AIDS Research and Treatment The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Fructosamine and Hemoglobin A1c Correlations in HIV-Infected Adults in Routine Clinical Care: Impact of Anemia and Albumin Levels Sun, 26 Jul 2015 09:45:25 +0000 Fructosamine is an alternative method to hemoglobin A1c (HbA1c) for determining average glycemia. However, its use has not been extensively evaluated in persons living with HIV (PLWH). We examined the relationship between HbA1c and fructosamine values, specifically focusing on anemia (which can affect HbA1c) and albumin as a marker of liver disease. We included 345 PLWH from two sites. We examined Spearman rank correlations between fructosamine and HbA1c and performed linear test for trends to compare fructosamine and HbA1c correlations by hemoglobin and albumin quartiles. We examined discrepant individuals with values elevated only on one test. We found a correlation of 0.70 between fructosamine and HbA1c levels. Trend tests for correlations between fructosamine and HbA1c were significant for both albumin () and hemoglobin () with the lowest correlations in the lowest hemoglobin quartile. We identified participants with unremarkable HbA1c values but elevated fructosamine values. These discrepant individuals had lower mean hemoglobin levels than those elevated by both tests. We demonstrated a large correlation between HbA1c and fructosamine across a range of hemoglobin and albumin levels. There were discrepant cases particularly among those with lower hemoglobin levels. Future studies are needed to clarify the use of fructosamine for diabetes management in PWLH. Luisa Duran, Carla Rodriguez, Dan Drozd, Robin M. Nance, J. A. Chris Delaney, Greer Burkholder, Michael J. Mugavero, James H. Willig, Amy H. Warriner, Paul K. Crane, Ben E. Atkinson, Robert D. Harrington, Shireesha Dhanireddy, Michael S. Saag, Mari M. Kitahata, and Heidi M. Crane Copyright © 2015 Luisa Duran et al. All rights reserved. Combination Antiretroviral Therapy for HIV in Rwandan Adults: Clinical Outcomes and Impact on Reproductive Health up to 24 Months Thu, 16 Jul 2015 07:25:43 +0000 Adult women () and men () initiating combination antiretroviral therapy (cART) and women not yet eligible for cART () in Kigali, Rwanda, were followed for 6–24 months between 2007 and 2010. In the cART groups, 21% of patients required a drug change due to side effects and 11% of patients had virological failure (defined as >1,000 HIV RNA copies/mL) after 12 months of cART. About a third of the pregnancies since HIV diagnosis were unintended. The proportion of women in the pre-cART group using modern contraception other than condoms (50%) was similar to women in the general population, but this proportion was only 25% in women initiating cART. Of the women who carried at least one pregnancy to term since having been diagnosed HIV-positive, a third reported to have participated in a prevention-of-mother-to-child-transmission (PMTCT, option A) intervention. Many patients were coinfected with herpes simplex virus type 2 (79–92%), human papillomavirus (38–53%), and bacterial sexually transmitted infections (STIs) with no differences between groups. We applaud the Rwandan government for having strengthened family planning and PMTCT services and for having introduced HPV vaccination in recent years, but additional work is needed to strengthen STI and HPV-related cancer screening and management in the HIV-positive population. Brenda Asiimwe-Kateera, Nienke Veldhuijzen, Jean Paul Balinda, John Rusine, Sally Eagle, Joseph Vyankandondera, Julie Mugabekazi, Pascale Ondoa, Kimberly Boer, Anita Asiimwe, Joep Lange, Peter Reiss, and Janneke van de Wijgert Copyright © 2015 Brenda Asiimwe-Kateera et al. All rights reserved. Relationships between Serum Levels of Atazanavir and Renal Toxicity or Lithiasis Thu, 07 May 2015 14:40:36 +0000 The main aim of this study is to describe the relationship between serum levels of atazanavir, renal toxicity, and lithiasis. This is a prospective observational study of patients being treated with atazanavir (ATV) at Son Espases Teaching Hospital, Palma de Mallorca, between 2011 and 2013. The study includes 98 patients. Sixteen were found to have a history of urolithiasis. During a median monitoring period of 23 months, nine patients suffered renal colic, in three of whom ATV crystals were evidenced in urine. Cumulative incidence of renal colic was 9.2 per 100 patients. The variables related to having renal colic were the presence of alkaline urine pH and lower basal creatinine clearance. The mean serum level of ATV was slightly higher in patients with renal colic—1,303 μg/L versus 1,161 μg/L—but did not reach statistical significance. Neither were any significant differences detected by analysing the levels according to the timetable for ATV dosage. Cumulative incidence of renal colic was high in patients being treated with ATV, in 33% of whom the presence of ATV crystals was evidenced in urine. We were unable to demonstrate a relationship between ATV serum levels and renal colic or progression towards renal failure. C. I. Marinescu, M. Leyes, M. A. Ribas, M. Peñaranda, J. Murillas, A. A. Campins, L. Martin-Pena, B. Barcelo, C. Barceló-Campomar, F. Grases, G. Frontera, and Melchor Riera Jaume Copyright © 2015 C. I. Marinescu et al. All rights reserved. Predictors of Mortality among Adult Antiretroviral Therapy Users in Southeastern Ethiopia: Retrospective Cohort Study Wed, 04 Mar 2015 13:17:20 +0000 Background. Although efforts have been made to reduce AIDS-related mortality by providing antiretroviral therapy (ART) services, still people are dying while they are on treatment due to several factors. This study aimed to investigate the predictors of mortality among adult antiretroviral therapy (ART) users in Goba Hospital, Southeast Ethiopia. Methods. The medical records of 2036 ART users who enrolled at Goba Hospital between 2007 and 2012 were reviewed and sociodemographic, clinical, and ART-related data were collected. Multivariable Cox proportional hazards regression model was used to measure risk of death and identify the independent predictors of mortality. Results. The overall mortality incidence rate was 20.3 deaths per 1000 person-years. Male, bedridden, overweight/obese, and HIV clients infected with TB and other infectious diseases had higher odds of death compared with their respective counterparts. On the other hand, ART clients with primary and secondary educational level and early and less advanced WHO clinical stage had lower odds of death compared to their counterparts. Conclusion. The overall mortality incidence rate was high and majority of the death had occurred in the first year of ART initiation. Intensifying and strengthening early ART initiation, improving nutritional status, prevention and control of TB, and other opportunistic infections are recommended interventions. Tesfaye Setegn, Abulie Takele, Tesfaye Gizaw, Dabere Nigatu, and Demewoz Haile Copyright © 2015 Tesfaye Setegn et al. All rights reserved. Prevalence of and Risk Factors for Lipoatrophy in Patients with HIV Infection in Nigeria Mon, 02 Mar 2015 12:45:59 +0000 Background. Although the association between lipoatrophy and highly active antiretroviral therapy (HAART) is well known, other nondrug factors may be associated with lipoatrophy in people living with HIV/AIDS (PLWHA). There are no reports of lipoatrophy from Nigeria, a country with the second largest number of PLWHA. We aimed to determine the prevalence, characteristics, and factors associated with lipoatrophy in a cohort of patients attending the HIV clinic in Lagos University Teaching Hospital, Nigeria. Methods. Two hundred and eighty-eight patients with HIV infection were recruited for the study. The study protocol involved administration of a questionnaire, targeted physical examination (including anthropometric indices and skin fold thickness), and bioelectrical impedance analysis measurements. Lipoatrophy was defined clinically. Results. Lipoatrophy was present in 75 (26.0%) persons. It was associated with lower body circumferences, skin fold thicknesses, and lower % body fat with preservation of skeletal muscle mass (all ). Male gender and HAART use were the factors associated with lipoatrophy on multivariate analysis . Conclusion. Lipoatrophy is frequently encountered in patients with HIV infection in Nigeria, with HAART use conferring an added factor in its development. There is need for more physician and patient awareness of this condition. Sandra Omozehio Iwuala, Olufunmilayo A. Lesi, Olufemi Adetola Fasanmade, Anas A. Sabir, Michael Adeyemi Olamoyegun, and Charles C. Okany Copyright © 2015 Sandra Omozehio Iwuala et al. All rights reserved. Resistance to Cotrimoxazole and Other Antimicrobials among Isolates from HIV/AIDS and Non-HIV/AIDS Patients at Bugando Medical Centre, Mwanza, Tanzania Sun, 22 Feb 2015 11:55:47 +0000 Bacterial resistance has increased in the AIDS era and is attributed to the widespread use of cotrimoxazole prophylaxis against opportunistic infections in HIV/AIDS patients. In Tanzania, cotrimoxazole prophylaxis has been used for more than ten years. Little is known, however, about its impact on the spread of antibiotic resistance in HIV positive patients. This cross-sectional study was done to compare magnitude of bacterial resistance to cotrimoxazole and other antimicrobials among isolates from HIV infected patients on cotrimoxazole prophylaxis and those not on prophylaxis and non-HIV patients attending Bugando Medical Centre (BMC). Susceptibility testing on obtained urine and swab specimens followed Clinical Laboratory Standard Institute, 2010, Guidelines. Of 945 samples collected, 155 had positive bacterial growth after 24 hours of incubation. Of the positive samples (72), 46.4% were from HIV positive patients. The common isolates were E. coli 41.3% (64/155), Klebsiella pneumoniae 17.5% (27/155), and Staphylococcus aureus 16.1% (25/155). Overall, bacterial resistance to cotrimoxazole was 118 (76.1%); among isolates from HIV patients bacterial resistance was 54 (75%), and for isolates from HIV patients on prophylaxis bacterial resistance was 36 (81.3%). HIV seropositivity and cotrimoxazole prophylaxis are not associated with antibiotic resistance observed in bacteria infecting patients attending BMC, Mwanza, Tanzania. Karol J. Marwa, Martha F. Mushi, Eveline Konje, Paul E. Alele, Jeremiah Kidola, and Mariam M. Mirambo Copyright © 2015 Karol J. Marwa et al. All rights reserved. Ascertainment and Verification of End-Stage Renal Disease and End-Stage Liver Disease in the North American AIDS Cohort Collaboration on Research and Design Thu, 19 Feb 2015 14:43:21 +0000 The burden of HIV disease has shifted from traditional AIDS-defining illnesses to serious non-AIDS-defining comorbid conditions. Research aimed at improving HIV-related comorbid disease outcomes requires well-defined, verified clinical endpoints. We developed methods to ascertain and verify end-stage renal disease (ESRD) and end-stage liver disease (ESLD) and validated screening algorithms within the largest HIV cohort collaboration in North America (NA-ACCORD). Individuals who screened positive among all participants in twelve cohorts enrolled between January 1996 and December 2009 underwent medical record review to verify incident ESRD or ESLD using standardized protocols. We randomly sampled 6% of contributing cohorts to determine the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of ESLD and ESRD screening algorithms in a validation subcohort. Among 43,433 patients screened for ESRD, 822 screened positive of which 620 met clinical criteria for ESRD. The algorithm had 100% sensitivity, 99% specificity, 82% PPV, and 100% NPV for ESRD. Among 41,463 patients screened for ESLD, 2,024 screened positive of which 645 met diagnostic criteria for ESLD. The algorithm had 100% sensitivity, 95% specificity, 27% PPV, and 100% NPV for ESLD. Our methods proved robust for ascertainment of ESRD and ESLD in persons infected with HIV. Mari M. Kitahata, Daniel R. Drozd, Heidi M. Crane, Stephen E. Van Rompaey, Keri N. Althoff, Stephen J. Gange, Marina B. Klein, Gregory M. Lucas, Alison G. Abraham, Vincent Lo Re III, Justin McReynolds, William B. Lober, Adell Mendes, Sharada P. Modur, Yuezhou Jing, Elizabeth J. Morton, Margaret A. Griffith, Aimee M. Freeman, and Richard D. Moore Copyright © 2015 Mari M. Kitahata et al. All rights reserved. A Meta-Analysis of Risky Sexual Behaviour among Male Youth in Developing Countries Thu, 29 Jan 2015 12:49:16 +0000 The purpose of this meta-analysis was to assess the association between risky sexual behaviour and level of education and economic status in male youth. Previous tests of the association of risky sexual behaviour with levels of education and economic status have yielded inconsistent results. Using data from 26 countries, from both within and outside Africa, we performed a meta-analysis with a specific focus on male youths’ risky sexual behaviour. We applied a random effects analytic model and calculated a pooled odds ratio. Out of 19,148 males aged 15–24 years who reported having sexual intercourse in the 12 months preceding the survey, 75% engaged in higher-risk sex. The proportion of higher-risk sex among male youth aged 15–19 years was nearly 90% in 21 of the 26 countries. The pooled odds ratio showed a statistically significant association of higher-risk sex with male youth younger than 20 years, living in urban centers, well educated, and of a high economic status. The overall proportion of condom use during youths’ most recent higher-risk sexual encounter was 40% and 51% among 15–19-year-olds and 20–24-year-olds, respectively. Our findings suggest that male youth’s socioeconomic status is directly related to the likelihood that they practice higher-risk sex. The relationship between income and sexual behaviour should be explored further. Yifru Berhan and Asres Berhan Copyright © 2015 Yifru Berhan and Asres Berhan. All rights reserved. Long-Term Consequences of Hepatitis C Viral Clearance on the CD4 (+) T Cell Lymphocyte Course in HIV/HCV Coinfected Patients Mon, 26 Jan 2015 08:57:14 +0000 The long-term impact of pegylated-interferon plus ribavirin treatment outcome on CD4 T cell course in patients coinfected with human immunodeficiency virus and hepatitis C virus is largely unclear in the literature. The aim of this study was to investigate the impact of HCV-RNA clearance by standard anti-HCV therapy on long-term CD4 cells recovery in HIV/HCV patients on successful combined antiretroviral therapy. We retrospectively enrolled HIV/HCV-coinfected patients on HIV medications and treated for hepatitis C. CD4 + T cell counts were registered at baseline and after hepatitis C therapy. Multiple linear regression analysis was performed to identify independent predictors of CD4 + T cell change following the anti-HCV treatment outcome. Of the 116 patients enrolled, 54 (46.6%) reached a sustained virological response. During a follow-up of 24 months, the SVR group showed a mean annual increase in CD4 + T cell from baseline of 84 cells/ll at 1 year and of a further 38 cells/ll within the second year (, 0.001, resp.). An insignificant mean increase of 77 cells/ll occurred in the non-SVR group within month 24 (). Variables associated with greater CD4 gains were higher nadir, lower preinterferon CD4 counts, and lower body mass index (BMI). J. Dazley, R. Sison, and J. Slim Copyright © 2015 J. Dazley et al. All rights reserved. Pharmacokinetics of Etravirine Combined with Atazanavir/Ritonavir and a Nucleoside Reverse Transcriptase Inhibitor in Antiretroviral Treatment-Experienced, HIV-1-Infected Patients Thu, 15 Jan 2015 10:26:55 +0000 Objectives. TEACH (NCT00896051) was a randomized, open-label, two-arm Phase II trial to investigate the pharmacokinetic interaction between etravirine and atazanavir/ritonavir and safety and efficacy in treatment-experienced, HIV-1-infected patients. Methods. After a two-week lead-in of two nucleoside reverse transcriptase inhibitors (NRTIs) and atazanavir/ritonavir 300/100 mg, 44 patients received etravirine 200 mg bid with one NRTI, plus atazanavir/ritonavir 300/100 mg or 400/100 mg qd ( each group) over 48 weeks. Results. At steady-state etravirine with atazanavir/ritonavir 300/100 mg qd or 400/100 mg qd decreased atazanavir by 18% and 9%, respectively, with no change in or versus atazanavir/ritonavir 300/100 mg qd alone (Day −1). Etravirine was 24% higher and 16% lower with atazanavir/ritonavir 300/100 or 400/100 mg qd, respectively, versus historical controls. At Week 48, no significant differences were seen between the atazanavir/ritonavir groups in discontinuations due to adverse events (9.1% each group) and other safety parameters, the proportion of patients with viral load <50 copies/mL (intent-to-treat population, noncompleter = failure) (50.0%, atazanavir/ritonavir 300/100 mg qd versus 45.5%, 400/100 mg qd), and virologic failures (31.8% versus 27.3%, resp.). Conclusions. Etravirine 200 mg bid can be combined with atazanavir/ritonavir 300/100 mg qd and an NRTI in HIV-1-infected, treatment-experienced patients without dose adjustment. Catherine Orrell, Franco Felizarta, André Nell, Thomas N. Kakuda, Ludo Lavreys, Steven Nijs, Lotke Tambuyzer, Rodica Van Solingen-Ristea, and Frank L. Tomaka Copyright © 2015 Catherine Orrell et al. All rights reserved. Determinants of Antiretroviral Therapy Adherence among Women in Southern Malawi: Healthcare Providers’ Perspectives Sun, 28 Dec 2014 08:26:46 +0000 Background. The purpose of this study was to explore healthcare providers’ perspectives on antiretroviral (ART) adherence in two ART clinics in southern Malawi. Nonadherence to ART is a significant hindrance to the success of HIV/AIDS treatment. Methods. A one-on-one semistructured interview was conducted with eight healthcare providers in two ART clinics in rural and urban southern Malawi. The interviews were focused on factors facilitating or hindering ART adherence and strategies to improve adherence. Interviews were audio-recorded, transcribed, and content-analyzed with the use of the constant comparison approach. Results. Of the eight participants, 63% were between the ages of 20 and 30 years and 37% were HIV counselors. Factors facilitating adherence include patients’ belief and knowledge, HIV/AIDS education, and a supportive network. Barriers to adherence include discrimination, nondisclosure of HIV status, food insecurity, medication side effects, religion, misinformation, and staff and drug shortages. Strategies to improve adherence were identified by participants to include nutritional/food supplementation for malnourished or undernourished patients and patient counseling. Conclusions. There is a need for collaborative efforts between healthcare providers, patients, and faith-based organizations to identify and address hindrances and facilitators to patients’ adherence. Further research is needed to develop strategies addressing religion, staff, and drug shortages. Ogbochi McKinney, Naomi N. Modeste, Jerry W. Lee, Peter C. Gleason, and Gisele Maynard-Tucker Copyright © 2014 Ogbochi McKinney et al. All rights reserved. Mucocutaneous Manifestations of HIV and the Correlation with WHO Clinical Staging in a Tertiary Hospital in Nigeria Sun, 21 Dec 2014 00:10:12 +0000 Skin diseases are indicators of HIV/AIDS which correlates with WHO clinical stages. In resource limited environment where CD4 count is not readily available, they can be used in assessing HIV patients. The study aims to determine the mucocutaneous manifestations in HIV positive patients and their correlation with WHO clinical stages. A prospective cross-sectional study of mucocutaneous conditions was done among 215 newly diagnosed HIV patients from June 2008 to May 2012 at adult ART clinic, Wesley Guild Hospital Unit, OAU Teaching Hospitals Complex, Ilesha, Osun State, Nigeria. There were 156 dermatoses with oral/oesophageal/vaginal candidiasis (41.1%), PPE (24.4%), dermatophytic infections (8.9%), and herpes zoster (3.8%) as the most common dermatoses. The proportions of dermatoses were 4.5%, 21.8%, 53.2%, and 20.5% in stages 1–4, respectively. A significant relationship (using Pearson’s Chi square with value ) was obtained between dermatoses and WHO clinical stages. Pearson’s correlation coefficient showed a positive correlation between the number of dermatoses and the WHO clinical stages. Dermatoses can therefore serve as diagnostic and prognostic markers in resource limited settings to initiate HAART in clinical stages 3 and 4. Olumayowa Abimbola Oninla Copyright © 2014 Olumayowa Abimbola Oninla. All rights reserved. HBV and HCV Coinfection among HIV/AIDS Patients in the National Hospital of Tropical Diseases, Vietnam Mon, 08 Dec 2014 13:22:00 +0000 Aim. To examine prevalence and characterization of HBV and HCV coinfection among HIV/AIDS patients. Methods. This cross-sectional, retrospective study analyzed 724 HIV/AIDS patients in the HIV clinic at the National Hospital of Tropical Diseases (NHTD), from 5/2005 to 4/2011. Results. The prevalence of HBV, HCV, and HIV coinfection was 50.3% (364/724), of which HbsAg, HCV, and both of HbsAg, and HCV positivity were 8.4%, 35.4%, and 6.5%, respectively. The cohort (364 patients) with HBV, HCV, and HIV coinfection live in the 30 provinces/cities in the North and Central area of Vietnam. We found statistically significant associations between heightened risk of coinfection with HIV and HCV in the age group 30–39 years (), male gender (), never married patients (), patients with a history of injection drug use (), and clinical stages 2–4 (). Coinfection with HBV/HIV was statistically significant associations between heightened risk of marital status (never married) () and those who reported transmission through sexual intercourse. Conclusion. Coinfection with viral hepatitis is common in HIV patients; further study of the impact and evolution of coinfection is necessary to find effective treatment algorithms. Bùi Vũ Huy, Kanxay Vernavong, and Nguyễn Văn Kính Copyright © 2014 Bùi Vũ Huy et al. All rights reserved. Adapting and Implementing a Community Program to Improve Retention in Care among Patients with HIV in Southern Haiti: “Group of 6” Sun, 07 Dec 2014 11:38:26 +0000 Objective. In Mozambique, a patient-led Community ART Group model developed by Médecins Sans Frontières improved retention in care and adherence to antiretroviral therapy (ART) among persons with HIV. We describe the adaptation and implementation of this model within the HIV clinic located in the largest public hospital in Haiti’s Southern Department. Methods. Our adapted model was named Group of 6. Hospital staff enabled stable patients with HIV receiving ART to form community groups with 4–6 members to facilitate monthly ART distribution, track progress and adherence, and provide support. Implementation outcomes included recruitment success, participant retention, group completion of monthly monitoring forms, and satisfaction surveys. Results. Over one year, 80 patients from nine communities enrolled into 15 groups. Six participants left to receive HIV care elsewhere, two moved away, and one died of a non-HIV condition. Group members successfully completed monthly ART distribution and returned 85.6% of the monthly monitoring forms. Members reported that Group of 6 made their HIV management easier and hospital staff reported that it reduced their workload. Conclusions. We report successful adaptation and implementation of a validated community HIV-care model in Southern Haiti. Group of 6 can reduce barriers to ART adherence, and will be integrated as a routine care option. John A. Naslund, Jodie Dionne-Odom, Cléonas Junior Destiné, Kristen M. Jogerst, Redouin Renold Sénécharles, Michelande Jean Louis, Jasmin Desir, Yvette Néptune Ledan, Jude Ronald Beauséjour, Roland Charles, Alice Werbel, Elizabeth A. Talbot, Patrice Joseph, Jean William Pape, and Peter F. Wright Copyright © 2014 John A. Naslund et al. All rights reserved. Establishment of Normal Reference Intervals for CD3+, CD4+, CD8+, and CD4+ to CD8+ Ratio of T Lymphocytes in HIV Negative Adults from University of Gondar Hospital, North West Ethiopia Tue, 18 Nov 2014 00:00:00 +0000 Background. Reference values for the CD3+, CD4+, CD8+, and CD4+ to CD8+ ratio T lymphocyte subsets are adopted from textbooks. But for appropriate diagnosis, treatment, and follow-up of patients, correct interpretations of the laboratory results from normal reference interval are mandatory. This study was, therefore, planned to establish normal reference interval for T lymphocytes subset count and CD4+ to CD8+ ratio. Methods. A cross-sectional study was conducted on apparently healthy adult individuals who visited voluntary counseling and HIV testing clinic Gondar University Hospital from April to May, 2013. Whole blood was analyzed using fluorescence-activated cell sorting (BD FACS, San Jose, CA) machine to enumerate the T-cell subpopulations. Results. Out of the total 320 study participants, 161 (50.3%) were men and 159 (49.7%) were women. The normal reference intervals were (655–2,823 cells/μL), (321–1,389 cells/μL), and (220–1,664 cells/μL) for CD3+, CD4+, and CD8+ T lymphocyte subsets, respectively, and CD4+ to CD8+ ratio was 0.5–2.5. Conclusion. The overall CD3+ T lymphocytes reference interval in the current study was wide; low CD4+ T lymphocytes, CD4 to CD8 ratio, and high CD8+ T lymphocytes values were observed. Addisu Gize, Biniam Mathewos, Beyene Moges, Meseret Workineh, and Lealem Gedefaw Copyright © 2014 Addisu Gize et al. All rights reserved. Evaluation of the Effectiveness of Peer Education in Improving HIV Knowledge, Attitude, and Sexual Behaviours among In-School Adolescents in Osun State, Nigeria Thu, 13 Nov 2014 13:56:02 +0000 Introduction. Young people are at the centre of the global HIV/AIDS epidemic. This study therefore aimed to evaluate the effectiveness of peer education in improving HIV knowledge, attitude, and preventive practices among in-school adolescents in Osun State, Nigeria. Methods. This was an intervention study that was carried out among in-school adolescents attending mixed secondary schools in Osun State, Nigeria. The study was in three stages: before intervention, intervention, and after intervention. The impact of peer education was evaluated twelve weeks after intervention. Data were collected using pretested semistructured questionnaires and data analysis was done with SPSS version 16. Results. At the preintervention stage, the study and control groups were similar in their sociodemographic characteristics, HIV knowledge, attitude, and preventive practices, including high risk behaviours for HIV/AIDS transmission. After the peer education intervention, those with good knowledge and positive attitudes towards HIV/AIDS increased significantly from 50.0% to 86.7% and from 49.0% to 85.6%, respectively (). Conclusion. The study showed that peer education is effective in improving knowledge, attitude, and some preventive practices towards HIV/AIDS among in-school adolescents. Educational programmes about HIV/AIDS should therefore be designed to target this age group putting into consideration their unique characteristics. Adeleye Abiodun Adeomi, Oluwatosin Adediran Adeoye, Esther Olufunmilayo Asekun-Olarinmoye, Olugbemiga Lanre Abodunrin, Adenike Iyanuoluwa Olugbenga-Bello, and Adedayo Olukemi Sabageh Copyright © 2014 Adeleye Abiodun Adeomi et al. All rights reserved. Assessment of Prevalence and Determinants of Occupational Exposure to HIV Infection among Healthcare Workers in Selected Health Institutions in Debre Berhan Town, North Shoa Zone, Amhara Region, Ethiopia, 2014 Thu, 13 Nov 2014 07:46:44 +0000 Introduction. Health care workers are exposed to different kinds of occupational hazards due to their day to day activities. The most common occupational exposure like body fluids is a potential risk of transmission of blood-borne infection like human immunodeficiency virus. Objective. To assess the prevalence and determinants of occupational exposure to human immunodeficiency virus infection. Methods and Materials. A descriptive cross-sectional institution based study was conducted in selected four health institutions in Debre Berhan town. Quantitative and qualitative data were collected using semistructured interviewer administered questionnaire. The frequency distribution of dependent and independent variables was worked out and presented using frequency table, graph, and chart. Result. The overall prevalence of occupational exposure of the health care workers was found to be 88.6% () in the past 12 months. Contact to potentially infectious body fluids accounts for the largest proportion (56.7%) followed by needle stick injury (31.5%) and glove breakage (28.8%). Conclusion. In this study majority (88.6%) of the health care workers had a risky occupational hazard that exposed them to human immunodeficiency virus infection during the past 12 months. The statistically significant determinant factors were professional status, working room, and time of personal protective equipment usage. Filmawit Aynalem Tesfay and Tesfa Dejenie Habtewold Copyright © 2014 Filmawit Aynalem Tesfay and Tesfa Dejenie Habtewold. All rights reserved. Plasma and Intracellular Antiretroviral Concentrations in HIV-Infected Patients under Short Cycles of Antiretroviral Therapy Sun, 09 Nov 2014 11:30:16 +0000 Study of plasma and intracellular concentrations of atazanavir, lopinavir, nevirapine, and efavirenz was conducted on 48 patients under short cycles of antiretroviral therapy. Intracellular concentrations (IC) were still measurable for all drugs after 85 h or 110 h drug intake despite the absence of drug in plasma for atazanavir and lopinavir. A linear relationship between plasma and intracellular efavirenz was observed. Further studies to fully understand the impact of IC in the intermittent antiviral treatment are required. Laura Zehnacker, Emuri Abe, Dominique Mathez, Jean-Claude Alvarez, Jacques Leibowitch, and Stéphane Azoulay Copyright © 2014 Laura Zehnacker et al. All rights reserved. Latent Toxoplasma gondii Infection and Associated Risk Factors among HIV-Infected Individuals at Arba Minch Hospital, South Ethiopia Sun, 09 Nov 2014 00:00:00 +0000 Toxoplasmosis is a parasitic disease caused by Toxoplasma gondii (T. gondii). The parasite has cosmopolitan distribution, infecting almost all species of warm-blooded animals. Latent T. gondii infection in HIV/AIDS patients is a risk for development of cerebral toxoplasmosis (CT). The aim of this study is to determine seroprevalence of latent T. gondii infection and assess its associated factors among individuals infected with HIV in Arba Minch Hospital, south Ethiopia. A facility-based cross-sectional study involving 170 HIV-infected individuals attending Arba Minch Hospital antiretroviral therapy (ART) clinic was conducted from April to June 2013. Data on demographic profile of the study participants and factors associated with T. gondii infection were gathered using a questionnaire. Serum was tested for IgG anti-T. gondii antibody by enzyme-linked immunosorbent assay (ELISA). Data were analyzed using SPSS version 20 software. Seroprevalence of latent T. gondii infection among the study participants was 88.2%. Consumption of raw meat (AOR = 4.361; 95% CI: 1.409–13.496) and involvement in farming/gardening activities (AOR = 4.051; 95% CI: 1.112–14.758) were independent predictors of T. gondii seropositivity. This study revealed high prevalence of latent T. gondii infection, similar to other studies. Monitoring of the patients to prevent reactivation of the latent T. gondii infection is recommended. Tsegaye Yohanes, Serkadis Debalke, and Endalew Zemene Copyright © 2014 Tsegaye Yohanes et al. All rights reserved. Evaluation of a Smoking Cessation Program for HIV Infected Individuals in an Urban HIV Clinic: Challenges and Lessons Learned Wed, 01 Oct 2014 09:02:17 +0000 Introduction. HIV infected persons have high prevalence of smoking and tobacco-associated health risks. Few studies describe smoking cessation programs targeting this population. The Infectious Disease Practice (IDP) in Newark, New Jersey, initiated a smoking cessation program (SCP) for HIV infected smokers. We report participation, abstinence rates, and predictors of abstinence. Methods. This is a prospective cohort study, comparing participants to non-SCP smokers, during April 1, 2011, to October 31, 2012. Intervention included one individualized counseling session with an offer of pharmacotherapy. Univariate and multivariate analyses were performed with self-reported seven-day point prevalence abstinence at six months as primary outcome measure. Results. Among 1545 IDP patients, 774 (51%) were current smokers of whom 123 (16%) participated in the SCP. Mean six-month abstinence rate amongst SCP participants was 16%. A history of cocaine or heroin use was predictive of continued smoking (odds ratio [OR] adjusted 0.20, 95% confidence interval [CI] 0.07–0.55) while smokers in the preparation stage of change were more likely abstinent at six months (OR adjusted 8.26, 95% CI 1.02–66.67). Conclusions. A low-intensity smoking cessation intervention in an HIV treatment setting is effective in a minority of participants. Further research is needed to better address barriers to smoking cessation such as substance use. Debra Chew, Michael B. Steinberg, Polly Thomas, Shobha Swaminathan, and Sally L. Hodder Copyright © 2014 Debra Chew et al. All rights reserved. Correlates of Inconsistent Refusal of Unprotected Sex among Armenian Female Sex Workers Wed, 01 Oct 2014 06:31:56 +0000 This cross-sectional study assessed the prevalence and correlates of inconsistent refusal of unprotected sex among female sex workers (FSWs) in Armenia. One hundred and eighteen street-based FSWs between the ages of 20 and 52 completed a questionnaire assessing FSWs’ demographic, psychosocial, and behavioral characteristics. A total of 52.5% () of FSWs reported inconsistent refusal of unprotected sex with clients in the past 3 months. Logistic regression analysis controlling for participants’ age and education revealed that perceiving more barriers toward condom use (AOR = 1.1; ), reporting more types of abuse (AOR = 2.1; ), and setting lower fees for service (AOR = 0.9; ) significantly predicted inconsistent refusal of unprotected sex. HIV-risk-reduction behavioral interventions tailored to FSWs working in Yerevan Armenia should address the factors identified in this study toward the goal of enhancing refusal of unprotected sex and ultimately preventing acquisition of sexually transmitted infections (STIs) including HIV. Karine Markosyan, Delia L. Lang, and Ralph J. DiClemente Copyright © 2014 Karine Markosyan et al. All rights reserved. Factors Associated with HIV Testing History among Pregnant Women and Their Partners in Georgia: The ANRS 12127 Prenahtest Trial Mon, 29 Sep 2014 00:00:00 +0000 Despite the benefits of timely diagnosis of HIV infection and the wide availability of VCT services, the acceptance of HIV testing and counseling still remains a challenge in Georgia. The goal of our study was to assess the history of HIV testing and associated factors among pregnant women. The recruitment of study participants took place during routine antenatal care visits at one of the large Maternity Hospitals in Tbilisi, capital of Georgia. A total of 491 pregnant women were included in the sample. More than a third of women (38.5%) reported that they were tested for HIV before the current pregnancy and almost all of them (91.5%) were tested during previous pregnancies. Bivariate analysis revealed statistically significant association of women’s history of HIV testing with age, education level, remunerated activity, history of STI, and multiparity. In multivariate analysis, the only independent predictor of being HIV tested was ever being pregnant. In conclusion, HIV testing history among women at reproductive age was poor in Georgia. Women mostly received HIV testing at prenatal centers. Efforts should be made to promote HIV testing in primary care settings, which would increase its acceptability and overall testing rate in the population. Maia Butsashvili, Maia Kajaia, George Kamkamidze, Patrice Tchendjou, Annabel Desgrees du Loû, François Dabis, and Joanna Orne-Gliemann Copyright © 2014 Maia Butsashvili et al. All rights reserved. Antiretroviral Therapy Helps HIV-Positive Women Navigate Social Expectations for and Clinical Recommendations against Childbearing in Uganda Thu, 18 Sep 2014 12:34:02 +0000 Understanding factors that influence pregnancy decision-making and experiences among HIV-positive women is important for developing integrated reproductive health and HIV services. Few studies have examined HIV-positive women’s navigation through the social and clinical factors that shape experiences of pregnancy in the context of access to antiretroviral therapy (ART). We conducted 25 semistructured interviews with HIV-positive, pregnant women receiving ART in Mbarara, Uganda in 2011 to explore how access to ART shapes pregnancy experiences. Main themes included: (1) clinical counselling about pregnancy is often dissuasive but focuses on the importance of ART adherence once pregnant; (2) accordingly, women demonstrate knowledge about the role of ART adherence in maintaining maternal health and reducing risks of perinatal HIV transmission; (3) this knowledge contributes to personal optimism about pregnancy and childbearing in the context of HIV; and (4) knowledge about and adherence to ART creates opportunities for HIV-positive women to manage normative community and social expectations of childbearing. Access to ART and knowledge of the accompanying lowered risks of mortality, morbidity, and HIV transmission improved experiences of pregnancy and empowered HIV-positive women to discretely manage conflicting social expectations and clinical recommendations regarding childbearing. Jasmine Kastner, Lynn T. Matthews, Ninsiima Flavia, Francis Bajunirwe, Susan Erikson, Nicole S. Berry, and Angela Kaida Copyright © 2014 Jasmine Kastner et al. All rights reserved. The Effect on Treatment Adherence of Administering Drugs as Fixed-Dose Combinations versus as Separate Pills: Systematic Review and Meta-Analysis Thu, 04 Sep 2014 00:00:00 +0000 Administering drugs as fixed-dose combinations (FDCs) versus the same active drugs administered as separate pills is assumed to enhance treatment adherence. We synthesized evidence from randomized controlled trials (RCTs) about the effect of FDCs versus separate pills on adherence. We searched PubMed for RCTs comparing a FDC with the same active drugs administered as separate pills, including a quantitative estimate of treatment adherence, without restriction to medical condition. The odds ratio (OR) of optimal adherence with FDCs versus separate pills was used as common effect size and aggregated into a pooled effect estimate using a random effect model with inverse variance weights. Out of 1258 articles screened, only six studies fulfilled inclusion criteria. Across medical conditions, administering drugs as FDC significantly increased the likelihood of optimal adherence (OR 1.33 (95% CI, 1.03–1.71)). Within subgroups of specific medical conditions, the favourable effect of FDCs on adherence was of borderline statistical significance for HIV infection only (OR 1.46 (95% CI, 1.00–2.13)). We observed a remarkable paucity of RCTs comparing the effect on adherence of administering drugs as FDC versus as separate pills. Administering drugs as FDC improved medication adherence. However, this conclusion is based on a limited number of RCTs only. Katy A. van Galen, Jeannine F. Nellen, and Pythia T. Nieuwkerk Copyright © 2014 Katy A. van Galen et al. All rights reserved. Oral Health Status and Oromucosal Lesions in Patients Living with HIV/AIDS in India: A Comparative Study Wed, 20 Aug 2014 10:37:36 +0000 Oral health status of HIV positive individuals is in poor condition which may be a sequela of variety of factors. This study was aimed at assessing and comparing the oral health status and oromucosal lesions between HIV positive and negative individuals in India. A total of 126 HIV positive and 532 HIV negative individuals were recruited for the study. Oral health status and oromucosal lesions were recorded using WHO oral health assessment form (1997). Data was analyzed using chi-square and independent sample student’s t test. Majority (85.7%) of people suffering from HIV belonged to lower socioeconomic status. The mean for DMFT score was found to be significantly higher in HIV positive individuals () as compared to HIV negative individuals () ( value ). Nearly 75% of HIV positive individuals showed oromucosal lesions with candidiasis (36%) being the most common. Nearly 50% of HIV positive individuals had community periodontal index (CPI) and loss of attachment (LOA) score >2. In conclusion HIV positive individuals have poor oral health status and poor periodontal status compared to control group. Effective policies need to be drafted to take care of the oral health of this high risk group. Sandeep Kumar, Prashant Mishra, Shilpa Warhekar, Bhuvnesh Airen, Deepika Jain, and Shaijal Godha Copyright © 2014 Sandeep Kumar et al. All rights reserved. Serum Micronutrient Status of Haart-Naïve, HIV Infected Children in South Western Nigeria: A Case Controlled Study Mon, 11 Aug 2014 12:35:09 +0000 Background. Though micronutrients are vital in the pathogenesis of human immunodeficiency virus infection, most studies have been conducted in adults. Knowledge of the status of key micronutrients in HIV infected African children will indicate if supplementation may be beneficial to these children living in this resource-poor region. Objectives. We sought to determine the micronutrient status and associated factors of HAART-naïve HIV infected children and compare them with those of the HIV negative controls. Methods. We enrolled 70 apparently stable HAART naïve HIV infected children. Seventy age and sex matched HIV negative children were equally enrolled as the controls. Their social class, anthropometry, clinical stage, CD4 counts, serum zinc, selenium, and vitamin C were determined. Results. The prevalence of zinc, selenium, and vitamin C deficiency in HIV infected subjects was 77.1%, 71.4%, and 70.0%, respectively, as compared to 44.3%, 18.6%, and 15.7% in HIV negative controls. Among the HIV infected subjects, 58.6% were deficient in the three micronutrients. Micronutrient status was related to the weight, clinical, and immunological stages but not BMI or social class. Conclusion. Deficiency of these key micronutrients is widely prevalent in HAART naïve HIV infected children irrespective of social class. This suggests that supplementation trial studies may be indicated in this population. H. C. Anyabolu, E. A. Adejuyigbe, and O. O. Adeodu Copyright © 2014 H. C. Anyabolu et al. All rights reserved. Determinants of Mortality among Adult HIV-Infected Patients on Antiretroviral Therapy in a Rural Hospital in Southeastern Nigeria: A 5-Year Cohort Study Wed, 06 Aug 2014 08:05:46 +0000 Background. Study examined the determinants of mortality among adult HIV patients in a rural, tertiary hospital in southeastern Nigeria, comparing mortality among various ART regimens. Methods. Retrospective cohort study of 1069 patients on ART between August 2008 and October 2013. Baseline CD4 counts, age, gender, and ART regimen were considered in this study. Kaplan-Meier method was used to estimate survival and Cox proportional hazards models to identify multivariate predictors of mortality. Median follow-up period was 24 months (IQR 6–45). Results. 78 (7.3%) patients died with 15.6% lost to followup. Significant independent predictors of mortality include age (>45), sex (male > female), baseline CD4 stage (<200), and ART combination. Adjusted mortality hazard was 3 times higher among patients with CD4 count <200 cells/μL than those with counts >500 (95% CI 1.69–13.59). Patients on Truvada-based first-line regimens were 88% more likely to die than those on Combivir-based first line (95% CI 1.05–3.36), especially those with CD4 count <200 cells/μL. Conclusion. Study showed lower mortality than most studies in Nigeria and Africa, with mortality higher among males and patients with CD4 count <200. Further studies are recommended to further compare treatment outcomes between Combivir- and Truvada-based regimens in resource-limited settings using clinical indicators. Kelechi N. Eguzo, Adegboyega K. Lawal, Cynthia E. Eseigbe, and Chisara C. Umezurike Copyright © 2014 Kelechi N. Eguzo et al. All rights reserved. Exploration of the Effect of Tobacco Smoking on Metabolic Measures in Young People Living with HIV Wed, 09 Jul 2014 11:15:33 +0000 We conducted cross-sectional, multicenter studies in HIV-positive young women and men to assess metabolic and morphologic complications from tobacco smoking in 372 behaviorally infected HIV-positive youth, aged 14–25 years. Measurements included self-reported tobacco use, fasting lipids, glucose, fat distribution, and bone mineral density (BMD; dual-energy X-ray absorptiometry scans). Overall, 144 (38.7%) self-reported smoking tobacco and 69 (47.9%) of these reported smoking greater than five cigarettes per day. Smokers versus nonsmokers had lower mean total cholesterol (146.0 versus 156.1 mg/dL; ) and lower mean total body fat percent (24.1% versus 27.2%, ). There was no difference between smokers and nonsmokers in fasting glucose or BMD. There appear to be only minimal effects from tobacco smoking on markers of cardiac risk and bone health in this population of HIV-positive youth. While these smokers may not have had sufficient exposure to tobacco to detect changes in the outcome measures, given the long-term risks associated with smoking and HIV, it is critical that we encourage HIV-positive youth smokers to quit before the deleterious effects become apparent. Mark L. Rubinstein, D. Robert Harris, Bret J. Rudy, Bill G. Kapogiannis, Grace M. Aldrovandi, and Kathleen Mulligan Copyright © 2014 Mark L. Rubinstein et al. All rights reserved. Cost of Care for HIV-Infected Patients with Co-Occurring Substance Use Disorder or Psychiatric Disease: Report from a Large, Integrated Health Plan Sun, 22 Jun 2014 07:43:15 +0000 Background. The costs of providing care to HIV-infected (HIV+) patients with co-occurring diagnoses of substance use (SU) disorder or psychiatric disease (PD) are not well documented. It is our objective to evaluate costs in these HIV+ patients receiving care in a large health plan. Methods. We conducted a retrospective cohort study from 1995 to 2010 to compare costs of healthcare in HIV+ patients with and without co-occurring SU disorder and/or PD diagnoses. Estimates of proportional differences in costs (rate ratios) were obtained from repeated measures generalized linear regression. Models were stratified by cost category (e.g., inpatient, outpatient). Results. Mean total healthcare costs per patient per year were higher in HIV+ patients diagnosed with SU disorder or PD compared to HIV+ patients without these comorbid conditions. After controlling for confounders, total mean costs remained significantly higher in patients diagnosed with SU disorder (RR = 1.24, 95% CI = 1.18–1.31) or PD (RR = 1.19, 95% CI = 1.15–1.24). Mean outpatient care costs were significantly greater in patients with both SU disorder and PD (RR = 1.52, 95% CI = 1.41–1.64). Conclusions. Given these higher expenditures in the care of HIV+ patients with comorbid SU disorder and/or PD, greater efforts to facilitate SU disorder or PD treatment initiation and persistence could provide substantial savings. Gerald N. DeLorenze, Ai-Lin Tsai, Michael A. Horberg, and Charles P. Quesenberry Jr. Copyright © 2014 Gerald N. DeLorenze et al. All rights reserved. Treatment Outcomes in a Decentralized Antiretroviral Therapy Program: A Comparison of Two Levels of Care in North Central Nigeria Tue, 17 Jun 2014 00:00:00 +0000 Background. Decentralization of antiretroviral therapy (ART) services is a key strategy to achieving universal access to treatment for people living with HIV/AIDS. Our objective was to assess clinical and laboratory outcomes within a decentralized program in Nigeria. Methods. Using a tiered hub-and-spoke model to decentralize services, a tertiary hospital scaled down services to 13 secondary-level hospitals using national and program guidelines. We obtained sociodemographic, clinical, and immunovirologic data on previously antiretroviral drug naïve patients aged ≥15 years that received HAART for at least 6 months and compared treatment outcomes between the prime and satellite sites. Results. Out of 7,747 patients, 3729 (48.1%) were enrolled at the satellites while on HAART, prime site patients achieved better immune reconstitution based on CD4+ cell counts at 12 () and 24 weeks () with similar responses at 48 weeks () and higher rates of viral suppression (<400 c/mL) at 12 () and 48 weeks (), but similar responses at 24 weeks (). Mortality was 2.3% versus 5.0% () at prime and satellite sites, while transfer rate was 8.7% versus 5.5% () at prime and satellites. Conclusion. ART decentralization is feasible in resource-limited settings, but efforts have to be intensified to maintain good quality of care. Prosper Okonkwo, Atiene S. Sagay, Patricia A. Agaba, Stephen Yohanna, Oche O. Agbaji, Godwin E. Imade, Bolanle Banigbe, Juliet Adeola, Tinuade A. Oyebode, John A. Idoko, and Phyllis J. Kanki Copyright © 2014 Prosper Okonkwo et al. All rights reserved.