120 research outputs found
A prospective analysis of viral immune escape in the chronic phase of the subtype C HIV-1 infections of India
Trimethoprim sulfamethoxazole drug resistance with co resistance to extended spectrum β-lactam antibiotics among bacterial isolates from HIV patients
PP-116 Profile of occult hepatitis B virus infection in an area with intermediate prevalence of HBV infection
Detection of pulmonary Mycoplasma pneumoniae infections in HIV-infected subjects using culture and serology
SummaryObjectiveThe true prevalence of Mycoplasma pneumoniae infections involving the respiratory tracts of HIV-infected individuals is still unclear. This study examined the prevalence of M. pneumoniae in 100 HIV-infected individuals at an AIDS care center in Chennai, India, using conventional laboratory techniques and interpretation criteria.MethodsDiagnosis was based on culture, cold agglutination test, and commercial enzyme-linked immunosorbent assay (ELISA) for the qualitative determination of IgM antibodies against M. pneumoniae. The efficacies of the different diagnostic procedures used in the study were analyzed.ResultsThe prevalence of M. pneumoniae was 31% by culture and 21% by IgM ELISA. Cough (p=0.03, OR 3.8, 95% CI 1–17.8), myalgia (p=0.04, OR 2.5, 95% CI 1–6.6), rales (p=0.04, OR 2.4, 95% CI 1–6.6), and cervical adenopathy (p=0.03, OR 2.7, 95% CI 1–7.1) were the symptoms that significantly corroborated culture positivity. Patients positive for M. pneumoniae by culture or IgM antibody had significantly greater CD4+ T-cell depletion and anemia than those without any evidence of infection.ConclusionsThis study provides the means to diagnose M. pneumoniae infection and information on the prevalence of the pathogen in HIV-infected individuals in resource constrained settings. Although modern molecular techniques may provide more insight into the prevalence of M. pneumoniae in HIV-infected individuals, conventional methods can still be used in diagnosis
A Descriptive Profile of Abused Female Sex Workers in India
This descriptive study presents the profiles of abused female sex workers (FSWs) in Chennai, India. Of 100 abused FSWs surveyed using a structured questionnaire, severe forms of violence by intimate partners were reported by most (98%) respondents. Of the total sample, 76% experienced violence by clients. Sexual coercion experiences of the FSWs included verbal threats (77%) and physical force (87%) by intimate partners and forced unwanted sexual acts (73%) by clients. While 39% of the women consumed alcohol before meeting a client, 26% reported that their drunkenness was a trigger for violence by clients. The findings suggest that there is an urgent need to integrate services, along with public-health interventions among FSWs to protect them from violence. Recognition of multiple identities of women in the contexts of intimate relationships versus sex work is vital in helping women to stay safe from adverse effects on health
Immune reconstitution inflammatory syndrome in association with HIV/AIDS and tuberculosis: Views over hidden possibilities
Gut immune components are severely compromised among persons with AIDS, which allows increased translocation of bacterial lipopolysaccharides (LPS) into the systemic circulation. These microbial LPS are reportedly increased in chronically HIV-infected individuals and findings have correlated convincingly with measures of immune activation. Immune reconstitution inflammatory syndrome (IRIS) is an adverse consequence of the restoration of pathogen-specific immune responses in a subset of HIV-infected subjects with underlying latent infections during the initial months of highly active antiretroviral treatment (HAART). Whether IRIS is the result of a response to a high antigen burden, an excessive response by the recovering immune system, exacerbated production of pro-inflammatory cytokines or a lack of immune regulation due to inability to produce regulatory cytokines remains to be determined. We theorize that those who develop IRIS have a high burden of proinflammatory cytokines produced also in response to systemic bacterial LPS that nonspecifically act on latent mycobacterial antigens. We also hypothesize that subjects that do not develop IRIS could have developed either tolerance (anergy) to persistent LPS/tubercle antigens or could have normal FOXP3+ gene and that those with defective FOXP3+ gene or those with enormous plasma LPS could be vulnerable to IRIS. The measure of microbial LPS, anti-LPS antibodies and nonspecific plasma cytokines in subjects on HAART shall predict the role of these components in IRIS
Does CD4+CD25+foxp3+ cell (Treg) and IL-10 profile determine susceptibility to immune reconstitution inflammatory syndrome (IRIS) in HIV disease?
HIV-specific T-lymphocyte responses that underlie IRIS are incomplete and largely remain hypothetical. Of the several mechanisms presented by the host to control host immunological damage, Treg cells are believed to play a critical role. Using the available experimental evidence, it is proposed that enormous synthesis of conventional FoxP3- Th cells (responsive) often renders subjects inherently vulnerable to IRIS, whereas that of natural FoxP3+ Treg cell synthesis predominate among subjects that may not progress to IRIS. We also propose that IRIS non-developers generate precursor T-cells with a high avidity to generate CD4+CD25+FoxP3+ Tregs whereas IRIS developers generate T-cells of intermediate avidity yielding Th0 cells and effector T-cells to mediate the generation of proinflammatory cytokines in response to cell-signaling factors (IL-2, IL-6 etc.). Researchers have shown that IL-10 Tregs (along with TGF-β, a known anti-inflammatory cytokine) limit immune responses against microbial antigens in addition to effectively controlling HIV replication, the prime objective of HAART. Although certain technical limitations are described herein, we advocate measures to test the role of Tregs in IRIS
Expansion of HIV Laboratory Diagnostic Services in Chennai, India 2001–2006: Is the Growth Commensurate with the Need?
Objective: To describe the changes in HIV services provided and the patient population utilizing voluntary counseling and testing (VCT) services at private testing laboratories in Chennai, India in 2001 and 2006. Methods: In 2001, a cross-sectional descriptive survey was conducted to assess the services provided and client population of 1,031 private laboratories. A subset of labs (9%) that had been surveyed in 2001 were also studied in 2006. Results: In 2001, significantly more high volume labs (.10 HIV tests per month) offered HIV diagnostic tests than low volume labs (,10 HIV test per month) (p,0.001). More high volume labs (20.0%) provided pre-test counseling as part of HIV testing than low volume labs (11.1%) (p = 0.003). Between 2001 and 2006, the number of labs that provided HIV diagnostic tests significantly increased, including ELISA (87.8 % vs. 40.0%), Western Blot (84.4 % vs. 13.3%), and Tridot (98.9 % vs. 72.2%) (p,0.001). Also the number of labs that reported greater than 10 women seeking HIV testing per month significantly increased from 14.5 % to 79.0 % (p = 0.006). More labs provided pre-test counseling in 2006 (34.4%) than in 2001 (21.1%) (p = 0.046). Conclusions: Though HIV diagnostic testing services have increasingly become available, counseling services have not expanded commensurately. Further outreach and education is necessary to expand comprehensive HIV VCT services in bot
An Approach to Addressing Ethical Issues in a Community-based Risk Assessment for HIV
Community-based assessment of HIV prevalence and behavioural risk
factors is the basis for deciding priorities of prevention and care
programmes. Here, upholding the human rights of participants in
assessment is of utmost importance. The objective of the paper was to
describe the process of implementation of an epidemiological survey to
assess HIV-related behavioural and biological factors in Chennai city
in South India and to suggest an ethical framework for conducting
similar assessment activities in developing-country settings. A survey
was conducted with participation from residents (n=1,659) of low-income
urban communities (slums) as part of a community-based
HIV/STD-prevention trial. Administration of the survey was preceded by
extensive community contact and household visits to inform community
members about the trial and assessment activities. Formative research
further strengthened rapport with community, highlighted community
concerns, and identified HIV-related risk behaviours that informed
questionnaire design. The process of obtaining informed consent began
before assessment activities and provided an opportunity for
individuals to discuss participation with their families and friends.
Privacy during assessment, comprehensive follow-up care for those who
tested positive for HIV/STDs, such as nutritional and prevention
counselling, referral services for opportunistic infections, and
antenatal-care options for pregnant women increased trust and
credibility of the project. The sustained availability of trial staff
to facilitate access to resources to address non-HIV/STD-related
felt-needs further strengthened participation of the community members.
These resources included liaison services with local government to
obtain public services, such as water and electricity and resources, to
address concerns, such as alcohol abuse and domestic violence. Based on
this experience, an ethical framework is suggested for conducting HIV
epidemiological risk assessment in developing countries. This framework
discusses the role of community participation, transparent and
comprehensive informed consent, timely dissemination of results, and
access to follow-up care for those living with HIV/STDs
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