<i  >Background</i>. Regular clinic attendance for antiretroviral (ARV) drug refills is important for successful clinical outcomes in HIV management. <i  >Methods</i>. Clinic attendance for ARV drug refills and medication adherence using a clinic-based pill count in 392 adult patients receiving antiretroviral therapy (ART) in a district hospital in Uganda were prospectively monitored over a 28-week period. <i  >Results</i>. Of the 2267 total scheduled clinic visits, 40 (1.8&#x25;) were missed visits. Among the 392 clients, 361 (92&#x25;) attended all appointments for their refills (regular attendance). Clinic attendance for refills was statistically significantly associated with medication adherence with regular attendant clients having about fourfold greater odds of achieving optimal (&#x2265;95&#x25;) medication adherence [odds ratio  <svg     style="vertical-align:-2.32048pt;width:82.762497px;" id="M1" height="15.0875" version="1.1" viewBox="0 0 82.762497 15.0875" width="82.762497"  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,12.138)"><path id="x28" d="M300 -147l-18 -23q-106 71 -159 185.5t-53 254.5v1q0 139 53 252.5t159 186.5l18 -24q-74 -62 -115.5 -173.5t-41.5 -242.5q0 -130 41.5 -242.5t115.5 -174.5z" /></g><g transform="matrix(.017,-0,0,-.017,5.944,12.138)"><path id="x4F" d="M381 665q131 0 226.5 -93t95.5 -239q0 -158 -96 -253t-238 -95q-137 0 -231 95t-94 238q0 142 92.5 244.5t244.5 102.5zM359 629q-89 0 -151 -74.5t-62 -208.5q0 -141 69 -233t175 -92q90 0 150.5 74t60.5 211q0 152 -69 237.5t-173 85.5z" /></g><g transform="matrix(.017,-0,0,-.017,18.489,12.138)"><path id="x52" d="M631 18l-4 -26q-24 0 -35 1q-57 3 -92.5 23t-69.5 68q-21 30 -101 160q-13 22 -30.5 31t-54.5 9h-32v-159q0 -63 14 -77.5t74 -19.5v-28h-262v28q62 5 76 19.5t14 77.5v402q0 62 -13 76t-73 19v28h248q109 0 159 -34q67 -42 67 -131q0 -115 -127 -172q27 -52 89 -144&#xA;q49 -71 81 -104q31 -36 72 -47zM212 316h48q73 0 108 29q55 42 55 124q0 76 -42 112t-104 36q-41 0 -54 -10q-11 -7 -11 -44v-247z" /></g><g transform="matrix(.017,-0,0,-.017,29.045,12.138)"><path id="x29" d="M275 270q0 -296 -211 -440l-19 23q75 62 116.5 174t41.5 243t-42 243t-116 173l19 24q211 -144 211 -440z" /></g><g transform="matrix(.017,-0,0,-.017,39.636,12.138)"><path id="x3D" d="M535 323h-483v50h483v-50zM535 138h-483v50h483v-50z" /></g><g transform="matrix(.017,-0,0,-.017,54.34,12.138)"><path id="x33" d="M285 378v-2q65 -13 102 -54.5t37 -97.5q0 -57 -30.5 -104.5t-74 -75t-85.5 -42t-72 -14.5q-31 0 -59.5 11t-40.5 23q-19 18 -16 36q1 16 23 33q13 10 24 0q58 -51 124 -51q55 0 88 40t33 112q0 64 -39 96.5t-88 32.5q-29 0 -64 -11l-6 29q77 25 118 57.5t41 84.5&#xA;q0 45 -26.5 69.5t-68.5 24.5q-67 0 -120 -79l-20 20l43 63q51 56 127 56h1q66 0 107 -37t41 -95q0 -42 -31 -71q-22 -23 -68 -54z" /></g><g transform="matrix(.017,-0,0,-.017,62.499,12.138)"><path id="x2E" d="M113 -12q-24 0 -39.5 16t-15.5 42q0 24 16 40.5t40 16.5t40 -16.5t16 -40.5q0 -26 -16 -42t-41 -16z" /></g><g transform="matrix(.017,-0,0,-.017,66.375,12.138)"><path id="x38" d="M249 635q70 0 116 -43t46 -105q0 -46 -28 -80q-22 -25 -80 -64q62 -35 97 -75t35 -99q0 -81 -63 -131t-135 -50q-83 0 -137.5 45.5t-54.5 123.5q0 52 45 95q29 28 89 64q-109 62 -109 155q0 66 50.5 115t128.5 49zM238 603q-42 0 -67.5 -31t-25.5 -72q0 -50 32.5 -79.5&#xA;t98.5 -62.5q61 48 61 124q0 59 -29.5 90t-69.5 31zM248 20q46 0 76.5 33.5t30.5 89.5q0 50 -39 85.5t-110 71.5q-81 -54 -81 -137q0 -67 35.5 -105t87.5 -38z" /></g><g transform="matrix(.017,-0,0,-.017,74.534,12.138)"><path id="x39" d="M244 635q90 0 143 -72t53 -177q0 -133 -65 -229.5t-171 -139.5q-79 -32 -140 -32l-5 30q109 18 185 91t101 186l-68 -36q-29 -16 -60 -16q-79 0 -129 51.5t-50 130.5q0 80 57 146.5t149 66.5zM228 602q-52 0 -78 -45.5t-26 -98.5q0 -69 36.5 -115.5t97.5 -46.5&#xA;q53 0 90 28q4 31 4 66q0 51 -9.5 95.5t-39 80.5t-75.5 36z" /></g>

		
	
</svg>, 95&#x25; CI: 1.48 to 10.25, exact <svg     style="vertical-align:-0.1638pt;width:58.712502px;" id="M2" height="11.375" version="1.1" viewBox="0 0 58.712502 11.375" width="58.712502"  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
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</svg>]. In multivariate analysis, clients in age category 35 years and below were less likely to achieve regular clinic attendance. <i  >Conclusion</i>. Monitoring of clinic attendance may be an objective and effective measure and could be a useful adjunct to an adherence measure such as pill counting in resource-constrained settings. Where human resource constraints do not allow pill counts or other time-consuming measures, then monitoring clinic attendance and acting on missed appointments may be an effective proxy measure.

Setor Kunutsor

John Walley

Elly Katabira

Simon Muchuro

Hudson Balidawa

Elizabeth Namagala

Eric Ikoona

Clinic Attendance for Medication Refills and Medication Adherence amongst an Antiretroviral Treatment Cohort in Uganda: A Prospective Study

<i  >Introduction</i>. Hepatotoxicity is a concern in HIV/hepatitis C virus (HCV) coinfected patients due to their underlying liver disease. This study assessed the incidence of hepatotoxicity in HIV/HCV co-infected patients in two outpatient infectious diseases clinics. <i  >Methods</i>. HIV/HCV co-infected adults were included in this retrospective study if they were PI or NNRTI na&#xef;ve at their first clinic visit and were initiated on an NNRTI- and/or PI-based antiretroviral regimen. Patients were excluded if they had active or chronic hepatitis B virus (HBV). The primary objective was to determine the overall incidence of severe hepatotoxicity. <i  >Results</i>. Fifty-six of the 544 patients identified met inclusion criteria. The incidence of severe hepatotoxicity was 10.7&#x25; (6/56 patients). Severe hepatotoxicity occurred with efavirenz (<svg style="vertical-align:-0.0pt;width:40.625px;" id="M1" height="10.6875" version="1.1" viewBox="0 0 40.625 10.6875" width="40.625"  xmlns="http://www.w3.org/2000/svg">
	<g transform="matrix(1.25,0,0,-1.25,0,10.6875)">
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			</text>

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</svg>), nevirapine (<svg style="vertical-align:-0.0pt;width:40.625px;" id="M2" height="10.6875" version="1.1" viewBox="0 0 40.625 10.6875" width="40.625"  xmlns="http://www.w3.org/2000/svg">
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</svg>), indinavir (<svg style="vertical-align:-0.0pt;width:40.625px;" id="M3" height="10.6875" version="1.1" viewBox="0 0 40.625 10.6875" width="40.625"  xmlns="http://www.w3.org/2000/svg">
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</svg>), nelfinavir (<svg style="vertical-align:-0.0pt;width:40.625px;" id="M4" height="10.6875" version="1.1" viewBox="0 0 40.625 10.6875" width="40.625"  xmlns="http://www.w3.org/2000/svg">
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</svg>), and saquinavir/ritonavir (<svg style="vertical-align:-0.0pt;width:40.625px;" id="M5" height="10.6875" version="1.1" viewBox="0 0 40.625 10.6875" width="40.625"  xmlns="http://www.w3.org/2000/svg">
	<g transform="matrix(1.25,0,0,-1.25,0,10.6875)">
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</svg>). <i  >Conclusion</i>. The incidence of severe hepatotoxicity appears to be low in this retrospective analysis of HIV/HCV co-infected patients receiving a PI-and/or NNRTI-based regimen.

Emily L. Heil

Mary L. Townsend

Kenneth Shipp

Amy Clarke

Melissa D. Johnson

Incidence of Severe Hepatotoxicity Related to Antiretroviral Therapy in HIV/HCV Coinfected Patients

This paper presents the findings of an exploratory study to investigate the challenges faced by people living with HIV/AIDS (PLWHA) in communities in Cape Town, South Africa. The primary goal of the study was to gather data to inform the adaptation of a group risk reduction intervention to the South African context. Qualitative methods were used to examine the experiences of PLWHA. Eight focus group discussions (FGDs) were conducted with 83 HIV-positive participants and 14 key informants (KIs) involved in work with PLWHA were interviewed. Findings revealed that AIDS-related stigma was still pervasive in local communities. This was associated with the difficulty of disclosure of their status for fear of rejection. Also notable was the role of risky behaviours such as lack of condom use and that PLWHA considered their HIV/AIDS status as secondary to daily life stressors like poverty, unemployment, and gender-based violence. These findings have implications for the adaptation or development of behavioural risk reduction interventions for PLWHA.

Allanise Cloete

Anna Strebel

Leickness Simbayi

Brian van Wyk

Nomvo Henda

Ayanda Nqeketo

Challenges Faced by People Living with HIV/AIDS in Cape Town, South Africa: Issues for Group Risk Reduction Interventions

<i>Background</i>. The homeostatic chemokine, CXCL13 (BLC, BCA-1), helps direct the recirculation of mature, resting B cells, which express its receptor, CXCR5. CXCL13/CXCR5 are expressed, and may play a role, in some non-AIDS-associated B cell tumors. <i>Objective</i>. To determine if CXCL13/CXCR5 are associated with AIDS-related non-Hodgkin's lymphoma (AIDS-NHL). <i>Methods</i>. Serum CXCL13 levels were measured by ELISA in 46 subjects who developed AIDS-NHL in the Multicenter AIDS Cohort Study and in controls. The expression or function of CXCL13 and CXCR5 was examined on primary AIDS-NHL specimens or AIDS-NHL cell lines. <i>Results</i>. Serum CXCL13 levels were significantly elevated in the AIDS-NHL group compared to controls. All primary AIDS-NHL specimens showed CXCR5 expression and most also showed CXCL13 expression.  AIDS-NHL cell lines expressed CXCR5 and showed chemotaxis towards CXCL13. <i>Conclusions</i>. CXCL13/CXCR5 are expressed in AIDS-NHL and could potentially be involved in its biology. CXCL13 may have potential as a biomarker for AIDS-NHL.

Daniel P. Widney

Dorina Gui

Laura M. Popoviciu

Jonathan W. Said

Elizabeth C. Breen

Xin Huang

Christina M. R. Kitchen

Juan M. Alcantar

Jeffrey B. Smith

Roger Detels

Otoniel Martínez-Maza

Expression and Function of the Chemokine, CXCL13, and Its Receptor, CXCR5, in Aids-Associated Non-Hodgkin's Lymphoma

<i>Background</i>. Suitable populations to sustain continued evaluation of HIV and sexually transmitted infection (STI) prevention interventions are required. We sought to determine whether fishermen are a suitable population for HIV intervention trials. <i>Methods</i>. In a cross-sectional descriptive survey, we selected 250 fishermen from proportional to size sampled boats. We collected socioeconomic and behavioral information, and specimens for HIV, herpes simplex virus (HSV-2), syphilis, gonorrhea, chlamydia and human papillomavirus (HPV) tests from consenting participants. <i>Results</i>. One third of the fishermen had concurrent sexual partnerships and two thirds were involved in transactional sex. About 70% were involved in extramarital sex with only one quarter using condoms in their three most recent sexual encounters. HIV prevalence was 26% and HSV-2 and HPV was 57%. Over 98% were willing to participate in a future HIV prevention clinical trial. <i>Conclusion</i>. Fishermen are a high-risk group for HIV/STI infections that may be suitable for HIV prevention trials. A cohort study would be useful to measure the incidence of HIV/STIs to ultimately determine the feasibility of enrolling this population in an HIV/STI prevention clinical trial.

Zachary A. Kwena

Craig R. Cohen

Norton M. Sang

Musa O. Ng'ayo

Jeremiah H. Ochieng

Elizabeth A. Bukusi

Fishermen as a Suitable Population for HIV Intervention Trials

<i>Background</i>. Adherence to antiviral therapy is important for HIV-infected people living in low- and middle-income countries, because of poor access to alternative regimens. <i>Methods</i>. We conducted a cross-sectional survey of adherence in Cambodian patients enrolled in the ESTHER program and treated with WHO first-line regimen for at least 6 months. The survey was based on a self-report questionnaire, drug assay, MCV measurement, visual analog scale, and viral load HIV RNA. <i>Results</i>. Two hundred fifty-nine patients treated for a median of 16 months participated in the survey. At inclusion in the program, 158 patients (61%) were ARV-naïve. The virological success rate was 71% overall and 81% in previously ARV-naive patients. Considered individually, the measures suggested perfect adherence in 71% to 93% of patients. In multivariate analysis adjusted for sex and therapeutic status before HAART initiation, only the biological markers were associated with virological efficacy. Self-funded treatment before entry to the program was highly predictive of virological failure. <i>Conclusion</i>. Adherence was excellent in these Cambodian patients. Biological markers were predictive of virological efficacy. MCV might thus serve as a simple alternative for assessing adherence and predicting virological efficacy among patients receiving AZT- or d4T-based regimens.

Olivier Segeral

Yoann Madec

Boroath Ban

Vara Ouk

Chan Roeurn Hak

Clotilde Le Tiec

Eric Nerrienet

Cécile Goujard

Anne Marie Taburet

Jean Francois Delfraissy

Arnaud Fontanet

Simplified Assessment of Antiretroviral Adherence and Prediction of Virological Efficacy in HIV-Infected Patients in Cambodia

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<p><em>AIDS Research and Treatment</em> publishes original research articles and review articles focused on all aspects of HIV and AIDS, from the molecular basis of the disease to translational and clinical research, prevention and education.</p>


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AIDS Research and Treatment publishes original research articles and review articles focused on all aspects of HIV and AIDS, from the molecular basis of the disease to translational and clinical research, prevention and education.

AIDS Research and Treatment