Peripheral artery disease in HIV-infected older adults on antiretroviral treatment in Thailand.

OBJECTIVES: HIV infection has become a chronic disease requiring long-term treatment. Premature cardiovascular disease resulting from atherosclerosis in the HIV-infected population has been observed. We assessed the prevalence of peripheral artery disease (PAD), a common consequence of atherosclerosis, in HIV-infected patients aged ≥ 50 years receiving antiretroviral treatment (ART). METHODS: This cross-sectional study was conducted in 12 community hospitals in Chiang Mai, Thailand. Inclusion criteria were as follows: (1) age ≥ 50 years, (2) positive HIV status, and (3) currently receiving ART. Age- and sex-matched hospital patients without documented HIV infection were enrolled as a comparison group. Clinical data were extracted from hospital records. Personal information and details of PAD-related symptoms were obtained through face-to-face interviews. The diagnosis of PAD was made using ankle-brachial index (ABI) measurement. RESULTS: Seven hundred and twenty-four participants were enrolled in the study (362 HIV-infected patients and 362 patients in the comparison group). In the HIV-infected group, 43% were male; the mean (± standard deviation) age was 57.8 ± 5.6 years. The mean (± standard deviation) times from HIV diagnosis and ART initiation were 10.0 ± 4.3 and 8.6 ± 3.5 years, respectively. The prevalence of abnormal ABI (< 1.00) was significantly lower in the HIV-infected group than in the comparison group (20 versus 27%, respectively; P = 0.03), while that of PAD (ABI ≤ 0.90) was not significantly different between the two groups (5 and 7%, respectively). In the HIV-infected group, female sex and low body mass index were independently associated with abnormal ABI. CONCLUSIONS: The prevalence of PAD when measured by ABI in HIV-infected older adults was relatively low. A follow-up study to determine the incidence of PAD and its persistence with time is warranted.

Factors influencing marital stability among HIV discordant couples in northern Thailand.

The burden of HIV in stable relationships places emotional, economic and physical stresses on families. We compared the influence of HIV notification on marital partnerships in northern Thailand among a cohort of HIV discordant couples, and identified factors associated with marital disruption. Data were collected using in-depth interviews with both members of six separated or divorced couples and 13 couples whose relationship remained intact. Five factors influenced marital stability following HIV notification: longer duration of relationship; economic constraints, extended family members' opinions, especially parents; the existence of children from the marriage; and fear of stigmatization by community members. Social influences, both overt and perceived, are important in shaping marital behaviour and decision-making in HIV epidemic areas. HIV counselling needs to be extended beyond the individual seeking testing to include stable partners (and perhaps further, to include the extended family), although it is recognized that this is not the norm for most HIV testing centres.

PIP: This study investigates the factors influencing marital stability among HIV discordant couples in northern Thailand. The influence of HIV notification on marital partnerships was compared between 6 separated or divorced couples and 13 couples whose relationship remained intact after positive HIV diagnosis of the husband through in-depth interviews. An ethnographic field guide was used in the interview, which addressed premarital background, marital relationships, and changes in the spousal relationship following notification of the husband's HIV test results. The results indicated that 5 factors influenced marital stability following HIV notification: 1) a longer duration of relationship; 2) economic constraints; 3) opinions of extended family; 4) presence of children; and 5) fear of stigmatization by community members. Separation and divorce usually occurred in short-duration, childless marriages and among high-income women. The findings suggest the need for culturally fitting HIV prevention and counseling programs with both the infected individual and his partner.