Журнал СПИДа и клинических исследований

Malaria and HIV are two of the most deadly diseases in Africa. Combined they account for 4 million deaths each year, and according to the Center for Disease Control and Prevention (CDC), there is an estimated 5 percent increase in malaria deaths in those who tested positive for HIV than those without HIV infection. Since the co-infections were recorded, malaria has seen a 28 percent increase in its incidence. These results raise the possibility that biological differences could alter the effect of co-infection and underscore the importance of identifying these factors for the implementation of control interventions focused on co-infection. Malaria associated death rates have nearly doubled for those with co-infections. The biological integrations between the malaria parasite and HIV are not fully understood, but it is conceivable that the parasite or viral load can increase by an order of magnitude due to coinfection. HIV-infected persons are at increased risk for clinical malaria; the risk is greatest when immune suppression is advanced. Malaria is associated with increases in HIV viral load that, while modest, may impact HIV progression or the risk of HIV transmission. We also showed that in the Full Model, total cause of deaths are from co-infection when the amplification factor , i ρ , i =1, 2, 3, 4, is larger than 25. We introduce a system of differential equations linking the host-vector system of malaria with co-infection with HIV. Data were collected from Sub-Saharan Africa for the global parameter estimates and we simulated for sensitivity analysis using data collected from Malawi. Finally, these simulations show that the HIV-induced increase in susceptibility to malaria infection has marginal effect on the new cases of HIV and malaria but increases the number of new cases of the dual HIV-malaria infection.

The relationship between knowledge about HIV/AIDS and its associated risky behaviors is complex and has not been sufficiently explored. It is especially important to look at some of the aspects of this relationship among people living with HIV/AIDS (PLWHA) in order to develop effective intervention strategies to reduce HIV/AIDS risky behaviors. The objective of this study was to investigate the association between knowledge about HIV/AIDS and its risky behaviors among PLWHA. Methods: Risk taking behavior among the participants was measured as the number of all risky behaviors before and after the knowledge of their HIV/AIDS positive status. Knowledge was measured by the extent to which participants answered the HIV/AIDS related questions. The relationships between the identified HIV/AIDS risky behaviors and the knowledge among PLWHA were analyzed using Structural Equation Modelling. Results: 341 questionnaires were administered and 326 (96%) were completed and returned from PLWHA clients of HIV/AIDS outreach facility in Alabama. Analysis revealed that, knowledge of HIV/AIDS, and knowledge of a properly used condom in preventing the infection through sexual activity were positively related with knowledge of where to get tested for HIV/AIDS. Using drugs before sex was significantly related with having sex with prostitutes (total effects\\\\\\\' standardized regression coefficient (TESRC)=0.29, p<0.001). Sharing the same syringe or needle with another person or other people to inject oneself was strongly related with number of sexual partners within one year (TESRC=0.25, p<0.001), and sex with injecting drug users (TESRC=0.45, p<0.001). Conclusion: A deeper understanding of HIV/AIDS and some of its transmission pathways appears to be very effective in practicing the taking of preventive measures such as using condoms or getting tested for HIV. Increasing access to HIV/AIDS education could therefore be very useful in providing further gains in HIV/AIDS awareness among PLWHA

Objective: In order to determine how risk factors of death among HIV-infected patients in French Guiana interact with one another and to define high risk population segments, an alternative statistical method to Cox proportional hazards models was used. Patients and methods: Data from HIV+ patients followed in the three main hospitals of French Guiana were used. Data were extracted from the prospective French Hospital Database for HIV (FHDH). To examine the nature of the relationships between time of death since the first consultation and a set of predictor variables (age at enrolment, gender, nationality, CD4 count at enrolment, presence or absence of HAART at enrolment, a declared addiction, and mode of acquisition of the virus) a survival tree analysis was used. Survival rates at 5 years and 10 years and their 95% confidence interval were also calculated. Results: This analysis permitted to reveal a new specific subgroup of HIV+ patients particularly at risk in French Guiana not already mentioned in the literature: the HIV+ female patients with a declared addiction. Conclusions: Prevention and care in this vulnerable segment of the HIV+ population identified by this methodology should be reinforced

With nearly two decades following the introduction of Highly Active Antiretroviral Therapy (HAART) in the management of HIV/AIDS, tremendous success has been recorded in the control of HIV replication and overall wellbeing and longevity of afflicted patients. But this success has not been complete as HAART strategy still suffers from a myriad of issues, chiefly deleterious side effects owing to oxidative stress-induced cellular injuries. Pointless to say that this has impeded progress made so far and has left researchers in the continued search for options. With changing trends in fertility concerns of many patients infected with HIV, a gradual but persistent trust towards procreative tendencies of these patients who are still within the reproductive age axis becomes a compelling issue for experts. Numerous research points to the beneficial effects of antioxidant augmentation in HAART especially relevant in the midst of escalated cost of antiretroviral drugs in resource-deprived settings. A continued attempt to elucidate pathophysiological mechanisms involved in HAART-associated oxidative stress-mediated reproductive injuries remains critically important to improving the treatment strategies for this epidemic condition. Therefore, an overview of our current knowledge on HAART induced changes via oxidant-antioxidant pathway becomes pertinent as we unravel the body of knowledge that may be necessary to guide future directions particularly in reproduction

Human immunodeficiency virus (HIV) infection, a major medical crisis that has hit families, communities & nations across the world, remains a major health concern of unprecedented dimension. Mounting evidence suggests that co-infections and inflammation may result in re-activation of latent virus and blunt the success of Highly Active Anti-retroviral Therapy (HAART). Periodontal diseases are chronic multibacterial infections that can result in significant bacterial & inflammatory load in the body and HIV infection has been found to be associated with various forms of periodontal diseases. Besides Immune Reconstitution Inflammatory Syndrome (IRIS), following HAART, may also lead to increased frequency of periodontal disease among these patients. If co-infections & inflammation can increase the risk of HIV reactivation, can periodontitis in an HIV infected individual lead to HIV re-activation. This question remains unanswered, but initial evidence suggests a probable role of periodontitis in HIV re-activation. The clinical implication of such a role is that, periodontitis being most often preventable and definitely treatable, every attempt should be made to prevent and promptly treat this disease in individuals with HIV infection.

Background: The extent to which Human Immunodeficiency Virus (HIV) is associated with increases in carotid Intima-Media Thickness (IMT) independent of conventional cardiovascular risk factors is unclear. Hence, we evaluated whether independent of conventional risk factors, an increased carotid IMT occurs in African HIV infected patients with chronic Critical Limb Ischemia (CLI). Methods: Carotid IMT was measured in 217 sequentially recruited patients with CLI, 25 of whom were HIV positive and in 430 randomly selected controls from a community sample. Results: As compared to HIV negative patients with CLI, HIV positive patients were younger (49 ± 10 vs. 64 ± 11 years, p<0.0001) and had a markedly lower prevalence of hypertension and diabetes mellitus (p<0.0001), but a similar proportion of patients smoked (76% vs 67%). However, as compared to patients with CLI who were HIV negative, HIV positive patients had a similar increase in carotid IMT (HIV positive= 0.75 ± 0.14 mm; HIV negative= 0.79 ± 0.14 mm; Controls= 0.64 ± 0.15, p < 0.0001 versus Controls) even after adjustments for age, sex and conventional risk factors (HIV positive= 0.75 ± 0.13 mm; HIV negative=0.73 ± 0.15 mm, Controls=0.66 ± 0.15, p < 0.005). IMT was similarly increased in HIV positive patients with CLI as compared to controls when assessed in men, smokers, and black African patients only (p < 0.05-0.0001), or in those who were receiving highly active antiretroviral therapy (n=12, 0.74 ± 0.10 mm) as compared to those not receiving therapy (0.75 ± 0.15 mm). As compared to controls, the age- sex- and conventional risk factor-adjusted odds of having an IMT ≥ 0.8 mm was similarly increased in patients with CLI who were HIV positive (odds ratio= 8.89, CI= 2.79-28.32, p= 0.0002) as those who were HIV negative (odds ratio= 2.70 CI= 1.51-4.81, p < 0.001). Conclusion: These results suggest that despite being of a younger age, with or without conventional risk factor adjustments, marked increases in carotid IMT in HIV in Africa are a risk factor for CLI.

Background: There has been limited research to date on the effects of food assistance provided to HIV-infected adults in resource-constrained settings with a high prevalence of malnutrition and chronic food insecurity. We compare Antiretroviral Therapy (ART) adherence, weight gain, and CD4+ lymphocyte change among HIV-infected adult enrolled in a clinic-based food assistance program in Lusaka, Zambia versus a control group of non-recipients. Methods: We conducted a cohort study incorporating interviewer-administered surveys and retrospective clinical data to compare ART patients receiving food assistance with a control group of non-recipients. Medication adherence was assessed using pharmacy dispensation records. We use propensity score matching to assess the effect of food assistance on outcome measures. Results: After 6 months, food assistance recipients (n=145) had higher ART adherence compared to nonrecipients (n=147, 98.3% versus 88.8%, respectively; p<0.01), but no significant effects were observed for weight or CD4+ lymphocyte count change. The improvement in adherence rates was greater for participants on ART for less than 230 days, and those with BMI<18.5 kg/m2, a higher HIV disease stage, or a CD4+ lymphocyte count ≤ 350 cells/μl. Conclusions: Promoting optimal medication adherence among persons on ART is relevant to public health and the success of HIV control efforts. The provision of food assistance to HIV-infected adults on ART may have an incentivizing effect which can improve medication adherence, particularly among patients recently initiated on treatment and those with poor nutrition or advanced disease. The effects on body weight and immune reconstitution appear minimal.

Knowledge of HIV transmission is a prerequisite to practicing safer behaviors to prevent HIV infections and may be expected to vary by region because of cultural and socioeconomic determinants. A cross-sectional study was conducted in rural Kenya using a standardized questionnaire assessing HIV transmission knowledge, sociodemographic and other characteristics. Participants were recruited from the voluntary counseling and testing clinic and the general hospital population of Moi District Hospital. “High” HIV transmission knowledge scorers (≥ 81%) (Mean score) were compared with “low” scorers (<81%). Bivariate and multivariate logistic regression analyses were performed to examine factors associated with HIV transmission knowledge. Of 214 participants, 70 (33%) were HIV-positive, 104 (49%) were HIV-negative, and 40 (19%) did not know. Factors associated with low knowledge in multivariate analyses were lower education (OR 2.36, CI 1.03-5.46), lower household money on healthcare (OR 2.03, CI 1.28-3.21), higher clinic transportation costs (OR 3.14, CI 1.20-9.82), sex without a condom (OR 2.18, CI 1.12-4.26), positive HIV status vs. negative (OR 2.50, CI 1.22-5.26) and positive HIV status vs. unknown (OR 3.57, CI 1.33-9.09). Mean HIV transmission knowledge score was relatively high; however, a large proportion of patients demonstrated low knowledge. Identifying individuals at risk for low knowledge will support targeted HIV education and prevention programs.

Objective: The objective of this study was to identify the factors associated with presentation for care with CD4 cell count <200/mm3. Design: A Retrospective monocentric cohort study of the Guadeloupe section of French Hospital Database for HIV was conducted. Methods: Group 1 Cohort (CD4 <200/mm3, n=1076), Group 2 (CD4 200-500, n=973) and Group 3 (CD4 >≥ 500/ mm3, n=627) patients were included between 1 January 1988 and 31 December 2009. Factors associated with late presentation (CD4 count <200 cells/μL) were assessed using descriptive statistics and ordered multivariable logistic regression. Results: At the time of diagnosis, 40.21% of patients had than less 200 CD4 lymphocytes/mm3. Age older than 30 years OR: 1.55[1.14-2.10], p=0.005, male gender OR: 1.83[1.58-2.12], p<0.0001, access to care before 1992 OR: 1.56[1.03-2.02], p=0.038 and alcohol use OR: 8.80[2.26-34.36], p=0.002 were independently associated with a low CD4 cell count. Conclusion: The findings of this study (underline the need to expand HIV testing beyond the usual facilities) may be of value in helping to achieve earlier access to treatment in HIV-infected patients in order to minimize the individual risk of morbidity and mortality.

We investigated the HCV genotypes in HIV positive people who inject drugs (PWID) identified in Dhaka, Bangladesh in 2003. Genetic analyses revealed that the PWIDs shared closely related HIV strains subtype C genotypes but HCV genotypes in them were distantly related. This indicates that the mode of transmission of HIV and HCV infections in PWIDs might be different.