எய்ட்ஸ் & மருத்துவ ஆராய்ச்சி இதழ்

Objective: The study purpose was to compare ambulatory function in men with and without HIV infection, and test the association with aerobic exercise capacity.

Methods: We conducted a cross-sectional study of 45 HIV-infected men and 37 age and race-matched HIVuninfected men at the Baltimore VA Medical Center. Participants performed cardiorespiratory exercise testing, sixminute walk (6-MW) and the 400-meter long distance corridor walk (LDCW) as part of a study of veterans without history of CVD.

Results: The mean (SD) age was 55 (6) years. Among the 82 male participants, 98% were African American race. The 6-MW distance correlated with aerobic exercise capacity (VO2peak) in both HIV-infected subjects (r=0.50, p<.001) and uninfected subjects (r=0.57, p<0.001). Duration in the 400 meter LDCW inversely correlated with VO2peak in HIV-infected (r=-0.52, p<.001) and uninfected subjects (r=- 0.48, p<.001). In linear regression models the variance in VO2peak explained by the endurance walk test was similar for the 6-MW and LDCW across HIV groups (all p>0.1). Between HIV groups, there was a significant difference in LDCW (p=0.01) but not in 6-MW (p=0.3).

Conclusions: In HIV-infected men without known CVD the 6-MW and LDCW, provide similar estimates of aerobic exercise capacity. The findings are comparable to uninfected men with similar demographic and clinical characteristics, and support endurance walk tests to estimate aerobic exercise capacity in HIV-infected patients.

Ultra-sensitive laboratory assays based on the Polymerase Chain Reaction (PCR) are playing an increasingly important role in HIV cure-related research. This article reviews the different assays available and how they have evolved. There is a great need for their standardization and for the establishment of reference reagents and testing algorithms to evaluate potential HIV cure-related treatments.

Objective: To perform a systematic review and meta-analysis of the efficacy of risk reduction interventions on HIV-related risk behaviors among people living with HIV/AIDS (PLWHA)

Methods: Studies included in the meta-analysis were randomized clinical trials (RCTs) of risk reduction interventions, which targeted PLWHA aged 18 year or older and assessed the changes of number of sexual partners, drug use, needle sharing, and/or alcohol abuse between pre- and post-intervention. The standardized mean differences (SMD) between study arms as well as between baseline and post-intervention, defined as the effect sizes (ES), were calculated in random effects models. Heterogeneity of studies was estimated by the I2 statistic.

Results: Twelve RCTs involving 3993 PLWHA were included in our analysis: seven reported impacts on the number of sexual partners, and three reported impacts on drug use, needle sharing, and alcohol abuse, respectively. There were no statistically significant impacts of risk reduction interventions on the number of total sexual partners (mean ES, -0.10; 95% confidence interval [CI], -0.26, 0.06; P=0.22) or on the subset of HIV-negative or unknownstatus sexual partners (mean ES, 0.003; 95% CI, -0.54, 0.54; P=0.99). Overall, risk reduction intervention studies documented a reduction of drug abuse (mean ES: -0.26; 95% CI: -0.51, -0.01; P=0.04) among HIV-infected drug users, but this impact was mainly attributable to one study. Risk reduction interventions did not show a reduction of needle sharing (mean ES, -0.15; 95% CI, -0.43, 0.13; P=0.29) or of alcohol abuse (mean ES, -0.10; 95% CI, -0.36, 0.17; P=0.47). No heterogeneity or publication bias was found across individual studies.

Conclusions: Our meta-analysis did not find a positive impact of risk reduction interventions on number of sexual partners, drug use, needle sharing, or alcohol abuse among PLWHA, but the small number of studies meeting our review criteria limits these findings.

Background: Biological testing for Sexually Transmitted Infections (STI) are challenged by sample collection and high testing costs, where self-reports are used in predicting STI status. The validity of self-reports among populations at STI risk has not been established clearly. The objective of this paper is to assess the validity of selfreported ‘STI symptoms’, self-reported ‘recent condom non- use’ and ‘inconsistent condom use’ in comparison with laboratory diagnosed STIs among men who have sex with men (MSM) in India.

Methods: Data were drawn from a cross sectional Integrated Behavioural and Biological Assessment survey conducted among MSM between 2005-2007 in India. Sensitivity analysis was used to assess the validity of selfreported ‘STI symptoms’, ‘recent condom non-use’ and ‘inconsistent condom use’ with laboratory diagnosed STIs (syphilis/Neisseria gonorrhoeae/ Chlamydia trachomatis). Multiple logistic regressions were used to identify population characteristics which were predictive of concordant self-reporting.

Results: Of 3895 MSM surveyed, 14.3% were diagnosed with any STI while 8.3% and 3% reported any STI symptom in past and current respectively. Recent condom non-use and inconsistent condom use was reported by 43.1% and 77.6% of respondents. Self-reported STI symptoms showed very low sensitivity (5-13) in predicting laboratory diagnosis of STIs. Self-reported inconsistent condom use and recent condom non-use showed higher sensitivity than self-reported STI symptoms (50-74.4), but were less specific (21-52.9). Combined self reports showed relatively higher sensitivity (52.3-77.9) and low specificity (18.9 -51.8). Overall self reports showed very high negative predictive value (84.4-87.9) and low positive predictive value (12.4-15.7). Education grade more than 12 [AOR: 3.2 (CI 1.7-5.9)], and STI/HIV information exposure [AOR: 1.4 (CI 1.0-2.0)] were predictive of concordant self-reporting of STI symptoms and inconsistent condom use respectively. Knowledge about STIs [AOR: 1.4 (CI 0.9-2.2)] and education grade more than12 [AOR: 2.5 (CI 1.2-5.3)] were predictive of concordant self-reporting of symptoms/risk.

Conclusions: Self-reports of STI symptoms, recent condom non-use and inconsistent condom use were not reliable in predicting true STI status of MSM and thus highlights the limitations in the validity of self-reports collected at different levels in the program setting. The study identified MSM education status, STI/HIV knowledge and information exposure, as predictors of concordant self-reporting of ‘symptoms’ and ‘inconsistent condom use’ with STI laboratory diagnosis, which could be utilized in future survey efforts for improving validity of self-reports.

Background: In a resource-limited setting, patients on antiretroviral treatment are monitored by using immunological and clinical assessment due to the inaccessibility of viral load monitoring. The aim of this study was to assess the rate and predictors of immunological failure among patients taking highly active antiretroviral treatment at Debremarkos hospital, Northwest Ethiopia.

Methods: Retrospective follow up study was conducted at Debremarkos hospital on 509 adults who had started antiretroviral treatment during the period between January 01, 2007 and April 01, 2008. Data were analyzed using SPSS version 20. Life table and Kaplan-Meier curve was used to estimate the cumulative probablities and median time for immunologic failure respectively. Cox proportional hazard model was fitted to compute hazard ratios with their 95% confidence intervals.

Result: The median follow up time was 36 months (Inter Quartile Range (IQR) = 12-49 months). 107 (21%) patients had developed immunological failure with a failure rate of 8 per 100 patient-years of follow up. Recurrent pneumonia infection (Adjusted Hazards Ratio (AHR)=1.62, 95% CI: 1.10, 2.40), unemployment (AHR: 1.74, 95% CI: 1.11, 2.74), inability to work due to health problem (AHR= 2.19, 95%CI: 1.20, 4.02), baseline CD4 count ≤ 100 cells/ mm3 (AHR: 2.16, 95% CI: 1.44, 3.25) and change in body weight (AHR: 4.34, 95% CI: 2.93, 3.23) were significant predictors of immunological failure.

Conclusion: The immunological failure rate was found to be high. Recurrent pneumonia infection, being unemployed, inability to work, baseline CD4count less than 100 cells/mm3 and decrease in body weight were predictors of immunological failure. Early initiation of highly active antiretroviral treatment, attempt to improve Socioeconomic status of patients, and counseling patients to have protein rich diets would prevent early immunologic failure.

Background: A practical guideline for detection and managements of some common infectious agents in cases with chronic ITP (Idiopathic Thrombocytopenic Purpura) is so important. Objectives: to investigate the role of H. pylori infection in children with chronic ITP in an endemic area. Materials and methods: A case control study done in pediatric ward Rasul Hospital, Tehran, Iran (2009-2010). 51 chronic ITP cases and 25 controls were assessed. H. pylori IgG & IgA ELISA (LDN -Germany) assesses in all cases and controls. All cases undergoing Bone Marrow Aspiration. H. pylori -PCR evaluated (QIAquickP® QIAGEN; Germany). P-value <0.05 was considered statistically significant. Results: cases were between 1- 20 years (mean 13.3.5 ± 7.6 y). Platelet count varied between 5000-1330000 (mean 63621 ± 37369.9) Positive H. pylori- IgA observed in 70% (36/51) of cases and 4% (1/25) of controls; p-value=0.00. H. pylori (IgG) was not significantly difference between cases and controls. [51% (26/51) vs. 32% (8/25), p-value=0.09] .Poor agreement observed between H. pylori –IgA and H. pylori - IgG antibodies and severity of thrombocytopenia in ITP cases (Kappa=-0.11; 0.04). Positive PCR results was % 5.9% (3/51) in ITP cases without significant difference in age between positive and negative PCR results (mean age 9.3 ± 9.7 years vs. 13.5 ± 7.52 years; p-value =0.3) Poor agreement between positive PCR and positivity of IgA (actual agreement=47.062%; p-value =0.5; Kappa=- 0.04), and IgG antibodies (actual agreement=40.91%; p-value =0.6; Kappa=- 0.04 respectively) were observed in ITP cases. Conclusion: We concluded that H. pylori infection (serologically) is high in young Iranian population. In chronic ITP, the H. pylori infection can be considered as an additional disorder which aggravates the main disease. The management of mild-to-moderate chronic ITP in Iranian patients, especially those with a recent onset of disease, should include an investigation for and eradication of infection with H. pylori.