World Journal of AIDS
ISSN / EISSN : 2160-8814 / 2160-8822
Current Publisher: Scientific Research Publishing, Inc. (10.4236)
Total articles ≅ 306
Latest articles in this journal
World Journal of AIDS, Volume 10, pp 159-169; doi:10.4236/wja.2020.103014
Background: In Togo, as in all sub-Saharan countries, the burden of HIV infection remains high. The registration of new cases of Buruli ulcer every year also remains a major public health problem. Buruli ulcer (BU) is a disabling disease and the presentation of lesions is frequently severe. A feature of BU and HIV coinfection is the rarity of cases, which makes its study difficult, but, nevertheless, important to study its seroprevalence, biological data, risk factors and genetic diversity. The purpose of this study is to explore the comorbidity of Buruli ulcer and HIV by evaluating HIV seroprevalence in BU patients, assessing demographic data, reviewing biological data including CD4+ T cell count, hemoglobin levels, and viral loads, and evaluating clinical and therapeutic data. Methods: This is a cross-sectional study including only BU patients confirmed by Ziehl Neelsen staining and IS 2404 PCR. The patients were hospitalized in the National Reference Center for Tsevie. They were recovered patients and patients undergoing outpatient treatment in the Gati and Tchekpo Deve treatment centers, respectively, within the Sanitary Districts of Zio and Yoto of the Maritime Region during the period from August 2015 to March 2017. Results: The number of HIV-positive BU patients is 4 out of a total of 83 BU patients. All patients are HIV-1 positive. HIV prevalence among BU patients is 4.8% compared to 2.5% nationally and 3% at regional level. Three BU patients are seropositive out of a total of 46 female patients while one patient under 15 years is seropositive out of a total of 37 male BU patients. There are a greater proportion of female patients with BU/HIV coinfections. Half of the BU/HIV positive patients (BU/HIV+) have a CD4+ TL of fewer than 500 cells/μl and the difference is significant between those of the BU HIV- and those of the BU/HIV+ patients. Two patients have undetectable viral loads while the other two have more than 1000 copies/ml (33,000 and 1,100,000 copies/ml). Anemia is significantly present in BU/HIV+ patients with a p-value = 0.003. Half of BU patients have primary education, while three-quarters of BU/HIV+ patients have no education. All patients are either in stage I or stage II of the AIDS WHO classification. All patients are on first line ARV therapy and only ARV nucleoside reverse transcriptase inhibitors (NRTIs) are used. Conclusion: In Togo, the prevalence of HIV in BU patients, although higher, is not significantly different from that of national and regional. The relatively high CD4+ LT levels of relatively high BU HIV + patients, undetectable viral loads, and AIDS WHO stages I and II indicate good quality management. Author Summary: Buruli ulcer disease (BUD) is a mycobacterial skin disease that leads to extensive ulcerations and causes disabilities in approximately 25% of the patients. Co-infection with HIV is described by the authors through the prism of risk factors and the severity of ulcerations. Healing time is described as longer than in BU/HIV- patients. The scarcity of cases seems to be an obstacle for further study. Noteworthy are the study of cases in Benin and the study of cohort cases in Cameroon. However, no study appears to be based on the seroprevalence of this morbid association, the biological data and the antiretroviral regimens. These regimens, if poorly instituted, conflict with antimycobacterial drugs against Buruli ulcer. This study, although confronted with the particular configuration of Togo, a country with a low HIV prevalence of 2.8% national prevalence and an average of 55 cases of Buruli ulcer per year, is studying the biological aspects of co-infection HIV/BU, including seroprevalence of HIV, CD4+ LT levels, patient viral load and hemoglobin levels and ARV regimens. This study shows the need for future studies, including the study of the genetic diversity of circulating Mycobacterium ulcerans strains in Togo and the study of Buruli ulcer co-infection/HIV and tuberculosis.
World Journal of AIDS, Volume 10, pp 195-199; doi:10.4236/wja.2020.103017
According to current guidelines, exposing mucous membrane to blood and body fluids of HIV infected people is risk of transmission. About 30% - 80% of HIV infected people have at least one oral manifestation. The most frequently occurring oral manifestations (pseudomembranous candidiasis, linear gingival erythema, etc.) give rise to bleeding either spontaneously or after stimulation, and strenuous stirring during oral sex and deep-mouth kissing increase risk of bleeding from oral manifestations, exposing oral and genital mucous membrane of partners to the blood. However, current guidelines assert that there’s little to no risk of getting HIV from oral sex and deep-mouth kissing. These guidelines are conflict with each other, suggesting potential problems with current prevention strategies which are based on the guidelines. After discussing existing data on animals, lesbians, young peoples, and occupational exposures, this paper suggests oral sex and deep-mouth kissing are risk factors when one partner has HIV-associated oral bleeding manifestations, and the number of infections associated with oral sex and deep-mouth kissing is significant. Current guidelines on HIV risk factors should be reevaluated urgently, and new studies should be undertaken with an open mind to explore risk factors.
World Journal of AIDS, Volume 10, pp 186-194; doi:10.4236/wja.2020.103016
HIV/AIDS is still an important public health issue in Vietnam and other developing countries. In Vietnam, Community-based organizations (CBOs) were officially considered as the key partners to approach vulnerable groups at high risks of HIV infection since 2010. Funds for HIV/AIDS prevention and control are facing difficulties due to rapid reduction by international organizations, while domestic funding has not yet met the demand, especially funding for prevention and communication activities. Our study aimed to assess the fundraising capacity of several CBOs in Ho Chi Minh City, Vietnam and analyze the challenges that they are facing now and in future in their work of HIV/AIDS management for community. The 03 typical and representative CBOs (G3VN, Smile and Strong Ladies) were chosen in our cross-sectional descriptive study. The electronic questionnaire was about fundraising reports over 3 years (2017-2019), organization structure (staff, mission, strategies) and the advantages and disadvantages in fundraising. Funds received over the year increased in total, but unstable in each projects. To have more funds, CBOs must invest time and money to have professional staff in fundraising and writing proposals. To meet requirement and survive, some CBO shifted to social enterprises and faced many difficulties in laws when being treated like profit companies. In Vietnam context, the key challenges which affect the role of funding are including: 1) Legal status; 2) Small scale; 3) Capacity of fundraising (finding calls, writing competence proposals); 4) Fewer funds on HIV/AIDS. In future, we should pay attention in scaling up and building fundraising capacity for CBOs in order to help them in applying for international funds in community projects or even in HIV/AIDS research for CBOs, social enterprises in the context of funds for nation-level phased out of Vietnam.
World Journal of AIDS, Volume 10, pp 107-118; doi:10.4236/wja.2020.102009
Background: South Africa is experiencing the worst HIV-driven tuberculosis (TB) epidemic in the world. More than 300,000 new cases of active TB are reported in the country each year with 60% co-infected with HIV. Isoniazid preventive therapy (IPT) is a key public health intervention for the prevention of TB among people living with HIV (PLHIV) and is recommended as part of a comprehensive HIV and AIDS care strategy. However, program data suggests that coverage of IPT service to be very low. This study aims to assess IPT initiation rate among newly diagnosed HIV-positive persons in three high HIV-burden districts of South Africa. Methods: A cross-sectional study was conducted using routine data generated from pre-ART and ART programs in 35 purposively selected primary health care (PHC) clinics in South Africa. The facilities were selected from three high HIV-burden districts with a mix of urban and rural settings. TB screening and IPT initiation status was assessed within a window period of one-year post HIV diagnosis. Initiation rate of IPT services among newly diagnosed HIV-positive persons was assessed. The chi-squared test was used to determine whether there was a significant difference in the proportion of newly diagnosed HIV-positive persons who were initiated on IPT by sex, age group, pregnancy status, health facility, district and location of facility. Results: We identified 12,413 newly diagnosed HIV patients aged 12-years-old and above between June 1, 2014 and March 31, 2015. TB screening was not conducted among 33% of newly diagnosed HIV-positive persons to rule out or confirm the presence of active TB. IPT was initiated in 42.2% of known IPT-eligible HIV-positive persons. Initiation of IPT services was lower in younger patients aged 12 to 20-years-old compared to older patients. The proportion of pregnant women who were initiated on IPT was higher compared to the proportion in non-pregnant women (51.0% and 40.1% respectively; P Conclusion: This analysis shows that initiation rate of IPT services among newly diagnosed HIV positive persons was low in the 35 participating facilities during the period under investigation. There was variability in IPT initiation rates across the facilities included in this study and among different sub-groups of the study sample. This study has identified specific population groups and geographic settings that should be targeted by programs to improve IPT services. There is a need to identify factors that contributed to the low initiation rate of IPT services among young HIV positive persons, women with unrecorded pregnancy status and in facilities located in inner city of Johannesburg. Customized interventions tailored to the specific needs of facilities and population groups should be instituted to strengthen uptake of IPT services.
World Journal of AIDS, Volume 10, pp 80-93; doi:10.4236/wja.2020.102007
The Human Immunodeficiency Virus (HIV) has a diversity that is equal to the complexity of its management. The group M (Major) is the dominant group in Sub-Saharan Africa and its distribution is very heterogeneous; the diversity of the virus is more heterogeneous in this region than elsewhere in the world which follows a complex and specific algorithm because of geographical positions and countries. This distribution is very dynamic, evolving and unpredictable. This review aimed to expose the specifics of the HIV Type 1 epidemic in Central Africa, in terms of the different molecular variants of HIV published for the region compared to the geographic location. Both Type 1 and Type 2 of HIV are prevalent in sub-Saharan Africa due to distinct geographical contexts. HIV-2 is mainly documented in West and Central Africa, particularly in Cameroon, Guinea-Bissau, Gambia, Senegal, Ivory Coast and Burkina-Faso however HIV-1 infection is widely distributed across the continent. The HIV-1 epidemic in Sub-Saharan Africa is dominated by the Group M. The different subtypes respect a certain geographical distribution across the continent. West Africa is dominated by subtype A, East and South Africa are dominated by subtype C, while Central Africa is dominated by strains A, C, D, F, H, J, CRF01-AE and CRF02-AG. This review is the first to present de molecular diversity of HIV-1 in metropolitan cities in all central African countries. The Circulating Recombinant Form (CRF02_AG) and subtypes A and G are present in all Central African countries and are also the most commonly encountered; followed by the subtypes D, F, G, C, B, J, K and several Circulating Recombinant Forms that are not represented in all Central African countries.
World Journal of AIDS, Volume 10, pp 23-35; doi:10.4236/wja.2020.101003
Background: Optimizing antiretroviral therapy is an essential step to reach the 90 - 90 - 90 targets. Despite tremendous progress made for antiretroviral treatment (ART) to be accessible in countries with limited resources, health care providers continue to face challenges due to the under-optimization of ART due to therapeutic failures and poor retention. Objectives: To determine the prevalence of adverse therapeutic outcomes in a decentralized health care center and to determine associated factors. Patients and Methods: This is a cross-sectional descriptive and analytical study targeting PLHIV, aged 18 years and over, on first line antiretroviral treatment (ART), monitored onsite from February 1st to December 31st, 2018. A data collection form was completed from medical records (clinical, immuno-virological, therapeutic and evolutionary). Data were also collected from interviews with patients for additional socio-demographic information including the level of HIV knowledge. Data were captured and analyzed using EPI 2002 and R software. Proportions were compared using the chi -square and Fisher tests and logistic regression. A value of p Results: 331 patients were enrolled with HIV-1 profile in 89% of the cases. A proportion of 55% was married and 98% came from the rural area. 80% were either not or poorly educated. The median of age was 44 ± 11 years with a F/M ratio of 3.5. 30% that had not shared their HIV status, and more than half had a low knowledge of HIV transmission. At baseline, 56% were symptomatic at WHO stage 3 or 4. They had severe immunosuppression with a median CD4 count of 217 ± 187 cells/mm3; the viral load was detectable in half of the patients with a median viral load (VL) of 97,000 ± 70,569 cp/ml. The antiretroviral regimens combined 2 nucleoside reverse transcriptase inhibitor (NRTI) with 1 no nucleoside reverse transcriptase inhibitor (NNRTI) in 88% of the cases. The median duration of follow-up was estimated at 60 ± 43 months. The prevalence of adverse therapeutic outcomes was 36% (119 patients). The proportion of virological failure was 19%, lost follow up was 20% and the mortality was 4%. The adverse therapeutic outcomes were associated with the age less than 25 years (p = 0.007) and with a late diagnosis (CD4 T cells at baseline less than 200 cell/mm3, p = 0.02). Conclusion: These results suggest the need to make new therapeutic classes available for first-line treatment and to promote actions improving retention in care.
World Journal of AIDS, Volume 10, pp 46-68; doi:10.4236/wja.2020.101005
World Journal of AIDS, Volume 10, pp 15-22; doi:10.4236/wja.2020.101002
Background: Human immunodeficiency virus (HIV) type 2 infection is predominantly found in West African nations, and approximately 1 - 2 million people are thought to be infected. HIV-associated nephropathy (HIVAN) occurs in about 7% of patients with HIV-1 infection and is one of the most important causes of end-stage renal disease in this population. The only reported case of HIVAN related to HIV-2 infection was described by Izzedine et al. (2006). Aim: The aim of this paper is to report a case of HIVAN in an HIV-2-infected patient, a rarely described condition. Case presentation: We describe a case of a 40-year-old HIV-2-infected female from Angola hospitalized following a six-month history of fever, fatigue, anorexia and weight loss. Laboratory data revealed anaemia, leukopenia and renal dysfunction with nephrotic range proteinuria. Renal biopsy was performed, revealing findings consistent with HIVAN. Also, a presumed diagnosis of ganglionic tuberculosis was established. Conclusion: The slow progression of HIV-2 disease could explain the low frequency of this condition, however, more studies should be carried out for a better understanding of HIV-2 pathophysiology and its associated complications.
World Journal of AIDS, Volume 10, pp 36-45; doi:10.4236/wja.2020.101004
Background: At enrolment into antenatal care, socio-demographic data of HIV infected pregnant women and lactating mothers are usually collected with little or no analysis done on them. This study was aimed to describe the socio-demographic profiles of naive to antiretroviral therapy (ART) HIV-infected pregnant women in the East region of Cameroon and to link this to retention in order to optimize the implementation of the prevention of mother-to-child transmission (PMTCT) interventions. Methods: A descriptive prospective study that lasted from February 2018 until February 2019 in three catchment health facilities in the East region for the recruitment and follow-up of participants who were consented HIV-infected pregnant women naive to ART. Socio-demographic, treatment compliance and adherence data were obtained by healthcare providers who were trained using a standard questionnaire that was conceived, tested and adapted for the study. Data were analyzed using Graph Prism (Graph pad 6.0, San Diego, USA). The Fisher exact and Chi-squared tests were used to establish the associations and independence between different variables at statistical significance level of p Results: A total of seventy (70) women were enrolled with age range varying between 15 and 40 years with a mean age of 26.5 ± 6.2 years. Loss-to-follow-up (LTFU) was observed among 17 women (24.29%). The Muslim religion, education below secondary level and the profession of housewife were significantly associated with LTFU at p = 0.01, p p = 0.0053, respectively. For participants who were retained until study endpoint, having secondary level of education or above and a profession other than housewife had a significant association (p = 0.0063), as well as being a Christian. Conclusion: Loss to follow-up in PMTCT program was associated with Muslim religion, primary level of education and the housewife occupation.
World Journal of AIDS, Volume 10, pp 1-14; doi:10.4236/wja.2020.101001
There are significant variations in PMTCT programme implementation in the country. Biennial serosentinel survey among pregnant women attending antenatal clinics provides estimates of HIV and for monitoring the epidemic. The objective of this work was to compare HIV prevalence trend using National ANC HSS data and PMTCT programme data in Gombe state over the last 10 years. Methodology: Cross-sectional comparative study. The HIV prevalence among pregnant women in Gombe State obtained from Gombe State PMTCT programme data from 2004-2014 was compared with the National Biennial sentinel survey for HIV in pregnant women attending ANC in the state over the same period. Results: Women tested for HIV during ANC in Gombe state increased from 4689 in 2004 to 74,737 in 2014. 447,732 women were cumulatively tested for HIV with a positivity rate of 2.1% (9543). ANC HIV positivity rates from PMTCT programme data witnessed a decline from 8.2% (385/4689) in 2004 to 0.6% (497/74,737) in 2014. Conversely, the National biennial HIV sero-prevalence sentinel survey reports for Gombe state in 2005, 2006, 2008, 2010, 2012 and 2014 were 4.9%, 4.4%, 4.0%, 4.2%, 4.1% and 3.4% respectively. The state PMTCT data showed a significant decline in HIV positivity rates among women, paralleled by increased testing, whereas the national sero-prevalence survey averaged 4.2%. Conclusion: While routine yearly Gombe state PMTCT programme data showed a declining HIV trend, biennially conducted seroprevalence in the state was consistent over the period. Implications are unclear to us; accurate estimation of HIV prevalence is a prerequisite for planning.