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Search Results: 1 - 10 of 135 matches for " Manoranjan Midde "
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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.
Mortality associated with community-acquired cephalosporin-resistant Escherichia coli in patients admitted to a district hospital in a resource-limited setting
Gerardo Alvarez-Uria,Uvummala Priyadarshini,Praveen K. Naik,Manoranjan Midde
Clinics and Practice , 2012, DOI: 10.4081/cp.2012.e76
Abstract: Studies performed in developed countries have shown that infections by third generation cephalosporin resistant Escherichia coli (G3CREC) are associated with increased mortality, but data from developing countries are scarce. In this observational study, we collected clinical and microbiological information of 194 patients admitted to a district hospital in India who had community-acquired isolation of Escherichia coli. The proportion of patients with G3CREC was 79.4%. In a multivariable logistic regression analysis, factors associated with 21-day mortality were isolation from a normally sterile site, HIV infection and isolation of G3CREC. Strains of Escherichia coli isolated from normally sterile sites had lower levels of resistance to quinolones and beta-lactam antibiotics. The proportion of meropenem and ciprofloxacin resistance was 11.1% and 80.9% respectively. The high proportion of G3CREC in the community and the association of G3CREC with 21-day mortality indicate that G3CREC is a major public health problem in developing countries.
Natural History and Factors Associated with Early and Delayed Mortality in HIV-Infected Patients Treated of Tuberculosis under Directly Observed Treatment Short-Course Strategy: A Prospective Cohort Study in India
Gerardo Alvarez-Uria,Praveen Kumar Naik,Raghavakalyan Pakam,Lakshminaryana Bachu,Manoranjan Midde
Interdisciplinary Perspectives on Infectious Diseases , 2012, DOI: 10.1155/2012/502012
Abstract: Despite the impressive global results of DOTS in India, the effectiveness of DOTS for the treatment of tuberculosis in HIV-infected patients is not well known. This is an observational prospective cohort study performed in Anantapur District, Andhra Pradesh, India. The study included 1000?DOTS antituberculosis treatment (ATT) episodes and 840 person-years. CD4 lymphocyte count was below 200?cells/mm3 in 77% of the cases, and 21% were retreatments. Two thirds were presented with extrapulmonary tuberculosis, and the most common form of extrapulmonary tuberculosis was tuberculous meningitis followed by pleuritis, abdominal tuberculosis, and lymphadenitis. Cumulative incidence of mortality was 16%, 26%, 39%, and 46% at 1, 3, 12, and 24 months, respectively. Factors associated with three-month (early) mortality were being homeless, having low CD4+ lymphocyte count, having tuberculous meningitis, belonging to a socially disadvantaged community, having more than 35 years, and being on an antiretroviral therapy at the moment of initiating the ATT. Factors associated with delayed mortality were having low CD4+ lymphocyte count, belonging to a socially disadvantaged community, receiving a category II ATT because of a previous episode of ATT and having acid fast bacilli in sputum before the ATT initiation. These findings indicate that there is an urgent need to improve the treatment of tuberculosis in HIV-infected patients in India. 1. Introduction Tuberculosis is a major public health problem worldwide. Although tuberculosis is a treatable disease, there were 8.8 million cases of tuberculosis and 1.45 million deaths from tuberculosis in 2010 [1]. With an incidence of 2.3 million cases, India has the highest burden of tuberculosis in the world, and one out of every four cases of tuberculosis worldwide occurred in India in 2010 [1]. India is also the third country in the world in terms of number of people infected by HIV, and 9% of patients with tuberculosis who are tested of HIV are HIV-infected [1, 2]. HIV and tuberculosis form a deadly synergy. Latent tuberculosis is common in developing countries, and the immunodeficiency produced by HIV increases the risk of developing active tuberculosis infection [3]. Moreover, HIV modifies the clinical presentation and the prognosis of tuberculosis. Patients with HIV infection have higher risk of extrapulmonary tuberculosis, tuberculosis relapse, and death than non-HIV-infected patients [4]. Treatment of tuberculosis in India has been implemented under the Revised National Control Tuberculosis Programme (RNTCP). RNTCP
Entry, Retention, and Virological Suppression in an HIV Cohort Study in India: Description of the Cascade of Care and Implications for Reducing HIV-Related Mortality in Low- and Middle-Income Countries
Gerardo Alvarez-Uria,Raghavakalyan Pakam,Manoranjan Midde,Praveen Kumar Naik
Interdisciplinary Perspectives on Infectious Diseases , 2013, DOI: 10.1155/2013/384805
Abstract: HIV treatment, care, and support programmes in low- and middle-income countries have traditionally focused more on patients remaining in care after the initiation of antiretroviral therapy (ART) than on earlier stages of care. This study describes the cumulative retention from HIV diagnosis to the achievement of virological suppression after ART initiation in an HIV cohort study in India. Of all patients diagnosed with HIV, 70% entered into care within three months. 65% of patients ineligible for ART at the first assessment were retained in pre-ART care. 67% of those eligible for ART initiated treatment within three months. 30% of patients who initiated ART died or were lost to followup, and 82% achieved virological suppression in the last viral load determination. Most attrition occurred the in pre-ART stages of care, and it was estimated that only 31% of patients diagnosed with HIV engaged in care and achieved virological suppression after ART initiation. The total mortality attributable to pre-ART attrition was considerably higher than the mortality for not achieving virological suppression. This study indicates that early entry into pre-ART care along with timely initiation of ART is more likely to reduce HIV-related mortality compared to achieving virological suppression. 1. Introduction By the end of 2011, more than 90% of the 34 million people infected with HIV worldwide were living in low- or middle-income countries [1]. 16.8$ billion was invested globally into HIV in 2011 and, in low- and middle-income countries, 89% of the investment was allocated to treatment care and support of HIV infected people [1]. One of the most important aims of the medical care of HIV patients is to initiate antiretroviral therapy (ART) before the development of HIV-related complications and to allow immunological recovery by maintaining long-term virological suppression. Despite important advances in the rollout of ART worldwide, 1.7 million people died of HIV-related pathologies in 2011 [1]. This high mortality could be explained by many factors including late presentation of HIV [2–5], poor engagement in medical care [6–9], poor retention in pre-ART care [10–12], late or no initiation of ART [13–15], high levels of attrition from care after ART initiation [16, 17], and poor virological suppression in patients on ART [18]. When designing programmes aimed at providing treatment, care, and support to people living with HIV, it is important to understand the contributions of these factors to the overall HIV mortality, in order to improve the efficiency of HIV
Initial Antituberculous Regimen with Better Drug Penetration into Cerebrospinal Fluid Reduces Mortality in HIV Infected Patients with Tuberculous Meningitis: Data from an HIV Observational Cohort Study
Gerardo Alvarez-Uria,Manoranjan Midde,Raghavakalyan Pakam,Praveen Kumar Naik
Tuberculosis Research and Treatment , 2013, DOI: 10.1155/2013/242604
Abstract: Tuberculous meningitis (TM) is the deadliest form of tuberculosis. Nearly two-thirds of HIV infected patients with TM die, and most deaths occur within one month. Current treatment of TM involves the use of drugs with poor penetration into the cerebro-spinal fluid (CSF). In this study, we present the mortality before and after implementing a new antituberculous regimen (ATR) with a higher drug penetration in CSF than the standard ATR during the initial treatment of TM in an HIV cohort study. The new ATR included levofloxacin, ethionamide, pyrazinamide, and a double dose of rifampicin and isoniazid and was given for a median of 7 days (interquartile range 6–9). The new ATR was associated with an absolute 21.5% (95% confidence interval (CI), 7.3–35.7) reduction in mortality at 12 months. In multivariable analysis, independent factors associated with mortality were the use of the standard ATR versus the new ATR (hazard ratio 2.05; 95% CI, 1.2–3.5), not being on antiretroviral therapy, low CD4 lymphocyte counts, and low serum albumin levels. Our findings suggest that an intensified initial ATR, which likely results in higher concentrations of active drugs in CSF, has a beneficial effect on the survival of HIV-related TM. 1. Introduction In 2011, there were 8.7 million incident cases of tuberculosis (13% of them in HIV infected patients) and 1.4 million deaths from tuberculosis (30% of them in HIV infected patients) [1]. With 25% mortality in non-HIV infected patients and 67% in HIV infected patients, tuberculous meningitis has the highest mortality among all forms of tuberculosis [2]. Moreover, tuberculous meningitis is more common in HIV infected patients and can comprise up to 19% of all cases of HIV-related tuberculosis [3, 4]. Currently, treatment of tuberculous meningitis involves the same drugs and doses as other forms of tuberculosis [5–7]. While isoniazid and pyrazinamide have good cerebrospinal fluid (CSF) penetration, rifampicin concentration in CSF may not reach the minimal inhibitory concentration for tuberculosis, and ethambutol and streptomycin have poor CSF penetration [2, 8]. Among second line drugs, levofloxacin, ethionamide and cycloserine have good penetration in CSF [8–10]. In a phase 2 randomized controlled trial investigating the safety of moxifloxacin and a higher intravenous dose of rifampicin during the first two weeks of treatment of tuberculous meningitis, the use of a higher dose of rifampicin was associated with a survival benefit [11]. These data suggest that increasing the CSF penetration of the initial treatment of
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