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We report an unplanned pregnancy in an HIV-positive woman in her 20s who was undergoing treatment for 6 months with alectinib (Alecensa) for stage IV non-small-cell lung carcinoma. Anaplastic lymphoma kinase (ALK)-tyrosine kinase inhibitor alectinib, a molecule that inhibits proteins involved in tumour cell growth, is the recommended first-line treatment option in case of ALK mutation. Although the patient was informed of the need for definitive contraception, she became pregnant during the treatment with alectinib. A complete tumour response was observed at the time the pregnancy was discovered. Treatment discontinuation was proposed as the patient wanted to keep the pregnancy. Alectinib was temporarily stopped throughout the remaining pregnancy period inline with the patient’s wishes. The pregnancy was uncomplicated. She delivered a healthy female baby vaginally, with treatment being resumed after delivery. After 34 follow-up months, the patient remained in oncological remission and the child’s physical development is normal.

Latar Belakang: HIV merupakan sejenis virus yang dapat menyebabkan turunnya kekebalan tubuh manusia. Pada wanita hamil dengan HIV mempunyai kemungkinan melahirkan anak dengan HIV. Dalam tugasnya, bidan mempunyai peran untuk melakukan pencegahan penularan HIV/AIDS dari ibu ke anak, termasuk melakukan perencanaan kehamilan terhadap wanita dengan HIV/AIDS. Penelitian bertujua untuk mengetahui kesiapan bidan dalam perencanaan kehamilan pada wanita dengan HIV/AIDS. Metode: Penelitian deskriptif observasional dengan pendekatan cross sectional. Besar sampel sebanyak 88 bidan yang bekerja di 12 puskesmas wilayah Surabaya. Teknik sampling dilakukan sesuai dengan daftar puskesmas yang telah diberikan oleh Dinas Kesehatan Kota Surabaya. Variabel dalam penelitian yaitu pengetahuan, sikap, dan kesiapan bidan dalam perencanaan kehamilan pada wanita dengan HIV/AIDS. Hasil: Didapatkan mayoritas bidan berusia 23-32 tahun (62,5%) dan lama bekerja 1-10 tahun (71,6%). Puskesmas yang memiliki layanan PMTCT sebanyak 11 puskesmas (91,7%) dan 100% puskesmas mempunyai lembar balik HIV/AIDS. Sebagian besar bidan mempunyai pengetahuan baik (87,5%). Sebanyak (48,9%) bidan memiliki sikap negative dan (53,4%) bidan tidak siap dalam perencanaan kehamilan terhadap wanita dengan HIV/AIDS. Kesimpulan: Sebagian besar bidan tidak siap dan masih memiliki stigma negatif terhadap ODHA. Mayoritas bidan belum mengetahui keuntungan dan kerugian dari jenis persalinan pada ibu dengan HIV/AIDS serta belum mengetahui pemberian nutrisi pada bayi bagi ibu dengan HIV/AIDS.Abstract Background: HIV is a type of virus that can cause a decrease in human immunity. In pregnant women with HIV it is possible to give birth to children with HIV. In their duties, midwives have a role to prevent HIV / AIDS transmission from mother to child, including pregnancy planning for women with HIV / AIDS. The study aimed to determine the readiness of midwives in pregnancy planning in women with HIV / AIDS. Method: An observational descriptive study with cross sectional approach. The sample size was 88 midwives who worked in 12 Puskesmas in Surabaya. The sampling technique was carried out according to the list of health centers that had been given by the Surabaya City Health Office. The variables in the study were the knowledge, attitudes, and readiness of midwives in pregnancy planning in women with HIV / AIDS. Results: The majority of midwives aged 23-32 years (62.5%) and working duration 1-10 years (71.6%) were obtained. Puskesmas that have PMTCT services are 11 health centers (91.7%) and 100% puskesmas have a back sheet of HIV / AIDS. Most midwives have good knowledge (87.5%). As many as (48.9%) midwives have a negative attitude and (53.4%) midwives are not ready for pregnancy planning for women with HIV / AIDS. Conclusion: Most midwives are not ready and still have a negative stigma towards PLWHA. The majority of midwives do not yet know the advantages and disadvantages of the type of childbirth to mothers with HIV / AIDS and do not yet know the provision of nutrition to infants for mothers with HIV / AIDS.

Tujuan dilakukan penelitian ini adalah untuk mengetahui seberapa besar pengaruh persepsi siswa terhadap ODHA. Penelitian ini menggunakan jenis penelitian kuantitatif dengan metode expost facto, yaitu penelitian yang bertujuan mengekspos kejadian-kejadian yang sedang berlangsung. Penelitian ini menggunakan teknik proportionate stratified probability sampling. Setelah dilihat pada tabel Isaac and Michael dengan taraf kesalahan 5% ditetapkan jumlah sampel 256 siswa. Instrumen dalam penelitian ini adalah skala persepsi dan angket pemahaman ODHA dengan reliabilitas 0,860 dan 0,789. Hasil dari penelitian menunjukan adanya pengaruh persepsi terhadap ODHA dengan nilai R2 = 0,055 = 5,5% ini berarti pengetahuan tentang ODHA mempengaruhi persepsi siswa sebesar 5,5% dan sisanya dipengaruhi oleh variabel lain yang tidak masuk dalam penelitian ini. The purpose of this study was to study the majority of students' perceptions of ODHA. This study uses a type of quantitative research with the post facto method, which is research that discusses ongoing events. This study uses a proportional stratified probability sampling technique. After looking at the tables of Isaac and Michael with a 5% error level, the number of samples is 256 students. The instrument in this study was the scale of perception and questionnaire for ODHA understanding with reliability of 0.860 and 0.789. The results of the study showed differences in perceptions of ODHA with a value of R2 = 0.055 = 5.5%. This meant that knowledge of ODHA affected students' perceptions of 5.5% and was accepted by other variables not included in this study.

Participation in a short message service program after sexually transmitted infection/HIV screening seemed quite good but varied according to patient profile. Several options should be proposed for delivering the results of sexually transmitted infection screening., Background Text messaging after sexually transmitted infection (STI)/HIV screening may be a cost-effective means of improving patient care, but it may not be appropriate for all patients. This study aimed to explore the profiles of patients who did not participate in a short message service (SMS) program after STI/HIV testing. Methods In October 2016, 396 patients in Paris were screened for STI/HIV and were invited to complete an anonymous self-administered questionnaire. Patients were offered the possibility of being notified by SMS after testing, 68% accepted (SMS group) and 32% did not (no-SMS group). Each of the 100 patients from the no-SMS group who had completed the questionnaire was matched with the next patient from the SMS group. Factors associated with nonparticipation in the SMS program were studied using conditional logistic regression models. Results Participation in the SMS program was not related to STI screening characteristics (screening results and seriousness of the diseases screened) but seemed to be related to patient characteristics. In multivariate analysis, compared with patients in the SMS group, those in the no-SMS group were more often older, socially less favored (born in Africa or Asia, no university diploma, living outside Paris). They also more often declined to answer sexual questions, which could reflect a need for privacy and discretion. Conclusions Although SMS after STI/HIV screening is well accepted, it does not suit all patients. Several contact options should be proposed to comply with patients' preferences and to reduce the risk of nondelivery of STI screening results.

Preliminary data on HIV-positive donor to HIV-positive recipient kidney transplantation suggest promising patient outcomes without adverse events. This is an important step in expanding the donor pool and opportunity for transplantation in HIV-positive patients.We herein report the first case of HIV-positive donor to HIV-positive recipient kidney transplantation in Denmark. Our patient has demonstrated a successful post-transplant course with excellent 1-year graft function, no rejection episodes, good virological control with undetectable HIV RNA, no signs of HIV-associated nephropathy, and no superinfections or opportunistic infections.This case corroborates findings from previous studies showing that kidney transplantation from carefully selected HIV-infected donors to carefully selected HIV-infected recipients seems to be a safe and effective treatment option, and supports the opportunity to expand the organ donor pool for this group of patients with end-stage renal disease.

© BMJ Publishing Group Limited 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ., Inhaled corticosteroids are generally considered safe and do not usually lead to systemic adverse events since their plasma concentrations are low due to hepatic metabolism by the cytochrome P450 3A4. However, when associated with inhibitors of this cytochrome, such as ritonavir, they may lead to iatrogenic Cushing syndrome by the systemic accumulation of corticosteroids and consequent suppression of the hypothalamic-pituitary-adrenal axis. We present a case of iatrogenic Cushing syndrome complicated by multifocal osteonecrosis in a patient with HIV infection on antiretroviral therapy with protease inhibitors boosted with ritonavir, after the association of inhaled fluticasone. This clinical case highlights a relevant interaction between corticosteroids and inhibitors of the cytochrome P450 and the severe consequences that may occur.

This work continues an article on risky sexual behavior and the spread of HIV infection. In this part, based on the results of surveys of the working-age population, the youth and the target group of psychoactive substance users, the relationship between increase in drug use and sexual behavior is examined. It is shown that use of certain drugs is connected to increase in sexual activity. Injecting drug users play a special role in the spread of HIV infection. The survey of the target group of drug users allowed us to describe a modern portrait of an injecting drug user, as well as the peculiarities of drug use and common high-risk sexual practices in this group. The impact on the rate of infection from the Russian penitentiary system is considered. It was revealed that with an annual decrease in the number of prisoners, the proportion of HIV-infected people is constantly growing, while HIV infection is by far the most frequent cause of death for convicts in Russia. The factors that influence HIV incidence rate among the convicts are examined.

Approximately 1%–10% of patients with HIV infection have been reported to have salivary gland enlargement. Parotid swelling in patients with HIV is often associated with salivary gland disease, including benign lymphoepithelial cysts (BLECs). The presence of BLEC can serve as an indicator of HIV infection, and the diagnosis of HIV-associated BLEC is usually based on clinical course, HIV confirmatory blood testing, such as western blot or viral detection, and imaging studies, but not on biopsies or immunostaining. To exclude other diseases such as tuberculosis and malignant lymphoma and to further improve the diagnostic accuracy of BLEC, the detection of the HIV-1 p24 antigen by immunohistochemistry is a useful diagnostic method. We report a case of a 65-year-old Japanese man with swelling of the parotid glands and HIV-associated BLEC confirmed via HIV-1 p24 immunohistochemical staining.

Veno-venous extracorporeal membrane oxygenation (ECMO) is being more commonly used in patients with acute respiratory distress syndrome (ARDS) due to potentially reversible illnesses. Survival from ARDS using ECMO has been reported even in patients with AIDS. However, the indications for ECMO for ARDS due to immune reconstitution inflammatory syndrome (IRIS) in patients with AIDS are unknown. A 23-year-old man with AIDS and Pneumocystis jirovecii pneumonia was admitted to the intensive care unit with severe ARDS refractory to mechanical ventilator support requiring ECMO. Although ECMO was discontinued, a second treatment with ECMO was necessary due to IRIS-associated ARDS, resulting in an excellent patient outcome. This patient's clinical course suggests two important messages. First, ECMO is a reasonable option for the treatment of patients with ARDS even in a patient with AIDS. Second, ECMO may be effective for the treatment of patients with IRIS.

A retired woman with left ophthalmic shingles of over 2 years' duration attended with bilateral vision loss and systemic upset. Acute retinal necrosis with detachment was detected on right fundus examination. Cataract in left eye precluded funduscopy. Ocular ultrasonography revealed fibrotic retinal detachment in the left eye. MRI brain and orbits also showed signals of retinal detachment. No abnormal MRI signal within the optic nerve or brain was found. Varicella zoster virus was detected in ocular aqueous and blood samples. High-dose intravenous acyclovir was administered. HIV test was positive with a very low CD4 count. Antiretroviral medications were prescribed. There was no recovery of vision. She was certified as blind, and social services were involved in seeking to provide alterations to her home in view of her severe disability. This case highlights the importance of suspecting HIV in patients with severe or chronic ophthalmic shingles. Images and implications for clinical practice are presented.

This paper aims to describe the psychometric properties of a new brief multidimensional scale to measure HIV/AIDS related attitudes for adolescents, the HIV Attitudes Scale (HIV-AS). Exploratory analysis aimed to find the theory-driven structure and to develop an empirically derived factor structure for HIV-AS, which was tested with a confirmatory factor analysis. Factorial invariance was studied across gender and age, and multigroup structural equation approach was used in order to compare the groups. Reliability, convergent and discriminant validity were examined. The analyses were based on a sample of 1216 Spanish adolescents. The instrument consists of 12 items distributed across four major factors: 1) Attitudes towards safe sex when there are obstacles, 2) Attitudes towards the HIV test, 3) Attitudes towards condom use, and 4) Attitudes towards people living with the AIDS. The HIV-AS shows good validity and internal reliability and equivalent four-factor structure across gender and the three age groups studied. It can be consider as a capable and parsimonious self- report scale for assessing major aspects of HIV/AIDS-related attitudes for adolescents. El objetivo de este estudio es describir las propiedades psicométricas de una nueva escala multidimensional para evaluar las actitudes sobre el VIH/SIDA en adolescentes, la Escala de Actitudes hacia el VIH/SIDA (HIV-AS). Se realizó un análisis factorial exploratorio con el fin de obtener la estructura factorial del instrumento, que fue puesta a prueba con un análisis factorial confirmatorio. Se analizó la invarianza factorial en función del sexo y la edad mediante ecuaciones estructurales multigrupo. Se examinó la fiabilidad, validez convergente y discriminante. Los análisis se realizaron con una muestra formada por 1216 adolescentes españoles. El cuestionario quedó compuesto por 12 ítems distribuidos en cuatro factores: 1) Actitud hacia las conductas de protección cuando existen obstáculos, 2) Actitud hacia la prueba de detección del VIH, 3) Actitud hacia el uso de preservativo, y 4) Actitud hacia las personas con VIH/SIDA. El cuestionario HIV-AS muestra una alta validez y fiabilidad, y una estructura de cuatro factores equivalente en los tres grupos de edad analizados. Se considera que la escala puede ser empleada de forma parsimoniosa para evaluar aspectos relevantes de las actitudes hacia el VIH/SIDA en adolescentes.

Objetivo: El estudio tuvo como objetivo construir y establecer las propiedades psicométricas del Cuestionario de adherencia al tratamiento para mujeres con VIH/sida (CAT-M VIH), con el fin de contribuir a lo que actualmente es una necesidad yuna prioridad a nivel mundial, tantopara el control de la infección como para el mejoramiento de la calidad de vida de las enfermas. Las medidas de evaluación actuales son limitadas y deficientes, siendo importante el desarrollo de nuevos instrumentos que consideren las diferencias según el género. Método: Elestudio fuede tipo instrumental (psicométrico). La muestra se seleccionó intencionalmente y estuvo compuesta por 121 mujeres con VIH/sida, atendidas en 8 instituciones de salud de la ciudad de Cali y que recibían tratamiento antirretroviral. Las propiedades psicométricas analizadas fueron la validez de contenido, la capacidad de discriminación de los ítems, la estructura factorial como indicador de validez de constructo y la fiabilidad del CAT-M VIH. Resultados: El cuestionario quedó conformado por 17 ítems que se refieren a comportamientos de adherencia a aspectos farmacológicos,a aspectos no farmacológicos yde autocuidado, a medidas para prevenir las infecciones de transmisiónsexual (ITS) y a disminuir el consumo de drogas. Cuenta con unas propiedades psicométricas preliminares aceptables, entre ellas, una adecuada fiabilidad (α=0.634) y una buena estructura interna. Los ítems que lo componen presentan adecuados índices de discriminación y pertinencia a nivel clínico. Conclusiones: El CAT-M VIH constituye una propuesta de mejoría de las limitaciones teóricas y metodológicas en la evaluación de la adherencia al tratamiento en mujeres; responde a una concepción integral que trasciende la toma de medicamentos antirretrovirales y con una gran utilidad a nivel clínico e investigativo que se discute en este artículo. Purpose: The purpose of the study was to construct and establish the psychometric properties of the questionnaire of adherence to treatment for HIV-infected women (CAT-M VIH), contributing to the current global need of controlling HIV infection and improving the qualityof life for HIV patients. The existingassessment measures are limited and deficient; hence, the development of new tools considering gender differences is important. Method: The study was instrumental (psychometric). The sample was composed of 121 women with HIV/aids attending 8 health-service facilities in the city of Cali and taking antiretroviral medication. The psychometric properties assessed were the content validity, the items discrimination ability, the factorial structure as an index to construct validity, and the reliability of the CAT-M VIH. Results: The questionnaire was finally composed of 17 items, which reflect adherence behavior to pharmacological treatment, to nonpharmacological and self-care aspects, to the prevention of sexually transmitted diseases advice, and to drug use restrictions. The preliminary psychometric properties are acceptable, having good reliability (a=0.634) and good internal structure. The items have adequate discrimination indexes and clinical relevance. Conclusions: The CAT-MVIHcould aid in improving the theoretical and methodological limitations in assessing adherence to treatment of women, responding to an integral concept of such that includes more than the antiretroviral medication taken and havingsubstantial clinical and research utility, which is discussed in this article. Investigación financiada por la Pontificia Universidad Javeriana, Cali, Colombia.