Suchergebnisse

Abstract Background Prevention of mother to child HIV transmission (PMTCT) remains a challenge in low and middle-income countries. Determinants of utilization occur – and often interact - at both individual and community levels, but most studies do not address how determinants interact across levels. Multilevel models allow for the importance of both groups and individuals in understanding health outcomes and provide one way to link the traditionally distinct ecological- and individual-level studies. This study examined individual and community level determinants of mother and child receiving PMTCT services in Tigray region, Ethiopia. Methods A multistage probability sampling method was used for this 2011 cross-sectional study of 220 HIV positive post-partum women attending child immunization services at 50 health facilities in 46 districts. In view of the nested nature of the data, we used multilevel modeling methods and assessed macro level random effects. Results Seventy nine percent of mothers and 55.7% of their children had received PMTCT services. Multivariate multilevel modeling found that mothers who delivered at a health facility were 18 times (AOR = 18.21; 95% CI 4.37,75.91) and children born at a health facility were 5 times (AOR = 4.77; 95% CI 1.21,18.83) more likely to receive PMTCT services, compared to mothers delivering at home. For every addition of one nurse per 1500 people, the likelihood of getting PMTCT services for a mother increases by 7.22 fold (AOR = 7.22; 95% CI 1.02,51.26), when other individual and community level factors were controlled simultaneously. In addition, district-level variation was low for mothers receiving PMTCT services (0.6% between districts) but higher for children (27.2% variation between districts). Conclusions This study, using a multilevel modeling approach, was able to identify factors operating at both individual and community levels that affect mothers and children getting PMTCT services. This may allow differentiating and accentuating approaches for different settings in Ethiopia. Increasing health facility delivery and HCT coverage could increase mother-child pairs who are getting PMTCT. Reducing the distance to health facility and increasing the number of nurses and laboratory technicians are also important variables to be considered by the government.

Abstract Pulmonary emphysema and bronchiectasis in HIV seropositive patients has been described in the presence of injection drug use, malnutrition, repeated opportunistic infections, such as Pneumocytis jirovici pneumonia and Mycobacterium tuberculosis infection, and has been linked to the presence of HIV virus in lung tissue. Given the high burden of pulmonary infections and malnutrition among people living with HIV in resource poor settings, these individuals may be at increased risk of developing pulmonary emphysema, potentially reducing the long term benefit of antiretroviral therapy (ART) if initiated late in the course of HIV infection. In this report, we describe three HIV-infected individuals (one woman and two children) presenting with extensive pulmonary cystic disease.

IntroductionThe source and significance of residual plasma HIV‐1 RNA detection during suppressive ART remain controversial. It has been proposed that nevirapine (NVP)‐based regimens achieve a greater HIV‐1 RNA suppression than regimens containing a protease inhibitor (PI). The aim of this study was to compare the effect of receiving NVP‐ vs PI‐based ART on the virological markers of HIV persistence in peripheral blood.Material and MethodsThe study population comprised 161 HIV‐1 infected patients receiving either NVP‐based (n=81) or PI‐based (n=80) ART and showing a HIV‐1 RNA load stably suppressed <40 copies/mL for median of 5.2 years (IQR 2.2–8.0). Residual viraemia was detected by real‐time PCR with 50% and 95% detection thresholds of 1 and 3 HIV‐1 RNA copies/mL, respectively. Cell‐associated (CA) unspliced HIV‐1 RNA, total HIV‐1 DNA and 2 LTR circles were quantified in peripheral blood mononuclear cells (PBMCs) using droplet digital PCR. Groups were compared by standard non‐parametric tests; factors associated with HIV‐1 detection were analyzed by univariate regression analysis and generalized linear models (SPSS® V22 and Rstudio).ResultsPlasma HIV‐1 RNA was detected in 37/81 (45.7%) and 47/80 (58.8%) subjects on NVP‐ and PI‐based ART, with median (IQR) levels of 5 (3–6) and 5 (3–8) copies/mL, respectively. HIV‐1 RNA detection was associated with shorter duration of suppressive ART regardless of treatment arm (p=0.007), and lower CD4 nadir (p=0.015). HIV‐1 DNA levels were median 282 (120–484) and 213 (87–494) copies/106 PBMCs in the two groups respectively, and were lowest (<100 copies/106 PBMCs) in subjects with lower plasma HIV‐1 RNA (p=0.049), CA unspliced HIV‐1 RNA (p=0.0001), 2 LTR circles (p=0.005) and pre‐ART HIV‐1 RNA load (p=0.0001).ConclusionsIn this comprehensive characterization of patients on long‐term suppressive ART, we did not observe evidence for a greater suppressive activity of NVP‐based over PI‐based therapy on plasma and intracellular markers of virus persistence. Overall excellent correlation was observed between the markers, allowing the identification of a subset of treated patients with low HIV‐1 expression as an important cohort for future HIV cure studies.