HIV/AIDS and Depression: When Two Conditions Coincide – Prevalence and Associated Factors.

Introduction: Depression is the most common mental illness among people living with HIV/AIDS (PLHA). While depression is common among other chronic illnesses, it is expected to be more with HIV/AIDS, which is a more stressful state. Thus, in this study, we tried to estimate the prevalence of depression along with its associated factors in people with HIV/AIDS. Method: This cross-sectional study was done at one ART Centre in North India. Over a period of one year, HIV/AIDS patients taking antiretroviral therapy were interviewed, estimating depression with PHQ-9. Using multivariate logistic regression, we examined the association of various factors with depression among HIV patients. Results: We observed that 16% of PLHA suffered from depression, while 3% had moderate and moderately severe depression. Among the factors associated with depression, we found alcohol consumption [OR 2.553; 95%CI 1.180 - 5.526], lower CD4 cell counts [OR 2.630; 95%CI 1.297 - 5.330], side effects from ART [OR 2.442; 95%CI 1.302 - 4.577], unsatisfaction from family support [OR 2.683; 95%CI 1.334 - 5.394] and no improvement from ART [OR 0.412; 95%CI 0.190 - 0.896] to be individually and significantly associated. Conclusion: Higher prevalence of depression among HIV/AIDS patients and its association with various factors should worry policymakers, prompting them to take necessary action.

Depression and its predictors among people living with HIV/AIDS on antiretroviral therapy

Background: HIV infection is one of the raising public health problems. HIV diagnosis is usually associated with stigma and often results in mental illness among the people infected. Depression is the most common mental illness in HIV patients as found by various studies. Hence the present study aimed to determine the proportion of depression and its socio-demographic and clinical predictors among people living with HIV/AIDS (PLHA).Methods: A hospital based cross sectional study was done among 322 PLHA on Antiretroviral therapy attending ART centre at GIMS Teaching Hospital, Gadag. After taking written informed consent from the patients, a predesigned proforma which included socio-demographic variables, clinical details, and CD-4 count, along with patient health questionnaire (PHQ) 9 was administered to assess depression in PLHA.Results: Out of the 322 people living with HIV/AIDS, 108 (33.5%) had depressed. According to PHQ 9 questionnaire, 19.9% had mild depression, 10.6% moderate depression and 3.1% had moderate severe depression. It was noted that 40.3% of females had depression compared to 24.8% of males. PHLA who were on ART for less than one year had higher proportion of depression (61.1%) compared to those with 5 years duration of ART (28.6%) and it was statistically significant.Conclusions: In the study 33.5% of PHLA had depression. Socio-economic status, gender, duration of ART had significant association with depression whereas age, education, place of residence, CD4 count were not associated with depression. Depression screening among PHLA can be done at regular follows ups at ART centres.

Prevalence of Sexually Transmitted Infections and its Associated factors among women living with HIV/AIDS

Background: Sexually transmitted infections (STIs) are significant public health problem in India. Studies have shown a considerably higher prevalence of STIs among females as well as in high-risk groups. Thus, we conducted this study to estimate the prevalence of STIs and to find out its associated factors among women living with HIV/AIDS. Material & Methods: A cross-sectional study was conducted at the ART centre, Aligarh. A total of 170 HIV positive women were approached with study tools comprising of pre-structured proforma. NACO STIs Syndromes were used to estimate STIs. Data was analyzed using the SPSS version 20.0, keeping significance at p<0.05. Results: We found the self-reported prevalence of STIs in HIV positive women to be 18.2% (31/170) at the time of interview and 49.4% (84/170) ever since the diagnosis of HIV. Most of the HIV women were presently having vaginal/cervical or urethral discharge syndrome (93.5%) and genital ulcer syndrome (16.1%). STIs were significantly associated with uneducated females and with irregular use of condoms. Conclusion: This study found the prevalence of STIs to be still higher among HIV positive women, in spite of years of targeted interventions reducing it. A proper action and further researches are required to explore and manage variables associating STIs for reducing its prevalence

Cardiovascular manifestations of people living with HIV/AIDS: Report from a hot spot in eastern India

Objective To study the profile and characteristics of cardiovascular abnormalities among patients living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) at a tertiary care hospital in India. The association of cardiovascular abnormalities with the CD4 count and disease stages, according to the World Health Organization (WHO) classification, was also analyzed. Methods A total of 200 patients with HIV/AIDS were compared with 50 healthy controls. All patients underwent blood investigations, chest X-ray, electrocardiography, and echocardiography. Results The mean age of the patients was 38.66 ± 9.22 years, with a male-to-female ratio of 3.25:1. Echocardiographic abnormalities were found in 52% of the patients and 12% of the controls, with the most common abnormality being left ventricular diastolic dysfunction. Echocardiographic abnormalities were markedly more common in patients with a CD4 count of <200/μL. The advanced stage of the disease, according to the WHO classification, was also associated with an increased incidence of echocardiographic abnormalities. Conclusions Cardiovascular abnormalities in the form of electrocardiogram and ECHO findings were present in 54.5% and 52% of patients, respectively. Echocardiographic findings showed significant correlation with CD4 count and WHO disease stage.

Quality of Life (QOL) among People Living with HIV/AIDS (PLHA) attending Tertiary Care Hospital of Delhi, India

As estimated by WHO, globally a total of 36.9 million [34.3 – 41.4 million] people were living with HIV in 2014. Quality of life (QOL) of HIV/AIDS patients is becoming an important element for understanding and assessing the overall health care and management in health care settings. The objective of this study was to determine the QOL of patients living with HIV/AIDS in Delhi. Systemic Random sampling method was used to identify the subjects from the antiretroviral therapy clinic (ART) situated in tertiary care hospital in Delhi. Methods: 200 patients were interviewed with the WHOQOL-HIV instrument. Questionnaire included items on socio-demographic data, multi-item scales and had six domains namely physical, psychological, level of independence, social relationships, environment and spirituality religion. Results: Study subjects were aged between 18-60 years with mean age of 34.46±8.76 years, and comprised of 41%females. 29 % of studied subjects were illiterate. More than 1/3rd of the patients (84% females) were unemployed and did not have any source of income. All QOL domains were observed to be higher for males in comparison to females. Single/widow patients had better QOL in comparison to married patients. QOL was observed to be better among those who were young, had better educational qualifications, were employed, asymptomatic, had shorter duration of treatment and those who stayed closer to the ART center. Conclusion: Correlation of scores of six domains with overall QOL score and among individual domains was found to be statistically significant.

A Study On Asymptomatic Vaginitis In Hiv Infection

Background: Vaginal discharge syndrome is common in women attending STI clinic. This may be vaginal/cervical and the presence of inflammation at these sites increase the risk of transmission and acquisition of HIV infection. Aim:To study the asymptomatic vaginitis in PLHAs. Materials & methods: An observational and prospective study for one year (year 2017) done in a tertiary care centre. A total of 152 women PLHAs participated and the diagnosis was made by correlation of clinical findings and microscopy.Results: The prevalence of asymptomatic vaginitis in PLHA was 79% (50/63 cases) which was considerably high when compared to STI clinic attendees. Vulvovaginal candidiasis was the commonest noted aymptomatic vaginitis followed by bacterial vaginosis. This states, it is the altered vaginal flora that causes asymptomatic vaginitis in PLHAs in common than the infections.Conclusion: This study stress the need for complete gynaecological evaluation and follow up in PLHAs.

Study of Cardiac Manifestations in Patients with HIV Infection and Their Correlation with CD4 Count in Indian Population.

Background: HIV continues to be a major global public health issue. In 2014 an estimated 36.9 million people were living with HIV, a global prevalence of 0.8 %. The clinical spectrum of HIV infection encompasses a spectrum ranging from an acute syndrome associated with primary infection to a prolonged symptomatic state to an advanced cardiac disease in HIV affected patients is becoming more prevalent as therapy and longevity improve Infection HIV is one of the causes of acquired heart disease in these patients. With advances in the management of patients living with HIV and AIDS (PLHA), not only survival has increased but manifestations of late stage HIV infection are encountered more often including cardiovascular complications. Aims and Objectives: To determine the prevalence and characteristics of cardiac manifestations in patients with HIV infection and to evaluate their correlation with CD4 count. Methods: During the period of 1 year from July 2015 to September 2016, total 100 cases of HIV/AIDS were included. The occurrence of cardiac involvement in HIV/AIDS cases was determined based on cardiac enzymes, ECG findings & 2D Echocardiography findings. An attempt was made to correlate various cardiac findings with CD4 T cell count. Results: Male to female ratio was 3:1. Common clinical symptoms were fever (68%), cough (44%) & extertional breathlessness (33%) Echocardiographic abnormalities were seen in 54.3% of patients. Reduced ejection fraction (below 50%) and fractional shortening below 30% were the most common cardiac abnormality (46.3%) followed by pericardial effusion (16.66%), pulmonary artery hypertension (11.11%), dilated cardiomyopathy (9.25%), diastolic dysfunction (9.25%), regional wall motion abnormality (1.85%) and valvular regurgitation (5.55%) respectively. Significant statistical positive correlation was observed between low CD4 count and echocardiographic abnormalities (p < 0.001). Pericardial effusion was seen more in patients with CD4 count below 200 (p < 0.05). Maximum number of echocardiographic abnormalities was seen in WHO clinical stage IV. Conclusion: Echocardiographic abnormalities are more prevalent in HIV/AIDS patients and their prevalence increases as the CD4 count falls andoccur more in advanced stage of the disease. So we should aim at starting ART early in HIV infected patients so as to improve the quality of life of people living with HIV/AIDS.

Comparison of Different Methods of Detection of Enteric Pathogenic Protozoa.

Purpose: The study was conducted to compare different methods of detection of pathogenic protozoan parasites in stool specimens of People Living with HIV/AIDS (PLHA). Materials and Methods: Stool specimens of 242 HIV sero-positive patients were examined using the wet mount technique, modified Ziehl-Neelsen's (ZN) staining, auto-fluorescence and auramine fluorescence staining. Patient specimens, 94 and 40 out of 242, were also subjected to Giardia antigen detection using an enzyme immunoassay and Cryptosporidium antigen detection by immuno-chromatography, respectively. For calculation of sensitivity, specificity, positive and negative predictive values, light microscopy of wet mounts and modified ZN stained smears for Giardia and Coccidia, respectively, were considered as gold standards. Results: Sensitivity of auto-fluorescence, auramine-O staining and antigen detection techniques was found to be 100% as compared to the routine standards. The specificity of auto-fluorescence was 90.6% and 100% for Cyclospora and Isospora, respectively; that of auramine-O staining was 98.9% for Cryptosporidium, 99.30% for Cyclospora and 100% for Isospora; and that of antigen detection was 90.6% and 97.7% for Cryptosporidium and Giardia, respectively. Conclusion: In laboratories requiring screening of large number of stool specimens for detection of protozoan parasites, fluorescence microscopy and antigen detection can be useful techniques. Confirmation of positive results, however, needs to be done with the standard techniques.

Assessing the Quality of life and Needs of HIV-AIDS Patients in Manipur A Preliminary Study.

This study aims to as.es. the quality of life (QoL) as perceived by HIV/AIDS patients and the needs of such people in their local context in Manipur. A cross sectional study was carried out in two selected districts of Manipur namely, Imphal west and Chandel. A total of 20 People Living with HIV/AIDS (PLHA) respondents were interviewed using WHOQoL-HIV instrument and a semi-structured interview. The overall quality of life mean score was 3.07 from the range of score between 0-5. Similarly, on a scale of 4-20, the scores in the six domains of the quality of life in descending orders were spirituality, religion, personal beliefs or SRPB (12.73); psychological (12.72); physical (12.41); level of independence (12.28); social relationship (11.83); and environment (11.54). Comparison of QoL showed female faring better with 3.12 mean score than their male counterparts (mean score: 2.83). The study also identified some of the needs of HIVIAIDS infected people in relation to clinical, financial, educational, psychological, socio-cultural, household needs, etc.