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Individuals with HIV are at increased risk for osteoporosis. A healthy diet with adequate calcium is recommended to promote bone health. However, lengthy nutritional assessments pose barriers to routine screenings in clinical practice. This study aimed to examine the validity and reproducibility of a six-item dietary calcium screening tool among Chinese individuals with HIV.
We conducted a two time-point study in an outpatient setting. Volunteers self-administered the six-item tool upon enrollment and again at one-month follow-up. At baseline, participants also completed a validated food frequency questionnaire and surveys regarding demographic and clinical risk factors.
Beijing, China; Shenzhen, Guangdong, China
Upon enrollment, 127 individuals with HIV participated in the study, of whom 83 completed the follow-up screening.
Mean age of participants was 35.2±9.3 years, average BMI was 22.8±3.8 kg/m2, and 89% were men. Among the participants, 54.7% reported calcium intake less than 800 mg/day. The six-item tool demonstrated fair-to-moderate relative validity with a correlation of 0.39 and 75.7% of subjects classified in same/adjacent quartiles as the reference, and moderate-to-good reproducibility with a correlation of 0.60 and 83.1% of subjects classified in same/adjacent quartiles. Finally, ROC analyses yielded a sensitivity of 87.0% and a specificity of 39.4% with optimized cut-off level.
The six-item tool presented adequate validity and reproducibility to identify individuals with low calcium intake among the target population, providing a convenient instrument for categorizing calcium intake in clinical practice, prompting referrals for further assessment, and raising awareness of dietary calcium in bone disease prevention.
Food insecurity is a structural barrier to HIV care in peri-urban areas in South Africa (SA), where approximately 80% of households are moderately or severely food insecure.(1) For people with HIV (PWH), food insecurity is associated with poor ART adherence and survival rates. Yet, measurement of food insecurity among PWH remains a challenge.
This study examines the factor structure of the 9-item Household Food Insecurity Access Scale (HFIAS, isiXhosa-translated) among PWH in SA using a restrictive bifactor model.
Primary care clinics in Khayelitsha, a peri-urban settlement in Cape Town, SA.
Participants (N=440) were PWH who received HIV care in Khayelitsha screening for a clinical trial. Most were categorized as severely (n=250, 56.82%) or moderately (n=107, 24.32%) food insecure in the past 30 days.
Revised parallel analysis suggested a 3-factor structure, which was inadmissible. A 2-factor structure was examined but did not adequately fit the data. A 2-factor restrictive bifactor model was examined, such that all items loaded on a general factor (food insecurity) and all but two items loaded on one of two specific additional factors, which adequately fit the data (CFI=0.995, SRMR=0.019). The two specific factors identified were: anxiety/insufficient quality, and no food intake. Reliability was adequate (ω=.82).
Results supported the use of a total score, and identified two specific factors of the HFIAS, which may be utilized in future research and intervention development. These findings help identify aspects of food insecurity that may drive relationships between the construct and important HIV-related variables.
Tick-borne encephalitis (TBE) is a vector-borne infection associated with a variety of potentially serious complications and sequelae. Vaccination against TBE is strongly recommended for people living in endemic areas. There are two TBE vaccination schemes – standard and rapid – which differ in the onset of protection. With vaccination in a rapid schedule, protection starts as early as 4 weeks after the first dose and is therefore especially recommended for non-immune individuals travelling to endemic areas. Both schemes work reliably in immunocompetent individuals, but only little is known about how TBE vaccination works in people with HIV infection. Our aim was to assess the immunogenicity and safety of the rapid scheme of TBE vaccination in HIV-1 infected individuals. Concentrations of TBE-specific IgG > 126 VIEU/ml were considered protective. The seroprotection rate was 35.7% on day 28 and 39.3% on day 60. There were no differences between responders and non-responders in baseline and nadir CD4 + T lymphocytes. No serious adverse events were observed after vaccination. The immunogenicity of the TBE vaccination was unsatisfactory in our study and early protection was only achieved in a small proportion of vaccinees. Therefore, TBE vaccination with the rapid scheme cannot be recommended for HIV-1 infected individuals.
Chapter 8 explains how blood-borne viruses are transmitted through contaminated injections. Throughout the world, intravenous drug users are a high-risk population for HIV and the hepatitis C virus. Medical interventions that re-used unsterilised syringes and needles were also implicated in the transmission of blood-borne viruses. In Egypt, millions were infected with the hepatitis C virus through the mass treatment of schistosomiasis, a parasitic disease. Hundreds of thousands of American soldiers were infected with the hepatitis B virus during World War II through a contaminated yellow fever vaccine. In Romania, Libya, the former Soviet Union, and more recently in Cambodia and Pakistan, large outbreaks of iatrogenic HIV infection have been reported and continue to occur.
Increasing numbers of children with perinatally acquired HIV (PaHIV) are transitioning into adult care. People living with behaviourally acquired HIV are known to be at more risk of psychosis than uninfected peers. Young adults living with PaHIV face numerous risk factors; biological: lifelong exposure to a neurotrophic virus, antiretroviral medication and immune dysfunction during brain development, and environmental; social deprivation, ethnicity-related discrimination, and migration-related issues. To date, there is little published data on the prevalence of psychotic illness in young people growing up with PaHIV.
We conducted a retrospective case note review of all individuals with PaHIV aged over 18 years registered for follow up at a dedicated clinic in the UK (n = 184).
In total, 12/184 (6.5%), median age 23 years (interquartile range 21–26), had experienced at least one psychotic episode. The presentation and course of the psychotic episodes experienced by our cohort varied from short-lived symptoms to long term illness and nine (75%) appear to have developed a severe and enduring mental illness requiring long term care.
The prevalence of psychosis in our cohort was clearly above the lifetime prevalence of psychosis in UK individuals aged 16–34 years, which has been reported to be 0.5–1.0%. This highlights the importance of clinical vigilance regarding the mental health of young people growing up with PaHIV and the need to integrate direct access to mental health services within the HIV centres providing medical care.
Incidental learning and memory, as well as processing speed, were examined in human immunodeficiency virus (HIV)-positive adults and a seronegative control group.
Participants completed a computerized Symbol-Digit Modalities Test (cSDMT) with two blocked conditions: a set of trials with the standard symbol–digit pairings and the second set with a rearranged symbol–digit pairings.
HIV-positive adults showed slower overall reaction time compared to the HIV-negative group. More importantly, the most cognitively impaired HIV-positive group showed no interference in the rearranged set of symbol–digit pairings from the standard pairings on the cSDMT.
The relative slowing, or interference, in the HIV-negative group and two HIV-positive groups (unimpaired and impaired) was quite large (between 122 and 131 ms). We argue that the lack of such relative slowing in the most cognitively impaired HIV-positive group indicates a deficit in incidental learning and memory.
Depression is common in people living with HIV (PLWH) and can contribute to neurocognitive dysfunction. Depressive symptoms in PLWH are often measured by assessing only cognitive/affective symptoms. Latinx adults, however, often express depressive symptoms in a somatic/functional manner, which is not typically captured in assessments of depression among PLWH. Given the disproportionate burden of HIV that Latinx adults face, examining whether variations in expressed depressive symptoms differentially predict neurocognitive outcomes between Latinx and non-Hispanic white PLWH is essential.
This cross-sectional study included 140 PLWH (71% Latinx; 72% male; mean (M) age = 47.1 ± 8.5 years; M education = 12.6 ± 2.9 years) who completed a comprehensive neurocognitive battery, Wechsler Test of Adult Reading (WTAR), and Beck Depression Inventory-II (BDI-II). Neurocognitive performance was measured using demographically adjusted T-scores. BDI-II domain scores were computed for the Fast-Screen (cognitive/affective items) score (BDI-FS) and non-FS score (BDI-NFS; somatic/functional items).
Linear regressions revealed that the BDI-NFS significantly predicted global neurocognitive function and processing speed in the Latinx group (p < .05), such that higher physical/functional symptoms predicted worse performance. In the non-Hispanic white group, the cognitive/affective symptoms significantly predicted processing speed (p = .02), with more symptoms predicting better performance. Interaction terms of ethnicity and each BDI sub-score indicated that Latinx participants with higher cognitive/affective symptoms performed worse on executive functioning.
Depressive symptoms differentially predict neurocognitive performance in Latinx and non-Hispanic white PLWH. These differences should be considered when conducting research and intervention among the increasingly culturally and ethnically diverse population of PLWH.
An ever increasing number of drugs are known to cause gastrointestinal injury. The histological features are often non-specific and a single drug can induce many different patterns, necessitating close collaboration between pathologists and clinicians to reach a correct diagnosis. However, there may be some histological clues that are helpful in the diagnosis of drug-induced injury.
HIV-1 proteins and highly active antiretroviral therapy (HAART) have been associated with microvascular endothelial dysfunction. Although nitrate-rich beetroot juice (NR-BJ) consumption has been shown to improve endothelial function in clinical population, its effects in HIV-infected patients has not been addressed. We investigated the effect of a single dose of NR-BJ on muscle oxygen saturation parameters in response to a handgrip exercise in HIV-infected patients. Fifteen HIV-infected patients received NR-BJ or nitrate-depleted beetroot juice (ND-BJ) in a double-blind cross-over design. Near-IR spectroscopy was utilised to assess muscle oxygen saturation parameters during rhythmic handgrip exercise after NR-BJ or ND-BJ supplementation. A significant faster muscle oxygen desaturation rate during exercise (–7·97 (sd 5·00) v. –5·45 (3·94) %/s, P = 0·005) and muscle oxygen resaturation rate during exercise recovery (0·43 (0·24) v. 0·28 (0·24) %/s, P = 0·030) after NR-BJ ingestion was found. However, no significant difference in exercise time until fatigue was observed. Salivary nitrite and urinary nitrate concentration were analysed after NR-BJ or ND-BJ. A significant increase in salivary nitrite and urinary nitrate in NR-BJ was observed compared with ND-BJ (P < 0·05). Our findings suggest that NR-BJ consumption may acutely improve muscle oxygen saturation during exercise and exercise recovery in HIV-infected patients undergoing HAART and who are expected to present microvascular damage. Thus, future studies investigating the chronic effects of NR-BJ are warranted to delineate a better nutritional strategy based on nitrate-rich foods.
The key populations who are most vulnerable to HIV – sex workers, people who inject drugs, men who have sex with men, transgender people – are criminalized in many countries, and often lead double lives, hiding in order to survive. This creates a data paradox, in which governments deny or minimize the existence of key populations, no research is done on their health needs, and lack of data reinforces official denialism. Criminalization of same-sex sexuality is statistically associated with implausibly low size estimates of men who have sex with men. Low size estimates can also contribute to implausibly high reported coverage of HIV testing among men who have sex with men, leading countries that are failing to reach key populations to mistakenly believe they are successful. In Kenya, a government effort to conduct a size estimation study of key populations, including gathering biometric data, faced resistance from those groups, who feared the data could expose them to risk of arrest and abuses. Working with Kenyan key populations advocates and human rights lawyers, the author documented this resistance, and growing demands by key populations that they play a leadership role in the design, implementation and evaluation of research about their health.
This chapter interrogates assumptions behind the models used both in cost-effectiveness analysis, and to set global targets. The models neglected to address how human rights realities, such as health sector discrimination and legal barriers, might undermine the optimistic scenarios the models predicted would result from scale-up of testing and treatment. The lack of quantitative research showing that addressing human rights would have a measurable impact on health, and that such work was cost-effective, meant that it was easy to exclude these and similarly unquantified considerations from biomedical scael-up. Thus in many countries, the work of addressing stigma, discrimination, criminalization, and gender inequality, while frequently cited as rhetorically important, is in practice an afterthought in planning, financing and implementing the HIV response. The second part of the chapter returns to Grenada to observe community activists and health officials wrestling with the challenges of quantification, as they debate which questions to ask in the study. While the global mathematical models aimed at simplicity in order to drive decision-makers to prioritize funding HIV programs, the CVC study wrestled with the problem of how best to capture local complexities and protect the fragile thread of trust they were beginning to establish with hidden communities.
To understand how community leadership can be incorporated in health research, this chapter tracks the first stages of a population size estimate in six Eastern Caribbean countries, with a focus on one of the countries, Grenada. Grenada is a small island state and an upper-middle-income country. While external aid previously funded much of the region’s HIV response, global health agencies are transitioning out to prioritize reaching the “end of AIDS” in high-prevalence, lower-income countries. However, criminalization and discrimination contribute to lack of resources for key populations in middle-income countries. In Grenada, abrupt US aid withdrawal left community groups dormant, without funding or staffing. In past studies, after the data was extracted, local groups saw no results of the research. A regional civil society group, Caribbean Vulnerable Communities (CVC), will lead this new population size estimation study. An ethnographic study of the CVC study highlights the challenges with finding and counting hidden key populations. CVC must restart old networks and rebuild trust. The activists negotiate for power and control of the data, using their arduous research to position revived community groups at the center of national HIV responses; hoping that the research will produce “something more than just data”.
In 2016, Venezuelans living with HIV asked the Global Fund to Fight AIDS, Tuberculosis and Malaria for emergency aid. But despite an economic catastrophe, Venezuela’s high national income made it ineligible. Data on HIV that might have helped was censored or had never been gathered. The public debate around this case highlighted the growing use of indicators and data in global health finance. Mathematical models had shown that ending HIV was achievable through rapid scale-up of testing and treatment to meet the Sustainable Development Goal of “ending AIDS” by 2030. But funding for the global HIV response has leveled off, and was not enough to meet the goals everywhere. Bilateral and multilateral donors were targeting funds where they could have the greatest impact, especially in Sub-Saharan African countries where HIV prevalence is high and national incomes low. Donors also needed to show progress to the politicians who approve their budgets. Yet how progress is measured through indicators and data is contested, including by civil society. As an example of how indicators can become sites of contest and levers of political power, the chapter examines Global Fund corporate Key Performance Indicators (KPIs) on lives saved, service coverage, and health systems strengthening.
In this chapter, the authors trace out the “natural history” of an intensely collaborative multisited comparison, which was distinct from many other comparative research projects because research at each site was carried out by a PhD-level anthropologist who was involved in the scientific development of the project rather than only in the implementation of a centrally directed project. It draws on their experiences with this once-in-a-lifetime opportunity, a large, US National Institutes of Health–funded multisite project, to discuss ways in which that comparative research could have been even more powerful, things that future comparative research should strive to avoid, recommended best practices, and what the authors would call “minimum adequate” approaches to comparative ethnography.
In the global race to reach the end of AIDS, why is the world slipping off track? The answer has to do with stigma, money, and data. Global funding for AIDS response is declining. Tough choices must be made: some people will win and some will lose. Global aid agencies and governments use health data to make these choices. While aid agencies prioritize a shrinking list of countries, many governments deny that sex workers, men who have sex with men, drug users, and transgender people exist. Since no data is gathered about their needs, life-saving services are not funded, and the lack of data reinforces the denial. The Uncounted cracks open this and other data paradoxes through interviews with global health leaders and activists, ethnographic research, analysis of gaps in mathematical models, and the author's experience as an activist and senior official. It shows what is counted, what is not, and why empowering communities to gather their own data could be key to ending AIDS.
Donor insemination (DI) has undergone radical changes in the last 25 years, for example exclusive use of frozen semen, and increasing use of DI for single women. A summary of these is presented as are the potential challenges we still face. The latter include key questions such as what are the key methods for optimising treatment. Can we improve our success rates? If so, how can this be done? Moreover, the use of DI as a research tool, often ignored, is presented.
During the 2017 European hepatitis A (HA) outbreak we assessed HA incidence in our cohort of 2300 HIV-infected patients, implemented preventive measures and evaluated practices and knowledge on sexually transmitted diseases (STD). HA incidence was assessed between 1 January 2017 and 31 December 2017 and included all symptomatic patients with virologically confirmed HA. Preventive measures consisted in identifying at risk and not immunised patients to propose them a free HAV vaccination, and an anonymous survey related to transmission routes of STD and to sexual behaviours. Twenty HA were diagnosed. All were homosexual men recently diagnosed with HIV and another STD. None were vaccinated against hepatitis A virus (HAV). Hospitalisation was required for 52%. We identified 250 patients at risk to acquire HAV and invited them to a free immunisation program. A total of 110 (44%) were vaccinated, of whom 74 responded to our survey. A majority of them (84%) reported recent active anal and oral sexuality with multiple (52%) male partners (81%), and ChemSex consumption (14%). Internet was the meeting link for 58%. Another STD history was found in 69%. One third of these individuals had no idea about STD transmission modes. This HA outbreak pointed the insufficient vaccine coverage against HAV and knowledge on STD, which may be improved by Internet.
Psychiatric morbidity was assessed in 55 HIV seropositive women who were attending either an HIV centre in Paris (n = 30) or a genitourinary clinic in London (n = 25). Demographic data and information concerning HIV disease, openness about diagnosis, counselling received, social and family support, sexual behaviour and attitudes towards fertility and pregnancy were recorded using a semi-structured interview. Moderate or severe levels of psychiatric distress were found in 60% of the women in Paris and 28% of those in London. Overall, these rates are higher than those found in comparable studies of HIV seropositive men. Psychiatric disorder was associated with a past history of intravenous drug use and older age. Over half of the women were in regular sexual relationships but safe sex precautions were frequently not used. Sixteen subjects among those of child bearing age were prepared to consider having children.
The aim of this study was to assess the prevalence of current mood disorders in HIV-seropositive patients treated with combined antiretroviral drug therapy including or not protease inhibitors.
Subjects and methods.
A random sample of 90 subjects consecutively attending, between February 1 and July 31, 1998, the outpatient unit of the Second Department of Infectious Diseases of the ‘L. Sacco’ Hospital in Milan was assessed by means of the Structured Clinical Interview for DSMIII-R (SCID) and the Zung Self-Rating Depression Scale (ZSDS).
Twenty-three-point-three percent of the subjects were classified in CDC stage A, 32.3% in CDC stage B and 44.4% in CDC stage C. A DSMIII-R psychiatric diagnosis of current mood disorder was found in 4.4% of the recruited sample (dysthymia: 2.2%; adjustment disorder with depressed mood: 2.2%).
Direct and indirect effect of new combination therapies, epidemiological changes in social groups affected by HIV and possible modifications in social perception of people with HIV infection may explain, at least in part, the decreased prevalence of current mood disorders observed in our study as compared to prevalence rates reported in the pre-HAART era.
All the HIV-infected patients having referred to our Liaison Psychiatry Service between October 1992 and June 1994 were considered in this study. Seventy patients underwent psychiatric assessment and medical/neurological evaluation. Forty-seven of these patients were also subjected to cognitive/neuropsychological examination by means of the Milan Overall Dementia Assessment (MODA). Depressive episodes, adjustment disorders and substance abuse were the most frequently encountered diagnoses. Taking into account neuropsychological data, we found that symptomatic patients performed worse on tests than did asymptomatic ones.