Lymphoma in an HIV-positive patient.

HIV/AIDS is considered to be revealing of oncological diseases, of which most frequent are lymphomas. The main causes for this type of disease are non-adherence and non-compliance to antiretroviral therapy (ART). We are hereby presenting a clinical case of lymphoma in an HIV-infected adult, with non-adherence for 30 months. In such a case the interdisciplinary collaboration with the hematologist was essential for the patient's survival.

Responsibility and expectations in antiretroviral therapy--patients' versus doctors' perspective.

AIM: This paper aims to uncover what patients really expect form ART, and also what infectious diseases doctors expect from a patient's ART regime, thus exploring an important side of adherence to ART. MATERIAL AND METHODS: From July to November 2014 we have conducted a qualitative study regarding both patients' and doctors' expectations form the ART. We interviewed 30 patients and 4 doctors. We used semi-structured interviews that were conducted in the Psychosocial Compartment of the HIV/AIDS Regional Center in Iasi. RESULTS: The patients we interviewed came from all 6 counties in the Moldova area. Age varied from 16 years to 59 years; 55% were female and 45% male. 30% came from a rural area. The most common expectations that patients have regarding ART are: "to help me live", "not to make me feel sick", "to be easy to take (not to big, not a lot)", "not to show on the outside what I have on the inside". The infectious diseases doctors that we interviewed work in the HIV/AIDS Regional Center in Iasi. Their expectations regarding an ART regimen for patients were: "to reduce HIV viral load", "to increase CD4 cell count" and "to have minimal impact on the proper functioning of other organs". Patients consider themselves the only factors responsible for their own ART adherence in 56.6% of cases; 20% consider the doctor to be responsible for their adherence, 16.6% feel that their family, friends, and spouse are responsible, and 6.6% (2 patients) couldn't answer. Infectious diseases doctors considered that patients are 100% responsible for adhering to the antiretroviral therapy. CONCLUSIONS: In order to assure adherence to the ART it is important to explore both the doctor and the patient's perspective and to find ways to find a common ground in building a healthy relationship.

The HIV-positive patient in intensive care--psychological profile.

AIM: This paper aims to outline the profile of HIV-positive patients in intensive care, in terms of psycho-emotional and vital parameters. MATERIAL AND METHODS: We evaluated the HIV-positive patients that required intensive care (IC), from January 2011 to December 2013, in the HIV/AIDS Regional of the "Sf. Parascheva" Infectious Diseases Clinical Hospital Iasi. RESULTS: From January 2011 to December 2013, the HIV/AIDS Regional Centre in Iasi recorded 2649 hospitalizations, of which 0.67% (18 cases) required intensive medical care. Of these 10 were males and 8 females, aged between 24 and 65 years with a median of 24 years. There were 29 deaths (1.09% of all hospitalizations), 11 of which in intensive therapy (38% of all deaths)--7 men and 4 women. CD4 counts in persons requiring IC care were between 1 and 112/mm3, and most naive patients who died were late-presenters. The main diseases diagnosed were pulmonary tuberculosis and pneumocystosis, the main cause of death being multiple organ failure. The duration of hospitalization ranged between 4.5 and 30 days. Treatment success rate was correlated with the CD4 and biological status: liver and renal failure, respiratory failure, meningeal coma, hypoproteinemia, diselectrolitemia. From a psychological perspective, patients that arrived in the intensive care showed a history of non-compliance and non-adherence, a personality structure often marked by a lack of respect for them, indifference or ignorance regarding the factors that generate well-being. CONCLUSIONS: HIV-positive patients in the position of requiring intensive care showed a marked immunological collapse due to abandonment of therapy or late detection.

The psycho-emotional profile of the HIV-positive naïve patient.

AIM: The paper aims to outline the naïve HIV-positive patient's profile, in terms of feelings and emotions post-diagnosis. MATERIAL AND METHODS: The evaluation took place from January 2011 to December 2013 in the Psycho-social Assistance Office of the "Sfânta Parascheva" Infectious Diseases Hospital in Iasi. We evaluated 146 patients newly diagnosed with HIV infection, both in terms of immunological and virusological and from a psychological perspective, using the Hamilton Anxiety Scale (HAMA), Beck Depression Inventory II (BDI) and the clinical interview. RESULTS: In a period of 3 years (January 2011 - December 2013) we registered in the HIV/AIDS Regional Center in Iasi, 146 new cases of HIV infection in adults, with distribution by years as follows: 46 in 2011, 45 in 2012, 55 in 2013; 39 cases were in Iasi, 39 in Suceava, 26 in Botosani, 18 in Neamt 18, 16 in Bacau and 6 in Vaslui. Of these, 51 were women and 95 men, aged between 24 and 46 years. From the immunological point of view, 11% of patients had values of CD4 > 500 (16 patients), 47% between 500 and 100 (69 patients) and 42% < 100 (61 patients). From a psychological perspective, the clinical interview revealed a state of fear in 68.5% of cases (fear of death, fear of complications, fear of other people's reaction to the diagnosis), confusion in 62% of cases (in terms of diagnosis, the mode of infection, the future), anger in 27% of cases (against the source of infection, against themselves, against God or divinity), guilt and self-blame in 7% of cases. Beck Depression Inventory (BDI) revealed moderate depression in 14% of patients; mild depression in 27% of patients and 58% of patients presented no symptoms of depression. Regarding the anxiety scale HAMA, in 54% of cases it showed mild anxiety, average anxiety in 28% of cases, 14% severe anxiety and 3% (4 cases) very severe anxiety. CONCLUSIONS: Patients newly diagnosed with HIV are a vulnerable population with a specific psycho-emotional profile. Multidisciplinary knowledge--in medical, psycho -emotional and social terms--of the patient's characteristics and needs helps to support adherence to the antiretroviral therapy and improve the quality of life.