Jornal de AIDS e Pesquisa Clínica

Nevirapine-based antiretroviral therapy against human immunodeficiency virus (HIV) among Tuberculosis (TB) co-infected individual is complicated as administration of rifampicin along with Nevirapine reduces the plasma concentration of Nevirapine. The objective of the present study is to compare efficacy and safety of Nevirapine 400 mg once daily (OD) based antiretroviral therapy (ART) with efavirenz based ART and twice daily dose (200 mg) of Nevirapine-based ART regimens in HIV-TB co-infected individuals. ART-naïve HIV-TB patients were randomly assigned to receive either Nevirapine 400 mg OD with zidovudine and lamivudine (Group 1; n=30), Nevirapine 200 mg BD (Group 2; n=30), efavirenz 600 mg (Group 3, n=31); Nevirapine 400 mg OD with tenofovir (Group 4; n=30) and Nevirapine 400 mg OD without concomitant antitubercular therapy (ATT) (Group 5; n=30). The end points were virological (viral load), immunological (CD4 count) and clinical responses and progression of HIV disease marked by the failure of ART. Our results suggest that Nevirapine 400 mg OD based therapy is as effective as efavirenz-based ART in terms of clinical, immunological and virological response. Our data suggests that Nevirapine 400 mg OD group had favorable treatment outcome as compared to Nevirapine 200 mg 1 BD group.

We conclude that Nevirapine 400 mg OD based ART combined with tenofovir and lamivudine could be an effective alternative to improve compliance in the resource-limited settings in patients with HIV-TB co-infection. Further large multicentric study with bigger sample size will be required to confirm these findings.

Introduction: The introduction of highly active antiretroviral therapy significantly improved the life expectancy and quality of life of HIV infected people. However, malnutrition is still a concern. The Nutritional status of HIV/AIDS patients and HIV disease progression association should be thoroughly investigated. The aim of this study is to investigate the association of nutritional status and CD4 cell counts in HIV/AIDs patients who are under HAART in Zewditu Memorial Hospital, Addis Ababa, Ethiopia. Method: This cross sectional study was conducted on 395 HIV/AIDS patients taking HAART in Zewditu Memorial Hospital from January to June 2016, Addis Ababa, Ethiopia. Socio-demographic information was collected using structured data collection sheet. Weight and Height of all HIV/AIDS patients were measured. Venous blood samples were collected using EDTA tubes for the determination of CD4, albumin and total protein. Data analysis was done using SPSS version 20 software. Chi-square test for the association between dependent and independent variables and multivariate regression analysis to evaluate the role of confounding variables were performed. The level of significance was set to 0.05 (α=5%). Results: The male to female ratio was 0.69:1. The mean age was 39.1 ± 10.15 years. The prevalence of malnutrition based on BMI was 60 (15.2%) with the mean BMI of 22.88 kg/m² (SD 4.17kg/m²). Three hundred thirty six (85.1%) CD4 cell counts were >200 cells/mm. Albumin level, BMI, opportunistic infection status and total protein level were not significantly associated with diminished CD4 cell counts (P value>0.05). The CD4 cell count was significantly associated with patients WHO AIDS stage (P-value=0.008) and year on HAART (P=0.048). Conclusion: Although there was no statistically significant association between nutritional status and CD4 cell counts, malnutrition is continued as a problem in HIV/AIDS patients taking HAART. So regular follow-up mainly nutritional and opportunistic infections assessment is necessary.

Introduction: To prevent passing infection to their infants, Mozambican mothers with HIV are advised to follow biomedical norms during breastfeeding. However, little is yet known about how HIV-positive mothers perceive biomedical norms during the breastfeeding period. Objective: To analyse lactating mothers’ perceptions and compliance with biomedical norms recommended for reducing the risk of mother-to-child transmission of HIV via breastfeeding. Method: A qualitative study was carried out consisting of in-depth interviews with 59 HIV-positive lactating mothers. This involved 5 focus group discussions, direct observation and 6 semi-structured interviews with nurses. We used Bourdieu’s theory of practice as a guiding framework for data analysis. Results: Findings revealed participants had mixed perceptions and inadequate knowledge about breast milk and exclusive breastfeeding. As well, participants struggled to comply with some biomedical norms. Approximately half of the participants breastfed immediately after childbirth. Most participants do breastfeed on demand and all participants complied with prescription regarding antiretroviral therapy for their infants. Of the 59 participants, 53 complied with prescription of antiretroviral therapy for themselves. A total of 56 participants did not comply with exclusive breastfeeding to the sixth month. This was due to a lack of knowledge about exclusive breastfeeding, the perception that both breast milk and formula were not enough to feed the baby up to the age of six months. Other factors included returning to school or work, illness of the mother and child, lack of disclosure of HIV status of the mother as well as social norms. Conclusion: The study results suggest participants’ perceptions, incorporated learned experiences and the social environment they inhabit seem to influence compliance to biomedical norms. These norms seem new, and participants are still processing its incorporation. Health education on exclusive breastfeeding and prevention of mother-to-child HIV transmission should take into account the participant’s perceptions and their social environment.

The bottom line for any successful HIV program is adherence to therapy and retention in care with the subsequent benefit of achieving undetectable viral levels. Research has shown that poor retention in care for HIV infection has a negative impact on survival and health outcomes. This study aimed to improve retention in care at a secondary health in Freetown, Sierra Leone through a participatory approach that involved health workers and support groups. Our interventions included implementing a participatory needs assessment, reorganising the patient flow, improving communication between health workers and people living with HIV/AIDS (PLHIV), trainings and capacity building and improving the content of support group meetings. The baseline period was from June 2012 to June 2013 while the post intervention period was from June 2013 to June 2014. At baseline, a total of 47 patients were newly diagnosed out of which 19 were male and 28 were female. The median age was 32. Twenty were single, 18 married, 7 widowed and one divorced with one confirmed dead. In all, 15 were retained in care while 31 were lost to follow up. Our baseline retention was therefore 33%. Post intervention, a total of 54 patients was newly diagnosed out of which 48 were female and six were male. The median age was 29. Twenty were single, 27 married and 7 widowed. Eleven were confirmed dead and 1 asked to be transferred to a nearby facility due to reasons of distance. Thirty nine were retained in care while three were lost to follow up. Our baseline retention was therefore 93%. The results therefore showed that retention in care improved from 33% to 93% over a 6 month period. We conclude that while there are generic interventions that could be applied at program level to improve retention in care, interventions need to be context specific and fully participatory to cater to the multi-pronged yet unique peculiarities of every setting.

While millions of men have been circumcised cumulatively under the mass male circumcision campaigns for the prevention of HIV, the uptake of male circumcision (MC) is below the set targets. This suggests that prevention of HIV is not a convincing motive for circumcision to the majority of men. Notably some men are undergoing male circumcision for other psychosocial motives, rather than the primary public health motive of preventing HIV transmission. These motives have not been explicitly studied in order to ascertain their potential impact on the male circumcision strategy of HIV prevention. This study aimed at assessing the psychosocial motives for undergoing male circumcision in Swaziland and determines their potential impact on the success of the mass male circumcision strategy. A qualitative study design was used, in which in-depth individual face-to-face unstructured interviews were conducted with 17 men seeking health care services at the Family Life Association of Swaziland clinic in Mbabane, Swaziland. All men aged 18 years and above were eligible. Results indicate that some men are undergoing circumcision primarily for psychosocial reasons rather than for HIV prevention. These psychosocial motives include: giving in to pressure from public health advocates, sexual partners and peers; to perceived sexual benefits of the procedure; to demonstrate one’s manhood, as well as to utilise the free and readily available male circumcision services. However, subsequent safe post-MC sexual behaviour is not guaranteed. Nevertheless, it was recommended that these motives be emphasised in the mass male circumcision campaigns, along with appropriate health education, in order to complement HIV prevention in promoting uptake of male circumcision and ensuring safe post-circumcision sexual behaviour.

Background: Access to reproductive health services by youth has received minimal attention given that Sexual Reproductive Health (SRH) service provision for many years has been tailored to meet the needs of the adult population. The youth have therefore been neglected partly due to cultural sensitivity that dictates what, when and how SRH information and services should be transmitted to them. The current study therefore sought to unveil and explore sociocultural factors influencing youth utilization of SRH services provided in health facilities. Methods: A mixed method approach was used to gain a comprehensive view of factors influencing utilization of adolescent sexual reproductive health (ASRH) services. Data were collected quantitatively by using semi-structured questionnaires and qualitatively through individual in-depth interviews and Focus Group Discussions (FDGs) among a total of 927 youth aged 15-24 years (222 out of school youth and 705 in-school youth). The study sample also comprised of 68 gate keepers who included: teachers, religious authorities, parents/guardians, traditional authorities and health professionals. Results: The study exposed factors underlying utilization of SRH services among Swazi youth. Such factors included the family, peers, religious and community values and norms. Youth who perceived their families, communities and peers to be liberating towards uptake of SRH services were more likely to utilize those services compared to youth who perceived the opposite. Conclusion: The results persuade optimistic youth programs determined to increase uptake of SRH services among youth to incorporate parental and community programs instead of exclusively focusing on youth in all interventions designed to propel protective sexual behaviour among youth at all service delivery levels. Recommendations: Parental, community, traditional and religious leadership involvement in the development and execution of youth program interventions should be prioritized.

One major barrier to achieving the primary goals of antiretroviral therapy is the development of drug resistance mutations to antiretroviral agents which render them less effective. For patients who are treatment experienced with many drug resistance mutations, selection of an effective antiretroviral regimen becomes challenging. We report a case of a 55 year old male on tenofovir, abacavir and nelfinavir with multiple resistance mutations to each of these agents, yet able to maintain viral suppression and high CD4 T cell counts. This patient was subsequently switched to protease inhibitor monotherapy for the management of HIV in the setting of multidrug resistance.

The concept and rationale that birthed the Three Ones principle highlighted the need for a unifying national strategic framework, one national coordinating body and a cohesive monitoring and evaluation framework. However, with civil society of People Living with HIV/AIDS (PLHIV) their networks and support groups being increasingly seen as the fulcrum of achieving the bottom lines of adherence and retention of any successful HIV program, their involvement and participation ought to be seen not as support casts but as valid and authentic pivots towards the quest to end AIDS. While the Three Ones has been implemented with varied success, this commentary calls for the inclusion of a fully functional and well-structured civil network of PLHIV as a Fourth One that supports, facilitates and galvanizes a robust PLHIV civil support network and that will triangulate with the three other key principles and ensure that the bottom lines are kept in the front burner.

Background: The prevalence of HIV among pregnant women and the risk vertical transmission of HIV necessitate attention. In the absence of appropriate interventions, about a third of children born to HIV-positive women are likely to be infected. Almost all children infected with HIV are infected through vertical or mother-to-child transmission. The introduction of life lifelong ART for people living with HIV (LLAPLA) among pregnant is a necessary intervention in the prevention of mother to child transmission. In order for LLAPLA to be effective and efficient, it requires full cooperation of clients by good adherence. Lack of commitment by clients will render the programme ineffective. Hence it is important to understand the factors that influence adherence to LLAPLA. The purpose of the study was to describe the correlates of LLAPLA among pregnant and breastfeeding women on ART. Methods: A cross-sectional survey was conducted among pregnant and breastfeeding women on ART at Mbabane PHU. Data was collected through face to face interviews using a structured questionnaire. Univariate, bivariate and multivariate analysis was done. Results: About 65% (n=158) participants had good adherence to ART while 31% (n=76) had poor adherence. Factors significantly associated to adherence were participant’s level of education (p=0.009), having a problem of forgetfulness (p=0.021), being listened to by the health worker (p=0.008) and having nice communication with the health worker (p=0.008). Predictors of good adherence were not having a problem of forgetfulness (p=0.015), the woman financially depending on her relatives (p=0.021) or being self-sustained financially (p=0.013) and not hiding ARVs from partner (p=0.004). There is still a need for more studies at a national level to investigate measures to improving adherence to LLAPLA.

Objective: The aim of the study was to estimate the prevalence of locomotor disorders among people living with HIV in Abidjan. Methods: A cross-sectional study was conducted in April–July 2014 at the Department of Infectious and Tropical Diseases in Abidjan. Data were collected with a questionnaire and four tests of locomotor function: 4-m walking speed, five timings from sit-to-stand, the timed “up and go” test and standing on one leg with the eyes closed. Logistic regression models were used to find factors associated with locomotors disorders. Results: Of the 308 patients included in our study, 67.5% were women, and the median age was 45 years. The median duration of HIV infection was 91 months, and 97.4% were receiving antiretroviral therapy. The locomotor test that showed the most frequent alteration (87% of patients) was standing on one leg with the eyes closed. The prevalence of locomotors disorders was estimated to be 34% (95% confidence interval (CI), 28.8–39.4). In the multivariate analysis, age (odds ratio (OR), 1.9; 95% CI, 1.1–3.2; p=0.014) and body mass index (OR, 2.5; 95% CI, 1.5–4.3; p=0.001) were significantly associated with the presence of locomotors disorders. No association was found with time since diagnosis of HIV infection or antiretroviral therapy. Conclusion: The prevalence of locomotors disorders among people living with HIV is high. Strategies should be developed to screen and treat these disorders in order to limit functional impairment in this population.

Objective: Rapid HIV testing and counselling in community settings delivered by trained peers can allow easier access to and uptake of HIV testing and care. The programme 'Live Better Knowing' offers rapid HIV testing to key populations across Brazil. This cross-sectional study aims at describing the HIV prevalence in population subgroups and at assessing the association of sex work (SW) and/or drug use with a positive HIV result. Methods: Between January 2013 and April 2016, key populations were invited for HIV rapid oral fluid tests (DPP HIV- 1/2 Bio-Manguinhos/Fiocruz, Rio de Janeiro, Brazil) by peers. HIV testing was offered in identified venues and areas where these populations socialize. Participants were interviewed using a brief questionnaire about their socio-demographic and risk behaviour. Multivariable logistic regression was used to assess the effect of SW and/or drug use on the risk of HIV. Results: Among the 43,358 participants, 42.9% were ciswomen, 2.9% were transvestites, 2.7% were transgender, 19.8% were men who have sex with men (MSM) and 31.9% were heterosexual men. Overall, 52.1% were first-time HIV testers. The HIV prevalence among the ciswomen, transvestites, transgender people, MSM and heterosexual men was 0.9%, 7.2%, 4%, 3.4% and 1%, respectively. Individuals who performed SW and used drugs had the highest HIV prevalence within each population group (ciswomen 1.7%, transvestites 8.1%, transgender 7.4%, MSM 5.9% and heterosexual men 2.6%). The adjusted odds ratios with 95% confidence intervals for selling sex combined with drug use were 2.90 (1.21-6.96) in ciswomen, 25.01 (2.67-234.57) in transgender people and 2.42 (1.31-4.48) in MSM. Conclusion: This outreach programme attracted persons with high risk practices who had never been tested. Our findings suggest that transvestites and transgender people (particularly those who sell sex) constitute a high risk population for HIV in urgent need of enhanced prevention, treatment and care services.