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Assessment of clinico-immunological profile of newly diagnosed HIV patients presenting to a teaching hospital of eastern India.
Indian Journal of Medical Research. 2014 Jun; 139(6):903-12.BACKGROUND & OBJECTIVES: Newly diagnosed HIV patients may be asymptomatic or present with a wide range of symptoms related to opportunistic infections, acute seroconversion illness or other medical illnesses. This study was designed to evaluate the socio-demographic parameters, spectrum of the presenting clinical conditions and concurrent immunological status of newly diagnosed HIV patients and document the WHO clinical stages at the time of HIV diagnosis. METHODS: This cross-sectional, observational study was undertaken over a 12 month period at a tertiary referral hospital in eastern India. Three hundred sixty consecutive newly diagnosed HIV patients were selected for the study from the HIV clinic and medicine wards of this hospital. Demographic and clinical data and relevant laboratory investigations of the patients were recorded and analyzed. RESULTS: Mean age of patients was 36.38+/-10.62 yr, while 63.89 per cent were males. The main mode of transmission of HIV for males and females were unprotected exposure to commercial sex (139, 60.44%) and intercourse with HIV seropositive spouses (89, 68.46%), respectively. Fever (104, 28.89%), weight loss (103, 28.61%) and generalized weakness (80, 22.22%) were the predominant symptoms. Overall mean CD4 count was 176.04+/-163.49 cells/mul (males 142.19+/-139.33 cells/mul; females 235.92+/-185.11 cells/mul). Overall, 224 opportunistic infections were documented in 160 patients, opportunistic diarrhoea (44, 12.22%) and pulmonary tuberculosis (39, 10.83%) being the commonest. There were 83 and 133 patients in WHO clinical stages 3 and 4, respectively; 291 (80.83%) patients were eligible for initiation of first-line antiretrovirals at presentation. INTERPRETATION & CONCLUSIONS: Advanced immunodeficiency and burden of opportunistic infections characterize newly diagnosed HIV patients in eastern India. The physicians should keep in mind that these patients may have more than one clinical condition at presentation.
Health outcomes and cost impact of the new WHO 2013 guidelines on prevention of mother-to-child transmission of HIV in Zambia.
PloS One. 2014; 9(3):e90991.BACKGROUND: Countries are currently progressing towards the elimination of new paediatric HIV infections by 2015. WHO published new consolidated guidelines in June 2013, which now recommend either 'Antiretroviral drugs (ARVs) for women living with HIV during pregnancy and breastfeeding (Option B)' or 'Lifelong antiretroviral therapy (ART) for all pregnant and breastfeeding women living with HIV (Option B+)', while de facto phasing out Option A. This study examined health outcomes and cost impact of the shift to WHO 2013 recommendations in Zambia. METHODS: A decision analytic model was developed based on the national health system perspective. Estimated risk and number of cases of HIV transmission to infants and to serodiscordant partners, and proportions of HIV-infected pregnant women with CD4 count of =350 cells/mm3 to initiate ART were compared between 2010 Option A and the 2013 recommendations. Total costs of prevention of mother-to-child transmission of HIV (PMTCT) services per annual cohort of pregnant women, incremental cost-effectiveness ratio (ICER) per infection averted and quality-adjusted life-year (QALY) gained were examined. RESULTS: Our analysis suggested that the shift from 2010 Option A to the 2013 guidelines would result in a 33% reduction of the risk of HIV transmission among exposed infants. The risk of transmission to serodiscordant partners for a period of 24 months would be reduced by 72% with 'ARVs during pregnancy and breastfeeding' and further reduced by 15% with 'Lifelong ART'. The probability of HIV-infected pregnant women to initiate ART would increase by 80%. It was also suggested that while the shift would generate higher PMTCT costs, it would be cost-saving in the long term as it spares future treatment costs by preventing infections in infants and partners. CONCLUSION: The shift to the WHO 2013 guidelines in Zambia would positively impact health of family and save future costs related to care and treatment.
Hormonal contraceptive methods for women at high risk of HIV and living with HIV. 2014 guidance statement. Recommendations concerning the use of hormonal contraceptive methods by women at high risk of HIV and women living with HIV.
Geneva, Switzerland, WHO, Department of Reproductive Health and Research, 2014.  p. (WHO/RHR/14.24)During 9-12 March 2014, the World Health Organization (WHO) convened a meeting of the Guideline Development Group (GDG) comprising 52 individuals representing a wide range of stakeholders, for the purpose of reviewing, and where appropriate, revising its Medical eligibility criteria for contraceptive use, fourth edition (MEC) guidance. Recommendations concerning the use of hormonal contraceptive methods by women at high risk of HIV and women living with HIV, including women taking antiretroviral therapy (ART), were among the many topics reviewed at this meeting. Given the public health importance of this topic, and at the encouragement of the GDG, the World Health Organization is issuing its contraceptive eligibility guidance for women at high risk of HIV and women living with HIV in advance of the entire guideline revision. It is anticipated that the revised fifth edition of the MEC will be completed in 2015. Recommendations for hormonal contraceptive use are provided for: women at high risk of HIV infection; women living with asymptomatic or mild HIV clinical disease (WHO stage 1 or 2); women living with severe or advanced HIV clinical disease (WHO stage 3 or 4); women living with HIV using antiretroviral therapy (ART). In addition to the recommendations themselves, this publication provides a description of the background and methods used in their development. An executive summary and information on dissemination and evaluation are also included. (Excerpts)
Geneva, Switzerland, UNAIDS, 2014 Jul.  p. (UNAIDS / JC2656)How do we close the gap between the people moving forward and the people being left behind? This was the question we set out to answer in the UNAIDS Gap report. Similar to the Global report, the goal of the Gap report is to provide the best possible data, but, in addition, to give information and analysis on the people being left behind. A new report by UNAIDS shows that 19 million of the 35 million people living with HIV globally do not know their HIV-positive status. The UNAIDS Gap report shows that as people find out their HIV-positive status they will seek life-saving treatment. In sub-Saharan Africa, almost 90% of people who tested positive for HIV went on to access antiretroviral therapy (ART). Research shows that in sub-Saharan Africa, 76% of people on ART have achieved viral suppression, whereby they are unlikely to transmit the virus to their sexual partners. New data analysis demonstrates that for every 10% increase in treatment coverage there is a 1% decline in the percentage of new infections among people living with HIV. The report highlights that efforts to increase access to ART are working. In 2013, an additional 2.3 million people gained access to the life-saving medicines. This brings the global number of people accessing ART to nearly 13 million by the end of 2013. Based on past scale-up, UNAIDS projects that as of July 2014 as many as 13 950 296 people were accessing ART. By ending the epidemic by 2030, the world would avert 18 million new HIV infections and 11.2 million AIDS-related deaths between 2013 and 2030.