Predictors of Adherence to Highly Active Antiretroviral Therapy among HIV Patients attending Selected Comprehensive Care Centres in Kericho County, Kenya

Highly Active Antiretroviral Therapy (HAART) is undoubtedly the only proven remedy known to improve the health outcomes and reduce AIDS-related mortality. However, just like other chronic diseases, HIV presents significant challenges in achieving and maintaining adherence to medication. The effectiveness of HAART solely depends on adherence. For maximum medication benefits, a nearperfect adherence levels of >95% is required yet data from different studies indicate that few, if any patients have achieved perfect adherence. The main objective of the study was to the determine predictors of adherence to Highly Active Antiretroviral Therapy among HIV patients attending selected comprehensive care centres in Kericho County. MATERIALS AND METHODS A descriptive cross-sectional study was adopted, involving 280 HIV patients (≥ 15 years) on HAART from three selected Comprehensive Care Centres in Kericho County, Kenya. Quantitative and qualitative data were collected using interviewer administered semi-structured questionnaires and key informant interviews, respectively. Purposive sampling was used to select the three health facilities while systematic sampling was used for participant selection. Adherence was measured using viral load. Data was analyzed using SPSS version 25. Logistic regression analysis was used to determine the association between adherence to HAART and various independent variables. Results were considered to be significant at p < 0.05). RESULTS AND CONCLUSION Seventy six percent (76%) of the respondents had optimal adherence while 24% had sub-optimal adherence. More females than males were on treatment. Use of HAART alternatives was a risk factor for sub-optimal adherence (p=0.011). Having someone/tool to remind of when to take medication and disclosure of HIV positive status to spouse were found to significantly promote adherence to HAART with p=0.034) and p=0.048, respectively. African Journal of Health Sciences Volume 34, Issue No.4, July- August 2021 465 RECOMMENDATIONS Several studies have been done on the socio-demographic and socio-economic factors associated with adherence to HAART. Findings from this study indicate that attitudes and practices towards HAART have significant effects on adherence hence more research should be done on attitudes and practice aspects of adherence

Neopterin and Biochemical Parameters as Indicators of Predicting HIV Disease Progression and Treatment Response: A Cross-sectional Study in Ghana

Background: Surrogate markers have been identified to play significant role in the pathogenesis and prognosis of HIV infection. However, there is limited data on the utility of neopterin estimation in HIV infection. Therefore, the study sought to measure and ascertains the trends of serum neopterin and other biochemical parameters as indicators of predicting HIV disease progression and treatment response among HIV seropositive individuals Methods: A cross-sectional study with 298 HIV seropositive individuals consisting of 165 HIV on highly active antiretroviral treatment and 136 naïve highly active antiretroviral patients. Venous blood was drawn for the assay of neopterin and the other biochemical parameters.Results:Neopterin was significantly lower (P<0.0001) in patients in the highly active antiretroviral therapy than those in the naïve highly active antiretroviral therapy group. Serum neopterin increased as the disease progresses and decreased as the duration of the therapy treatment increased (p=0.0001). At a cut of point of 54.5nmol/L, neopterin gave a sensitivity of 97.5%, specificity of95.9% and an area under the curve of 0.99.Conclusion: Neopterin has shown to be to be good marker in predicting HIV disease progression especially in patients with CD4 counts less than 200mm-3and a useful indicator of patient’s response to therapy treatment.

Virus de la inmunodeficiencia humana en la era TARGA. Experiencia en un hospital de referencia / Human immunodeficiency virus in the intensive care unit in the targa era. Experience in a referral hospital

INTRODUCTION: The cause of ICU admission of HIV patients has changed during the HAART era. OBJECTIVE: To analyze HIV + patients admitted in the ICU of a tertiary university hospital, reference in HIV patients, during the HAART era. To describe the epidemiology of the disease in the ICU, cause of admission and comorbidities. Material and METHODS: Descriptive, retrospective study. HIV + patients admitted to the ICU from May 2013 to November 2017. Collected data: HIV diagnosis, HIV related previous illnesses, previous admissions, HBV coinfection, HCV, lymphocytes, CD4, adherence to treatment, cause of admission, microbiological isolation, severity scores (SOFA, SAPS II, APACHE II), mechanical ventilation, vasoactive drugs, albumin, intra ICU mortality). RESULTS: 1,511 patients were analyzed, 27 had previous diagnosis of HIV +, 5 (18.9%) were not adherent to treatment. Cause of admission: 13 patients altered level of consciousness. 7 patients acute respiratory failure. Seven patients shock. DISCUSSION: Patients who were not adherent to treatment or coinfected with HCV-HBV had lower average of CD4, lymphocyte, albumin and hemoglobin values which were associated with higher mortality and need for vasoactive drugs. (p < 0.005). Non treatment adherent HIV patients admitted to the ICU with infection have higher mortality percentages than those who comply with treatment (p < 0.005).

INTRODUCCIÓN: La causa en ingreso en UCI de los pacientes VIH ha cambiado durante la era TARGA. OBJETIVO: Analizar los pacientes VIH+ que ingresan en UCI de un hospital terciario universitario, referencia de pacientes VIH, durante la era TARGA. Describir la epidemiología de la enfermedad en UCI, motivos de ingreso, comorbilidades. MATERIAL Y MÉTODOS: Estudio descriptivo, retrospectivo. Pacientes VIH+ que ingresan en UCI desde mayo de 2013 hasta noviembre de 2017. Se recoge: diagnóstico VIH, enfermedades previas relacionada, ingresos previos, coinfección VHB, VHC, linfocitos, CD4, cumplimiento de tratamiento, causa de ingreso, aislamiento microbiológico, scores de gravedad (SOFA, SAPS II, APACHE II) ventilación mecánica, fármacos vasoactivos, albúmina, mortalidad intra UCI). RESULTADOS: Se analizan 1.511 pacientes, 27 presentan diagnóstico previo VIH+, 5 (18,9%) no eran cumplidores de tratamiento. Causa de ingreso: 13 pacientes con alteración del nivel de conciencia. Siete pacientes con insuficiencia respiratoria aguda. Siete pacientes shock. DISCUSIÓN: Los pacientes no cumplidores o coinfectados con VHC-VHB, presentan valores medios de CD4, linfocitos, albúmina y hemoglobina menores que se asocian a mayor mortalidad y necesidad de fármacos vasoactivos (p < 0,005). Los pacientes VIH no cumplidores que ingresan en UCI con infección, presentan porcentajes de mortalidad mayores que los cumplidores de tratamiento (p < 0,005).

Moxibustion combined with highly active antiretroviral therapy for CDand γ chain cytokines of HIV infected patients / 中国针灸

<p><b>OBJECTIVE</b>To compare the effects of moxibustion combined with highly active antiretroviral therapy (HAART) and simple HAART for human immunodeficiency virus (HIV) infected patients.</p><p><b>METHODS</b>A total of 100 patients with HIV receiving HAART were randomized into an observation group and a control group, 50 cases in each one. In the observation group, moxibustion was used at Zusanli (ST 36), Guanyuan (CV 4) and Sanyinjiao (SP 6), etc. combined with HAART of zidovudine, lamivudine, nevirapine and efavirenzone, etc. Simple HAART was used in the control group. The patients were observed for 18 months. The indexes were CD, CD/CD, interleukin 2 (IL-2), interleukin 7 (IL-7), the incidence of side effects and the score of quality of life.</p><p><b>RESULTS</b>After treatment, CD, CD/CD, serum IL-2 and the scores of quality of life (physiological, psychological, social relation fields and comprehensive score) increased and serum IL-7 decreased compared with those before treatment in the two groups (<0.01,<0.05), with better results except CDin the observation group (<0.01,<0.05). The incidences of gastrointestinal side effects and total side effects in the observation group were lower than those in the control group (14% (7/50) vs 32% (16/50), 58% (29/50) vs 80% (40/50), both<0.05).</p><p><b>CONCLUSION</b>Moxibustion combined with HAART for HIV infected patients could reduce the incidence of side effects, improve medication compliance, CD/CD, IL-2, IL-7 and the quality of life.</p>

Lepromatous leprosy and human immunodeficiency virus co-infection associated with phenomenon of Lucio versus immune reconstitution inflammatory syndrome / Lepra lepromatosa y coinfección con el virus de la inmunodeficiencia humana asociada a fenómeno de Lucio versus síndrome inflamatorio de reconstitución inmune

Diffuse lepromatous leprosy (DLL) is a severe clinical outcome of lepromatous leprosy (LL). The aetiologic cause is believed to be different from Mycobacterium leprae. A new species, Mycobacterium lepromatosis, was identified from a group of Mexican patients with DLL, and severe leprosy reactional state type 3 (Lucio's phenomenon). However, a total sequencing of its genome is necessary to prove the existence of this new species. This is a report on a non-typical Colombian case of leprosy - HIV coinfection, associated with an immune reconstitution inflammatory syndrome clinically compatible with a leprosy reaction type 3 or Lucio's phenomenon.

La lepra difusa (LLD) es una variedad de la lepra lepromatosa (LL), frecuente enMéxico. El agente etiológico se cree que es diferente a Mycobacterium leprae y se considerauna especie nueva denominada Mycobacterium lepromatosis, hecho que no se ha comprobado.El reporte de este caso se realiza para dar a conocer el cuadro clínico atípico que presentóuna paciente colombiana con coinfección VIH---LL variedad difusa (LLD), asociado a síndromede reconstitución inmunológica, compatible clínicamente con una leprorreacción tipo 3 o fenó-meno de Lucio.

Influence of Qingdu capsule on pharmacokinetics of HAART drugs / 中国药学杂志

OBJECTIVE: To assess the influence of Qingdu (QD) capsule on the pharmacokinetic of HAART. METHODS: The 36 SD rats were divided into 3 groups. Rats in Group HAART were given, using an intragastric gavage needle, highly active antiretroviral therapy (HAART) containing zidovudine (AZT), 2',3'-dideoxy-3'-thiacytidine (3TC) and efavirenz (EFV). Group HAART+QD were given HAART and QD capsule simultaneously. Group HAART+QD (2 h interval) were given HAART and then given QD capsule 2 h later. Blood samples were collected at 0, 0.5, 1, 2, 3, 4, 6, 8, 10 and 12 h. AZT, 3TC, and EFV concentrations were tested with high performapce liquid chromatography-tandem mass spectrometry (HPLC-MS/MS). Pharmacokinetic parameters were compared among different groups. RESULTS: The t1/2 of AZT were statistically different among the three groups (P<0.05), Group HAART+QD (2 h interval) had the lease t1/2 of AZT than the other two groups. There were no statistical differences among groups for the AUC0-12, tmax, ρmax and CL of AZT, and all five parameters of 3TC and EFV. CONCLUSION: QU doesn't show influence on pharmacokinetic parameters of AZT+3TC+EFV regimen, but intention should be paid to individual differences.

Nested-PCR detection of cytomegalovirus and herpesviruses 6,7 and 8 in saliva from human immunodeficiency virus-infected subjects / 实用口腔医学杂志

CMV,HHV-6,HHV-7 and HHV-8 DNA in unstimulated whole saliva from 245 HIV-infected subjects and 30 healthy controls were examined by nested-PCR assays.Prevalence of CMV,HHV-6,HHV-7 and HHV-8 in saliva of HIV-infected subjects was 34.7%, 83.3%,70.2% and 14.3% respectively,that of the controls 10.0%,56.7%,70.0% and 0% respectively(between 2 groups,P 0.05).Multi-infection was observed in all subject.

Estado nutricional, clínico e padrão alimentar de pessoas vivendo com HIV/Aids em assistência ambulatorial no município de São Paulo / Nutritional and clinical status, and dietary patterns of people living with HIV/AIDS in ambulatory care in Sao Paulo, Brazil

INTRODUÇÃO: Atualmente, a abordagem nutricional desempenha papel essencial no tratamento de pessoas que vivem com HIV/aids, particularmente no caso de alterações metabólicas pelo uso da terapia antirretroviral (TARV) que podem estar associadas ao maior risco de doenças cardiovasculares (DCV). OBJETIVO: Caracterizar o estado nutricional, clínico e a qualidade da dieta de pessoas que vivem com HIV/aids. METODOLOGIA: Trata-se de um estudo transversal envolvendo pessoas que vivem com HIV/aids em atendimento na rede de serviços especializados no município de São Paulo. Os usuários desta rede, em uso ou não de TARV, foram recrutados no período de dezembro de 2004 a maio de 2006, durante consultas de rotina. Foram coletados dados sociodemográficos, clínicos, bioquímicos, antropométricos e dietéticos. A qualidade da dieta foi avaliada segundo escores de padrão de consumo predominantemente "não protetor" e "protetor" para DCV. RESULTADOS: A amostra foi constituída por 238 pacientes em TARV e 76 sem TARV. A média dos níveis de colesterol total, triglicérides e glicemia foram maiores no grupo TARV (p < 0,001). A maior parte dos participantes do estudo, com e sem TARV, apresentava-se eutrófica, com média de índice de massa corporal 24,4 (± 4,3) e 24,3 (± 3,5) kg/m², respectivamente. A relação cintura-quadril foi maior entre homens em TARV que entre aqueles sem TARV (0,90 ± 0,06 versus 0,87 ± 0,05) (p < 0,001). O grupo em TARV apresentou média de escores indicativa de maior consumo de alimentos "não protetores" para DCV (p = 0,001). CONCLUSÃO: Foram evidenciadas condições nutricionais e metabólicas indesejáveis entre aqueles em TARV, predisponentes ao risco de DCV. É apontada a necessidade de direcionamento das intervenções em saúde a pessoas que vivem com HIV/aids, para o controle dos fatores associados a essas doenças antes do desfecho final.

INTRODUCTION: Nutrition currently plays a key role in the treatment of people living with HIV/AIDS (PLHA), especially in the case of metabolic alterations due to highly active antiretroviral therapy (HAART), which could be related to cardiovascular diseases (CD). OBJECTIVE: to describe the nutritional and clinical status, and the quality of diet of PLHA. METHODS: It is a cross-sectional study involving a network of ambulatory care facilities for PLHA in the city of São Paulo, Brazil. Patients, in use of HAART or not, were selected from December 2004 to may 2006, through routine clinic visits. We collected: socio-demographic, clinical, biochemical, anthropometric measures and dietary data. Diet quality was evaluated according to a "protecting" or "non-protecting" pattern of consumption scores for CD. RESULTS: The sample had 238 patients on HAART and 76 without treatment. Mean serum levels of total cholesterol, triglycerides and glucose were higher in the HAART group (p < 0.001). The majority of patients of both the treated and untreated group were eutrophic with a mean body mass index (BMI) of 24.4 (± 4.3) kg/m² and 24.3 (± 3.5), respectively. The waist-hip ratio was higher among men on HAART (0.90 ± 0.06 versus 0.87±0.05) (p < 0.001). The HAART group showed a mean food pattern score indicating a higher consumption of "non-protecting" foods for CD (p = 0.001). CONCLUSION: The results showed undesired nutritional and metabolic conditions among patients on HAART associated with CD. It is necessary to manage health intervention programs for PLHA in order to control cardiovascular risk factors before final outcomes.

Clinical manifestations and survival of children with perinatal HIV-infection in Northeast Thailand

Background: The number of Thai children with perinatal HIV-infection receiving antiretroviral therapy has been increasing.Objectives: To describe clinical manifestations and survival of children with perinatal HIV infection.Methods: All children with perinatal HIV infection who received care at a university hospital in Northeast Thailand between January 1998 and December 2006 were included in this study. Children were assessed for their outcomes through December 31, 2007.Results: There were 322 perinatally HIV-infected children, 55.3% were female. The median age at the first clinical event was 51 months (interquartile range (IQR) =13-82). The three most common initial clinical events were pruritic papular eruption, recurrent or chronic respiratory tract infection, and persistent diarrhea. The three most common opportunistic infections were pulmonary tuberculosis, oral candidiasis, and pneumonia. Two hundred and forty three (75.5%) children received antiretroviral therapy (ARV). The initial ARV was monotherapy in 12 children (4.9%), dual therapy in 71 (29.2%), and a highly active antiretroviral therapy (HAART) regimen in 157 (64.6%). ARV was started at the median age of 76 months (IQR=47-99). As of December 31, 2007, 236 children were alive and 54 (16.8%) were known to have died. The one- and 5-year survival rates of all children were 99.4% (95%CI= 97.5-99.8%) and 93.9% (95%CI=90.6-96.0%), respectively. In children who presented with CDC clinical class C, the one-and 5-year survival rates were 96.0% (95%CI=84.9%-98.9%) and 75.7% (95%CI=60.4-85.8%), respectively.Conclusion: Survival rates among perinatally HIV-infected children in Northeast Thailand, including those who developed AIDS, increased. This might be due to the availability of ARV treatment and holistic care.