Impact Of Methadone Maintenance Therapy On Hiv Incidence In Perak, 2008 - 2017: A Cox Regression Analysis

@#In 2005, Ministry of Health introduced the Needle Syringe Exchange Program (NSEP) and Methadone Maintenance Therapy (MMT) program as a part of Harm Reduction program to combat HIV infection in Malaysia among people who inject drug (PWIDs). Expenditures were estimated approximately RM10 millions per year to establish and sustain the NSEP and MMT centres. This study examined the impact of MMT program on preventing HIV seroconversion among registered MMT clients that are people who inject drug (PWIDs), and to identify other predictors of HIV seroconversion among this group. This was a retrospective cohort study done in the state of Perak involving a total of 212 randomly selected MMT clients registered between 2008-2017 in 6 clinics. This study looks at data collected from the last ten-year cohort from baseline to follow-up. A questionnaire was used to obtain socio-demographic data, sexual and drugs abuse history. Test results for HIV were obtained from medical records. Cox regression analysis was performed to examine factors associated with seroconversion and Kaplan-Meier analysis to estimate HIV survival time. This study displayed that both Methadone take home supply (HR 10.4, 95% CI: 1.6 – 68.8) and unprotected sexual practice (HR 5.9, 95%CI: 1.1 – 31.5) shown higher risks of HIV seroconversion compared to DOTS and condom practice among MMT clients respectively. Mean survival for HIV seroconversion among MMT clients was 104.44 (95%CI: 101.85 – 107.04) months. This study provides reliable evidence that MMT program markedly reduces incidence of HIV infection among people who inject drug (PWIDs).

Primary HIV Infection as an Unusual Cause of Neutropenia in Crohn’s Disease: A Case Report.

Although primary human immune deficiency virus (HIV) infection is a well described entity, it is frequently misdiagnosed or underdiagnosed. This has been attributed to the non-specific clinical features at presentation, inadequate history taking and a low index of suspicion by practicing clinicians. Haematological abnormalities are a recognised feature of HIV infection and may present in the form of pancytopenia or isolated cytopenias. One of the cardinal features of HIV seroconversion is leucopenia, however primary HIV infection as a cause of neutropenia and lymphopaenia in Crohn’s disease, has to our knowledge, not been described in the medical literature. We present a case of profound neutropenia in Crohn’s disease secondary to acute HIV sero-conversion illness.

Infección por VIH posterior a exposición ocupacional de riesgo biológico en trabajadores de la salud / HIV infection after biohazard occupational exposure to HIV in health care

Se describe el caso de una mujer auxiliar de enfermería quien sufrió accidente de riesgo biológico luego de punción con aguja, al canalizar una vena periférica. La auxiliar de enfermería era residente en área rural y fue atendida en urgencias de su hospital local. El origen de la exposición (fuente) fue positivo para VIH y negativo para VHB y VHC. La trabajadora de la salud accidentada fue negativa para VIH, VHB y VHC y no recibió profilaxis antirretroviral (ARV) postexposición y luego fue remitida a nuestra institución. Este es el primer reporte en Colombia de seroconversión al VIH luego de exposición ocupacional.

We report a postexposure HIV infection in a woman nursing assistant, resident in rural area. She suffered biohazard exposure after needlestick incident during channeling of peripheral vein. She was attended at their local hospital emergency room. The serostatus on the patient's exposure source (source) was HIV positive and negative for HBV and HCV. The health worker was negative for HIV, HBV and HCV and she did not receive antiretroviral (ARV) prophylaxis at the initial consultation. Thereafter she was referred to our institution. This is the first report of HIV infection after occupational exposure in Colombia.

La carga viral como determinante en la primoinfección por VIH, presentación de un caso / Viral load as determinant of primary HIV infection, clinical case report

La primoinfección por el virus de la inmunodeficiencia humana (VIH) es sintomática en casi el 70% de los casos pero en la mayoría de ellos, el diagnóstico pasa desapercibido debido a su sintomatología inespecífica, el conjunto de manifestaciones clínicas se conoce como síndrome retroviral agudo. Al ser sub diagnosticada la enfermedad es potencialmente contagiosa en su período latente o diagnosticada en la etapa SIDA. El caso clínico es un masculino de 31 años de edad, ingresa al Hospital Clínico Viedma el 19 de marzo del 2014, con alzas térmicas no cuantificadas, lesiones máculopapulosas diseminadas con predominio en tórax y miembros superiores no dolorosas, pruriginosas además de rinorrea, astenia, anorexia y odinofagia progresiva. El paciente tenía antecedente de enfermedad de dengue hace un mes. Se realiza serología, con ELISA positivo para VIH y Western Blot indeterminado. Se solicita carga viral con valores extremadamente altos confirmando la primoinfección por VIH.

Primary infection by the virus of the human immunodeficiency virus (HIV) is symptomatic in about 70% of cases but in most of them, the diagnosis goes unnoticed because of its nonspecific symptoms, the set of clinical manifestations is known as acute retroviral síndrome. When the disease is diagnosed sub potentially contagious in the latent period or AIDS diagnosed in stage. The clinical case is a male of 31 years old, entered the Hospital Viedma on march 19, 2014, with unquantified thermal spikes, maculopapular lesions scattered predominantly in the chest, not painful, itchy runny nose plus upper limbs, with asthenia, anorexia and progressive odynophagia. The patient had a history of dengue illness a month ago. Serology was performed with positive HIV ELISA and Western Blot indeterminate. Viral load is requested with extremely high values confirming HIV primary infection.

Risk-based assessment does not distinguish between recent and chronic HIV-1 infection in Rio de Janeiro, Brazil

This study investigated the risk factors associated with recent and chronic HIV infections among individual attending a voluntary counseling and testing (VCT) site in Rio de Janeiro, Brazil. In a cross-sectional study, recent HIV infections were detected by the sensitive/less-sensitive test, using Serologic Testing Algorithm for Recent HIV Seroconversion (STARHS) strategy, and compared to chronic HIV infection and HIV negative individuals. Seroincidence was estimated and risk factors associated with recent and chronic infections were assessed using multinomial logistic regression. Among the 7,379 individuals tested between June 2006 and April 2007, the overall prevalence and incidence of HIV infection were 7.5 percent; and 1.39/100 PY, respectively. In multivariate analysis, having a HIV positive steady partner was a risk factor for recent and for chronic HIV infection for MSM, heterosexual male and women. No differences in risk factors for recent and chronic infections were found between MSM and heterosexual males. Among women, chronic infected individuals were more likely than HIV negatives to be older. Recently HIV infected women were more likely than HIV negatives to be less educated; and more likely than HIV negatives and chronically infected to report having more partners. Routinely used risk-based assessment in testing centers in Brazil lack sensitivity to distinguish between recent and chronic infections, particularly among MSM and heterosexual males. Steady relationships and serosorting may be playing a key role in maintaining the HIV epidemics in Brazil.