Many practical clinical questions regarding the management of human immunodeficiency virus (HIV)—associated neurocognitive disorder (HAND) remain unanswered. We sought to identify and develop ...practical answers to key clinical questions in HAND management. Sixty-six specialists from 30 countries provided input into the program, which was overseen by a steering committee. Fourteen questions were rated as being of greatest clinical importance. Answers were drafted by an expert group based on a comprehensive literature review. Sixty-three experts convened to determine consensus and level of evidence for the answers. Consensus was reached on all answers. For instance, good practice suggests that all HIV patients should be screened for HAND early in disease using standardized tools. Follow-up frequency depends on whether HAND is already present or whether clinical data suggest risk for developing HAND. Worsening neurocognitive impairment may trigger consideration of antiretroviral modification when other causes have been excluded. The Mind Exchange program provides practical guidance in the diagnosis, monitoring, and treatment of HAND.
It is now thirty years since the discovery of AIDS but its origins continue to puzzle doctors and scientists. Inspired by his own experiences working as an infectious diseases physician in Africa, ...Jacques Pepin looks back to the early twentieth-century events in Africa that triggered the emergence of HIV/AIDS and traces its subsequent development into the most dramatic and destructive epidemic of modern times. He shows how the disease was first transmitted from chimpanzees to man and then how urbanization, prostitution, and large-scale colonial medical campaigns intended to eradicate tropical diseases combined to disastrous effect to fuel the spread of the virus from its origins in Léopoldville to the rest of Africa, the Caribbean and ultimately worldwide. This is an essential new perspective on HIV/AIDS and on the lessons that must be learnt if we are to avoid provoking another pandemic in the future.
AIDS stigmas create significant barriers to HIV prevention, testing, and care and can become internalized by people living with HIV/AIDS. We developed a psychometric scale to measure internalized ...AIDS-related stigmas among people infected with HIV. Items were adapted from a psychometrically sound test of AIDS-related stigmas in the general population. Six items reflecting self-defacing beliefs and negative perceptions of people living with HIV/AIDS were responded to dichotomously, Agree/Disagree. Data collected from people living with HIV/AIDS in Cape Town South Africa (n=1068), Swaziland (n=1090), and Atlanta US (n=239) showed that the internalized AIDS Stigma Scale was internally consistent (overall alpha coefficient=0.75) and time stable (r=0.53). We also found evidence in support of the scale's convergent, discriminant, and criterion-related validity. The Internalized AIDS-Related Stigma Scale appears reliable and valid and may be useful for research and evaluation with HIV-positive populations across southern African and North American cultures.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
The modern antiretroviral treatment of human immunodeficiency virus (HIV-1) infection has considerably lowered the incidence of opportunistic infections. With the exception of the most severe ...dementia manifestations, the incidence and prevalence of HIV-associated neurocognitive disorders (HAND) have not decreased, and HAND continues to be relevant in daily clinical practice. Now, HAND occurs in earlier stages of HIV infection, and the clinical course differs from that before the widespread use of combination antiretroviral treatment (cART). The predominant clinical feature is a subcortical dementia with deficits in the domains concentration, attention, and memory. Motor signs such as gait disturbance and impaired manual dexterity have become less prominent. Prior to the advent of cART, the cerebral dysfunction could at least partially be explained by the viral load and by virus-associated histopathological findings. In subjects where cART has led to undetectable or at least very low viral load, the pathogenic virus–brain interaction is less direct, and an array of poorly understood immunological and probably toxic phenomena are discussed. This paper gives an overview of the current concepts in the field of HAND and provides suggestions for the diagnostic and therapeutic management.
After silence Finkelstein, Avram
2017., 20171107, 2017, 2017-11-07
eBook
Early in the 1980s AIDS epidemic, six gay activists created one of the most iconic and lasting images that would come to symbolize a movement: a protest poster of a pink triangle with the words ...“Silence = Death.” The graphic and the slogan still resonate today, often used—and misused—to brand the entire movement. Cofounder of the collective Silence = Death and member of the art collective Gran Fury, Avram Finkelstein tells the story of how his work and other protest artwork associated with the early years of the pandemic were created. In writing about art and AIDS activism, the formation of collectives, and the political process, Finkelstein reveals a different side of the traditional HIV/AIDS history, told twenty-five years later, and offers a creative toolbox for those who want to learn how to save lives through activism and making art.
HIV Affected and Vulnerable Youth: Prevention Issues and Approaches provides suggestions for support of vulnerable youth who must face chronic disease or death, poverty, drug abuse, and racism, as ...well as the tribulations that accompany adolescence. Social workers, case managers, psychologists, and nurses who work with HIV-affected and vulnerable youth and their families will find unique recommendations on how to assist these individuals in resisting risky behaviors.
This unique collection of research studies expands on the current knowledge while informing us of how much more there is to be learned. This informative book will enlighten you about the children and mothers who are most likely to be affected by the HIV disease, the poor people of color living in substandard housing who are subjected to discrimination and social isolation. The multiple losses experienced by these women and children because of infection, crime, and substance abuse are included in this valuable book but most importantly you will discover how you can alleviate some of the stresses caused by these losses. Through HIV Affected and Vulnerable Youth, you will discover multiple ways to successfully help the adolescents in your practice deal with the challenges inherent to HIV, economic hardships, and substance abuse.
Comprehensive and intelligent, this important book will help you address the needs of HIV-affected children or families with humanity, sensitivity, and ethnically sensitive interventions. With HIV Affected and Vulnerable Youth, you will find unique interventions to help the youth and family in your community by:
discovering how facing the mortality of an HIV-infected family member has profound psychological effects on a child or adolescent and how you can help ease this crisis for your clients
understanding why many youth who must cope with the eminent death of a family member deal with this crisis by engaging in risky behaviors which may result in HI
Background. Cryptococcal meningitis (CM) is a leading cause of death in individuals infected with human immunodeficiency virus (HIV). Identifying factors associated with mortality informs strategies ...to improve outcomes. Methods. Five hundred one patients with HIV-associated CM were followed prospectively for 10 weeks during trials in Thailand, Uganda, Malawi, and South Africa. South African patients (n = 266) were followed for 1 year. Similar inclusion/exclusion criteria were applied at all sites. Logistic regression identified baseline variables independently associated with mortality. Results. Mortality was 17% at 2 weeks and 34% at 10 weeks. Altered mental status (odds ratio OR, 3.1; 95% confidence interval CI, 1.7–5.9), high cerebrospinal fluid (CSF) fungal burden (OR, 1.4 per log10 colony-forming units/mL increase; 95% CI, 1.0–1.8), older age (>50 years; OR, 3.9; 95% CI, 1.4–11.1), high peripheral white blood cell count (>10 – 109 cells/L; OR, 8.7; 95% CI, 2.5–30.2), fluconazole-based induction treatment, and slow clearance of CSF infection were independently associated with 2-week mortality. Low body weight, anemia (hemoglobin <7.5 g/dL), and low CSF opening pressure were independently associated with mortality at 10 weeks in addition to altered mental status, high fungal burden, high peripheral white cell count, and older age. In those followed for 1 year, overall mortality was 41%. Immune reconstitution inflammatory syndrome occurred in 13% of patients and was associated with 2-week CSF fungal burden (P = .007), but not with time to initiation of antiretroviral therapy (ART). Conclusions. CSF fungal burden, altered mental status, and rate of clearance of infection predict acute mortality in HIV-associated CM. The results suggest that earlier diagnosis, more rapidly fungicidal amphotericin-based regimens, and prompt immune reconstitution with ART are priorities for improving outcomes.
Institutions that have collected video testimonies from the few remaining Holocaust survivors are grappling with how to continue their mission to educate and commemorate. Noah Shenker calls attention ...to the ways that audiovisual testimonies of the Holocaust have been mediated by the institutional histories and practices of their respective archives. Shenker argues that testimonies are shaped not only by the encounter between interviewer and interviewee, but also by technical practices and the testimony process. He analyzes the ways in which interview questions, the framing of the camera, and curatorial and programming preferences impact how Holocaust testimony is molded, distributed, and received.
Introduction
HIV‐1 infection leads to chronic inflammation and to an increased risk of non‐AIDS mortality. Our objective was to determine whether AIDS‐defining events (ADEs) were associated with ...increased overall and cause‐specific non‐AIDS related mortality after antiretroviral therapy (ART) initiation.
Methods
We included HIV treatment‐naïve adults from the Antiretroviral Therapy Cohort Collaboration (ART‐CC) who initiated ART from 1996 to 2014. Causes of death were assigned using the Coding Causes of Death in HIV (CoDe) protocol. The adjusted hazard ratio (aHR) for overall and cause‐specific non‐AIDS mortality among those with an ADE (all ADEs, tuberculosis (TB), Pneumocystis jiroveci pneumonia (PJP), and non‐Hodgkin's lymphoma (NHL)) compared to those without an ADE was estimated using a marginal structural model.
Results
The adjusted hazard of overall non‐AIDS mortality was higher among those with any ADE compared to those without any ADE (aHR 2.21, 95% confidence interval (CI) 2.00 to 2.43). The adjusted hazard of each of the cause‐specific non‐AIDS related deaths were higher among those with any ADE compared to those without, except metabolic deaths (malignancy aHR 2.59 (95% CI 2.13 to 3.14), accident/suicide/overdose aHR 1.37 (95% CI 1.05 to 1.79), cardiovascular aHR 1.95 (95% CI 1.54 to 2.48), infection aHR (95% CI 1.68 to 2.81), hepatic aHR 2.09 (95% CI 1.61 to 2.72), respiratory aHR 4.28 (95% CI 2.67 to 6.88), renal aHR 5.81 (95% CI 2.69 to 12.56) and central nervous aHR 1.53 (95% CI 1.18 to 5.44)). The risk of overall and cause‐specific non‐AIDS mortality differed depending on the specific ADE of interest (TB, PJP, NHL).
Conclusions
In this large multi‐centre cohort collaboration with standardized assignment of causes of death, non‐AIDS mortality was twice as high among patients with an ADE compared to without an ADE. However, non‐AIDS related mortality after an ADE depended on the ADE of interest. Although there may be unmeasured confounders, these findings suggest that a common pathway may be independently driving both ADEs and NADE mortality. While prevention of ADEs may reduce subsequent death due to NADEs following ART initiation, modification of risk factors for NADE mortality remains important after ADE survival.
This Review was undertaken by the Networks of Ministry of Education HIV&AIDS Focal Point from countries in sub-Saharan Africa participating in the Accelerate Initiative, together with stakeholder and ...partner representatives.The education sector has become increasingly recognized as playing a key external role in prevention and in reducing stigma, and an important internal role in providing access to care, treatment and support for teachers and staff, a group that in many countries represents more than 60% of the public sector workforce.In 2002, the Joint United Nations Programme on HIV&AIDS (UNAIDS) Inter-Agency Task Team (IATT) on Education established the Accelerate Initiative Working Group to support countries in sub-Saharan Africa as they accelerate their education sector responses to HIV&AIDS through the establishment of programs with strong local ownership, capable of accessing suitable funding and implementation at all levels of the education sector. The Networks of Ministry of Education HIV&AIDS Focal Points, established through the Initiative under the auspices of the Africa Union Regional Economic Communities, have rapidly taken ownership of the Accelerate Initiative.This Review explores the experiences of education sectors across sub-Saharan Africa as they accelerate their response to HIV&AIDS within the Accelerate Initiative. It demonstrates that leadership by Ministries of Education has been crucial in mobilizing activities, and that full participation of all stakeholders is needed for effective implementation. Since 2002: 37 countries have participated; 4 Networks have been established; 1,350 education staff members and 76 development partners have participated in 120 training days; 75% of participating countries are now accessing funds through their National AIDS Committees; 76% have an HIV&AIDS education sector strategy
and plan; 91% train teachers to protect themselves; all countries are now implementing HIV prevention education; 74% are training teachers in the life skills approach; and 71% provide free education for orphans and vulnerable children.
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