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Search Results: 1 - 10 of 6872 matches for " Gerardo Alvarez-Uria "
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Factors associated with delayed entry into HIV medical care after HIV diagnosis in a resource-limited setting: Data from a cohort study in India
Gerardo Alvarez-Uria
PeerJ , 2013, DOI: 10.7717/peerj.90
Abstract: Studies from sub-Saharan Africa have shown that a substantial proportion of patients diagnosed with HIV enter into HIV medical care late. However, data from low or middle-income countries outside Africa are scarce. In this study, we investigated risk factors associated with delayed entry into care stratified by gender in a large cohort study in India. 7701 patients were diagnosed with HIV and 5410 entered into care within three months of HIV diagnosis. Nearly 80% entered into care within a year, but most patients who did not enter into care within a year remained lost to follow up or died. Patient with risk factors related to having a low socio-economic status (poverty, being homeless, belonging to a disadvantaged community and illiteracy) were more likely to enter into care late. In addition, male gender and being asymptomatic at the moment of HIV infection were factors associated with delayed entry into care. Substantial gender differences were found. Younger age was found to be associated with delayed entry in men, but not in women. Widows and unmarried men were more likely to enter into care within three months. Women belonging to disadvantaged communities or living far from a town were more likely to enter into care late. The results of this study highlight the need to improve the linkage between HIV diagnosis and HIV treatment in India. HIV programmes should monitor patients diagnosed with HIV until they engage in HIV medical care, especially those at increased risk of attrition.
Description of the cascade of care and factors associated with attrition before and after initiating antiretroviral therapy of HIV infected children in a cohort study in India
Gerardo Alvarez-Uria
PeerJ , 2015, DOI: 10.7717/peerj.304
Abstract: In low- and middle-income countries, the attrition across the continuum of care of HIV infected children is not well known. The aim of this study was to investigate predictors of mortality and loss to follow up (LTFU) in HIV infected children from a cohort study in India and to describe the cascade of care from HIV diagnosis to virological suppression after antiretroviral therapy (ART) initiation. Multivariable analysis was performed using competing risk regression. The cumulative incidence of attrition due to mortality or LTFU after five year of follow-up was 16% from entry into care to ART initiation and 24.9% after ART initiation. Of all children diagnosed with HIV, it was estimated that 91.9% entered into care, 77.2% were retained until ART initiation, 58% stayed in care after ART initiation, and 43.4% achieved virological suppression on ART. Approximately half of the attrition occurred before ART initiation, and the other half after starting ART. Belonging to socially disadvantaged communities and living >90 min from the hospital were associated with a higher risk of attrition. Being >10 years old and having higher 12-month risk of AIDS (calculated using the absolute CD4 lymphocyte count and the age) were associated with an increased risk of mortality. These findings indicate that we should consider placing more emphasis on promoting research and implementing interventions to improve the engagement of HIV infected children in pre-ART care. The results of this study can be used by HIV programmes to design interventions aimed at reducing the attrition across the continuum of care of HIV infected children in India.
Prevalence and Antibiotic Susceptibility of Community-Associated Methicillin-Resistant Staphylococcus aureus in a Rural Area of India: Is MRSA Replacing Methicillin-Susceptible Staphylococcus aureus in the Community?
Gerardo Alvarez-Uria,Raghuprakash Reddy
ISRN Dermatology , 2012, DOI: 10.5402/2012/248951
Abstract:
Prevalence and Antibiotic Susceptibility of Community-Associated Methicillin-Resistant Staphylococcus aureus in a Rural Area of India: Is MRSA Replacing Methicillin-Susceptible Staphylococcus aureus in the Community?
Gerardo Alvarez-Uria,Raghuprakash Reddy
ISRN Dermatology , 2012, DOI: 10.5402/2012/248951
Abstract: Staphylococcus aureus (SA) is the most common cause of skin and soft tissue infections (SSTIs) and nosocomial infections. In developed countries there is a major concern about the rise of community-associated methicillin-resistant SA (CA-MRSA), but data from developing countries are scarce. In this study we describe the prevalence and antibiotic susceptibility of CA-MRSA and healthcare-associated MRSA (HA-MRSA) in a district hospital from rural India. We identified 119 CA-SA infections and 82 HA-SA infections. The majority of infections were SSTI, and the proportion of MRSA in CA-SA and HA-SA infections was 64.7% and 70.7%, respectively. The proportion of CA-MRSA in children <5 years was 73.7%. We did not observe any linezolid or vancomycin resistance. CA-SA had high levels of resistance to ciprofloxacin and low levels of resistance to chloramphenicol, doxycycline, rifampicin, and clindamycin. CA-MRSA had higher proportion of resistance to ciprofloxacin, erythromycin, gentamicin, and cotrimoxazole than CA methicillin-susceptible SA (CA-MSSA). HA-MRSA had higher proportion of resistance to clindamycin and doxycycline than CA-MRSA. The results of this study indicate that MRSA is replacing MSSA in CA-SA infections. If these findings are confirmed by other studies, the spread of CA-MRSA can be a major public health problem in India. 1. Introduction Although Staphylococcus aureus (SA) is a commensal organism, persistently or transiently present in up to 80% of healthy individuals, it is the most common cause of skin and soft tissue infections (SSTIs) and nosocomial infections, and it is able to produce necrotizing pneumonia, septic arthritis, endocarditis, and osteomyelitis [1, 2]. Before the antibiotic era, the mortality of blood stream infections caused by SA was above 80% [3]. After the discovery of penicillin, the mortality of SA infections was reduced dramatically [4]. However, soon after the introduction of penicillin, penicillinase-producer SA strains were described. These penicillin-resistant strains spread into hospitals and years later into the community [4]. Penicillin-resistant strains became more common than penicillin-susceptible strains, first in hospitals and later in the community, by the late 1970s [2]. Antibiotic drugs that were effective against penicillinase-producer strains such as methicillin became the drugs of choice for treating SSTI and other SA-related infections. However, soon after the introduction of methicillin, SA strains with a modified transpeptidase that had low affinity for beta-lactam antibiotics were described [2].
Socio-demographic risk factors associated with HIV infection in patients seeking medical advice in a rural hospital of India
Gerardo Alvarez-Uria,Manoranjan Midde,Praveen K. Naik
Journal of Public Health Research , 2012, DOI: 10.4081/jphr.2012.e14
Abstract: Despite the fact that two thirds of HIV infected people in India are rural residents, risk factors associated with HIV infection in rural areas are not well known. In this study we have collected socio-demographic data of 6406 patients who were tested for HIV infection in a rural hospital of India and we have investigated risk factors associated with HIV. In women the most important risk factor was being a widow and the risk was higher in younger than in older widows. Other variables found to be associated with HIV infection were age between 25 and 45 years in men, low education level (especially those who only completed primary education) and working in a field not related to agriculture in scheduled castes and men from scheduled tribes. The results of this study express the need for HIV screening of widows who live in rural areas of Indian States with high HIV prevalence.
Factors Associated with Late Presentation of HIV and Estimation of Antiretroviral Treatment Need according to CD4 Lymphocyte Count in a Resource-Limited Setting: Data from an HIV Cohort Study in India
Gerardo Alvarez-Uria,Manoranjan Midde,Raghavakalyan Pakam,Shanmugamari Kannan,Lakshminarayana Bachu,Praveen Kumar Naik
Interdisciplinary Perspectives on Infectious Diseases , 2012, DOI: 10.1155/2012/293795
Abstract: We describe the CD4 lymphocyte count at HIV presentation in an HIV cohort from a rural district of India. The majority of patients were diagnosed for their HIV-related symptoms, although a sizeable proportion of women were diagnosed because of antenatal screening or for having an HIV-positive partner. Patients diagnosed of HIV for antenatal screening or having an HIV-positive sexual partner had higher CD4 lymphocyte count than patients having tuberculosis or HIV-related symptoms. The proportion of patients diagnosed with CD4 count <200 and <350 cells/mm3 were 46% and 68.7%, respectively, and these figures did not change during the five years of the study. Factors associated with late presentations were male sex, older age, not having a permanent house, and, in women, lower education and being a widow or separated. With the implementation of 2010 WHO guidelines, the number of newly diagnosed patients who will require HIV treatment will increase 13.8%. If the CD4 count threshold for initiating HIV treatment is increased from 350 to 500 cells/mm3, the number of patients in need of treatment would increase 15.7%. Therefore, new strategies for avoiding HIV late presentation are urgently needed in developing countries. 1. Introduction International HIV guidelines for the use of antiretroviral therapy (ART) in adults are shifting towards earlier initiation of HIV treatment [1–3]. Late initiation of ART is associated with higher risk of death and opportunistic infections as well as poorer response to treatment [4, 5]. However, patients who are diagnosed when their CD4 lymphocyte count is low are not able to get the benefits of an early ART initiation. From the public health point of view, these patients have a longer period of undiagnosed HIV infection. Late presentation of HIV delays patients from receiving education for avoiding the infection to others and precludes them from receiving ART, which can reduce their HIV viral load and, therefore, lowering the risk of HIV transmission to others. In Europe and North America, approximately 30 to 35% of patients have CD4 lymphocyte count below 200?cells/mm3 at HIV diagnosis [6, 7]. Despite having more than 90% of the world burden of people living with HIV [8], information about the immunological situation at HIV diagnosis of patients from developing countries is scarce [9]. The aim of this study is to describe the CD4 lymphocyte count at HIV presentation in patients from a rural district of India and to investigate factors associated with late presentation [10]. We have also performed a simulation of how many people
Rapid Diagnosis of Pulmonary and Extrapulmonary Tuberculosis in HIV-Infected Patients. Comparison of LED Fluorescent Microscopy and the GeneXpert MTB/RIF Assay in a District Hospital in India
Gerardo Alvarez-Uria,Jose M. Azcona,Manoranjan Midde,Praveen K. Naik,Srinivasulu Reddy,Raghuprakash Reddy
Tuberculosis Research and Treatment , 2012, DOI: 10.1155/2012/932862
Abstract: HIV-related tuberculosis is difficult to diagnose and is associated with high morbidity and mortality. Recently, the World Health Organization has endorsed the GeneXpert MTB/RIF (Xpert) assay for the diagnosis of pulmonary tuberculosis in HIV-infected patients from developing countries, but information about the use of Xpert for the diagnosis of extrapulmonary tuberculosis is scarce. In this study, we compared the performance of light-emitting diode (LED) auramine fluorescent microscopy and the Xpert assay for the diagnosis of tuberculosis in HIV infected patients in a district hospital of India. Although at higher cost, Xpert outperformed LED fluorescent microscopy in all type of specimens, especially in cerebrospinal fluid where the number of positive results was increased 11 times. Pleural fluid, ascitic fluid, pus, and stool specimens also yielded positive results with the Xpert assay. When collecting two additional early-morning sputum samples, the increase of the number of positive results with the Xpert assay was lower than previously reported for HIV infected patients. Rifampicin resistance was observed in 2.2% of the cases. The results of this study show that the Xpert assay can dramatically improve the rapid diagnosis of tuberculous meningitis and other types of extrapulmonary tuberculosis of HIV infected patients. 1. Introduction In 2010, there were 350,000 tuberculosis-related deaths in HIV-infected people, most of them in developing countries [1]. One of the most important reasons for this high number of deaths is the difficulty of diagnosing tuberculosis in the HIV population [2, 3]. There is an urgent need for implementing new diagnostic methods for tuberculosis in resource-limited setting with high HIV prevalence. Microbiological identification of Mycobacterium tuberculosis from cultures is the gold standard for diagnosing tuberculosis infection. However, culture of mycobacteria is not able to provide a rapid diagnosis for the clinical management of severe cases and requires expensive and sophisticated laboratory facilities that cannot be afforded in most of resource-limited settings. The World Health Organization (WHO) has recently endorsed the implementation of light-emitting diode (LED) fluorescent microscopy and the GeneXpert MTB/RIF assay for national tuberculosis programmes in developing countries [4, 5]. LED fluorescent microscopy is less expensive than the conventional fluorescence microscopy, has been shown 84% sensitivity (95% confidence interval [CI], 76 to 89) and 98% specificity (95% CI, 85 to 97) against culture as the
Point of care testing of HIV in children younger than 18 months with three different HIV virological assays. Experience from a district hospital in a resource-limited setting
Gerardo Alvarez-Uria,Jose M. Azcona,Srinivasulu Reddy,Manoranjan Midde
Microbiology Research , 2012, DOI: 10.4081/mr.2012.e14
Abstract: Diagnosis of HIV in children younger than 18 months can be challenging in developing countries because requires the use of HIV virological tests. In this study we describe the experience with three commercial assays, HIV- 1 DNA polymerase chain reaction (PCR) (Roche Amplicor 1.5) with dried blood spot, HIV-1 RNA PCR (Roche COBAS TaqMan) with plasma and reverse transcriptase activity assay (Cavidi Exavir Load 3) with plasma in a rural setting of India. Sensitivity and specificity were 98.1% (95% confidence interval [CI] 90- 100) and 99.3% (95% CI 97.9-99.9) for the HIV- 1 RNA PCR assay, 66.7% (95% CI 29.9-92.5) and 100% (95% CI 96.8-100) for the HIV-1 DNA PCR assay, and 100% (95% CI 48-100) and 98.7% (95% CI 92.8-100) for the reverse transcriptase activity assay respectively. The low sensitivity of the HIV-1 DNA PCR assay in this setting is worrisome and warrants further investigations.
Gender differences, routes of transmission, socio-demographic characteristics and prevalence of HIV related infections of adults and children in an HIV cohort from a rural district of India
Gerardo Alvarez-Uria,Manoranjan Midde,Raghavakalyan Pakam,Praveen K. Naik
Infectious Disease Reports , 2012, DOI: 10.4081/idr.2012.e19
Abstract: Despite 67% of HIV infected people in India are rural residents, the epidemiology of HIV in rural areas is not well known. This is an observational cohort study of 11,040 HIV infected people living in a rural district of India. The prevalence of hepatitis B, hepatitis C and syphilis of HIV infected patients were compared to the seroprevalence in 16,641 blood donors from the same area. The age of diagnosis in adults was below 35 years in 70% of cases and 56% were illiterate. One third of women were widows and only 3.6% of adults had a permanent job. Women were diagnosed at earlier age, had lower level of education, had poorer employment conditions and depended more on their relatives than men. In a survey performed to a subgroup of patients, 81% of women referred to have acquired HIV from their spouse, whereas 51% of men acquired HIV from commercial sex. Patients with HIV had significantly higher prevalence of hepatitis B, hepatitis C and syphilis than blood donors. Seroprevalence of HIV-2, hepatitis C and toxoplasmosis were low compared to other sites. Six percent were children (<15 years) and almost half of them had lost one or both of their parents. The study shows the poor socio-economical situation and the high level of illiteracy of people living with HIV in rural India, especially women. Future health programmes of HIV in India should take into account the particularities of the HIV epidemic in rural areas.
False negative HIV antibody test in HIV infected children who receive early antiretroviral treatment in a resource-limited setting
Gerardo Alvarez-Uria,Praveen K. Naik,Manoranjan Midde,Shanmugamari Kannan
Infectious Disease Reports , 2012, DOI: 10.4081/idr.2012.e6
Abstract: With the implementation of 2010 World Health Organization guidelines, the number of infants from developing countries who will initiate antiretroviral therapy (ART) will increase considerably. In this study we describe the HIV antibody tests of 14 HIV infected children who initiated ART at age less than one year in a rural setting of India. The HIV rapid test was negative in seven and indeterminate in two cases, whereas the HIV enzyme-linked immunosorbent assay (ELISA) antibody test was negative in three and indeterminate in one case. In one child who had both negative HIV rapid test and ELISA initially, HIV serology turned positive after having a virological failure to ART, suggesting the possibility of utilizing HIV serology for monitoring ART effectiveness in children who experience HIV seroreversion. In conclusion, HIV seroreversion of children with early initiation of ART is common and should be considered for avoiding misdiagnosis of HIV infection.
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