HIV/AIDS Patients’ Survival Rate between One Co-infection and More Than One Opportunistic Co-infection at Haji Adam Malik General Hospital Medan in 2015-2017

Background: AIDS is a collection of disease symptoms caused by HIV that damages the human immune system. Decreased immunity causes the patient to be very susceptible to various, often fatal, infectious diseases (opportunistic infections). Aim: To determine the difference in HIV/AIDS patients' survival rate between one co-infection and more than one opportunistic co-infection at Haji Adam Malik Hospital Medan in 2015-2017. Methods: This is a retrospective cohort analytic study using secondary data from medical records of HIV patients from January 2015-December 2017. The samples were 34 HIV/AIDS patients who met the inclusion and exclusion criteria, selected by consecutive technique sampling. Descriptive statistical analysis was used for demographic data. Kaplan Meier's statistical analysis was used for endurance or survival tests. The difference was considered statistically significant if p<0.05. Results: The most opportunistic infections found were diarrhea in 265 subjects (55.67%), followed by toxoplasmosis in 159 subjects (33.40%), oral candidiasis 141 subjects (29.62%), CMV 78 subjects (16.39%), pneumonia 63 subjects (13.24%), sepsis 62 subjects (13.03%), PCP 45 subjects (9.45%), hepatitis B 38 subjects (7.98%), chlamydia 24 subjects (5.04%), hepatitis C 14 subjects (2, 94%), Herpes zoster 11 subjects (2.31%), lymphadenopathy 4 subjects (0.84%), and the least common were NHL 1 subject (0.21%) and Penicilosis 1 subject (0.21%). Conclusion: The HIV patients’ survival rates are different based on the number of opportunistic infections. According to the order, the most common opportunistic infections were diarrhea, toxoplasmosis, and oral candidiasis. Keywords: HIV/AIDS, opportunistic infections, oral candidiasis, toxoplasmosis, diarrhea.

Hepatitis B virus prevalence, immunization and immune response in people living with HIV/AIDS in Istanbul, Turkey: a 21-year data analysis

Objective: We aimed to determine Hepatitis B virus (HBV) prevalence, immune status, and the prevalence of antibody response in people living with HIV/AIDS (PLWHA) in Istanbul, Turkey. Methods: The study includes PLWHA aged 18 years and older who were followed-up for at least 6 months from 1997 to 2018. Results: Of the 653 patients with PLWHA, 99 (15.2%) were both antiHBc-IgG and antiHBs positive, 120 (18.3%) were antiHBc-IgG positive/antiHBs negative. HBsAg was positive in 40 (6.1%) patients. HBsAg positive coinfection (≤40 years 4.6% vs. >40 years 21.7%, p<0.001) and antiHBc-IgG positivity/antiHBs negativity (≤40 years 14.0% vs. >40 years 26.5, p<0.001) were higher in PLWHA older than 40 years. The prevalence of HIV/HBV coinfection reached a peak level of 22.2% in 2004, and it decreased to 3.3% in 2018. The prevalence of immunization before HIV diagnosis was low (15.6%). The prevalence of antibody response (anti-HBs>10 IU/L) after immunization for HBV was 50%. A higher protective response was associated with CD4+≥350 cell/mm3 (59.3%, p=0.014). Conclusion: HBV coexistence in PLWHA remains an imperatively important problem. The most conclusive methods in solving this problem are to prevent transmission by immunization and control measures. Also, HBV screening should in no manner be neglected in PLWHA. Keywords: HIV; Hepatitis B; prevalence.

Comparison of Sleep Quality in Pre-HAART and on HAART HIV Patients

Background/aim: People with HIV are often reported to experience poor sleep quality. Factors that can cause poor sleep quality in HIV patients, including the use of ARV therapy. The pathophysiology of poor sleep quality in HIV patients is still unclear. Poor sleep quality is one of the complaints in the late stages of HIV infection, where it is suspected that HIV itself affects the biological center of sleep. This study was aimed to determine the comparison of sleep quality in HIV patients pre-HAART and with HAART more than 1 year. Method: This study uses data collection methods in the form of interviews with samples which will later be presented in the form of analytical observational study. Consecutive data collection on HIV patients before and after ARV therapy who was outpatient at the VCT outpatient clinic Dr. Soetomo General Hospital from June-July 2021. Data analysis using SPSS Version 23 for windows. Results: A total of 40 subjects were divided into HIV pre-HAART and on HAART. From the statistical analysis using SPSS program significant with p= 0.004 (OR 15.5 (95% CI (1.73-139.6)) Conclusion: HIV patients on HAART for more than 1 year are known to have increased 15.5 times the risk of poor sleep quality. Keywords: HIV, HAART, sleep quality.

The Stigmatization of HIV/AIDS Victims in Sub-Saharan Africa and the Gospel

One of the most challenging issues in dealing with HIV/AIDS in Africa is breaking through the stigmas surrounding the disease and building resilience in communities where large numbers of people are infected with HIV or otherwise affected by the pandemic. This article explores the relationship between shame, fear, guilt, witchcraft, and HIV/AIDS stigmatization by looking at key features of the African traditional worldview and culture. We point out predominant witchcraft beliefs and how they translate to community attitudes towards people living with HIV and AIDS. We highlight the influence of prevailing beliefs in witchcraft and how they aggravate the experience of fear, shame, and stigmatization by people infected with or otherwise affected by HIV. Relevant aspects of the gospel are brought to bear to answer these challenges. KEYWORDS: HIV/AIDS, stigmatization, shame culture, fear culture, witchcraft, ubuntu

Partner Notification Services (PNS) Among HIV Positive Key Populations: An Important Strategy Towards Achieving UNAIDS 95.95.95 Goals by the Year 2030

Key Populations are the major drivers of the HIV epidemic in most settings; thus, identifying positive KPs and their sexual partners becomes a strong strategy in the effort to achieve the first UNAID 95 goal. This study describes the level of acceptability and outcome of PNS among HIV-positive KPs using the various approaches for PNS. A descriptive study of all HIV positives KPs initiating ART in 7 One-Stop-Shop facilities that accepted PNS was conducted over 3 months. With the consent of patients who accepted PNS, their partners were reached using any of the PNS approaches. Partners who consented for HTS were tested, and positives partners were linked to ART services. Data were analyzed to describe the acceptability and outcome of PNS among KPs. Only 846/2,486 (34%) positive KPs accepted PNS. The 846 KPs elicited 941 partners, out of which 938 (99.6%) accepted HTS. 421/938 (45%) of the partners tested positive compared to PWIDF (15%), MSM (7%), FSW (4%) and PWIDM (4%). 129/421 (31%) of the positive partners were already known positives, with 61% already on ART. The commonest method of PNS accepted among KPs was the passive method (54%), followed by the contract method (22%), provider-initiated (19%), and dual method (5%). There was poor acceptance of PNS among KPs and, the HIV positivity rate was much higher among their partners than any of the KPs sub-groups. The passive approach was the most preferred method of PNS among KPs. This should be considered strongly as we scale up PNS in Nigeria. Keywords: HIV/AIDS, Key Populations in Nigeria, Partner notification services, UNAIDS 95-95-95 targets.

Validity of Ziehl-Neelsen and LED Fluorescence Microscopy Technique in the Diagnosis of Mycobacterium Tuberculosis Infection among HIV Patients in Lafia, Nigeria, 2017

Tuberculosis (TB) is a public health problem caused by the Mycobacterium tuberculosis complex. An estimated 70% of TB patients living with HIV are from sub-Saharan Africa largely depends on direct smear microscopy light microscopy for TB diagnosis, which has low Sensitivity, especially among HIV patients. Hence, we conducted this study to evaluate the Performance of Auramine O LED Fluorescence microscopy and the Ziehl-Neelsen technique in Tuberculosis among HIV-positive patients. The study was conducted using a cross-sectional design among 107 consecutively selected HIV/AIDS patients with presumptive Tuberculosis attending ART clinic in Dalhatu Araf Specialist Hospital (DASH), Lafia, Nasarawa State. Three samples were collected from each patient in two visits. Each sample was examined using ZN, LED FM, and Gene-Xpert. Data on socio-demographic characteristics was collected from the subject participant. Univariate and bivariate analyses were done using MS Excel and Epi Info. The Sensitivity and Specificity were compared using McNemar’s chi-square. Seventy-three (68%) patients were female, 33 (30.8%) were in the age group 28-32 years, and 61 (56%) were employed. Ziehl-Neelsen and LED fluorescent microscopy respectively yielded 11 (10.3%) and 15 (14.0%) positive results, while Gene-Xpert gave 18 (16.3%). The Sensitivity for direct ZN and LED FM were 61.1% and 83.3 %, respectively (P-value 0.01) with 100% specificity for both methods. LED microscopy has a much higher sensitivity than ZN microscopy and would be a better alternative in the diagnosis of Tuberculosis in high HIV settings where the use and expertise with culture and Gene-Xpert are limited. Keywords: HIV, LED Fluorescence, Sensitivity, Specificity, Ziehl-Neelsen.

Adolescent girls’ perception about their ability to safely offer HIV self-test kits to sexual partners: a feasibility study in Siaya County, Kenya

Background: Adolescent girls (AG) in sub-Saharan Africa are at elevated risk of acquiring HIV, yet few know the HIV status of their sexual partners. Interventions to promote testing among partners are urgently needed. Objectives: To explore AG’s perceived ability to safely distribute HIV self-tests to their partners, if partners would self-test, and how to minimize partner violence. Methods: We recruited HIV-negative AG ages 15-19 years with a partner of unknown HIV status or who tested negative >6 months previously. Using mixed-methods for data collection and regression and inductive thematic analysis for quantitative and qualitative analysis, respectively, we determined factors associated with the study objectives. Results: We enrolled 101 AG, median age 17.3 years, sexual debut 15-16 years, and 54.5% reported ≥2 lifetime partners. Most participants (95.0%) would offer self-tests to their partners and 95.1% reported high-to-moderate chance their part- ner would self-test. No participant attribute was associated with perceived ability to offer self-test or likelihood of partner testing. To avoid violence, AG recommended politeness, indirect approach, voluntariness, and highlighting advantages of self-testing. Conclusions: AG believe they can safely distribute self-tests to their partners, and most partners would self-test, expanding utility of HIV self-tests to include partners of AG. Keywords: HIV self-testing; partner testing; couples testing; adolescent girls; Kenya.

Experience of our First-Ever Living Donor Liver Transplantation In Hiv-Positive Patient-Report From Developing Country with Literature Review

Human Immunodeficiency Virus (HIV) is one of the gravest health challenges worldwide in the present era as it has been for the past 4 decades. HIV has always been a sort of stigma and most clinicians are reluctant to perform liver transplantation for chronic liver disease patients with HIV co-infection. Patients with CD4+ cell count >100/ml along with suppressed mRNA levels on PCR, stable HAART regimen, and absence of any AIDS-specific illness or opportunistic infectionsare the requirements for selecting HIV-positive recipients for liver transplantation. We report the first living donor liver transplant in an HIV-positive recipient in a developing country. Here are the details of the case. Keywords: HIV, living donor, Liver transplantation, developing country

Single Nucleotide Polymorphisms (SNPs), Phylogeny and Spatiotemporal analysis of pro gene in HIV samples from Pakistan

Background: The increase in incidence of HIV infection with limited treatment options has enhanced the morbidity and mortality in South Asian countries. The mutations, geographical and genetic diversity in Pro gene in HIV positive patients from other South Asian countries can be helpful for treatment options. Aim: To identify mutations and genetic diversity in Pro gene in HIV positive patients in Pakistan and compare the sequences to neighbouring countries China and India. Methods: The HIV protease gene or pro-gene sequence were retrieved from NCBI. The sequence were studied from Pakistan, China and India were analysed for their linkage and genetic mutations through bioinformatics tools, MEGAX and CLUSTALW Results: The phylogenetic analysis of samples for maximum likelihood and mutation from South Asian countries Pakistan, China and India individually displayed variation in sequences of HIV pro gene in all these isolates. Whereas Pakistani isolates have more genetic similarities with the isolates from China than India. Conclusion: The phylogeny analysis depicts there is gradual evolution in viral types and possible entry is through the neighbouring transmission might have been through social connections. The mutations studies provides bases for the novel targets for the drug design and development against HIV. Keywords: HIV, Protease gene, MEGA, Phylogenetic analysis, Pakistan

A cross sectional survey of side effects of antiretroviral (ARV) in outpatients HIV by Naranjo Algorithm

Background: The main modality in HIV patients is the administration of long-treatment antiretroviral therapy (ARV). One of the problems from the use of ARV therapy is the side effects that can reduce patient compliance in taking medication, which has the potential to cause treatment failure. Objective: This study aims to examine the side effects and their causality in the use of ARVs in outpatient HIV patients at the VCT Clinic, Bhayangkara H.S. Hospital. Samsoeri Mertojoso Surabaya. Methods: This research was a prospective observational study with a cross-sectional design. Side effect data were taken from HIV patients by interview using the Naranjo algorithm. HIV patients who met the inclusion criteria were included in the study sample using consecutive sampling. This research was conducted from January to March 2020. Results: There were 72 outpatient HIV patients who met the inclusion criteria. The most opportunistic infections found in HIV patients are tuberculosis and Pneumocystis pneumonia. The results showed that the most common side effects experienced by patients were dizziness (43%), nausea and vomiting (31%), and rash (11%) with the highest Naranjo score being in the probable category of 86%. The Naranjo score in HIV patients with opportunistic infections and with comorbidities was significantly smaller than those in HIV patients without opportunistic infections or without comorbidities with independent t-test (P <0.05). Conclusion: The side effects in HIV patients while undergoing treatment with antiretroviral therapy are classified as a minor side effect and the cause of the side effects that occur is thought to be due to the probable category of ARV therapy. Keywords: HIV Patients, Antiretroviral, Side Effects, Naranjo's Algorithm.