Background:Acquired immune deficiency syndrome (AIDS) is now considered as a manageable chronic illness. There has been a dramatic reduction in human immunodeficiency virus (HIV) related morbidity and mortality due to antiretroviral therapy. A high level of adherence (>95%) is required for antiretroviral therapy to be effective. There are many barriers to adherence in both developed and developing countries.Aim:The aim of our study was to determine adherence levels and factors influencing adherence to antiretroviral therapy among people living with HIV.Materials and Methods:Using a cross-sectional study design, 116 HIV positive patients receiving antiretroviral therapy for at least 1 year were interviewed using a semi structured questionnaire. The collected data was analyzed using Statistical Product and Service Solutions (SPSS) version 11.5. Chi-square test was done. A P value of < 0.05 was considered statistically significant.Results:Of 116 participants, 63.7% reported adherence ≥ 95%. Mean adherence index was 91.25%. Financial constraints, forgetting to take medication, lack of family care, depression, alcohol use, social stigma and side effects to antiretroviral therapy were barriers for adherence in our study.Conclusion:Adherence to antiretroviral therapy in south India is suboptimal. Intensive adherence counseling should be provided to all patients before initiation ofantiretroviral therapy. Health care providers must identify possible barriers to adherence at the earliest and provide appropriate solutions.

The clinical spectrum of dengue fever ranges from asymptomatic infection to dengue shock syndrome. Dengue is classically considered a non-neurotropic virus. Neurological complications are not commonly seen in dengue. The neurological manifestations seen in dengue are encephalitis, meningitis, encephalopathy, stroke and Guillain-Barré syndrome. Dengue encephalitis is a rare disease. We report an interesting case of dengue encephalitis from Southern India. A 49-year-old gentleman presented with fever, altered sensorium and seizures. Dengue NS-1 antigen test was reactive. Dengue IgM was also positive. CSF PCR was negative for herpes simplex 1 & 2. Dengue encephalitis should be considered in the differential diagnosis of fever with altered sensorium, especially in countries like India where dengue is rampant.

Background Human immunodeficiency virus (HIV) remains a public health priority in Latin America. While the burden of HIV is historically concentrated in urban areas and high-risk groups, subnational estimates that cover multiple countries and years are missing. This paucity is partially due to incomplete vital registration (VR) systems and statistical challenges related to estimating mortality rates in areas with low numbers of HIV deaths. In this analysis, we address this gap and provide novel estimates of the HIV mortality rate and the number of HIV deaths by age group, sex, and municipality in Brazil, Colombia, Costa Rica, Ecuador, Guatemala, and Mexico. Methods We performed an ecological study using VR data ranging from 2000 to 2017, dependent on individual country data availability. We modeled HIV mortality using a Bayesian spatially explicit mixed-effects regression model that incorporates prior information on VR completeness. We calibrated our results to the Global Burden of Disease Study 2017. Results All countries displayed over a 40-fold difference in HIV mortality between municipalities with the highest and lowest age-standardized HIV mortality rate in the last year of study for men, and over a 20-fold difference for women. Despite decreases in national HIV mortality in all countries—apart from Ecuador—across the period of study, we found broad variation in relative changes in HIV mortality at the municipality level and increasing relative inequality over time in all countries. In all six countries included in this analysis, 50% or more HIV deaths were concentrated in fewer than 10% of municipalities in the latest year of study. In addition, national age patterns reflected shifts in mortality to older age groups—the median age group among decedents ranged from 30 to 45 years of age at the municipality level in Brazil, Colombia, and Mexico in 2017. Conclusions Our subnational estimates of HIV mortality revealed significant spatial variation and diverging local trends in HIV mortality over time and by age. This analysis provides a framework for incorporating data and uncertainty from incomplete VR systems and can help guide more geographically precise public health intervention to support HIV-related care and reduce HIV-related deaths.

Background: HIV associated neurocognitive dysfunction (HAND) ranges from asymptomatic neurocognitive impairment (ANI) to mild neurocognitive disorders (MND) to HIV associated dementia (HAD). Cognitive impairment may impact medication adherence which will ultimately affect morbidity and mortality. Aim: This study was undertaken to evaluate neurocognitive dysfunction among HIV positive patients using the International HIV Dementia scale(IHDS). Materials and Methods: This cross sectional study was conducted in a tertiary care hospital attached to a medical college that caters to a large number of HIV positive patients. The subjects for this study included HIV positive patients belonging to WHO stage 1 or 2. Data collection was done using a pre tested questionnaire. The International HIV Dementia scale(IHDS) was used to assess HAND. Results: Out of the 101 patients studied, 69(68.3%) were males and 32(31.7%) were females. Among these patients, 88 (87.1%) were receiving antiretroviral therapy (ART), 84 (83.2%) were in WHO stage 1. 91 (90.1%) patients had HAND. There were statistically significant differences in the gender and educational level between patients with or without HAND. As age advanced the percentage of patients having HAND also increased. Conclusion: There was high prevalence of HIV associated neurocognitive dysfunction among HIV positive individuals in our study. Also there was an increase in HIV associated neurocognitive dysfunction with increase in age. DOI: http://dx.doi.org/10.3126/ajms.v5i4.8724 Asian Journal of Medical Sciences 2014 Vol.5(4); 61-64

Providing universal access to cART is the main aim of national programs. It is high time that these programs focus on fertility issues of PLWHA. Reproductive rights of PLWHA need to be respected. Physicians and HIV counselors should proactively discuss and address reproductive issues of PLWHA.

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Background. Depression is one of the most prevalent psychiatric diagnoses seen in HIV-positive individuals. Women with HIV are about four times more likely to be depressed than those who are not infected. Aims. To assess the sociodemographic and clinical correlates of depression among women living with HIV/AIDS. Setting and Design. One public and one private hospital in Mangalore, Coastal South India, and cross-sectional design. Methods and Materials. Study constituted of 137 HIV-positive women, depression was assessed using BDI (Beck Depression Inventory), and social support was assessed using Lubben Social Network Scale. Statistical Analysis. All analysis was conducted using SPSS version 11.5. Chi-square test with P value less than 0.05 was taken as statistically significant. Results. Among 137 HIV-positive women, 51.1% were depressed. Around 16% were having moderate to high risk for isolation. Depression was statistically significant in rural women, widowed women, and lower socioeconomic class women. Conclusion. Depression is highly prevalent among women living with HIV which is still underdiagnosed and undertreated, and there is a need to incorporate mental health services as an integral component of HIV care.