Problems of providing services to people affected by HIV/AIDS: service providers and recipients perspectives

This qualitative study aimed to identify the health-care problems of people living with HIV [PLHIV] in 2 large cities: Tehran and Kermanshah. Two main groups of stakeholders - service providers [policy-makers, managers, physicians and counsellors] and service recipients [PLHIV and their relatives] - participated in focus group discussions and in-depth interviews. We identified 24 themes covering the major health problems of PLHIV, including: incomplete and inadequate coverage of health-care services; patients' substance abuse; patients' fear of stigma; occupational burnout of certain service providers; patients' dissatisfaction with some of the services provided by counselling centres/clinics; medical staff's failure to observe confidentiality; and patients' lack of access to required specialized services. The problems and needs identified can inform the design and implementation of health programmes in our country and elsewhere in the Eastern Mediterranean Region

[High-risk behaviors of HIV positive individuals referred to behavioral counseling centers of universities of medical sciences in Tehran]

Development of effective antiretroviral therapies [ART] has reduced mortality and increased life expectancy among individuals with HIV infection. Antiretroviral therapy regiments have improved symptoms and quality of life among these patients, whose sexual and reproductive needs, have, therefore, increased as well. In 2010, 20.8% of HIV-infected Iranians acquired the disease through sexual relations. The objective of this study was to define high-risk sexual behaviors among individuals infected with HIV referred to the Triangular Clinics of Universities of Medical Sciences in Tehran. This cross-sectional interview-based survey included 400 HIV-positive individuals selected by consequential sampling. The majority [60%] of the subjects was males, and 44.2% of men and 51.3% of women with HIV were in the age group 34-25 years. On the whole, 15.6% of the women and 49.6% of the men had high-risk sexual behaviors after diagnosis of HIV infection. Further analysis of the data showed that 62.5% of HIV-positive individuals were not aware of the risks of unsafe sexual relationship [using no condom] for HIV-positive transmission.. Based on the logistic regression module, it was found that factors strongly associated with high-risk sexual behavior were being male, being single, under high school diploma/graduate degree, alcohol intake and use of hormonal and permanent methods of family planning [p<0.05]. The findings of this study confirm previous reports showing common high-risk sexual behaviour after diagnosis in HIV-positive populations. Providing suitable health services and advice on fertility and sexual health will result in no- or low-risk sexual life for couples

evaluation of association between HLA and disease progression among HIV/ADIS patients referred to Imam Khomeyni Hospital

Background: Human leukocyte antigen [HLA] class I and class II is believed to play a major role in the immune response to HIV, and are known to be associated with rates of progression to AIDS. This study measured the rates of variation within well-defined epitopes to determine associations with the HLA-linked exposure of disease progression. The aim of this study was to evaluate the association between HLA and disease progression among Iranian HIV/AIDS patients in comparison with general population. Materials and methods: In this case- control study, the role of HLA class I [A, B] and class II [DRB1, DQA1 and DQB1] alleles were investigated in 48 HIV infected Iranian patients compared with 100 healthy individuals. HLA typing was carried out by PCR amplification using sequence specific primers [PCR-SSP]. The primer was supplied by the standard kit. The disease progression was determined based on changes in stage of disease. Results: Among 48 HIV infected patients and the control group a>positive association was observed with HLA- DRB1* 0301 [1.32< OR< 7.09, P= 0.0037], HLA- DQA1 * 0501[1.01< OR< 4.97, P=0.03], HLA- DQB1 * 0201 [0.98< OR< 3.50 P= 0.04] as well as a negative association with HLA- DRB1 * 1301 [0.01< OR< 0.98, P= 0.022] in HIV progression. In this study, no significant association was found with the analyzed HLA-B*2701 and HLA-B* 5701 alleles in the case of HIV progression. Conclusion: In our study among HIV infected patients the HLA- DRB1 * 0301, HLA- DQA1 * 0501 and HLA- DQB1 * 0201 were the most important predictors for the HIV progression, whereas, HLA- DRB1 *1301 detected as strong protectors. As the results of the limitations in present study such as being small sample size, studies among a larger population would be necessary to in HIV infected patients with predisposing HLA alleles for early therapy

Pulmonary tuberculosis in patients with HIV/AIDS in Iran

Pulmonary tuberculosis is still the most common form of tuberculosis in HIV infected patients having different presentations according to the degree of immunosuppression. This study appraised the impact of HIV infection on clinical, laboratory and radiological presentations of tuberculosis. The clinical, laboratory and radiological presentations of pulmonary TB in 56 HIV-infected patients were compared with 56 individually sex and age matched HIV-seronegative ones, admitted to Imam Hospital in Tehran [1999-2006] using paired t-test in a case control study. All cases and the controls were male. Fever was found in 83.9% of the HIV positive patients compared to 80% of the HIV negative ones. Cough was the most common clinical finding in the HIV negative group [89.3% vs. 82.1% in HIV positive group]. Among radiological features, cavitary lesions, upper lobe and bilateral pulmonary involvement were observed significantly less often in the HIV-infected group. On the contrary, lymphadenopathy was just present in the HIV positive group in this series of patients [12%] and primary pattern tuberculosis was more common, as well [71% vs. 39%, P= 0.02]. The Tuberculin test was reactive in 29% of the HIV/TB patients. The coexistence of both infections alters the picture of tuberculosis in many aspects and should be taken into account when considering a diagnosis of HIV infection and its potential for TB co-infection, and vice-versa

[Effectiveness of designed health education package on healthy behaviors of patients with tuberculosis at Pasteur Institute of Iran]

Tuberculosis [TB] is the most common infectious disease. It causes more than 2 millions deaths annually around the world. The aim of this study was to investigate the effectiveness of designed health education package on healthy behaviors of patients with tuberculosis at Pasteur Institute of Iran. This research was a quasi-experimental study that was carried out on 31 smear positive patients who referred to Pasteur Institute in 2004. Questionnaire and self report checklist were used to collect the required data. The educational needs were recognized and then the health educational package was designed. After that, the questionnaire and checklist filled out and educational package was performed for 8 weeks. The effect of training was evaluated by post-test after two months and the obtained results compared with the results of pretest. The main data was analyzed by analysis of variance, paired T-test and Pearson correlation coefficient tests in order to evaluate the effectiveness of intervention on knowledge, attitude and behavior of the patients before and after the intervention. The average age in study group was 33.71 years old [SD=13.68] and the sex frequency was 54.8 for males and 45.2 for females. There was a significant correlation between the change of attitude and the previous family history of TB [P<0/001]. However, there was no significant correlation among the past jail and the previous tobacco use with the patient.s knowledge, attitude and practice. Analysis of the data, before and after the educational package intervention showed a significant difference among knowledge, attitude and practice before and after education [p<0/001]. Health education has an important role in improving knowledge, positive attitude and adopting healthy behaviors in the patients with Tuberculosis

[Emerging and pandemic of influenza A[H1N1]]

Influenza is one of the known viral infectious diseases, which has killed millions of peoples during pandemics, epidemics and sporadic forms. One of the most remarkable features of influenza virus is the frequency of changes in antigenicity. Alteration of the antigen structure of the virus leads to infection with variants to which little or no resistance is present in the population at risk. Pandemics of influenza type A, result from the emergence of a new virus which the population contains no or limited immunity to it. The interval between pandemics is 10-30 years. But Influenza virus has been causing epidemics of febrile respiratory disease every 1 to 3 years. Pandemic [H1N1] 2009 is a new virus that has not circulated among human population before. This virus is different from previous or current human seasonal influenza viruses. Influenza type A[H1N1] virus is transmitted by inhaling infected droplets expelled by coughing or sneezing or by touching contaminated hands or surfaces as the same as the normal seasonal flu. The symptoms and signs of A[H1N1] influenza are as similar as seasonal influenza and include fever, coughing, runny nose and sore throat. Some people have also reported, nausea, vomiting and diarrhea. People with existing cardiovascular disease, respiratory disease, diabetes and cancer are at higher risk of serious complications. Asthma and other respiratory disease are other underlying conditions associated with severe disease. Pregnant women are at higher risk for more severe disease and obesity may be another risk factor for severe disease. To prevent spread, people should cover their mouth and nose when coughing or sneezing, stay at home when they are unwell, clean their hands regularly, and avoid crowded areas if possible. The pandemic virus is currently susceptible to neuraminidase inhibitors; Oseltamivir and Zanamivir but resistant to Amantadine and Rimantadine. Ministry of health and medical education, Center for Infectious Diseases Management in Islamic Republic of Iran is ready for control and management of novel influenza A[H1N1]

[Combination therapy of albendazole and praziquantel in treatment of hydatid cyst]

The standard therapy of hydatid cyst is surgery, but in non-operable patients and multiple organ involvement medical therapy may be more useful. Efficacy of drugs especially in short duration in treatment of hydatid cyst is unknown. This study was carried out to evaluate the effect of combination therapy with Albendazole and praziquantel in treatment of hydatid diseases. In a nonrandomized clinical trial, 9 hydatid cyst patients with multiple organ involvement or post surgical recurrence were treated with albendazole and praziquentel for 3 months. The average follow up was 18 months. Response to treatment was assessed through the observation of the symptoms, radiologic [CT scan, sonography, and X-ray]. Symptoms disappeared in 7 [77/8%] patients and improved partially in 2 [22/2%]. Radiologic assessment showed significant improvement in 5 [55/6%] and partial improvement in 4 [44/4%] patients. Combination therapy with albendazol and praziquentel is effective in treatment of hydatid cyst and can be used as an alternative to surgery in disseminated and non-operable cases

SSU-rRNA gene analysis of cryptosporidium spp. in HIV positive and negative patients

Cryptosporidium is an apicomplexan parasite of humans and a wild range of domestic as well as wild animals. An 833-bp fragment of the 18S-rRNA gene was used to identify Cryptosporidium spp. recovered from children and adult patients, in human immunodeficiency virus [HIV] positive and negative patients in Iran. Initial identification of cryptosporidiosis was carried out by Ziehl-Neelsen acid-fast staining method of stool samples. The samples, then, were identified specifically by nested PCR, targeting the most polymorphic region of the 18S-rRNA gene. The genotype encountered was detected by re-striction endonuclease digestion of the nested-PCR product. Among 17 analyzed isolates, two different genotypes of Cryptosporidium were identified; 24% of the isolates belonged to C. parvum human genotype, and 76% to the potentially zoonotic species of C. parvum bovine genotype. The results of the present study showed that in contrast to HIV negative individuals, HIV positive individuals were more likely to be infected with zoonotic genotypes of the parasite; it was also confirmed the fact that zoonotic transmission of the parasite in Iran was as frequent as the transmission of anthroponotic origin. These outcomes are helpful for researchers to establish the corresponding prevention and treatment measures

Frequency of hypothyroidism and factors affecting it in HIV-infected patients in Tehran, Iran [2004]

A wide spectrum of endocrine abnormalities including thyroid dysfunction has been observed in HIV-infected patients with different results. This study was conducted to determine the frequency of thyroid dysfunction and to identify factors affecting the development of hypothyroidism in HIV-infected patients. Free T4, FT3, TSH, and thyroglobulin levels of 88 HIV-infected patients receiving care at UT counseling center for Behavioral Disorders in Tehran, an out patient referral center, were measured and data on their age, sex, body weight, BMI, history of opium and injection addictions, duration of HIV infection, disease stage, history of opportunistic infection or malignancy, CD4 cell count, antiretroviral treatment with antiretroviral drugs [HAART], receipt of other drugs [TMP-SMX, antituberculosis drugs, and steroids], and hepatitis C virus Co-infection were collected. Inclusion of the subjects was simply random. 17% of subjects had hypothyroidism; 1.1% had overt hypothyroidism; 2.3% subclinical hypothyroidism and 13.6% had low FT4 levels. The multivariate analysis showed that none of the studied factors were associated with the development of hypothyroidism. As none of the above-mentioned factors are not associated with the development of hypothyroidism, hypothyroidism should be considered in HIV-infected patients

[ survey of contamination with genital mycoplasma in women with bacterial vaginalis by PCR method]

Genital mycoplasmas can cause infection of the genitourinary tract. These organisms are associated with bacterial vaginosis, pelvic inflammatory disease, endometritis, cervicitis, Nongonococcal urethritis. Spontaneous abortion, premature birth, neonatal pneumonia and meningitis, and infertility. The aim of this study was to determine the ability of PCR method for diagnosis and identification of genital mycoplasma in culture negative samples taken from women suffering from bacterial vaginosis. 174 genital samples were taken from women suffering from bacterial vaginosis during January until December 2005. Two genital swabs were taken from each patient. One of them was cultured on the mycoplasma specific media for isolation of mycoplasma. The other swab was immersed in PBS buffer and frozen until DNA extraction. To detect the presence of mycoplasma and ureaplasma in genital DNA Samples: a 520-bp fragment of the 16S rRNA was amplified. The specific primers used for this purpose were: MGSO, UGSO, MY- ins. From 174 samples,71 samples [40.8%] were positive by culture for mycoplasma and ureaplasma. From 103 culture negative samples. According to PCR results, 14 samples [13.6%] were positive and 89 Samples [86.4%] were negative for mycoplasma and ureaplasma. This study showed that PCR method is more sensitive than culture for detection genital mycoplasma, Therefore PCR is a rapid, sensitive and easy method to detect genital mycoplasmas in urogenital swabs

Prevalence of intestinal parasitic pathogens among HIV-positive individuals in Tehran and Kermansha, Iran

Parasites are important enteric pathogens among patients with immunodeficiency virus [HIV] infection. In our country there are very few reports on prevalence of intestinal parasites among these patients. In the present study we have determined the prevalence of intestinal parasites among HIV-positive individuals visited in different medical centers in Iran. Single stool samples were collected and analyzed for various intestinal parasites from 206 HIV-positive individuals with different immune status. The data were tested for statistical significance with [2] and Mann-Whitney U tests. The overall prevalence of intestinal parasites was 18.4% [95%CI: 13.7-24.3]. In particular, the following parasites were identified: Giardia lamblia [7.3%], Blastocystis hominis [4.4%], Entamoeba coli [3.9%], and Cryptosporidium parvum [1.5%]. Strongyloides stercoralis and Hymenolepis nana were also found in two cases and Dicrocoelium dendriticum in one. Intestinal parasites were significantly more common among patients with diarrhea [n=28] than those without [n=178] [p < 0.001]. Besides, CD4 counts were significantly lower among individuals with diarrhea than those without [p < 0.001]. This study highlights the importance of testing for intestinal parasites among Iranian HIV-positive patients especially those with low immunity presented with diarrhea

Report of thirteen cases of mucormycosis

Thirteen cases of mucormycosis in ten diabetics, one leukemic, and one burned patient, and one in an apparently normal person are reported. The presenting form included rhinocerebral in 11 and cutaneous in two cases. The diagnosis was established by KOH preparation and biopsy and it was confirmed with culture. Rhizopussp. was the causative agent in 11 and Mucor sp. In one case.Amphotericin B was administered in 10 patients as soon as the diagnosis of mucormycosis was made. Of these, four patients survived

Cutaneous mucormycosis in a normal boy

A case of generalized cutaneous mucormycosis is reported in a healthy young boy. He had multiple nodular lesions on his thigh, leg, neck, and chest. Direct examination, culture of the discharges of lesions, and biopsy specimen obtained from the thigh lesion were negative for fungal elements. Histologic examination of the autopsy specimen revealed broad, non-septate hyphae and in culture, Rhizopus sp. were isolated. The diagnosis was made too late for appropriate therapeutic intervention. This is the first report of mucormycosis in a healthy person in Iran