The crucial first step in the prevention of mother-to-child transmission of HIV is awareness of pregnant women of their HIV status. The aim of this study was to define the percentage of patients who received HIV tests between 2001 and 2007 in a German city hospital.
In this retrospective cohort analysis at a University hospital in a German urban area, 12,873 deliveries were retrospectively analysed to determine whether an HIV test had been performed during prenatal counselling.
The number of HIV tests performed increased significantly between 2001 and 2007 from 59.6 to 76.7%. On average, 69.9% of the analysed deliveries were tested for HIV.
Although awareness of the importance of HIV screening in newborns has increased in recent years, the numbers are still unsatisfactory. Therefore, further education is necessary to prevent HIV infection in early pregnancy and avoid HIV mother-to-child transmission.Read more
Pneumonia in South African children remains a major public health concern. The costs of hospital admission for pneumonia should be determined, especially where human immunodeficiency virus (HIV) infection is common.
To determine the hospital costs of children (HIV-infected vs. non-HIV-infected) admitted for the management of pneumonia and compare them in the public and fee-for-service sectors.
A retrospective review of paediatric admissions in 2007 was performed. Costs were determined for the public and fee-for-service sectors. Outcome measures included hospital mortality and comparative costs of admission.
There were 132 admissions in a public sector facility (67% HIV-infected), and 7882 in the fee-for-service sector (1.2% HIV-infected). Total mortality was respectively 25% in the public and 0.04% in the fee-for-service sectors. The mean cost for HIV-infected patients was respectively US$639.06 and US$10 540.04 in the public and fee-for-service sectors. For non-HIV-infected patients, the cost was respectively US$399.45 and US$3936.87. Length of stay for HIV-infected patients was longer by respectively 1.8 days and 5.7 days in the public sector among admissions to the ward and to the paediatric intensive care unit.
Admission for HIV-infected children with pneumonia costs significantly more in both sectors. Preventive strategies are needed.Read more
To estimate trends in hospitalizations and days of care of HIV-infected individuals in US hospitals from 1982 to 2010.
Secondary data analysis of the National Hospital Discharge Survey.
Hospitalizations of HIV-infected individuals increased from 1982 to a peak of 216 086 by 1995, fell 36% by 1997, and then decreased to 118 236 by 2010. Days of care for HIV-uninfected individuals decreased 14.7% from 6.1 days in 1982 to 5.2 days in 2010 yet dropped 62.7% from 17.6 to 7.1 days for HIV-infected individuals. Hospitalized HIV-infected individuals were more likely than uninfected individuals to be male, black, 35 to 44 years old, Medicaid recipients, and be hospitalized in the northeast, in hospitals with more than 500 beds and in government-operated hospitals.
Hospitalizations and days of care for HIV-infected individuals have decreased dramatically in recent years and at rates greater than for HIV-uninfected individuals yet involve some populations and affect certain hospitals disproportionately.Read more
Distinct roadblocks prevent translating basic findings in viral pathogenesis into therapies and implementing potential solutions in the clinic. An ongoing partnership between the Volkswagen Foundation and Nature Medicine resulted in an interactive meeting in 2012, as part of the "Herrenhausen Symposia" series. Current challenges for various fields of viral research were recognized and discussed with a goal in mind--to identify solutions and propose an agenda to address the translational barriers. Here, some of the researchers who participated at the meeting provide a concise outlook at the most pressing unmet research and clinical needs, identifying these key obstacles is a necessary step towards the prevention and cure of human viral diseases.Read more
Experts suggest that effective public action can prevent the spread of HIV/AIDS. Countries dependent on natural resource wealth, such as oil, are likely to suffer from governance failures and thereby suffer lower quality public health. Since the cost of fighting disease redistributes income away from rulers, resource wealth is likely to lead to neglect of public action aimed at stemming a deadly disease. We test this proposition in 137 countries from 1990 until 2008 using oil wealth as a proxy for endogenous policy choices on the prevalence of HIV/AIDS, a proxy outcome for ineffective policy and neglect of public action. We find that the 'resource curse' seems to affect the spread of HIV/AIDS, even though oil-rich countries ceteris paribus should have more financial resources for effective public action. The results are robust to a host of controls, alternative indicators, and fixed effects estimation.Read more
The HIV epidemic in Papua New Guinea is now described as a generalized epidemic; that is, more than 1% of people aged 15 to 49 years are infected with HIV. The individual behavior of people is not the single most important factor that places them at risk of infection and drives the spread of the epidemic. Rather, a diverse range of factors—biological, sociocultural, and political—makes people vulnerable to infection and dictates their access to care and treatment services. This article examines these biological, sociocultural, and political influences on the HIV epidemic and on prevention and treatment strategies in Papua New Guinea.Read more
The HIV/AIDS epidemic, one of the leading public health problems to have affected sub-Sahara Africa, is a multifaceted problem with social, behavioral and biological aspects. In the absence of a cure, behavioral change has been advocated as an intervention strategy for reversing the epidemic. Empirical studies have found heavy alcohol consumption to be a fueling factor for HIV/AIDS infection and progression. Previously , we formulated and analyzed a one-sex deterministic model to capture the dynamics of this deadly interaction. But, since alcohol drinking habits, consequent risky sexual practices, alcohol-induced immune suppression, etc., can be different for men and women, the primary objective of our present paper is to construct a two-sex model aimed at shedding light on how both sexes, with varying heavy alcohol consumption trends, contribute differently to the HIV/AIDS spread. Based on numerical simulations, supported by the UNAIDS epidemiological software SPECTRUM and using the available data, our study identifies heavy drinking among men and women to be a major driving force for HIV/AIDS in Botswana and sub-Sahara Africa and quantifies its hazardous outcomes in terms of increased number of active TB cases and economic burden caused by increased need for AntiRetroviral Therapy (ART). Our simulations point to the heavy-drinking habits of men as a major reason for the continuing disproportionate impact of HIV/AIDS on women in sub-Sahara Africa. Our analysis has revealed the possibility of the phenomenon of backward bifurcation. In contrast to the result in some HIV vaccination models , backward bifurcation in our model is not removed by replacing the corresponding standard incidence function with a mass action incidence, but is removed by merging the two susceptible classes of the same sex into one, i.e., by ignoring acquisition of, and ongoing recovery from, heavy-drinking habits among the susceptible population.Read more
Cheilitis glandularis is a rare disorder of unknown etiology characterized by inflammation of the minor salivary glands of the lower lip. The present report details the features of a patient who presented with cheilitis glandularis and was subsequently found to also have undiagnosed HIV infection.Read more
An HIV-infected man taking long-term zidovudine and didanosine presented with a polyphenotypic expression of nucleoside reverse transcriptase inhibitor (NRTI)-induced mitochondrial toxicity. Clinical features included lactic acidosis, myopathy, Fanconi-type proximal tubulopathy, pancreatic dysfunction, pseudo-obstruction, mega-oesophagus, peripheral sensory neuropathy and osteoporosis. A muscle biopsy showed morphologically abnormal mitochondria and respiratory chain biochemistry revealed marked reductions in the activity of respiratory chain enzymes containing mitochondrial DNA-encoded subunits. Southern blotting showed no mitochondrial DNA depletion and long PCR revealed only minor deletions. Following withdrawal of NRTI therapy, the lactic acidosis, pancreatic dysfunction and Fanconi's tubulopathy rapidly improved. Over the next 6 months there was marked improvement in osteoporosis, myopathy and neuropathy. At this stage, dual protease inhibitors and nevirapine were started. A repeat muscle biopsy 14 months after presentation showed normal morphology and respiratory chain biochemistry was almost normal.Read more
We examine some simple mathematical models which have been recently employed to predict the evolution of population dynamical systems involving virus particles. They include: (1) A general two-component antibody-viral system; (2) A simplified two-component model for HIV-1 dynamics (3) An HIV-1 three-component model including virions and (4) A four-component HIV-1 dynamical model which includes both latently and actively infected cells. For each system we find equilibrium points and analyse their local stability properties in order to obtain a global phase portrait. Analytical methods are complemented with numerical solutions. In all four models there are at most two equilibrium points for physically meaningful values of the variables. As the viral growth rate parameter increases through a critical value, a transcritical bifurcation occurs. One critical point (P1) is always found at zero viral or infected cell levels and non-zero antibody or uninfected cell levels. For parameter values in their usual ranges, P1 is either an asymptotically stable node or a saddle point. When the critical point P2 occurs at biologically meaningful values, it is either an asymptotically stable node or an asymptotically stable spiral point. For all three HIV-1 models, the values of the parameters at which P2 makes a transition to physically meaningful values are precisely those at which P1 changes from an asymptotically stable node to an unstable saddle point. The global pictures for all four models are similar and examples are represented graphically. No limitcycle solutions were found in any of the models for parameter values in their usual ranges. In the four-component HIV-1 model, the effects of varying each parameter are found and conditions under which P2 changes from spiral point to node are investigated numerically. The effects of reverse transcriptase inhibitors and protease inhibitors, two classes of drugs used to treat HIV-1 infection, are examined in the three-component model for early HIV-1 dynamics.Read more