HIV Hurts the Immune System
People who are HIV positive have been tested and found to have signs of the human immunodeficiency virus in their blood. HIV destroys part of the immune (say: ih-myoon) system. Specifically, it affects a type of white blood cell called the T lymphocyte (say: lim-fuh-site), or T cell. T cells are one type of "fighter" cell in the blood that help the body fight off all kinds of germs and diseases.
After HIV enters the body, it piggybacks onto a T cell and works its way inside of that cell. Once inside, the virus completely takes over the T cell and uses it as a virus-making factory to make a lot of copies of itself. The newly made viruses then leave the T cell and go on to infect and destroy other healthy T cells as they continue to multiply inside the body. After the virus invades the T cells, they can no longer properly fight infections.
Someone who is infected with the virus is called HIV positive. But it may take years for the virus to damage enough T cells for that person to get sick and develop AIDS. And thanks to new medications, someone infected with HIV can stay relatively healthy and symptom-free for many years. But these medications are very expensive and not available to everyone in the world.
Although the HIV-positive person may feel fine, the virus is silently reproducing itself and destroying T cells. And during this time, the person is still contagious (say: kon-tay-jus), which means he or she is able to give the disease to others.
When the person's immune system has weakened and more of the blood's T cells have been destroyed by the virus, the person can no longer fight off infections. This is when he or she gets very sick. A doctor diagnoses a person with AIDS when the person has a very low number of T cells and shows signs of a serious infection.
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Showing posts with label AIDS. Show all posts
Showing posts with label AIDS. Show all posts
Monday, December 31, 2012
Welcome to INP+
Welcome to INP+
INP+ is an ISO 9001:2008 certified CBO - a national network for people living with HIV/AIDS. INP+ is a social movement by and for People Living with HIV/AIDS (PLHIV) in enforcing the recognition for Human Rights of PLHIV in India. INP+ has waged a long and intensive struggle against fear, ignorance, prejudice and despair born out of the epidemic and stood to represent courage, insight, acceptance and hope to hundreds and thousands of People Living with HIV/AIDS.
We support PLHIV to form self help groups from the bottom up and foster bonding with intra- and intercommunity groups to gain strength and support.
Our members include besides PLHIV, people from diverse orientation and marginalized sections of the society – MSM (Men having Sex with Men), IDU (Injecting Drug Users), Sex workers etc. The membership is open to all Indians living with HIV irrespective of gender, caste, religion etc.
Browse through our site to learn more about INP+ and how you can contribute!
INP+ is an ISO 9001:2008 certified CBO - a national network for people living with HIV/AIDS. INP+ is a social movement by and for People Living with HIV/AIDS (PLHIV) in enforcing the recognition for Human Rights of PLHIV in India. INP+ has waged a long and intensive struggle against fear, ignorance, prejudice and despair born out of the epidemic and stood to represent courage, insight, acceptance and hope to hundreds and thousands of People Living with HIV/AIDS.
We support PLHIV to form self help groups from the bottom up and foster bonding with intra- and intercommunity groups to gain strength and support.
Our members include besides PLHIV, people from diverse orientation and marginalized sections of the society – MSM (Men having Sex with Men), IDU (Injecting Drug Users), Sex workers etc. The membership is open to all Indians living with HIV irrespective of gender, caste, religion etc.
Browse through our site to learn more about INP+ and how you can contribute!
How often will my doctor want to see me?
How often will my doctor want to see me?
Your doctor will probably want to see you every 6 months as long as your CD4 cell count is higher than 500. Your doctor will probably want to see you every 3 months if your CD4 cell counts are below 500. However, if you take a new medicine, your doctor will want to see you more often, to check your response to the medicine or to see if your HIV infection is getting worse.
Return to top
What else can help me?
Some medicines can help prevent the other infections and complications that come when HIV lowers your body's resistance (makes your immune system weak). Here are some things that can help people with HIV:
* A flu shot every fall helps prevent the flu.
* A shot every 5 to 7 years can prevent pneumonia caused by the bacteria called Streptococcus pneumoniae. It's easier for people who have HIV to get this kind of pneumonia.
* A tuberculosis (TB) skin test every year can tell if you have TB. TB is a very serious illness, especially in people who have HIV.
* A Pap test for women to check for dysplasia (a pre-cancer condition) and for cancer of the cervix. Both of these conditions occur more often in women who have HIV infection. At first, Pap tests are done every 6 months. After 2 Pap tests in a row are normal, you might only have to get them once a year.
* A hepatitis B test for people who are at risk for hepatitis B infection. You're at risk for this infection if you inject drugs. If the test shows you don't have hepatitis B infection, your doctor might want you to have the hepatitis B vaccine to protect you from getting the infection.
* A medicine called TMP-SMZ can help. This antibiotic would be given to you if your CD4 cell count is less than 200. It helps prevent pneumonia caused by a bacteria called Pneumocystis jiroveci. This antibiotic also helps prevent another infection, called toxoplasmosis.
* Azithromycin, clarithromycin and rifabutin can help when your CD4 cell count is lower than 50 to 75. They keep you from getting an infection caused by a bacteria called Mycobacterium avium.
Return to top
A note about vaccines
Sometimes the amount of a certain vaccine cannot keep up with the number of people who need it. More info...
Return to top
What is the best time to start taking these medicines?
Almost all experts agree that medicines for HIV should be started before the person's CD4 cells fall under 200. Most doctors want their patients to start taking medicines earlier, when the CD4 cell count is between 200 and 500. You and your doctor should talk about which medicines to take and when to start taking them. (See the handout on HIV and Plasma Viral Load Testing for more information on your CD4 cell count and your plasma viral load.)
Return to top
Which are the best drugs for me to use?
Each person should talk to his or her doctor about the medicines for HIV. Most doctors treat their patients with more than one medicine.
Your doctor will test your blood to see when you should start taking medicine. The blood tests can also show how well your medicine is working. The tests will help your doctor decide if your treatment should change.
Return to top
Where can I get more information about HIV treatments?
Many cities have telephone hotlines for both patients and the general public. Look for the number in your telephone yellow pages, under AIDS information.
Return to top
More Information
STIs, HIV and AIDS
* How to Reduce Your HIV and AIDS Risk
* Coping With an HIV Diagnosis
* HIV Infection in Women
* HIV, Pregnancy and AZT
* How to Take HIV Medicines
* HIV and Plasma Viral Load Testing
* Avoiding Infections When You Have HIV
* HIV
* Pneumocystis pneumonia (PCP) and HIV
* Nutrition and Exercise When You Have HIV
* Occupational Exposure to HIV
Return to top
Other Organizations
* CDC HIV/AIDS Information
* HIV/AIDS Treatment Information Service
* The Body: The Complete HIV/AIDS Resource
Return to top
printPrinter-friendly version
Share this page
Make text biggerMake text bigger
spanish buttonSpanish / Español
Source
Written by familydoctor.org editorial staff.
American Academy of Family Physicians
Reviewed/Updated: 12/10
Created: 05/97
Your doctor will probably want to see you every 6 months as long as your CD4 cell count is higher than 500. Your doctor will probably want to see you every 3 months if your CD4 cell counts are below 500. However, if you take a new medicine, your doctor will want to see you more often, to check your response to the medicine or to see if your HIV infection is getting worse.
Return to top
What else can help me?
Some medicines can help prevent the other infections and complications that come when HIV lowers your body's resistance (makes your immune system weak). Here are some things that can help people with HIV:
* A flu shot every fall helps prevent the flu.
* A shot every 5 to 7 years can prevent pneumonia caused by the bacteria called Streptococcus pneumoniae. It's easier for people who have HIV to get this kind of pneumonia.
* A tuberculosis (TB) skin test every year can tell if you have TB. TB is a very serious illness, especially in people who have HIV.
* A Pap test for women to check for dysplasia (a pre-cancer condition) and for cancer of the cervix. Both of these conditions occur more often in women who have HIV infection. At first, Pap tests are done every 6 months. After 2 Pap tests in a row are normal, you might only have to get them once a year.
* A hepatitis B test for people who are at risk for hepatitis B infection. You're at risk for this infection if you inject drugs. If the test shows you don't have hepatitis B infection, your doctor might want you to have the hepatitis B vaccine to protect you from getting the infection.
* A medicine called TMP-SMZ can help. This antibiotic would be given to you if your CD4 cell count is less than 200. It helps prevent pneumonia caused by a bacteria called Pneumocystis jiroveci. This antibiotic also helps prevent another infection, called toxoplasmosis.
* Azithromycin, clarithromycin and rifabutin can help when your CD4 cell count is lower than 50 to 75. They keep you from getting an infection caused by a bacteria called Mycobacterium avium.
Return to top
A note about vaccines
Sometimes the amount of a certain vaccine cannot keep up with the number of people who need it. More info...
Return to top
What is the best time to start taking these medicines?
Almost all experts agree that medicines for HIV should be started before the person's CD4 cells fall under 200. Most doctors want their patients to start taking medicines earlier, when the CD4 cell count is between 200 and 500. You and your doctor should talk about which medicines to take and when to start taking them. (See the handout on HIV and Plasma Viral Load Testing for more information on your CD4 cell count and your plasma viral load.)
Return to top
Which are the best drugs for me to use?
Each person should talk to his or her doctor about the medicines for HIV. Most doctors treat their patients with more than one medicine.
Your doctor will test your blood to see when you should start taking medicine. The blood tests can also show how well your medicine is working. The tests will help your doctor decide if your treatment should change.
Return to top
Where can I get more information about HIV treatments?
Many cities have telephone hotlines for both patients and the general public. Look for the number in your telephone yellow pages, under AIDS information.
Return to top
More Information
STIs, HIV and AIDS
* How to Reduce Your HIV and AIDS Risk
* Coping With an HIV Diagnosis
* HIV Infection in Women
* HIV, Pregnancy and AZT
* How to Take HIV Medicines
* HIV and Plasma Viral Load Testing
* Avoiding Infections When You Have HIV
* HIV
* Pneumocystis pneumonia (PCP) and HIV
* Nutrition and Exercise When You Have HIV
* Occupational Exposure to HIV
Return to top
Other Organizations
* CDC HIV/AIDS Information
* HIV/AIDS Treatment Information Service
* The Body: The Complete HIV/AIDS Resource
Return to top
printPrinter-friendly version
Share this page
Make text biggerMake text bigger
spanish buttonSpanish / Español
Source
Written by familydoctor.org editorial staff.
American Academy of Family Physicians
Reviewed/Updated: 12/10
Created: 05/97
What happens during a routine office visit?
What happens during a routine office visit?
Your doctor will check several things to find out how strong your HIV infection has become. Your doctor will ask you about your symptoms. He or she will look for any signs that the HIV infection is getting worse. Your doctor will also do a blood test to check your CD4 cell count and your viral load. Some of the things that might tell your doctor that your HIV infection has gotten worse since your last visit are the following:
* New symptoms of nausea, vomiting, fatigue, fever, headache, chills, night sweats, cough, shortness of breath or diarrhea.
* Signs of weight loss, mouth sores (such as thrush, which is a yeast infection) or bigger lymph nodes (glands located in your neck, armpits and hip area).
* A drop in the CD4 cell count in your blood.
* A rise in the viral load in your blood.
Your doctor will check several things to find out how strong your HIV infection has become. Your doctor will ask you about your symptoms. He or she will look for any signs that the HIV infection is getting worse. Your doctor will also do a blood test to check your CD4 cell count and your viral load. Some of the things that might tell your doctor that your HIV infection has gotten worse since your last visit are the following:
* New symptoms of nausea, vomiting, fatigue, fever, headache, chills, night sweats, cough, shortness of breath or diarrhea.
* Signs of weight loss, mouth sores (such as thrush, which is a yeast infection) or bigger lymph nodes (glands located in your neck, armpits and hip area).
* A drop in the CD4 cell count in your blood.
* A rise in the viral load in your blood.
How does the doctor tell if the medicines are workin
How does the doctor tell if the medicines are working?
Three tests can measure the amount of the virus in your blood. Your doctor can use this information to find out how your body is responding to the medicine.
* The CD4 cell count. CD4 cells are a kind of white blood cell (sometimes called T-lymphocytes, or T-cells) in your blood. CD4 cells are important because they help your body fight infections. Unfortunately, these cells are also the main target of the virus that causes HIV infection. This virus cripples the CD4 cells. In people who don't have HIV, the CD4 level is between 500 and 1,200 cells per mm3 (cubic millimeter). Your doctor will probably give you medicine to fight HIV when your CD4 cell count drops below a certain level. One goal of treatment for HIV infection is to keep your CD4 cell count as high as possible.
* Viral load. The viral load is the number of copies of HIV in your blood. A person who doesn't have HIV infection has a viral load of 0. Medicine that lowers the amount of HIV in the body is usually given when your viral load measures more than 10,000 to 30,000 viral copies per mL (milliliter) of blood. A second goal of treatment is to make the viral load as low as possible.
* CBC. The complete blood count (also called the CBC) measures the number of red and white cells in your blood. Red blood cells carry oxygen from your lungs to all the tissues of your body. White blood cells fight infections. They keep your body's immune system strong. A large drop in red blood cells and a large drop in white blood cells can occur when HIV infection is getting worse. This drop can also be caused by the same medicines that you take to fight HIV (medicines like zidovudine). Your doctor uses the CBC to help decide when to change your medicines. Your doctor wants to keep your red and white blood cell counts high enough to keep you healthy.
Three tests can measure the amount of the virus in your blood. Your doctor can use this information to find out how your body is responding to the medicine.
* The CD4 cell count. CD4 cells are a kind of white blood cell (sometimes called T-lymphocytes, or T-cells) in your blood. CD4 cells are important because they help your body fight infections. Unfortunately, these cells are also the main target of the virus that causes HIV infection. This virus cripples the CD4 cells. In people who don't have HIV, the CD4 level is between 500 and 1,200 cells per mm3 (cubic millimeter). Your doctor will probably give you medicine to fight HIV when your CD4 cell count drops below a certain level. One goal of treatment for HIV infection is to keep your CD4 cell count as high as possible.
* Viral load. The viral load is the number of copies of HIV in your blood. A person who doesn't have HIV infection has a viral load of 0. Medicine that lowers the amount of HIV in the body is usually given when your viral load measures more than 10,000 to 30,000 viral copies per mL (milliliter) of blood. A second goal of treatment is to make the viral load as low as possible.
* CBC. The complete blood count (also called the CBC) measures the number of red and white cells in your blood. Red blood cells carry oxygen from your lungs to all the tissues of your body. White blood cells fight infections. They keep your body's immune system strong. A large drop in red blood cells and a large drop in white blood cells can occur when HIV infection is getting worse. This drop can also be caused by the same medicines that you take to fight HIV (medicines like zidovudine). Your doctor uses the CBC to help decide when to change your medicines. Your doctor wants to keep your red and white blood cell counts high enough to keep you healthy.
Sunday, December 30, 2012
HIV Treatment
HIV Treatment
What is HIV?
The human immunodeficiency virus (HIV) attacks the body's immune system. A healthy immune system is what keeps you from getting sick.
Because HIV damages your immune system, you are more likely to get sick from bacteria and viruses. It is also harder for your body to fight off these infections when you do get them, so you may have trouble getting better. HIV is the condition that causes acquired immunodeficiency syndrome (AIDS).
HIV can only be passed from person to person through body fluids, such as blood, semen and vaginal fluid. Children born to infected mothers can also become infected during pregnancy. The most common ways HIV is passed are:
* By having unprotected anal, vaginal or oral sex with an infected person.
* By sharing needles and syringes for injecting drugs with an infected person.
Return to top
How can my doctor tell if I have HIV or AIDS?
First your doctor tests to see if you have HIV infection. Your blood is tested with an ELISA (enzyme-linked immunosorbent assay) test. If this test is positive for HIV, your blood is tested again with the Western blot test. If both tests are positive, you are diagnosed with HIV infection.
Three things show that a person who has HIV infection has developed AIDS. If any one or more of the following are present, the person has AIDS:
* A CD4 cell count (discussed below) of less than 200
* A CD4 cell percentage of less than 14%
* An AIDS-indicator illness
An AIDS-indicator illness is a physician-diagnosed medical problem that occurs in people who have advanced HIV infection. About 25 medical problems are considered AIDS-indicator illnesses. They include conditions like Pneumocystis pneumonia, Kaposi's sarcoma and wasting syndrome. If a person who is infected with HIV gets an AIDS-indicator illness, that person has AIDS.
Return to top
What is HIV?
The human immunodeficiency virus (HIV) attacks the body's immune system. A healthy immune system is what keeps you from getting sick.
Because HIV damages your immune system, you are more likely to get sick from bacteria and viruses. It is also harder for your body to fight off these infections when you do get them, so you may have trouble getting better. HIV is the condition that causes acquired immunodeficiency syndrome (AIDS).
HIV can only be passed from person to person through body fluids, such as blood, semen and vaginal fluid. Children born to infected mothers can also become infected during pregnancy. The most common ways HIV is passed are:
* By having unprotected anal, vaginal or oral sex with an infected person.
* By sharing needles and syringes for injecting drugs with an infected person.
Return to top
How can my doctor tell if I have HIV or AIDS?
First your doctor tests to see if you have HIV infection. Your blood is tested with an ELISA (enzyme-linked immunosorbent assay) test. If this test is positive for HIV, your blood is tested again with the Western blot test. If both tests are positive, you are diagnosed with HIV infection.
Three things show that a person who has HIV infection has developed AIDS. If any one or more of the following are present, the person has AIDS:
* A CD4 cell count (discussed below) of less than 200
* A CD4 cell percentage of less than 14%
* An AIDS-indicator illness
An AIDS-indicator illness is a physician-diagnosed medical problem that occurs in people who have advanced HIV infection. About 25 medical problems are considered AIDS-indicator illnesses. They include conditions like Pneumocystis pneumonia, Kaposi's sarcoma and wasting syndrome. If a person who is infected with HIV gets an AIDS-indicator illness, that person has AIDS.
Return to top
India has 53,000 HIV positive children: Govt
India has 53,000 HIV positive children: Govt
IANS, Jul 29, 2009, 07.46pm IST
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NEW DELHI: Nearly 53,000 children in the country are HIV positive, with Tamil Nadu topping the list with new 2,650 cases, health minister Ghulam Nabi Azad told the Lok Sabha on Wednesday.
The minister said in 2006, about 2,253 cases were reported, while the following year 24,977 were registered. In November 2008, the figure touched 19,116.
"The cumulative total among children now stands at 52,973 in May 2009," Azad said.
India has 2.5 million HIV/AIDS cases.
The minister said the major source of the HIV infection in children is vertical transmission from their infected pregnant mothers.
"To arrest this trend, the Prevention of Parent to Child Transmission (PPTCT) programme is being implemented since 2002," he said.
"In the year 2008, a total of 4.1 million pregnant women were counselled and tested, of whom 19,986 were found positive and 10,179 mother-baby pairs received prophylactic treatment to prevent transmission from infected mother to infant," he added.
Till May this year, Tamil Nadu reported the maximum new cases among children with 2,651 cases, as compared to 2,446 cases in 2008. It is followed by Maharashtra where 1,269 cases were reported till May as compared to 2008 when it topped the list of new cases at 4,714.
Andhra Pradesh, which had recorded the highest number of new cases among children in 2007 with 6,460 cases, this time till May showed a decline with 748 cases.
Last year, Delhi recorded 3,807 new cases and since then it has registered 748 cases.
Only Arunachal Pradesh and Sikkim reported no cases this year.
Azad said the number of Integrated Counselling and Testing Centres have been increased from 1,476 to 5,155, while facilities providing treatment increased from 52 to 217 over the three year period.
He further said nearly 758,600 HIV positive people were being provided services under the National AIDS Control Programme's third phase. The National AIDS Control Organisation (NACO), a state-run anti-AIDS agency, provides quality health care for people living with HIV/AIDS.
"Treatment facilities are available in 217 medical facilities where treatment is being provided with anti-retroviral drugs to 232,908 patients, of whom 14,474 are children," the minister added.
Read more: India has 53,000 HIV positive children: Govt - The Times of India http://timesofindia.indiatimes.com/life-style/health-fitness/India-has-53000-HIV-positive-children-Govt/articleshow/4834663.cms#ixzz19UW4piPu
IANS, Jul 29, 2009, 07.46pm IST
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NEW DELHI: Nearly 53,000 children in the country are HIV positive, with Tamil Nadu topping the list with new 2,650 cases, health minister Ghulam Nabi Azad told the Lok Sabha on Wednesday.
The minister said in 2006, about 2,253 cases were reported, while the following year 24,977 were registered. In November 2008, the figure touched 19,116.
"The cumulative total among children now stands at 52,973 in May 2009," Azad said.
India has 2.5 million HIV/AIDS cases.
The minister said the major source of the HIV infection in children is vertical transmission from their infected pregnant mothers.
"To arrest this trend, the Prevention of Parent to Child Transmission (PPTCT) programme is being implemented since 2002," he said.
"In the year 2008, a total of 4.1 million pregnant women were counselled and tested, of whom 19,986 were found positive and 10,179 mother-baby pairs received prophylactic treatment to prevent transmission from infected mother to infant," he added.
Till May this year, Tamil Nadu reported the maximum new cases among children with 2,651 cases, as compared to 2,446 cases in 2008. It is followed by Maharashtra where 1,269 cases were reported till May as compared to 2008 when it topped the list of new cases at 4,714.
Andhra Pradesh, which had recorded the highest number of new cases among children in 2007 with 6,460 cases, this time till May showed a decline with 748 cases.
Last year, Delhi recorded 3,807 new cases and since then it has registered 748 cases.
Only Arunachal Pradesh and Sikkim reported no cases this year.
Azad said the number of Integrated Counselling and Testing Centres have been increased from 1,476 to 5,155, while facilities providing treatment increased from 52 to 217 over the three year period.
He further said nearly 758,600 HIV positive people were being provided services under the National AIDS Control Programme's third phase. The National AIDS Control Organisation (NACO), a state-run anti-AIDS agency, provides quality health care for people living with HIV/AIDS.
"Treatment facilities are available in 217 medical facilities where treatment is being provided with anti-retroviral drugs to 232,908 patients, of whom 14,474 are children," the minister added.
Read more: India has 53,000 HIV positive children: Govt - The Times of India http://timesofindia.indiatimes.com/life-style/health-fitness/India-has-53000-HIV-positive-children-Govt/articleshow/4834663.cms#ixzz19UW4piPu
The HIV/AIDS situation in different states
The HIV/AIDS situation in different states
Map of India Map of India showing the worst affected states.
The vast size of India makes it difficult to examine the effects of HIV on the country as a whole. The majority of states within India have a higher population than most African countries, so a more detailed picture of the crisis can be gained by looking at each state individually.
The HIV prevalence data for most states is established through testing pregnant women at antenatal clinics. While this means that the data are only directly relevant to sexually active women, they still provide a reasonable indication as to the overall HIV prevalence of each area.23
The following states have recorded the highest levels of HIV prevalence at antenatal and sexually transmitted disease (STD) clinics over recent years.
Andhra Pradesh
Andhra Pradesh in the southeast of the country has a total population of around 76 million, of whom 6 million live in or around the city of Hyderabad. The HIV prevalence at antenatal clinics was 1% in 2007. This figure is smaller than the reported 1.26% in 2006, but remains the highest out of all states.24 HIV prevalence at STD clinics was very high at 17% in 2007. Among high-risk groups, HIV prevalence was highest among men who have sex with men (MSM) (17%), followed by female sex workers (9.7%) and IDUs (3.7%).25
Goa
Goa, a popular tourist destination, is a very small state in the southwest of India (population 1.4 million). In 2007 HIV prevalence among antenatal and STD clinic attendees was 0.18% and 5.6% respectively.26 The Goa State AIDS Control Society reported that in 2008, a record number of 26,737 people were tested for HIV, of which 1018 (3.81%) tested positive.27
Karnataka
Karnataka, a diverse state in the southwest of India, has a population of around 53 million. HIV prevalence among antenatal clinic attendees exceeded 1% from 2003 to 2006, and dropped to 0.5% in 2007.28 Districts with the highest prevalence tend to be located in and around Bangalore in the southern part of the state, or in northern Karnataka's "devadasi belt". Devadasi women are a group of women who have historically been dedicated to the service of gods. These days, this has evolved into sanctioned prostitution, and as a result many women from this part of the country are supplied to the sex trade in big cities such as Mumbai.29 The average HIV prevalence among female sex workers in Karnataka was just over 5% in 2007, and 17.6% of men who have sex with men were found to be infected.30
Maharashtra
Maharashtra is a very large state of three hundred thousand square kilometres, with a total population of around 97 million. The capital city of Maharashtra - Mumbai (Bombay) - is the most populous city in India, with around 14 million inhabitants. The HIV prevalence at antenatal clinics in Maharashtra was 0.5% in 2007.31 At 18%, the state has the highest reported rates of HIV prevalence among female sex workers.32 Similarly high rates were found among injecting drug users (24%) and men who have sex with men (12%).33
Tamil Nadu
With a population of over 66 million, Tamil Nadu is the seventh most populous state in India. Between 1995 and 1997 HIV prevalence among pregnant women tripled to around 1.25%.34 The State Government subsequently set up an AIDS society, which aimed to focus on HIV prevention initiatives. A safe-sex campaign was launched, encouraging condom use and attacking the stigma and ignorance associated with HIV. Between 1996 and 1998 a survey showed that the number of men reporting high-risk sexual behaviour had decreased.35
In 2007 HIV prevalence among antenatal clinic attendees was 0.25%.36 HIV prevalence among injecting drug users was 16.8%, third highest out of all reporting states. HIV prevalence among men who have sex with men and female sex workers was 6.6% and 4.68% respectively.37
Manipur
Manipur is a small state of some 2.4 million people in northeast India. Manipur borders Myanmar (Burma), one of the world's largest producers of illicit opium. In the early 1980s drug use became popular in northeast India and it wasn't long before HIV was reported among injecting drug users in the region.38 Although NACO report a state-wise HIV prevalence of 17.9% among IDUs, studies from different areas of the state find prevalence to be as high as 32%.39
HIV is no longer confined to IDUs, but has spread further to the general population. HIV prevalence at antenatal clinics in Manipur exceeded 1% in recent years, but then declined to 0.75% in 2007.40 Estimated adult HIV prevalence is the highest out of all states, at 1.57%.41
Mizoram
The small northeastern state of Mizoram has fewer than a million inhabitants. In 1998, an HIV epidemic took off quickly among the state's male injecting drug users, with some drug clinics registering HIV rates of more than 70% among their patients.42 In recent years the average prevalence among this group has been much lower, at around 3-7%.43 HIV prevalence at antenatal clinics was 0.75% in 2007.44
Nagaland
Nagaland is another small northeastern state where injecting drug use has again been the driving force behind the spread of HIV. In 2003 HIV prevalence among IDUs was 8.43%, but has since declined to 1.91% in 2007. HIV prevalence at antenatal clinics and STD clinics was 0.60% and 3.42% respectively in 2007.45
The Punjab
The Punjab, a state in northern mainland India, has shown an increase in prevalence among injecting drug users (13.8% in 2007) in recent years.46 One of the richest cities in the Punjab, Ludhiana, has an HIV prevalence of 21% among IDUs while the HIV prevalence among IDUs in the capital of the state, Amritsar, has reached 30%.47 Denis Broun, head of UNAIDS in India has stated, "the problem of IDUs has been underestimated in mainland India, as most of the problem was thought to be in the northeast." 48
Map of India Map of India showing the worst affected states.
The vast size of India makes it difficult to examine the effects of HIV on the country as a whole. The majority of states within India have a higher population than most African countries, so a more detailed picture of the crisis can be gained by looking at each state individually.
The HIV prevalence data for most states is established through testing pregnant women at antenatal clinics. While this means that the data are only directly relevant to sexually active women, they still provide a reasonable indication as to the overall HIV prevalence of each area.23
The following states have recorded the highest levels of HIV prevalence at antenatal and sexually transmitted disease (STD) clinics over recent years.
Andhra Pradesh
Andhra Pradesh in the southeast of the country has a total population of around 76 million, of whom 6 million live in or around the city of Hyderabad. The HIV prevalence at antenatal clinics was 1% in 2007. This figure is smaller than the reported 1.26% in 2006, but remains the highest out of all states.24 HIV prevalence at STD clinics was very high at 17% in 2007. Among high-risk groups, HIV prevalence was highest among men who have sex with men (MSM) (17%), followed by female sex workers (9.7%) and IDUs (3.7%).25
Goa
Goa, a popular tourist destination, is a very small state in the southwest of India (population 1.4 million). In 2007 HIV prevalence among antenatal and STD clinic attendees was 0.18% and 5.6% respectively.26 The Goa State AIDS Control Society reported that in 2008, a record number of 26,737 people were tested for HIV, of which 1018 (3.81%) tested positive.27
Karnataka
Karnataka, a diverse state in the southwest of India, has a population of around 53 million. HIV prevalence among antenatal clinic attendees exceeded 1% from 2003 to 2006, and dropped to 0.5% in 2007.28 Districts with the highest prevalence tend to be located in and around Bangalore in the southern part of the state, or in northern Karnataka's "devadasi belt". Devadasi women are a group of women who have historically been dedicated to the service of gods. These days, this has evolved into sanctioned prostitution, and as a result many women from this part of the country are supplied to the sex trade in big cities such as Mumbai.29 The average HIV prevalence among female sex workers in Karnataka was just over 5% in 2007, and 17.6% of men who have sex with men were found to be infected.30
Maharashtra
Maharashtra is a very large state of three hundred thousand square kilometres, with a total population of around 97 million. The capital city of Maharashtra - Mumbai (Bombay) - is the most populous city in India, with around 14 million inhabitants. The HIV prevalence at antenatal clinics in Maharashtra was 0.5% in 2007.31 At 18%, the state has the highest reported rates of HIV prevalence among female sex workers.32 Similarly high rates were found among injecting drug users (24%) and men who have sex with men (12%).33
Tamil Nadu
With a population of over 66 million, Tamil Nadu is the seventh most populous state in India. Between 1995 and 1997 HIV prevalence among pregnant women tripled to around 1.25%.34 The State Government subsequently set up an AIDS society, which aimed to focus on HIV prevention initiatives. A safe-sex campaign was launched, encouraging condom use and attacking the stigma and ignorance associated with HIV. Between 1996 and 1998 a survey showed that the number of men reporting high-risk sexual behaviour had decreased.35
In 2007 HIV prevalence among antenatal clinic attendees was 0.25%.36 HIV prevalence among injecting drug users was 16.8%, third highest out of all reporting states. HIV prevalence among men who have sex with men and female sex workers was 6.6% and 4.68% respectively.37
Manipur
Manipur is a small state of some 2.4 million people in northeast India. Manipur borders Myanmar (Burma), one of the world's largest producers of illicit opium. In the early 1980s drug use became popular in northeast India and it wasn't long before HIV was reported among injecting drug users in the region.38 Although NACO report a state-wise HIV prevalence of 17.9% among IDUs, studies from different areas of the state find prevalence to be as high as 32%.39
HIV is no longer confined to IDUs, but has spread further to the general population. HIV prevalence at antenatal clinics in Manipur exceeded 1% in recent years, but then declined to 0.75% in 2007.40 Estimated adult HIV prevalence is the highest out of all states, at 1.57%.41
Mizoram
The small northeastern state of Mizoram has fewer than a million inhabitants. In 1998, an HIV epidemic took off quickly among the state's male injecting drug users, with some drug clinics registering HIV rates of more than 70% among their patients.42 In recent years the average prevalence among this group has been much lower, at around 3-7%.43 HIV prevalence at antenatal clinics was 0.75% in 2007.44
Nagaland
Nagaland is another small northeastern state where injecting drug use has again been the driving force behind the spread of HIV. In 2003 HIV prevalence among IDUs was 8.43%, but has since declined to 1.91% in 2007. HIV prevalence at antenatal clinics and STD clinics was 0.60% and 3.42% respectively in 2007.45
The Punjab
The Punjab, a state in northern mainland India, has shown an increase in prevalence among injecting drug users (13.8% in 2007) in recent years.46 One of the richest cities in the Punjab, Ludhiana, has an HIV prevalence of 21% among IDUs while the HIV prevalence among IDUs in the capital of the state, Amritsar, has reached 30%.47 Denis Broun, head of UNAIDS in India has stated, "the problem of IDUs has been underestimated in mainland India, as most of the problem was thought to be in the northeast." 48
Wednesday, November 7, 2012
Rapid testing at labour and delivery to prevent mother-to-child HIV transmission in developing settings: issues and challenges.
Rapid testing at labour and delivery to prevent mother-to-child HIV transmission in developing settings: issues and challenges.
Worldwide, approximately 2.5 million children (95% CI: 2.2-2.6) are living with HIV infection. In 2007 alone, approximately 420,000 children (95%CI:350,000-540,000) were newly infected with HIV - a vast majority of these infections were acquired through maternal-foetal transmission. Many of these infections could have been reduced by timely diagnosis and the delivery of interventions aimed at preventing mother-to-child HIV transmission. This perspective examines the attitudes preventing women from accessing HIV testing early on during pregnancy and the issues and challenges that remain in the institutionalization of interventions to prevent mother-to-child HIV transmission at labour and delivery. Socio-cultural and economic factors prevent women from accessing testing at an opportune time during pregnancy. In addition, a lack of adequate infrastructure often prevents timely delivery of interventions to those who access testing at the last minute (i.e., during labour and delivery). In the wake of a paediatric HIV epidemic and the need for lifelong provision of antiretroviral therapy to infected children, a simple strategy for provision of round-the-clock rapid testing and counselling services in the labour rooms may be cost saving to the healthcare systems worldwide.
Editors’ note: Although studies of programmes of point-of-care rapid HIV testing in labour and delivery have been conducted around the world, the need for additional infrastructure resources, such as round-the-clock counsellors and user friendly and accurate rapid tests, has been an impediment to wider implementation. With only 33% of women needing antiretroviral prophylaxis in pregnancy worldwide actually able to access it, innovations are needed to improve coverage. Labour and delivery are not times conducive to reflection on the personal advantages and disadvantages of knowledge of serostatus but two-stage counselling (short prepartum and extended postpartum), attention to privacy and confidentiality, timely confirmation of results to reduce false-positives and false-negatives, and community-based education engaging partners and highlighting the importance of preventing HIV transmission to infants could identify more babies in need of intrapartum and post-exposure prophylaxis and more mothers needing tailored infant feeding counselling in addition to evaluation for antiretroviral treatment, and care and support.
open-ended interviews with 41 individuals living with HIV
open-ended interviews with 41 individuals living with HIV and attending a clinic in Mbarara, Uganda, to understand structural barriers to antiretroviral adherence and clinical care. Almost all respondents cited the need to locate funds for the monthly clinic visit as a constant source of stress and anxiety, and lack of money for transportation was a key factor in cases of missed doses and missed medical appointments. Participants struggled with competing demands between transport costs and other necessities such as food, housing and school fees. These findings suggest that transportation costs can compromise both antiretroviral adherence and access to care. Interventions that address this barrier will be important to ensure the success of antiretroviral programs in sub-Saharan Africa.
Editors' note: With mean per capita income in Uganda the equivalent of 25 USD per month and monthly refill visit roundtrip transport costs ranging from 0.60 to 11.75 USD, it is not surprising that serious sacrifices by patients are required in other essential arenas such as food and school fees. These findings suggest that the concept of ‘access to medicine or lack thereof’ rather than the concept of ‘failure to adhere’, reframes the problem of missed doses as one anchored in structural and financial barriers that need to be addressed by treatment programmes and communities. Many ideas come to mind for piloting such as decentralisation to deliver drugs directly to the community through drug dispensaries, primary care clinics, and home-based care, along with transport cost subsidization for those being stabilised on their regimens and for subsequent 6 monthly control visits.
southern Africa in an observational cohort study originating from Aid for AIDS
southern Africa in an observational cohort study originating from Aid for AIDS, a private sector disease management program in southern Africa. Adolescents (age 11-19 years; n = 154) and adults (n = 7622) initiating antiretroviral treatment between 1999 and 2006 and having a viral load measurement within 1 year after antiretroviral treatment initiation were included. The primary outcomes were virologic suppression (HIV viral load antiretroviral treatment initiation. Secondary outcome was adherence assessed by pharmacy refills at 6, 12, and 24 months. The authors used a multivariate loglinear regression and Cox proportional hazards. A significantly smaller proportion of adolescents achieved 100% adherence at each time point (adolescents: 20.7% at 6 months, 14.3% at 12 months, and 6.6% at 24 months; adults: 40.5%, 27.9%, and 20.6% at each time point, respectively; P <0.01).>Patients achieving 100% 12-month adherence were significantly more likely to exhibit virologic suppression at 12 months, regardless of age. However, adolescents achieving virologic suppression had significantly shorter time to viral rebound (adjusted hazard ratio 2.03; 95% confidence interval: 1.31 to 3.13;P <0.003).>Adolescents were less likely to experience long-term immunologic recovery despite initial CD4 T-cell counts comparable to adults. Compared with adults, adolescents in southern Africa are less adherent to antiretroviral treatment and have lower rates of virologic suppression and immunologic recovery and a higher rate of virologic rebound after initial suppression. Studies must determine specific barriers to adherence in this population and develop appropriate interventions.
Editors’ note: Both because the number of adolescents on antiretroviral treatment continues to expand and because this population is most likely to benefit from optimal adherence with longest life expectancy on optimal treatment, determining the underlying reasons for the poor adherence that increases risk of morbidity and drug resistance is urgent. This study assessed adherence and outcomes among adolescents started on antiretroviral treatment when their CD4+ counts fell to 350 cells whose parents were employed by companies participating in a private sector employer-subsidized medical insurance programme in 9 countries in southern Africa. The adolescents were less likely than were adults to be on the non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimens which can achieve viral suppression with moderate levels (70-90%) of adherence. However, this cannot fully explain why adolescents were 50% less likely to maintain perfect adherence at all time points and were 70-75% less likely to be virologically suppressed at 1 and 2 years after treatment initiation. Equivalent studies in the public sector are needed to confirm these findings and qualitative studies are needed to determine the causes and provide avenues for solutions to what must be underscored as a priority treatment programme challenge.
IV Infection and Travel: Pretravel Recommendations and Health-Related Risks. Top HIV Med
IV Infection and Travel: Pretravel Recommendations and Health-Related Risks. Top HIV Med
In the current era of globalization and ease of air travel combined with the increased survival attained since the advent of potent antiretroviral therapy, HIV-infected individuals are travelling to remote and resource-limited areas of the world. Travel-related health risks in a patient with HIV depend on the patient’s immune status, destination, travel itinerary, and type of travel. HIV-infected patients with a CD4+ count of 200 cells/mm3 or lower, particularly those who are treatment-naive and newly diagnosed, are at increased risk of complications when travelling to resource-poor settings. These increased risks include those of acquiring gastrointestinal, respiratory, and endemic tropical infectious diseases. Individuals with a CD4+ count higher than 200 cells/mm3 (whether receiving antiretroviral treatment or not) are considered to have limited immune deficiency for the purpose of travel-related recommendations; in general, they may safely receive most recommended and required vaccines. Pretravel consultation before departure is crucial to address strategies to protect against vaccine-preventable diseases (routine, recommended, and required vaccinations); vector-borne diseases, particularly malaria; gastrointestinal infections; and sexually transmitted diseases. HIV-infected travellers who are ill, particularly those with fever, should undergo an immediate medical evaluation to rule out the possibility of a life-threatening infectious disease such as malaria.
Editors’ note: This excellent review should be required reading for all UN staff living with HIV who travel internationally or who live in resource-constrained settings. It compiles current knowledge on the use of live attenuated and inactivated vaccines by CD4+ count and provides practical advice. This includes delaying travel until 3 months after starting antiretroviral treatment to avoid immune reconstitution syndromes during travel, keeping medication with its official documentation in hand luggage with a back-up supply in checked luggage, hand hygiene with water and soap or alcohol-based solutions, knowing about potential protease inhibitor drug interactions with malaria treatment, careful attention to water and food safety to avoid enteric infections, adherence to safer sex strategies, and the importance of prompt evaluation of fever while travelling or on return .
common in HIV-infected women.
common in HIV-infected women. Dolan Looby and colleagues investigated the long-term effects of transdermal testosterone on body composition, bone mineral density, quality of life, and safety. Twenty-five HIV-infected women with free testosterone below the median (Women demonstrated low androgen levels (1.3 +/- 0.1 pg/ml) with relatively low weight (22.8 +/- 0.6 kg/m) and low bone mineral density (-0.61 +/- 0.17 SD hip T score) at baseline. No statistically significant differences were seen between the groups at baseline. The discontinuation rate was 16% and did not differ between treatment groups (P = 0.24). Free testosterone by equilibrium dialysis increased over 18 months (7.9 +/- 1.8 vs. 0.3 +/- 0.4 pg/ml; P = 0.002, testosterone vs. placebo). Testosterone was well tolerated and did not affect lipids, liver, or safety indices. Lean mass (1.8 +/- 0.5 vs. 0.8 +/- 0.9 kg; P = 0.04) and BMI (1.6 +/- 0.4 vs. 0.8 +/- 0.6 kg/m; P = 0.03, testosterone vs. placebo) increased in response to testosterone, whereas fat mass remained unchanged. Testosterone increased bone mineral density at the hip (0.01 +/- 0.01 vs. -0.01 +/- 0.01 g/cm; P = 0.02) and trochanter (0.01 +/- 0.01 vs. -0.02 +/- 0.01 g/cm; P = 0.01, testosterone vs. placebo). Testosterone significantly improved depression indices (-6.8 +/- 2.2 vs. -1.9 +/-3.1; P = 0.02) and problems affecting sexual function (-1.8 +/- 0.8 vs. 0.5 +/-0.5; P = 0.01, testosterone vs. placebo). Long-term testosterone administration was well tolerated in HIV-infected women and resulted in significant improvements in body composition, bone mineral density, and quality of life indices. Further evaluation of the safety and efficacy of testosterone use among HIV-infected women is warranted.
Androgen deficiency is highly prevalent among women living with HIV and is associated with reduced lean body mass, bone mineral density, and quality of life. Whereas treatment is routine in HIV-positive men with low testosterone levels, no treatment strategies exist for women with similar problems. This is the first long-term (18 months) randomised controlled trial in HIV-positive women of the effects of testosterone administered via a transdermal patch versus a control patch. Because it reveals very encouraging effects on bone mineral density, body composition, and quality of life without signs of virilisation, further studies of long-term treatment with testosterone for women living with HIV should proceed to see if these encouraging findings are confirmed.
see issue 59 of HIV This Week
Using the guinea pig air sampling model of the 1950s to advance further their DNA fingerprinting study which showed that 8.5% of 118 TB patients were responsible for 98.9% of the guinea pig infections (see issue 59 of HIV This Week), these authors turned their attention to preventing TB transmission. This is the first controlled evaluation assessing the effects on airborne TB transmission in a clinical setting of upper-room ultraviolet (UV) light that kills M. tuberculosis and negative ionization which gives airborne particles a charge that makes them stick to surfaces. Despite the high humidity of Lima (70 to 90%) which would affect UV germicidal efficacy, upper-room UV light had a marked effect reducing both TB infection (70%) and disease (54%). Although these are guinea pig studies, the evidence for this environmental control measure is strong. Upper-room UV lighting is relatively low cost compared to mechanical ventilation and should be expertly installed now in all waiting rooms, out-patient and emergency departments, and antiretroviral treatment facilities where undiagnosed and untreated TB patients are likely to be found. Designing simple UV fixtures for low-resource settings will facilitate scale-up further.
the HIV pandemic and the emergence of multidrug
the HIV pandemic and the emergence of multidrug- and extensively drug-resistant TB. Effective TB infection control measures are urgently needed. Escombe et al evaluated the efficacy of upper-room ultraviolet (UV) lights and negative air ionization for preventing airborne TB transmission using a guinea pig air-sampling model to measure the TB infectiousness of ward air. For 535 consecutive days, exhaust air from an HIV-TB ward in Lima, Peru, was passed through three guinea pig air-sampling enclosures each housing approximately 150 guinea pigs, using a 2-d cycle. On UV-off days, ward air passed in parallel through a control animal enclosure and a similar enclosure containing negative ionizers. On UV-on days, UV lights and mixing fans were turned on in the ward, and a third animal enclosure alone received ward air. TB infection in guinea pigs was defined by monthly tuberculin skin tests. All guinea pigs underwent autopsy to test for TB disease, defined by characteristic autopsy changes or by the culture of Mycobacterium tuberculosis from organs. 35% (106/304) of guinea pigs in the control group developed TB infection, and this was reduced to 14% (43/303) by ionizers, and to 9.5% (29/307) by UV lights (both p <0.0001>TB disease was confirmed in 8.6% (26/304) of control group animals, and this was reduced to 4.3% (13/303) by ionizers, and to 3.6% (11/307) by UV lights (both p <0.03>TB infection was prevented by ionizers (log-rank 27; p <0.0001)>and by UV lights (log-rank 46; p <0.0001).>TB disease was prevented by ionizers (log-rank 3.7; p =0.055) and by UV lights (log-rank 5.4; p=0.02). An alternative analysis using an airborne infection model demonstrated that ionizers prevented 60% of TB infection and 51% of TB disease, and that UV lights prevented 70% of TB infection and 54% of TB disease. In all analysis strategies, UV lights tended to be more protective than ionizers. In conclusion, upper-room UV lights and negative air ionization each prevented most airborne TB transmission detectable by guinea pig air sampling. Provided there is adequate mixing of room air, upper-room UV light is an effective, low-cost intervention for use in TB infection control in high-risk clinical settings.
AIDS prevention in Portuguese-speaking Africa: a review of the recent literature in the social sciences and health. Cad Saude Publica. 2009;25(3):680-6.
The article reviews academic literature in the social sciences and health on the problems and challenges of sexually transmitted diseases and HIV prevention in Portuguese-speaking African countries. Based on a bibliographic survey of the SciELO, PubMed, and Sociological Abstracts databases between 1997 and 2007, the research under review was organized into two groups, according to content. The first group of studies sought to understand sexually transmitted diseases and HIV vulnerability among social groups by examining local cultural and socioeconomic factors as related to gender dynamics, sexuality, colour/race, religion and health care. The second group encompassed critical assessments of shortcomings in the sexually transmitted diseases and HIV educational messages delivered by governments and international agencies. Attention is called to the way in which the presence of traditional medicine systems and the occurrence of civil wars in the post-colonial period affect the sexually transmitted diseases and HIV epidemic in the African countries under study.
Portuguese-speaking African countries, known by the acronym PALOP (Países Africanos de Língua Oficial Portuguesa) are Mozambique, Angola, Cape Verde, Guinea-Bissau, Equatorial Guinea, and São Tomé and Principe. Although there are cultural and socio-economic similarities between these countries, appreciation of local contexts is critical to understanding how healthcare practices, gender roles, and the interpretation of prevention messages are mediated locally by cultural dynamics and socio-economic and political contexts. This review suggests that demystifying condom use in a pragmatic CNN approach (condoms, needles, and negotiation) as opposed to the moralizing ABC approach (abstinence, be faithful, and condoms for marginalized populations), along with frank and open discussions of sexuality in public fora and the media, would achieve positive results, particularly if accompanied by advances in citizenship rights and equal opportunities.
Tuesday, November 6, 2012
sexually transmitted infections among female sex workers in Cambodia
sexually transmitted infections among female sex workers in Cambodia: high turnover seriously challenges the 100% Condom Use Programme. BMC Infect Dis. 2008;8:167.
Cambodia ’s 100% Condom-Use Programme, implemented nationally in 2001, requires brothel-based female sex workers to use condoms with all clients. In 2005, Sopheab et al conducted a sexually transmitted infection survey among female sex workers. This paper presents sexually transmitted infection prevalence and related risk factors, and discusses prevalence trends in the context of the 100% Condom-Use Programme in Cambodia. From March-May, 1079 female sex workers from eight provinces consented to participate, provided specimens for syphilis, chlamydia, and gonorrhoea testing, and were interviewed. Univariate and multivariate logistic regression analysis was used to determine factors associated with sexually transmitted infections. The prevalence of sexually transmitted infection was compared with data from the 1996 and 2001 sexually transmitted infection surveys. Most female sex workers were young (55% aged 15-24) and new to sex work ( 60% had worked 12
Editors’ note: Successful 100% condom use programmes in Thailand in late 1989 and Cambodia in late 1998 were rigorously conducted with high coverage and intensity. Sustaining such results given the high turnover among sex workers requires regular evaluations of programme quality and impact. Using curable bacterial sexually transmitted infection prevalence makes sense as they are good biological markers reflecting recent risk behaviour but different data collection methods, specimen-sampling techniques, and laboratory methods can make comparison of survey results hazardous. One thing is clear – Cambodia’s 100% condom-use programme, implemented nationally in 2001, should focus attention on ascertaining and addressing the prevention needs of new sex workers.
Bernays S, Rhodes T. Experiencing uncertain HIV treatment delivery in a transitional setting: qualitative study.
Bernays S, Rhodes T. Experiencing uncertain HIV treatment delivery in a transitional setting: qualitative study.
Advances in HIV treatment availability mean that the promise of highly active anti-retroviral treatment to turn HIV into a manageable chronic illness is becoming a reality for millions. However the mutability of the virus means that treatment adherence demands are high, and the supply of these life-saving treatments needs to be constant. The onus is generally placed on the individual to adhere, and there is little focus in research or policy on the state’s adherence to delivering treatment consistently. Bernays and colleagues undertook in-depth qualitative interviews to explore the narratives of HIV treatment experience among 41 people living with HIV and 18 HIV treatment service providers in Serbia and Montenegro, a transitional setting in which state delivered and funded HIV treatment is inconsistently available. Data were analysed inductively and thematically. Treatment shortages were common so the delivery of appropriate HIV treatment was not continuous. Access to reliable treatment and supply forecast information was weak and uneven. The insecure treatment situation fostered significant anxiety amongst people living with HIV. In the absence of reliable and sustained treatment access, information, and support, people living with HIV absorb the anxieties of system failures. This uncertainty led to an individuation of “treatment”. People living with HIV adopted rationing strategies to mediate their anxiety, energy and hope. This predominately resulted in varying forms of disengagement and neglect for social change. It is likely that this has significant negative implications for the promotion of HIV treatment advocacy and anti-stigma efforts.
Editors’ note: Adherence literature to date has focused primarily on patient adherence to treatment regimens rather than on the social and psychological effects of involuntary treatment interruptions. Fragile treatment delivery undermines the quality of life and capacity of people living with HIV to manage it as a manageable, chronic illness. Although some people in this study reduced their anxiety by fostering networks and resources to gain access to information and treatment, a form of social capital to generate security, others withdrew, trusting no one but their treatment provider and becoming less likely to disclose to others. This research highlights the clear need for a social science of scale-up
Delany-Moretlwe S, Lingappa JR and Celum C. New Insights on Interactions Between HIV-1 and HSV-2.
Delany-Moretlwe S, Lingappa JR and Celum C. New Insights on Interactions Between HIV-1 and HSV-2. .
Herpes simplex type 2 (HSV-2) infection is common and frequently asymptomatic. Concerns exist about the high prevalence of HSV-2, particularly in areas of high HIV prevalence, because of observations that HSV-2 is associated with an increased risk of HIV acquisition, transmission, and disease progression. Several randomized trials have tested or are testing whether HSV-2 treatment can limit the spread of HIV, with mixed results. Although treatment with acyclovir, 400 mg twice daily, does not reduce HIV incidence, suppressive acyclovir and valacyclovir reduce HIV levels in plasma and in the genital tract. Ongoing trials are evaluating whether HSV suppression will reduce HIV transmission and disease progression. Until a protective HSV-2 or HIV vaccine is available, effective interventions that reduce the effect of HSV-2 on HIV transmission are critically needed.
Editors’ note: This excellent summary of what is known about the complex and bidirectional interactions between HIV-1 and herpes simplex virus–2 (HSV-2) was published before the May 8 th release of results from the multi-centre Partners in Prevention Study of 3408 discordant couples conducted in Botswana, Kenya, Rwanda, South Africa, Tanzania, Uganda and Zambia. To test whether HSV-2 daily suppressive therapy would reduce HIV transmission, HIV/HSV-2 co-infected partners were randomised to receive acyclovir 400 mg twice daily or matching placebo for 2 years while the uninfected partner was followed-up for HIV-1 seroconversion. Although acyclovir reduced the frequency of genital ulcers by 73% and HIV viral load by 40%, no significant difference was found in the rate of HIV transmission. A 17% reduction in HIV disease progression produced by low cost acyclovir was an intriguing result worthy of further study. With more than half a billion people infected with HSV-2, including up to 90% of people living with HIV, developing an HSV-2 vaccine continues to be a very high priority.
Male Circumcision for the Prevention of HSV-2 and HPV Infections and Syphilis. N Engl J Med.
Male Circumcision for the Prevention of HSV-2 and HPV Infections and Syphilis. N Engl J Med.
Male circumcision significantly reduced the incidence of human immunodeficiency virus (HIV) infection among men in three clinical trials. Tobian and colleagues assessed the efficacy of male circumcision for the prevention of herpes simplex virus type 2 (HSV-2) and human papillomavirus (HPV) infections and syphilis in HIV-negative adolescent boys and men. They enrolled 5534 HIV-negative, uncircumcised male subjects between the ages of 15 and 49 years in two trials of male circumcision for the prevention of HIV and other sexually transmitted infections. Of these subjects, 3393 (61.3%) were HSV-2– seronegative at enrolment. Of the seronegative subjects, 1684 had been randomly assigned to undergo immediate circumcision (intervention group) and 1709 to undergo circumcision after 24 months (control group). At baseline and at 6, 12, and 24 months, the authors tested subjects for HSV-2 and HIV infection and syphilis, along with performing physical examinations and conducting interviews. In addition, they evaluated a subgroup of subjects for HPV infection at baseline and at 24 months. At 24 months, the cumulative probability of HSV-2 seroconversion was 7.8% in the intervention group and 10.3% in the control group (adjusted hazard ratio in the intervention group, 0.72; 95% confidence interval [CI], 0.56 to 0.92; P = 0.008). The prevalence of high-risk HPV genotypes was 18.0% in the intervention group and 27.9% in the control group (adjusted risk ratio, 0.65; 95% CI, 0.46 to 0.90; P = 0.009). However, no significant difference between the two study groups was observed in the incidence of syphilis (adjusted hazard ratio, 1.10; 95% CI, 0.75 to 1.65; P = 0.44). In addition to decreasing the incidence of HIV infection, male circumcision significantly reduced the incidence of HSV-2 infection and the prevalence of HPV infection, findings that underscore the potential public health benefits of the procedure.
date, limited statistical power, confounding by sexual practices correlated with a high risk of transmission, and determination of circumcision status only by self-report have plagued observational studies on male circumcision and sexually transmitted infections. This randomised, controlled trial in rural Uganda demonstrates that male circumcision in adolescent boys and men significantly reduces the incidence of herpes simplex virus-2 (HSV-2) infection and the prevalence of human papilloma virus (HPV) infection. Whether the latter is due to decreased HPV acquisition or increased HPV clearance is unclear but it does explain the lower risk of cervical cancer experienced by women whose partners are circumcised. The adjusted efficacy of male circumcision was 28% for the prevention of HSV-2, an infection thought to be a cofactor in HIV acquisition. This may explain in part the incontrovertible partial protection from HIV afforded by male circumcision.
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