Seek and treat: HIV update 2011

Estimados colegas dejo aqui otro artículo.
Saludos
Dr. carlos Erazo

http://www.ccjm.org/content/78/2/95.full.pdf+html

Although mortality rates from human immunodeficiency virus (HIV) infection have declined dramatically in the United States, the incidence of new infections has not improved for more than a decade. The case is now strong for routine screening and early treatment of HIV infection to reduce transmission of the infection and to give patients an opportunity to live a reasonably healthy life.
Clinicians in all health care settings should routinely and matter-of-factly test their patients for HIV infection, just as they screen for other diseases.

Using Pre-Exposure Prophylaxis (PrEP) as a Prevention Tool for MSM: The Promise Comes with Challenges

Estimados colegas, este es un nuevo cometario sobre la implementación del PREP , en USA.
Saludos
Dr. Carlos Erazo

http://blog.aids.gov/2011/02/using-pre-exposure-prophylaxis-prep-as-a-prevention-tool-for-msm-the-promise-comes-with-challenge-.html?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+aids%2Fgov+%28Blog.AIDS.gov%29

By Ronald Valdiserri, M.D., M.P.H, Deputy Assistant Secretary for Health, Infectious Diseases, U.S. Department of Health and Human Services

Dr. Ronald Valdiserri

On Saturday, February 26^th, I attended a day-long meeting organized by the Centers for Disease Control and Prevention (CDC) and hosted by the Fenway Community Health Center in Boston. The theme of the meeting was “Moving forward with PrEP Implementation.” Meeting participants included researchers involved in the original iPrEX study and other ongoing HIV prevention studies, health care providers caring for men-who-have-sex-with-men (MSM), state and local health department program directors, MSM community advocates, policy experts, and federal officials.
The meeting began with a detailed review of the iPrEx study, which included nearly 2,500 participants from Peru, Ecuador, Brazil, Thailand, South Africa, and the United States. Participants were MSM engaging in high-risk sex with other men—including a small number of transgender women who reported high-risk sex with men. The study findings, released in November 2010, showed that sexually active MSM who took a once-daily pill containing 2 anti-HIV drugs were 44% less likely to become infected with HIV, compared with participants who took a placebo.
Because iPrEx was a “blinded” study, participants did not know if they were receiving active drugs or placebos (inactive drugs). As such, all study participants received intensive risk-reduction counseling. Along with this counseling, all study participants also received monthly HIV testing, condom provision, and treatment for other acquired sexually transmitted diseases.
When these results were summarized at the Saturday meeting in Boston, the audience was reminded that the level of protection experienced by study participants who received the active drug varied widely, depending upon how consistently they took their daily pills. For those who took the daily drug at least 90% of the time, HIV risk was reduced by 73%. Others, who took the drug less frequently, had only a 21% reduction in HIV risk. Given this finding, a significant theme of our discussion in Boston was the critical role that adherence counseling must play in any future efforts to develop and implement PrEP programs for MSM.
The U.S. Public Health Service is currently at work on guidelines for PrEP use among MSM. In the meantime, CDC has released interim guidance, as well as a fact sheet on Pre-Exposure Prophylaxis for HIV Prevention (PDF). But, as our meeting in Boston highlighted, there are many critical questions that must be answered before we can move this important prevention research finding from the pages of a scientific journal and into the day-to-day lives of MSM who are at high, ongoing risk for HIV infection. Several of the major questions raised by participants were:

• Among the diverse communities of MSM in the U.S., what subset of men would be the most appropriate candidates for this new prevention tool?
• Given the disproportionate burden of HIV infection among MSM of color—many of whom also live at or near the poverty level—how will daily drug treatments be financed?
• In the real world of competing needs and resource constraints, how should PrEP programs for MSM be combined with other prevention approaches for MSM to result in the greatest pay-off in terms of decreasing new HIV infections?
• How do we build the needed capacity among medical providers, health departments, and community-based organizations so that PrEP can be implemented as part of a comprehensive package of HIV prevention services for MSM at risk for HIV?
• Could PrEP serve as a “gateway” into other equally effective—and perhaps less costly—prevention approaches for MSM?

While everyone at the Boston meeting recognized the promise of this new tool, there was a general consensus that PrEP is not a “magic bullet” and that it should not be viewed as the sole approach to reducing new HIV infections among MSM.
Moving forward with discussions about how to implement PrEP as a new prevention strategy for MSM, let’s keep in mind the necessity of supporting combined biomedical, behavioral, and structural approaches—all of which are called for in the National HIV/AIDS Strategy. Given the ongoing burden of new HIV infections among MSM communities in the United States, we are obliged to carefully examine our current approaches and, when called for, make changes in where and how we deliver our HIV prevention services.

Postpartum changes in plasma viral load and CD4 percentage among HIV-infected women from Latin American and Caribbean countries: the NISDI Perinatal Study

Saludos
Dr. Carlos Erazo
http://www.scielo.br/pdf/mioc/v106n1/16.pdf

The goal of this study was to evaluate changes in plasma human immunodeficiency virus (HIV) RNA concentration [viral load (VL)] and CD4+  percentage (CD4%) during 6-12 weeks postpartum (PP) among HIV-infected women and to assess differences according to the reason for receipt of antiretrovirals (ARVs) during pregnancy [prophylaxis (PR) vs. treatment (TR)]. Data from a prospective cohort of HIV-infected pregnant women (National Institute of Child Health and Human Development International Site Development Initiative Perinatal Study) were analyzed. Women experiencing their first pregnancy who received ARVs for PR (started during pregnancy, stopped PP) or for TR (initiated prior to pregnancy and/or continued PP) were included and were followed PP. Increases in plasma VL  (≥ 0.5 log 10 ) and decreases in CD4% (≥ 20% relative decrease in CD4%) between hospital discharge (HD) and PP were assessed. Of the 1,229 women enrolled, 1,119 met the inclusion criteria (PR: 601; TR: 518). At enrollment, 87%  were asymptomatic. The median CD4% values were: HD [34% (PR); 25% (TR)] and PP [29% (PR); 24% (TR)]. The  VL increases were 60% (PR) and 19% (TR) (p < 0.0001). The CD4% decreases were 36% (PR) and 18% (TR) (p < 0.0001). Women receiving PR were more likely to exhibit an increase in VL [adjusted odds ratio (AOR) 7.7 (95%  CI: 5.5-10.9) and a CD4% decrease (AOR 2.3; 95% CI: 1.6-3.2). Women receiving PR are more likely to have VL increases and CD4% decreases compared to those receiving TR. The clinical implications of these VL and CD4% changes remain to be explored. 

Vertical transmission of HIV-1 in the western region of the State of São Paulo

Saludos colegas
Dr. Carlos Erazo

http://www.scielo.br/pdf/rsbmt/v44n1/02.pdf

ABSTRACT

Introduction: This study aimed to determine the prevalence of vertical HIV-1 transmission  in the western region of the State of São Paulo, Brazil. Methods: The study analyzed the medical records of HIV-1-infected mothers and infant pairs living in the municipalities of São Paulo Regional Health Departments DRS II (Araçatuba) and DRS XI (Presidente Prudente). From March 2001 to March 2006, blood samples were collected and referred to the Molecular Biology Unit of the Adolfo Lutz Institute (ALI), Presidente Prudente. HIV-1-RNA viral load was determined by bDNA assay. Results: The number of births (109/217, 50.2%) and vertical HIV-1 transmissions (6/109, 5.5%) that occurred in DRS II was similar to births (108/217, 49.8%) and vertical transmissions (7/108, 6.5%) in DRS XI (p > 0.05). Although 80% (4/5) of the infected children were male in DRS II, while in DRS XI, 75% (6/8) were female, no differences between sex regarding infected and noninfected children in the regions of Araçatuba and Presidente Prudente were verified. The overall vertical HIV-1 transmission rate was 6%. No consistent reduction in the prevalence of vertical HIV-1 transmission occurred over the years. About 20% of mothers did not know the HIV-1 status 

of their newborns eight months after delivery. Conclusions: In the present study, MTCT prevalence rates were about 70% higher than those previously determined in the State of São Paulo, with no reduction throughout the period. Furthermore, a significant number of mothers did not know the HIV-status of their newborns eight months after delivery

Acceptability of donated breast milk in a resource limited South African setting

Estimados colegas, continuo colocando información en este sitio donde podemos continuar informandonos de lo que existe en cuanto a VIH.

Saludos 

Dr. Carlos Erazo

http://www.internationalbreastfeedingjournal.com/content/pdf/1746-4358-6-3.pdf

Background 

The importance of breast milk for infants’ growth, development and overall health is widely recognized. In situations where women are not able to provide their infants with sufficient amounts of their own breast milk, donor breast milk is the next preferred option. Although there is considerable research on the safety and scientific aspects of donor milk, and the motivations and experiences of donors, there is limited research addressing the attitudes and experiences of the women and families whose infants receive this milk. This study therefore examined attitudes towards donated breast milk among mothers, families and healthcare providers of potential recipient infants.  

Methods 

The study was conducted at a public hospital and nearby clinic in Durban, South Africa. The qualitative data was derived from eight focus group discussions which included four groups with mothers; one with male partners; and one with grandmothers, investigating attitudes towards receiving donated breast milk for infants. There was also one group each with nurses and doctors about their attitudes towards donated breast milk and its use in the hospital. The focus groups were conducted in September and October 2009 and each group had between four and eleven participants, leading to a total of 48 participants. 

Results 

Although breast milk was seen as important to child health there were concerns about undermining of breast milk because of concerns about HIV and marketing and promotion of formula milks. In addition there were concerns about the safety of donor breast milk and discomfort about using another mother’s milk. Participants believed 3 that education on the importance of breast milk and transparency on the processes 

involved in sourcing and preparing donor milk would improve the acceptability.  

Conclusions 

This study has shown that there are obstacles to the acceptability of donor milk, mainly stemming from lack of awareness/familiarity with the processes around donor breast milk and that these could be readily addressed through education. Even the more psychological concerns would also likely be reduced over time as these educational efforts progress. With government and health care worker endorsement and commitment, breast milk donation could have a promising role in improving child health.

The STEP Study Provides a Hint That Vaccine Induction of the Right CD8 1 T Cell Responses Can Facilitate Immune Control of HIV

Estimados colegas , este es un estudio interesante vale la pena leerlo.

Saludos 

Dr. Carlos Erazo

The STEP study was a large, randomized, placebo-controlled, test-of-concept vaccine trial using an Ad5 vector expressing human immunodeficiency virus (HIV)–1 Gag, Pol, and Nef designed to induce T cell immunity to HIV-1. This trial was stopped and unblinded in 2007 after an interim analysis showed that the vaccine did not achieve efficacy for the 2 primary study end points, HIV-1 acquisition and plasma HIV-1 RNA levels 3 months after diagnosis of HIV-1 infection, and suggested that vaccinated individuals with high preexisting antibody titers against Ad5 might be at a higher risk of acquiring HIV-1 infection [1–2]. These results initiated reconsideration in the HIV-1 research field of the role of T cells in protection from HIV-1 infection and disease progression.

http://jid.oxfordjournals.org/content/203/6/753.full.pdf+html

“One Teabag Is Better than Four”: Participants Response to the Discontinuation of 2% PRO2000/5 Microbicide Gel in KwaZulu-Natal, South Africa

Estimados colegas, otro artículo.

Saludos 

Dr. Carlos Erazo

http://www.plosone.org/article/info:doi/10.1371/journal.pone.0014577

Introduction

The Microbicides Development Programme evaluated the safety and effectiveness of 0.5% and 2% PRO2000/5 microbicide gels in reducing the risk of vaginally acquired HIV. In February 2008 the Independent Data Monitoring Committee recommended that evaluation of 2% PRO2000/5 gel be discontinued due to futility. The Africa Centre site systematically collected participant responses to this discontinuation.

Methods

Clinic and field staff completed field reports using ethnographic participant observation techniques. In-depth-interviews and focus group discussions were conducted with participants discontinued from 2% gel. A total of 72 field reports, 12 in-depth-interviews and 3 focus groups with 250 women were completed for this analysis. Retention of discontinued participants was also analysed. Qualitative data was analysed using NVivo 2 and quantitative data using STATA 10.0.

Results

Participants responded initially with fear that discontinuation was due to harm, followed by acceptance after effective messaging, and finally with disappointment. Participants reported that their initial fear was exacerbated by being contacted and advised to visit the clinic for information about the closure. Operational changes were subsequently made to the contact procedures. By incorporating feedback from participants, messages were continuously revised to ensure that information was comprehensible and misconceptions were addressed quickly thereby enabling participants to accept the discontinuation. Participants were disappointed that 2% PRO2000/5 was being excluded as a HIV prevention option, but also that they would no longer have access to gel that improved their sexual relationships with their partners and assisted condom negotiations. In total 238 women were discontinued from gel and 185 (78%) went on to complete their scheduled follow-up period.

Discussion

The use of qualitative social science techniques allowed the site team to amend operational procedures and messaging throughout the discontinuation period. This proved instrumental in ensuring that the discontinuation was successfully completed in a manner that was both understandable and acceptable to participants.

Associação entre violência por parceiro íntimo contra a mulher e infecção por HIV

Estimados colegas , otro artículo interesante.

Saludos

Dr.Carlos Erazo

RESUMO

OBJETIVO: Analisar a associação entre a violência por parceiro íntimo contra mulheres e a infecção ou suspeita de infecção pelo vírus da imunodefi ciência humana (HIV).

MÉTODOS: Estudo transversal com base em dados de questionários aplicados face-a-face e de prontuários médicos de 2.780 mulheres de 15 a 49 anos, atendidas em unidades do sistema único de saúde da Grande São Paulo, SP, em 2001-2002. As mulheres foram categorizadas em: usuárias em tratamento 

por serem “soropositivas para o HIV”, com “suspeita de HIV” e aquelas que procuraram os serviços por outros motivos. A violência por parceiro íntimo contra mulheres na vida foi categorizada por gravidade e recorrência dos episódios de violência. A associação com o desfecho foi testada pelo modelo de Poisson com variância robusta e ajustada por variáveis sociodemográfi cas, sexuais e reprodutivas.

RESULTADOS: A prevalência de violência foi de 59,8%. Sofrer violência reiterada e grave apresentou maior associação de infecção confi rmada pelo HIV (RP = 1,91). A violência independente da gravidade e da recorrência dos episódios apresentou maior associação para a suspeita de infecção por HIV (RP = 1,29). 

CONCLUSÕES: A violência por parceiro íntimo contra mulheres tem papel relevante nas situações de suspeita e confi rmação da infecção pelo HIV, sendo essencial incluir sua detecção, controle e prevenção como parte da atenção integral à saúde das mulheres.

HCV co-infection in HIV positive population in British Columbia, Canada

Estimados colegas este es otro artículo interesante.

Saludos

Dr. Carlos Erazo

http://www.biomedcentral.com/content/pdf/1471-2458-10-225.pdf

Abstract

Background: As HIV and hepatitis C (HCV) share some modes of transmission co-infection is not uncommon. This study used a population-based sample of HIV and HCV tested individuals to determine the prevalence of HIV/HCV coinfection, the sequence of virus diagnoses, and demographic and associated risk factors. Methods: Positive cases of HIV were linked to the combined laboratory database (of negative and positive HCV antibody results) and HCV reported cases in British Columbia (BC).

Results: Of 4,598 HIV cases with personal identifiers, 3,219 (70%) were linked to the combined HCV database, 1,700  (53%) of these were anti-HCV positive. HCV was diagnosed first in 52% of co-infected cases (median time to HIV identification 3 1/2 years). HIV and HCV was diagnosed within a two week window in 26% of cases. Among individuals who were diagnosed with HIV infection at baseline, subsequent diagnoses of HCV infection was independently associated with: i) intravenous drug use (IDU) in males and females, Hazard Ratio (HR) = 6.64 (95% CI: 4.86-9.07) and 9.76 (95% CI: 5.76-16.54) respectively; ii) reported Aboriginal ethnicity in females HR = 2.09 (95% CI: 1.34-3.27) and iii) males not identified as men-who-have-sex-with-men (MSM), HR = 2.99 (95% CI: 2.09-4.27). Identification of HCV first compared to HIV first was independently associated with IDU in males and females OR = 2.83 (95% CI: 1.84-4.37) and 2.25 (95% CI: 1.15-4.39) respectively, but not Aboriginal ethnicity or MSM. HIV was identified first in 22%, with median time to HCV identification of 15 months; Conclusion: The ability to link BC public health and laboratory HIV and HCV information provided a unique opportunity to explore demographic and risk factors associated with HIV/HCV co-infection. Over half of persons with HIV infection who were tested for HCV were anti-HCV positive; half of these had HCV diagnosed first with HIV identification a median 3.5 years later. This highlights the importance of public health follow-up and harm reduction measures for people identified with HCV to prevent subsequent HIV infection.

Short-course zidovudine for perinatal HIV-1 transmission in Bangkok, Thailand: a randomised controlled trial

Estimados colegas, aqui un artículo interesante en cuanto a la Transmisión materno infantil.
Saludos
Dr. Carlos Erazo


http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T1B-3WBNMWW-7&_user=10&_coverDate=03/06/1999&_rdoc=1&_fmt=high&_orig=search&_origin=search&_sort=d&_docanchor=&view=c&_searchStrId=1656570567&_rerunOrigin=scholar.google&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=cd7a81cfe38a07a91f1e78f5db2d535c&searchtype=a

DEPOSITO DE INFORMACION SOBRE EL ESTUDIO HSH

http://sites.google.com/site/ecuadorencuestahsh2010/home

Introduction to Biostatistics

Otro curso gratis para poder ingresar lea el silabus que esta en el siguiente link>

http://www.ccghe.jhmi.edu/assets/Biostats_Syllabus2.pdf

Saludos
Dr. Carlos Erazo

Introduction to Research Ethics Distance Education Online Course http://ccghe.org

Introduction to Research Ethics
Distance Education Online Course
http://ccghe.org

Estimados Colegas este curso on line es gratuito, les adjunto el link para que se enteren de este curso y participen los que esten interesados.

Saludos

Dr, Carlos Erazo
http://www.ccghe.jhmi.edu/assets/Research_Ethics_Online_Syllabus.pdf

Resolución sobre la actualización de la Clasificación Internacional Uniforme de Ocupaciones

Estimados colegas, este es el documento  donde se coloca la lista internacional de ocupaciones respaldados por la OIT(Organización Internacional del Trabajo) .
Esta clasificación será la que se utilizará en el nuevo formato de notificación de casos SIDA.

Les dejo el Link para que puedan bajar el pdf de este documento.
Saludos
Dr. Carlos Erazo


http://www.ilo.org/public/spanish/bureau/stat/isco/docs/resol08.pdf

A Surprising Prevention Success: Why Did the HIV Epidemic Decline in Zimbabwe?

 Estimados colegas, miren este artículo intersante realizado en Zimbawe.
Saludos
Dr. Carlos Erazo

http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000414

* Existe un creciente reconocimiento de que la prevención primaria, incluyendo el cambio de comportamiento, debe ser central en la lucha contra el VIH / SIDA. Los éxitos anteriores en Tailandia y Uganda no puede ser totalmente relevantes para los países afectados del sur de África.
     * Se realizó una síntesis amplia multi-disciplinario de los datos disponibles sobre las causas de la notable disminución de VIH que se ha producido en Zimbabwe (29% de prevalencia de adultos estimada en 1997 a 16% en 2007), en el contexto de graves sociales, políticos, y económico interrupción.
     * Los cambios de comportamiento asociados con la reducción del VIH, principalmente reducciones en las relaciones sexuales extramaritales, comercial e informal, y las reducciones asociadas en los países socios de concurrencia-parecen haber sido estimulada principalmente por una mayor conciencia de las muertes por SIDA y en segundo lugar por el deterioro económico del país. Estos cambios fueron ayudados probablemente por los programas de prevención de la utilización de los medios de comunicación de masas y basados en la iglesia, el lugar de trabajo y otras actividades de comunicación interpersonal.
     * El enfoque en la reducción de socios, además de promover el uso de preservativos para el sexo casual y otros enfoques basados en la evidencia, es crucial para el desarrollo de programas de prevención más eficaz, especialmente en las regiones con epidemias generalizadas de VIH.

FELIZ DIA DEL MÈDICO

ESTIMADOS COLEGAS BUENOS DIAS, RECIBAN TODOS UNA FRATERNA FELICITACIÓN EN ESTE DÍA INTERNACIONAL DEL MÉDICO.

SALUDOS

DR. CARLOS ERAZO

Pulmonary Disease in HIV

Estimados colegas ,les comparto otro artículo interesante.
Saludos
Dr. Carlos Erazo

"Both infectious and noninfectious pulmonary diseases were more common among HIV-positive patients than among HIV-negative controls.
Potent combination antiretroviral therapy has substantially reduced the incidence of infectious pulmonary complications of HIV infection. In a recent analysis of U.S. veterans, investigators compared the incidence of infectious and noninfectious respiratory illnesses between HIV-positive and HIV-negative individuals.
The study population consisted of 33,000 HIV-positive patients and 67,000 HIV-negative controls matched for demographic characteristics. The median age in the cohort was 45, and 98% of participants were men. A subset analysis indicated that although most participants were past or current smokers, the proportion was significantly higher among HIV-positive patients (80% vs. 76%). Pulmonary diagnoses were identified using ICD-9 codes.
Bacterial pneumonia was by far the most common infectious illness and occurred about five times more frequently in HIV-positive patients than in HIV-negative controls. Chronic obstructive pulmonary disease (COPD), lung cancer, pulmonary hypertension, and pulmonary fibrosis were also significantly more common among HIV-positive patients. All these differences held after adjustment for smoking status. The incidence of asthma was similar between groups.
Comment: The notable finding here is the increased rate of noninfectious pulmonary diseases — particularly COPD — among HIV-positive patients, even after adjustment for smoking status. Whether this increased risk would still be present in a population with a lower rate of smoking is unknown. Regardless, the authors argue that HIV can be considered one of the many contributors to chronic lung disease, and certainly the results provide additional impetus for emphasizing smoking cessation in clinical care."
— Paul E. Sax, MD
Published in Journal Watch HIV/AIDS Clinical Care February 14, 2011

Citation(s):

Crothers K et al. HIV infection and risk for incident pulmonary diseases in the combination antiretroviral therapy era. Am J Respir Crit Care Med 2011 Feb 1; 183:388.

• Original article (Subscription may be required)"

Statins Prevent Vascular Events, Independent of Baseline CRP Levels

Estimados colegas , aqui les dejo un estudio sobre las estatinas y la prevención de eventos vasculares, recordando el manejo integral de las personas que viven con el virus de inmunodeficiencia y el artículo anterior en el que disminuye la progresión de la enfermedad.

Saludos
Dr. Carlos Erazo
http://general-medicine.jwatch.org/cgi/content/full/2011/217/5?q=etoc_jwgenmed

"Contrary to some claims, statins benefited high-risk patients with low C-reactive protein levels.
In the 2008 JUPITER trial, healthy adults — with LDL cholesterol levels <130 mg/dL and C-reactive protein (CRP) levels 2 mg/L — who received rosuvastatin (20 mg daily) for 2 years experienced significantly fewer cardiovascular endpoints than those who received placebo (JW Gen Med Nov 18 2008). JUPITER suggested that statins had particular benefits in patients with high baseline CRP levels whose risk was otherwise low, perhaps through an anti-inflammatory effect.
In the industry-supported Heart Protection Study, >20,000 U.K. adults at high risk for vascular events received simvastatin (40 mg) or placebo daily for a mean of 5 years. Overall, patients who received simvastatin had 24% fewer first vascular events (myocardial infarction, stroke, or revascularization) than those who received placebo.
LDL cholesterol and CRP levels were available for 2727 patients. When these patients were stratified into six groups according to baseline CRP levels (from <1.25 to 8.0 mg/L), vascular risk was significantly lower for simvastatin recipients than for placebo recipients in all groups, with no relation to CRP levels. When patients were categorized as having high or low CRP levels and high or low LDL cholesterol levels at baseline, simvastatin recipients with low CRP and LDL cholesterol levels had proportional reductions in vascular risk that were similar to those in participants with high CRP and LDL cholesterol levels.
Comment: Recent evidence suggests that statins produce similar proportional reductions in vascular events regardless of baseline LDL cholesterol levels, and this study suggests that benefits of statins are independent of baseline CRP levels as well, at least in high-risk patients."
— Bruce Soloway, MD
Published in Journal Watch General Medicine February 17, 2011

Citation(s):

Heart Protection Study Collaborative Group. C-reactive protein concentration and the vascular benefits of statin therapy: An analysis of 20 536 patients in the Heart Protection Study. Lancet 2011 Feb 5; 377:469. (http://dx.doi.org/10.1016/S0140-6736(10)62174-5)

Survival after neuroAIDS Association with antiretroviral CNS Penetration-Effectiveness score

Estimados colegas , aquí otro artículo realcionado con VIH.
Saludos
Dr. Carlos Erazo

http://www.neurology.org/content/76/7/644.abstract

Objective: We examined if the CNS Penetration-Effectiveness (CPE) score of antiretroviral drugs was associated with survival after a diagnosis of HIV-related encephalopathy, progressive multifocal leukoencephalopathy (PML), cerebral toxoplasmosis, or cryptococcal meningitis.

Methods: Using data from the FHDH-ANRS CO4, we compared the survival of 9,932 HIV-infected patients diagnosed with a first neurologic AIDS-defining event in the pre–combination antiretroviral therapy (cART) (1992–1995), early cART (1996–1998), or late cART (1999–2004) periods. Follow-up was subdivided (CPE < 1.5 and CPE ≥ 1.5), and relative rates (RR) of death were estimated using multivariable Poisson regression models.

Results: In the pre-cART and early cART periods, regimens with CPE ≥ 1.5 were associated with lower mortality after HIV-related encephalopathy (RR 0.64; 95% confidence interval [CI] 0.47–0.86 and RR 0.45; 95% CI 0.35–0.58) and after PML (RR 0.79; 95% CI 0.55–1.12 and RR 0.45; 95% CI 0.31–0.65), compared to regimens with CPE < 1.5, while in the late cART period there was no association between the CPE score and the mortality. A higher CPE score was also associated with a lower mortality in all periods after cerebral toxoplasmosis (RR 0.68, 95% CI 0.56–0.84) or cryptococcal meningitis (RR 0.50, 95% CI 0.34–0.74). Whatever the neurologic event, these associations were not maintained after adjustment on updated plasma HIV-RNA (missing, <500, ≥500 copies/mL) with RR ranging from 0.82 (95% CI 0.36–1.91) to 1.02 (0.69–1.52).

Conclusion: At the beginning of the cART era, the CPE score was of importance for survival after severe neurologic event, while in the late cART period, the additional effect of CPE score vanished with more powerful antiretroviral regimens associated with plasma viral load control.

Trial suggests statin may affect markers associated with progression of HIV

 Estimados colegas , aquí un resultado muy interesante sobre las estatinas en el progreso de la infección por VIH.


Saludos
Dr. Carlos Erazo

http://jid.oxfordjournals.org/content/early/2011/01/31/infdis.jiq115.full.pdf+html


A recent multicenter clinical trial of atorvastatin, a type of cholesterol-lowering drug, found that although the drug did not inhibit plasma HIV RNA levels, it did inhibit expression of cellular markers of immune activation and inflammation in patients with HIV infection. Since immune activation and inflammation are associated with progression of HIV infection, the implication is that the statin may inhibit disease progression and help in the infection's management. The findings are in a study, available online, published in The Journal of Infectious Diseases.
The investigators, led by Anuradha Ganesan, MD, of the National Naval Medical Center and the Infectious Disease Clinical Research Program in the Department of Preventive Medicine and Biometrics at the Uniformed Services University of the Health Sciences in Bethesda, Md., randomized 22 HIV-1-infected patients not on antiretroviral therapy and with cholesterol levels lower than those requiring statin therapy in a double-blind protocol of high-dose drug or placebo for eight weeks. After a four-to-six-week washout phase, each group was switched to the other treatment for another eight weeks.
The primary objective was to study the effect of atorvastatin on plasma HIV-1 RNA levels, as previous studies had shown conflicting results. The effect on cellular markers of immune activation was a secondary objective. HIV-1 RNA levels were not significantly affected by the drug, but levels of such immune activation markers as CD38 and HLA-DR on CD4 and CD8 T cells were reduced.
The researchers noted that their findings with atorvastatin suggest that understanding the mechanism by which statins affect immune markers may identify new approaches for the management of HIV infection. They point out, however, that their trial was not designed to demonstrate clinical benefits, for which larger studies of longer duration are needed.
In an accompanying editorial, Andrew Carr, MD, of St. Vincent's Hospital in Sydney, Australia, agreed, noting that "a very large study would probably be required to determine whether potentially positive effects of statin therapy on inflammatory biomarkers will translate into less HIV disease progression."

Fast Facts:

1. Statins show potential to alter the chronic immune activation observed in HIV-1 infected patients.
2. In the study, investigators randomized 22 HIV-1-infected patients not on antiretroviral therapy and with cholesterol levels lower than those requiring statin therapy in a double-blind protocol of high-dose atorvastatin or placebo for eight weeks. After a four-to-six-week washout phase, each group was switched to the other treatment for another eight weeks.
3. HIV-1 RNA levels were not significantly affected by the drug, but levels of such immune activation markers as CD38 and HLA-DR on CD4 and CD8 T cells were reduced.

A Randomized, Placebo-Controlled Trial of Abacavir Intensification in HIV-1–Infected Adults With Virologic Suppression on a Protease Inhibitor–Containing Regimen

HIV Clinical Trials, 01/17/2011

Hammer SM et al. – The strategy of intensification with abacavir in patients who are virologically suppressed on a stable antiretroviral regimen does not confer a clinical or virologic benefit. As antiretroviral regimens have become more potent since this trial was completed, it will be even more difficult to prove that late intensification of already virologically suppressed patients will add benefit. However, studies are warranted with drugs with new mechanisms of action to determine whether the level of persistent viremia below 50 copies/ mL can be further reduced and what influence this may have on latent HIV reservoirs.

http://www.mdlinx.com/family-medicine/sdoc-article.cfm/3448375

Cognitive and psychosocial development of HIV pediatric patients receiving highly active anti-retroviral therapy: a case-control study

Abstract
Background: The psychosocial development of pediatric HIV patients has not been extensively evaluated. The
study objectives were to evaluate whether emotional and social functions are differentially associated with HIVrelated
complications.
Methods: A matched case-control study design was conducted. The case group (n = 20) consisted of vertically
infected children with HIV (aged 3-18 years) receiving HAART in Greece. Each case was matched with two randomly
selected healthy controls from a school-based population. CNS imaging and clinical findings were used to identify
patients with HIV-related neuroimaging abnormalities. The Wechsler Intelligence Scale III and Griffiths Mental Abilities
Scales were applied to assess cognitive abilities. The age specific Strengths and Difficulties Questionnaire was used to
evaluate emotional adjustment and social skills. The Fisher’s exact test, student’s t-test, and Wilcoxon rank sum test
were used to compare categorical, continuous, and ordinal scores, respectively, of the above scales between groups.
Results: HIV patients without neuroimaging abnormalities did not differ from patients with neuroimaging
abnormalities with respect to either age at HAART initiation (p = 0.306) or months of HAART treatment (p = 0.964).
While HIV patients without neuroimaging abnormalities had similar cognitive development with their healthy
peers, patients with neuroimaging abnormalities had lower mean General (p = 0.027) and Practical (p = 0.042)
Intelligence Quotient scores. HIV patients without neuroimaging abnormalities had an increased likelihood of both
Abnormal Emotional Symptoms (p = 0.047) and Hyperactivity scores (p = 0.0009). In contrast, HIV patients with
neuroimaging abnormalities had an increased likelihood of presenting with Abnormal Peer Problems (p = 0.033).
Conclusions: HIV patients without neuroimaging abnormalities are more likely to experience maladjustment with
respect to their emotional and activity spheres, while HIV patients with neuroimaging abnormalities are more likely
to present with compromised social skills. Due to the limited sample size and age distribution of the study
population, further studies should investigate the psychosocial development of pediatric HIV patients following the
disclosure of their condition.

http://www.biomedcentral.com/content/pdf/1471-2431-10-99.pdfhttp://www.biomedcentral.com/content/pdf/1471-2431-10-99.pdf

Markers of atherosclerosis and inflammation and mortality in patients with HIV infection☆

Este es un artículo que nos hace ver la realidad de la atención integral en los pacientes que viven con VIH.

Espero que les sea útil

Saludos 

Dr. Carlos Erazo

http://www.atherosclerosis-journal.com/article/PIIS0021915010009135/abstract?rss=yes

Abstract 

Objective

HIV-infected patients are at increased risk for cardiovascular disease, which may be mediated in part by inflammation. Surrogate marker studies suggest an increased prevalence of vascular abnormalities in HIV infection. We examined the association of all-cause mortality in HIV-infected patients with carotid artery intima-media thickness (cIMT) and high-sensitivity C-reactive protein (hsCRP).

Design and methods

Baseline risk factors, cIMT and hsCRP were prospectively measured in 327 HIV-infected participants. Follow-up time with median of 3.1 years was calculated from baseline to death or censored dated 7/31/07. Cox Proportional Hazards models were used to study risk factors associated with mortality.

Results

Thirty-eight (11.6%) of participants have died since study enrollment. cIMT was significantly higher in those who died and decedents were significantly more likely to have cIMT above the 75th percentile. Those who died had higher hsCRP than those alive and more had hsCRP values above 3mg/L. CD4 count was lower and log10 viral load was higher in decedents, but antiretroviral regimens were similar in both groups. cIMT and hsCRP levels were significantly associated with mortality (HR=2.74, 95% CI 1.26–5.97, p=0.01; HR=2.38, 95% CI 1.15–4.9, p=0.02).

Conclusions

Our study demonstrated a strong association of carotid IMT and hsCRP with all-cause death in this HIV-infected population despite being similar with respect to exposure to antiretroviral medications. Together these surrogate markers may be indices of chronic inflammation and unfavorable outcomes in HIV-positive patients.

Oral Tenofovir/FTC for Pre-Exposure Prophylaxis: The iPrEx Study

In the first-ever efficacy trial of antiretroviral-based pre-exposure prophylaxis, once-daily oral tenofovir significantly reduced the risk for HIV acquisition among men who have sex with men.
The use of antiretroviral therapy (ART) for HIV prevention holds great promise, as demonstrated by two major trials this year: First, the CAPRISA 004 study demonstrated a 39% reduction in the risk for HIV acquisition among women who used a 1% tenofovir vaginal gel both shortly before and shortly after sex (JW AIDS Clin Care Jul 26 2010). Second, a phase II study demonstrated the safety of oral tenofovir monotherapy as pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) (Abstract FRLBC102, AIDS 2010). Now, results are available from iPrEx, the first-ever efficacy trial of ART-based PrEP.
Nearly 2500 HIV-negative MSM in South America, the U.S., Thailand, and South Africa were randomized 1:1 in double-blinded fashion to receive once-daily oral tenofovir/FTC or placebo. Both groups received condoms and intensive counseling regarding sexual risk behavior, and every 4 weeks, underwent rapid enzyme-linked immunosorbent assay (ELISA) testing. All participants were screened and treated for urethral sexually transmitted infections (STIs) and syphilis at study entry, every 24 weeks on-study, and for any clinical suspicion of STIs.
During 3324 person-years of follow-up (median, 1.2 years), 36 incident HIV infections were identified in the tenofovir/FTC group versus 64 in the placebo group, for a relative risk reduction of 44% (95% confidence interval, 15%–63%). As was seen in CAPRISA 004, efficacy was strongly related to product use, with risk reductions as follows:

• 32% (95% CI, –41%–67%) at adherence levels <50%
  
• 50% (95% CI, 18%–70%) at adherence levels 50%
  
• 73% (95% CI, 41%–88%) at adherence levels 90%
  

Adverse events and discontinuations were similar between groups, except for an early excess of nausea and weight loss in the tenofovir/FTC group. Serum creatinine elevations occurred in 25 patients in the tenofovir/FTC group versus 14 in the placebo group (P=0.08); all were resolved upon drug discontinuation. Risk compensation (an increase in high-risk sexual behavior in response to perceived protection from the intervention) was not observed in either treatment group.
Viral set points and CD4-cell counts were similar throughout follow-up between patients who seroconverted in the tenofovir/FTC group and those who did so in the placebo group. No drug resistance was observed among those who seroconverted on-study. A nested case-control analysis indicated that most seroconversions within the tenofovir/FTC group likely occurred when the drug was not detectable in plasma or intracellular compartments.
Comment: Although the overall efficacy of PrEP in this study (44%) is disappointing compared to projected estimates, the results demonstrate proof-of-principle and suggest that greater efficacy is possible with higher adherence levels. Interestingly, the case-control analysis hints that taking the drug shortly before exposure might be more relevant to efficacy than overall adherence levels are. Ongoing trials exploring different preparations, components, and intervals of ART within various at-risk populations will help clarify the optimal use of ART as a prevention tool. In the meantime, decisions about policy around ART as prevention — and about the obligations of research teams to offer PrEP and/or tenofovir-based microbicide gel as part of future prevention trials — just got exponentially more complicated.
— Raphael J. Landovitz, MD
Dr. Landovitz is Assistant Professor, Division of Infectious Diseases, Center for Clinical AIDS Research and Education, University of California, Los Angeles. He reports no conflicts of interest.
Published in Journal Watch HIV/AIDS Clinical Care November 23, 2010

Citation(s):

Grant RM et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med 2010 Nov 23; [e-pub ahead of print]. (http://dx.doi.org/10.1056/NEJMoa1011205)

Michael NL. Oral preexposure prophylaxis for HIV — Another arrow in the quiver? N Engl J Med 2010 Nov 23; [e-pub ahead of print]. (http://dx.doi.org/10.1056/NEJMe1012929)

Interim Guidance: Preexposure Prophylaxis for the Prevention of HIV Infection in Men Who Have Sex with Men

The iPrEx study was conducted in Peru, Ecuador, Brazil, Thailand, South Africa, and the United States. Eligible participants were consenting HIV-uninfected men and male-to-female transgender adults (aged ≥18 years) who reported sex with a man and reported engaging in high-risk sexual behaviors during the preceding 6 months, and had no clinical contraindication to taking a combined formulation of 300 mg TDF and 200 mg FTC (TDF/FTC).*

LINK: http://www.cdc.gov/mmwr/pdf/wk/mm6003.pdf

HIV/AIDS Clinical Care / Guía del CDC para profilaxis pre exposición para HSH

HIV/AIDS Clinical Care

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HIV/AIDS Clinical Care for February 14, 2011 CLINICAL PRACTICE GUIDELINE WATCH Interim CDC Guidance on Pre-Exposure Prophylaxis for HIV Prevention in MSM Free! February 14, 2011 | Raphael J. Landovitz, MD, MSc In the wake of the iPrEx study, the CDC offers some general guiding principles for the implementation of pre-exposure prophylaxis. Reviewing: Centers for Disease Control and Prevention (CDC). MMWR Morb Mortal Wkly Rep 2011 Jan 28; 60:65 SUMMARY AND COMMENT What's the Best Way to Measure ART Adherence? February 14, 2011 | Keith Henry, MD The matter is neither simple nor settled. Reviewing: McMahon JH et al. Clin Infect Dis 2011 Feb 15; 52:493 SUMMARY AND COMMENT More Evidence that Treatment Interruptions Are Not SMART February 14, 2011 | Yasir Ahmed, MD, and Helmut Albrecht, MD Intermittent antiretroviral therapy results in inferior CD4-cell recovery and increased rates of opportunistic infections and death, compared to continuous therapy. Reviewing: Kaufmann GR et al. AIDS 2011 Feb 20; 25:441 SUMMARY AND COMMENT Not So Fast: Hepatitis B Vaccination in HIV-Infected Patients February 14, 2011 | Rajesh T. Gandhi, MD An accelerated vaccination schedule improves compliance but sacrifices efficacy in those with CD4 counts <500 cells/mm3. Reviewing: de Vries-Sluijs TEMS et al. J Infect Dis 2011 Jan 25; SUMMARY AND COMMENT Pulmonary Disease in HIV February 14, 2011 | Paul E. Sax, MD Both infectious and noninfectious pulmonary diseases were more common among HIV-positive patients than among HIV-negative controls. Reviewing: Crothers K et al. Am J Respir Crit Care Med 2011 Feb 1; 183:388 SUMMARY AND COMMENT Starting and Switching Antiretroviral Therapy in Children February 14, 2011 | Holly Rawizza, MD First-line PI- and NNRTI-based therapies offer equivalent virologic efficacy in children without prior exposure to NNRTIs. However, when failure occurs, an immediate switch is necessary for those on NNRTIs. Reviewing: The PENPACT-1. (PENTA 9/PACTG 390) Study Team. Lancet Infect Dis 2011 Feb 1; SUMMARY AND COMMENT HIV and Stroke February 9, 2011 | Rajesh T. Gandhi, MD The proportion of hospitalized stroke patients who are HIV-infected is increasing; multiple reasons are likely. Reviewing: Ovbiagele B and Nath A. Neurology 2011 Feb 1; 76:444 Free Full-Text Article Clinical Practice Guideline Watch Interim CDC Guidance on Pre-Exposure Prophylaxis for HIV Prevention in MSM In the wake of the iPrEx study, the CDC offers some general guiding principles for the implementation of pre-exposure prophylaxis. The iPrEx study recently demonstrated proof-of-principle for the efficacy of oral chemoprophylaxis in preventing HIV infection among men who have sex with men (MSM). Daily tenofovir/FTC (Truvada) was associated with a 44% reduction in the risk for HIV acquisition, relative to placebo; efficacy was strongly associated with medication adherence (JW AIDS Clin Care Nov 23 2010). These results are tremendously exciting, but many questions remain about the appropriate use of pre-exposure prophylaxis (PrEP) in real-world clinical settings. On January 28, 2011, the CDC offered some interim guidance. The key points are as follows: PrEP should be considered for use only in MSM who are at ongoing high risk for HIV acquisition. PrEP candidates should undergo conventional HIV antibody testing to ensure that they are HIV-negative. Those with signs or symptoms of acute HIV infection should undergo viral-load testing or nucleic acid amplification testing (NAAT). All candidates should be screened for other sexually transmitted infections (STIs) and for hepatitis B. Tenofovir/FTC, dosed at 1 tablet daily, is the only currently recommended PrEP regimen. It should not be used in people with creatinine clearance <60 mL/minute. PrEP should be prescribed for only 3 months at a time, to ensure appropriate follow-up. Every 2 to 3 months, PrEP recipients should receive HIV antibody testing, counseling regarding risk reduction and medication adherence, and assessment for possible signs and symptoms of STIs. STI testing should be conducted every 6 months. Serum creatinine levels should be assessed 3 months after PrEP initiation and then yearly. HIV antibody testing should be performed at discontinuation of PrEP. Comment: These guidelines provide basic recommendations for clinicians who are interested in implementing PrEP based on the data that are currently available. The recommendation for follow-up every 2 to 3 months is clearly a concession to the reality that monthly follow-up (as was done in iPrEx) is unlikely to be feasible or practical outside the research setting. Many prevention experts will also take issue with the instruction to provide baseline viral-load testing and NAAT only to candidates who are clinically symptomatic; in the iPrEx study, investigators inadvertently enrolled 10 individuals with acute HIV infection, presumably because they were asymptomatic. Given the resistance consequences of missing such infection, one could argue that if an individual is at sufficient risk to warrant PrEP intervention, he should be screened at baseline with both HIV antibody testing and viral-load testing or NAAT. Alternatively, the fourth-generation HIV test that involves both antigen and antibody detection could be employed as a compromise between sensitivity and cost for detection of acute infection. More formal PrEP guidelines from the U.S. Department of Health and Human Services and the FDA are eagerly anticipated and are likely to include guidance on the type of provider that should be prescribing PrEP, application to other populations, and longer-term safety follow-up. — Raphael J. Landovitz, MD, MSc Dr. Landovitz is Assistant Professor, Division of Infectious Diseases, Center for Clinical AIDS Research and Education, University of California, Los Angeles. He reports no conflicts of interest. Published in Journal Watch HIV/AIDS Clinical Care February 14, 2011 Citation(s): Centers for Disease Control and Prevention (CDC). Interim guidance: Preexposure prophylaxis for the prevention of HIV infection in men who have sex with men. MMWR Morb Mortal Wkly Rep 2011 Jan 28; 60:65. (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6003a1.htm) Medline abstract (Free)

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School: a place for children to learn their HIV status?

Estimados colegas, les dejo otro editorial interesante, la escuela puede ser el lugar donde los niños sepan y aprendan de su estatus serologico.
Saludos
Dr. Carlos Erazo

http://download.thelancet.com/pdfs/journals/lancet/PIIS0140673611601839.pdf

"The South African Government has announced that it will soon launch a controversial step in its national campaign to test 15 million people for HIV by June this year. Under the plans, children and adolescents will be off ered voluntary HIV testing and counselling in high schools. The details of the initiative are thin at present. The health department has promised that the campaign will be “professional” and “responsible”; that testing will be done in private spaces on school premises during weekends and school holidays; that it will be phased in; and that extensive monitoring and evaluation will be done. An expert task team has been set up to work on implementation, including the provision of ageappropriate counselling, support, and care, and they will make their recommendations public in due course. The team has a lot to address. Under South African law, children aged 12 years and older can give consent to a HIV test. But how should a health worker determine whether consent provided by a 12-year-old or adolescent is suffi ciently informed? Will those who test positive get access to antiretroviral therapy? How will health workers ensure confi dentiality? Will children be pressured by peers or parents to divulge their test results? Will condoms be given to those who come for testing? And how often will testing be off ered? The task team should also be allowed to consider whether schools are the best place for children to learn their HIV status. Problems in the national HIV testing and counselling campaign, launched last April, also heed a cautionary warning. Monitoring and evaluation of the campaign has been poor and there have been reports of HIVpositive people not being referred for treatment, clinics not complying with national testing and counselling protocols, and anecdotal reports of coercive testing. 18% of young people (15–24 years) in South Africa report having fi rst sex by 15 years, and early sexual debut is associated with increased risk of HIV infection.
Improving access to age-appropriate HIV testing, treatment, and counselling for children and adolescents is, therefore, important. But South Africa must take its time and consider how best to do this, to ensure the campaign does not do more harm than good."  The Lancet

Potential utility of empirical tuberculosis treatment for HIV-infected patients with advanced immunodeficiency in high TB-HIV burden settings [Unresolved issues]

Estimados colegas , aquí les dejo otro artículo interesante sobre la co infección VIH-TB
Saludos 
Dr. Carlos Erazo
http://www.ingentaconnect.com/content/iuatld/ijtld/2011/00000015/00000003/art00002

Authors: Lawn, S.D.¹; Ayles, H.²; Egwaga, S.³; Williams, B.⁴; Mukadi, Y.D.⁵; Santos Filho, E.D.⁶; Godfrey-Faussett, P.⁷; Granich, R.M.⁸; Harries, A.D.⁹

Abstract:
"The human immunodeficiency virus (HIV) and HIV-associated tuberculosis (TB-HIV) epidemics remain uncontrolled in many resource-limited regions, especially in sub-Saharan Africa. The scale of these epidemics requires the consideration of innovative bold interventions and `out-of-the-box' thinking. To this end, a symposium entitled `Controversies in HIV' was held at the 40th Union World Conference on Lung Health in Cancun, Mexico, in December 2009. The first topic debated, entitled `Annual HIV testing and immediate start of antiretroviral therapy for all HIV-infected persons', received much attention at international conferences and in the literature in 2009. The second topic forms the subject of this article. The rationale for the use of empirical TB treatment is premised on the hypothesis that in settings worst affected by the TB-HIV epidemic, a subset of HIV-infected patients have such a high risk of undiagnosed TB and of associated mortality that their prognosis may be improved by immediate initiation of empirical TB treatment used in conjunction with antiretroviral therapy. In addition to morbidity and mortality reduction, additional benefits may include prevention of nosocomial TB transmission and TB preventive effect. Potential adverse consequences, however, may include failure to consider other non-TB diagnoses, drug co-toxicity, compromised treatment adherence, and logistical and resource challenges. There may also be general reluctance among national TB programmes to endorse such a strategy. Following fruitful debate, the conclusion that this strategy should be carefully evaluated in randomised controlled trials was strongly supported. This paper provides an in-depth consideration of this proposed intervention"

Keywords: empirical treatment; tuberculosis; HIV; Africa; mortality

CHIPREV ESTUDIO DE PREVALENCIA DE VIH Y FACTORES ASOCIADOS EN HOMBRES QUE TIENEN SEXO CON HOMBRES

 Este es otro estudio realizado en Chile sobre la prevalencia de HSH y sus factores asociados.
Saludos
Dr. Carlos Erazo

http://www.scribd.com/doc/34664715/Estudio-de-Prevalencia-de-VIH-y-Factores-Asosidados-en-Hombres-que-tienen-Sexo-con-Hombre-Chile-Enero-2009

"El informe final del Estudio de Prevalencia de VIH y Factores Asociados en Hombres que Tienen Sexo con Hombres (CHIPREV), representa el último documento elaborado en el marco del estudio, con el objetivo de dar a conocer los principales resultados de la investigación realizada en la Región Metropolitana.

En cuanto a su estructura, este informe se divide en siete partes o capítulos que

pueden sintetizarse de la siguiente manera:

•En primer lugar se incluye un resumen ejecutivo que señala brevemente la importancia del estudio, la metodología aplicada y los resultados más relevantes.

•Luego se presenta el detalle de los antecedentes que justificaron la realización de esta investigación, considerando el contexto epidemiológico internacional y nacional, así como las experiencias en materia de vigilancia epidemiológica desarrolladas previamente en Chile.

•En tercera instancia se exponen los aspectos metodológicos del estudio, incluyendo una detallada descripción de sus objetivos, el tipo de muestreo utilizado, y los  procedimientos y actividades que permitieron su implementación.

•A continuación se presentan los resultados referidos al proceso de reclutamiento, considerando el comportamiento de las cadenas de participantes derivadas de cada semilla incorporada al estudio, así como el cierre de los casos mediante la entrega de los resultados serológicos a los participantes.

•En la siguiente sección se exponen las características de las semillas o participantes iniciales de la investigación, así como la descripción de la muestra lograda, mediante un análisis efectuado a partir del programa SPSS.

•El capítulo de análisis de resultados se basa en el análisis estadístico realizado a través el programa RDSAT y permite conocer los resultados del estudio en cuanto a prevalencia de VIH, así como en relación a otras variables socio comportamentales y su vinculación con los resultados serológicos.

•Finalmente se detallan las conclusiones de la investigación, referidas a los aprendizajes metodológicos derivados de esta primera experiencia chilena con un muestreo basado en quienes responden y a la interpretación de los principales resultados generados."

SEXUALIDAD MASCULINA Y VIH EN BOLIVIA

 Estimados colegas  este estudio es interesante para entender otros estudios que se están realizando en el país.
Saludos
Dr. Carlos Erazo


http://www.ombres.org.gt/documentos/sexualidad-vih-bolivia.pdf

"Se trata del primer estudio desarrollado en Bolivia utilizando el método de muestreo RDS y el Software RDSAT para el análisis de la información; aspectos que permitieron obtener la seroprevalencias del VIH y de las ITS (herpes y sífilis) y conocer el comportamiento de la población de hombres que tienen sexo con hombres."

HIV and Stroke

"The proportion of hospitalized stroke patients who are HIV-infected is increasing; multiple reasons are likely.

Although HIV infection and specific antiretroviral agents have been linked to cardiovascular disease, little is known about the incidence of stroke in HIV-infected patients. To explore this topic, investigators examined time trends in the proportion of hospitalized stroke patients who have HIV infection.

The researchers analyzed data from the Nationwide Inpatient Sample, which includes discharge information on a large number of patients hospitalized throughout the U.S. They used ICD-9 codes to identify hospitalizations for stroke and applied a weighting factor to correct for potential overascertainment. They derived rate denominators from U.S. census data, including for the total number of persons living with HIV.

Between 1998 and 2006, the stroke-hospitalization rate in the general HIV-negative population decreased by 17% (from 375 to 311 per 100,000 persons). In contrast, the rate in the HIV-positive population — after an initial period of decline before 2001 — increased by 43% (from 90 to 129 per 100,000) between 2001 and 2006. Of all patients hospitalized with stroke, 0.09% were HIV-positive in 1997 and 0.15% were HIV-positive in 2006. This increase in the proportion of patients with HIV infection was seen for ischemic stroke but not for subarachnoid or intracerebral hemorrhage. During the study period, the prevalence of other risk factors for stroke, such as hypertension, increased in the HIV-infected population.

Comment: Although this study shows that a growing proportion of patients hospitalized for stroke are HIV-infected, it does not tell us why. The finding may be related, in part, to the fact that HIV-infected patients are now living long enough to develop complications such as stroke. Moreover, risk factors for stroke may be more common in HIV-infected patients than in the general population — this is certainly true for smoking. The authors speculate that HIV infection, metabolic derangements, or antiretroviral medications could be contributing to risk for stroke, but more research is needed before firm conclusions can be drawn.

— Rajesh T. Gandhi, MD

Published in Journal Watch Infectious Diseases February 9, 2011

Citation(s):

Ovbiagele B and Nath A. Increasing incidence of ischemic stroke in patients with HIV infection. Neurology 2011 Feb 1; 76:444.

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• Medline abstract (Free)