Background Depression is a common mental health problem in medical students worldwide. The association between depression and motivation in Vietnamese medical students is not well-documented. Objectives To estimate the prevalence of self-reported depression and to identify associated risk factors among medical students at Hanoi Medical University (HMU). Method A cross-sectional study was conducted on medical students with clinical experience at HMU from November 2015 to January 2016. We used the multistage cluster random sampling technique to select and invite students to complete a questionnaire including demographic characteristics, Patient Health Questionnaire 9 (PHQ-9), Academic Motivation Scale (AMS), and International Physical Activity Questionnaire Short Form (IPAQ). Results Among 494 participants (78.8% response rate), the prevalence of self-reported depression was 15.2% (95%CI:12.0%-19.0%), and suicidal ideation was 7.7% (95%CI:6.2%-9.5%). Self-reported depression was significantly associated with perceived financial burden, physical inactivity, being senior student, perceived negative influence of night shifts, and non-self-determined motivation profile. Suicidal ideation was significantly associated with perceived financial burden and non-self-determined motivation profile. In the multivariable regression models, significant risk factors for self-reported depression were non-self-determined motivation (PR = 2.62, 95%CI:1.68–4.07), perceived financial burden (PR = 1.95, 95%CI:1.39–2.73), and vigorous level of physical activity (PR = 0.43, 95%CI:0.20–0.942). For suicidal ideation, non-self-determined motivation (PR = 2.33, 95%CI:1.13–4.80) and perceived financial burden (PR = 1.91, 95%CI:1.16–3.13) were significant risk factors. Strengths and limitations The strengths of our study included a representative sample, a good response rate, and using a good depression screening tool. However, the PHQ-9 only allowed us to screen for depression, and the translation of the AMS and IPAQ into Vietnamese could potentially decrease these tools’ validity. Conclusion The prevalence of self-reported depression and suicidal ideation in medical students is notably higher compared to the general population in Vietnam. Non-self-determined motivation and financial burden were the prominent risk factors for both the depression and suicidal ideation in medical students.

IntroductionHIV-1 infection is associated with extensive B-cell abnormalities, manifested by phenotypic alterations and polyclonal B-cell activation, increased frequencies of B-cell malignancies, hypergammaglobulinemia, as well as poor antigen-specific immune responses to recall and de novo antigens. [1][2][3][4][5] In secondary lymphoid tissue, HIV-1 infection induces follicular hyperplasia and alterations in the architecture of germinal center (GC) 6 and splenic marginal zones. 7 Defects in the B-cell compartment become overt already during primary HIV-1 infection 8 as measured by a decline of B-cell number, increased expression of activation, and apoptosis markers. 9 The mechanisms by which HIV-1 impairs humoral immunity may be the result of intrinsic B-cell defects and/or a lack of functional dialogue between B and T cells in secondary lymphoid organs.Lymphocyte migration and recirculation between the periphery and lymphoid tissue are critical for effective immunity and are in part regulated by chemokine receptors on lymphocytes together with the expression of their respective ligands (chemokines) in different tissue compartments. 10,11 In recent years, increasing attention has been given to the potential role of viruses to interfere with chemokine receptor expression, binding, and signaling. [12][13][14] In this respect, HIV-1 has been extensively studied because the virus uses CXC chemokine receptor 4 (CXCR4) and CC chemokine receptor 5 (CCR5) as coreceptors for entry into target cells, in addition to the main receptor, the CD4 molecule. 15 However, the expression of chemokine receptors in the context of B-cell trafficking is still poorly studied in chronic HIV-1 infection.The chemokine receptor CXCR4 is broadly expressed on a majority of B cells in the bone marrow (BM), as well as in the periphery, and plays an important role for early B-cell development 16,17 and plasma cell homing to the BM. 18,19 On the other hand, CXCR5 is expressed by mature B cells and contributes to the recruitment of naive B cells into the lymph nodes 20 where the GC reaction occurs with class switch, somatic hypermutation, and affinity maturation. The microanatomic organization of GCs into light and dark zones has been attributed to the expression of CXCR4 and CXCR5. 21,22 B cells also express a moderate amount of CCR7, which contributes to the migration within the lymph node. 23 In the present study, we examined the cell surface expression of chemokine receptors CXCR4, CXCR5, and CCR7 on B cells isolated from the blood of HIV-1-infected patients because these receptors mediate important events of B-cell homing to lymphoid tissue. 20,[23][24][25][26] Using gene expression profiling of chemokine receptors and chemokines, we found a high level of CXC chemokine ligand 13 (CXCL13) mRNA in B cells from HIV-1-infected patients compared with controls; in addition, these cells secreted a high level of the CXCL13 protein after in vitro activation. Histopathology studies performed in lymphoid tissues revealed the presence of CXCL13 ϩ B cel...

Class switch recombination and somatic hypermutation occur in mature B-cells in response to antigen stimulation. These processes are crucial for the generation of functional antibodies. During HIV-1 infection, loss of memory B-cells, together with an altered differentiation of naïve B-cells result in production of low quality antibodies, which may be due to impaired immunoglobulin affinity maturation. In the current study, we evaluated the effect of HIV-1 infection on class switch recombination and somatic hypermutation by studying the expression of activation-induced cytidine deaminase (AID) in peripheral B-cells from a cohort of chronically HIV-1 infected patients as compared to a group of healthy controls. In parallel, we also characterized the phenotype of B-cells and their ability to produce immunoglobulins in vitro. Cells from HIV-1 infected patients showed higher baseline levels of AID expression and increased IgA production measured ex-vivo and upon CD40 and TLR9 stimulation in vitro. Moreover, the percentage of CD27−IgA+ and CD27−IgG+ B-cells in blood was significantly increased in HIV-1 infected patients as compared to controls. Interestingly, our results showed a significantly increased number of somatic hypermutations in the VH genes in CD27− cells from patients. Taken together, these results show that during HIV-1 infection, CD27− B-cells can also produce class switched and somatically hypermutated antibodies. Our data add important information for the understanding of the mechanisms underlying the loss of specific antibody production observed during HIV-1 infection.

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Objective: To investigate the distribution of opportunistic infections (OIs) and factors associated with acquiring OIs in human immunodeficiency virus (HIV)-infected men who have sex with men (MSM) in comparison to those of heterosexual patients. Method: A cross-sectional study was conducted on 82 HIV-infected MSM and 120 HIV-infected heterosexual men in Bach Mai Hospital, Hanoi, Vietnam. Demographical characteristics and clinical data were collected and analyzed using appropriate statistics (Mann–Whitney, Chi-square, Fisher’s exact test, and logistic regression). Results: The prevalence of OIs among MSM and heterosexual patients were 63.4% and 81.7%, respectively. The most frequent OI in the MSM group was human papilloma virus (HPV) (11%), followed by hepatitis B virus (8.5%), mycobacterium tuberculosis (7.3%), and Talaromycosis (2.4%). Conclusions: Multivariate logistic regression analysis showed that buying sex (odds ratio (OR) = 4, 95% confidence interval (CI): 1.13–14.25) and injecting drugs (OR = 13.05, 95% CI: 2.39–71.21) were associated with increased odds of having OIs in heterosexual patients while increasing age (OR = 1.1, 95% CI: 1.01–1.24) was correlated to increased odd of acquiring OIs in the MSM group. HIV-infected MSM accumulates OIs with increasing age, while heterosexual individuals increase opportunistic infections by buying sex or injecting drugs.