Background. Studies on HIV-associated central nervous system (CNS) diseases in Cameroon are rare. The aim of this study was to describe the clinical presentation, identify aetiological factors, and determine predictors of mortality in HIV patients with CNS disease. Methods. From January 1, 2004 and December 31, 2009, we did at the Douala General Hospital a clinical case note review of 672 admitted adult (age &#x2265; 18 years) HIV-1 patients, and 44.6&#x25; (300/672) of whom were diagnosed and treated for HIV-associated CNS disease. Results. The mean age of the study population was <svg style="vertical-align:-0.3003pt;width:74.362503px;" id="M1" height="11.2875" version="1.1" viewBox="0 0 74.362503 11.2875" width="74.362503" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
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</svg> years, and median CD4 count was 49 cells/mm3 (interquartile range (QR): 17&#x2013;90). The most common clinical presentations were headache (83&#x25;), focal signs (40.6&#x25;), and fever (37.7&#x25;). Toxoplasma encephalitis and cryptococcal meningitis were the leading aetiologies of HIV-associated CNS disease in 32.3&#x25; and 25&#x25; of patients, respectively. Overall mortality was 49&#x25;. Primary central nervous system lymphoma (PCNSL) and bacterial meningitis had the highest case fatality rates of 100&#x25; followed by tuberculous meningitis (79.8&#x25;). Low CD4 count was an independent predictor of fatality (AOR: 3.2, 95&#x25;CI: 2.0&#x2013;5.2). Conclusions. HIV-associated CNS disease is common in Douala. CNS symptoms in HIV patients need urgent investigation because of their association with diseases of high case fatality.

Henry Namme Luma 

Benjamin Clet Nguenkam Tchaleu

Elvis Temfack

Marie Solange Doualla

Daniela Pamela Ntchankam Ndenga

Yacouba Njankouo Mapoure

Alfred Kinyuy Njamnshi

Vincent-de-Paul Djientcheu

HIV-Associated Central Nervous System Disease in Patients Admitted at the Douala General Hospital between 2004 and 2009: A Retrospective Study

Introduction. There have been no scales specifically developed to assess physician-patient communication behaviors (PPCB) in the sub-Saharan population. Aim. We revised an existing PPCB scale and tested its psychometric properties for HIV patients in Kenya. Methods. 17 items (five-point scale) measuring PPCB were initially adopted from the Matched Pair Instrument (MPI). Between July and August 2011, we surveyed a convenient sample of 400 HIV adult patients, attending three Academic Model Providing Healthcare program (AMPATH) clinics in Eldoret, Kenya. Of these 400, eight also participated in cognitive interviews, and 200 were invited to return after one week for follow-up interviews; 134 (67&#x25;) returned and were interviewed. Construct and content validity were established using an exploratory factor analysis, bivariate analyses, internal consistency, test-retest reliability and cognitive interviews. Results. Construct and content validity supported a one-dimensional measure of 13 PPCB items. Items assessed physicians&#x2019; effort to promote a favorable atmosphere for interaction with HIV patients. Biases associated with encoding and comprehension of specific terms, such as &#x201c;discussion, involvement or concerns,&#x201d; were noted. Internal consistency (Cronbach&#x2019;s alpha = .81) and one-week retest reliability scores (.82) supported the reliability of the 13-item scale. Discussion. The revised PPCB scale showed acceptable validity and reliability in Kenya.

Juddy Wachira

Susan Middlestadt

Michael Reece

Chao-Ying Joanne Peng

Paula Braitstein

Psychometric Assessment of a Physician-Patient Communication Behaviors Scale: The Perspective of Adult HIV Patients in Kenya

A qualitative assessment was made of service provider and user perceptions of the quality of integrated reproductive health services established through a pilot intervention in Cambodia. The intervention aimed to promote pregnant women's HIV testing and general utilization of reproductive health facilities as well as improve the follow-up of HIV-positive women and exposed infants through strengthened referral and operational linkages amongst health facilities/services and community-based support interventions for PLHIV. The study was conducted in one operational district where the intervention was piloted and for comparative purposes in a district where integrated services had yet to be implemented. Service providers in the pilot district reported improved collaboration and coordination of services, more effective referral, and the positive impact of improved proximity of HIV testing through integrated local level facilities. Community-based support teams for PLHIV embraced their expanded role, were valued by families receiving their assistance, and were understood to have had an important role in referral, PMTCT follow-up and countering PLHIV stigmatization; findings which underscore the potential role of community support in integrated service provision. Challenges identified included stigmatization of PLHIV by health staff at district hospital level and a lack of confidence amongst non-specialized health staff when managing deliveries by HIV-positive women, partly due to fear of HIV transmission.

Joanna White

Th&#xe9;r&#xe8;se Delvaux

Chhorvann Chhea

Sarun Saramony

Vichea Ouk

Vonthanak Saphonn

The Linked Response: Lessons Emerging from Integration of HIV and Reproductive Health Services in Cambodia

This observational analysis examined the clinical outcomes of patients receiving etravirine-(ETR-) based therapy, particularly with protease inhibitors (PIs) other than darunavir (DRV) and with raltegravir (RAL). Data included treatment-experienced adults in the HIV Research Network who began ETR-containing antiretroviral regimens in 2008&#x2013;2010. The primary objective was to assess 6-month outcomes (durability, i.e., still on an ETR-containing regimen; change in CD4+ cell count and HIV-1 RNA &#x3c;400&#x2009;copies/mL). The cohort included 587 patients receiving ETR; 42&#x25; of ETR use was in patients not on DRV/ritonavir (r). Patients receiving ETR plus DRV/r had longer durability versus those on ETR plus a PI other than DRV/r at months 6 (91.2&#x25; versus 85.5&#x25;) and 12 (77.4&#x25; versus 65.2&#x25;), respectively. Patients on regimens with a PI other than DRV/r were the least likely to be receiving ETR at month 6 (85.5&#x25;) versus patients on other ETR-based regimens. Patients on regimens without a PI and without RAL had lower virologic suppression (month 6, 54.2&#x25;; month 12, 63.2&#x25;) versus patients on other ETR-based regimens. In a clinical care, nontrial setting, ETR was used in regimens without DRV/r. In this population, the 6-month response rates were similar and durable across all regimens, except when ETR was used without RAL and without a PI.

Kelly Gebo

Cindy Voss

Joseph Mrus

HIV Research Network

Patterns of Use and Outcomes in Patients Treated with Etravirine in the HIV Research Network

Background. Clinical benefits of ART are well documented, but less is known about its effects on economic outcomes such as work status and income in sub-Saharan Africa. Methods. Data were examined from 482 adult clients entering HIV care (257 starting ART; 225 not yet eligible for ART) in Kampala, Uganda. Self-reported data on work status and income were assessed at baseline, months 6 and 12. Multivariate analysis examined the effects of ART over time, controlling for change in physical health functioning and baseline covariates. Results. Fewer ART patients worked at baseline compared to non-ART patients (25.5&#x25; versus 34.2&#x25;); 48.8&#x25; of those not working at baseline were now working at month 6, and 50&#x25; at month 12, with similar improvement in both the ART and non-ART groups. However, multivariate analysis revealed that the ART group experienced greater improvement over time. Average weekly income did not differ between the groups at baseline nor change significantly over time, among those who were working; being male gender and having any secondary education were predictive of higher income. Conclusions. ART was associated with greater improvement in work status, even after controlling for change in physical health functioning, suggesting other factors associated with ART may influence work.

Annet Nannungi

Glenn Wagner

Bonnie Ghosh-Dastidar

The Impact of ART on the Economic Outcomes of People Living with HIV/AIDS

Background. Suboptimal adherence to antiretroviral therapy (ART) is still pervasive. The effect of using a mobile phone call intervention to improve patient adherence is currently not known. Objective. This study aims to investigate the effects of a phone call intervention on adherence to ART and quality of life (QOL) of treatment-naive and treatment-experienced patients. Methods. A randomized controlled trial was conducted in the three largest public hospitals. Adherence was measured by self-completed questionnaires. QOL was assessed by the WHOQOL-HIV BREF. Outcomes were assessed at day 15, at 1, 2, and 3 months after start of treatment for treatment-naive patients and at 3 months after study enrollment for treatment-experienced patients. Results. A total of 103 treatment-naive and 93 treatment-experienced HIV/AIDS patients were consecutively recruited. Results show that a phone call intervention could maintain high self-reported adherence among both treatment-naive and treatment-experienced patients. After three months, significant QOL improvements were observed in domains of physical health <svg style="vertical-align:-2.3205pt;width:78.637497px;" id="M1" height="15.0875" version="1.1" viewBox="0 0 78.637497 15.0875" width="78.637497" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
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</svg>, level of independence <svg style="vertical-align:-2.3205pt;width:78.637497px;" id="M2" height="15.0875" version="1.1" viewBox="0 0 78.637497 15.0875" width="78.637497" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
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</svg>, environment <svg style="vertical-align:-2.3205pt;width:78.637497px;" id="M3" height="15.0875" version="1.1" viewBox="0 0 78.637497 15.0875" width="78.637497" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
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</svg>, and spirituality/religion/personal beliefs <svg style="vertical-align:-2.3205pt;width:78.637497px;" id="M4" height="15.0875" version="1.1" viewBox="0 0 78.637497 15.0875" width="78.637497" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
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</svg> among treatment-naive patients. Conclusion. A mobile phone call intervention to patients could maintain high adherence rates although no statistically significant differences were found. A phone call could improve some domains of QOL among treatment-naive patients.

Dongsheng Huang

Rassamee Sangthong

Edward McNeil

Virasakdi Chongsuvivatwong

Weibin Zheng

Xuemei Yang

Effects of a Phone Call Intervention to Promote Adherence to Antiretroviral Therapy and Quality of Life of HIV/AIDS Patients in Baoshan, China: A Randomized Controlled Trial

Giuseppe Ippolito

Jay A. Levy

Anders Sonnerborg


							Ferdinand Mugusi

Ferdinando Dianzani

AIDS and HIV Infection after Thirty Years

Purpose. Little is known about the risky sexual behaviors of HIV-positive female sex workers (FSWs) in the developing world, which is critical for programmatic purposes. This study aims to shed light on their condom use with regular clients as well as husband/cohabiting partner, a first in India. Methods. Multivariate logistic regression analyses for consistent condom use with regular clients and husband/cohabiting partner are conducted for the sample of 606 HIV-positive FSWs. Results. Older FSWs are 90&#x25; less likely and nonmobile FSWs are 70&#x25; less likely to consistently use condoms. FSWs on ART are 3.84 times more likely to use condoms. Additionally, FSWs who changed their occupation after HIV diagnosis are 70&#x25; less likely to use condoms. FSWs who are currently cohabiting are more likely to consistently use condoms with repeat clients and are 3.22 times more likely to do so if they have felt stigma associated with being HIV-positive. FSWs who have multiple repeat clients, and who do not know the sexual behavior of these clients, are more likely to use condoms consistently. Conclusion. This study would help inform programs to target the following particularly vulnerable HIV-positive FSWs: those who are older, those who changed their occupation post-HIV diagnosis, and those who are nonmobile.

Apoorva Jadhav

Parinita Bhattacharjee

T. Raghavendra

James Blanchard

Stephen Moses

Shajy Isac

Shiva S. Halli

Risky Behaviors among HIV-Positive Female Sex Workers in Northern Karnataka, India

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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.

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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