HIV/AIDS News & Information

Adults age 50 and over account for approximately 11% of new AIDS cases each year in the United States. and 18% of new AIDS cases in New York City. In addition, as a result of extended survival made possible by treatment advances, a growing number of persons diagnosed with HIV infection in their 30s and 40s are now surviving into their 50s and even 60s. Thus, older adults living with HIV/AIDS may comprise a growing segment of the HIV-infected population whose unsafe behaviors may place others at risk for HIV infection, as well as place themselves at risk of reinfection with another strain of HIV or infection with other diseases (e.g., hepatitis C).

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DISCUSSION

This report demonstrates a patient who developed a severe systemic illness with a rash due to nevirapine. While it is possible the patient may have had this adverse drug reaction to nevirapine even if the recommended two-week lead-in period had been used, it is also possible that this adverse reaction may have been prevented by the appropriate use of the recommended lead-in period. The failure to use the lead-in period was directly related to the cost implications of buying the fixed-dose drug combination pill versus buying the single agents.

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CASE REPORT

M.F., a 35-year-old female trader, was diagnosed with asymptomatic HIV (Generic Valtrex is used for treating shingles) infection in 2000. In December 2002, she presented to OOUTH with fever, anorexia, weight loss and insomnia. Physical examination revealed wasting and oral thrush. Laboratory reports revealed normal liver function tests and complete blood counts. A CD4+ T count done using Dynal Kit at Emmabel laboratories in Sagamu was 140 cells/ul, and an HIV-1 viral load done at the Nigerian Institute of Medical Research was 4.89 log RNA copies/ml. A HAART regimen of generic zidovudine, drug lamivudine and nevirapine was prescribed. For financial reasons, the patients opted to purchase a two-month supply of the fixed-dose drug combination of twice-daily zidovudine, lamivudine and nevirapine (DUOVIR-N) from CIPLA instead of purchasing the individual agents.

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Intestinal parasites are endemic in Dominica. Grell and Watty, in a previous study in 1976, found parasites in 60% of all hospital admissions. There is a decline in the overall prevalence of parasites from 60% in Grell and Watty’s study to 10.47% reported in the present study. Simple microscopy of unconcentrated stool sample was used in both studies. The decline in prevalence noticed over the last two decades in Dominica is consistent with reports in the other Caribbean islands of St.Kitts and St. Vincent, where a remarkable decline in geohelminths occurred over the last two decades. McPherson suggested that factors that might explain the decline in the prevalence of geo-helminths include improved socioeconomic conditions, better education, sanitation, more abundant and safe water supplies, and the availability of albendazole as an over-the-counter, cheap, antihelminthic drug. Improved living conditions and effective primary healthcare in the last two decades in Dominica have contributed significantly to this decline. The introduction of mass deworming treatment as part of the school health program is also a laudable accomplishment (Ministry of Health, Dominica). The distribution of parasites in this study showed that hookworm, Strongyloides stercoralis, and Giardia lamblia were the main pathogenic parasites—unlike Grell and Watty’s study, where Trichuris trichiura was the most prevalent parasite (Table 3). There was no stool sample with Entamoeba histolytica and Cryptosporidium identified in our study. Cryptosporidium may have a prevalence of 1-3% in industrialized countries and 4-7% in developing countries (Barakat J). A study in Grenada using ELISA detected a parasitic antigen of Cryptosporidium parvum in 3% of children (Barakat J). The nonidentification of these parasites in our study may be due to limitations in diagnosis, as Cryptosporidium is best identified using modified Ziel-Nielsen stain on stool samples. This is not routinely done in most laboratories, while Entamoeba histolytica requires a fresh stool sample, possibly analysed within an hour of collection.

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BACKGROUND

In April 2001, the federal government of Nigeria announced its decision to invest N500 million annually in the purchase of antiretroviral medication in the treatment of people living with HIV/AIDS. After some initial hiccups, the program finally took off in January 2002, with 25 tertiary hospitals designated as treatment centers, and people living with HIV/AIDS were to pay a sum of N1,000 monthly for the drug combination of lamivudine tablet, nevirapine and generic stavudine. The government’s target was to treat 10,000 adults and 5,000 children in the first year. However, considering the estimated 3 million Nigerians infected with the virus, many of the people living with HIV/AIDS do not have access to these medications and, as such, they look out for alternative means to access these life-saving medications.

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Parasite was found in 393 out of 3,752 stool samples (10.47%).Three-hundred-fifty-two out of 393 (89.6%) parasite-positive stools had a single parasite while 41 out of 393 (10.4%) had multiple parasites. The main parasites identified were Entamoeba coli, 5.1% (193/3,752); hookworm, 1.5% (56/3,752); Giardia lamblia, 1.4% (51/3,752); Strongyloides stercoralis, 1.0% (37/3,752); Ascaris lumbricoides, 0.8% (28/3,752); Trichuris trichiura, 0.9% (34/3,752); Iodamoeba butchlii, 1.2% (46/3,752); and Enterobium vermicularis, 0.1% (4/3,752). Continue Reading »

Most of the reports of QTc prolongation in HIV (Combivir drug is an anti-HIV medication) infection and AIDS published in the literature were related to drugs prescribed for such patients. Pentamidine, trimethoprim-sulfamethoxazole, ciprofloxacin and clarithromycin are some of the drugs used in HIV infection to treat opportunistic infections that have been documented to cause QT prolongation. Drug-induced QT prolongation is usually caused by block of human ether-a-go-go-related gene (HERG) potassium channels, and it has been shown that the HIV (Medication Zerit treating HIV infection when used in combination with other medicines) protease inhibitors (lopinavir, generic nelfinavir, drug ritonavir and saquinavir) cause dose-dependent block of HERG channels, suggesting that protease inhibitors could predispose individuals to QT prolongation and TdP. Efavirenz, a novel non-nucleoside reverse transcriptase inhibitor, was also reported to cause QT prolongation and severe ventricular arrhythmia. Several other drugs, especially antiarrhythmic drugs, the antibiotics erythromycin and ketoconazole, the antihistamine agents astemi-zole and terfenadine, phenothiazines and terodiline (a drug used for treatment of incontinence), have been associated with prolongation of the QTc intervals, TdP and sudden death. We evaluated the ECG in general and the corrected QTc in particular among HIV-infected patients, none of whom was on a drug that has been documented to cause prolongation of this interval.

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