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Purpose: To study epidemiology and clinical findings of cataract in HIV+ patients. Methods: A total of 32 HIV+ patients, 11 with uveitis/retinitis before surgery and 21 without, mean follow-up 44.9 ± 36.6 months, and 114 HIV- patients, 57 with uveitis/retinitis before surgery and 57 without, were retrospectively compared. Results: Visual acuity improved in all HIV+ patients (p

Introduction Cryptococcal meningitis (CM) is an opportunistic fungal disease with a high mortality among HIV-positive patients with severe immunosuppression (CD4 count

This study was carried out to provide information on the haematologic indices of HIV Patients on ART and those not on ART. Blood sample was collected from 160 subjects, 55 HIV-infected patients on antiretroviral therapy (ART), 55 HIV-infected patients not on ART and 50 apparently healthy HIV Sero-negative individuals as controls. Platelet (PLT), Total white blood cell Count (TWBC), Lymphocyte Count (LYMPH), Neutrophil Count (NEUT), Haemoglobin (HGB), Red Blood Cell Count (RBC), Mean Cell Volume (MCV), Mean cell Haemoglobin (MCH), Mean Cell Haemoglobin Concentration (MCHC), Red Cell Distribution Width (RDW), Platelet Distribution Width (PDW), Mean Platelet Volume (MPV) and Retroviral screening (RVS) of the subjects were determined using standard methods after obtaining ethics approval and informed consent of the subjects. ANOVA and t-test were used for statistical analysis. HGB, RBC and MCHC were significantly lower in HIV patients (F=60.57; 19.26; 12.83; 9.84; P

Introduction : disclosure of Human immunodeficiency virus (HIV) sero-status is reportedly low in low-income countries especially among women. Pregnant women require special support to reduce the risk of mother-to-child transmission and to adopt effective management strategies. We compared the disclosure status and factors affecting willingness for disclosure in pregnant and non-pregnant women in Osun State, South-West Nigeria. Methods : we conducted a comparative cross-sectional survey of 235 pregnant and non-pregnant women each from Anti-Retroviral Clinics in Osun State, Nigeria. We selected respondents from private and public facilities; with secondary and tertiary facilities selected from the public owned facilities in September 2016 using a two-stage sampling technique. We collected data with a pretested semi-structured questionnaire. We analyzed data with chi-square and logistic re/b>: HIV status disclosure was 84.3% (198) among pregnant compared with 60.0% (141) in non-pregnant respondents (p Conclusion : disclosure of HIV seropositive status was higher among pregnant women compared to non-pregnant women due to attention placed on prevention of mother-to-child transmission of HIV. Information, Education and Communication materials on the need to disclose HIV status were provided to respondents. We recommend more intense health education campaign, couple counselling and involvement of partners in patients’ care.

Background: In Myanmar, HIV seropositive children are being enrolled in an integrated HIV care (IHC) Program for HIV treatment and care since 2005. Objectives: To assess the: (a) attrition (death or loss-to-follow-up) rates among children (aged ≥ 18 months to

La criptocococis meníngea es la infección fúngica más frecuente del sistema nervioso central; generalmente se presenta en pacientes VIH seropositivos, aunque existe una proporción considerable de paciente VIH seronegativos, siendo en estos casos su presentación más agresiva. Esta infección tiene manifestaciones neurológicas variables que son secundarias al aumento de la presión intracraneal. La ventriculitis con hidrocefalia secundaria es una de las complicaciones de mayor morbi-mortalidad especialmente en pacientes VIH seronegativos. Presentamos un reporte de caso de criptocococis meníngea género Neoformans subtipo Grubbi con ventriculitis e hidrocefalia secundaria en paciente VIH seronegativo confirmado por histopatología Meningeal criptocococis is the most common fungal infection of the central nervous system, occuring in HIV seropositive patients, although there is a significant proportion of HIV seronegative patients, in whom the presentation is more aggresive. This infection has variable clinical manifestations secondary to increased intracranial pressure. Ventriculitis with hydrocephalus is one of the complications with the poorest outcome and mortality especially in HIV seronegative patients. We present a case report of meningeal criptocococis Neoformans subtype Grubbi with ventriculitis and secondary hydrocephalus in HIV seronegative patient confirmed by histopathology

New York City has experienced the largest HIV epidemic among persons who use psychoactive drugs. We examined progress in placing HIV seropositive persons who inject drugs (PWID) and HIV seropositive non-injecting drug users (NIDU) onto antiretroviral treatment (ART) in New York City over the last 15 years. We recruited 3511 PWID and 3543 NIDU from persons voluntarily entering drug detoxification and methadone maintenance treatment programs in New York City from 2001 to 2014. HIV prevalence declined significantly among both PWID and NIDU. The percentage who reported receiving ART increased significantly, from approximately 50% (2001-2005) to approximately 75% (2012-2014). There were no racial/ethnic disparities in the percentages of HIV seropositive persons who were on ART. Continued improvement in ART uptake and TasP and maintenance of other prevention and care services should lead to an “End of the AIDS Epidemic” for persons who use heroin and cocaine in the New York City.

Objective: To determine the occurrence of tuberculosis (TB) among HIV infected patients and their CD4+ cell count profile. Methods: A total of 263 HIV-seropositive patients either hospitalized or reporting to the antiretroviral therapy centre for follow up were included in the study. HIV-seropositive patients were then investigated clinically, radiologically and microbiologically for diagnosis of pulmonary TB as per the revised guidelines issued by WHO. Two early morning sputum samples were collected from patients, and isolation and identification of Mycobacterium tuberculosis was done as per standard protocol. Results: Out of them 41 (15.6%) were TB positive and 222 (84.4%) were TB negative. Among TB positive patients, smear positive and culture positive patients were 19 (7.2%), while smear negative and culture positive were 9 (3.4%). Mean CD4+ T cell counts for HIV-seropositive and HIV-related TB patients were 156.14 cells/µL and 197.24 cells/µL respectively. Conclusions: The clinical manifestations in HIV-related TB patients are quite variable and lead to difficulties in diagnosis. Thus radiological evaluation along with proper laboratory investigation in all clinically suspected cases of tuberculosis is the key for prompt diagnosis and treatment.

Background: Oral lesions have been reported to be early clinical features of HIV infection. Objective: The purpose of this study was to establish the prevalence of oral lesions in HIV Seropositive female patients and correlate the CD4 count with the appearance of oral lesions in the female patients attending Lagos University Teaching Hospital (LUTH) and University of Benin Teaching Hospital, Benin (UBTH). Methods: A prospective study was undertaken in 172 newly diagnosed adult HIV infected female patients (not on antiretroviral therapy), who attended the PEPFAR clinic at LUTH and the HIV Clinic of the University of Benin Teaching Hospital, Benin City, Nigeria. They were assessed for oral lesions which were evaluated using EEC/WHO (2003) – Classification on the diagnostic criteria for oral lesions in HIV. Data were collected using an interviewer administered questionnaire. Following Oral examination undertaken, oral lesions were detected, recorded and Original Research Article

Background: HSV-2 is a common cause of genital ulcer disease worldwide and has become a prominent public health issue over recent years. The major public health importance of HSV-2 relates to its potential role in facilitating HIV transmission. This study was done to know the association of HSV-2 and HIV, to compare the seropositivity of HSV-2 in HIV seropositive and HIV seronegative individuals and also to study the influence of certain factors on HSV-2 infection. Methods: Blood samples collected from 132 HIV seropositive individuals and 50 HIV seronegative blood donors were screened for HSV-2 type specific IgG antibodies by ELISA. Results: 84 samples of the test group tested positive for HSV-2 (63.63%), which is significantly higher compared to 3 (6%) positives of the control group. HSV-2 seropositivity was significantly higher in individuals with multiple sexual partners, illiterates, daily wage workers. Conclusions: High seropositivity of HSV-2 in HIV seropositive individuals demonstrates the need for regular screening of HSV-2 in HIV seropositive individuals. It also clearly shows that education and occupation will influence the prevalence of HIV and HSV-2.

Human immunodeficiency virus (HIV) infection is endemic in South Africa. Non-Hodgkin lymphoma (NHL) occurs with increased frequency in HIV seropositive individuals. The increase in NHL has been more marked in the last decade, with HIV being the major contributor to this increase. More than 70% of the adult NHL patients at Chris Hani Baragwanath Academic Hospital (CHBAH), Soweto, Johannesburg, are HIV seropositive. In addition, HIV has impacted on the clinical presentation—being more aggressive and atypical. Histologically, HIV-NHL typically manifests as B-cell, high grade lymphomas, including diffuse large B-cell lymphoma (DLBCL); Burkitt lymphoma (BL); B-cell lymphoma, unclassifiable, with features intermediate between DLBCL and BL and plasmablastic lymphoma. The latter two entities, which were previously rare or unknown, have gained prominence in the last decade, occurring primarily in HIV seropositive individuals. HIV-NHL, being associated with all these adverse prognostic factors results in a poorer overall survival.

The presentation and course of Sexually transmitted diseases(STI) may be altered by presence of coexisting HIV status. Aim of the study was to study the prevalence of STI in 50 females with HIV infection and 50 females without HIV infection and to study the pap smear of patients to look for any cellular changes (dysplasia) due to sexually transmitted infections. Material and methods: The present study was an observational study, which was undertaken on 100 females with STIs (50 females with coexistent HIV infection and 50 females without HIV infection), in the age group 15-49 years attending Skin and VD OPD of Rajindra hospital, Patiala. Results: In our study, the commonest presenting complaint in case of both HIV positive (66%) and HIV negative (80%) women was vaginal discharge. PAP smear abnormalities were present in 28 (56%) HIV positive women and 11 (22%) HIV negative women. In case of HIV positive women, the inflammation was trichomonal in 4 (8%), bacterial in 2 (4%), fungal in 2 (4%) and non-specific in 20 (40%) patients. In HIV negative women, the inflammation was trichomonal in 2 (4%) patients, bacterial in 2 (4%) patients and non-specific in 7 (14%) patients. The difference in abnormality seen in PAP smear between HIV positive and HIV negative women is statistically significant only in case of non-specific inflammation which is more common in case of HIV positive women. Conclusion: From the present study, it was concluded vaginal discharge was the commonest presenting complaint in both HIV positive and HIV negative women, though the commonest cause of vaginal discharge was candidiasis in HIV positive females and bacterial vaginosis in HIV negative females. Also, PAP smear abnormalities were significantly higher in HIV positive women than HIV negative women. So it is important that HIV positive women should have complete gynecological evaluation including a PAP smear with aggressive screening of STIs.

Pain remains highly prevalent in HIV-seropositive (HIV+) patients despite their well-suppressed viremia with combined antiretroviral therapy. Investigating brain abnormalities within the pain matrix, and in relation to pain symptoms, in HIV+ participants may provide objective biomarkers and insights regarding their pain symptoms. We used Patient-Reported Outcome Measurement Information System (PROMIS®) pain questionnaire to evaluate pain symptoms (pain intensity, pain interference and pain behavior), and structural MRI to assess brain morphometry using FreeSurfer (cortical area, cortical thickness and subcortical volumes were evaluated in 12 regions within the pain matrix). Compared to seronegative (SN) controls, HIV+ participants had smaller surface areas in prefrontal pars triangularis (right: p = 0.04, left: p = 0.007) and right anterior cingulate cortex (p = 0.03) and smaller subcortical regions (thalamus: p ≤ 0.003 bilaterally; right putamen: p = 0.01), as well as higher pain scores (pain intensity-p = 0.005; pain interference-p = 0.008; pain-behavior-p = 0.04). Furthermore, higher pain scores were associated with larger cortical areas, thinner cortices and larger subcortical volumes in HIV+ participants; but smaller cortical areas, thicker cortices and smaller subcortical volumes in SN controls (interaction-p = 0.009 to p = 0.04). These group differences in the pain-associated brain abnormalities suggest that HIV+ individuals have abnormal pain responses. Since these abnormal pain-associated brain regions belong to the affective component of the pain matrix, affective symptoms may influence pain perception in HIV+ patients and should be treated along with their physical pain symptoms. Lastly, associations of lower pain scores with better physical or mental health scores, regardless of HIV-serostatus (p

BackgroundMarijuana use is common among HIV+ individuals, but few studies have examined long-term trends in prevalence and correlates of use.MethodsWe evaluated trends (1984-2013) in the annual prevalence of current (past 6-month use) and daily (among current users) marijuana use and determined correlates of use among 2742 HIV-seropositive (HIV+) and 3172 HIV-seronegative (HIV-) men who have sex with men in the Multicenter AIDS Cohort Study (MACS). Poisson regression models were used to estimate prevalence ratios of marijuana use separately for the men who were enrolled before 2001 (early-cohort) and after 2001 (late-cohort).ResultsOver the 29 years of the study, the prevalence of current marijuana use declined significantly, whereas daily use among users increased among all men in the early and late-cohorts. A HIV+ status was associated with higher prevalence of marijuana use among the men in the early-cohort (adjusted prevalence ratio [aPR] = 1.53, 95% confidence interval [CI]:1.42, 1.64, p =

Resumen Introducción. La neurocriptococosis es una infección fúngica oportunista que representa un alto costo en vidas humanas y para la economía de los países. Sus agentes causales, las especies del complejo Cryptococcus neoformans/Cryptococcus gattii, tienen una fase sexuada y otra asexuada, cuatro serotipos principales y siete variedades moleculares con diferencias clínico-epidemiológicas, fenotípicas y de sensibilidad a los antifúngicos. Objetivo. Caracterizar molecularmente los aislamientos clínicos de C. neoformans de Guayaquil, Ecuador. Materiales y métodos. Se determinó el tipo de apareamiento, el serotipo y la variedad molecular mediante reacción en cadena de la polimerasa y análisis del polimorfismo de los fragmentos de restricción de 27 aislamientos levaduriformes previamente identificados como C. neoformans mediante métodos convencionales. Los aislamientos fueron recuperados del líquido cefalorraquídeo de pacientes con síndrome neurológico seropositivos para HIV, internados en el Hospital de Infectología "Dr. José Daniel Rodríguez Maridueña", entre diciembre de 2013 y enero de 2015. Resultados. Se demostró el amplio predominio de C. neoformans del serotipo A, MATα y el genotipo VNI entre los aislamientos estudiados. Conclusiones. Estos datos son similares a los obtenidos en otros países y son los primeros de su tipo en Guayaquil, Ecuador, por lo cual constituyen un aporte importante al conocimiento de la criptococosisen esta ciudad. Abstract Introduction: Neurocryptococcosis is an opportunistic fungal infection that represents a high cost in human lives and for the economy of countries. Its causative agent, the Cryptococcus neoformans/Cryptococcus gattiispecies complex, has a sexual and an asexual phase, four major serotypes and seven molecular varieties with phenotypic, clinical-epidemiological and antifungal susceptibility differences. Objective: To characterize by molecular methods clinicalisolates of C. neoformans from Guayaquil, Ecuador. Materials and methods: We determined mating types, serotypes and molecular varieties by PCR and RFLP in 27 yeast isolates previously identified as C. neoformans by conventional methods. The isolates were recovered from cerebrospinal fluid of HIV seropositive patients with neurological syndrome admitted at "Dr. José Daniel Rodríguez Maridueña" Hospital from December, 2013, to January, 2015. Results: We established a wide prevalence of C. neoformans serotype A, MATαand genotype VNI among the studied isolates. Conclusions: These data are similar to those obtained in other countries and the first identified by molecular characterization in Guayaquil, Ecuador. Therefore, they constitute an important contribution to the knowledge on cryptococcosis in this country.

Two hundred and fifty five patients with human immunodeficiency virus (HIV) infection were screened for hepatitis B virus surface antigen (HBsAg) over a period of 3 years. These patients were followed up every 6 month. 10.2% of HIV seropositive cases revealed presence of HBsAg. It was also observed that almost half (47.6%) of these cases developed carrier state.

Introduction En Afrique subsaharienne, les méthodes de diagnostic de la tuberculose sont insuffisantes et reposent essentiellement sur la microscopie. Elles constituent un réel frein pour le contrôle de la tuberculose. La présente étude voudrait évaluer les performances du GeneXpert MTB/RIF vis à vis de la microscopie classique de Ziehl-Neelsen à l’Hôpital Provincial Général de Référence de Bukavu, à l’Est de la République Démocratique du Congo après 10 mois d’utilisation. Méthodes Les résultats de la coloration au Ziehl-Neelsen et de la biologie moléculaire sur GeneXpert MTB/RIF de 452 patients suspects de tuberculose ont été colligés. La validité d’un test par rapport à l’autre dans la détection de la tuberculose a été étudiée. Résultats Dans le groupe entier, la fréquence de la tuberculose pulmonaire était de 16.3%. La positivité était significativement plus élevée pour le GeneXpert MTB/RIF que pour le Ziehl-Neelsen dans le groupe entier (15.9% vs 9.3%, p= 0.03) et chez les séropositifs pour le VIH (52.0% vs 24.0%; p = 0.007). Cependant, la sensibilité de GeneXpert MTB/RIF comparé au Ziehl-Neelsen n’était pas maximale (95.2%). Enfin, GeneXpert MTB/RIF a détecté 20.8% de résistance à la rifampicine. Conclusion La présente étude confirme la supériorité de GeneXpert MTB/RIF sur la coloration de Ziehl-Neelsen dans la détection de la tuberculose et dans la prédiction de la multi résistance. Son utilisation systématique couplée au Ziehl-Neelsen permettrait de mieux contrôler la tuberculose en Afrique subSaharienne.

Introduction Cardiovascular risk factors place HIV-infected patients at increased risk for cardiovascular diseases (CVDs) due to complex interactions between traditional CVD risk factors, antiretroviral therapy (ART) and HIV infection itself. The report of the 2012 National Reproductive Health Survey Plus indicated that the prevalence of HIV/AIDS in Nigeria is about 3.4% while Ondo State has a prevalence of 4.3%. This study was therefore designed to evaluate the CD4+ T-cell count, atherogenic indices and risk score of adult HIV seropositives on Highly Active Antiretroviral Therapy (HAART), those not yet started on HAART and HIV seronegative control subjects. Hypothesis tested was the effect of the various drugs on the indices determining the risk level. Methods Serum levels of CD4+ cell count of adult HIV seropositive subjects on HAART, HAART naive subjects and seronegative controls were determined using flow cytometry while their atherogenic indices and Framingham risk score were determined from enzymatic spectrophotometrically determined lipids and lipoproteins. Ethical approval was obtained from the Ondo State Ministry of Health Research Ethics Committee, Akure, Nigeria. All data were expressed as Mean ± Standard Deviation and analysed with Analysis of Variance (ANOVA) while multiple comparisons were done using Post Hoc Bonferonni test. Results The average duration (in months) of the use of HAART in the group 1 subjects is 25.63±19.99 while the average duration (in months) of cotrimoxazole use for subjects in group 2 is 7.10±4.89. There was a significant mean increased weight in the control subjects as compared with that of the other two groups. The mean serum cardiac risk ratio (CRR), atherogenic index of plasma (AIP), atherogenic coefficient (AC) and Framingham Risk Score (FRS) were significantly increased in the HAART group as compared with those of the two other groups. Conclusion HIV appears to have negatively altered the exogenous and endogenous synthesis and metabolism of lipids and lipoproteins in the liver, with ultimate effect on the atherogenic indices and risk score. This is worsened by antiretroviral therapy as the increased levels of these indices were mainly seen in the HAART group, constituting a major risk for cardiovascular diseases in these patients, thus increasing mortality rate.

HIV infection natural history is extremely changed, today. When we observed HIV virus infection for the first time in 80’s, this was a dramatic diagnosis and people were frightened by patients affected. This behaviour explained the great diffusion of HIV infection in the past time and the usefulness of prevention strategy. Instead of, in the last two decades, global prevention strategies explained how the infection could be transmitted and they reduced the HIV seropositive patient’s stigma. In 90’s, the HIV infection turned from a lethal pathology into a chronic infection. In that period infact, we learn how mixed together some old and new drugs, that combined became HAART, the first strongly active HIV therapy. Nowadays, the HIV infection is considered as a chronic one. In 2014, there were 35.000.000 patients living with HIV infection in the world. More than 40.000.000 persons died in the world during this epidemic disease. In the past, the virus transmission was especially related to parenteral transmission, intravenous drug use and homosexual behaviours. Today, the most important way of transmission is the sexual one. The reduction of viral transmission in intravenous drug users population is obviously related to a great prevention work by specialized services, who take care of that kind of patients (Servizio per le Dipendenze Patologiche: Ser.D). In the last two decades, we observed a reduction of the new HIV seroconversions and of the AIDS related deaths. The HAART therapy is now available also in the poorest parts of the world, like Africa, for example. WHO encourages all the Countries to defeat HIV infection at least in 2030, but this project seems to be an utopic one.

Histoplasmosis is a systemic fungal disease that may be presented with a variety of clinical manifestations, usually as an opportunistic infection in immunocompromised individuals. We present an HIV seropositive patient with a large fleshy growth causing left-sided nasal obstruction, as an unusual presentation. The lesions shrunk dramatically and almost completely on intravenous amphotericin-B lipid complex (ABLC) given for 2 weeks followed by long-term oral itraconazole.

Background & objectives: Immunocompromised individuals mainly HIV infected patients are at a great risk for developing toxoplasmosis. The presence of toxoplasmosis among HIV-infected patients directly correlates with the prevalence of anti- Toxoplasma gondii antibodies and the degree of immunosuppression (measured by CD4 counts). The data regarding the seroprevalence of toxoplasmosis in HIV-infected patients are scarce in India. Therefore, this study was initiated to find out the seroprevalence of toxoplasmosis in treatment-naïve HIV seropositive patients and to determine its association with CD4 counts, if any. Methods: Four hundred newly diagnosed antiretroviral therapy (ART) naïve adult HIV positive patients coming for CD4 count estimation were tested for the presence of anti- Toxoplasma IgG antibodies. Risk factors for acquisition of toxoplasmosis as well as the age, gender and CD4 counts of the patient were noted down. Results: Toxoplasma IgG was positive in 292 (73%) patients, and the positivity was not related to their CD4 counts. The proportion of anti- Toxoplasma IgG positivity showed no significant association with age, gender and risk factors of the patients. Interpretation & conclusions: In the absence of any specific vaccine or prophylaxis for toxoplasmosis, it is pertinent to screen all HIV-positive patients for Toxoplasma IgG at diagnosis, irrespective of their CD4 counts, and sensitize them about the means to prevent either acquisition or activation of infection to avert the development of toxoplasmic encephalitis.

Background: The epidemiology of HIV should be understood especially with regard to various socio-demographic factors because the most effective approaches for its prevention and control are awareness and life style changes. Aim: This study was undertaken to determine the socio-demographic characteristics and immunological profile of HIV seropositive patients attending the antiretroviral therapy (ART) clinic of Lok Nayak hospital in New Delhi, India. Methods: Two hundred and fifty two, HIV seropositive subjects were enrolled in the study irrespective of their ART status. Subjects were staged as per the World Health Organization (WHO) staging system and the socio-demographic data and clinical signs and symptoms were recorded for all subjects on a predesigned performa. CD4+ T lymphocyte count was determined by the Fluorescent Activated Cell Sorting (FACSCount TM ) system . Results: Mean age of study subjects was 33.6 years ± 8.3 years, 66.3% were males, 73.4% were married, 27.7% were illiterate. 32.9 % of subjects were employed in unskilled and semiskilled occupations. Majority of patients belonged to upper lower social class as per the modified Kuppuswamy’s scale. 72.2% had acquired infection through the heterosexual route. 66.3% of the cases were in WHO clinical stage I & II of illness at the time of registration. The median CD4+ T lymphocyte count for all patients was 279 Cells/ µl.

Background: To characterize the HIV-seropositive patients who underwent HIV screening and counseling in a Chinese general hospital and to provide evidence for the HIV/AIDS prevention and control strategy in China. Methods: We retrospective analyzed data of all the patients who were screened for HIV infection and found to be HIV-positive in our hospital from January 2010 to December 2016. The demographic and social characteristics of the HIV-seropositive patients were described in order to estimate the risk factors. Results: Among 611,445 patients who were screened for HIV, 329 cases were confirmed to be HIV-positive by Western blot test. These patients were predominantly male, accounting for 83.59% (275/329) of cases. Majority of male patients 82.91% (228/275) acquired HIV infection via sexually transmitted route and about 122 male patients (53.51%) were homosexual. The female gender accounted for only 16.41% (54/329) and 77.78% (42/54) of them were infected by a male partner. Conclusions: Our results showed the MSM (men who have sex with men), females and adults over 65 years old have different sexual and psychosocial characteristics and these characteristics should be taken into account for HIV prevention, intervention and treatment when preventative strategies of HIV/AIDS shift from high-risk groups to the general population in China.

Introduction Systematic reviews show that women living with HIV (WLHIV) have high unmet sexual and reproductive health (SRH) needs due to barriers to access sexual and reproductive health services (SRHS). In Latin America and the Caribbean (LAC), as of 2016, there were nearly one million WLHIV, but the existing evidence of their SRH needs comes from a few individual studies. This systematic review provides an overview of these women's needs to help define new and/or adapt existing public health strategies to the local context. This review synthesizes the evidence from the literature on the use of and access to SRHS related to family planning, antenatal care, abortion services and violence against WLHIV in LAC. Methods Using a systematic review of mixed studies, a search was performed in MEDLINE, EMBASE, LILACS, INASP, POPLINE, SCOPUS, for studies conducted in LAC, from 2004 to 2017, as well as contact with authors and hand search as needed. Two independent reviewers evaluated the quality of the studies using the Mixed Methods Appraisal Tool; inclusion was conducted according to the PRISMA flow diagram. An exploratory narrative synthesis followed by quantitative synthesis data was undertaken. Group analysis or meta‐analysis was not considered appropriate given the level of heterogeneity of the studies. Results A total of 18 studies in 13 LAC countries for a population of 5672 WLHIV were included. Data from individual studies reported unmet family planning needs; higher, but inconsistent use of condom as the sole contraceptive method OR=1.46 [1.26 to 1.69]; lesser use of other non‐permanent contraceptive methods OR=0.26 [0.22 to 0.31]; more unplanned pregnancies OR=1.30 [1.02 to 1.66]; more induced abortions OR=1.96 [1.60 to 2.39]; higher risk of immediate postpartum sterilization; and higher exposure to sexual and institutional violence by WLHIV when compared with women without HIV. Conclusions This review presents evidence from LAC about the SRH unmet needs of WLHIV that must be addressed by decreasing institutional and structural barriers, facilitating services and reducing stigma, and discrimination among healthcare providers to improve access to SRHS based on human rights, so women independently of their HIV status can make their own reproductive decisions, free of violence and coercion.

Background: Study of demographic features like age, educational status of the patient and her husband, occupation of the patient and her husband and religion of the retropositive pregnant women compared to controls. Methods: In this prospective study patients were selected from Vani Vilas Hospital attached to Bangalore Medical College attending the antenatal Clinic of Obstetrics and Gynaecology. The study period was for 2 years. The study group comprised of 100 HIV seropositive patients. The control group comprised of 100 HIV seronegative patients. At enrollment, data collection of demographic features like age, educational status of the patient and her husband, occupation of patient and her husband, and religion of the retropositive pregnant women compared to controls. Results: The minimum and maximum age in the study group was 18 and 36 years respectively and in the control group 17 and 35 years respectively. Around 73% of pregnant women in the study group were below 25 years of age. 89% of pregnant women in the study group were Hindus. Around 36% of women in the study group were illiterate compared to 21% in the control group. Around 45% of women in the control group have studied till secondary school. In this study, most of the women in both the groups were housewives. There was one commercial sex worker and 8 women had polygamous relationship in the study group. The occupational pattern of the husbands was analyzed and 34% of the husbands of HIV positive women were drivers. 56% of the husbands in the study group admitted to have had multiple sexual partners, whereas only 9% admitted so, in the control group. Conclusions: Retropositive pregnant women were younger; most of them were house wives. Husbands of retropositive pregnant women were drivers and most of them had multiple sexual partners.

Respiratory viral infections, especially influenza have a potential to form a fatal association with cryptococcosis in the setting of compromised immunity. Considering the lethality of these two infections, we report an unusual case of dual infection of pandemic influenza A H1N1 and disseminated cryptococcosis in an HIV seropositive individual.

Revised Stress and Coping Theory proposes that positive affect serves adaptive functions, and its beneficial effects are heightened during stressful periods. This study examined the prospective relationship between positive affect and engagement in care during the 18 months after a HIV seropositive diagnosis.The Coping, HIV, and Affect Interview (CHAI) cohort study enrolled 153 individuals who had recently received a HIV seropositive diagnosis. Using logistic and linear regression, baseline positive affect was examined as a predictor of linkage to HIV care, antiretroviral therapy (ART) persistence (i.e., starting ART and remaining on it during subsequent follow-up assessments), and mean log₁₀ HIV viral load over follow-up.After controlling for education, T-helper (CD4+) count, HIV viral load, and negative affect, higher baseline positive affect independently predicted increased odds of linkage to HIV care at 3 months postdiagnosis (adjusted OR [AOR] = 1.10; 95% CI = 1.01-1.21) and ART persistence over the 18-month follow-up period (AOR = 1.08; 95% CI = 1.01-1.16). Positive affect was not directly associated with lower mean HIV viral load over follow-up. However, one standard deviation higher positive affect indirectly predicted 6.7% lower HIV viral load via greater odds of ART persistence (βindirect = -0.18, p.05).Greater positive affect predicts linkage to HIV care and ART persistence. ART persistence, in turn, is associated with lower HIV viral load. Clinical research is needed to examine whether interventions designed to enhance positive affect can boost the effectiveness of HIV treatment as prevention.

Background: One third of the world’s population constituting 2 billion people are infected with Tuberculosis (TB), which is the second most common cause of mortality amongst communicable diseases. Nigeria ranks fourth among 22 high TB burden countries. One of the major challenges to the control of TB is the presence and interaction of TB with HIV. In many parts of Africa, infection with HIV has further increased TB morbidity and mortality. To effectively control TB in Africa the co-infection with HIV must be perfectly understood and adequate measures and strategies developed and implemented. Methods: This was a cross sectional descriptive study, carried out between January 2012 and April 2014 at the DOTS clinic of a tertiary hospital in South-Eastern Nigeria. Three hundred and eighty-four tuberculosis patients were interviewed using a structured questionnaire and data on their HIV status and other characteristics were collected. Data were analysed using SPSS Version 20. Results: Three hundred and eighty-four tuberculosis patients participated in the study. Eighty-six patients (22.4%) were HIV seropositive. There were 182 males (47.4%) and 202 females (52.6%). The commonest age group was the group 20 - 39 years (51.6%). HIV seropositivity was highest among the age group 20 - 39 years and this was statistically significant (X2 = 11.14, p = 0.01). The married patients had the highest proportion of HIV seropositivity and this was statistically significant (X2 = 40.76, p = 0.00). The unemployed patients had the highest proportion of HIV seropositivity and it was statistically significant (X2 = 35.14, p = 0.00). Conclusion: Some basic characteristics of tuberculosis patients predispose them to HIV/TB co-infection. The characteristics must be explored further and be factored in the strategies to control tuberculosis in Africa.

OBJECTIVES There is limited research about cochlear function in adults who are human immunodeficiency virus (HIV) positive (+). The aim of the present study was to collect measures of cochlear function in a large sample of adults with, or at risk for, HIV infection, to evaluate associations between HIV status, HIV treatment, and cochlear function. DESIGN Distortion product otoacoustic emissions (DPOAEs) were used to evaluate cochlear function in 506 participants; 329 men, 150 of whom were HIV+, and 177 women, 136 of whom were HIV+. DPOAEs were measured at frequencies 1000, 2000, 3000, 4000, and 6000 Hz. A DPOAE nonresponse (NR) was defined as an absolute DPOAE level less than -15 dB SPL or a difference between the absolute DPOAE level and the background noise level less than 6 dB. The total number of NRs was calculated for each ear. The associations of demographic variables, HIV status, and HIV treatment with number of NRs were evaluated with univariate and multivariate ordinal regression models. RESULTS There was a statistically significant increase in the odds of higher numbers of NRs with age, being male, and being non-Black, but not with HIV status. Among HIV+ participants, there were no statistically significant associations of the HIV disease status or treatment variables with higher number of NRs. CONCLUSION The authors found no evidence of impaired cochlear function by HIV disease status or highly active antiretroviral therapy-treated HIV infection in this cross-sectional study.

Objective: To assess the pattern of condom use among HAART naive and experienced patients in north eastern Nigeria. Methods: An interviewer-administered questionnaire was used to assess the pattern of condom use among 201 HIV clients. Participants included for this comparative cross sectional study were divided into two group: HAART experienced participants that had been on therapy for at least 12 months and HAART naive participants that had been registered at least 3 months before the beginning of the study. Results: Almost half of the HAART naive and substantial proportion of HAART experienced couples never used condom. Few (13.4%) HAART experienced and 16.5% naive participants always used condom. Inconsistent condom use among HAART naive and experienced partners was 38.8% and 41.8% respectively. Spouse notification of HIV was significantly associated with the use of condoms (p = 0.02; OR 1.32, 95% CI: 1.06 - 1.64). The stepwise logistic regression indicated that female (OR 2.40; CI: 1.09 - 3.82), partner notification of HIV sero-positive status (OR 1.32; CI: 1.06 - 1.64, yes versus none), occupation as a civil servant (OR 1.40; CI: 0.15 - 1.05), are factors independently associated with condom use in our studied participants. Conclusion: We report that condom use is uncommon among HIV clients in our environment. Condom is significantly influenced by partner notification of HIV seropositive status, occupation as a civil servant and female gender. This study supports an absence of association between condom uptake and HAART use. Intensive and regular condom counselling for every HIV-positive outpatient who attends the clinic in our environment is expedient. We recommend interventions directed at increasing condom use among HIV clients in our environment.

Co-infection with human immunodeficiency Virus HIV and (HCV) is becoming a major global problem, leading to increased morbidity and mortality in both developed and developing countries. This research hence examines the risk factors and transmission of HIV and HCV co-infection. Two hundred and ninety (290) subjects were screened, with HCV global immunochromatographic test kit. Possible risk factors to co-infectious status of subject were determined using a well-structured questionnaire. Out of the 290 sera tested, 25 (8.6%) were positive for HCV antibodies. Considering Age of subjects screened, females aged 11-20 years recorded a high positivity of 3.1 %,( X 2 = 2.755, P-value = 0.839; P>0.05).Marital status of subjects showed that single subjects recorded 13(4.5%), (X 2 = 0.679,P-value = 0.712 ; P > 0.05)positivity compared to married subjects with 4.1%. There were no significant correlations between HCV infection with Age and Marital Status; P - values = 0.839 and 0.712 respectively (i.e P > 0.05). Significant correlation was found between HCV antibodies and educational status, (Value x 2 = 7.957,P-value = 0.047; P < 0.05).However, Volunteers with secondary school level of education recorded 10(3.4%) positivity. The result obtained showed that Seroprevalence to HCV antibodies in this study was high, hence the need for its early diagnosis among HIV patients is strongly advocated to reduce the risk of further complications among these subjects.

The human caliciviruses (HuCVs) are important causes of gastroenteritis worldwide. Norovirus (NoV) and sapovirus (SaV) have been detected in HIV-seropositive children but the genetic diversity of HuCVs circulating in these individuals is largely unknown. In this study the prevalence and genotype diversity of HuCVs circulating in Kenyan HIV-positive children, with or without diarrhea, from the year 1999 to 2000 was investigated. The overall prevalence of HuCVs was 19% with NoV predominating at 17% (18/105) and SaV present in 5.7% (6/105) of specimens. Human CVs were detected in both symptomatic (24%) and asymptomatic (16%) children. Co-infections with other enteric viruses were detected in 21.6% of children with diarrhea but only in 4.4% of children without diarrhea. Remarkable genetic diversity was observed with 12 genotypes (7 NoV, 5 SaV) being identified in 20 HuCV-infected children. NoV genogroup II (GII) strains predominated with GII.2 and GII.4 each representing 27% of the NoV-positive strains. The GII.4 strain was most closely related to the nonepidemic GII.4 Kaiso 2003 variant. Other NoV genotypes detected were GI.3, GII.6, GII.12, GII.14, and GII.17. Five different SaV genotypes (GI.2, GI.6, GII.1, GII.2, and GII.4) were characterized from six specimens. Diarrheal symptoms were not associated with any specific HuCV genotype. Overall the HuCV genotype distribution detected in this study reflects those in other studies worldwide. The strains detected are closely related to genotypes that have circulated on several continents since the year 2000.

Introduction : le risque de transmission du VIH de la mere a l’enfant sans chimiotherapie perinatale est de 30 a 40 %. Le traitement prophylactique aux antiretroviraux (ARV) du nouveau-ne de mere seropositive au VIH reduit fortement le risque de transmission. L’etude avait pour objectif le suivi des enfants nes de meres seropositives au VIH de 0-18 mois au niveau de trois sites prevention de la transmission mere-enfant (PTME) a Bamako et un de Koulikoro.Methodes : l’etude etait longitudinale prospective avec suivi d’une cohorte d’enfants nes de meres seropositives au VIH pendant 18 mois. Les suivis clinique, biologique et psychosocial ont ete assures jusqu’a l’âge de 18 mois. Les donnees collectees sur un questionnaire servant de dossier ont ete saisies et analysees avec le logiciel MS ACCESS version 3.Resultats : au total, 157 femmes enceintes seropositives au VIH et 161 nourrissons ont ete inclus. L’alimentation artificielle a ete pratiquee chez 93,2 % des enfants. La prophylaxie ARV a ete recue par 89,8 % des meres et 100 % des nourrissons. Parmi les enfants, 72,67 % (117/161) ont ete suivis jusqu’a 18 mois, 3,4 % etaient infectes au VIH, 20 % etaient perdus de vue et 9,31 % de deces ont ete enregistres. Au cours du suivi, 68,2 % des femmes ont partage l’information de leur statut avec leurs maris ; 83,2 % des maris ont fait le test et 58,4 % d’entre eux ont eu une serologie VIH positive.Conclusion : les suivis clinique, biologique et psychosocial sont realisables au niveau des sites PTME et peuvent contribuer a une reduction de la transmission.

AIM: To determine the prevalence of human immunodeficiency virus (HIV) infection among tuberculosis patients, to compare the clinical features of tuberculosis among HIV seropositive and seronegative patients, & to correlate the seropositive tuberculosis patients with the CD4 count. METHODS: This study was undertaken in Gandhi Medical College, Hamidia Hospital, Bhopal, in department of medicine during November 2008 to November 2009. A total of 150 radio logically and / or bacteriologically confirmed patients of tuberculosis were tested for HIV seroprevalence. RESULTS: Among 150 tuberculosis patients, thirteen (8.66%) were found to be HIV seropositive. Eleven (84.6%) were males and two (15.4%) were females. Among 13 HIV seropositive patients ten (76.92%) patients were in the age group of 21 - 40 years. Out of eleven HIV seropositive male patients five (45.45%) were labourers, four (36.36%) were truck drivers, Among HIV seropositive patients, eight (61.53 %) belonged to urban area & five (38.47%) were from rural areas. Eleven (84.6%) had contracted HIV infection through sexual contact, one was IV drug abuser, one was supposed to be infected by blood transfusion. five (38.46%) patients had disseminated/military tuberculosis (DTB/MTB), three (23.07%) patients had pulmonary tuberculosis, three (23.07%) had pleural effusion, two (15.38%) had neurotuberculosis. Ten (76.92%) seropositive patients had CD4 count

Background There are few surveillance studies analyzing genotypes or primary (transmitted) drug resistance in HIV-infected blood donors in Brazil. The aim of this study was to characterize patterns of HIV genotypes and primary resistance among HIV-seropositive donors identified at 4 geographically dispersed blood centers in Brazil. Methods All HIV-infected donors who returned for counseling at the 4 REDS-II Hemocenters in Brazil from January 2007 to March 2011 were invited to participate in a case-control study involving a questionnaire on risk factors. Viral sequencing was also offered to positive cases to assign genotypes and to detect and characterize primary resistance to reverse transcriptase and protease inhibitors according to World Health Organization guidelines. Results Of the 341 HIV-seropositive donors who consented to participate in the risk factor and genetics study, pol sequences were obtained for 331 (97%). Clade B was predominant (76%) followed by F (15%) and C (5%). Primary resistance was present in 36 [12.2%, 95% confidence interval (CI) 8.2 to 15.5] of the 303 individuals not exposed to antiretroviral therapy, varying from 8.2% (95% CI: 2.7 to 13.6) in Recife to 19.4% in Sao Paulo (95% CI: 9.5 to 29.2); there were no significant correlations with other demographics or risk factors. Conclusions Although subtype B remains the most prevalent genotype in all 4 areas, increasing rates of subtype C in Sao Paulo and F in Recife were documented relative to earlier reports. Transmitted drug resistance was relatively frequent, particularly in the city of Sao Paulo which showed an increase compared with previous HIV-seropositive donor data from 10 years ago.

Background This analysis compared the frequency of persistent Trichomonas vaginalis (TV) among HIV-seropositive and HIV-seronegative women.

Access to sputum smear microscopy in high-tuberculosis (TB)-burden regions is limited by a scarcity of microscopes and experienced technicians. We evaluated the accuracy of CellScope, a novel digital fluorescence microscope that may expand access to microscopy. The study utilized smear microscopy slides prepared from sputum specimens submitted by consecutive adults with ≥2 weeks of cough who were admitted to Mulago Hospital (Kampala, Uganda). Conventional light-emitting diode (LED) fluorescence microscopy (FM) and mycobacterial culture were performed by experienced technicians. Two U.S.-based postgraduate researchers without prior microscopy experience restained, imaged, and interpreted the slides using CellScope. We assessed whether sensitivity and specificity of CellScope-based LED FM was noninferior to conventional LED FM by using a preselected margin of inferiority of 15%. Of 525 patients included, 72% were HIV seropositive and 39% had culture-confirmed TB. The proportions of positive results were similar with CellScope and conventional LED FM (34% versus 32%, respectively; P = 0.32), and agreement was substantial. CellScope accuracy was within the noninferiority margin for both sensitivity (63% versus 70%; difference, −7%; 95% confidence interval [CI], −13% to −1%) and specificity (85% versus 92%; difference, −7%; 95% CI, −12% to −3%). A subanalysis of 43 slides evaluated by each CellScope reader found substantial interreader reliability (custom-weighted kappa, 0.65) and variable intrareader reliability (custom-weighted kappa, 0.11 versus 0.48). CellScope offers promise for expanding microscopy services. Future studies should evaluate the device when operated by health workers in low-resource settings, the feasibility of image transmission and analysis by experienced microscopists, and the accuracy of automated image analysis algorithms.

BACKGROUND: HIV & Tuberculosis is a common co- infection that we come across in developing countries. Diagnosis is done by demonstration of acid fast bacilli (AFB) &Tuberculin skin test (TST). Skin test depends on cell mediated immune response which is generally compromised in HIV infected. OBJECTIVE: To compare the demonstration of AFB &TST reactivity in tuberculosis patients who are HIV seropositive & seronegative MATERIALS & METHODS: The study was conducted in the tuberculosis hospital which is attached to the Mysore medical college, Mysore. All patients clinically suspected or diagnostically confirmed as pulmonary tuberculosis were subjected for HIV screening test as per NACO guidelines .Total of 200 patients included for the study out of which 100 each were HIV seropositive & seronegative. They were subjected for microscopic examination of sputum& TST. Sputum microscopy was performed as per RNTCP guidelines. PPD antigen was injected intra- dermally on the left forearm & read after 48 hours & results were noted down. RESULTS: Study group divided into two categories. Category A: Pulmonary tuberculosis patients with HIV seropositivity Category B: Pulmonary tuberculosis patients with HIV seronegativity. Male preponderance was observed in both 79% & 70% with the mean age of 32.7 ± 7.3 years, in females seronegativity was more i.e.30% compared to 21% in seropositive with mean age of 29.3 ± 5.6 years. AFB demonstrated by Sputum microscopy in 99% HIV seronegatives & 54% of HIV seropositives. TST results classified into groups with No response, induration of 1-5mm,6-9mm & >10mm. Among category A 9 of them exhibited No response,32 of them 1-5mm,27 of them 6-9mm & 32 of them >10mm.All category B has responded to TST with only one patient with 1-5mm,25 with 6-9mm,74 with >10mm. DISCUSSION: There is statistically significant difference (p>0.05) in TST &AFB demonstration in pulmonary tuberculosis patients with HIV seropositive & seronegative. Sensitivity of TST is reduced as TST is indicator of cell mediated immune response which is generally compromised in HIV seropositive. Demonstration of AFB is also reduced in HIV seropositive cases. CONCLUSION: TST & demonstration of AFB are common tests done to screen for HIV-TB co infection in HIV seropositive. As the sensitivity of these tests are reduced in HIV seropositive it needs to be interpreted with care.

Summary Background We evaluate the effectiveness of combination treatment using photodynamic therapy after carbon dioxide laser in preventing the recurrence of condylomata acuminata for intraanal warts in HIV positive homosexual men. A retrospective survey of 41 patients referred to the STD clinic of the Fourth People's Hospital of Shenzhen for the treatment of intraanal warts among HIV positive homosexual men between Janurary 2009 and September 2011. Methods The patients who accepted CO 2 laser monotherapy for the same diagnosis were used as the comparison group. After the confirmation of the diagnosis of HIV infection and intraanal warts, the patients were treated with the combination treatment using PDT with 5-ALA thermal gel immediately after CO 2 laser ablation of the warts. PDT was performed with irradiation of 100 J/cm 2 at an irradiance of 100–150 mW/cm 2 with a semiconductor laser, wavelength 635 nm. PDT therapy was repeated twice with 2 weekly intervals. Follow up examinations including an anoscopy every 4 weeks after the latest PDT. Results After 3 cycles of PDT treatments, 39 cases of anoscopy examination showed no new or recurrent lesions. At the end of the sixth months, recurrence occurred in 12(29%) cases. HPV 11 was present in 6 (50%) of these recurrences. HPV 6/11 or 16/18 remains positive in 19 cases (46.3%) and HPV negative in 22 cases. Conclusions The combination treatment with CO 2 laser and PDT is much more effective in reducing the treatment cycles and the time intervals of the whole treatment for intraanal warts in HIV infected people.

HIV and tuberculosis infections are known to be associated with vasculopathy including occlusive disease and aneurysm formation. We report a case of 43-year-old male with miliary and central nervous system (CNS) tuberculosis; recently, diagnosed as HIV seropositive, on antiretroviral and antitubercular treatment presenting with painful neck swelling. He was found to have common carotid artery (CCA) pseudoaneurysm that was managed by endovascular stent grafting. HIV vasculopathy-related CCA pseudoaneurysm is a potentially life-threatening rare entity. Treatment of an immunocompromised patient by endovascular approach minimizes hospital stay and avoids wound-related complications. To the best of our knowledge, there has been no case report describing endovascular treatment of CCA pseudoaneurysm in an HIV-positive patient with low CD4 count and coexistent disseminated tuberculosis.