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AIM: To determine the prevalence of hepatitis B virus (HBV) in adult human immunodeficiency virus (HIV) patients with CD4+ T-cell count less than 500/mm(3) and without antiretroviral therapy; to describe different HBV-HIV coinfection virological profiles; and to search for factors associated with HBs antigen (HBsAg) presence in these HIV positive patients. METHODS: During four months (June through September 2006), 491 patients were received in four HIV positive monitoring clinical centers in Abidjan. INCLUSION CRITERIA: HIV-1 or HIV-1 and 2 positive patients, age ≥ 18 years, CD4+ T-cell count < 500/mL and formal and signed consent of the patient. Realized blood tests included HIV serology, CD4+ T-cell count, quantitative HIV RNA load and HBV serological markers, such as HBsAg and HBc antibody (anti-HBcAb). We performed HBeAg, anti-HBe antibody (anti-HBeAb), anti-HBc IgM and quantitative HBV DNA load in HBsAg positive patients. Anti-HBsAb had been tested in HIV patients with HBsAg negative and anti-HBcAb-positive. HBV DNA was also tested in 188 anti-HBcAb positive patients with HBsAg negative status and without anti-HBsAb. Univariate analysis (Pearson χ(2) test or Fischer exact test) and multivariate analysis (backward step-wise selection logistic regression) were performed as statistical analysis. RESULTS: Mean age of 491 patients was 36 ± 8.68 years and 73.3% were female. Type-1 HIV was found in 97% and dual-type HIV (type 1 plus type 2) in 3%. World Health Organization (WHO) clinical stage was 1, 2, 3 and 4 respectively in 61 (12.4%), 233 (47.5%), 172 (35%) and 25 patients (5.1%). Median CD4+ T-cell count was 341/mm(3) (interquartile range: 221-470). One hundred and twelve patients had less than 200 CD4+ T-cell/mm(3). Plasma HIV-1 RNA load was elevated (≥ 5 log(10) copies/mL) in 221 patients (45%). HBsAg and anti-HBcAb prevalence was respectively 13.4% and 72.9%. Of the 66 HBsAg positive patients, 22 were inactive HBV carriers (33.3%), 21 had HBeAg positive hepatitis (31.8%) and 20 had HBeAg negative hepatitis (30.3%). HBeAg and anti-HBeAb were indeterminate in 3 of them. Occult B infection prevalence (HBsAg negative, anti-HBcAb positive, anti-HBsAb negative and detectable HBV DNA) was 21.3%. Three parameters were significantly associated with the presence of HBsAg: male [odds ratio (OR): 2.2; P = 0.005; 95% confidence interval (CI): 1.3-3.8]; WHO stage 4 (OR: 3.2; P = 0.01; 95% CI: 1.3-7.9); and aspartate aminotransferase (AST) level higher than the standard (OR: 1.9; P = 0.04; 95% CI: 1.02-3.8). CONCLUSION: HBV infection prevalence is high in HIV-positive patients. HBeAg positive chronic hepatitis and occult HBV infection are more frequent in HIV-positive patients than in HIV negative ones. Parameters associated with HBsAg positivity were male gender, AIDS status and increased AST level.
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More than 90% of pediatric AIDS results from the transmission of the virus through HIV positive pregnant mothers to their children. However, little has been known about factors associated with unintended pregnancies after knowing their HIV seropositive status, or contraceptive use among HIV positive women under antiretroviral treatment (ART). We investigated thus factors associated with unintended pregnancies after knowing seropositive status, and also factors associated with the non-use of contraceptives among HIV positive women under ART. We carried out a cross-sectional study in Kigali, Rwanda in 2007. A total of 565 HIV positive women under ART were interviewed. We examined the associated factors of unintended pregnancies or non-use of contraceptives using logistic regression analysis. Among all the respondents (n = 565), 132 women became pregnant after knowing their HIV seropositive status. Among them, 82 (62.7%) got pregnant unintentionally. Those who had two or more children (adjusted OR, 3.83) were more likely to get pregnant unintentionally. Meanwhile, among all, 263 had sexual intercourse during the last three months. Of them, 85 women did not use any contraceptives. Those who did not agree that 'HIV positive children can survive as long as HIV negative children' (adjusted OR, 2.28), and those who 'can always ask partner to use a condom' (adjusted OR, 9.83), were more likely to use contraceptives. This study suggests that HIV positive women under ART need special support to avoid unintended pregnancies especially those who have two or more children. Moreover, interventions are also needed to improve women's understanding of the prognosis of pediatric AIDS, and condom-use negotiation skills.
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Antirretrovirales/uso terapéutico , Conducta Anticonceptiva/estadística & datos numéricos , Infecciones por VIH/tratamiento farmacológico , Seropositividad para VIH/psicología , Embarazo no Planeado , Estudios Transversales , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Oportunidad Relativa , Embarazo , Rwanda , Factores Socioeconómicos , Encuestas y CuestionariosRESUMEN
BACKGROUND: In countries with high rates of chronic HBV, the World Health Organization recommends screening all HIV-infected adults for hepatitis B surface antigen (HBsAg) before initiating antiretroviral therapy (ART), and starting HIV-HBV-coinfected patients on regimens containing lamivudine (3TC) or emtricitabine (FTC) plus tenofovir disoproxil fumarate (TDF). Here, we estimated the prevalence of untreated HIV-infected adults with negative serum HBsAg and detectable plasma HBV DNA in Côte d'Ivoire. METHODS: This was a cross-sectional survey. We tested all untreated HIV type-1 (HIV-1)-infected adults with CD4(+) T-cell counts <500 cells/mm(3) for HBsAg, hepatitis B core antibodies (anti-HBc) and HBsAg antibodies (anti-HBs). We measured plasma HBV DNA in patients who tested positive for HBsAg and/or anti-HBc. RESULTS: We included 495 adults, of whom 73% were women. Median CD4(+) T-cell count was 329 cells/mm(3) and median HIV RNA was 4.9 log(10) copies/ml. Overall, 63 (13%) patients had chronic hepatitis B (HBsAg-positive), 115 (23%) had never been exposed to HBV (HBsAg-negative, anti-HBc-negative and anti-HBs-negative), 108 (22%) had signs of cured infection (anti-HBc-positive and anti-HBs-positive) and 209 (42%) had isolated anti-HBc (HBsAg-negative, anti-HBc-positive and anti-HBs-negative). Of these, 51 (10%) had detectable HBV DNA. Median HBV DNA level was 5.2 log(10) copies/ml (interquartile range [IQR] 3.2-8.8) for patients with chronic hepatitis and 2.2 log(10) copies/ml (IQR 1.8-2.7) for those with occult HBV infection. CONCLUSIONS: Among ART-naive HIV-1-infected African adults, 13% were HBsAg-positive and 42% had isolated anti-HBc, including 10% who had occult HBV. The clinical implications of high occult HBV prevalence are unknown. Future studies should assess the benefits of routine use of 3TC or FTC plus TDF as first-line ART in African settings, where HBV DNA tests are unavailable.
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ADN Viral/sangre , Infecciones por VIH/epidemiología , VIH-1/efectos de los fármacos , Virus de la Hepatitis B/efectos de los fármacos , Hepatitis B Crónica/epidemiología , Adenina/análogos & derivados , Adenina/uso terapéutico , Adulto , Anciano , Terapia Antirretroviral Altamente Activa/efectos adversos , Recuento de Linfocito CD4 , Côte d'Ivoire/epidemiología , Estudios Transversales , ADN Viral/análisis , Desoxicitidina/análogos & derivados , Desoxicitidina/uso terapéutico , Emtricitabina , Femenino , Infecciones por VIH/complicaciones , Anticuerpos contra la Hepatitis B/sangre , Anticuerpos contra la Hepatitis B/inmunología , Antígenos del Núcleo de la Hepatitis B/sangre , Antígenos del Núcleo de la Hepatitis B/inmunología , Antígenos de Superficie de la Hepatitis B/sangre , Antígenos de Superficie de la Hepatitis B/inmunología , Virus de la Hepatitis B/inmunología , Hepatitis B Crónica/complicaciones , Hepatitis B Crónica/inmunología , Humanos , Lamivudine/uso terapéutico , Masculino , Persona de Mediana Edad , Organofosfonatos/uso terapéutico , Prevalencia , Tenofovir , Organización Mundial de la Salud , Adulto JovenRESUMEN
We investigated a nosocomial infection of severe acute respiratory syndrome (SARS) in Vietnam in 2003 and attempted to identify risk factors for SARS infection. Of the 146 subjects who came into contact with SARS patients at Hospital A, 43 (29.5%) developed SARS, and an additional 16 (11%) were asymptomatic but SARS-coronavirus (CoV) seropositive. The asymptomatic infection rate accounted for 15.5% of the total number of infected patients at Hospital A, which was higher than that of 6.5% observed at Hospital B, to where all patients from Hospital A were eventually transported (P<0.05). At Hospital A, the risk for developing SARS was 12.6 times higher in individuals not using a mask than in those using a mask. The SARS epidemic in Vietnam resulted in numerous secondary infections due to its unknown etiology and delayed recognition at the beginning of the epidemic. The consistent and proper use of a mask was shown to be crucial for constant protection against infection with SARS.
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Infección Hospitalaria/transmisión , Brotes de Enfermedades/prevención & control , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Síndrome Respiratorio Agudo Grave/transmisión , Coronavirus Relacionado al Síndrome Respiratorio Agudo Severo , Infección Hospitalaria/epidemiología , Infección Hospitalaria/prevención & control , Infección Hospitalaria/virología , Hospitales Generales , Humanos , Control de Infecciones/métodos , Máscaras/estadística & datos numéricos , Cuerpo Médico de Hospitales , Personal de Enfermería en Hospital , Personal de Hospital , Equipos de Seguridad/estadística & datos numéricos , Factores de Riesgo , Síndrome Respiratorio Agudo Grave/epidemiología , Síndrome Respiratorio Agudo Grave/prevención & control , Síndrome Respiratorio Agudo Grave/virología , Encuestas y Cuestionarios , VietnamRESUMEN
BACKGROUND: One of the remaining challenges in the prevention of mother-to-child transmission of HIV is to reduce the risk of the transmission during pregnancy. It remains to be investigated which factors affect intrauterine HIV transmission and how they can be identified and addressed during pregnancy. METHODS: Granulocyte elastase in the endocervical mucus of HIV-positive pregnant women in Zambia was measured, and its association with intrauterine transmission of HIV-1 from the mother to the fetus was investigated. RESULTS: The intrauterine transmission rate determined by polymerase chain reaction assay of DNA from neonates at birth was 15.3%. The risk for intrauterine transmission was 8.65-fold higher in women who were positive for granulocyte elastase than in those who were negative. CONCLUSION: We suggest that the women showing positive granulocyte elastase at delivery be strongly suspected of having and if having had chorioamnionitis during pregnancy, which could affect the intrauterine transmission of HIV.
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Moco del Cuello Uterino/enzimología , Seropositividad para VIH/epidemiología , Seropositividad para VIH/transmisión , Transmisión Vertical de Enfermedad Infecciosa , Elastasa de Leucocito/análisis , Complicaciones Infecciosas del Embarazo/epidemiología , Femenino , Seropositividad para VIH/complicaciones , Hospitales de Enseñanza , Humanos , Recién Nacido , Embarazo , Estudios Retrospectivos , Factores de Riesgo , Cervicitis Uterina/complicaciones , Cervicitis Uterina/diagnóstico , ZambiaRESUMEN
A cross-sectional questionnaire survey was conducted on 470 pregnant women in Lusaka, Zambia. Multivariate analysis revealed school attendance and child deaths as independently significant variables positively associated with HIV seropositivity. Among women with fidelity, HIV prevalence was not significantly lower, and condom use was much lower than among women who were having extramarital affairs. Factors significantly associated with condom use within and outside of marriage differed-age and number of live births within, and sexual transmission knowledge outside of marriage. School attendance was not effective for gaining knowledge on sexual transmission or condom use. Regular own earning was significantly effective for condom use in both groups, irrespective of school attendance. The following should be implemented intensively: effective education on HIV and sex in and out of school before early sexual debut, further implementation of family planning with emphasis on condom use, and empowering women by assisting with their economic independence.
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Condones/estadística & datos numéricos , Historia Reproductiva , Factores Socioeconómicos , Población Urbana/estadística & datos numéricos , Adolescente , Adulto , Estudios Transversales , Femenino , Seropositividad para VIH , Humanos , Estado Civil , Embarazo , Esposos/estadística & datos numéricos , ZambiaRESUMEN
The ability of HIV-1 to evolve resistance to antiretroviral drugs leads to treatment failure. By nucleotide sequencing of HIV-1 subtype B isolates, amino acids responsible for drug resistance have been identified. Less information is available, however, on the extent and distribution of these amino acids in HIV-1 nonsubtype B viruses circulating mainly in developing countries. More HIV-infected patients in the developing world are now using antiretroviral drugs, and hence there is a need to monitor drug resistance mutations in HIV-1 non-subtype B viruses. This study examines the prevalence of drug resistance mutations in 28 antiretroviral drug-naive HIV-1-infected Zambians. HIV-1 proviral DNA was extracted from peripheral blood mononuclear cells. The region encompassing gag p17 to env C2-V3-C3 was amplified by the polymerase chain reaction followed by direct sequencing. Sequence analyses for drug resistance-associated mutations in th e protease and reverse transcriptase genes, and HIV-1 subtyping, were done. Overall, 92.8% of the generated sequences were HIV-1 subtype C. The generated sequences revealed only secondary associated, but no primary, drug-resistance mutations The most frequent secondary mutations in the protease and RT genes were, respectively, I93L(91.7%), L89M (79.2%), M3611V (79%, 4.2%), and R211K (70.8%), S48T (62.5%). The atypical residues M41N (3.6%) and D67A (3.6%) were detected in the RT gene. This study reveals many naturally occurring polymorphisms in HIV-1 subtype C isolates from antiretroviral drug-naive individuals. Such polymorphisms could lead to rapid treatment failure and development of drug-resistant HIV-1 mutants in individuals undergoing antiretroviral therapy.