Patient-reported outcomes among people living with HIV on single- versus multi-tablet regimens: Data from a real-life setting

Background The use of single-tablet regimens (STRs) in HIV treatment is ubiquitous. However, reintroducing the (generic) components as multi-tablet regimens (MTRs) could be an interesting cost-reducing strategy. It is essential to involve patient-reported outcome measures (PROs) to examine the effects of such an approach. Hence, this study compared PROs of people living with HIV taking an STR versus a MTR in a real world setting. Materials and methods This longitudinal study included 188 people living with HIV. 132 remained on a MTR and 56 switched to an STR. At baseline, months 1-3-6-12-18 and 24, participants filled in questionnaires on health-related quality of life (HRQoL), depressive symptoms, HIV symptoms, neurocognitive complaints (NCC), treatment satisfaction and adherence. Generalized linear mixed models and generalized estimation equations mixed models were built. Results Clinical parameters and PROs of the two groups were comparable at baseline. Neurocognitive complaints and treatment satisfaction did differ over time among the groups. In the STR-group, the odds of having NCC increased monthly by 4,1% as compared to the MTR-group (p = 0.035). Moreover, people taking an STR were more satisfied with their treatment after 6 months: the median change score was high: 24 (IQR 7,5–29). Further, treatment satisfaction showed a contrary evolution in the groups: the estimated state score of the STR-group increased by 3,3 while it decreased by 0,2 in the MTR-group (p = 0.003). No differences over time between the groups were observed with regard to HRQoL, HIV symptoms, depressive symptoms and adherence. Conclusions Neurocognitive complaints were more frequently reported among people on an STR versus MTR. This finding contrasts with the higher treatment satisfaction in the STR-group over time. The long-term effects of both PROs should guide the decision-making on STRs vs. (generic) MTRs.

A Crossectional Study of Rajayakshma Symptoms in HIV Positive Patients

Background: According to Ayurveda, the HIV Symptoms may be correlated with Rajayakshama (Kshaya). The Symptoms, causative factors and treatment for the latter were found mentioned in many ancient Ayurvedic texts. Present study was aimed to assess the correlation of Rajayakshama symptoms described in Charak Samhita and symptoms seen in HIV positive patient. Material and Method: Present study was a Cross-sectional Survey Study, conducted in patientsof 25 - 50 years age group, irrespective of sex, religion, economic & marital status, diagnosed patients of HIV antibody test positive minimum 2 year ago.Results: Maximum number of HIV patient were from 31-40 years age group(67%). Majority of HIV patients were Female (81%).53 % patients’ were HIV Antibody Test Positive more than 2 year ago & 47% patients were more than 10 year ago.97 % patients were on ART Medication and only 3% patients were not given ART Medication.Ansatapa, Jwara and Parshwashulawere observed in all 100% patient. other symptoms Shirashula(99%); Aruchi(96%);Swarabheda(94%); Swasa(87%); Kasa(60%), Atisara(51 %); Raktasthivana(12%) and Raktavamana(4%). 69% cases were observed with 8-11 symptoms of Rajayakshma. 30% cases had 5-7 symptoms and only 1% cases had 1-4 symptoms of Rajayakshma.Conclusion: this disease is more related to mental status of the person. Following Dinacharya, Rutucharya, Sadvrittapalana, Aachararasayana etc. explained in Ayurveda will definitely help in treating AIDS and improving patient’s health.

A Review of the Composition and Health Benefits of Sweet Potato

Plant-based medicine is a popular emerging field. If one follows the research of this domain, will observe that the majority of the work is focused on different herbs as medicinal plants. However, many vegetables and fruits, their juices and extracts, possess medicinal properties and have been used as such since ancient times. Sweet potato (Ipomoea batatas) is one of the main aliments in many countries. Although regarded as a staple food, people observed its beneficial and medicinal properties. Bioactive components such as anthocyanin, polyphenolic compounds, coumarins, calystegines and triterpenes have been indicated to stimulate immune function, reducing oxidative stress and free radical damage, reduce cardiovascular disease risk, suppress cancer cell growth, prevent and improve symptoms of diabetes and hypoglycemia, suppress HIV symptoms, act as hepatoprotective while being part of a nutritious aliment all together. A sweet potato diet can therefore supplement medication for any of the above-mentioned affections. The current article sets to review the benefits and medicinal properties of sweet potato as regarded by specialty literature. The outcome is to list the main components and the medical benefits observed, outlining the potential uses of Ipomoea batatas in the plant-based medicine field. The review sets to investigate components in all plant parts: tuberous roots, leaves and young shoots.

Journeys to HIV testing and diagnosis among adults aged 50+ years in England: A qualitative interview study

Objectives In England, older adults (aged ≥50 years) are at greater risk of being diagnosed with advanced stage HIV infection than younger adults. We explored journeys to testing and diagnosis among older adults, examining factors associated with late HIV diagnosis in this age group. Methods Semi-structured qualitative interviews were performed with 12 adults diagnosed with HIV at age 50+ years and 12 health care professionals working in sexual health/HIV services. Data were analysed thematically, using the Model of Pathways to Treatment as a framework for analysis. Results Older adults were often found to experience non-linear and complex diagnostic journeys. Pathways to diagnosis were affected by 6 factors: (i) the non-specific nature of HIV symptoms and their misattribution as being age-related; (ii) symptom severity, impact, and visibility; (iii) HIV health literacy; (iv) perceptions of HIV risk; (v) geographical location; and (vi) assessment in non-specialist settings. Conclusions Older adults appear to encounter additional barriers to HIV testing compared with younger people, particularly when they are not part of a group targeted in HIV prevention and testing campaigns. To diagnose HIV more promptly in adults aged 50+ years, HIV knowledge and risk perception must increase in both older people and health care professionals. Health care professionals need to look beyond the ‘high risk’ groups that are most affected by HIV and consider HIV more readily in the diagnostic process.

Sex, Drugs, and Acholic Stools

Hepatitis C virus (HCV) infection causes an acute, sometimes icteric, illness and is typically transmitted through contact with blood of an infected person. Roughly 75% of exposed individuals will develop a chronic infection, and 25% of cases will spontaneously resolve, although slightly lower rates of spontaneous clearance have been observed in people living with HIV. Symptoms of acute HCV are similar to other acute viral hepatidites, such as hepatitis A, B, or E, and include jaundice, scleral icterus, nausea, vomiting, fatigue, dark urine, and acholic stools. However, the majority of patients with acute HCV have few symptoms and do not present to medical care. Chronic infection with HCV can cause liver inflammation, scarring, and damage and can lead to cirrhosis, liver cancer, and death, as well as several extrahepatic manifestations. HCV is a curable infection, and therapies have improved significantly with the development of direct-acting antivirals, which can achieve cure rates of 95% and greater with courses of 2 to 3 months of oral therapy.

HIV-Related Stress Experienced by Newly Diagnosed People Living with HIV in China: A 1-Year Longitudinal Study

This study explored the HIV-related stressors that people living with HIV (PLWH) commonly experience and express as stressful at the time of diagnosis and 1 year later. The factors associated with stress levels and whether social support would moderate the negative effects of stress on psychological health (depressive and anxiety symptoms) were also investigated. Newly diagnosed PLWH were consecutively recruited in this study. Participants rated their stress with the HIV/AIDS Stress Scale at baseline and 1 year later. Social support, depression, and anxiety were also self-reported at both time points. There were significant decreases in stress levels 1 year after diagnosis. Stressors regarding confidentiality, disclosure, emotional distress, fear of infecting others, and excessive attention to physical functions were the most problematic at baseline and 1-year follow-up. A younger age, married status, not living alone, less income, presence of HIV symptoms, and lack of social support were associated with higher levels of stress. No stress-buffering effect of social support on depressive and anxiety symptoms was found in this study. Interventions to reduce stress among PLWH should take into consideration the following priority stressors: confidentiality, discrimination/stigma, serostatus disclosure, distressing emotions, fear of infecting others, and excessive attention to physical functions. More attention should be paid to PLWH with younger age, not living alone, less income, presence of HIV symptoms, and lack of social support.

Neurosyphilis presenting as visually asymptomatic bilateral optic perineuritis

A 39-year-old Caucasian man presented with headaches and retro-orbital pain but normal vision. Bilateral optic nerve swelling was found on funduscopy though optic nerve function and computed perimetry were normal and there was no relative afferent pupillary defect. CT venogram and MRI were unremarkable. Cerebrospinal fluid (CSF) opening pressure was normal on lumbar puncture and Treponema pallidum antibodies and T. pallidum particle agglutination test were positive on CSF analysis. He tested negative for HIV. Symptoms rapidly resolved with 2 weeks of intravenous benzylpenicillin. At 1 month follow-up, the right optic nerve swelling had reduced while the left optic nerve swelling had increased; his vision remained unaffected and he was symptom free and continued to have no objective evidence of optic nerve dysfunction.

Same-Day HIV Pre-Exposure Prophylaxis (PrEP) Initiation During Drop-in Sexually Transmitted Diseases Clinic Appointments Is a Highly Acceptable, Feasible, and Safe Model that Engages Individuals at Risk for HIV into PrEP Care

Objective Strategies to increase pre-exposure prophylaxis (PrEP) uptake are needed. We hypothesized that same-day PrEP initiation in a sexually transmitted diseases (STD) clinic would be acceptable, feasible, and safe, and that individuals would engage in ongoing PrEP care. Method Individuals aged ≥ 18 years were evaluated for PrEP. Exclusion criteria were HIV, history of renal dysfunction or chronic hepatitis B infection, pregnancy, indications for HIV post-exposure prophylaxis, or positive screen for acute HIV symptoms. One hundred individuals received a free 30-day PrEP starter pack and met with a patient navigator to establish ongoing care. Bivariate analysis and multivariable logistic regression were used to compare individuals who did and did not attend at least 1 PrEP follow-up appointment within 180 days of enrollment. Client satisfaction surveys were given 3 months after enrollment. Results The majority (78%) of participants completed at least 1 PrEP follow-up appointment, and 57% attended at least 2 follow-up appointments. After adjusting for race and ethnicity, age, health insurance status, and annual income, only income was associated with follow-up appointment attendance. Each additional $10,000 increase in income was associated with a 1.7-fold increase in the odds of attending a PrEP follow-up appointment (95% confidence interval, 1.07–2.66, P = .02). The majority (54%) of individuals completed the satisfaction survey and all respondents liked the option of same-day PrEP initiation. Conclusions Our study suggests STD clinic-based, same-day PrEP initiation is acceptable, feasible, safe, and links a high proportion of individuals into ongoing PrEP care. Additional resources may be needed to support low-income individuals’ retention in care.

Assessment of Palliative Care Needs in Hospital Settings in Rwanda

Background: Rwanda is among the first African countries with a palliative care (PC) policy and implementation plan. A partnership with the Ministry of Health (MoH) through the Rwanda Biomedical Centre (RBC) and the University of Edinburgh has supported an integrated approach including expanding the evidence base. Aim: To assessing the need for (PC) to inform policy, service delivery and training. Methods: A point prevalence PC needs assessment was conducted in nine public hospitals (referral, provincial and district). A records census identified those with life-limiting illness (LLI) who were then invited to participate by interview. The assessment tool included the APCA African POS, POS S, WHO performance status and demographic information. Results: 608 case notes were reviewed, 152 eligible and 124 completed assessment. 25% of all patients admitted had LLI, of which 99.2% had evidence of unmet need determined by at least one score on the APCA POS ≥ 3. Diagnoses 29% cancer, 29% cardiovascular disease, 16.9% end-stage organ failure and 13.7% HIV. Symptoms with greatest impact; nausea and vomiting (34.7%) and pain (32.3%). 63.7% with WHO performance status 4 or 5. 8.1% seen by existing PC services. Conclusion: Although the MoH and RBC are making bold steps toward developing PC in Rwanda, there remains a significant amount of unmet PC needs. Meeting this need requires recognition of the scope of PC needs beyond cancer, feedback to the hospitals and health care workers, thinking strategically how to further strengthen the health system and further capacity building and training.