Suchergebnisse

The 2001 Doha Declaration of the World Trade Organisation (WTO) confirmed the right of countries to override patents in the interest of public health (Ford, et al., 2007). Later resolutions from the WTO as well as from the United Nations (UN) reflected the emerging consensus that medicines required to treat pandemic illnesses are a basic human right (Galvao, 2005). International assistance with regard to the public provision of antiretroviral drugs (ARVs) has been closely associated with this shift, resulting in a new hope for the widespread treatment of AIDS. ARV drugs themselves have also undergone substantial technical development. Simpler, combined dosage formats and a greater range of suitable medications provide more options for short-course interventions (to prevent the transmission of HIV from mother to child) and for long-term treatment of AIDS with highly active antiretroviral therapy (HAART).

Awoke Seyoum Tegegne,1 Molalign Tarekegn Minwagaw2 1Department of Statistics, Bahir Dar University, Bahir Dar, Ethiopia; 2Department of Public Health, Amhara Community Health Institution, Bahir Dar, EthiopiaCorrespondence: Awoke Seyoum Tegegne, Department of Statistics, Bahir Dar University, Po. Box 79, Bahir Dar, Ethiopia, Tel +251 918779451, Fax + 251 2205927, Email bisrategebrail@yahoo.comBackground: Tuberculosis is one of the leading infectious diseases for people living with HIV. Therefore, the purpose of this study was to investigate factors affecting the development of TB among HIV-positive adults under treatment in government hospitals of Amhara Region, Ethiopia.Methods: A hospital-based retrospective study design was conducted among 700 HIV-positive adults under HAART in 17 government hospitals in the Amhara region, Ethiopia.Results: Age of the patients (AOR = 1.122, 95% CI:1.013, 2.234), baseline CD4 cell count (AOR = 0.888, 95% CI: 0.714, 0.945), patients living without their partner (AOR = 1.212, 95% CI: 1.051, 1.123), females under treatment (AOR = 0.786, 95% CI; 0.564, 0.845), non-opportunistic diseases (AOR = 0.865, 95% CI: 0.731, 0.938), patients not disclosed their HIV status (AOR = 1.241, 95% CI: 1.087, 2.341), rural patients (AOR = 1.135, 95% CI: 1.032, 1.453, patient with no education (AOR = 1.125, 95% CI: 1.056, 1.546), low adherence patients (AOR = 1.225, 95% CI: 1.191, 2.453), bedridden patients (AOR = 1.223, 95% CI: 1.131, 1.521), ambulatory patients (AOR = 1.156, 95% CI:1.091, 1.267), non-smoker patients (AOR = 0.854, 95% CI: 0.686, 0.935) significantly affected on the variable of interest. Similarly, alcohol intake, drug toxicity and baseline clinical WHO stages significantly affected for the development of tuberculosis in HIV-positive patients under treatment.Conclusion: In this study, baseline CD4 cell count, female patients, non-opportunistic diseases, and non-smoking status were negatively associated with the development of TB, whereas age of patients, living without partners, patients with no education, patients with low adherence, bedridden and ambulatory patients were positively associated to the development of TB in HIV patients. The findings obtained in this study are important for both service providers and patients. More attention should be given to those positively associated variables to response variables. The regional health bureau should open TB/HIV co-infection subsections like ART sections in each hospital.Keywords: TB development, HIV-positive people, HAART, binary logistic regression model

A total of 755 highly active antiretroviral therapy (HAART)-naive HIV-infected patients were enrolled at a government hospital in Thailand from 1 June 2000 to 15 October 2002. Census date of survival was on 31 October 2004 or the date of HAART initiation. Of 700 (92·6%) patients with complete data, the prevalence of hepatitis B virus (HBV) surface antigen and anti-hepatitis C virus (HCV) antibody positivity was 11·9% and 3·3%, respectively. Eight (9·6%) HBV co-infected patients did not have anti-HBV core antibody (anti-HBcAb). During 1166·7 person-years of observation (pyo), 258 (36·9%) patients died [22·1/100 pyo, 95% confidence interval (CI) 16·7-27·8]. HBV and probably HCV co-infection was associated with a higher mortality with adjusted hazard ratios (aHRs) of 1·81 (95% CI 1·30-2·53) and 1·90 (95% CI 0·98-3·69), respectively. Interestingly, HBV co-infection without anti-HBc Ab was strongly associated with death (aHR 6·34, 95% CI 3·99-10·3). The influence of hepatitis co-infection on the natural history of HAART-naive HIV patients requires greater attention.

A total of 755 highly active antiretroviral therapy (HAART)-naive HIV-infected patients were enrolled at a government hospital in Thailand from 1 June 2000 to 15 October 2002. Census date of survival was on 31 October 2004 or the date of HAART initiation. Of 700 (92·6%) patients with complete data, the prevalence of hepatitis B virus (HBV) surface antigen and anti-hepatitis C virus (HCV) antibody positivity was 11·9% and 3·3%, respectively. Eight (9·6%) HBV co-infected patients did not have anti-HBV core antibody (anti-HBcAb). During 1166·7 person-years of observation (pyo), 258 (36·9%) patients died [22·1/100 pyo, 95% confidence interval (CI) 16·7–27·8]. HBV and probably HCV co-infection was associated with a higher mortality with adjusted hazard ratios (aHRs) of 1·81 (95% CI 1·30–2·53) and 1·90 (95% CI 0·98–3·69), respectively. Interestingly, HBV co-infection without anti-HBc Ab was strongly associated with death (aHR 6·34, 95% CI 3·99–10·3). The influence of hepatitis co-infection on the natural history of HAART-naive HIV patients requires greater attention.

AbstractObjectiveTo assess survival and success rates of dental implants and the occurrence of peri‐implant diseases (mucositis/peri‐implantitis) in HIV‐1‐infected individuals.Material and methodsIn this prospective study, 13 HIV‐1‐infected individuals undergoing highly active antiretroviral therapy (with undetectable plasma HIV RNA levels, and CD4+ T cells > 350/mm3) were followed after implant placement, as well as 13 non‐HIV‐1‐infected matched controls. Patients enrolled in this study were followed up to 120 months (mean = 40.6 months; standard deviation = 22.2; range 18 –120 months). Twenty‐five implants were placed in pristine healed sites for each group and bone augmentation procedures, when needed, were done only for contour augmentation. Patients were enrolled in a strict periodontal/peri‐implant supportive therapy protocol with three recalls per year. The two groups were compared regarding subject‐level characteristics (age, gender, smoking, diabetes) and implant‐level characteristics (marginal bone level, peri‐implant health status).ResultsAll the implants healed uneventfully and reached 100% survival rates (after at least 18 months) in both groups. There were no significant differences between groups for peri‐implant diseases (mucositis/peri‐implantitis) and for all subject‐level co‐variables (p > .05). Only the variables dental implant prosthesis type (DIPT) (p = .021, d = .86) and follow up (p = .011, d = .77) showed statistically significant differences between groups.ConclusionThe findings suggest that well‐controlled HIV‐1‐infected individuals are eligible to undergo implant therapy, achieving survival and success rates comparable to non‐HIV‐1‐infected controls.

IntroductionSince the introduction of HAART the desire to become a mother in women with HIV has become a viable option due to the drastic reduction in vertical transmission. The aim of this study was to look at the epidemiology, clinical characteristics, and safety of antiretroviral drugs and rate of vertical transmission in our cohort in the Munster region, Ireland.MethodsWe retrospectively reviewed all pregnant women with HIV who attended the ID clinic from January 2002 to April 2012. Patients' demographics, pertinent laboratory data, and pharmacy records were reviewed and statistically analysed.Results105 HIV‐positive women, with a total of 165 pregnancies, were seen from January 2002 to April 2012 at Cork University Hospital: 46 patients were previously known to be HIV‐infected at their first pregnancy and 59 were diagnosed during antenatal screening (median of 32 week gestation at diagnosis). The median age at the time of pregnancy was 32 and the HIV transmission was 90% sexual: 39 women were from Europe/Asia and 66 were African; only two women were HCV co‐infected and one was HBV co‐infected. Of the patients diagnosed with HIV prior to pregnancy, 13 were on treatment, all of whom had no detectable virus at the start and during pregnancy. The median CD4+ at the start of pregnancy was 490 cells/µl. The median weeks of gestation at the start of HAART was 28 before 2006 and 20 after 2006, in accordance with National Guidelines. The HAART regime used was in line with current Guidelines. 18 pregnancies ended in miscarriage before week 12 gestation and 2 pregnancies resulted in intrauterine death at 28 weeks. 145 pregnancies progressed to delivery at full term but 10 infants were born before the 37th week, with one baby born at 23 weeks: 63 had SVD and 82 underwent C‐section, of whom 12 emergency C‐section due to prolonged membrane rupture. Most of the C‐sections were planned due to obstetric reasons. 2 infants were born HIV+: in one case the mother was a late presenter at 38 of gestation; and in other the mother had poor compliance with viral load detectable at the time of labour. The overall number of pregnancies per year has been stable over the ten years (average of 14 pregnancies per year).ConclusionThe use of cART with high level of adherence and a close clinical management during pregnancy has shown to dramatically reduce the vertical transmission of HIV in our cohort.

BACKGROUND: Tuberculosis is one of the leading infectious diseases for people living with HIV. Therefore, the purpose of this study was to investigate factors affecting the development of TB among HIV-positive adults under treatment in government hospitals of Amhara Region, Ethiopia. METHODS: A hospital-based retrospective study design was conducted among 700 HIV-positive adults under HAART in 17 government hospitals in the Amhara region, Ethiopia. RESULTS: Age of the patients (AOR = 1.122, 95% CI:1.013, 2.234), baseline CD4 cell count (AOR = 0.888, 95% CI: 0.714, 0.945), patients living without their partner (AOR = 1.212, 95% CI: 1.051, 1.123), females under treatment (AOR = 0.786, 95% CI; 0.564, 0.845), non-opportunistic diseases (AOR = 0.865, 95% CI: 0.731, 0.938), patients not disclosed their HIV status (AOR = 1.241, 95% CI: 1.087, 2.341), rural patients (AOR = 1.135, 95% CI: 1.032, 1.453, patient with no education (AOR = 1.125, 95% CI: 1.056, 1.546), low adherence patients (AOR = 1.225, 95% CI: 1.191, 2.453), bedridden patients (AOR = 1.223, 95% CI: 1.131, 1.521), ambulatory patients (AOR = 1.156, 95% CI:1.091, 1.267), non-smoker patients (AOR = 0.854, 95% CI: 0.686, 0.935) significantly affected on the variable of interest. Similarly, alcohol intake, drug toxicity and baseline clinical WHO stages significantly affected for the development of tuberculosis in HIV-positive patients under treatment. CONCLUSION: In this study, baseline CD4 cell count, female patients, non-opportunistic diseases, and non-smoking status were negatively associated with the development of TB, whereas age of patients, living without partners, patients with no education, patients with low adherence, bedridden and ambulatory patients were positively associated to the development of TB in HIV patients. The findings obtained in this study are important for both service providers and patients. More attention should be given to those positively associated variables to response variables. The regional health bureau should open TB/HIV ...

Objective: identifying the association between knowledge about antiretroviral therapy and the level of
compliance to adults' treatment in outpatient clinics. Method: a cross-sectional study carried out in the
Countryside of Pernambuco in 2013. Study participants were 256 adults under antiretroviral therapy. There
were used three data collection instruments. For comparison analysis of qualitative variables the Pearson's
chi-squared test was used. It was approved by the Research Ethics Committee of the Oswaldo Cruz University
Hospital under number 205.799. Results: 70,3% of people with regular and low level of compliance to the
antiretroviral were detected and 84,8% with a regular level of knowledge. A significant association between
the level of knowledge and the level of compliance with the treatment was identified (p<0,001). Conclusion:
the knowledge level about antiretroviral therapy seems to influence the compliance with treatment,
suggesting that the health professionals intensify their educational actions in health by involving the theme.
It is recommended further studies in this field of research.

In 2007, less than one-third of all HIV-positive South Africans in need of lifeextending highly-active antiretroviral treatment (HAART) are accessing it through the public health system. This 'treatment gap' poses a significant challenge to health practitioners and researchers given the complex factors that influence the provision (supply) and uptake (demand) of this public health intervention. This qualitative study, conducted in 2006, set out to explore some of the demand-side factors affecting uptake and adherence to HAART among a cohort of HIV-positive people living in the Western Cape. Two significant and interrelated findings emerged from the research: one, political equivocation influenced the use of lay and untested HIV remedies among the cohort, with lay remedies represented as 'benign' compared to the 'risks' of using biomedicine like HAART; second, psycho-social and physical factors, like hope, stigma and fear or experience of HAART's side-effects, affected the respondents' health seeking behaviour. This preliminary qualitative study suggests that political equivocation and national activism compound, and also obscure, nuanced personal responses to managing illness and securing health. In order for the hard-won HAART roll-out to succeed in reaching 80% of all those in need by 2011, as per the 2007 – 2011 HIV/AIDS and STI National Strategic Plan, researchers and practitioners need to consider and address both supply and demand-side factors inhibiting access and adherence to HAART in South Africa.

IntroductionThe scale‐up of highly active antiretroviral therapy (HAART) has led to a significant improvement in survival of the HIV‐positive patient but its effects on health‐related quality of life (HRQOL) are less known and context‐dependent. Our aim was to assess the temporal changes and factors associated with HRQOL among HIV‐positive adults initiating HAART in Burkina Faso.MethodsHIV‐positive people initiating HAART were prospectively included and followed over a one‐year period in three HIV clinics of Ouagadougou. HRQOL was assessed at baseline and at each follow‐up visit using physical (PHS) and mental (MHS) summary scores derived from the Medical Outcome Study 36‐Item short‐form health survey (MOS SF‐36) questionnaire. Toxicity related to HAART modification and self‐reported symptoms were recorded during follow‐up visits. Determinants associated with baseline and changes in both scores over a one‐year period were assessed using a mixed linear model.ResultsA total of 344 patients were included. Their median age at baseline was 37 years [interquartile range (IQR) 30–44] and their median CD4 count was 181 cells/mm3 (IQR 97–269). The mean [standard deviation (SD)] PHS score increased from 45.4 (11.1) at baseline to 60.0 (3.1) at 12 months (p<10−4) and the mean (SD) MHS score from 42.2 (8.7) to 43.9 (3.4) (p<10−2). After one year of treatment, patients that experienced on average two symptoms during follow‐up presented with significantly lower PHS (63.9) and MHS (43.8) scores compared to patients that presented no symptoms with PHS and MHS of 68.2 (p<10−4) and 45.3 (p<10−3), respectively.DiscussionThe use of HAART was associated with a significant increase in both physical and mental aspects of the HRQOL over a 12‐month period in this urban African population. Perceived symptoms experienced during follow‐up visits were associated with a significant impairment in HRQOL. The appropriate and timely management of reported symptoms during the follow‐up of HAART‐treated patients is a key component to restore HRQOL.