Jornal de AIDS e Pesquisa Clínica

Objective: To identify factors associated with HIV-transmission from husbands to their wives within the existing HIV prevention and control program environment in West Bengal, India. Methods: In this cross-sectional study, information was collected from the study participants on socio-demography and various health issues including sexually transmitted diseases (STDs). They were also tested for blood borne and sexually transmitted infections. Women living with HIV were compared for behavioral and biologic markers against women who did not have the virus. Both these groups of women were married to HIV sero-reactive men. To detect recent HIV infection, HIV sero-negative women were tested by Polymerase Chain Reaction. Results: Of the 234 married couples, 29% (69/234) lived in HIV discordant relationship where wives were not infected with HIV and the rest were concordant for HIV infection. Six of the 165 women living in concordant relationship acquired HIV infection recently. Fifty six percent of the husbands were in advanced stage of HIV disease with CD4 count ≤200/μl while tested for the first time at ART center. Factors independently associated with HIV concordance were 'wives experiencing any STD-symptom after marriage' (Adjusted Odds Ratio (AOR) 2.05; 95% CI 1.09 - 3.83; p=0.02) and 'self-reported male condom use/reduced frequency of sex with spouse' (AOR 2.99; 95% CI 1.29-6.94; p=0.01). Although 'HSV-2 concordance' (Odds Ratio (OR) 2.46; 95% CI 1.32-4.59; p=0.004) and 'bacterial vaginosis' (OR 2.57; 95% CI 1.18-5.61; p=0.02) were associated with HIV infection in wives in uni-variate analyses, the strength of such associations weakened in multi-variate model. ART intake by husbands did not offer any protection against HIV infection in wives. Conclusions: Early initiation of ART among HIV discordant couples, strengthening of STD prevention and control and limitation of self-reported sexual risk reduction to inform HIV-program in India are underscored.

Objectives: To determine the effectiveness of the introduction of fixed-dose combinations of antiretrovirals (FDCAs) in reducing resistance, and to describe trends of resistance-associated mutations (RAMs) in relation to drug exposure and the risk factors associated with multi-class drug resistance (MCDR) in Catalonia (Spain). Methods: Observational prospective study of HIV Resistance in Catalonia from 2002 to 2008. We included 2,718 HIV+ patients (≥16 years of age) with virological failure (Viral Load>1000 copies/ml). Differences between the Pre-FDCAs period (2002-2005) and the Post-FDCAs period (2005-2008) were assessed by multivariate logistic regressions. Prevalence of resistances and exposure to ARVs. trends were also assessed by test of trend Results: We observed a downward trend from 2002 to 2008 in all class-resistance mutations and RAMS (p<0.0001). This trend coincides with a reduction in exposure to older ARVs., and with an increase in exposure to newer drugs. Multivariate analyses showed the Post-FDCAs period as an independent protective factor for the presence of any resistance, for MCDR, and for major mutations of reverse transcriptase and protease, with Odds Ratios (95% CI) between 0.32 (0.26-0.39) and 0.67 (0.51-0.86). Male sex, sexual transmission group, older age, duration of HIV infection, number of treatment failures and exposure to three-class drugs are also risk factors for the presence of MCDR. Conclusions: There was an important reduction of the risk of class-resistances, MCDR and RAMs in the Post- FDCAs period independently of others factors. Reductions in specific mutations are related to changes in antiretroviral use. These results support the use of FDCAs for the treatment of HIV infection.

Background: To determine the perceived prevalence (the response of known HIV diagnosis) and trends of HIV infection among mem who have sex with men (MSM) frequenting gay bathhouses; and (2) to identify the risk factors associated sexual practices.

Methods: A total of 424 MSM (Mean age 35.64, SD=10.05) recruited through informal social networks and the Internet participated in this study. Most participants were single and self-identified as gay (66.7%). Participants were asked to recall their sexual experiences while visiting a bathhouse for sexual purposes.

Results: 9.4% (n=40) of participants reported being HIV positive and approximately 14.5% (n=62) reported not knowing their status. MSM visited the bathhouses 1.76 times per month (SD=2.12) and involved themselves with 3 men (on average) per each visit. Statistically significant differences between having sex with or without a condom were found (p<0.001) reflect that risky behavior occurs (95% CI). Risk practices involving fluid exchange (condomless practices) were also reported. Ejaculation in the mouth was reported by 29.3% to 48.9% of all participants, and ejaculation in the anus was reported by 15.8% to 17.4% of all participants. Linear regression indicated that sex role, substance use, sexual orientation and number of monthly visits were predictors of sexual practices involving fluid exchange.

Conclusion: Results from this study show that HIV prevalence and HIV-related practices is high among MSM who use bathhouses to engage in sexual activity, and this can serve as a reference for researchers interested in these behavioral patterns and for local authorities aiming to promote health education among MSM.

Background: HIV Status disclosure and sexual behavior of PLWHAS is vital for HIV prevention efforts and the couple’s health in the context of accelerated highly active antiretroviral therapy. Therefore it is essential to see serostatus disclosure and sexual behavior of PLWHAs who are taking ART as this has implication for prevention of HIV epidemic.

Objective: To assess sero status disclosure and condom use among PLWHAs who are on ART in Assela town health facilities, Arsi Zone, Oromiya Region.

Methodology: institution based cross sectional study was conducted using both quantitative and qualitative methods from February to April 2013 among 324 PLWHAs who are taking ART from Assela town health institutions. Structured and pretested questionnaire was used for data collection of qualitative part and semi-structured questionnaire was used for qualitative part.

Result: More than half of the participants 167 (51.5%) were females. The majority 264 (81.5%) were married. Over all 94.1% of the respondents had disclosed their HIV positive result to their regular partner. Knowledge of partners’ sero status, prior discussion about HIV, type of relationship with partner, living in the same home and duration of HIV test were determinants of sero status disclosure. The proportion of consistent condom use in this study was (60.8%) and the main reason reported for not using condom were partner’s refusal (37.4%). Prior discussion about HIV test, duration since ART started, history of condom use and sex of respondent were found to be determinants of consistent condom use.

Conclusion: Although the magnitude of HIV positive status disclosure to regular partner found in this study was encouraging, lack of disclosure by a minority resulted in a limited ability to engage in preventive behaviors. Therefore HIV prevention programs and organizations working on HIV should further enhance disclosure and condom use using different mechanisms like mass health education and face to face counseling.

Background: Skin manifestations are usually the first presentation in HIV infection. Most common of these manifestations is herpes zoster. This study was carried out to determine HIV seroprevalence in patients with herpes zoster and to identify factors that may affect its prevalence.

Methods: 40 patients were included in the study after clinical confirmation of herpes zoster. Every patient was interviewed privately to assess demographic, social and medical information. Data were obtained with high confidentiality. Blood samples were collected and tested for presence of antibodies against HIV.Khartoum.

Results: Out of the 40 patients screened, 6 (15%) were found HIV seropositive, with significant association in patients with previous herpes zoster attack, history of traveling to endemic areas and sexually transmitted infections.

Conclusion: We found high prevalence of HIV in patients with herpes zoster. These results may indicate the need for early screening of herpes zoster patients to facilitate better management of HIV infection.

Background: The prevalence of sexual risk behaviour among South African university students is high. Alcohol consumption has been identified as one of the underlying factors to students’ sexual risk behaviour. There is a dearth of studies conducted on the relationship between students’ alcohol use and sexual risk behaviour. The aim of this study is to investigate the relationship between alcohol use and sexual risk behaviour among sexually active students at the University of KwaZulu-Natal.

Methods: The study was underpinned by a quantitative research paradigm. A questionnaire designed to be completed by students without the intervention of the researcher was used. In the questionnaire, alcohol use was measured as use over the previous six months compared with instances related to engaging in penetrative sex and on the most recent incident of penetrative sex. In the context of this study, the concept sexual risk behaviour is used to imply not using condoms in the past six months with a new partner or having multiple sexual partners. The relationship between students’ alcohol use and sexual risk behaviour was determined by performing bivariate and multiple logistic regressions.

Results: There was statistical significant relationship between alcohol use and having multiple sexual partners among female and male students. Among males, failure to use condoms consistently with new partners was significant. This phenomenon was common among male students who frequently used alcohol in relation to engaging in penetrative sex (OR 0.74; CI, 0.00-2.07). Though there was no statistical significance, findings reveal that the risk of not using condom with new partners was twice higher among female students in particular among females who frequently used alcohol in relation to engaging in penetrative sex.

Conclusion: Findings in this study are in agreement with, and build on previous studies that related alcohol use to having multiple sexual partners. Failure to use condoms consistently was related to consuming alcohol in relation to engaging in penetrative sex. This experience was common both among female and male students who frequently used alcohol in relation to engaging in penetrative sex.

Background: In HIV-patients, a proportion of benign HPV-associated oral lesions (HPV-OLs) contain high risk- HPV (HR-HPV) sequences. Recent studies demonstrated a p16INK4a overexpression in HPV-induced cancer and dysplastic lesions through pRB degradation by the E7-HPV oncoprotein; so, it has been considered a surrogate marker of HR-HPV oncogenic activity.

Objective: To establish the p16INK4a expression in HPV-OL from HIV-infected patients. Materials and method: A cross-sectional study was conducted in three HIV/AIDS referral centers in Mexico City. We performed histopathological diagnosis, HPV-DNA amplification, direct sequencing, and p16INK4a immunohistochemical staining in HPV-OLs. The U-Mann-Whitney, X2, and Fisher’s exact tests were used to determine the association between variables.

Result: In a total of 849 adult HIV-individuals examined, we found 29 (3.4%) patients with HPV-OLs, being multifocal epithelial hyperplasia (51.7%) the most common. Low-risk-HPV (LR-HPV) types were identified in 82.7% and HR-HPV in 10.3%. HPV-OLs exhibited a moderate/strong but only nuclear p16INK4a immunoexpression; no correlation between p16INK4a expression and HPV type were found.

Conclusion: In HPV-OLs from HIV-infected patients, the comparable p16INK4a immunoexpression, independently of the specific HPV-type, as well as the absence of cytoplasmic staining, may suggest a lack of HR-HPV activity. Longitudinal studies based on oncogenic viral gene expression are warranted.

Objective: This study was aimed to correlate in vivo interferon (IFN) inducible gene (IFIG) expression and IFIG induction with viral-load (VL) and VL-kinetics of Human-Immunodeficiency-Virus (HIV) or Hepatitis-C-Virus (HCV) in HIV-positive patients treated with pegylated IFN-alpha-2a (PegIFNα).

Methods: HIV mono-infected patients (N=8) and HIV/HCV co-infected patients (N=23, without HIV-viremia) were treated with PegIFNα (180 μg/week) for 12 and 48 weeks, respectively. Blood sampling for monitoring IFIG expression occurred at day_0 and week_3, _6 and _12 for HIV mono-infected patients vs. only at day_0 and week_48 for HIV/ HCV co-infected subjects. IFIG expression (N=20) was measured in peripheral blood mononuclear cells by bDNAassay. VL levels/changes in plasma were analyzed for correlation with IFIG expression/induction at/between selected time points. Overall, P<0.05 was considered significant.

Results: None of the 20 IFIG expression profiles at day_0 correlated significantly with HIV-VL at day_0. Expression at day_0 of 3 IFIG (APOBEC3G/OAS1/OAS2) correlated significantly (r>+0.42/P<0.05) with HCV-VL at day_0. The strongest antiviral effect [measured as median viral decline per week: ΔVL/week (log10)] occurred in common against HIV and HCV between day_0 and week_3 during 12 weeks of continuous PegIFNα treatment in both cohorts. Expression at day_0 of 1 IFIG (APOBEC3A) correlated significantly (r<-0.71/P<0.05) with HIV-ΔVL/week (log10) from day_0 to week_3. No significance was reached in correlations between expression values of 20 IFIG at day_0 and HCV-ΔVL/week (log10) from day_0 to week_3. No significant correlation was detected between IFIG expression changes (ΔIFIG=induction) from day_0 to week_3 and HIV-ΔVL/week (log10) from day_0 to week_3. Interestingly, induction of 1 IFIG (ΔISG20) from day_0 to week_48 was significantly associated (P<0.05) with permanent HCV clearance.

Conclusion: This study demonstrates the differential specificity of PegIFNα mediated molecular actions by dissecting the kinetics of IFIG expression and induction, suggesting multiple, possibly non-overlapping mechanisms for antiviral effects against HCV and HIV.

Objective: Human Papillomavirus (HPV) infection is found to be more prevalent in HIV-infected than uninfected men (73% vs. 43%). Young men who have sex with men (YMSM) with HIV with HPV anal lesions often deny or are unaware of these lesions. Unless screened, these lesions will remain undiagnosed with a potential for transmission to sexual partners and disease progression. We explored screening practices for HPV and therapeutic/diagnostic outcome of HPV screening among YMSM with HIV, including co-infection with other STIs.

Methods: Chart review of all HIV+ adolescent males, age 13-24 years, reporting MSM, engaged in care, 2007-2009, at an inner city HIV clinic for adolescents and young adults.

Results: The average number of males enrolled in care was 143 per year (range 127-166) and none received HPV vaccination. By visual inspection 50 YMSM were identified with anal HPV lesions: 46% received anal cytology, 30% were identified as abnormal (ASCUS, LGSIL, or HGSIL); 90% received medical treatment (Imiquimod or Podophylline); 72.3% with no evidence that lesions cleared; 68.6% were referred to Colorectal surgical clinic. In addition, 62% had STIs diagnosed: syphilis (42%); gonorrhea (39%); chlamydia (26%), and HSV (19%), Hepatitis B (6%); Hepatitis C (3%). Clearance of HPV was associated with having more than one STI (p=0.03).

Conclusions: Detecting genital warts by visual inspection without acetic acid is an insensitive screening, thus the number of males suspected to have HPV would be higher than the 50 identified by visual inspection. In this cohort of HIV+ YMSM with HPV, a third were identified as having abnormal cytology, which is worrisome for infection with oncogenic HPV subtypes. Not all received HPV medical and or referred for surgical treatment. The majority of the cohort was co-infected with STIs, and having more than one STI was associated with clinical clearance of HPV lesions

Background: Every day there are nearly 1800 new HIV infections in children under 15 years of age, more than 90% occurring in the developing world. Most (about 90%) of these infections are associated with mother-to-childtransmission (MTCT). Moreover about, 1400 children under 15 years of age die of an HIV-related illness per day. Hence, this study tried to assess the knowledge, attitude, and practice with prevention of mother-to-child transmission of HIV/AIDS among pregnant mothers attending antenatal clinic.

Methods: An institution-based cross-sectional study was conducted among pregnant mothers attending antenatal care clinic at Ambo General Hospital from April 1-May 30, 2014. A systematic random sampling technique was used to select 238 antenatal care attendees. Data were collected through structured pre-tested questionnaire. The data were entered into Epi Info and analyzed by using SPSS software for windows. Frequency and percentage were done.

Results: The study showed that all of the respondents heard about HIV/AIDS and about MTCT of HIV. Concerning the time of transmission of the virus from the infected mother to her child, 74 (31.4%) responded that it could be through breast feeding, 69 (29.2%) during pregnancy, 6 (27.5%) during labor and 2 (11.9%) did not know respectively. All the respondents have been tested for HIV. Among these, 87 (36.38%) tested six months ago, 76 (32.2%) tested three months ago, 37 (15.7%) tested one year ago and 36 (15.3%) tested on the recent pregnancy. All of them had preand post-counseling services. The study have showed that most of the respondents, 221 (93.6%), had good attitude towards PMTCT of HIV, while only 6.4 (28.73%) had poor attitude.

Conclusion: Accordingly all of the mothers knew about prevention of mother-to-child transmission of HIV and 93.6% had good attitude towards it. Only 44.4% of the respondents knew that antiretroviral drugs given for seropositive pregnant mothers could reduce the risk of HIV transmission. All the of mothers have been tested for HIV/ AIDS. Much has better to be done to maintain mothers knowledge, attitude and of all to promote the use of ART and other PMTCT of HIV methods through organized intervention programs as well as by ensuring the supply of the ART medications used for PMTCT of HIV beside the treatment of established infection.

Objectives: Concerns related to stigma and confidentiality limit HIV-related study recruitment and retention of Black men who have sex with men and women (MSMW). This paper examines lessons learned from recruitment strategies utilized in enrolling 437 participants between 2007 and 2011 for a randomized controlled trial to test a culturally specific HIV risk-reduction intervention for Black MSMW.

Methods: Interested respondents completed a brief screener and participants completed surveys at baseline and at post, 3 and 6 months follow-up. Recruitment patterns were assessed by examining the source of study information reported when respondents were asked how they learned about the study. Chi-square tests were then conducted to examine differences in the distribution of participants by self-reported HIV status, age group and socio-economic status (SES) for each type of study information source.

Results: Regardless of HIV or SES, study respondents were more likely to have received information about the study through a service agency than from other sources. Participants ages 30-49 and 50+ years were most likely to have learned about the study from an agency (34.9% and 27.0%, respectively) or another participant/friend (20.1%, 23.1%) and least likely to have found out from bus (0.8%, 0.0%) or radio (1.3%, 0.0%) advertisements; whereas younger participants were more likely to have heard about the study through a friend/participant (23.4%) than an agency (15.4%). Although, 14.1% of participants’ ages less than 30 years reported the Internet as their source of study information, this compared to just 2.7% and 4.8% for participants in the 30-49 and 50-plus age groups.

Conclusions: While agencies and referrals from personal networks appear to be the most significant recruitment source for potential HIV research participants, there is evidence that Internet based tools may enhance recruitment, particularly among younger Black MSMW.

Objective: To assess the immunologic and virological response after 5 years of highly active antiretroviral therapy (HAART) in treatment naive HIV-1 infected adults presenting late in the course of their disease.

Design: Prospective long term observational study. The response to HAART is described in HIV-1 infected ARV naïve adults initiating treatment at CD4+ cell counts < 200 during June 2005 through December 2005 in Barbados, West Indies. Baseline values as well as 5 years post-HAART values for CD4+ cell counts and viral load were recorded for the cohort.

Results: 50 ARV naïve HIV-1 infected adults initiated treatment when their CD4+ cell count was, 200. Most received Combivir plus Nevirapine or Efavirenz. At the baseline, their median CD4+count was 36 cells/μL (IQ Range:15-82) and their median viral load was at 75,000 (4.87 log10) with an IQ Range of 52,700-226,000. After 5 years of therapy, the median increase in the CD4+ cell count was 122 cell/μL (IQ Range, 45-185). Twenty three (46%) patients had achieved CD4+ cell counts of >200 cells/μL. 36 (72%) patients had an undetectable viral load (<50 copies/mL). The median decline in viral load at 5 years of therapy was 74,950 (4.87 log10) copies/mL with an IQ Range of 52,700 -226,000.

Conclusion: In this relatively small cohort of treatment naïve patients presenting late in the course of HIV disease, there was good immunological and virological response after 5 years of initiating HAART irrespective of their baseline CD4+ counts and viral load, age or gender.

Background: Mother-to-child HIV transmission remains very high in Cameroon. Therefore follow-up of numerous HIV-infected infants is a critical issue in the country. Here, we investigated the file of HIV-infected infants remaining asymptomatic in the absence of anti-retroviral therapy (ART). The first goal was to obtain an estimate of the prevalence of infants with an HIV controller like status.

Method: HIV-infected infants, aged 6 months to 17 years presenting at CIRCB for biological examinations were enrolled upon signed a proxy-consent. The enrollment took place from April 2011 to February 2013. From the medical file of 359 HIV vertically-infected infants, 41 were found naive of anti-retroviral therapy and free of clinical symptoms. Diseases related to HIV infection (oral candidosis, zona, chronic diarrhea, pulmonary tuberculosis, dermatitis) were more particularly checked and corresponding infants not included in the study. From the selected infants, CD4 counts and viral load were recorded. Non-exposed children were enrolled as control group.

Results: Of the 359 infants, 41 were ARV-naive and free from HIV clinical symptoms. Five of them (12%) exhibit a viral load < 1200 RNA copies/ml. Their CD4 counts were found not statistically different from those of a control group of HIV negative infants (p=0.33). Furthermore, ten years after contamination, three children did exhibit a viral load < 5500 RNA copies/ml. Altogether, this suggests the existence of pediatric HIV controllers (pHIC) with a frequency much higher (>10%).

Conclusion: Our preliminary cross-sectional study highly suggests the existence of pediatric HIV controllers like in Cameroon despite all disfavoring living conditions. However, a longitudinal study would be required to confirm this hypothesis. The development of an HIV vaccine applicable to infants of countries with high incidence of HIV-infected people should benefit from the immunological analysis explaining the HIV controller (HIC) status.