Jornal de AIDS e Pesquisa Clínica

Background: Active patient involvement is one of the aims of patient-centered care. Little is known regarding the unique impact of patients’ active participation in their care on health outcomes, and scales are needed to measure this construct. The aim of the present study was to examine the application of the Doctor-Patient Relationship: Active Patient Involvement (DPR:API) scale, a 5-item scale, in predicting relevant health outcomes among HIV positive patients.

Methods: In Study 1 we compared active patient involvement between long survivors (those who survived more than twice as long as expected after getting an AIDS defining symptom; n=176) and normal course controls (HIV positive patients; n=79). Study 2 was a longitudinal study following the normal course controls to determine whether active patient involvement at baseline would predict adherence to combination antiretroviral therapy (ART; percentage of missed doses) using the AIDS Clinical Trials Group scale (ACTG) at one-year follow-up.

Results: In Study 1, long survivors were significantly higher on active patient involvement than the normal course HIV controls. In Study 2, hierarchical multiple regression models showed that patients’ involvement in their care at baseline significantly predicted change in percentage of missed doses one year later, such that patients who were more involved early in treatment became more adherent to ART after one year.

Conclusion: Findings highlight the relevance of patient involvement in their care to important health outcomes. Interventions designed to help patients become more active in their care throughout the illness trajectory might positively affect medication-taking behaviors and survival. The DRP:API offers an easy and quickly-administered tool to assess patient involvement within the context of both research and practice.

Aim: This retrospective notes review determined the aetiology, clinical presentation and mortality in patients with pleural effusion over a 5-year period. Method: A retrospective audit of patients' folders from January 2008-December 2012. Data collected included demographics, clinical presentation, and laboratory and mortality outcome. Results: Of 199 folders reviewed, 108 were males. Male:female ratio was 1.18:1. Major symptoms were cough 156(78.4%), chest pain 142(71.4%) and dyspnoea 130(65.3%). Major signs included pyrexia 120(60.3%), ascites 48(24.1%) and hypotension 42(21.1%). The more common aetiology were TB 84(42.2%), parapneumonic 28(14.07%) and cardiac failure 28(14.07%). Forty-six (37.1%) of 120 patients screened were HIV positive. Mortality was 33(16.6%). Conclusion: Pleural effusion is a common presentation in our clinical practice. Bacterial infection particularly TB is the most common cause. The mortality rate in patients with pleural effusion is still high. Determining the aetiology and early intervention are needed to reduce the mortality in patients with pleural effusion.

Hepatitis B infection is a major cause of morbidity and mortality in HIV-infected patients. While the majority of persons infected with hepatitis B are found in the developing world and were infected at birth or in early childhood, most studies in HIV and HBV co-infection have been conducted in developed countries, where the main modes of transmission are either intravenous drug use or sexual transmission. The few studies that have been conducted in resource-limited settings have very few patients, and the laboratory parameters for proper evaluation of these studies are frequently incomplete. The applicability of United States and European guidelines for HBV-co-infected HIV patients in resource-limited settings (RLS) is therefore uncertain, and may be constrained by financial issues especially with regard to appropriate initiation of antiretroviral treatment. This review discusses the few studies conducted in RLS, and proposes guidelines for treatment based on the best available evidence from these studies. In addition, the effect of co-infection on disease progression, including the role of HBV genotypes and HIV subtypes and the use of hepatitis B vaccination in HIV infection is reviewed.

Background: Healthy sexuality is a developmental process which needs investments from parents. Nonetheless, little is known about the effect of parenting practices and styles on the sexual risk behavior of young people. Objectives: to assess the effect of different parenting styles and parenting practices on the sexual behavior of adolescents.

Methods: A cross-sectional study was conducted among 3840 randomly selected high school adolescents using three stage sampling in Addis Ababa, Ethiopia. Data were collected by a self-administered anonymous pre tested questionnaire. Logistic regression analysis was done to identify parental factors associated with sexual behavior.

Results: From the 3543 students participated in this study 723(20.4%) respondents reported ever having sexual intercourse and nearly three -quarter of those who initiated sex were involved in risky sexual practices. Respondents who live with both parents [AOR= 0.48 (95%CI: 0.21-0.83)] and perceived connected to their parents [AOR= 0.51(95%CI: 0.22-0.96)] were less likely to experience risky sexual behavior. Similarly, students from authoritarian and authoritative parents were more likely to have safe sexual practices [AOR = 0.38(95%CI: 0.23-0.86)] and [AOR = 0.41(95%CI: 0.24-0.93)] respectively compared to children from permissive parenting styles. In addition, parent child communication about sexual issues [AOR =0.56 (95%CI: 0.31-0.94)] and parental monitoring were protective from risky sexual behavior [AOR =0.52(95%CI: 0.32-0.92)].

Conclusion: Appropriate parenting practices have a shielding effect from adolescent sexual risk behavior. Interventions that enable parents to build proper parenting practices, skills and styles have paramount importance.

Background: Antiretroviral therapy (ART) programmes have been extensively scaled-up in countries like Uganda. While success of these programmes largely depends on lasting patient retention, attrition rates are often especially high in the first year after treatment initiation. Our study aimed at analysing recent data of a Ugandan ART patient cohort regarding 12 months ART outcomes and programme retention.

Methods: Virika Hospital in Fort Portal, Western Uganda, is offering ART services according to national treatment standards. A routinely collected patient monitoring database was used for retrospective analysis, following-up 369 patients for 12 months after enrolment. Primary outcome indicator was 12 months retention (being alive and active in programme). We assessed clinical ART progress, attrition, mortality and influencing factors, particularly gender differences.

Results: From 369 ART patients, two-thirds were female. Overall ART outcomes and adherence in this cohort were satisfying, but in men, improvement of CD4-cell counts and weight gain after 12 months were significantly lower than in female patients. In total, one in eight patients (12.2%) was subject to all-cause attrition after 12 months. We identified low CD4-cell count at ART enrolment as the only independent risk factor for attrition after 12 months (p=0.037), while male patients were at highest risk for this, showing significantly lower CD4-cell counts at ART initiation (p=0.008).

Conclusion: We found overall outcomes of this ART programme encouraging, however, attention must be paid particularly to male ART patients. Men were underepresented in our cohort, enrolled in the ART programme at later disease stage, and showed worse ART outcomes after 12 months. Our data suggests that the known challenge of male ART performance is persisting, and that it has not sufficiently been addressed in the past years. Especially the problem of male late-presenters in ART programmes should lead to action in health services planning and implementation, for example by offering more HIV testing opportunities to men.

Introduction: Oral lesions may be the first indicator of HIV infection or of HIV-disease progression. Few studies have characterized oral lesions in HIV-seropositive South Africans receiving HAART. This aim of this study is to define the prevalence of HIV-associated oral lesions in a South African population sample and to investigate the relationship between these lesions and gender, age, CD4+ T-cell count, neutrophil count, viral load, type of HAART, and alcohol and tobacco use.

Methods: Four hundred and thirty five patients were interviewed and examined. Additional data was obtained from their hospital files. Descriptive statistics and Chi-squared tests with p<0.05 considered as significant, were applied.

Results: Four hundred and eighteen participants (96%) were on HAART. Thirty-two (7%) had oral lesions strongly associated with HIV infection and 24 (6%) had ‘other lesions’. Some presented with multiple lesions. A total of 41 oral lesions associated with HIV infection were recorded and of these, oral candidiasis was the most common (68%). No relationships existed between the presence of oral lesions associated with HIV infection and gender, age, neutrophil count and alcohol and tobacco use.

Conclusions: The prevalence of oral lesions strongly associated with HIV-infection in this study population was significantly associated with CD4+ T cell count, viral load and the type of antiretroviral treatment.

Background and objectives: Streptococcus pneumoniae continues to cause serious infections in HIV-positive individuals in the era of highly active anti-retroviral therapy. This led to the recommendation to revaccinate HIV-positive individuals with PPV23 five years after primary vaccination. The benefits of revaccination and the impact of long term highly active anti-retroviral therapy (HAART) on antigen-specific B cell reconstitution have remained unclear thus far and were investigated.

Design and methods: We assessed antibody levels, opsonophagocytic activity and phenotype of pneumococcal polysaccharide (PPS) specific-B cells post-revaccination in long term HAART cohorts stratified according to CD4 count as group A (CD4>200) and group B (CD4<200). Anti-PPS IgG, IgM and functional antibody response against vaccine serotypes 14 and 23F were measured by ELISA and opsonophagocytic assay followed by phenotypic analysis of PPS14 and 23F-specific B cells using fluorescently labeled PPS.

Results: Significant increases in total and functional antibody titers were noted in groups A and B post-vaccination concomitant with significant rise in PPS-specific IgM memory B cells, a critical B cell subset required for protection against PPS although the overall response remained significantly diminished compared to HIV-negative volunteers.

Conclusion: Comparable increases in opsonophagocytic titers between study groups A and B concomitant with a comparable rise in PPS-specific IgM memory B cells indicate revaccination to be beneficial regardless of the degree of CD4 T cell reconstitution. These findings emphasize the importance of defining effective vaccination practices amongst high-risk individuals.

Introduction: The presence of HIV/AIDS increases the risk of development of mental disorders and the presence mental illness affects disease progression. The resulting co morbidity complicates help -seeking, diagnosis, quality of care provided, treatment and its outcomes, and adherence. Despite the fact that developing countries carry huge burden of both HIV/AIDS and mental illness, no data about the co-occurrence/link and factors associated is available in local setting. The aim of this study was to assess the prevalence of common mental disorder and associated factors among PLHA at Comprehensive HIV Care and Treatment Clinic of Debre Markos referral Hospital in 2013/2014. An institution-based cross sectional study with the Amharic version of the SRQ was conducted. Ethical clearance was obtained from Institutional Review Board of Debre Markos University and Informed consent was obtained.

Result: Mean age was 37.9 years ± 10.05 years. Prevalence of CMD is found to be 24.3%. Significant associations were found between CMD and past psychiatric illness, ART regimen, marital status, HIV/AIDS disclosure and perceived stigma.

Conclusion and recommendation: There was a significant burden of mental illness among HIV-infected individuals in this setting. It is important to note that the link between HIV care and treatment services and psychiatric service should strengthen. Hospital administrators must give better attention to inpatient mental health service including substance abuse treatment. Clinicians also should always assess HIV-infected subjects for depression, anxiety and other common mental disorders to ensure early detection and treatment.

Background: Newly diagnosed HIV-positive individuals are 35 to 100-fold more susceptible to Streptococcus pneumoniae infection compared to non-infected individuals. Therefore, the 23-valent pneumococcal polysaccharide vaccine (PPV23) has previously been recommended, though efficacy and effectiveness of vaccination remains controversial. Early severe B cell dysfunction is a central feature of HIV infection. The specific nature of the immune cells involved in the production of protective antigen-specific antibodies in HIV-positive individuals remains to be elucidated.

Objectives: Evaluate the antibody and antigen-specific B cell response to the 23-valent pneumococcal polysaccharide vaccine in newly diagnosed HIV-positive patients. Moreover, determine if newly diagnosed patients with CD4<200 cells/µl benefit from 6-12 months of HAART, allowing partial viral suppression and immune reconstitution, prior to immunization.

Methods: Newly diagnosed HIV-positive patients with CD4>200 cells/µl and CD4<200 cells/µl were immunized with PPV23. Patients with CD4<200 cells/µl received either immediate or delayed immunization following 6-12 months of HAART. Antibody responses, opsonophagocytic activity and phenotypic analysis of pneumococcal polysaccharidespecific B cells were studied.

Results: Newly diagnosed HIV-positive patients demonstrated CD4-dependent increases in antibody and opsonophagocytic titers thought to be commensurate with protection. Functional opsonophagocytic titers of patients with CD4<200 cells/µl immunized immediately compared to patients with CD4<200 cells/µl receiving HAART for 6-12 months were not significantly different. Pneumococcal polysaccharide-specific B cells were distributed evenly between IgM memory and switched memory B cells for all groups, but IgM memory B cells were significantly lower than in HIV-negative individuals.

Conclusions: Despite CD4-dependent pneumococcal polysaccharide-specific deficiencies in newly diagnosed HIV-positive patients, vaccination was beneficial based on opsonophagocytic titers for all newly diagnosed HIV-positive groups. In HIV-positive patients with CD4<200 cells/µl, 6-12 months of HAART did not improve opsonophagocytic titers or antibody concentrations. Based on these findings, immunization with the 23-valent pneumococcal polysaccharide vaccine should not be delayed in newly diagnosed HIV-positive patients with CD4<200 cells/µl.