An Evaluation of Renal Care received by Human Immunodeficiency Virus(HIV) Patients admitted in a Tertiary Hospital in Sierra Leone

INTRODUCTION: The burden of HIV is on the rise and patientswith HIV are also vulnerable to renal impairment from bothacute and chronic causes. This study sets out to evaluate renalcare received by such patients.METHODS: The study was conducted at Connaught Hospital,the main tertiary hospital (for medical and surgical cases) in thecountry. A retrospective review of all admitted patients withHIV between January and December 2019. Data was collectedusing a well- structured study proforma. RESULTS: A total of 230 patients were admitted with HIV duringthe study period. The mean age of patients was 36.9 ± (11.5) years with a female preponderance of 61.3%. A vast majority ofthe patients (54.8%) could afford to do some renal investigationsand only 13.9% were seen by renal physicians; 69.1% of patientswith azotaemia died while on admission.CONCLUSION: The extent of renal care observed from thestudy was poor because the majority of the patients were notseen b y r e na l physic ia ns a nd co uld no t affor d r e na linvestigations. Also, the occurrence of renal impairment inpatients with HIV suggests a poor prognosis. WAJM 2022;39(11): 1193­1197.

Prevalence of Intestinal Parasites in HIV Seropositive Patients Attending an Integrated Counselling and Testing Centre

HIV infection is the most disastrous and invariably fatal disease. Its devastating effect is due to its relentless and eventually complete destruction of the immune system. As a result, people infected with HIV die not due to the virus itself, but rather due to plethora of opportunistic infections that characterize AIDS. Intestinal parasitic infections are a significant cause of morbidity and mortality in patients infected with HIV in which Diarrhoea is one of the most common clinical presentations.1 With this background, a prospective study was carried out to determine the prevalence of intestinal parasites in HIV seropositive patients attending an Integrated Counselling Testing Centre (ICTC) of a tertiary care hospital.METHODSA cross-sectional study was conducted in a tertiary care multispecialty teaching hospital for a period of one year. Stool specimens of 250 HIV seropositive patients above 18 years of age and belonging to all genders, were screened for intestinal parasites in the present study. The stool specimens submitted were processed using direct wet mounts, concentration technique of formol ether, sedimentation and saturated common salt solution, and permanent staining techniques using Modified Acid-Fast staining, Trichrome staining and Modified Trichrome staining methods.RESULTSThe prevalence of intestinal parasites in HIV seropositive patients was found to be 27.6% (69/250). Protozoan parasites were predominant and were detected in 81.15% (56/69), followed by intestinal helminths in 11.59% (8/69) and coccidian parasites in 7.24% (5/69).CONCLUSIONSIntestinal parasites are a common source of infection in HIV seropositive patients. These patients are a threat not only to themselves but also to others in the community as well. Hence routine screening of all HIV seropositive patients is a must in order to prevent and reduce morbidity and mortality in the community.

Isolation of Candida albicans among HIV Patients Presenting with Oral Thrush in Abuja, Nigeria

Background: Candida infections are known contributors to the high morbidity and mortality rates seen in HIV positive patients.Methodology: This was a descriptive cross-sectional study. The study was carried out at the Microbiology research laboratory, department of Medical Microbiology, University of Abuja Teaching Hospital, Gwagwalada. The population is made up of two hundred and ten (210) patients who presented with oral thrush between fifteen years and seventy years which comprises of 160 HIV seropositive and 50 non age and sex matched HIV seronegative patients. Culture, Microscopy and ELISA methods were used for isolation of Candida albicans. An interviewer-administered, structured questionnaire was used as the study tool Results: The mean age for the isolation of Candida albicanswas 30 ± 18.7 years, with the highest proportion of isolates within the age range of 21-30 years accounting for 27.1% of the study population recruited and the lowest proportion of isolates being 41-50 years accounting for 8.0%.From the 210 subjects withCandida albicansin the study, one hundred and sixty (160) representing 76.2 were isolated from HIV seropositive clients and Candida albicansisolation rate among HIV seronegative population was 23.8%.Conclusion: The sensitivity, specificity and positivepredictive value of using Grams reaction methods in the diagnosis of Candida albicanswas 22.9%, 95.2% and 82.6%. The sensitivity, specificity and positive predictive value of using ELISA methods was 25.7%, 86.7% and 65.9%.In this study, there was preponderance of Candida albicansisolate among the young and the old in HIV seropositive patients but largely isolated from older patients among HIV seronegative patients

A comparative study of methods of Pneumocystis Jiroveci pneumonia in HIV patients with CD4 count less than 200 and the clinical outcome in tertiary care hospital

Background: Pneumocystosis is an opportunistic fungal infection of the respiratory system leading to interstitial plasma cell pneumonia, caused by a taxonomically unique fungus Pneumocystis jiroveci. Major developmental stages of the organism include the small (1 to 4 μm) pleomorphic trophozoite or trophic form; the 5 to 8 μm cyst, which has a thick cell wall and contains up to eight intra cystic bodies; and the precyst, an intermediate stage. The life cycle of P. jiroveci probably involves asexual replication by the trophic form and sexual reproduction by the cyst, which ends in the release of the intra cystic bodies an intracellular stage has not been identified. Aim of study: Comparing the role of clinical diagnosis, chest radiography, sputum microscopy and polymerase chain reaction for Pneumocystis jiroveci Pneumonia in HIV seropositive patients with CD4 less than 200, to know the clinical outcome of PCP patients after treatment. 151 HIV seropositive patients were recruited for study as per inclusion criteria. Materials and methods: The study was conducted in the Department of TB and Chest Medicine, Government Stanley Medical College, Chennai from 2016-2017. Thorough clinical examination G. Allwyn Vijay, S.B. Sivaraja. A comparative study of methods of Pneumocystis Jiroveci pneumonia in HIV patients with CD4 count less than 200 and the clinical outcome in tertiary care hospital. IAIM, 2019; 6(3): 148-155. Page 149 including general and systemic examination was done meticulously with vital signs monitoring and SpO2 was measured with pulse oximetry. Results: Out of 151 HIV seropositive patients examined clinically, 81 individuals were diagnosed as PCP patients. But the sputum microscopy with Gomori methenamine silver staining which was taken as gold standard test, diagnosed 41 cases of PCP only. PCR was positive in 2 more patients who were missed in GMS staining. Sputum PCR was having the highest sensitivity (100%), highest specificity (97%), highest positive predictive value (93%) and also the highest negative predictive value (100%). Among 90 PCP patients diagnosed clinically, 74 of 90 (82.2%) patients recovered from the illness after treatment and 16 of 90 (17.8%) patients died due to illness. Conclusion: As revealed in our study, induced sputum analysis is a simple procedure, without significant adverse effects, and with a good diagnostic yield for P. jiroveci pneumonia determination in HIV-positive patients. IFAT is very sensitive and specific, though the expensive method for the detection of this organism.

Association between serum B12 and folate levels and manifestations of oral lesions in HIV adult patients

@#Introduction: Micronutrient deficiencies are common in Human Immunodeficiency Virus (HIV) infection. The long-term side effects of antiretroviral therapy (ART), specifically Azidothymine (AZT), include low serum levels of vitamin B12 and folate, which in turn, lead to megaloblastic anaemia and oral lesions. Methods: A crosssectional study was conducted to determine the associations between manifestation of oral lesions and serum vitamin B12 and folate levels in HIV-adult patients with or without receiving ART therapy. Oral lesions were determined based on the ECClearinghouse diagnostic criteria. Serum vitamin B12 and folate were assessed by electrochemiluminescence immunoassay (ECLIA). Sixty participants (48 males and 12 females) aged 20 to 51 years were recruited from a private hospital in Bandung, Indonesia. Results: Subnormal levels of serum vitamin B12 and folate were found in 16.6% and 6.7% HIV patients, respectively. Significantly lower serum levels of vitamin B12 and folate were shown in HIV patients receiving ART than those without ART. Oral lesions were found in all the participants with subnormal levels of serum vitamin B12 and folate. Presence of oral lesions was significantly associated with low levels of serum vitamin B12 in HIV patients with ART, but not with low folate levels. Conclusion: Low levels of serum vitamin B12 and folate were shown in HIV patients, indicating the need for early nutritional intervention to ensure optimal nutritional status and prevention of oral lesions in HIV patients.

Evaluation of the effects of passion fruit peel flour (Passiflora edulis fo. flavicarpa) on metabolic changes in HIV patients with lipodystrophy syndrome secondary to antiretroviral therapy

ABSTRACT This study evaluated the effects of using passion fruit peel flour together with diet therapy and counseling in 36 patients with HIV lipodystrophy who were in an ambulatory clinic in a university hospital. The patients were divided into two groups. One received 30 g of passion fruit peel flour daily for 90 days and diet therapy counseling. The other group received only diet therapy counseling. The metabolic changes were analyzed before and after the intervention, with a significance level predetermined at p ≤ 0.05. The use of passion fruit peel flour was effective in reducing total cholesterol and triacylglycerides after 30 days. The concentrations of LDL-C decreased, while HDL-C increased in the blood of lipodystrophy patients after 90 days passion fruit peel flour treatment. No significant differences in food consumption were seen between groups. The use of 30 g of passion fruit peel flour for 90 days together with diet therapy counseling was effective in improving plasma concentrations of total cholesterol, LDL-C, HDL-C and triacylglycerides.

Study Of Sociodemographic & Clinical Features Of Tuberculosis Cases In HIV Patients.

Background: Infection with HIV is the most potent risk factor for progression to active tuberculosis. Mycobacterium tuberculosis only have an approximately 10% lifetime risk of developing TB compared with 60% or more in persons infected with HIV and TB. Methodology: 100 HIV infected patients having symptoms of Tuberculosis were taken up for the study for a period of 18 months, meeting the criteria for the present study. Diagnosis of tuberculosis was based on clinical evaluation, sputum smear. Results: 100 HIV patients studied for period of 18 months . Majority of patients were in the age group of 30-41 years. 64% were males and 36% females. Labourers are commonly affected. Common presenting symptoms were fever(74%) cough (72%) and weight loss(62%). Associated clinical findings were pallor(63%), (12%) and oral thrush(14%). Pulmonary TB (69%) is the most common form. Conclusion: Majority of patients were in the age group of 30-41 years, 64% were males 36% females. Most common occupation affected was labourers. Fever (74%), cough (72%) and weight loss (62%), pallor (63%), lymphadenopathy (12%) and oral thrush (14%). Most common form of tuberculosis was pulmonary TB (69%). Among extra pulmonary tuberculosis pleural effusion (8%) was the most common presentation.

Molecular analysis of methicillin-resistant Staphylococcus aureus dissemination among healthcare professionals and/or HIV patients from a tertiary hospital

Abstract INTRODUCTION: Methicillin-resistant Staphylococcus aureus (MRSA) is a nosocomial pathogen in community settings. MRSA colonized individuals may contribute to its dissemination; the risk of MRSA infection is increased in human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) patients, although the prevalence of colonization in this group is not well established. The present study addressed this issue by characterizing MRSA isolates from HIV/AIDS patients and their healthcare providers (HCPs) to determine whether transmission occurred between these two populations. METHODS: A total of 24 MRSA isolates from HIV-infected patients and five from HCPs were collected between August 2011 and May 2013. Susceptibility to currently available antimicrobials was determined. Epidemiological typing was carried out by pulsed-field gel electrophoresis, multilocus sequence typing, and Staphylococcus cassette chromosome (SCCmec) typing. The presence of heterogeneous vancomycin-intermediate Staphylococcus aureus (hVISA) and heterogeneous daptomycin-resistant Staphylococcus aureus (hDRSA) was confirmed by population analysis profile. Isolates characterized in this study were also compared to isolates from 2009 obtained from patients at the same hospital. RESULTS: A variety of lineages were found among patients, including ST5-SCCmecII and ST30-SCCmecIV. Two isolates were Panton-Valentine leukocidin-positive, and hVISA and hDRSA were detected. MRSA isolates from two HCPs were not related to those from HIV/AIDS patients, but clustered with archived MRSA from 2009 with no known relationship to the current study population. CONCLUSIONS: ST105-SCCmecII clones that colonized professionals in 2011 and 2012 were already circulating among patients in 2009, but there is no evidence that these clones spread to or between HIV/AIDS patients up to the 7th day of their hospitalization.

Occult hepatitis B virus infection in Moroccan HIV infected patients.

Background: The purpose of this study is to assess the prevalence of Occult hepatitis B virus Infection (OBI) among antiretroviral treatment naïve HIV-1 infected individuals in Morocco and to determine factors favouring its occurrence. Methods: The retrospective study was conducted in the Mohammed V military teaching hospital in Rabat between January 2010 and June 2011. It included patients with confirmed HIV infection, tested negative to serological detection of HBV surface antigen (HBsAg) and did not received antiviral treatment or hepatitis B vaccine. All samples were tested for anti-HBc, anti-HBs and anti-HCV antibodies using enzyme immunoassay (ELISA). The detection of HBV DNA was performed by real-time PCR using two specific primers for a gene in the region C of the viral genome. The sensitivity of the technique was 20 copies/ml. Results: A total of 82 samples were analyzed, 19 (23 %) were found to have isolated anti-HBc, 07 (8.5%) with associated anti-HBc and Anti-HBs. No anti-HCV marker was detected on these screening samples. The HBV DNA was detected in 48 (58%) samples, of which, males constituted 58% (28/48). The mean age of these patients was 38 ± 8.2 (29-56), the median HIV-1 viral load and CD4 cell count HIV-1 infected patients were 127500 (54108-325325) copies/ml and 243 [80-385] cells/mm3 respectively and 27.1% (13/48) of these patients were found to have isolated anti-HBc. A significant correlations between DNA HBV and HIV viral load higher than 100000 copies/ml (P = 0.004), CD4 cell count lower than 400 cells/mm3 (P = 0.013, P = 0.006) and isolated anti-HBc samples (P <0.005) were founded. However there was no significant association with age, sex, transmission mode and clinical stage. Conclusion: The consequences of this high prevalence of OBI in Morocco need to be considered in laboratory diagnosis of HBV infection in HIV infected patients and the PCR seems to be inevitable for a better diagnosis and therapy.

Epidemiology of Coccidian Parasites in HIV Patients of Northern Uganda.

understood. This study aimed at determining the epidemiology of coccidian parasites and their associated risk factors. This was a cross sectional study carried out in Arua district in West Nile region of Northern Uganda for a period of five months. Materials and Methods: Participants in the study included HIV positive patients presenting with diarrhea. A total of 111 patients were included and classified into children, middle aged and adults. A structured questionnaire was administered, stool samples were obtained using sterile stool containers and laboratory analysis carried out using modified Ziehl-Neelsen technique (ZN). Ethical clearance was acquired and the consent of the patients was sought. Results and Discussion: Prevalence of Coccidian parasites among HIV patients was found to be 5.4% and Cryptosporidium parvum showed more prevalence than Isospora belli and Cyclospora cayatenensis i.e. (3.6%), (1.8%) and (0.0%) respectively. Most Cryptosporidium parvum infections occurred in children (13.6%) compared to adults (3.3%); with a significant relationship of (p = 0.02). The infection was higher in females (7.1%) than males (2.4%) (p = 0.19). The major risk factors associated with the disease were mainly consumption of contaminated and un-boiled water from taps and boreholes. HIV patients who took co-trimoxazole and drunk boiled water were shown to have a low prevalence of coccidian parasites of 1.9% and 2.6% respectively (p<0.05). This is because cotrimoxazole is a prophylactic drug for opportunistic infections and proper boiling of drinking water kills coccidian parasites. Conclusion and Recommendations: The study highlighted the importance and need to screen for coccidian parasites and emphasis on regular taking of prophylactic treatment as a way of controlling opportunistic infections in HIV patients. Future prevalence studies of Coccidia amongst healthy, HIV sero-negative children and adults of similar age groups in similar settings are recommended to ratify the relationship.

Prevalence of Disseminated Cryptococcosis among Human Immunodeficiency Virus Infected Patients in Benin City, Nigeria.

Aim: To determine the prevalence of disseminated cryptococcosis among symptomatic HIVinfected patients, attending the Antiretroviral Treatment Clinic at the University of Benin Teaching Hospital, Benin City, Nigeria. Study Design: Cross-sectional study. Place and Duration of Study: Department of Internal Medicine and Department of Medical Microbiology, University of Benin Teaching Hospital, Edo State, Nigeria, between September 2010 and August 2011. Methodology: Five hundred consecutive symptomatic HIV-infected patients, on ART were enrolled into this cross-sectional study (266 males, 234 females, age range 18-81 years, mean age, 40.08 years). A blood sample collected from each participant was screened for serum cryptococcal antigen (CRAG) using the cryptococcal Latex agglutination test. The viral load and CD4+ T -cell count were also determined in parallel. A structured questionnaire was used to gather Information on socio demographic characteristics, medical and treatment history of participants. Data collected and the results of laboratory tests were analyzed using the SPSS software, version 22.0. Results: The prevalence of serum cryptococcal antigen was 9.8%. Majority (66.8%) of the participants had a CD4+ T-cell count of less than 100 cells/μl. The association between serum CRAG and CD4+ T-cell was found to be significant (P < .001). Viral load done for only 90 of the participants was high in 51.1%. The association between serum CRAG and viral load was found to be significant (P < .001). Conclusion: The prevalence of serum CRAG was high among symptomatic HIV- infected patients on ART, in Benin city, Nigeria, despite ART implementation. There is need therefore for a routine cryptococcal antigen test for all symptomatic HIV-infected patients on ART, while further microbiological investigations for those with positive result are recommended for appropriate medical intervention.

Knowledge and attitudes of adult HIV positive patients to HIV/AIDS in Selected ART Clinics in Yola, Nigeria

Though cases of AIDS are visible in Nigeria and awareness of HIV is high, correct knowledge on HIV transmission and prevention has remained low with significant numbers of people living with HIV/AIDS having low attitudes towards life and the disease itself. This study determined the baseline knowledge on HIV transmission and prevention, and attitudes towards HIV/AIDS of adult HIV positive patient enrolled into care at all four comprehensive antiretroviral therapy (ART) sites in Yola, Nigeria. Baseline reports on the knowledge and attitudes of adult HIV positive patients were obtained from a three arm randomized single blind clinical trial involving 386 randomly selected adult HIV patients who were enrolled into ART care at all four comprehensive ART sites in Yola. An administered, validated structured questionnaire was used for data collection. Outcome measures were sound knowledge on HIV transmission and prevention, and attitudes towards HIV/AIDS. Data was analyzed using SPSS version 22. Test of significance was at α level 0.05. Overall 237 (61.4%) had sound knowledge on HIV transmission and prevention, while 346 (89.6%) of respondents had high attitudes towards HIV/AIDS. Though majority of respondents had sound knowledge on HIV transmission and prevention as well as high attitudes towards HIV/AIDS, interventions to improve knowledge and attitudes among this group of individuals would improve positive preventive strategies.

Coinfección de hepatitis B y/o hepatitis C en pacientes infectados por virus de inmunodeficiencia humana (VIH) / Hepatitis B and/or hepatitis C co-infection in patients infected by the human immunodefficiency virus (HIV)

La coinfección con los virus de hepatitis B (VHB) y/o hepatitis C (VHC) puede provocar complicaciones en el paciente VIH+. El objetivo de este estudio fue evaluar la frecuencia de marcadores serológicos en la coinfección del VHB y/o VHC en plasmas de pacientes infectados por VIH y su correlación con el estatus virológico del VIH e inmunológico del paciente. Se evaluaron 1.846 plasmas positivos para VIH, referidos al Instituto Nacional de Higiene “Rafael Rangel” para la determinación de marcadores serológicos del VHB y VHC. Se realizaron análisis de carga viral del VIH-1 y recuento de linfocitos T CD4+/CD8+ para evaluar el estatus virológico e inmunológico, respectivamente de la población estudiada. La frecuencia de coinfección por VHB ó VHC fue de 15% y 5%, respectivamente mientras que la coinfección VHB/VHC fue de 0,16% (3/1.846) en pacientes infectados por VIH. No se observó asociación entre presencia de marcadores serológicos del VHB ó el VHC y bajos ó elevados niveles de ARN genómico del VIH (p=0,81 y p=0,31, respectivamente) ni valores bajos ó normales del índice CD4/CD8 (p=0,75 y p=0,06, respectivamente). Estos resultados sugieren que la coinfección con VHB o VHC no parece influir en los estatus virológico e inmunológico de la población evaluada.

Co-infection with hepatitis B (HBV) virus and/or hepatitis C (HCV) virus can induce complications in HIV+ patients. The purpose of this study was to evaluate the frequency of serologic markers in HBV and/ or HCV in plasma of HIV infected patients, and its correlation with the HIV viral status and the immunological status of the patient. The study included the evaluation of 1,846 HIV positive plasmas referred to the Instituto Nacional de Higiene “Rafael Rangel” for the determination of HBV and HCV serologic markers. The evaluation of the viral and immunological status was done by the analysis of the HIV-1 viral load and CD4+/CD8+ T lymphocyte counts, respectively, in the population studied. The frequency of HBV or HCV co-infection was 15% and 5%, respectively, while HBV/HCV co-infection was 0.16% (3/1,846) in HIV infected patients. There was no association between the presence of HBV or HCV serologic markers and low or normal values of the HIV genomic RNA (p=0.81 and p=0.31, respectively) nor low or normal values of the CD4/CD8 index (p=0.75 and p=0.06, respectively). These results suggest that HBV or HCV co-infection does not seem to influence the viral and immunological status of the evaluated population.

Clinical Profile of pulmonary tuberculosis in patients with HIV infection.

Background: Tuberculosis is the commonest opportunistic infection and commonest cause of death in HIV/AIDS patients in India. Objective: To study the clinical, radiological and immunological profile of pulmonary tuberculosis in HIV infected patients. Methods: We conducted a retrospective study of 60 patients of pulmonary tuberculosis in patients with Human immunodeficiency virus positive. The diagnosis of tuberculosis was based on clinical evaluation, bacteriological examination including sputum smear and culture, tuberculin skin test and chest radiograph. CD4+ T cell counts were done on all patients. Results: Commonest risk factor for HIV transmission was sexual exposure in 47 cases (78%).35 cases (58.33%) had CD4+ T cell count <200/mm3, 25 cases (41.67%) had CD4+ T cell >200. constitutional symptoms (91.66%)like weight loss, anorexia, fatigue, night sweats are more common than classical symptoms of pulmonary TB like chest pain (66.66%) ,cough with/without expectoration (58.33%), dyspnoea (61.66%), fever (75%) and haemoptysis (8.33%). Most common opportunistic infection was oral/esophageal candidiasis (22%).35% of pstients had typical pattern and 65% had atypical pattern of pulmonary TB on chest radiograph. 80% of patients with CD4+ T cell count <200/mm3 had atypical pattern. In pulmonary tuberculosis sputum smear for AFB was positive in 20% cases & negative in 80% cases. Majority of the patients with positive sputum smear had CD4+T cell count >200/mm3. MDR-TB was documented in 9 (12%) of patients. 4 cases have CD4+ count <200and 5 cases have CD4+count >200. total mortality was 10% among 60 patients. Conclusion: Tuberculosis infection in patients with HIV is more common in second & third decade of life more common in males. Atypical features are more common than typical features in HIV-TB patients. Negative/anergic TST is more common in patients of HIV-TB co infection due to compromised CMI. Disseminated and multifocal lesions were more common in severe degree of immune compromise (CD4+ <200), whereas cavitory lesion and unifocal opacities were relatively more common in patients having CD4+ >200. Sputum AFB negative pulmonary TB is more if CD4 <200

Personality Psychopathology in HIV Infected Patients.

Introduction: Given the magnitude of the problem and the multiple physical and psychological stressors that persons with HIV face in India, a study was planned to assess magnitude of substance abuse, and extent of personality psychopathology in HIV positive patients attending A.R.T. clinic at P.B.M. Hospital, Bikaner (Raj.). Aims: To assess and identify the extent of personality psychopathology in HIV patients Material and Method: 50 new seropositive patients without any severe medical illness, CD4 count above 350 and not on Antiretroviral Therapy were selected for study from ART Centre, PBM Hospital, Bikaner during 1 January 2010 to 31st December 2010. Personality psychopathology was assessed in study subjects for inter group comparison on various parameters like drug abuse, sex, etc., and other socio–demographic data on a self designed Performa and International Personality Disorder Examination (IPDE). Data were analyzed using appropriate statistical methods. Results: 77 % [14 out of 18] male HIV positive patients with substance abuse had disorder level of personality psychopathology, compared to 36% [4 out of 11] male HIV positive patients without substance abuse. 17 female patients out of 21 had only trait level of personality psychopathology. Conclusion: Majority of patients with substance abuse had co-morbid personality disorder and therefore it suggests that HIV infection may be consequent to basic personality problem.

Counselling for Newly Diagnosed HIV Patients in Malaysia: Challenges and Best Practices

A HIV positive diagnosis greatly affects the psychological and emotional well-being of the person receiving the blood test results. The newly diagnosed patient is usually in shock even though they may be subconsciously aware that they have put themselves at risk. Immediate counselling must be provided by trained counsellors to ensure that the patient has access to timely support and correct information specific to the patient‟s needs in order to increase understanding and acceptance of the diagnosis. The establishment of hospital based Hospital Peer Support Programmes (HPSP) and development of non-hospital based Support Services; be it Self-help Groups or Support Groups; to strengthen the treatment services provided at Treatment Centres. People Living with HIV (PLHIV), including those representing various marginalised communities, are trained and equipped with the skills and knowledge to provide the much needed support services. Challenges still abound in the efforts to increase acceptance to the set-up and running of PLHIV provided HPSP services; as well as address resistance toward the presence of non-medically trained personnel in a healthcare setting. Benefits of having targeted community-specific HPSP counsellors available at Treatment Centres can assist in ensuring acceptance of diagnosis; enhance observance to follow-up and monitoring appointments; greater comprehension to treatment procedures; increased readiness to commencing HAART; and encourages improved adherence and compliance. Concerted efforts must be placed on actively recruiting and providing training to PLHIV from various marginalised communities in order to strengthen the support services currently available at Treatment Centres. It is essential that the Ministry of Health, Director Generals of all hospitals, as well as doctors and nurses of Infectious Diseases clinics understand the benefits of putting in place Community-specific HPSP services.

Quality of life of HIV+ patients undergoing pharmacotherapeutic follow-up

The influence of pharmacotherapeutic follow-up (PTF) on quality of life was evaluated in 45 HIV+ patients, who were undergoing initial antiretroviral therapy at a specialized care center in northeast Brazil. PTF lasted nine months and quality of life was analyzed at the 1st and 9th meetings using a questionnaire validated for Brazil. The study identified 643 problems related to antiretrovirals and there were 590 pharmaceutical interventions during the PTF. The comparative analysis between the results of the 1st and the 9th meeting was statistically significant for all domains of the questionnaire. For asymptomatic patients, only one domain was statistically significant. For symptomatic patients, six domains were significant. Patients with one year of HIV/AIDS diagnosis had statistically significant differences in five domains. The results suggest that the PTF contributed to improving quality of life, particularly for symptomatic patients and those diagnosed for at least one year - important target groups for Pharmaceutical Treatment.

A influência do seguimento farmacoterapêutico (SFT) sobre a qualidade de vida foi avaliada em 45 pacientes HIV+ assistidos em serviço de atendimento especializado do nordeste brasileiro. O SFT teve duração de 9 meses e a qualidade de vida foi analisada no 1º e 9º encontros através de questionário validado no País. Identificaram-se 643 problemas relacionados aos antirretrovirais e realizaram-se 590 intervenções farmacêuticas durante o SFT. A análise comparativa entre os resultados de qualidade de vida do 1º e 9º encontro foi estatisticamente significativa em todos os domínios do questionário. Quando analisados somente os pacientes assintomáticos, apenas um domínio apresentou significância estatística. Entre os sintomáticos, seis domínios foram significativos. Pacientes com até um ano de diagnóstico de HIV/AIDS apresentaram validade estatística em cinco domínios. Os resultados sugerem que o SFT contribuiu para a melhoria da qualidade de vida dos pacientes, sobretudo dos sintomáticos e/ou com até um ano de diagnóstico, representando grupos-alvo para a prática da Atenção Farmacêutica.

Psychiatric Disorders in HIV Infected Patients.

Introduction: Psychological and psychiatric issues associated with HIV infection have received considerable attention in the last decade owing to the emotional impact of the disease and its effect on an individual’s personal, sexual, occupational social and emotional life. Aims: To study the phenomenology of psychiatric disorders in relation to HIV infection. Material and Method: 50 new seropositive patients without any severe medical illness,CD4 count above 350 and not on Antiretroviral Therapy were selected for study from ART Centre, PBM Hospital, Bikaner during 1 January 2010 to 31st December 2010. Equal number of attendants of patients were also assessed on same parameter as control group after recording socio–demographic data on a self designed Performa, Montgomery Asberg Depression Rating scale (MADRS), Hamilton Anxiety Rating Scale (HARS) and Brief Psychiatric Rating Scale (BPRS) were administered. Data were analyzed using appropriate statistical methods. Results: 8 out of 18 (45%) male HIV patients with substance abuse reported moderate–severe tension, 1/3 of patients exhibited moderate–severe depression and 15 (84%) were moderate to severely anxious. Among known drug abuse patients, 7 (64%) had moderate to severe anxiety and depression, 8 (72%) felt moderate to severe tensions. All males were moderate to severely hostile. Psychopathology was more frequent in females. Where tension, moderate to severe anxiety and depression were present in 90% of patients. Conclusion: Results indicate that the 65–85 % of non drug abuse male suffer from moderate to severe psychopathology,and the psychopathology in drug abusers is approximately 45% .The females were the worst sufferers.

Acercamiento al conocimiento de los procesos adversos en la terapia antirretroviral / Rapprochement to knowledge of adverse processes in antiretroviral therapy

Existen riesgos inherentes a la terapia con fármacos, tanto conocidos como desconocidos, asociados con el uso terapéutico de drogas, prescriptas y no prescriptas. Se realizó un estudio experimental de intervención educativa en personas con VIH/sida (PVS) del Policlínico Giraldo Aponte Fonseca del municipio Guamá de la provincia Santiago de Cuba en el período de Septiembre a Diciembre del 2009, con el objetivo de fortalecer los conocimientos de las personas con VIH/sida con tratamiento antirretroviral de las Reacciones Adversas Medicamentosas. El universo-muestra estuvo constituido por la totalidad de las personas con VIH (14) que tienen tratamiento antirretroviral. Para la investigación se dividió el estudio en tres etapas: Diagnóstico, Intervención y Evaluación, además se analizaron variables de interés como: edad, sexo, conocimientos de las Reacciones Adversas Medicamentosas, cómo tomar los medicamentos y reacciones adversas y efectos indeseables al tomar los antirretrovirales. Los datos obtenidos se procesaron por el método manual utilizando una calculadora y los resultados se exponen en tablas estadísticas utilizando el porciento como unidad de resumen. Obteniéndose como resultado el predominio del grupo de edades entre los 35 39 años y el sexo femenino. Se concluyo planteando que se logro fortalecer los conocimientos en las reacciones adversas medicamentosas que se presentan al administrarse los medicamentos antirretrovirales, así como, sus efectos indeseables(AU)

There are risks inherent in the pharmacotherapy, well-known or not, associated with the therapeutic use of drugs, prescribed or not. An experimental study was conducted on educational intervention in HIV/AIDS persons from the Giraldo Aponte Fonseca Polyclinic of the Guamá municipality, Santiago de Cuba province from September to December, 2009 to strength the knowledges of this type of patients under antiretroviral treatment on Drug Adverse Reactions. The universe-sample included all the HIV-persons (14) under antiretroviral treatment. For research, study was divided into three stages: diagnosis, intervention and assessment, also interesting variables were analyzed including: age, sex, knowledges of Drugs Adverse Reactions, how to take drugs and adverse reactions and undesirable effects when they take the antiretroviral drugs. Data obtained were processed by manual method using a calculator and results are showed in statistical tables using the percentage as summary unit. There was predominance of 35-30 age group and female sex. We conclude proposing that it was possible to strength the knowledges in drug adverse reactions present at moment of antiretroviral administration, as well as its undesirable effects(AU)