumbashi and to identify risk of death during this co-infection. Methods: This is a cross-sectional study of children under-15, treated for tuberculosis from January 1, 2013 to December 31, 2015. Clinical, paraclinical and outcome data were collected in 22 DOTS of Lubumbashi. A statistical comparison was made between dead and survived HIV-infected TB children. We performed the multivariate analyzes and the significance level set at p-value <0.05. Results: A total of 840 children with TB were included. The prevalence of HIV infection was 20.95% (95% CI: 18.34-23.83%). The mortality rate was higher for HIV-infected children (47.73%) compared to HIV-uninfected children (17.02%) (p<0.00001). Age <5 years (aOR=6.50 [1.96-21.50]), a poor nutritional status (aOR=23.55 [8.20-67.64]), and a negative acid-fast bacilli testing (aOR=4.51 [1.08-18.70]) were associated with death during anti-TB treatment. Conclusion: TB and HIV co-infection is a reality in pediatric settings in Lubumbashi. High mortality highlights the importance of early management.


Assuntos
Antituberculosos/administração & dosagem , Infecções por HIV/epidemiologia , Estado Nutricional , Tuberculose/epidemiologia , Criança , Pré-Escolar , Coinfecção , Estudos Transversais , República Democrática do Congo/epidemiologia , Terapia Diretamente Observada , Feminino , Infecções por HIV/mortalidade , Humanos , Masculino , Prevalência , Fatores de Risco , Tuberculose/tratamento farmacológico , Tuberculose/mortalidade
10.
Pan Afr Med J ; 33: 302, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692863

RESUMO

Introduction: People with disabilities have been identified as a key risk population for HIV. The aim of this study was to investigate HIV status, knowledge, attitudes, behaviours and its correlates in persons with and without disabilities in South Africa. Methods: Cross-sectional data of 26404 participants 15 years and older from the "2012 South African national HIV prevalence, incidence and behaviour survey" were analysed. Results: 1348(5.3%) had a disability. Persons with a disability were older (median age 52 years, IQR=24; versus 36 years, IQR=29), more often men, had a lower education and lower income and more likely living in a rural area than persons without disability. The prevalence of HIV infection was 16.7% in persons with disability, 23.0% in persons with visual/hearing or speech disability, 31.6% in persons with hearing disability and 16.2% in persons without disability. Antiretroviral (ARV) exposure in the HIV positive population was 41.3% among persons with disability and 30% in persons without disability. In multivariable logistic regression analysis, persons with disability had a lower odds to know an HIV testing site (Odds Ratio=OR: 0.46, Confidence Interval=CI: 0.22, 0.98) and a higher odds to have had two or more sexual partners in the past 12 months (OR 2.74, CI: 1.44, 5.21), had casual or transactional sex (OR: 6.25, CI: 2.57, 15.21) and psychological distress (OR: 2.10, CI: 1.50, 2.95) than persons without disability. In multivariable logistic regression analysis in both groups (with and without disability), psychological distress (OR: 2.90, CI: 1.53, 5.47, and OR: 1.90, CI: 1.20, 3.01, respectively) and high HIV stigma (OR: 0.31, CI: 0.25, 0.67, and OR: 0.57, CI: 0.34, 0.96, respectively) were associated with increased prevalence of HIV infection. Conclusion: The study found a high prevalence of HIV infection in persons with disabilities, in particular in those with hearing impairment. In some areas, persons with disability showed lower knowledge and higher risk behaviours than persons without disabilities. There is a need to strengthen HIV information and communication strategies geared towards targeting people with all types of disabilities.


Assuntos
Pessoas com Deficiência/estatística & dados numéricos , Infecções por HIV/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Assunção de Riscos , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Comportamento Sexual/estatística & dados numéricos , Parceiros Sexuais , África do Sul/epidemiologia , Inquéritos e Questionários , Adulto Jovem
11.
Pan Afr Med J ; 33: 290, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692824

RESUMO

We present a 34-year-old HIV positive woman who presented with a 2-month history of abdominal pain, abdominal distension, night sweats and fever. She had a firm, immobile and irregular abdominopelvic mass of about 30 weeks uterine size. Investigations showed a haemoglobin of 6.5g/dl, (NR 12-14) cancer antigen 125 of 44U/ml (NR 0-35), serum beta human chorionic gonadotropin (HCG) of 0.258mIU/ml (NR 0-5) and alpha fetoprotein of 7ng/ml (NR <10). Her CD4 count was 63cells/mm3. At laparotomy there was a left ovarian mass and the rest of the abdomen and omentum looked grossly normal, leading to the conclusion that the primary was in the ovaries. A total abdominal hysterectomy, bilateral adnexectomy and infracolic omentectomy were done. Sigmoidectomy and Hartmann's procedure were also performed. Histology of the specimens showed a large B cell lymphoma. She has since been commenced on chemotherapy and antiretroviral therapy and has been doing well.


Assuntos
Doenças dos Anexos/diagnóstico , Infecções por HIV/tratamento farmacológico , Linfoma Difuso de Grandes Células B/diagnóstico , Neoplasias Ovarianas/diagnóstico , Doenças dos Anexos/patologia , Adulto , Fármacos Anti-HIV/administração & dosagem , Contagem de Linfócito CD4 , Feminino , Humanos , Histerectomia/métodos , Linfoma Difuso de Grandes Células B/terapia , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/terapia
12.
Pan Afr Med J ; 33: 277, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692880

RESUMO

Introduction: Adherence is vital to effective antiretroviral therapy (ART) for reducing viral load and HIV/AIDS-related morbidity and mortality. This study was aimed at evaluating the adherence of HIV seropositive patients to ART in a tertiary institution in Nigeria. Methods: A cross sectional observational study was conducted among 400 HIV seropositive patients. The study was carried out between December 2016 and February 2017 at the HIV clinic of the Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria. Results: The mean age of the HIV patients was 42.2±9.5 years with a predominant female gender (Male:Female = 1:2.8). The median CD4 counts increased from 302.1±15.0cells/mm3 at diagnosis to 430.8±13.3cells/mm3 at the time of the study. Majority of participants were unaware of their spouses' HIV status (59.3%) while 32.5% of participants had a serodiscordant spouse. Poverty was a major challenge as 73.3% earned less than 140 dollars per month. Depressive symptoms, anxiety disorder and insomnia were also reported in 40.7%, 33.2% and 47.2% respectively. Poor adherence to ART was observed in almost 20% of the patients. Logistic regression indicated that predictors of poor adherence were depression, anxiety and low CD4 counts. Conclusion: Adherence to anti-retroviral therapy was good amongst the majority of HIV seropositive patients. Depression, anxiety disorder and low CD4 count were however associated with poor adherence. This emphasizes the role of the psychology units as integral part of the HIV clinic to assist patients' adherence to anti-retroviral regimens.


Assuntos
Fármacos Anti-HIV/administração & dosagem , Contagem de Linfócito CD4 , Infecções por HIV/tratamento farmacológico , Adesão à Medicação/estatística & dados numéricos , Adulto , Ansiedade/epidemiologia , Estudos Transversais , Depressão/epidemiologia , Feminino , Infecções por HIV/psicologia , Humanos , Masculino , Adesão à Medicação/psicologia , Pessoa de Meia-Idade , Nigéria , Inquéritos e Questionários
13.
Pan Afr Med J ; 33: 213, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692660

RESUMO

Introduction: HIV self-testing could add a new approach to scaling up HIV testing with potential of being high impact, low cost, confidential, and empowering for users. Methods: Pregnant women attending antenatal clinics (ANC) and their male partners were recruited in 14 clinics in the eastern and central regions of Kenya and randomly allocated to intervention or control arms at a ratio of 1:1:1. Arm 1 received the standard of care, which involved invitation of the male partner to the clinic through word of mouth, arm 2 received an improved invitation letter, and arm 3 received the same improved letter and, two self-testing kits. Analysis was done using adjusted odds ratios (aOR) at 95% confidence intervals (CI) to calculate and determine effects of HIV self-testing in increasing uptake of male partner testing. Results: A total of 1410 women and 1033 men were recruited; 86% (1217) women and 79% (1107) couples were followed up. In arm 3, over 80% (327) of male partners took HIV test, compared to only 37% (133) in arm 2 and 28% (106) in arm one. There was a statistical significance between arm one and two (p-value=0.01) while arm three was statistically significant compared to arm two (p-value<0.001). Men in arm three were twelve times more likely to test compared to arm one (aOR 12.45 (95% CI 7.35, 21.08)). Conclusion: Giving ANC mothers test kits and improved male invitation letter increased the likelihood of male partner testing by twelve times. These results demonstrate that HIV self-test kits could complement routine HIV testing methods in the general population.


Assuntos
Infecções por HIV/diagnóstico , Programas de Rastreamento/métodos , Cuidado Pré-Natal/métodos , Parceiros Sexuais , Adolescente , Adulto , Testes Diagnósticos de Rotina , Feminino , Humanos , Quênia , Masculino , Programas de Rastreamento/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Gravidez , Adulto Jovem
14.
Pan Afr Med J ; 33: 209, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692730

RESUMO

Introduction: management of tuberculosis (TB) and Human Immunodeficiency Virus (HIV) within primary health care (PHC) facilities involve nursing students as part of them integrating theory to practice. Clinical learning for nursing students requires adequate support from the Nursing Education Institution (NEI) and nursing professionals. Given the dearth of literature regarding clinical support for nursing students in the management of TB/HIV in PHC setting, this study is aimed at exploring and describing nursing students' experiences regarding clinical support. Methods: a phenomenological design was used to explore and describe the experiences of nursing students using an individual, unstructured, in-depth interview. Audio-taped interviews were transcribed verbatim and analysed using Atlas TI software. Results: themes derived from the study were factors inhibiting clinical support which incorporated shortage of professional nurses (PNs), lack of accompaniment, fear of managing TB/HIV patients and negative attitudes of PNs; outcomes of poor clinical support included inability to integrate TB/HIV theory to practice and lack of confidence among nursing students; nursing students' desired outcomes through clinical support included becoming a competent TB/HIV nurse and the ability to integrate TB/HIV theory to practice; and strategies to strengthen and promote clinical support in TB/HIV management through strengthened occupational health and safety learning, provision of knowledge regarding post-exposure prophylaxis and infection control, and appointed clinical PN for students in each facility. Conclusion: the development of policies for clinical support, increasing supervision, appointment of clinical preceptors and accompanists in facilities where nursing students are placed would promote clinical learning within the NEI and the production of competent and confident nurses.


Assuntos
Infecções por HIV/enfermagem , Atenção Primária à Saúde/organização & administração , Estudantes de Enfermagem/estatística & dados numéricos , Tuberculose/enfermagem , Adulto , Competência Clínica , Feminino , Humanos , Entrevistas como Assunto , Masculino , Adulto Jovem
15.
Pan Afr Med J ; 33: 224, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692753

RESUMO

Introduction: Despite increasing efforts to address the reproductive health needs of persons living with Human Immuno-Deficiency Virus (HIV), a high unmet need for contraception exists among HIV+ women in sub-Saharan Africa. Currently, Ethiopia promotes integration of family planning (FP) services in to HIV chronic care. Yet the contraceptive prevalence rate among clients remains low. The objective of the study was to assess the role of socio-cultural factors on modern family planning use among HIV+ clients attending Anti-Retroviral Therapy clinics in Addis Ababa sub-cities. Methods: The study involved a facility based cross sectional survey. The ten sub cities were initially categorized/stratified into 5 based on direction (East, West, South, North and Central) and from each category one sub city was randomly selected. The total sample size was proportionally allocated to the selected health facilities according to previous monthly average client load per health center. Participants were selected using simple random sampling technique during their routine visit at the health centers. Data were collected through a semi-structured interviewer administered questionnaire. Both descriptive and inferential statistics were generated and results considered significant at 95% confidence level using STATA version 14.0. Results: Six hundred and thirty-six clients participated in the study. Majority of them were age between 30-39 years. Though majority, 607 (95.4%) participants approved the use of modern FP method, current use rate stood at 39%. Condom was the most (14.5%) commonly used single method. The odds of FP use by participants who disclosed their HIV status were almost twice that of their counterparts (AOR= 1.84; 95% CI: 1.14, 2.95). Participants who held discussion with their spouse/partners concerning FP, irrespective of the frequency had an odd of more than four when using FP than their counterparts (AO= 4.35; 95% CI: 2.69, 7.04). Conclusion: This study revealed that 6 out of every 10 HIV+ clients are not currently using FP methods. Disclosure of HIV status as well as open discussion with spouse/partner were positively associated with family planning use. These study findings call for comprehensive and client focus FP education and counseling in line with disclosure of HIV status and dialogue with spouse/partner in order to increase uptake and utilization of FP among clients. Partners have a great influence on the use and choice of FP methods, so their views are paramount.


Assuntos
Comportamento Contraceptivo/estatística & dados numéricos , Serviços de Planejamento Familiar/estatística & dados numéricos , Infecções por HIV/epidemiologia , Educação Sexual/estatística & dados numéricos , Síndrome de Imunodeficiência Adquirida/epidemiologia , Adulto , Preservativos/estatística & dados numéricos , Anticoncepção/métodos , Anticoncepção/estatística & dados numéricos , Estudos Transversais , Revelação/estatística & dados numéricos , Etiópia , Serviços de Planejamento Familiar/organização & administração , Feminino , Humanos , Masculino , Saúde Reprodutiva , Parceiros Sexuais/psicologia , Inquéritos e Questionários , Adulto Jovem
16.
Pan Afr Med J ; 33: 222, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31692792

RESUMO

Introduction: HIV-2, endemic in West Africa, has a natural resistance to non-nucleoside reverse transcriptase inhibitors (NNRTIs) which makes it difficult to treat it in developing countries. Methods: We conducted a descriptive, longitudinal, prospective study over the period November 2005-June 2017. Virologic failure has been defined as any viral load greater than 50 copies/ml after 6 months of ARV treatment administered twice. Assays for detecting drug-resistance mutations was performed in the protease-coding region and in the reverse transcriptase-coding region. Results: Data from a total of 110 patients were collected. The patients had a median age of 46 years (ranging from 18 to 67) with a sex-ratio F/M of 2.54. At inclusion, viral load could be assessed in 44% of cases with a median of 935cp/ml (ranging from 17 to 144038). Antiretroviral regimen consisted of a combination of 2 NRTIs and 1IP in 94% of cases. The median follow-up was 1200 days (ranging from 1 to 3840); 94 then 76 patients completed their 12-month and 24-month assessments respectively. At 24-month follow-up, 39 patients had virologic failure, reflecting a prevalence of 39% estimated at 33% at 12-month follow-up and at 11% at 24-month follow-up; NRTIs resistance was observed in 45% of patients, IP resistance in 41% of patients while multi-NRTIs resistance and multi-IP resistance in 30% of patients. Conclusion: Currently, there is an urgent need to make available the new therapeutic classes of ARV for second line ART for patients living with HIV-2 with therapeutic failure in resource-limited settings.


Assuntos
Infecções por HIV/tratamento farmacológico , Inibidores da Protease de HIV/administração & dosagem , HIV-2/isolamento & purificação , Inibidores da Transcriptase Reversa/administração & dosagem , Adolescente , Adulto , Idoso , Farmacorresistência Viral/genética , Quimioterapia Combinada , Feminino , Seguimentos , Infecções por HIV/epidemiologia , Infecções por HIV/virologia , Inibidores da Protease de HIV/farmacologia , HIV-2/efeitos dos fármacos , HIV-2/genética , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Inibidores da Transcriptase Reversa/farmacologia , Senegal/epidemiologia , Carga Viral , Adulto Jovem
17.
Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi ; 31(5): 498-503, 2019 Jul 25.
Artigo em Chinês | MEDLINE | ID: mdl-31713378

RESUMO

OBJECTIVE: To investigate the prevalence and risk factors of Blastocystis hominis infections among patients with HIV/AIDS in Fuyang City, Anhui Province. METHODS: A cross-sectional study was conducted in Fuyang City, Anhui Province in 2016. The demographic and socioeconomic status, and the lifestyle and production style were collected using a questionnaire survey. B. hominis DNA was detected in subjects'stool samples using a PCR assay, and the CD4+ T lymphocyte count and HIV viral load were measured in the subjects' blood samples. The risk factors of B. hominis infections among patients with HIV/AIDS were identified using univariate and multivariate logistic regression analyses. RESULTS: A total of 398 HIV/AIDS patients were enrolled in this study, with a mean age of 49.3 years, a mean body weight of 55.9 kg and a mean height of 164.4 cm. The prevalence of B. hominis infection was 6.78% in the study subjects, and no gender- (χ2 = 1.589, P = 0.207), education level- (χ2 =0.508, P = 0.776), marital status- (χ2 = 0.419, P = 0.811) or occupation-specific prevalence (χ2 = 2.744, P = 0.615) was detected. Among the patients with HIV/AIDS, there were no significant differences in the age (t = 0.370, P = 0.712), height (t = 1.587, P =0.113), body weight (t = 0.516, P = 0.606), CD4+ T lymphocyte count (t = 1.187, P = 0.230) or HIV viral load (t = 0.193, P =0.496) between B. hominis-infected and uninfected individuals. Dinking non-tap water [OR = 6.554, 95% CI: (1.876 to 22.903)] and keeping dogs [OR = 5.895, 95% CI: (2.017 to 17.225)] were identified as risk factors for B. hominis infection in patients with HIV/AIDS. CONCLUSIONS: The prevalence of B. hominis infection is high in HIV/AIDS patients, and drinking non-tap water and keeping dogs are risk factors for B. hominis infection among HIV/AIDS patients.


Assuntos
Infecções por Blastocystis , Blastocystis hominis , Infecções por HIV , Animais , Infecções por Blastocystis/complicações , Infecções por Blastocystis/epidemiologia , Estudos Transversais , Cães , Fezes/parasitologia , Feminino , HIV , Infecções por HIV/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco
18.
Vestn Oftalmol ; 135(5): 61-69, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31714514

RESUMO

INTRODUCTION: The current epidemic situation in Russia is characterized by increasing rate of co-infection (HIV/tuberculosis). Damage to the organ of vision is more common among patients with this pathology, presenting significant difficulties in diagnosis of the ophthalmic manifestations. High-tech imaging method - optical coherence tomography (OCT) allows exploration of the eye tissues with high accuracy and depth, as well as evaluation of the structure of the choroid and microcirculation parameters of the anterior and posterior eye segments.


Assuntos
Coinfecção , Infecções por HIV , Tuberculose , Corioide , Infecções por HIV/complicações , Humanos , Federação Russa , Tomografia de Coerência Óptica , Tuberculose/complicações
20.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(10): 1191-1196, 2019 Oct 10.
Artigo em Chinês | MEDLINE | ID: mdl-31658515

RESUMO

The number of people living with HIV/AIDS (PLHIV), new HIV infections, and deaths due to HIV in China were estimated. These data provided evidences for the analysis on current HIV/AIDS epidemic in China, development of AIDS prevention and control strategies and public health education. However, whether the estimation results could be fully used in practice depends on appropriate interpretation. Since the differences in estimation methods and data to produce the estimates for each year, it is not suitable to directly use the estimation results of different years to conclude the HIV/AIDS epidemic trends. The 2018 estimation results indicated that the number of PLHIV is already beyond one million by the end of 2018 and would keep growing, causing much pressure of for HIV/AIDS prevention and control. With the increased burden of case management, innovative strategies are needed to reduce secondary transmission of HIV and control the aggravating spread to general population. Less than 70%, which is significantly lower than the goal of China's 13th Five-year Action plan for AIDS prevention and control. All local governments have the necessity of analyzing percentage of PLHIV who know their status, to conduct targeted strategies and measures for the improvement of HIV case finding. New HIV infection is the core indicator for HIV epidemic evaluation. The number of estimated new HIV infections is around 80 000 in 2018. It is necessary to further improve the strategy and increase the intensity to effectively reduce the new infection of HIV.


Assuntos
Síndrome de Imunodeficiência Adquirida/epidemiologia , Epidemias , Infecções por HIV/epidemiologia , Síndrome de Imunodeficiência Adquirida/prevenção & controle , China/epidemiologia , Infecções por HIV/prevenção & controle , Humanos
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