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  • ISSN: 2374-0094
    Current Issue
    Volume 4, Issue 2
    Research Article
    Kesaobaka Modukanele*, Jennifer Sherwin, Elizabeth White, Justen Manasa, Lynn S. Zijenah, Mary Bassett, Seble Kassaye, and David Katzenstein
    Introduction: HIV genetic diversity and envelope (env) tropism, V3 loop CCR5 (R5) or CXC4 (X4) co-receptor use, are associated with HIV pathogenesis and transmission (Tx). Co-receptor use was estimated from env V3 loop sequences clones by a Subtype C position specific scoring matrix from 18 pregnant women and 4 of their infants. Viral diversity in env RNA from plasma (PL) and cervix (Cx) was estimated as nucleoside ambiguity and intra-clonal ambiguity from 18 women in late pregnancy. Infant infection was determined by DNA-PCR at 2, 6 and 24 weeks.
    Results: The 18 pregnant women had median CD4 364 cells/mm3, Pl and Cx virus load of 4.0 log10 copies/ml and 3.5 log10 copies/ml, respectively. Seven of 18 women transmitted HIV and 4 infants’ env were sequenced. Eight of the 18 women (44%) had X4 tropic clones or X4/R5 tropism whilst 10 had exclusively R5 virus by cPSSM. Of 4 infected infants’ virus 3 were R5, and one X4 tropic. Nucleoside ambiguity and diversity to estimate duration of infection, and X4/R5 Dual tropism were associated with MTCT.
    Importance: Genotypic detection of X4 and dual tropic X4/R5 virus among subtype C infected women demonstrate high levels of diversity in association with transmission. Low cost, rapid genotyping may identify risk of transmission and guide the appropriate use of R5 entry inhibitors to prevent mother to child transmission in subtype C infection in Southern Africa.
    Eugenia Quiros-Roldan, Maria Chiara Pezzoli, Marialma Berlendis, Elena Raffetti, Alice Ferraresi*, Paola Rodari, Francesco Castelli and the COPD in HIV Study Group
    Chronic Obstructive Pulmonary Disease (COPD) is under diagnosed in HIV-infected people and screening guidelines are lacking. This study aims to determinate the feasibility of a screening program and the prevalence of COPD under diagnosis in a HIV-positive cohort. We screened all outpatients attending their routine visit for HIV monitoring at the Clinic of Spedali Civili General Hospital, Brescia, from February 2015 to January 2016. The screening program consisted in: a) a questionnaire, b) a pre-bronchodilator peak flow measured with portable spirometer c) a post-bronchodilator peak flow measured with spirometer performed during a Pneumologist visit, for people who were positive for dot b. We invited 1463 subjects but only 89.6% of them completed the program. Two-hundred-eighy-two had a positive questionnarie and 65 patients showed respiratory impairment at portable spirometer. Diagnostic spirometry evidenced COPD in 22 patients (1.7% of all patients), among them 2 patients (9.1%) had severe grade COPD (GOLD stage 3, according to the Global Initiative for Chronic Obstructive Lung Disease). Only 89.6% of patients completed the program. Patients with, compared to patients without exacerbations, showed lower CD4 count at screening (534/mm3 vs 781/mm3 for patients with GOLD 1 and 495/mm3 vs 781/mm3 for patients with GOLD 2). The positive predictive value (the probability that a patient with abnormal test results had truly a COPD), was 33.8% for COPD screening questionnaire and the portable spirometer applied in series. Screening programs seems to be problematic as part of routine practice in HIV-infected patients: one in ten patients did not completed the program. Moreover, we found a prevalence of COPD under diagnosed of 1.7%.
    Seid Emamu, Fitsum Sebsebe and Gebremedhin Bedemariam
    Using a cross sectional study design a total of 95 patients with HIV/AIDS who visited the ART Pharmacy to collect their medicines was interviewed using WHO QOL BREF, a standard structured interview format, prepared by the WHO after translated to the local, Amharic language. Of them70 (73.7%) were females. The female to male ratio was 2.8:1. Most of the respondents were between the ages of 30-49 years (68.1%). And living as married (35.8%; n = 34), 23.2% (n = 22) were single, 17.9% (n= 17) were widowed, 16.8% (n=16) were separated, 6.3% (n=6) were divorced. Most patients completed secondary school (34.7%; n = 33) and 82.1% (n = 78) received education levels above primary education. The mean scores of health related quality of life was highest for spirituality domain with the score of 3.79.In addition to the domains moderate value, higher CD4; greater than 350, count and living as Quality of Life of HIV/AIDS Patients on Highly Active. ..
    Review Article
    Pritika Chawla and Matthias T. Dittmar*
    Introduction: In recent years, interest has grown in looking at strategies of prevention, including using antiretroviral treatment as prevention in the form of pre-exposure prophylaxis (PrEP). PrEP was shown to be effective in reducing incidence of HIV infection in several trials.
    Methods: PubMed and Google Search Engine were used to search for relevant articles and reports published in English. Additionally, reference lists of publications were used to further expand the search for relevant literature.
    Results: TDF or TDF/FTC has been shown to have relatively good safety profiles and minimal drug resistance. Several challenges still persist that require consideration before PrEP can be implemented on a global scale, including adherence, social stigma around HIV, effects on risk behaviors and cost. Adherence stands to be the greatest factor dictating effectiveness of PrEP, with high adherence correlating directly with greater effectiveness.
    Discussion and conclusion: As resources are limited, prioritisation of PrEP to high risk groups is crucial. It would be unethical to not provide PrEP to those groups that need support most but who have the least likelihood to be adherent. Extra initiative should be taken to identify these marginalized high risk groups, and increase contact with sexual health services. An initial pilot programme, where PrEP is a mandatory part of health delivery offered with counseling and regular monitoring, would be the best way to transition PrEP from clinical trials to real life clinical practice.
    Kate Coleman-Sarfo* and Emmanuel DeGraft Klo
    Background: According to the HIV Sentinel Survey 2015, there has been a gradual decrease in the trend prevalence of HIV in Ghana. Studies conducted in the African sub-region have however identified the phenomenon of discordance as the main driving force in the incidence of the disease. Discordance in HIV refers to a pair of long-term sexual partners in which one is retroviral positive and the other is not. Interestingly, some of these studies have estimated that over 70% of new infections occur in serodiscordant marital/co-habiting relationships.
    Regardless of the cause of discordance, some of these couples, upon disclosure, encountered challenges such as the disintegration of the union, negotiations for sexual relations, job losses, stigmatization by family and friends, financial strains due to ill health, fear of infecting the children/partner and the fear of dying. This study aimed at critically analyzing the possible challenges encountered by discordant couples in their relationship and ascertained if the demographic details of the positive partners being on ARVs had any correlation on the challenges encountered.
    Methods: A sample of 40 patients living in discordance was drawn purposively from the patients attending the ART Clinic (Antiretroviral Therapy) at the 37 Military Hospitals in Accra, Ghana. Questionnaires were administered and the data compiled and analyzed using STATA 13. Descriptive statistics, including percentages and frequencies were used to capture and analyze the various challenges faced by such couples. Further, Chi-square tests, Fisher’s exact test and multiple regressions where necessary was used to examine whether socio-demographic characteristics like gender, age, educational level and religion had a significant association on challenges faced by the discordant couples. Results and Conclusions: Fear of infecting their kids, dying, financial strain and inconsistent use of condoms were some of the main challenges encountered by respondents. There was, however, a significant correlation between gender and challenges such as financial strain (p=0.01) and fear of infecting kids (p=0.001). We find that most of the HIV-positive respondents who have had some form of education claim that their negative partners are supportive and committed to staying in the relationship. More Christians than Muslim respondents appeared not to be confronted by constant threats of separation/divorce (p=0.02) from their negative partners.
    We posit that our findings highlight relevant issues relating to discordance which, though important have received little attention. For example, our finding that regular use of condoms by discordant couples appeared to be a real challenge in spite of the risk of transmission to the negative partner suggests the need for more education. Overall, our findings suggest that more work and resources need to be pumped into awareness creation of the potential welfare challenges faced by discordant couples with an emphasis on preventive strategies to forestall transmission among such couples, thereby mitigating both physical and psychological stresses they may be facing.
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