Hiv seropositivity Research Papers - Academia.edu (original) (raw)

The purpose of this study was to examine the effects of a nurse's counseling intervention on high-risk sexual behaviors of HIV-positive patients and to explore the relationship of gender, race, age, and education to high-risk sexual... more

The purpose of this study was to examine the effects of a nurse's counseling intervention on high-risk sexual behaviors of HIV-positive patients and to explore the relationship of gender, race, age, and education to high-risk sexual behaviors. A convenience sample of 20 adults who were newly diagnosed with HIV and were being treated at an inner-city out-patient clinic was used. Subjects were administered a questionnaire to determine their precounseling AIDS knowledge and precounseling sexual behaviors. A registered nurse then counseled them about safesex practices. After 2-3 months the questionnaire was readministered to determine the effects of counseling on AIDS knowledge and high-risk sexual behaviors. Although statistical analysis indicated a significant main effect for change in high-risk sexual behaviors after counseling, there were no significant relationships among change and the individual demographic variables of age, gender, race, and education. Pretest knowledge was not found to influence pretest behavior, nor was posttest knowledge found to affect posttest behavior. Paired t tests indicated a significant change in high-risk sexual behavior scores after counseling but no significant change in knowledge scores.

Amidst growing global endorsements of new biomedical HIV prevention strategies, ARV-based pre-exposure prophylaxis (ARV PrEP) has garnered considerable attention as a potentially promising prevention strategy. Though it may offer more... more

Amidst growing global endorsements of new biomedical HIV prevention strategies, ARV-based pre-exposure prophylaxis (ARV PrEP) has garnered considerable attention as a potentially promising prevention strategy. Though it may offer more effective protection for certain at-risk groups than conventional prevention strategies (such as sexual partner reduction, condom use, and prevention of mother-to-child transmission), PrEP is more costly. PrEP requires more ongoing contact between individuals and providers, and a level of surveillance from the health system that is not necessary with other preventive measures. In this sense, it represents a new biotechnology for HIV prevention that poses particular challenges for worldwide implementation, given developing countries' struggling health systems and incomplete HIV treatment programs. Since the emergence of PrEP has stimulated ethical discussions premised on incomplete knowledge of efficacy and implementation, this paper explores the ethical parameters of a likely scenario for PrEP usage in a single, resource-poor country. We first develop a plausible model for PrEP deployment and utilization based on current PrEP research, while carefully considering the reigning institutional values of feasibility and effectiveness in global health approaches. Drawing on ethnographic research of HIV treatment and prevention approaches in Lesotho, we address ethical questions arising from this scenario of PrEP delivery. Lesotho presents a compelling and emblematic case study of PrEP's potential successes and pitfalls in a developing country, given the country's high HIV prevalence, struggles to achieve universal access to HIV treatment regimes, continued existence of stigma around the epidemic, and difficulties in addressing persistent social inequalities that fuel infections.

The aim of the research to be presented in this article was to explore, within an Irish context, HIV positive patients' experiences of hospitalisation, and particularly their experiences of nursing care. This paper reports on one of the... more

The aim of the research to be presented in this article was to explore, within an Irish context, HIV positive patients' experiences of hospitalisation, and particularly their experiences of nursing care. This paper reports on one of the dominant themes to emerge in the study-the experience of stigma among persons living with HIV during their hospitalisation. A volunteer sample of 10 former in-patients of hospitals in the Republic of Ireland's capital, Dublin, were interviewed in depth, and data were analysed using a qualitative content analysis. Findings indicate that while some participants experienced stigma from nurses, such stigma was stratified according to the means by which the disease had been contracted, with drug users expressing the greatest feelings of stigma from nurses. Data also suggest that the location of nursing care favoured by many participants was segregated care in specialist units, because it enabled them to avoid being discredited by other patients who did not have the virus, as well as potentially 2 offering social support from like-situated others. Finally, patients experienced breaches in confidentiality because of institutional policies that made their disease conspicuous, and from some nurses' nonchalance in handling information about their disease. The analysis draws on Goffman's conceptualisations of stigma to explain the social process underlying participants' accounts.

Background: Vaccine-induced antibodies to envelope proteins frequently cause HIV seroconversion in uninfected recipients of HIV vaccine candidates and may thus have an impact on the vaccinee's ability to donate blood or acquire a life... more

Background: Vaccine-induced antibodies to envelope proteins frequently cause HIV seroconversion in uninfected recipients of HIV vaccine candidates and may thus have an impact on the vaccinee's ability to donate blood or acquire a life insurance policy. Objective: To determine the occurrence of positive test results when commonly used HIV immunoassays are used to screen sera of HIV-uninfected volunteers who received an adjuvanted HIV-1 vaccine candidate containing HIV-1 antigens p24, reverse transcriptase, Nef and p17. Study design: Sera of 50 subjects who received this polyprotein vaccine in a single center in Belgium were tested with 6 HIV screening assays and 1 confirmation test. All samples were drawn one year after the administration of the first of two vaccine doses given with one month interval. Results: Forty-five (90%) sera showed a positive test result in at least one of the 7 HIV tests used. The positivity rates were 88% in the Elecsys HIV Combi assay, 74% in the ADVIA Centaur EHIV and 48% in the PRISM HIV O Plus assay. Conclusions: Interpretation of HIV test results is becoming increasingly complex with the growing number of volunteers participating in prophylactic HIV vaccine trials worldwide and the rising number of viral antigens included in these vaccine candidates. The results of this study in recipients of a highly immunogenic adjuvanted polyprotein HIV vaccine candidate devoid of envelope proteins, illustrate the increasing need for approaches that can discriminate HIV infection-induced antibodies from those elicited by a vaccine.

This study sought to identify barriers and facilitators to dental care among families of predominately low socioeconomic status having children with and without HIV. Twelve focus group sessions with African-American and Hispanic... more

This study sought to identify barriers and facilitators to dental care among families of predominately low socioeconomic status having children with and without HIV. Twelve focus group sessions with African-American and Hispanic caregivers and 18 individual semistructured interviews with key informant health care providers were held at two sites: a hospital-based program (HBP) and a dental school-based program (DSBP), that provide pediatric dental services. SPSS Textsmart software was used to analyze qualitative data within and across group types and sites. Focus group participants (n = 72, averaging 6 women per group) included: HIV-seropositive biological mothers of HIV-seropositive children (4 groups); HIV-seronegative caregivers of HIV-seropositive children (4 groups); and Medicaid-eligible, HIV-seronegative caregivers of HIV-seronegative children (4 groups). The most commonly expressed barrier to dental care across groups was poor interpersonal communication between dental staff...

Background: Heart rate variability (HRV) is a marker of cardiac autonomic tone. Depressed HRV has been reported in patients with AIDS. We conducted this study to find out if HRV is depressed in human immunodeficiency virus (HIV)-positive... more

Background: Heart rate variability (HRV) is a marker of cardiac autonomic tone. Depressed HRV has been reported in patients with AIDS. We conducted this study to find out if HRV is depressed in human immunodeficiency virus (HIV)-positive individuals without AIDS. Methods: We studied prospectively HRV by spectral analysis of short-term electrocardiography (ECG) monitoring in 21 HIVpositives (33F11 years) and in 18 healthy volunteers (31F9 years). None of the HIV-positives had any clinical evidence of autonomic or cardiac dysfunction. Echocardiography was also performed in HIV-seropositives to rule out left ventricular (LV) systolic dysfunction. All these individuals did not have any evidence of AIDS. Results: Mean CD4+ lymphocyte count was 426F166/mm 3 . The ejection fraction (EF%) of HIV patients was 62.4F6.4.The total power of HRV was reduced significantly in HIV-positive individuals ( p<0.00001). All the components of HRV were reduced. Conclusions: HRV is reduced in HIV-seropositive individuals in early stages of infection as well without any clinical evidence of autonomic dysfunction. This may serve as an early marker of future global sympathovagal imbalance. D

Various approaches to preventing mother-to-child transmission (MTCT) of HIV have recently been, or are being, evaluated in developing countries, especially in Africa. New findings from these trials are now becoming available, the... more

Various approaches to preventing mother-to-child transmission (MTCT) of HIV have recently been, or are being, evaluated in developing countries, especially in Africa. New findings from these trials are now becoming available, the implications of which, for population-based intervention programmes, need urgent consideration. A critical review of 18 randomized trials and other relevant studies from developing and industrialized countries. Most African results relate to trials of antiretroviral agents (ARV). They demonstrate efficacy in reducing transmission in the first 6 months of life with short regimens of zidovudine (ZDV), with or without lamivudine (3TC), and nevirapine (NVP) alone. Preliminary results suggest the long-term efficacy of zidovudine. Antiseptic and nutritional interventions have been shown to reduce maternal and infant mortality and morbidity but not MTCT of HIV. HIV confidential voluntary counselling and testing for pregnant women, a short regimen of peripartum ARV...

This study was designed to determine the bioavailability and dose linearity and proportionality of ganciclovir after multiple oral administrations of 3,000 mg to 6,000 mg per day. In an open-label, randomized, four-treatment crossover... more

This study was designed to determine the bioavailability and dose linearity and proportionality of ganciclovir after multiple oral administrations of 3,000 mg to 6,000 mg per day. In an open-label, randomized, four-treatment crossover design, 24 patients seropositive for human immunodeficiency virus (HIV) and cytomegalovirus (CMV) received in random order multiple oral doses of ganciclovir 1,000 mg every 3 hours (six times a day), 1,000 mg four times a day, and 1,000 mg three times a day and a single 5-mg/kg intravenous infusion (over 1 hour) of ganciclovir. Blood samples for pharmacokinetic determinations were obtained on day 3 of each oral regimen and on the day of the intravenous infusion over a 24-hour time interval. Mean steady-state average serum concentrations of ganciclovir were 0.54, 0.79, and 0.99 microgram/mL, respectively, with the 3, 4, and 6 g/day oral regimens. The steady-state area under the concentration-time curve (AUC0-24) for the 6,000 mg/day oral regimen approached that of the single-dose intravenous regimen. There was a proportional increase in AUC0-24 between the 3 and 4 g/day dosage regimens, but not between the 4 and 6 g/day regimens. This suggests nonlinear absorption of ganciclovir at higher dosages, although the departure from proportionality was less than 11%.

The aim of this work was to assess HIV/AIOS perceptions and risky behaviors of adults living in squatter areas in order to take decisions about the relevant messages and health education methods that should be used to prevent HN... more

The aim of this work was to assess HIV/AIOS perceptions and risky behaviors of adults living in squatter areas in order to take decisions about the relevant messages and health education methods that should be used to prevent HN transmission in the studied communities. Two methods were used to collect data in this cross sectional study, focus group discussion and structured interview. The study was carried out in six squatter areas in Cairo, four of them located in west Cairo and two in east Cairo. Results: 237 community members and community leaders shared in the study, 44.7% were males and 55.3% females, 64.1% were married and 34% single. Community members represented two-thirds of the sample while one-third were community leaders. Participants 174

Background: Reducing substance use and unprotected sex by HIV-positive persons improves individual health status while decreasing the risk of HIV transmission. Despite recommendations that health care providers screen and counsel their... more

Background: Reducing substance use and unprotected sex by HIV-positive persons improves individual health status while decreasing the risk of HIV transmission. Despite recommendations that health care providers screen and counsel their HIVpositive patients for ongoing behavioral risks, it is unknown how to best provide ''prevention with positives'' in clinical settings. Positive Choice, an interactive, patient-tailored computer program, was developed in the United States to improve clinic-based assessment and counseling for risky behaviors.

in the absence of antiviral therapy, the extent to which such defects contribute to the long-term containment of viremia is not known. Most previous studies examining for such defects have involved small numbers of subjects, primarily... more

in the absence of antiviral therapy, the extent to which such defects contribute to the long-term containment of viremia is not known. Most previous studies examining for such defects have involved small numbers of subjects, primarily focused on subjects expressing HLA-B57, or have examined single viral genes, and they have focused on cellular proviral DNA rather than plasma viral RNA sequences. Here, we attempted viral sequencing from 95 HIV-1 elite controllers (EC) who maintained plasma viral loads of <50 RNA copies/ml in the absence of therapy, the majority of whom did not express HLA-B57. HIV-1 gene fragments were obtained from 94% (89/95) of the EC, and plasma viral sequences were obtained from 78% (61/78), the latter indicating the presence of replicating virus in the majority of EC. Of 63 persons for whom nef was sequenced, only three cases of nef deletions were identified, and gross genetic defects were rarely observed in other HIV-1 coding genes. In a codon-by-codon comparison between EC and persons with progressive infection, correcting for HLA bias and coevolving secondary mutations, a significant difference was observed at only three codons in Gag, all three of which represented the historic population consensus amino acid at the time of infection. These results indicate that the spontaneous control of HIV replication is not attributable to shared viral genetic defects or shared viral polymorphisms.

suggested that children and young adults were rarely infected with H pylori, by contrast with the results of an Estonian study using the same identification methods.2 We now believe that H pylori colonisation may be transient in children... more

suggested that children and young adults were rarely infected with H pylori, by contrast with the results of an Estonian study using the same identification methods.2 We now believe that H pylori colonisation may be transient in children and young adults of families with infected adults. A 1-year follow-up study involving repeated sampling of dental plaque with disposable devices is in progress. As H pylori-like organisms of the oral microflora may give false-positive PCR tests on plaque material in certain patients with primers based on the urease gene or the 26 kDa protein and other H pylori genes, we are also investigating animal helicobacter strains together with H-pylori-like organisms to define the specificity of our 26 kDa surface protein gene-based PCR. With the report by Dr Mapstone and colleagues (Feb 13, p 447) on the detection of H pylori in faeces by PCR, we will also evaluate PCR in faeces from our patients. 281 25 Hassleholm TADEUSZ TYSZKIEWICZ 1. Soltesz V, Zeeberg B, Wadström T. Optimal survival of Helicobacter pylori under various transport conditions. J Clin Microbiol 1992; 30: 1453-56. 2. Vorobjova T, Maaroos H-I, Uibo R, Wadström T, Wood WG, Sipponen P. Helicobacter pylori: histological and serological study on gastric and duodenal ulcer patients in Estonia. Scand J Gastroenterol 1991; 26 (suppl 186): 84-89. 3. Hammar M, Tyszkiewicz T, Wadstrom T, O'Toole PW. Rapid detection of Helicobacter pylori in gastic biopsy material by polymerase chain reaction.

Sexually transmitted diseases (STD) are defined as a group of communicable diseases which have in common that they are transmitted predominantly by sexual contact. The number of agents now known to be sexually transmitted include some 20... more

Sexually transmitted diseases (STD) are defined as a group of communicable diseases which have in common that they are transmitted predominantly by sexual contact. The number of agents now known to be sexually transmitted include some 20 pathogens. Some of these agents (such as Chlamydia trachomatis, herpes simplex virus, human papilloma virus, hepatitis B r virus, human immunodeficiency virus) tend to replace the classical "venereal diseases" both in importance and frequency as these agents are often more difficult to detect, treat, and control. Sexually transmitted diseases are a major public health problem in most African countries on account of their frequency, their associated morbidity and mortality, their impact on maternal and infant health, as well as their economic costs in terms of health expenditure and lost productivity, and, last but not least, because of their social consequences. Recent epidemiological studies using sophisticated diagnostic technologies greatly extend our knowledge on the true spectrum of complications and sequelae associated with these infections. Nongonococcal urethritis-caused to 40% by Chlamydia trachomatis-and gonococcal infections are together the most frequent sexually transmitted diseases. The increasing importance of chlamydial infections, in contrast to a gradual decrease of gonococcal infections, is related to the fact that these 45 infections frequently cause asymptomatic or mild disease and do not motivate patients to seek medical care, resulting in an extended period of infectivity and high risk of developing complications. Untreated gonorrhoea and chlamydial infections are the most common causes of epididymitis in males under the age of 35 years and may lead to decreased fertility. In some parts of sub-saharan Africa where urethritis often goes untreated, epididymitis is the leading course of male infertility. Also urethral strictures still from a large part of urogenital practice in some African countries. An estimated 8-16% of women with untreated endocervical gonococcal or chlamydial infections will develop acute salpingitis following an ascending spread of these pathogens. After one episode of acute salpingitis approximately 10% of women may become infertile due to complete tubal occlusion. Similarly, the risk for women to develop an ectopic pregnancy after salpingitis is 6-10 times greater than in controls. Ectopic pregnancies in areas with insufficient health services carry a high mortality risk. Maternal infections with STD may not only have adverse effects on pregnancy outcome but may cause serious morbidity and mortality in the newborn (e.g. congenital syphilis, ophthalmia neonatorum, herpes simplex virus infection of the neonate, chlamydial pneumonia, congenital HIV infection). AIDS is an example "par excellence" of a sexually transmitted disease of public health importance requiring extensive clinical services and posing enormous financial and social problems for the individual and the society at large. AIDS and the other viral STD have greatly increased the interest in primary prevention strategies such as health education and behavioral modification, for the control of sexually transmitted diseases.

Drug injectors are at risk for infection with human immunodeficiency virus (HIV) and other blood-borne pathogens through the exchange of (infected) blood resulting from unhygienic injecting practices. Research attention and public... more

Drug injectors are at risk for infection with human immunodeficiency virus (HIV) and other blood-borne pathogens through the exchange of (infected) blood resulting from unhygienic injecting practices. Research attention and public discussion have focused primarily on the sharing of syringes and needles. While the focus on syringe sharing has sparked important interventions (bleach distribution, syringe exchange) it may have obscured the social relationship in which injecting equipment is used. Drug sharing plays a crucial role in the social organization of the drug using subculture. In this paper, various drug sharing practices and other distinguishable aspects of the injecting process--collectively termed Syringe-Mediated Drug Sharing (SMDS)--are described. All of these behaviors may put injecting drug users (IDUs) at risk for infection. The purpose of this paper is to stimulate scientific inquiry into SMDS behaviors and the social contexts which shape them. Descriptions are based primarily on field studies in Rotterdam and New York City. Recommendations for safer injecting training and education are proposed, as are directions for future research.

While polypropylene mesh remains the preferred prosthesis material for hernioplasties, there are some problems with infections, intestinal obstruction and fistulization, and migration particularly in immunodepressed patients. A new... more

While polypropylene mesh remains the preferred prosthesis material for hernioplasties, there are some problems with infections, intestinal obstruction and fistulization, and migration particularly in immunodepressed patients. A new degradable and reabsorbable material, the porcine small intestinal submucosa (Surgisis) has been developed for hernia repairs in humans. This prospective study evaluated the safety and efficacy of Lichtenstein hernioplasty using the Surgisis inguinal hernia matrix soft-tissue graft as a mesh in ten immunodepressed subjects. Six subjects were HIV-positive in the immunodepressive phase, and the other four had undergone transplantation (three kidney, one liver). There were no intraoperative or postoperative complications, recurrences, or wound infections. Thus Lichtenstein's hernioplasty using the Surgisis inguinal hernia matrix soft-tissue graft in immunodepressed patients promises safety and efficacy.

The aim of this study was to evaluate the influence of complete or partial removable dental prostheses (RDPs) on the frequency of Candida albicans isolated from the mouth and the presence of oral candidiasis in human immunodeficiency... more

The aim of this study was to evaluate the influence of complete or partial removable dental prostheses (RDPs) on the frequency of Candida albicans isolated from the mouth and the presence of oral candidiasis in human immunodeficiency virus-positive (HIV+) patients correlated with CD4 levels. One hundred ninety-three HIV+ patients were evaluated; 68 had RDPs and 125 did not. CD4 cell count was obtained after blood sampling and performed on the day of clinical examination. The material was collected from the buccal mucosa for isolation of yeasts with a sterile swab and seeded onto Sabouraud dextrose agar with chloramphenicol. C albicans strains were identified by testing germ tubes and chlamydospore formation and biochemical (zymogram, auxanogram) characteristics. The results were subjected to the Fischer exact test and chi-square tests. C albicans were isolated from 45 (66.17%) patients who had RDPs and 48 (38.4%) who did not (P = .0003). The presence of oral candidiasis was observed...

Aim. This paper is a report of an analysis of the concept of HIV disclosure. Background. There is a growing interest among healthcare providers and researchers in HIV disclosure as an effective HIV prevention and early disease management... more

Aim. This paper is a report of an analysis of the concept of HIV disclosure. Background. There is a growing interest among healthcare providers and researchers in HIV disclosure as an effective HIV prevention and early disease management initiative. However, the concept still remains unclear. Conceptual clarity is important for providing an expanded theoretical definition and understanding of attributes of HIV disclosure. This information is useful in constructing better HIV disclosure measures in HIV/AIDS nursing practice and research. Data sources. A computer search of the following databases was conducted to capture the meaning and processes of HIV disclosure among HIV-positive individuals: PubMed, CINAHL and PSYCINFO. Only English language journals were used. Publication dates of the literature review ranged from 1999 to 2009. The following key words were used: HIV disclosure, self-disclosure, disclosure and serostatus disclosure. Methods. The Walker and Avant (2005) concept analysis model (Strategies for Theory Construction in Nursing, Pearson Prentice Hall, River, NJ, 2005) was used to guide the analysis process, which was completed in 2009. Results. The concept analysis revealed that HIV disclosure is a complex process characterized by the following attributes: experiencing an event, communicating something, timing, and contextual environment, protecting someone, relationship status and improving something or being therapeutic. In addition, the process of HIV disclosure varies across time. Conclusion. The proposed HIV disclosure attributes provide nursing scholars and researchers with new directions on how to reframe research questions, develop measurement tools to reflect better the diversity and fluidity of the process of HIV disclosure among HIV-positive individuals. Policy implications include the need to develop approaches that protect individual and public rights.

We hypothesized that heterophil antibodies reactive with animal proteins used in blot preparation caused nonspecific staining (NSS) on HIV Western blot (WB) studies, causing indeterminate results. We analyzed samples showing NSS on HIV WB... more

We hypothesized that heterophil antibodies reactive with animal proteins used in blot preparation caused nonspecific staining (NSS) on HIV Western blot (WB) studies, causing indeterminate results. We analyzed samples showing NSS on HIV WB using a multiplexed immunoassay to simultaneously measure IgG antibodies to animal IgG (bovine, goat, sheep, mouse) and bovine serum albumin. Heterophil antibodies reactive with IgG from several animal species were detected in 23 (49%) of 47 samples showing NSS on HIV WB; 15 positive samples demonstrated antibodies to all 5 antigens. Similar IgG heterophil antibodies were detected in only 2 (8%) of 24 control samples. Of the HIV WB samples with a positive HIV-1 enzymelinked immunosorbent assay (ELISA) result at the time of WB testing (11/47), heterophil antibodies were found in 8 (73%) of 11. Preabsorption with bovine, goat, and sheep IgG removed heterophil antibodies detected by the multiplexed assay and, in some cases, eliminated reactivity in ELISA and WB testing. Heterophil antibodies are associated with indeterminate HIV immunoassay results and are an important cause of false-positive HIV ELISA results. Multiplexed immunoassays provide a powerful tool for screening patients for heterophil antibodies and resolving possible false-positive results.

This study examines the effects of depressive symptoms and mental health quality of life on utilization of highly active antiretroviral therapy (HAART) among HIV-seropositive women. Data were collected biannually from 1996 through 1998 in... more

This study examines the effects of depressive symptoms and mental health quality of life on utilization of highly active antiretroviral therapy (HAART) among HIV-seropositive women. Data were collected biannually from 1996 through 1998 in a prospective cohort study. Women reported use of antiretroviral therapy, health and mental health status, demographics, and social and behavioral factors; CD4 count and viral load also were assessed. Random effects regression models estimated the longitudinal effects of depressive symptoms and mental health quality of life on the probability of HAART utilization, controlling for clinical indicators (CD4 count, viral load, symptom presence), demographics (race, age, education), behavioral factors (drug/alcohol use, clinical trials participation), service features (insurance status, mental health service utilization), and study site. High levels of depressive symptoms and poor mental health quality of life were found, and they significantly reduced the probability of HAART utilization. Receiving mental health services significantly increased the probability of utilizing HAART. HIV-seropositive women characterized as being in poor mental health were less likely to use HAART, whereas those receiving treatment of mental health difficulties were more likely to use HAART. These findings suggest that efforts to enhance women's access to psychological treatment may increase their use of the latest HIV therapies.

Background: This randomized clinical trial compared 16-week interventions with interpersonal psychotherapy, cognitive behavioral therapy, supportive psychotherapy, and supportive psychotherapy with imipramine for human immunodeficiency... more

Background: This randomized clinical trial compared 16-week interventions with interpersonal psychotherapy, cognitive behavioral therapy, supportive psychotherapy, and supportive psychotherapy with imipramine for human immunodeficiency virus (HIV)-positive patients with depressive symptoms. Methods: Subjects (N = 101; 85 male, 16 female) with known HIV seropositivity for at least 6 months were randomized to 16 weeks of treatment. Inclusion criteria were 24-item Hamilton Depression Rating Scale score of 15 or higher, clinical judgment of depression, and physical health sufficient to attend outpatient sessions. Therapists were trained in manualized therapies specific for HIVpositive patients. Treatment adherence was monitored.

ObjectiveTo assess the risk factors associated with heterosexual HIV transmission among South Indian discordant couples enrolled in clinical care.To assess the risk factors associated with heterosexual HIV transmission among South Indian... more

ObjectiveTo assess the risk factors associated with heterosexual HIV transmission among South Indian discordant couples enrolled in clinical care.To assess the risk factors associated with heterosexual HIV transmission among South Indian discordant couples enrolled in clinical care.MethodsA nested matched case–control study of serodiscordant couples in which the HIV-infected partner (index case) was enrolled in care. Demographic and clinical characteristics, sexual behaviours, CD4 cell count and plasma HIV-1 RNA loads were measured at enrolment and longitudinally over 12 months of follow-up. The study included 70 cases who seroconverted during study follow-up and 167 matched controls who remained persistently serodiscordant.A nested matched case–control study of serodiscordant couples in which the HIV-infected partner (index case) was enrolled in care. Demographic and clinical characteristics, sexual behaviours, CD4 cell count and plasma HIV-1 RNA loads were measured at enrolment and longitudinally over 12 months of follow-up. The study included 70 cases who seroconverted during study follow-up and 167 matched controls who remained persistently serodiscordant.ResultsThe incidence of HIV infection among the initially seronegative partners was 6.52 per 100 person-years. Persistently discordant patients were more likely to have initiated highly active antiretroviral therapy (HAART) than patients in seroconverting relationships (62.9%vs. 42.9%) (P=0.001). Patients in seroconverting relationships had significantly higher plasma viral loads (PVLs) than patients in discordant relationships at enrolment, at 6 months and at 12 months (P<0.05). Patients in seroconverting relationships were less likely to use condoms with their primary partners than patients in discordant relationships (P<0.05). Patients in relationships that seroconverted between 6 and 12 months were diagnosed more often with genital Herpes simplex than patients in discordant relationships (P=0.001). In the univariate and multivariate logistic regression, the following variables were associated with seroconversion: PVL >100 000 [odds ratio (OR): 1.82; 95% confidence interval (CI): 1.1–2.8], non-disclosure of HIV status (OR: 5.5; 95% CI: 4.3–6.2) and not using condoms (OR: 2.8; 95% CI: 2.4–3.6).The incidence of HIV infection among the initially seronegative partners was 6.52 per 100 person-years. Persistently discordant patients were more likely to have initiated highly active antiretroviral therapy (HAART) than patients in seroconverting relationships (62.9%vs. 42.9%) (P=0.001). Patients in seroconverting relationships had significantly higher plasma viral loads (PVLs) than patients in discordant relationships at enrolment, at 6 months and at 12 months (P<0.05). Patients in seroconverting relationships were less likely to use condoms with their primary partners than patients in discordant relationships (P<0.05). Patients in relationships that seroconverted between 6 and 12 months were diagnosed more often with genital Herpes simplex than patients in discordant relationships (P=0.001). In the univariate and multivariate logistic regression, the following variables were associated with seroconversion: PVL >100 000 [odds ratio (OR): 1.82; 95% confidence interval (CI): 1.1–2.8], non-disclosure of HIV status (OR: 5.5; 95% CI: 4.3–6.2) and not using condoms (OR: 2.8; 95% CI: 2.4–3.6).ConclusionsCouples-based intervention models are crucial in preventing HIV transmission to seronegative spouses. Providing early treatment for sexually transmitted infections, HAART and enhancing condom use and disclosure could potentially decrease the risk of HIV transmission within Indian married couples.Couples-based intervention models are crucial in preventing HIV transmission to seronegative spouses. Providing early treatment for sexually transmitted infections, HAART and enhancing condom use and disclosure could potentially decrease the risk of HIV transmission within Indian married couples.

Background Opioid dependence is associated with low rates of treatment-seeking, poor adherence to treatment, frequent relapse, and major societal consequences. We aimed to assess the effi cacy, safety, and patient-reported outcomes of an... more

Background Opioid dependence is associated with low rates of treatment-seeking, poor adherence to treatment, frequent relapse, and major societal consequences. We aimed to assess the effi cacy, safety, and patient-reported outcomes of an injectable, once monthly extended-release formulation of the opioid antagonist naltrexone (XR-NTX) for treatment of patients with opioid dependence after detoxifi cation.

The study, in which the author aim to understand the contextual risks of HIV-positive serostatus and intimate partner violence (IPV) of 32 Latina women, involved focus groups, in-depth face-to-face narratives, and community meetings. The... more

The study, in which the author aim to understand the contextual risks of HIV-positive serostatus and intimate partner violence (IPV) of 32 Latina women, involved focus groups, in-depth face-to-face narratives, and community meetings. The data emerged into four themes: histories of trauma, living with HIV, vulnerability, and la suerte (luck). In addition to the themes, women in this study talked about how structural and cultural factors such as machismo, marianismo, and fatalism are implicated in the risk for HIV and IPV. Women in the study reconceptualized the notion of IPV to denote a form of situational abuse, such as threats of deportation, that is exacerbated by their HIV status.

An acute hemiplegia secondary to a large cerebral infarct is described in a 16-month-old infant with congenitally-acquired human immunodeficiency virus infection. Serial imaging studies during the next year documented improvement in his... more

An acute hemiplegia secondary to a large cerebral infarct is described in a 16-month-old infant with congenitally-acquired human immunodeficiency virus infection. Serial imaging studies during the next year documented improvement in his hemiplegia and a static underlying human immunodeficiency virus encephalopathy. Acquired immunodeficiency syndrome should be included in the differential diagnosis of children with acute hemiplegia.

The effectiveness of self-management programs to improve physical, psychosocial, health knowledge, and behavioral outcomes for adults living with HIV has not been well established. This article reviews the effectiveness of self-management... more

The effectiveness of self-management programs to improve physical, psychosocial, health knowledge, and behavioral outcomes for adults living with HIV has not been well established. This article reviews the effectiveness of self-management education programs to improve physical, psychosocial, health knowledge, and behavior outcomes for adults living with HIV/AIDS. A systematic review of English articles using CINAHL, MEDLINE, and PsycINFO were used to identify and retrieve relevant studies. Each database was searched from its earliest record to October 2010. Search terms included HIV/AIDS, self-management, self-care, patient education, and education programs. Only studies that (1) reported on a HIV-specific intervention that aimed to increase participants HIVrelated knowledge through a self-management component, (2) included a control group, (3) provided skills training or targeted behavior change, and (4) reported clinical outcomes were included. Independent data extraction by one author using the methods described in the Cochrane Handbook for Systematic Reviews. A second reviewer checked the data extraction. Six protocols were reported in eight publications (n = 1178), all contained elements of self-management interventions. Effect size calculations were not conducted due to limitations in the available data. The review found randomized controlled trials (RCT) evidence sufficient to infer that selfmanagement programs for people living with HIV/AIDS result in short-term improvements in physical, psychosocial, and health knowledge and behavioral outcomes. Statistically significant improvements were reported for intervention participants compared to control participants across most outcomes. There is insufficient evidence to provide conclusions regarding the long-term outcomes of HIV-specific self-management interventions.

Interpersonal psychotherapy (IPT) is an effective treatment for depression across the lifespan and across cultures. However, even when delivered with fidelity, some patients drop out and others do not improve sufficiently. Attention to... more

Interpersonal psychotherapy (IPT) is an effective treatment for depression across the lifespan and across cultures. However, even when delivered with fidelity, some patients drop out and others do not improve sufficiently. Attention to IPT treatment attrition, dropout, nonresponse, or failure can elucidate its limitations and the opportunities to improve its effectiveness. Studies of factors known to moderate and negatively predict IPT depression treatment response are reviewed along with recommended modifications to improve outcomes. Although the risk of treatment failure always exists, it is possible to enhance treatment effectiveness by attending to the therapeutic alliance, strategically addressing depression, and adapting IPT to patient characteristics. These include adding pharmacotherapy, extending the course of treatment, and targeting specific symptoms or interpersonal vulnerabilities. Case examples illustrate several of these points.

Sexual health is defined in terms of well-being, but is challenged by the social, cultural and economic realities faced by women and men with HIV. A sexual rights approach puts women and men with HIV in charge of their sexual health.... more

Sexual health is defined in terms of well-being, but is challenged by the social, cultural and economic realities faced by women and men with HIV. A sexual rights approach puts women and men with HIV in charge of their sexual health. Accurate, accessible information to make informed choices and safe, pleasurable sexual relationships possible is best delivered through peer education and health professionals trained in empathetic approaches to sensitive issues. Young people with HIV especially need appropriate sex education and support for dealing with sexuality and self-identity with HIV. Women and men with HIV need condoms, appropriate services for sexually transmitted infections, sexual dysfunction and management of cervical and anogenital cancers. Interventions based on positive prevention, that combine protection of personal health with avoiding HIV/STI transmission to partners, are recommended. HIV counselling following a positive test has increased condom use and decreased coercive sex and outside sexual contacts among discordant couples. HIV treatment and care have reduced stigma and increased uptake of HIV testing and disclosure of positive status to partners. High adherence to antiretroviral therapy and safer sexual behaviour must go hand-in-hand. Sexual health services have worked with peer educators and volunteer groups to reach those at higher risk, such as sex workers. Technological advances in diagnosis of STIs, microbicide development and screening and vaccination for human papillomavirus must be available in developing countries and for those with the highest need globally. A2007 Reproductive Health Matters. All rights reserved.

Objective-Given the disproportionate impact of neurologic disorders such as HIV on racial/ ethnic minorities, neuropsychologists are increasingly evaluating individuals of diverse linguistic backgrounds. This study compares the utility of... more

Objective-Given the disproportionate impact of neurologic disorders such as HIV on racial/ ethnic minorities, neuropsychologists are increasingly evaluating individuals of diverse linguistic backgrounds. This study compares the utility of two brief and one comprehensive language measure to account for variation in English neuropsychological performance within a bilingual population. Method-Sixty-two HIV+ English/Spanish bilingual Latino adults completed three language measures in English and Spanish: Self-Reported Language Ability; Verbal Fluency (FAS/PMR); and the Woodcock Munoz Language Survey-Revised (WMLS-R). All participants also completed an English language neuropsychological (NP) battery. Results-It was hypothesized that the comprehensive English/Spanish WMLS-R language dominance index (LDI) would be significantly correlated with NP performance, as well as the best predictor of NP performance over and above the two brief language measures. Contrary to our hypothesis, the WMLS-R LDI was not significantly correlated to NP performance, whereas the easily administered Verbal Fluency and Self-Report LDIs were each correlated with global NP performance and multiple NP domains. After accounting for Verbal Fluency and Self-Report LDI in a multivariate regression predicting NP performance, the WMLS-R LDI did not provide a unique contribution to the model.

Failure to understand the risk of false-negative HIV test results during the window period results in anxiety. Patients typically want accurate test results as soon as possible while clinicians prefer to wait until the probability of a... more

Failure to understand the risk of false-negative HIV test results during the window period results in anxiety. Patients typically want accurate test results as soon as possible while clinicians prefer to wait until the probability of a false-negative is virtually nil. This review summarizes the median window periods for third-generation antibody and fourth-generation HIV tests and provides the probability of a false-negative result for various days post-exposure. Data were extracted from published seroconversion panels. A 10-day eclipse period was used to estimate days from infection to first detection of HIV RNA. Median (interquartile range) days to seroconversion were calculated and probabilities of a false-negative result at various time periods post-exposure are reported. The median (interquartile range) window period for third-generation tests was 22 days (19-25) and 18 days (16-24) for fourth-generation tests. The probability of a false-negative result is 0.01 at 80 days' ...

Antiviral agents can be used to prevent HIV transmission before exposure as preexpo-sure prophylaxis (PrEP), after exposure as postexposure prophylaxis, and as treatment of infected people for secondary prevention. Considerable research... more

Antiviral agents can be used to prevent HIV transmission before exposure as preexpo-sure prophylaxis (PrEP), after exposure as postexposure prophylaxis, and as treatment of infected people for secondary prevention. Considerable research has shed new light on antiviral agents for PrEP and for prevention of secondary HIV transmission. While promising results have emerged from several PrEP trials, the challenges of poor adherence among HIV-negative clients and possible increase in sexual risk behaviors remain a concern. In addition, a broader pipeline of antiviral agents for PrEP that focuses on genital tract pharmacology and safety and resistance issues must be developed. Antiretroviral drugs have also been used to prevent HIV transmission from HIV-infected patients to their HIV-discordant sexual partners. The HIV Prevention Trials Network 052 trial demonstrated nearly complete prevention of HIV transmission by early treatment of infection, but the generalizability of the results to other risk groups -including intravenous drug users and MSM -has not been determined. Most importantly, the best strategy for use of antiretroviral agents to reduce the spread of HIV at either the individual level or the population level has not been developed, and remains the ultimate goal of this area of investigation.

We have entered a new era in HIV prevention whereby priorities have expanded from biomedical discovery to include implementation, effectiveness, and the effect of combination prevention at the population level. However, gaps in knowledge... more

We have entered a new era in HIV prevention whereby priorities have expanded from biomedical discovery to include implementation, effectiveness, and the effect of combination prevention at the population level. However, gaps in knowledge and implementation challenges remain. In this Review we analyse trends in the rapidly changing landscape of HIV prevention, and chart a new path for HIV prevention research that focuses on the implementation of effective and efficient combination prevention strategies to turn the tide on the HIV pandemic.

Adolescents infected with human immunodeficiency virus (HIV) represent a heterogeneous group of pubertal children and young adults. Antiretroviral therapy (ART) in adolescents is complex and depends on multiple factors. The continued use... more

Adolescents infected with human immunodeficiency virus (HIV) represent a heterogeneous group of pubertal children and young adults. Antiretroviral therapy (ART) in adolescents is complex and depends on multiple factors. The continued use of higher (weight-or surface-based) pediatric doses can result in potentially toxic drug exposure, whereas early introduction of lower adult doses can lead to the development of drug resistance and virologic failure. The physiological and psychosocial changes during puberty create strong grounds for an individualized therapeutic approach in HIV-infected adolescents.

'Ils nous apportent le SIDA et disent que c'est nous qui le leur donnons' : Le contexte socio-structurel de la vulnérabilité des travailleuses du sexe face à l'infection par le VIH à Ibadan, au Nigeria JENNIFER MUNOZ, ADEBOLA ADEDIMEJI,... more

'Ils nous apportent le SIDA et disent que c'est nous qui le leur donnons' : Le contexte socio-structurel de la vulnérabilité des travailleuses du sexe face à l'infection par le VIH à Ibadan, au Nigeria JENNIFER MUNOZ, ADEBOLA ADEDIMEJI, OLAYEMI ALAWODE 62 Perceived stigma among patients receiving antiretroviral treatment: A prospective randomised trial comparing an m-DOT strategy with standard-of-care in Kenya Stigmatisation perçue par les patients recevant un traitement antirétroviral: un essai randomisé prospectif comparant une stratégie m-DOT (traitement modifié sous surveillance directe) à la norme de précaution au Kenya SUSAN KAAI, SANDRA BULLOCK, AVINA SARNA, MATTHEW CHERSICH, STANLEY LUCHTERS, SCOTT GEIBEL, PAUL MUNYAO, KISHORCHANDRA MANDALIYA, MARLEEN TEMMERMAN, NAOMI RUTENBERG 71 A comparison in HIV-associated stigma among healthcare workers in urban and rural Gujarat Comparaison de la stigmatisation associée au VIH parmi les travailleurs de la santé dans les zones urbaines et rurales du Gujarat KARTAVYA J VYAS, GULAB R PATEL, DEEPAK SHUKLA, WILLIAM C MATHEWS 76 The quality of material care provided by grandparents for their orphaned grandchildren in the context of HIV/ AIDS and poverty: a study of Kopanong municipality, free State La qualité de la prise en charge matérielle fournie par les grandsparents aux petits-enfants orphelins dans le contexte du VIH/Sida et de la pauvreté: une étude de la municipalité de Kopanong, Free State

Complete necrosis of the penis and scrotum due to strangulation of the external genitalia is unusually encountered in urologic emergencies. Urological conservative management is recommended. Delayed presentation is a major source of... more

Complete necrosis of the penis and scrotum due to strangulation of the external genitalia is unusually encountered in urologic emergencies. Urological conservative management is recommended. Delayed presentation is a major source of complications. We report the case of a psychotic patient, who was transferred from the emergency department in a context of complete necrosis of the external genitalia. This patient's history included chronic psychotic disorder and positive HIV serology, but he refused to take either neuroleptic or antiretroviral therapy. Complete amputation of the penis and bilateral orchidectomy were performed. We report the first six months of medical management.

In 2001, CDC, the National Institutes of Health, and the Infectious Diseases Society of America convened a working group to develop guidelines for therapy of human immunodeficiency virus (HIV)-associated opportunistic infections to serve... more

In 2001, CDC, the National Institutes of Health, and the Infectious Diseases Society of America convened a working group to develop guidelines for therapy of human immunodeficiency virus (HIV)-associated opportunistic infections to serve as a companion to the Guidelines for Prevention of Opportunistic Infections Among HIV-Infected Persons. In recognition of unique considerations related to HIV infection among infants, children, and adolescents, a separate pediatric working group was established. Because HIV-infected women coinfected with opportunistic pathogens might be more likely to transmit these infections to their infants than women without HIV infection, guidelines for treating opportunistic pathogens among children should consider treatment of congentially acquired infections among both HIV-exposed but uninfected children and those with HIV infection. In addition, the natural history of opportunistic infections among HIV-infected children might differ from that among adults. ...

Very little information exists with regard to sex party behaviors in young men who have sex with men (YMSM), often defined as men ranging in age from 13 to 29 years. The current analysis examines sex party attendance and behavior in a... more

Very little information exists with regard to sex party behaviors in young men who have sex with men (YMSM), often defined as men ranging in age from 13 to 29 years. The current analysis examines sex party attendance and behavior in a sample of 540 emergent adult gay, bisexual, and other YMSM in New York City, ages 18-29 years. Findings indicate that 8.7% (n=47) of the sample had attended a sex party 3 months prior to assessment. Sex party attendees reported that parties included both HIV-positive and HIV-negative men; attendees also reported unprotected sex and limited access to condoms and lubricant. As compared with those who did not attend sex parties, those who did indicated significantly more lifetime and recent (last 3 months) casual sex partners, drug use (both number of different drugs used and total lifetime use), psychosocial burden (history of partner violence and number of arrests), and total syndemic burden (a composite of unprotected anal sex, drug use and psychosocial burden). These results indicate that while only a small percentage of the overall sample attended sex parties, the intersection of both individual risk factors coupled with risk factors engendered within the sex party environment itself has the potential to be a catalyst in the proliferation of the HIV/AIDS epidemic in urban settings. Lastly, given that sex parties are different than other sex environments, commercial and public, with regard to how they are accessed, public health strategies may need to become more tailored in order to reach this potentially highly risky group.

A divide exists between categories of men who have sex with men (MSM) in India based on their sex position, which has consequences for the design of novel HIV prevention interventions. We examine the interaction between sex position and... more

A divide exists between categories of men who have sex with men (MSM) in India based on their sex position, which has consequences for the design of novel HIV prevention interventions. We examine the interaction between sex position and other attributes on existing HIV risk including previous HIV testing, unprotected anal intercourse (UAI), and HIV serostatus among MSM recruited from drop-in centers and public cruising areas in the twin cities of Hyderabad and Secunderabad, India. A survey was administered by trained research assistants and minimally invasive HIV testing was performed by finger-stick or oral testing. HIV seropositive MSM underwent CD4 + lymphocyte count measurement. In our sample (n = 676), 32.6% of men were married to women, 22.2% of receptive only participants were married, and 21.9% of men were HIV seropositive. In bivariate analysis, sex position was associated with previous HIV testing, UAI, HIV serostatus, and CD4 + lymphocyte count at diagnosis. In multivariate analysis with interaction terms, dual unmarried men were more likely to have undergone an HIV test than insertive unmarried men (odds ratio [OR] 2.8; 95% confidence interval [CI] 1.2-6.5), a relationship that did not hold among married men. Conversely, dual married men were less likely than insertive married men to engage in UAI (OR 0.3; 95% CI 0.1-0.6), a relationship that did not hold among unmarried men. Further implementation research is warranted in order to best direct novel biologic and behavioral prevention interventions towards specific risk behaviors in this and other similar contexts.