Depression and diagnosis of neurocognitive impairment in HIV-positive patients

Neurocognitive impairment (NCI) is frequently observed in patients infected with human immunodeficiency virus (HIV) and results from the compromise of subcortical brain structures by the virus. The manifestations of NCI range from asymptomatic impairment to dementia. In addition to cognitive impairment resulting from HIV infection, other factors such as depression are associated with the loss of cognitive functions. The aim of this study was to estimate the prevalence of NCI in HIV-positive patients in a city in southern Brazil and to establish possible associations for the prevalence of NCI with HIV-related and other risk factors. This cross-sectional study of HIV-positive outpatients was conducted in a specialized care service in the city of Pelotas in Southern Brazil. Sociodemographic data and HIV-related information were collected, and all patients underwent psychiatric and neurocognitive evaluations. The prevalence of NCI among the 392 patients was 54.1% when tracked using the IHDS (International HIV Dementia Scale) and 36.2% when the IHDS was associated with a battery of complementary tests. A bivariate analysis suggested an association of NCI with gender, age, educational level, depression, current CD4 count and lowest CD4 count. The association of NCI with depression remained in the Poisson regression (PR=1.96, 95%CI=1.12-3.42). The prevalence of cognitive impairment in HIV-positive patients estimated in this study is in accordance with international and Brazilian data. Of the factors analyzed, depression showed the greatest evidence of association with neurocognitive loss. Based on our findings, the inclusion of instruments to evaluate depression in our services for patients with HIV and acquired immunodeficiency syndrome (AIDS) is recommended.

Prevalencia de microsporidios intestinales y otros enteroparásitos en pacientes con VIH positivo de Maracaibo, Venezuela / Prevalence of intestinal microsporidia and other intestinal parasites in hiv positive patients from Maracaibo, Venezuela.

Introducción. Desde 1985, los microsporidios se consideran parásitos causantes de infecciones emergentes y oportunistas en individuos inmunocomprometidos en todo el mundo. Objetivo. Detectar la presencia de microsporidios y otros enteroparásitos en pacientes con VIH/sida del Servicio Autónomo Hospital Universitario de Maracaibo (SAHUM), donde no existían estudios previos en este campo. Materiales y métodos. Las muestras fecales se analizaron mediante examen directo, método de concentración con formol-éter, coloración de Kinyoun y coloración Gram-cromotropo rápida. Se realizaron PCR separadas para diferenciar Entamoeba histolytica o Entamoeba dispar , cuando se observó el complejo E. histolytica/dispar al microscopio. Mediante historia clínica se obtuvo información del paciente. Resultados. De los 56 individuos participantes, 38 (67,86 %) presentaron alguna especie parasitaria comensal o patógena en su muestra fecal. Predominaron los individuos portadores de especies parásitas patógenas (26/38). Fueron diagnosticados protozoos como Isospora belli (17,65 %), Blastocystis spp .(17,65 %), Cryptosporidium spp. (7,84 %), complejo Entamoeba histolytica/dispar (5,88 %) , Entamoeba coli (3,92 %) , Giardia lamblia (3,92 %) , Endolimax nana (3,92 %) , Cyclospora cayetanensis (3,92 %) y Chilomastix mesnili (1,96 %). Entre los helmintos, Ascaris lumbricoides, Trichuris trichiura y Strongyloides stercoralis, presentaron un porcentaje de 27,27 % cada uno, e Hymenolepis nana , de 18,18 %. Solo se detectó E. histolytica en uno de los tres casos que presentaron el complejo al examen microscópico. Mediante Gram-cromotropo, 17 muestras evidenciaron esporas del filo Microsporidia, lo que equivale a un 33,33 % de prevalencia. Conclusión. Los microsporidios pueden ocupar el primer lugar de prevalencia en pacientes con VIH positivo, cuando se utilizan técnicas diagnósticas específicas.

Objective: To detect the presence of microsporidia and other enteric parasites in patients with HIVAIDS of the Autonomous Services University Hospital of Maracaibo (SAHUM), where there are no previous studies in this field. Materials and methods: Fecal samples were analyzed by means of direct exam, concetration method with formal-ether, Kinyoun coloration and fast Gram-Chromotrope coloration. Separate PCR were perfomed to differentiate Entamoeba histolytica and Entamoeba dispar , when the E. histolytica/E. dispar complex was observed in the microscope. Information on the patient was obtained trough clinical history. Results: Of 56 individuals that participated, 38 (67.86%) presented some commensal parasite and/ or pathogenic species in their fecal sample. Carriers of pathogenic species were predominat (26/38). Protozoa such as Isospora belli protozoa (17.65%), Blastocystis spp. (17.65%), Cryptosporidium spp. (7.84%), E. histolytica/E. dispar (5.88%), Entamoeba coli (3.92%), Giardia lamblia (3.92%), Endolimax nana (3.92%), Cyclospora cayetanensis (3.92%), and Chilomastix mesnilli (1.96%) were diagnosed. Among the helminths, Ascaris lumbricoides, Trichuris trichiura and Strongyloides stercoralis , had a percentage of 27.27% each, and Hymenolepis nana , 18.18%. Entamoeba histolytica was only detected in one of three cases presenting complex microscopic examination. By Gram-chromotrope, 17 samples showed spores of the Microsporidia phylum, equivalent to 33.33% prevalence. Conclusion: Microsporidia may be first prevalente in HIV positive patients when specific diagnostic techniques are used.

Alcohol, drugs, and risky sexual behavior are related to HIV infection in female adolescents / Álcool, drogas e comportamento sexual de risco estão relacionados à infecção por HIV em mulheres adolescentes

OBJECTIVE: To examine associations between risk factors for HIV infection in a sample of young women who sought HIV testing in a city of southern Brazil. METHOD: Cross-sectional study with a consecutive convenience sample of 258 female adolescents aged 13 to 20 years evaluated in an anonymous testing site for HIV and sexually transmitted diseases in Brazil. Risk behavior for HIV was assessed with the Brazilian version of the Risk Assessment Battery and HIV status was assessed through ELISA (Enzyme Linked Immunosorbent Assay). RESULTS: Overall seropositivity rate was 7.4 percent. HIV-seropositive patients had significantly more sexual intercourse in exchange for money, higher rates of pregnancy and abortion, as well as earlier sexual debut. In multiple analyses with the inclusion of two composite variables (sex risk and drug risk), only drug risk was associated with positive HIV status (OR = 4.178; IC 95 percent = 1.476-11.827). CONCLUSION: Our findings suggest that high HIV seropositivity among female adolescents seeking HIV testing in Brazil directly reflects the need for effective interventions specifically designed to prevent risk behaviors in order to halt the spread of HIV infection.

OBJETIVO: Descrever fatores de risco para infecção pelo HIV numa amostra de adolescentes do sexo feminino que procurou fazer o teste HIV em uma cidade do sul do país. MÉTODO: Num estudo transversal, 258 adolescentes do sexo feminino foram avaliadas em relação ao seu estado sorológico para o vírus HIV e comportamentos de risco utilizando-se a versão brasileira da escala Risk Assessment Battery. RESULTADOS: A taxa geral de soropositividade foi de 7,4 por cento. As jovens soropositivas tiveram significativamente mais relações sexuais em troca de dinheiro, história de gravidez e aborto prévio, bem como iniciação sexual mais precoce do que as adolescentes soronegativas. Nas análises multivariadas, com a inclusão de duas variáveis compostas ("risco sexual" e "risco por drogas"), apenas "risco por drogas" esteve associada com o estado sorológico HIV positivo (OR = 4,178 IC 95 por cento = 1,476-11,827). CONCLUSÃO: Nossos achados indicam que a alta soropositividade encontrada nas jovens adolescentes que procuraram testagem evidencia a necessidade de que se desenvolvam medidas de intervenção preventivas especialmente dirigidas para comportamento de risco em mulheres adolescentes para evitar a disseminação da infecção HIV.

Socio-demographic characteristics of HIV-exposed and HIV-infected Jamaican children

BACKGROUND: In the face of the continuing pandemic of HIV/AIDS, the burden of the disease is now largest in the resource-poor developing world. The Joint United Nations Programme on HIV/AIDS (UNAIDS) has listed the adult prevalence rate for the Caribbean as second only to Sub-Saharan Africa. OBJECTIVE: To document the socio-demographic characteristics of paediatric and perinatal HIV/AIDS in Kingston, Jamaica. METHODS: A cohort of HIV-infected pregnant women were identified at the leading maternity centres in Kingston and St Catherine and were enrolled in the Kingston Paediatric and Perinatal HIV/AIDS Programme. Infants born to mothers within the programme were prospectively enrolled. Infants and children identified after delivery, whether HIV-exposed or infected, were also enrolled (retrospective group). All were followed according to standardized protocols. RESULTS: We report on a total of 239 children, 78 (prospective group) and 161 (retrospective group). Among the retrospective group, 68 were classified as infected. For the prospective group, the patients were recruited within twenty-four hours of birth in 98.7 of cases, whereas in the retrospective group, the median age of recruitment was 2.6 years. The median age of the mother was 27 years and that of the father was 33 years. There were seven teenage mothers. Twenty-six per cent of the children were in institutional care. Family size ranged from one to nine children--the median was two children. For those parents where occupation was reported, the majority held semi-skilled or unskilled jobs. Patients attended their regional clinics. CONCLUSION: HIV/AIDS represents a significant human and financial burden on a developing country such as Jamaica and this underscores the need for urgent and sustained interventions to stem the epidemic

Fatores de risco para gestantes portadoras do HIV-1 em funçäo do local de residência / Risk factors for HIV-1 positive pregnant women according to their site of residence

Objetivo: pesquisar se o local de residência das gestantes está relacionado com maior prevalência de fatores de risco envolvidos na transmissao do HIV. Pacientes e métodos: as 3.451 parturientes registradas na Maternidade do Hospital Guilherme Alvaro, na cidade de Santos, foram divididas em dois grupos: residentes em Santos e residentes em cidades vizinhas. Estes dois grupos foram comparados, em funçao da prevalência de sorologia anti-HIV e dos fatores de risco envolvidos na transmissao do HIV. Resultados: os resultados sorológicos foram positivos em 97 pacientes (2,82 por cento); destas, 96 informaram o local de residência. Para as parturientes moradoras em Santos, a prevalência anti-HIV foi de 3,l por cento (67/2.162); para as moradoras em cidades vizinhas, 2,3 por cento (29/1.230). O teste do Qui-Quadrado (p = O,1742) nao foi significativo para os dois grupos. Na avaliaçao dos fatores de risco, em funçao do local de residência, nao foram encontradas diferenças significativas nos dois grupos. Conclusoes: nos últimos cinco anos houve significativa diminuiçao na diferença de prevalência anti-HIV nos dois grupos. Para as residentes em Santos, a prevalência passou de 3,6 por cento para 3,1 por cento (queda de 16 por cento) e para as de cidades vizinhas subiu de 1,54 para 2,3 por cento (52 por cento). Nas gestantes moradoras em cidades vizinhas é maior a referência de alcoolismo (20,6 por cento versus 7,4 por cento), uso de drogas (27,5 por cento versus 17,9 por cento) e parceiro drogado (51,7 por cento versus 38,8 por cento). Atualmente, o fato da gestante residir na cidade de Santos nao representa um fator de risco para AIDS, em relaçao às outras cidades da Baixada Santista.

HIV/AIDS risk perception, HIV risk behaviors, and HIV seropositivity among injection drug users in Puerto Rico

This paper assesses the factors related to self perception of developing AIDS among a group of 1,568 Puerto Rican injection drug users (IDUs). Incarceration history, years of drug injection, sharing needles, renting and borrowing needles, sharing rinse water or cooker, and having an IDU sex partner yielded a moderate association with HIV/AIDS risk perception. Use of sterile needles, shooting drugs alone, having had previous treatment episodes, and all the variables related to health status were also moderately associated with HIV/AIDS risk perception. A logistic regression model based on backwards elimination procedure, which included statistically significant variables in the bivariate analyses, yielded the variables living with children, sex with an IDU partner, shooting drugs alone, perception of health, having had a sexually transmitted disease, and results of HIV testing as statistically significant (p < 0.05)