Quality of life and needs assessment on people living with HIV and AIDS in Malawi.

PURPOSE: Malawi is a sub-Saharan African nation with a severe HIV epidemic. The quality of life (QoL) has never been investigated among people living with HIV and AIDS (PLWHA) in Malawi. This study examines the QoL and associated factors including life needs among PLWHA at different stages of their illness in the northern region of Malawi. METHODS: Survey analysis of consecutive outpatient participants receiving highly active antiretroviral therapy at the Rainbow Clinic and non-HIV patients receiving care at the affiliated Mzuzu Central Hospital during a one-month period was performed. Laboratory testing and clinical diagnosis were used to determine HIV status, determine CD4 count, and classify WHO clinical stage. A total of 267 HIV-infected patients and 598 non-HIV participants completed a needs assessment and a Short Form-36 (SF-36) questionnaire, which contained a QoL subscale. SF-36 subscales and needs assessment scores were analyzed using t-test, ANOVA test, and Generalized Linear Model-Tukey's test. RESULTS: HIV-positive patients had significantly lower physical functioning (p=0.0365), mental health (p=0.001), social functioning (p<0.0001), and mental component summary (p=0.0069) scores than HIV-negative patients. Further, WHO Stage III HIV patients had significantly lower vitality (p=0.0439) and mental health (p=0.0022) scores than WHO Stages I and II patients; and WHO Stage IV patients had significantly lower vitality (p=0.0015), mental health (p=0.0006), and physical component summary (p=0.0443) scores than WHO Stages I and II patients. Finally, AIDS patients, as determined by CD4 count, had significantly lower bodily pain (p=0.0423) and physical component summary (p=0.0148) scores than non-AIDS, HIV-positive patients. CONCLUSION: HIV patients undergoing treatment in Malawi have a significantly lower QoL, both mentally and physically, than their non-HIV counterparts. Further, HIV patients at more advanced stages, both by the WHO definition and by CD4 count, have a significantly lower QoL than HIV patients at earlier stages of the disease.

Molecular epidemiology of HIV-1 subtype B, CRF01_AE, and CRF07_BC infection among injection drug users in Taiwan.

OBJECTIVE: An explosive outbreak of HIV-1 circulating recombinant form (CRF) 07_BC among injection drug users (IDUs) in Taiwan was first reported in 2004 and reach the peak in 2005. The objectives of this study were to investigate the molecular epidemiology of different HIV-1 subtypes and their associated risk factors among Taiwanese IDUs in 2004 and 2005. METHODS: Questionnaires and blood specimens were collected from inmates from 4 detention centers and 2 prisons. HIV-1 subtypes were determined using nested polymerase chain reactions with multiplex primers and phylogenetic analyses. A case-control study was conducted to elucidate risk factors associated with CRF07_BC infection. RESULTS: A total of 93.8%, 4%, and 2.2% of 451 inmates with IDU history were infected with CRF07_BC, subtype B, and CRF01_AE, respectively. Besides CRF07_BC, a new outbreak of CRF01_AE infection was identified among IDUs from central region. Multivariate analysis showed that sharing dissolved heroine solution [odds ratio (OR) = 17.2], sharing syringes (OR = 34), number of persons sharing syringes (2 vs. 1, OR = 3.1), and lower educational level (OR = 2.3) were risk factors associated with CRF07_BC infection. CONCLUSIONS: Sharing dissolved heroine solution is a neglected risk factor associated with HIV-1 infection and it should be emphasized in the AIDS education and harm reduction programs immediately.