Idiopathic AIDS enteropathy and treatment of gastrointestinal opportunistic pathogens.

Diarrhea in patients with acquired immune deficiency syndrome (AIDS) has proven to be both a diagnostic and treatment challenge since the discovery of the human immunodeficiency virus (HIV) virus more than 30 years ago. Among the main etiologies of diarrhea in this group of patients are infectious agents that span the array of viruses, bacteria, protozoa, parasites, and fungal organisms. In many instances, highly active antiretroviral therapy remains the cornerstone of therapy for both AIDS and AIDS-related diarrhea, but other targeted therapies have been developed as new pathogens are identified; however, some infections remain treatment challenges. Once identifiable infections as well as other causes of diarrhea are investigated and excluded, a unique entity known as AIDS enteropathy can be diagnosed. Known as an idiopathic, pathogen-negative diarrhea, this disease has been investigated extensively. Atypical viral pathogens, including HIV itself, as well as inflammatory and immunologic responses are potential leading causes of it. Although AIDS enteropathy can pose a diagnostic challenge so too does the treatment of it. Highly active antiretroviral therapy, nutritional supplementation, electrolyte replacements, targeted therapy for infection if indicated, and medications for symptom control all are key elements in the treatment regimen. Importantly, a multidisciplinary approach among the gastroenterologist, infectious disease physician, HIV specialists, oncology, and surgery is necessary for many patients

AIDS Treatment in South Asia: Equity and Efficiency Arguments for Shouldering the Fiscal Burden When Prevalence Rates are Low

The slower spread of AIDS in South Asian countries, combined with the fact that most South Asian countries have higher per capita incomes than the most severely affected countries of other regions imply that the various impacts of the disease will be smaller in South Asia than in the worst affected countries in other regions. While justified with respect to the impact of the disease on economic output, on poverty, or on orphanhood, this conclusion does not follow with respect to the health sector, where the relatively minor public role in health care delivery and the entrepreneurial and heterogeneous private health and pharmaceutical sectors combine to magnify the potential impact of the epidemic. This paper uses recent epidemiological data on the extent and rate of spread of HIV/AIDS in South Asian countries and alternative scenarios regarding future government efforts to expand access to AIDS treatment in order to estimate the future need for antiretroviral treatment in South Asian countries and the fiscal burden that their governments will shoulder if they decide to provide or finance all of the needed care. Since AIDS treatment cannot be presumed to slow HIV transmission and may speed it, the usual argument for paying for such treatment with public funds is on equity grounds—that it will prevent poverty and orphanhood. Indeed this paper estimates that public financing of AIDS treatment might avert poverty for about three percent of the Indian population, for example. However, data on the quality of private health care in India suggests that another effect of publicly produced AIDS treatment would be to crowd out lower-quality private AIDS treatment, thereby preventing some of the negative spillovers of poor quality private treatment. The paper closes by arguing on efficiency grounds that the government role in AIDS treatment should encompass both regulation of the private sector and support for quality “structured” AIDS treatment in the public sector.AIDS, HIV, South Asia

Treatment of HIV/AIDS at South Africa's Largest Employers: Myth and Reality

Background: In the past three years, many large employers in South Africa have announced publicly their intention of making antiretroviral treatment (ART) available to employees. Reports of the scope and success of these programs have been mostly anecdotal. This study surveyed the largest private sector employers in South Africa to determine the proportion of employees with access to ART through employer-sponsored HIV/AIDS treatment programs. Methods: All 64 private sector and parastatal employers in South Africa with more than 6,000 employees were identified and contacted. Those that agreed to participate were interviewed by telephone using a structured questionnaire. Results: 52 companies agreed to participate. Among these companies, 63% of employees had access to employer-sponsored care and treatment for HIV/AIDS. Access varied widely by sector, however. Approximately 27% of suspected HIV-positive employees were enrolled in HIV/AIDS disease management programs, or 4.4% of the workforce overall. Fewer than 4,000 employees in the entire sample were receiving antiretroviral therapy. In-house (employer) disease management programs and independent disease management programs achieved higher uptake of services than did medical aid schemes. Conclusions: Publicity by large employers about their treatment programs should be interpreted cautiously. While there is a high level of access to treatment, uptake of services is low and only a small fraction of employees medically eligible for antiretroviral therapy are receiving it

Prejudice, Vulnerability, Adhesion Process, Religiousness Regarding the Life Routine with AIDS: Life Stories

Objective: To communicate life stories of people who suffer from acquired immunodeficiency-syndrome with a higher vulnerability registered at the Municipal Secretary of Social Assistance and the diagnostic’s influence on their daily routine. Method: Descriptive and exploratory study based on oral life history. Thirteen people with AIDs took part in the study via a semi-structured interview. The narratives were analyzed using Bardin’s thematic content analysis. Results: Three thematic axes emerged from Bardin’s content analysis: prejudice and discrimination regarding the life routine with aids; Reaction when facing the diagnostic and the adhesion process for the antiretroviral treatment; Confrontation of religion and religiousness on people with aids. Conclusion: The people living with aids, a chronic and stigmatizing disease, need the support of multidisciplinary teams and an improvement in relation to the access, the coverage and the meaning assigned to the disease, besides a better quality of life and social assistance. We conclude that religion did not contribute to facing these people’s conditions. It brought blame, incorrect information that may impair the treatment and their follow-up. One infers that health education regarding HIV/AIDS needs to be remodeled on all of society’s segments

Treatment of HIV/AIDS at South Africa's Largest Employers: Myth and Reality

Background: In the past three years, many large employers in South Africa have announced publicly their intention of making antiretroviral treatment (ART) available to employees. Reports of the scope and success of these programs have been mostly anecdotal. This study surveyed the largest private sector employers in South Africa to determine the proportion of employees with access to ART through employer-sponsored HIV/AIDS treatment programs. Methods: All 64 private sector and parastatal employers in South Africa with more than 6,000 employees were identified and contacted. Those that agreed to participate were interviewed by telephone using a structured questionnaire. Results: 52 companies agreed to participate. Among these companies, 63% of employees had access to employer-sponsored care and treatment for HIV/AIDS. Access varied widely by sector, however. Approximately 27% of suspected HIV-positive employees were enrolled in HIV/AIDS disease management programs, or 4.4% of the workforce overall. Fewer than 4,000 employees in the entire sample were receiving antiretroviral therapy. In-house (employer) disease management programs and independent disease management programs achieved higher uptake of services than did medical aid schemes. Conclusions: Publicity by large employers about their treatment programs should be interpreted cautiously. While there is a high level of access to treatment, uptake of services is low and only a small fraction of employees medically eligible for antiretroviral therapy are receiving it

Modeling TB-HIV syndemic and treatment

Tuberculosis (TB) and human immunodeficiency virus (HIV) can be considered a deadly human syndemic. In this article, we formulate a model for TB and HIV transmission dynamics. The model considers both TB and acquired immune deficiency syndrome (AIDS) treatment for individuals with only one of the infectious diseases or both. The basic reproduction number and equilibrium points are determined and stability is analyzed. Through simulations, we show that TB treatment for individuals with only TB infection reduces the number of individuals that become co-infected with TB and HIV/AIDS, and reduces the diseases (TB and AIDS) induced deaths. Analogously, the treatment of individuals with only AIDS also reduces the number of co-infected individuals. Further, TB-treatment for co-infected individuals in the active and latent stage of TB disease, implies a decrease of the number of individuals that passes from HIV-positive to AIDS.Comment: This is a preprint of a paper whose final and definite form is: Journal of Applied Mathematics (ISSN 1110-757X) 2014, Article ID 248407, http://dx.doi.org/10.1155/2014/24840

Speech and language therapy versus placebo or no intervention for speech problems in Parkinson's disease

Parkinson's disease patients commonly suffer from speech and vocal problems including dysarthric speech, reduced loudness and loss of articulation. These symptoms increase in frequency and intensity with progression of the disease). Speech and language therapy (SLT) aims to improve the intelligibility of speech with behavioural treatment techniques or instrumental aids

HIV And The Need For A Voluntarist Approach

After a decade of fighting AIDS, the public health community has come to recognize that strategies to combat the infection must be premised on voluntarism and not on coercion. Attempts to combat AIDS with coercive public health strategies stem from a desire to force AIDS into an ill-fitting traditional disease-response framework, overlooking the differences between HIV and other sexually transmitted diseases, including the limitations in available treatment modalities for HIV. A return to such a cramped, narrowly-medicalized view of the AIDS epidemic has enormous social implications and a coercive strategy would frustrate efforts to stem the spread of the disease. Further, such strategies would hamper the willingness of those in need of medical care and education to benefit from existing programs. This essay explores some of the possible explanations for the apparent erosion of the voluntarist consensus and calls for a return to such a voluntarist approach through effective health care and education efforts

HIV And The Need For A Voluntarist Approach

After a decade of fighting AIDS, the public health community has come to recognize that strategies to combat the infection must be premised on voluntarism and not on coercion. Attempts to combat AIDS with coercive public health strategies stem from a desire to force AIDS into an ill-fitting traditional disease-response framework, overlooking the differences between HIV and other sexually transmitted diseases, including the limitations in available treatment modalities for HIV. A return to such a cramped, narrowly-medicalized view of the AIDS epidemic has enormous social implications and a coercive strategy would frustrate efforts to stem the spread of the disease. Further, such strategies would hamper the willingness of those in need of medical care and education to benefit from existing programs. This essay explores some of the possible explanations for the apparent erosion of the voluntarist consensus and calls for a return to such a voluntarist approach through effective health care and education efforts