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HIV Test

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55681. HIV-1 infected patients older than 50 years. PISCIS cohort study. (Abstract)

HIV-1 infected patients older than 50 years. PISCIS cohort study. The aim of this study is to characterize the ways in which older HIV-infected people differ from younger HIV-infected people.Prospective cohort study. PISCIS cohort includes newly attended HIV-infected subjects since January 1, 1998. Naive patients were selected. Two groups were defined: G1 (>or=50 years at time of diagnosis, n=493) and G2 (18-49 years, n=4511). Statistical analysis was performed using chi(2), Student's t test (...) cells/mm(3) whereas for G2 it was 196 cells/mm(3) (p<0.001). Mortality was 9% for G1 and 4% for G2 (p<0.001).HIV-infected people diagnosed at the age of 50 years or older showed different features. They showed good viral and immunological response to HAART.

2008 Journal of Infection

55682. Quality of STIs and HIV/AIDS care as perceived by biomedical and traditional health care providers in Zambia: Are there common grounds for collaboration? (Abstract)

Quality of STIs and HIV/AIDS care as perceived by biomedical and traditional health care providers in Zambia: Are there common grounds for collaboration? To explore biomedical and traditional health care providers' (BHPs and THPs, respectively) perceptions of good quality of care and opinions on weaknesses in the services they provide to patients with STIs and HIV/AIDS.Using data from a cross-sectional survey, we post-coded two open-ended questions related to THPs' and BHPs' perceptions on good (...) quality of care and on provided care. The post-coding was done following Donabedian's framework of assessment of quality of care, and allowed transformation of qualitative data into quantitative. The analysis is based on comparison of frequencies, proportions and subsequent chi-square tests and odds ratios.Ndola and Kabwe, Zambia Main measures: Proportions of responses from 152 BHPs and 144 THPs.Substantial proportions of providers from both sectors perceived drugs availability (63% of BHPs and 70

2008 Complementary Therapies In Medicine

55683. Sexual transmission is associated with spontaneous HCV clearance in HIV-infected patients. (Abstract)

Sexual transmission is associated with spontaneous HCV clearance in HIV-infected patients. There are conflicting data regarding the incidence and factors implicated in the spontaneous clearance of hepatitis C virus (HCV) after acute infection. The aim of this study was to determine the epidemiological factors that predict the resolution of acute HCV infection without therapy in patients with human immunodeficiency virus (HIV) infection.We conducted a retrospective, multivariate analysis (...) of epidemiological data from HIV-infected patients presenting from 2000 to 2007 with evidence of past or present HCV infection. Data were collected from one American and two European HIV treatment clinics. A final cohort of 769 HIV-infected patients referred for treatment with available test results for antibody to HCV, HCV RNA, and hepatitis B surface antigen were included for the analysis. We calculated spontaneous clearance rates based on race, geographical location, gender, transmission risk factors

2008 Journal of Hepatology

55684. Coinfection with HIV-1 and Simian Foamy Virus in West Central Africans. Full Text available with Trip Pro

Coinfection with HIV-1 and Simian Foamy Virus in West Central Africans. Frequent infection with zoonotic simian foamy virus (SFV) has been reported among HIV-negative primate hunters in rural Cameroon. Plasma samples obtained from urban commercial sex workers (CSWs; n = 139), patients with sexually transmitted diseases (n = 41), and blood donors (n = 179) in the Democratic Republic of Congo [formerly known as Zaire] and Cameroon were tested for SFV and HIV-1 infection. One CSW and one blood (...) donor were found to be seropositive for both SFV and HIV-1, thereby documenting what are, to our knowledge, the first reported cases of dual SFV and HIV infection. The findings of the present study suggest opportunities for bloodborne and sexual transmission of SFV and highlight the importance of defining the clinical consequences of dual infections.

2008 Journal of Infectious Diseases

55685. Prevalence of HIV-1 drug resistance after failure of a first highly active antiretroviral therapy regimen in KwaZulu Natal, South Africa. Full Text available with Trip Pro

Prevalence of HIV-1 drug resistance after failure of a first highly active antiretroviral therapy regimen in KwaZulu Natal, South Africa. Emergence of human immunodeficiency virus type 1 (HIV-1) drug resistance may limit the benefits of antiretroviral therapy in resource-limited settings. The prevalence of resistance was assessed among patients from KwaZulu Natal, South Africa, following failure of their first highly active antiretroviral therapy (HAART) regimen.Genotypic resistance testing (...) was performed on plasma virus samples from patients who experienced virologic failure of their first HAART regimen at 2 clinics in KwaZulu Natal. Clinical and demographic data were obtained from medical records. Regression analysis was performed to determine factors associated with > or =1 significant drug resistance mutation.From January 2005 through August 2006, a total of 124 antiretroviral-treated adults who experienced virologic failure were enrolled. The predominant subtype was HIV-1C. Virus samples

2008 Clinical Infectious Diseases

55686. The impact of HIV tropism on decreases in CD4 cell count, clinical progression, and subsequent response to a first antiretroviral therapy regimen. Full Text available with Trip Pro

The impact of HIV tropism on decreases in CD4 cell count, clinical progression, and subsequent response to a first antiretroviral therapy regimen. Human immunodeficiency virus (HIV) uses 2 distinct chemokine receptors, CCR5 (R5) or CXCR4 (X4), during entry. Viruses may be R5 tropic, X4 tropic, or dual/mixed (D/M) tropic. R5-tropic virus predominates at high CD4 cell counts, with the number of X4-tropic strains increasing as CD4 cell count decreases.We investigated the relationship between (...) at 12 months (P=.026). Two hundred twenty-nine individuals infected with R5-tropic virus and 60 individuals infected with X4- or D/M-tropic virus commenced antiretroviral therapy between tropism testing and the time of data analysis. Time to viral suppression and the proportion of patients achieving viral suppression were similar at 6, 12, and 24 months. CD4 cell count increases were similar. Clinical events were significantly more common in the group infected with X4- or D/M-tropic virus

2008 Clinical Infectious Diseases

55687. Independent Effects of Genetic Variations in Mannose-Binding Lectin Influence the Course of HIV Disease: The Advantage of Heterozygosity for Coding Mutations. Full Text available with Trip Pro

Independent Effects of Genetic Variations in Mannose-Binding Lectin Influence the Course of HIV Disease: The Advantage of Heterozygosity for Coding Mutations. The in vivo impact of mannose-binding lectin (MBL), a molecule involved in innate immunity, on the pathogenesis of human immunodeficiency virus (HIV)-1 infection and AIDS is unknown.A total of 1102 HIV-positive and 2213 HIV-negative adult subjects were screened for polymorphisms in the coding and promoter regions of MBL2, the gene (...) , including steady-state viral load, baseline CD4(+) T cell counts, and delayed-type hypersensitivity skin test responses, an in vivo marker of cell-mediated immunity. The effects of MBL2 variations were most evident in those who possessed protective genotypes of CCR5 and a high copy number of CCL3L1, the most potent HIV-suppressive CCR5 ligand.MBL2 genotypes are independent determinants of HIV disease progression and heterozygosity for MBL2 coding mutations confer disease-retarding effects. MBL-dependent

2008 Journal of Infectious Diseases

55688. Expanded Access to Highly Active Antiretroviral Therapy: A Potentially Powerful Strategy to Curb the Growth of the HIV Epidemic. Full Text available with Trip Pro

Expanded Access to Highly Active Antiretroviral Therapy: A Potentially Powerful Strategy to Curb the Growth of the HIV Epidemic. We developed a mathematical model using a multiple source of infection framework to assess the potential effect of the expansion of highly active antiretroviral therapy (HAART) coverage among those in medical need on the number of individuals testing newly positive for human immunodeficiency virus (HIV) and on related costs in British Columbia, Canada, over the next (...) 25 years. The model was calibrated using retrospective data describing antiretroviral therapy utilization and individuals testing newly positive for HIV in the province. Different scenarios were investigated on the basis of varying assumptions regarding drug resistance, adherence to HAART, therapeutic guidelines, degree of HAART coverage, and the timing of HAART uptake. Expansion of HAART lead to substantial reductions in the growth of the HIV epidemic and related costs. These results provide

2008 Journal of Infectious Diseases

55689. Management of cryotherapy-ineligible women in a "screen-and-treat" cervical cancer prevention program targeting HIV-infected women in Zambia: Lessons from the field. Full Text available with Trip Pro

(LEEP) providers, and adapted LEEP to a resource-constrained setting.We successfully trained 15 nurses to perform visual inspection with acetic acid (VIA) followed by immediate cryotherapy. Women with positive tests but ineligible for cryotherapy were referred for further evaluation. We trained four Zambian physicians to evaluate referrals, perform punch biopsy, LEEP, and manage intra-operative and post-operative complications. From January 2006 through October 2007, a total of 8823 women (41.5% HIV (...) Management of cryotherapy-ineligible women in a "screen-and-treat" cervical cancer prevention program targeting HIV-infected women in Zambia: Lessons from the field. We demonstrate the feasibility of implementing a referral and management system for cryotherapy-ineligible women in a "screen-and-treat" cervical cancer prevention program targeting HIV-infected women in Zambia.We established criteria for patient referral, developed a training program for loop electrosurgical excision procedure

2008 Gynecologic Oncology

55690. The impact of HIV on mortality during in-patient rehabilitation of severely malnourished children in Malawi. (Abstract)

The impact of HIV on mortality during in-patient rehabilitation of severely malnourished children in Malawi. A prospective cohort study measured mortality during nutritional rehabilitation among HIV-infected and uninfected children, aged 6-59 months, with severe acute malnutrition (SAM). Children were tested for HIV and CD4% on admission to the nutrition rehabilitation unit (NRU). Mortality was assessed by following children to 4 months post discharge from the NRU or death if earlier. Overall (...) mortality was 14.8% (67/454) and HIV prevalence was 17.4% (79/454). HIV-infected children were significantly more likely to die than uninfected children [35.4% (28/79) vs. 10.4% (39/375), P<0.001], and 85.7% of deaths occurred in children with a CD4% less than 20. Forty percent (18/45) of HIV-infected children with a CD4% <20 died, in contrast to 15% (3/20) of HIV-infected children with a CD4% >20 (P=0.05). Routine testing and treatment for HIV among all malnourished children is necessary to improve

2008 Transactions of the Royal Society of Tropical Medicine & Hygiene

55691. Detection of Cryptosporidium parvum in HIV-infected patients in Malaysia using a molecular approach. (Abstract)

Detection of Cryptosporidium parvum in HIV-infected patients in Malaysia using a molecular approach. This cross-sectional study determined the prevalence of cryptosporidiosis in HIV-infected patients using polymerase chain reaction (PCR). Stool specimens were collected from HIV infected patients who were admitted to Hospital Raja Perempuan Zainab II, Kota Bharu, Malaysia, for various indications from December 2004 to December 2005. A modified acid-fast stain was performed on the direct stool (...) smears, then the stool specimens were further tested using nested PCR targeting the 18S rRNA gene of Cryptosporidium parvum, with a built-in internal control (IC). Out of 59 samples, 11 were positives. Nested PCR identified a total of nine samples (16%) compared to microscopy, which identified only three samples. All PCR negative results showed IC amplicons, suggesting that these samples were true negatives and were not due to inhibition of PCR. This study highlights the importance of molecular

2008 Southeast Asian Journal of Tropical Medicine and Public Health

55692. Low prevalence of transmitted antiretroviral drug resistance in a large UK HIV-1 cohort. Full Text available with Trip Pro

Low prevalence of transmitted antiretroviral drug resistance in a large UK HIV-1 cohort. To describe current practice in testing for transmitted antiretroviral drug resistance (TDR) and the prevalence of TDR in a large UK HIV-1 cohort.The study includes a retrospective analysis of newly diagnosed HIV-1-infected patients presenting to eight HIV clinics in the north of England between March 2005 and March 2007. Resistance mutations were defined by IAS-USA. Predicted phenotypes were calculated (...) by the Stanford University database.Five hundred and fifty-eight patients were studied, of whom 394 (70.6%) had heterosexually acquired HIV and 377 (67.6%) were infected outside the UK. TDR testing was performed in 406 patients (72.8%). Thirteen of 392 viral resistance profiles (3.3%) showed genotypic TDR. There was no significant association between TDR and any demographic or risk factor or baseline CD4 count. In particular, rates of TDR were similar in white British (6/147, 4.1%) and black African (7/224

2008 Journal of Antimicrobial Chemotherapy

55693. Rates of Tuberculosis Transmission to Children and Adolescents in a Community with a High Prevalence of HIV Infection among Adults. Full Text available with Trip Pro

Rates of Tuberculosis Transmission to Children and Adolescents in a Community with a High Prevalence of HIV Infection among Adults. Tuberculin skin test surveys are routinely used to test for tuberculosis (TB) infection in communities, but there are few data from tuberculin skin test surveys from countries in which both TB and human immunodeficiency virus (HIV) infection are prevalent.We conducted a tuberculin skin test survey among 831 school-going children aged 5-17 years in a community (...) that was experiencing an increase in the prevalence of TB and HIV infection. Responses to purified protein derivative RT23 were measured 3 days after the test was administered to determine tuberculin skin test results.The prevalence of tuberculin skin test results positive for TB (i.e., an induration >or=10 mm in diameter in response to the skin test) ranged from 26.2% among children aged 5-8 years to 52.5% among children aged 14-17 years. The overall annual risk of infection was 4.1% using a 10-mm cutoff and 2.0

2008 Clinical Infectious Diseases

55694. Prevalence of infection with hepatitis B and C virus and coinfection with HIV in medical inpatients in Malawi. (Abstract)

Prevalence of infection with hepatitis B and C virus and coinfection with HIV in medical inpatients in Malawi. Coinfection with hepatitis B (HBV) or hepatitis C (HCV) adversely affects the prognosis of HIV infection and vice versa, and results in complex interactions with antiretroviral therapy. These infections are common in sub-Saharan Africa but there are few data on prevalence of coinfection. All three components of the most common ART regimen used in Africa, stavudine, lamivudine (...) and nevirapine, can cause hepatic problems and lamivudine resistant HBV is known to emerge after HBV monotherapy in coinfected patients. Point of care (POC) tests for HBV and HCV are widely used but have not been validated in field tests in sub-Saharan Africa.Prospective observational study of sequential adult inpatients in medical wards of a large urban teaching hospital in Malawi in 2004. Comparison of demographic risk factors with HIV antibody status determined using local double POC test protocols

2008 Journal of Infection

55695. Valproic acid without intensified antiviral therapy has limited impact on persistent HIV infection of resting CD4+ T cells. Full Text available with Trip Pro

Valproic acid without intensified antiviral therapy has limited impact on persistent HIV infection of resting CD4+ T cells. Valproic acid and intensified antiretroviral therapy may deplete resting CD4+ T-cell HIV infection. We tested the ability of valproic acid to deplete resting CD4+ T-cell infection in patients receiving standard antiretroviral therapy.Resting CD4+ T-cell infection was measured in 11 stably aviremic volunteers twice prior to, and twice after Depakote ER 1000 mg was added (...) to standard antiretroviral therapy. Resting CD4+ T-cell infection frequency was measured by outgrowth assay. Low-level viremia was quantitated by single copy plasma HIV RNA assay.A decrease in resting CD4+ T-cell infection was observed in only four of the 11 patients. Levels of immune activation and HIV-specific T-cell response were low and stable. Valproic acid levels ranged from 26 to 96 microg/ml when measured near trough. Single copy assay was performed in nine patients. In three patients

2008 AIDS

55696. Kaposi's sarcoma in HIV-negative men having sex with men. (Abstract)

in a retrospective study. Clinical data were collected using a standardized form. Risk factors for human herpesvirus-8 infection and for the development of Kaposi's sarcoma were systematically recorded.Between 1995 and 2007, 28 men met the defined inclusion criteria. Mean age at first symptoms of Kaposi's sarcoma was 53 years. Clinical presentation resembled classical Kaposi's sarcoma, with limited disease in most patients. No cellular or humoral immunodeficiency was observed. Serologic tests for human (...) Kaposi's sarcoma in HIV-negative men having sex with men. Four epidemiologic forms of Kaposi's sarcoma have been described, all of which are associated with the human herpesvirus-8. In western countries, human herpesvirus-8 is more prevalent in homosexual men than in the general population, and anecdotal cases of Kaposi's sarcoma in HIV-negative homosexual men have been reported.We included HIV-negative homosexual and bisexual male patients with histologically proven Kaposi's sarcoma

2008 AIDS

55697. Sexual risk behaviour and knowledge of HIV status among community samples of gay men in the UK. (Abstract)

questionnaires, and oral fluid samples (tested for HIV antibodies) were obtained from 3672 men (61% response rate).Of 3501 men with a confirmed positive or negative oral fluid result, 318 were HIV positive (9.1%). Of these, 131 (41.2%) were undiagnosed; 81.1% of men with undiagnosed HIV had previously tested (92.2% tested negative; the remainder did not know the result); 62.3% still thought that they were negative. Undiagnosed and diagnosed men reported greater sexual risk and sexually transmitted infections (...) of their HIV-positive status. Clinics should proactively offer testing to reduce undiagnosed HIV, target repeat testing at high-risk men who have previously tested negative, and initiate evidence-based behavioural interventions to reduce sexual risk among men living with diagnosed HIV as well as those testing negative.

2008 AIDS

55698. Antiretroviral Therapy Is Associated with Reduced Serologic Failure Rates for Syphilis among HIV-Infected Patients. Full Text available with Trip Pro

Antiretroviral Therapy Is Associated with Reduced Serologic Failure Rates for Syphilis among HIV-Infected Patients. Syphilis and human immunodeficiency virus (HIV) frequently coexist in patients, but the effects of immunosuppression on the course of syphilis are unknown. Our goal was to determine whether the degree of HIV-mediated immunosuppression and the use of highly active antiretroviral therapy impact syphilis serologic responses.We assessed all cases of syphilis with positive serologic (...) test results from 1990 through 2006 in a prospective, observational clinical cohort of HIV-infected patients. We defined seroreversion as the loss of reactivity in a patient who previously had a serologic test result positive for syphilis. We defined serologic failure as the lack of a 4-fold decrease in rapid plasma reagin titers 270-365 days after therapy or a 4-fold increase in titers > or =30 days after therapy. We used Cox proportional hazards models with statistical adjustments for multiple

2008 Clinical Infectious Diseases

55699. Maternal HIV status and pregnancy outcomes in northeastern Tanzania: a registry-based study. (Abstract)

-uninfected women for all outcomes, except for low Apgar score.HIV testing and infection were associated with socio-demographic factors. Untreated HIV-infected women had higher risks of adverse pregnancy outcomes, and risks were also increased for women with unknown HIV status. There is still a need to increase availability of HIV testing, education and adequate therapy for pregnant women. (...) Maternal HIV status and pregnancy outcomes in northeastern Tanzania: a registry-based study. The proportion of women delivering with known HIV status in sub-Saharan Africa is not well described. Risk of HIV transmission to newborns is a major concern, but there may also be increased risks for other adverse pregnancy outcomes.Hospital registry.North East Tanzania (1999-2006).Singletons (n = 14,444).Births were grouped by maternal HIV status and socio-demographic factors predicting HIV status

2008 BJOG

55700. From affected to infected? Orphanhood and HIV risk among female adolescents in urban Zimbabwe. (Abstract)

From affected to infected? Orphanhood and HIV risk among female adolescents in urban Zimbabwe. Despite the 15 million children orphaned by AIDS, and fears of sexual vulnerability, little is known about the link between orphanhood and HIV risk.A random sample of 1283 15 to 19-year-old girls in a high-density suburb of Harare was identified in a cross-sectional survey in 2004. A total of 863 agreed to be interviewed and 839 provided a specimen for HIV and herpes simplex virus type-2 (HSV-2 (...) ) testing. Sexual health outcomes, sexual behaviours and marriage were assessed by type and timing of orphanhood.Half of the participants were single or double orphans. Prevalence of HIV and/or HSV-2 was higher among orphans than non-orphans [17 versus 12%; age-adjusted odds ratio (aOR) = 1.5; 95% confidence interval (CI) 1.0-2.3]. Associations with orphan status were only significant among the 743 never-married participants. In comparison with non-orphaned peers, increased sexual risk (defined as HSV2

2008 AIDS

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