Jornal de AIDS e Pesquisa Clínica

A workshop entitled: “Revisiting HIV inactivation, elite controllers, immunogenetics and new strategies for developing HIV vaccines” took place during a Eurovaccine Conference held in Rome in June 2016. The purpose of this workshop was to revisit old and new concepts and strategies in HIV vaccinology in the light of novel, and sometimes unexpected, data from recent preventative and therapeutic vaccine approaches that could guide future vaccine research. Panelists were asked to respond to five questions regarding key points and critical issues and problems in current HIV/AIDS vaccine research. Their responses are summarized.

Expanding HIV testing and counselling among pregnant women is critical for identifying those in need of followup care and subsequent interventions. Data from PPTCT centers provide invaluable inputs for estimating the seroprevalence of HIV among pregnant women within a region of the state. A retrospective analysis was carried out to look at the trends in the seroprevalence over a ten years period and overall effectiveness of the PPTCT program. At the M.G.M. Hospital in Kalamboli, Navi Mumbai, Maharashtra in India, women registered at the antenatal clinic of the hospital and consenting to undergo testing after counselling were tested for HIV seropositivity. Three different HIV antibody detection tests were used as per the National AIDS Control Organization (NACO) guidelines. Out of a total of 27256 women who had registered, 26516 (97.3%) underwent counselling and all of these agreed to undergo testing. Most women that underwent counselling and testing for HIV were in the second trimester of their pregnancy. Maximum women (66%) who agreed for counselling and HIV testing belonged to the age group of 21-30 years. Majority of the women counseled (82%) were aware of HIV and AIDS. 89% of the women who were positive for HIV belonged to the age group of 21-30 years. Overall seropositivity for the ten years was 0.6%. The HIV seropositivity decay rate of -0.351 (p<0.0006, 95% CI: -0.499 to -0.203) shows significant downward trend among pregnant women in Navi Mumbai over the last decade. The trend analysis of the data in our study suggests that if the PPTCT program is implemented effectively, the prevalence of new seropositive women could be halved in as little as two years.

Background: Female genital tract, including vulval, histoplasmosis is reported rarely despite an increased propensity for cutaneous involvement by disseminated histoplasmosis (DH), even in patients with acquired immunodeficiency syndrome (AIDS). Methods: Sixteen year retrospective study investigating vulval involvement by histoplasmosis. Results: Of 239 patients with DH, 6 had vulval involvement and were confirmed to have HIV infection and AIDS. Seventeen biopsies (9 vulval, 8 extravulval) from these 6 patients form the study cohort. Patients 1 to 4 had simultaneous vulval (5) and extravulval (5) cutaneous biopsies. Eight cutaneous biopsies demonstrated diffuse dermal infiltration by histiocytes containing budding yeasts of H. capsulatum variant capsulatum (HCVC). A single thigh lesion demonstrated diffuse dermal karyorrhexis and myriad extracellular HCVC and a lymph node were diffusely effaced by histiocytes containing HCVC. Patient 5 had concomitant, co-lesional disseminated Kaposi sarcoma and HCVC infection. Patient 6 had 2 initial biopsies that demonstrated H. capsulatum variant duboisii (HCVD). Three biopsies of persistent facial and vulval plaques and a vulval ulcer, despite amphotericin treatment, confirmed HCVD, Cytomegalovirus and HCVD and Herpes simplex virus infection in each of the persistent lesions, respectively. Patients 2, 3 and 4 died before treatment was commenced. Patient 5 was lost to follow-up and did not receive any treatment. Patient 1 had resolution of DH following treatment with itraconazole. Persistent cutaneous lesions (Patient 6) healed with aciclovir and ganciclovir but uterine cervical squamous carcinoma was diagnosed 6 months later. Conclusion: Vulval involvement by histoplasmosis shares overlapping clinical features with many infections and tumors. Vulval biopsies are pivotal for diagnosis and allied therapeutic monitoring, particularly in the context of AIDSassociated co-morbid pathology.

It is estimated that 93% of the global schistosomiasis prevalence is found in sub-Saharan Africa, with the highest prevalence and intensity rates occurring in children and adolescents. Schistosomiasis infection is associated with detrimental developmental effects. The current study presents a hierarchical conceptual framework for understanding the role of socio-cultural-cognitive factors that influence risk behaviour among children, especially young girls, living in this hyperendemic setting. This study sought to determine the impact of caregiver monitoring on adolescent girl’s risk behaviours that may increase their risk of infection, especially with schistosomiasis, a neglected tropical disease that is pandemic in this region and has been associated with increased risk of HIV infection. This was a school-based, cluster, randomised, cross-sectional study conducted among 970 adolescent girls living in KwaZulu-Natal, South Africa. A questionnaire was administered by a trained research counsellor and urine samples were co microscopy. Microscopy results showed a moderate prevalence of schistosomiasis infection (32.2%) among girls. Binary logistic regression revealed social (playing and swimming) and domestic (collecting water, doing laundry and washing blankets) water contact behaviours as significant predictors of infection. Caregiver monitoring was ineffective in reducing risk behaviours. The current study presents a conceptual model for understanding disease acquisition among children living in resource limited settings. The SCC model highlights the role of social and culturally rooted interactions that influence an adolescent girl’s capacity to act; subsequently increasing their risk of schistosomiasis and HIV infection.

Introduction: Worldwide over half of all new infections are among young people. The primary prevention and control of the spread of HIV/AIDS infection is through awareness and changing behaviour remains at the highest priority. The aim of the study was to assess the attitude and cognitive distortion towards HIV/AIDS among undergraduate students of Madda Walabu University Southeast Ethiopia. Methods: Cross sectional study with quantitative methods of data collection was employed among 605 randomly selected under graduate regular students in March, 2014. Data were collected using self-administering questionnaire. The analysis employed using SPSS version 20 to calculate t-test and ANOVA. Result: The average number of students of Madda Walabu University who had poor attitude on sexual abstinence241 (39.8%), mutual monogamy 274 (45.3%), use of condom 227 (37.5%) and towards people living with HIV. The ANOVA psychological–cognitive distortion of the study participants had statistically significant difference among students age [F (6,594)=2.134, P<0.05] and academic year level [F (6,598)=2.471, p<0.05] on their total score of all-or- nothing thinking. Statistical significant difference was also observed between age and overgeneralization thinking of participants, F (6,594)=2.619, p<0.05 and residential status, F(6,593)=3.646, p<0.01. Similarly, age of the students has a statistical significant effect on mental filtration, F (6,594=2.399, p<0.05). One sample t-test showed t-value for abstinence (t=-1.096, mutual monogamy df=604, <0.05) and condom use (t=-283, df=604, p<0.05) was less than the critical t-value at 0.05 level. Conclusion: Socio-demographic variables such as age, sex, academic year level, admission type, had significant effect on cognitive distortions or dysfunctional belief about sexual abstinence, mutual monogamy and condom use. Students indicate unfavourable attitude towards those infected with HIV/AIDS. HIV/AIDS counselling, health education and intervention strategies must focus on behavioural changes, safer sex and changing the negative attitude towards HIV/AIDS.

Background: HIV/AIDS pandemic is the world’s most deadly disease that has killed more than 25 million people so far. Appropriate antiretroviral viral treatment (ART) reduces mortality and morbidity and enhances quality of life. Adherence to both follow up clinics and drugs is crucial to this effect. Objective: To assess level of adherence to antiretroviral treatment and its determinants among patients on ART in Oromia regional state, Ethiopia. Methods: Cross-sectional study design was used. For the study purpose, the region was divided into four strata so that different socioeconomic characteristics of the study population will be represented. List of health facilities that had a case load of >500 patients across the strata was used as sampling frame and health facilities were randomly selected. The Sample size was proportionally assigned to health facilities and every other patient visiting the selected health facility was included and a total of 1632 study participants (age 15 years and above) were interviewed. The patients’ follow up chart was used to extract baseline clinical data. Epi Info 7 was used for data entry and analyzed using SPSS 20. Descriptive statistics were used to determine sociodemographic characteristics and level of adherence. Logistic regression model was used to identify predictors of adherence. Results: Ninety seven percent of patients had good adherence to ART. Factors associated with better adherence were housewives (AOR, 5.10; 95% CI, 1.30, 19.98), baseline CD4 count <350 cells/ml (AOR: 2.21; 95% CI: 1.13, 4.34) and patients free of addictive substances (AOR: 7.42; 95% CI: 1.46, 37.81). Significant proportions of patients believe that worshiping and holy water (“Tsebel”) can cure HIV/AIDS. Conclusion: The vast majority (97%) of the respondents were in optimum adherence to the treatment. Various factors were associated with optimum adherence to antiretroviral treatment. Knowledge and attitude of PLWHA towards ART should be addressed carefully.

Nocardiosis is relatively uncommon in children and adults with acquired immunodeficiency syndrome (AIDS), despite the profound associated cellular immunodeficiency. Acquired most often by inhalation and less commonly by percutaneous inoculation, subsequent hematogenous dissemination may lead to infection of almost any organ, with a particular predilection for the central nervous system. Nocardial brain abscesses are rare. To the best of our knowledge, pediatric Nocardial brain abscesses have not been documented in Human Immunodeficiency Virus (HIV)-infected children in the English-language literature, to date. In reporting two Nocardial brain abscesses in a 9 year old AIDS patient with intermittent seizures, we highlight the difficulty associated with the ante-mortem diagnosis of Nocardial brain abscesses, and the need for cognizance of rare entities occurring in HIV-infected children. Furthermore, we emphasize the pivotal role of the autopsy in finalizing the nature of the cerebral pathology, the cause of the seizures albeit post-mortem, a cause of death and in providing a platform for continued learning in the AIDS era.

Background: This paper introduces a method to estimate HIV incidence in Brazil using surveillance data. The interest is to estimate the annual lag (time from infection to reporting) distribution among incident cases in a given year with observations arising from a right truncated version of the distribution. Methods: For each treatment-naïve HIV case aged 15 years and over reported from 2004 to 2015 we estimated the time since infection based on a statistical model that relates the first CD4 count to time since infection. Under the assumption the lag distribution is expressed by a logistic probability distribution, we estimated HIV incidence as the upper limiting value of the logistic function. Since this approach requires at least eight observations per year, to estimate HIV incidence in recent years (2009-2013), we used linear regression models to estimate the missing observations for these years due to truncation in 2015. Using this approach, HIV incidence was estimated from 2004 to 2013, separately for males and females. Results: In 2013, HIV incidence among people aged 15 years and over was estimated to be 44827 (95% CI 41143-47987), 32459 men (95% CI: 29775-34642) and 12368 women (95% CI: 11368-13345). Results from 2004- 2013 have shown an increase among men and a slow decrease among women. The estimated proportion of cases reported less than one year after infection increased from 24.6% to 35.2%, among men, and from 35.1% to 45.8%, among women. For men who became infected from 2004 to 2013, 35.6% of the cases were not reported by year 2015 and among women, 23.2%. Conclusion: The delay between HIV infection and diagnosis is of concern. Designing interventions to motivate testing is essential, especially among most-at-risk groups, as the faster HIV infected cases are linked to care, the faster the HIV incidence curve will turn downward.

The search for a preventive vaccine that can halt the global pandemic is the ultimate goal of HIV research. Development of a vaccine against HIV-1 has been plagued by many insurmountable challenges. Different vaccine concepts have been tested to overcome these challenges. Experimental vaccines that showed promise in preclinical studies were advanced into clinical trials. Yet, human trials proved to be a huge disappointment until the results of the RV144 trial in Thailand. This trial not only provided the first evidence of a modest efficacy, but also valuable insights on the possible immunologic correlates of vaccine protection. Currently, the HIV vaccine research landscape has been rejuvenated by two major developments. On one hand, there has been a resurgence of interest in T cell-based vaccines with the promising results obtained using a recombinant cytomegalovirus vector vaccine. On the other hand, the discovery of more than a hundred broadly neutralizing antibodies from cohorts of HIV-infected individuals has led to the development of antibody-based preventive vaccines. Innovations in the design of vaccines, vaccination strategies and clinical trial programs will be necessary to accelerate the search for a prophylactic HIV vaccine. This article reviews the current status of HIV vaccine research and provides a roadmap to future efforts in vaccine development.

Limbic encephalitis is an inflammatory condition that affects the central nervous system with more involvement of the limbic system anatomical regions. The Chronic Inflammatory demyelinating polyradiculoneuropathy (CIDP) is an immune-mediated inflammatory disease of the peripheral nerve. Through literature review, it seems that simultaneous involvement by these two diseases in HIV seroconversion is rare. This case study and literature review shows us how is important heterogeneous clinical presentations and early diagnosis in the presented pathologies.