जर्नल ऑफ एड्स एंड क्लिनिकल रिसर्च

Issue: Uganda has HIV prevelance of 7.3%; however HIV prevalence in Masaka is at 10%. TASO Masaka has 383 active adolescents in care. Men’s uptake of Safe Male Circumcision is at 34% in the central area of Uganda including Masaka. Safe male circumcision (SMC) is one intervention for HIV prevention that targets male adolescents directly. SMC was conducted at the facility with one mobilizer doing mobilization. There was also limited community leadership involvement in the program. To improve adolescents’ uptake of SMC services, TASO Masaka came up with strategies like training community linkage facilitators to mobilize adolescents for SMC, targeting schools, conducting dialogue meetings and setting up circumcision camps.

Description: 6 dialogue meetings were conducted in 6 districts to allow community participation. 2 linkage facilitators were trained in SMC and community mobilization. Targeting schools for sensitization and encouraging adolescents seek consent from their parents. Offering free transport to facility and camping sites, Provided IEC through videos, flipcharts, fliers complemented by health talks and one to one counseling. Circumcised Peers were encouraged to do mobilization of their fellow peers. HCT and safe male circumcision services are provided to all eligible clients. Follow ups are done after 48 h, 7 days and 6 weeks. SMC telephone hotline was established for follow ups.

Lessons learnt: Dialogue meetings help program implementers to work in a coordinated manner with meaningful involvement of community leadership. A total of 20786 adolescents received HCT and circumcision (6/1/2014 to 17/12/2015 contributing to 85% of the total men circumcised.

Peer to peer mobilization has worked more with adolescents as compared to men. A school approach (221 schools) targeted many adolescents for mobilization and follow up services, 16628) adolescents were followed up in the review period. SMC camps bring services nearer to the community a, total of 1883 adolescents were circumcised in camps. 20786 Adolescents have tested for HIV, 100 treated sexually transmitted infections and receive risk reduction messages. The SMC hotline improved follow-ups, linkages and mobilization. Interventions that target a particular group for HIV prevention need a multidisciplinary approach.

In order to evaluate the genetic diversity of HIV-1 subtypes and transmitted drug resistance (TDR) mutations in northern Mozambique, we analyzed 120 plasma specimens obtained from drug naive blood donors candidates, who tested positive during routine HIV screening in three blood banks in that region. The genotyping for HIV-1 resistance was performed using Trugene Genotyping SystemTM. HIV-1 genetic subtypes were defined based on entire PR and partial RT gene regions, using REGA HIV-1 Subtyping Tool version 3.0 algorithm and confirmed by phylogenetic inference, using NJ algorithm. The majority of genotyped samples were classified as HIV-1 subtype C (80.0%), followed by subtype A1 (10.5%), subtype D (3.2%) and subtype G (2.1%). The inter-subtype recombinant forms (A1/C, A1/D and C/D) were identified in four participants (4.2%). TDR mutations associated with nucleoside and nonnucleoside reverse transcriptase inhibitors (K219E, G190A, K101E and K103N) were observed in five (5.3%) subjects.

Although a large proportion of HIV-1 subtype C was observed, non-C and recombinant forms together correspond to 20% in this study, which is different from what was described in central and southern regions, where subtype C was almost 100%. However, the profile mutations from this study correlate with the ARVs used both for first line schemes and PMTCT in Mozambique. This data reinforces the necessity of continuous surveillance of HIV-1 diversity, TDR and routes of spread, through inner cities of Mozambique to understand better the dynamics of the HIV-1 epidemic and support national public health policies in the country.

Purpose: Race and HIV are intertwined in complex ways. African Americans, particularly those residing in the southern United States, are at great risk for contracting and subsequently transmitting HIV. Research on the extent to which members of this population understand the risks associated with engaging in specific behaviors is limited. This paper examines HIV knowledge among at-risk adult African American men and women and the factors associated with levels of HIV knowledge. Methods: Based on a conceptual model derived from Social Disorganization Theory and Syndemics Theory, interviews were conducted between 2009 and 2011. Questionnaire-based interviews were conducted with 1,864 respondents from 80 strategically-chosen census block groups in Atlanta, Georgia. An innovative approach to assessing amount of HIV knowledge was implemented, to derive better estimates of the extent of knowledge. Results: Overall, HIV knowledge was low (average=43.5% correct answers). Seven factors were identified as contributing uniquely to having higher levels of knowledge about HIV transmission: (1) younger age, (2) being educated beyond the high school level, (3) being gay, lesbian or bisexual, (4) experiencing sexual abuse during childhood and/or adolescence, (5) drinking alcohol less frequently, (6) knowing a larger number of HIV-infected persons and (7) knowing anyone currently living with “full blown” AIDS. Conclusion: HIV educational and intervention programs targeting at-risk African American adults need to develop effective ways of bolstering a solid understanding of how HIV is/not transmitted. In particular, efforts need to be targeted toward older adults, those with lower levels of educational attainment and persons who are not acquainted with anyone who is HIV-infected.

Objective: The U.S. Virgin Islands (USVI) currently has the 3rd highest per capita rate of HIV in the United States. The purpose of this descriptive study was to examine the risk factors that contribute to high rates of HIV in the USVI. Methods: Data from the CDC Behavioral Risk Factor Surveillance System (BRFSS) from 2005 and 2009 were examined using statistical analysis with PASW 18.0 software. Local HIV surveillance data presented in the USVI 2012- 2016 HIV Prevention Plan was also reviewed. Descriptive statistics were conducted using chi squared tests and a logistical regression model to examine sociodemographic factors that may contribute to HIV risk. Results: Aggregation of data from the USVI indicate an increase in reported history of HIV testing and a decrease in reported high HIV-associated risk behavior between 2005 and 2009. Analysis of the data showed that being a young adult significantly (twice higher) increased the odds of being at high risk for HIV as 19.7% of 18-24 year olds reported high HIV risk. Adults between the ages of 25-44 were 2.2 times more likely to be at a high risk for HIV, and 59.2% reported high risk. Being between the ages of 25 and 44 was the only found statistically significant predictor of high HIV risk of any category, even among other categories that were reported as being at high risk by the 2014 USVI HIV Surveillance Report. Conclusion: Using results from this study, future HIV prevention plans could be tailored to the high risk age group of young adults in order to facilitate HIV care and treatment. More studies are needed to examine the HIV-associated sexual risk behaviors of young adults

Objective: The authors’ draw on neurobiological theory to posit that sexual risks might be associated with neurological changes, specifically, those neuro-adaptive changes associated with addictions. We propose that low levels of brain-derived neurotrophic factor (BDNF), a signaling molecule involved in cognitive, emotional, and addiction behaviors, may play a key role in the expression of high-risk sexual behaviors.

Methods: In a prospective cohort of 400 people living with HIV (PLWH), information was collected regarding smoking (Fagerström Test for Nicotine Dependence), hazardous alcohol use (men >14 and women >7 drinks/week), sexual behaviors. To assess the role of BDNF, platelet poor plasma was obtained to measure BDNF levels and participants were dichotomized into Groups 1 (BDNF ≤ 5000 pg/mL) and 2 (BDNF >5000 pg/mL).

Results: Over two-thirds of the participants reported multiple risk behaviors, confirming our hypothesis that Group 1 would have a general risk-taking tendency. Individuals in Group 1 were more likely to smoke (p=0.0001) and to drink alcohol hazardously (HAU) more days per week (p=0.04), particularly hard liquor (p=0.001). In support of our hypothesis, Group 1 was also more likely to report sex under the influence of drugs/alcohol (p=0.003) and to exchange sex for money (p=0.03). Men from Group 1 had multiple partners (p=0.09), and engaged in unprotected anal sex (p=0.08) more than those in Group 2. The results from regressions showed that BDNF (p=0.05), use of antidepressants (p=0.003), hazardous alcohol use (p=0.0001) and the BDNF x gender interaction (p=0.022) were significant predictors of high-risk sexual behaviors. Further supporting our postulate, participants with low BDNF showed triple the risk of herpes (p=0.05).

Conclusion: This innovative approach demonstrated for the first time that substance abuse disorders (especially alcohol abuse), high-risk sexual behaviors, and sexually transmitted diseases occur more frequently in individuals with low BDNF levels. These findings suggest the importance of using BDNF modifiers in preventive interventions concerning people living with HIV. Given the limitations of the design, new studies among the general population are needed to confirm the generalizability of the findings.

Treatment of choice in ART therapy for HIV-1 viremia remains an issue as all treatments interrupt HIV repopulation albeit at different reproductive points. The issue was addressed by grouping patients into two-tiered HIV level design of High >50,000 and Low <50,000 plasma cps/ml. The High group with 3 patients had combined class ART using NRTI plus NNRTI or PI regimens until viremia was reduced to <75 cps/ml and then PI alone. The Low group with 11 patients had PIMT regimen. CD4 T cell levels were monitored throughout. ART efficacy was assessed as total number of months of controlled (<75 cps/ml) viral infection level vs. number of months of uncontrolled levels of (>75 cps/ml). In that adherence/non-adherence to regimen is a confound, it was also assessed by rate of suppression: HIVj-HIVk/ HVj-HVn. In the High group, one patient attained long term controlled HIV viremia over 56 months vs. 3 months of uncontrolled viremia while the other two patients (21 vs. 25; 9 vs. 11) did not. Corresponding values in Group 2 ranged from 6 months to 139 months vs. <5 months A t-test for correlated means (with control for duration differences) showed significant difference: t=4.10, α=<0.01, df=10. Suppression rates, both within and across groups, were from: 0.99-1.0 of cps/ml. Accordingly, PI monotherapy can maintain long term viremia suppression for viral levels of <50,000 cps/ml and ART is operative within an inferred functionally closed boundary system as no host characterization including CD4 T cell level affected ART outcome.

Background: Ivory Coast, Cameroon and Gabon are the highly HIV/AIDS prevalent West African countries. However, studies show that nationally representative or comparative studies had never been done. Hence, this study was focused on associates of comprehensive HIV/AIDS knowledge and acceptance attitude towards people living with HIV/AIDS (PLHA) among male youth of the three countries and comparison by country.

Method: We utilized nationally representative datasets from Demographic and Health Surveys (DHS) of Ivory Coast 2011/2012, Cameroon 2011 and Gabon 2012. A total of 6576 male youth; 1811 (27.5%) Ivorian, 2803 (42.6%) Cameroonian and 1962 (29.8%) Gabonese was taken. We used IBM SPSS version 22 to run multivariate logistic regression taking p-values less than 0.05 as significant.

Results: The comprehensive knowledge of HIV/AIDS and acceptance attitude towards PLHA in all the three countries were low; especially knowledge in Ivory Coast (39.1%) and attitude in Gabon (22.5%) were very low. On multivariate analysis, only age, residence, educational level, and wealth index were significant associates of comprehensive HIV/AIDS knowledge. On the other hand, age, religion, educational level, and wealth index were significant associates of acceptance attitude towards PLHA. On comparison, Gabonese (AOR=1.50, p<0.001) and Cameroonians (AOR=1.44, p<0.001) were more likely to have comprehensive HIV/AIDS knowledge than Ivorians. However, Ivorians were 1.18 (AOR=0.85, p=0.032) and Cameroonians were1.26 (AOR=1.26, p=0.001) times more likely to have acceptance attitude than Gabonese.

Conclusion: Comprehensive HIV/AIDS knowledge and acceptance attitude towards PLHA in the three countries and specifically, acceptance attitude in Gabon was considerably low. Hence, it is crucial to give emphasis on planning policy of transmitting information to youth in a contextually applicable to the socio-cultural differences.

Background: The announcement of HIV-positive status is a critical moment of psycho-social destabilization that can induce changes in the behavior of an individual such a beginning or increased tobacco consumption.

Objective: The objective was to study the relationship between the HIV positive status announcement and smoking behavior among people living with human immunodeficiency virus (HIV) in Bamako after the discovering their status.

Methods: We did a descriptive cross-sectional study over six months from January to June 2012. Data were collected by interviewing HIV infected patients in three health care centers, departments of pulmonary diseases, department of infectious and tropical diseases and the largest HIV clinic in Mali (CESAC of Bamako). All participants have signed an informed consent before the interview. Data were analyzed using Epi-Info version 7.1.5.2 software.

Results: A total of 301 HIV-infected people were included, 24% patients were current smokers 6.3% former smokers and 69.7% non-smokers. Smokers were male in majority with 93.2%. After their HIV infection status announcement, 64.9% have increased their tobacco consumption while 10.8% have decreased their consumption. Majority of patients have a good knowledge of the health risks of smoking. Of those who continue to smoke, 83.8% reported that they tried and fail to stop smoking at least one time. The main reason of their cessation was the effect on their health. And the main reason for the failure was the constant thinking of the disease.

Conclusion: The announcement of the HIV positivity status must be accompanied by psychosocial support helping to overcome the emotion and stress and a smoking cessation program must be added to HIV screening program.

Although Epstein Barr Virus (EBV)-associated myoid tumors (EBV-MTs) are a well-recognized entity, commonly associated with immunocompromise and immunosuppression, including Human Immunodeficiency Virus (HIV) infection and acquired immunodeficiency syndrome (AIDS), they are reported uncommonly. An expanding spectrum of EBV-MTs has emerged in the last decade, associated with an increasing range of organ involvement. EBV-MTs are associated with diagnostic pitfalls, incomplete etiopathogenetic understanding and treatment challenges. This review revisits EBV-MTs in the HIV and AIDS setting. The characteristics of EBV, their etiopathogenetic role in neoplasia, in general and in HIV-associated EBV-MTs in particular, are discussed. Historical, demographic and diagnostic clinicopathological features of EBV-MTs are detailed, classification and diagnostic challenges are emphasized, treatment options and dilemmas are presented briefly and outcome-associated factors are described. While attention is drawn to current demographic, classification, etiopathogenetic and management uncertainties and hiatuses, potential future approaches to address these shortcomings are also alluded to.

Objective: This study evaluated the immunologic (CD4 cell count), virological (HIV RNA viral load), hepatic (alanine and aspartate aminotransferase - ALT and AST), renal (creatinine) and hematological (hemoglobin -HB, White Blood Cell - WBC, Lymphocytes - LYM and platelets - PLT) response to a six months ART treatment among HIV participants in Nairobi Kenya.

Methods: Blood samples were obtained from 599 consenting HIV infected participants receiving HIV treatment in Nairobi. CD4 cell counts were measured using flow cytometer and viral load determined using real-time polymerase chain reaction. The blood hematology, liver and kidney function tests were also measured. One-way ANOVA and Linear regression analysis were conducted.

Results: The median age at ART initiation was 41 years (IQR 35-47 years). The majority of participants (60.3%) were female and 56.1% started on regimens with 2 NRTIs and efavirenz based NNRTI. About 40% of the participants were failing treatment 6 month post ART initiation. The CD4 count significantly increased at the 6-month post ART initiation (301.7 ± 199.4 to 329.4 ± 305.8; P<0.05). Hepatotoxicity (ALT and AST levels >5 times the upper limit of normal - ULN) and renal abnormalities (elevated serum creatinine levels) were all high at month 6 compared to baseline; ALT (2.5 to 10.5%), AST (5.3 to 23.4%) and creatinine (63.4 to 68.84%). Fewer participants at month 6 had anemia (29.4% verses 56.4%), leucopenia (42.4% vs. 46.9%) and thrombocytopenia (6.5% vs. 84.1%) compared to baseline. In multivariable models, baseline levels of this parameter, ART regimen and duration with HIV at ART initiation were the most important determinant of month 6 levels.

Conclusion: These data demonstrate sustained immunologic/virologic response to ART among participants remaining on therapy. Anemia, leucopenia and thrombocytopenia were minimized with marginal hepatotoxicity and renal impairment seen. Interventions leading to earlier HIV diagnosis and initiation of ART could substantially improve patient outcomes in Kenya.