These tests are also commercially available: The choice of second-line tests depended on their availability at the testing lab and patients' ability to pay for them.
In some cases, commercial western blot assay was conducted in addition to antibody tests HIV Blot 2. Plasma viral concentrations were measured at various independent hospitals and commercial labs at patients' own choice. As PCR tests are expensive, very few patients were able to afford such tests. Depending on the individual lab, the commercial viral load kits were used without any specific preference.
The sensitivities of these tests were and 50 viral copies per mL, respectively. In addition, qualitative tests for HIV-1 were performed by in-house developed PCR method according to our own published protocol [ 31 ]. Data were analyzed with StatMost software version 2. The main parametric pairwise test was Student's -test. For assessment of correlation between seronegative status and viral load, we have used nonparametric Spearman's rank-order test. The significance level for all tests was set at. The duration of V1 treatment until a patient sought to check the antibody status ranged between 2 weeks and 15 months with an average of 7.
All patients were tested for HIV seropositivity prior to administration of V1. While most of them were tested only once before treatment initiation, on average, there were two positive tests per patient. Once patients knew the seronegative status, many of them had tests repeated, often at different labs to ascertain that they were truly negative. Thus, the average number of post-treatment tests was slightly higher 3 tests but not statistically significant. The results are summarized in Table 1 which shows only those tests for which we have traceable records.
At baseline, we had 13 Since patients with fewer symptoms were recovering faster, the correlation analysis was conducted to see if there is a relation between severity of disease and time to serodeconversion. The results indicate that earlier you start treatment, faster you expect to see the disappearance of HIV antibodies Spearman's rank correlation, ;. In nine patients, viral loads were barely detectable or undetectable after treatment, but unfortunately four of these patients had no matching PCR tests at study entry.
Qualitative PCR tests which were conducted at the end of study were either positive or negative. But the majority of patients had not tested for viral load primarily due to the fact that they could not afford expensive PCR tests. Nevertheless, from what is available to us, there is a clear impression that serodeconversion correlates with lowered or undetectable viral load.
Unfortunately, we do not have the complete pairwise set of data to confirm this impression by a robust parametric test. We thus have performed nonparametric Spearman's rank order correlation analysis on available outcome results, that is, nine patients: We assume that four patients—nos. Each viral load test, whether positive or negative, was entered as a binary value. For example, patient no. Patients who had no results had zeros entered as values. In this manner, we have constructed a two-way table to evaluate whether HIV-seronegative status had any association with negative or positive PCR results.
The results revealed positive linear relationship with at. We thus conclude that serodeconversion correlates positively with low or undetectable viral load. Another reliable test that could be performed on available data is establishment of the odds ratio, which could tell whether our findings differ from published incidence of false-positive or false-negative results in large populations of individuals screened for HIV antibodies. Such a statistical test was aimed to reveal whether the observed incidence of serodeconversion, that is, 23 individuals out of , could happen randomly as a result of laboratory error.
This analysis was performed in contingency table comparing side by side our data with published surveys of diagnostic accuracy of HIV tests. The results are presented in Table 2. As can be seen from Table 2 , what we have observed is statistically different in every single case. All obtained OR values were distant from 1—a ratio that one would expect to see if there was no difference between our outcome and frequencies reported by others. Due to the retrospective nature of this study, the data, especially concerning viral load, are incomplete. Nevertheless, it is clear that obtained results are highly unusual.
Why would previously HIV-antibody-positive patients become seronegative after treatment with V1? The possibility that all these patients were false-positive at the baseline is unlikely since they were symptomatic and sought V1 treatment because they were suffering from AIDS-related symptoms. These symptoms, that is, low CD4 counts; weight loss; a whole range of opportunistic infections: One may argue that clinical symptoms were not HIV-related and all these patients were initially false-positive due to random incidence of such cases in general population.
On the contrary, in placebo-controlled, randomized phase II clinical trial of V1 published in , we have shown that one out of 29 V1-treated patients became HIV-negative, suggesting much higher conversion rate [ 29 ]. The cases of true, confirmed seroreversion, that is, a seroreactive or positive sample with subsequently one or more nonreactive samples from the same person, are extremely rare [ 10 — 18 ].
In fact, most, if not all, cases of apparent seroreversion seem to be errors of attribution or lab testing [ 1 — 4 ]. Further review of these cases revealed that five actually were HIV-seroreactive patients who had samples from nonreactive individuals mistakenly attributed to them, while the sixth had a testing error.
Mistakes in the testing process were identified in other 26 cases indicating the cumulative error rate of In this paper, we included only those patients who had confirmed tests traceable to the original testing lab and excluded anyone who had indeterminate results or whose records could not be traced. The odds ratio analysis comparing our data with published reports of false-positive or false-negative cases in large surveys rules out that what we have observed is a random event due to testing error see Table 2. Children younger than 18 months who are born to HIV-positive mothers require virological testing yet there has been limited progress on this in the region.
Male circumcision is common West Africa. A study found countries that report on both the proportion of Muslim men who were circumcised and the proportion of the population who are Muslim show a close match. Male circumcision is less common in Central Africa. Despite the region having significant populations of people who use drugs, harm reduction interventions, which help prevent HIV transmission through injecting drug use, are scarce.
The only government-run harm reduction programme in West Africa is in Senegal.test5.expandit.io/reading-theatre.php
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The country implements small-scale, community-based needle and syringe programmes and opioid substitution therapy. In , Ghana began collecting data on people who inject drugs to establish an evidence base for future programming. In , this programming was yet to be implemented. This means that around 4 million people living with HIV need treatment but are not receiving it. Coverage varies between countries.
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However, in Nigeria which is home to 3. Underlying factors such as the lack of national and international political will, weak health services, and lack of support for community organisations exacerbate the situation. Men are less likely than women to start treatment, and those who do begin ART are more likely to have advanced HIV progression. This disparity is thought to be due, in part, to harmful gender norms that lead men to view seeking HIV testing and treatment as a sign of weakness.
This is the lowest regional paediatric ART coverage rate of any region in the world. This is further compounded by second- or third-line ARVs being either scarce or unavailable. This region reflects the fact that global prevalence of HIV drug resistance HIVDR is rising, mainly due to resistance to first-line antiretroviral treatment regimes. Weak health systems and low levels of adherence are the main drivers. In West and Central Africa, many non-government organisations NGOs concerned with protecting the rights of people living with HIV have seen a decrease in funding since the global recession.
As a result, some have had to scale down or stop activities. Additionally, the fragmentation of civil society organisations into distinct language-speaking groups primarily English and French leads to constraints in exchanging experiences and support between countries in the region. The region remains a difficult place for key populations such as men who have sex with men.
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This hostile environment often prevents people from accessing HIV services. For example, following the passage of the Same-Sex Marriage Prohibition Act in Nigeria in , a greater proportion of men who have sex with men in the country reported being afraid to seek healthcare. In Mauritania and Northern Nigeria, the death penalty exists for men who have sex with men.
Sex work is illegal in most countries in the region. Male and transgender sex workers are not allowed to register. In addition to heavy regulations on legal sex work, Senegal retains criminal penalties for solicitation, brothel ownership, and procuring sex work. However, when sex workers register their files are sent to the police, which sex workers say facilitates harassment, abuse, and extortion at the hands of authorities.
Sex work is also legal in Burkina Faso, although profiting from others engaging in sex work is illegal. In many countries in the region there are laws criminalising people who expose others to HIV or transmit the virus sexually. This fuels HIV-related stigma, which can cause significant barriers to accessing HIV prevention, treatment and care services. As a result, there are data gaps, questions about the validity of existing data, and a lack of quality available data, all of which hamper adequate programming.
Data on key populations is also lacking, as many countries do not record consistent, national level data on these groups. Humanitarian crises such as the Ebola epidemic in West Africa put yet more strain on already weak healthcare systems, with patients suffering as a result. Civil society is well established in North America and Western Europe.
In Central Europe, the influence of civil society tends to be greater in higher-income countries. In the early days of the epidemic, HIV activism was closely associated with gay communities in the USA and other industrialised Western nations. A move towards more conservative agendas and a roll back of rights in some countries such as the USA has seen civil society groups and governments in the region clash in recent years. There are also reports of civil society scapegoating, which have a particularly high negative impact on more vulnerable groups such as people who are lesbian, gay, bisexual or transgender LGBT.
In Europe, overall financing for civil society activity is reducing, which is also a major concern. A number of social barriers exist that prevent key affected populations from accessing HIV services. Language barriers, marginalisation and social exclusion contribute to the vulnerability of migrants. Many also belong to at-risk sub-populations such as asylum seekers, refugees, sex workers and men who have sex with men.
Female migrants also commonly report sexual harassment, abuse and rape. All these factors contribute to preventing many female migrants accessing vital HIV services. HIV-related stigma and discrimination is prevalent in the region. A review of the European MSM Internet Survey, which was conducted in across 38 European countries, found men who have sex with men who are living in countries with higher levels of stigma had reduced odds of diagnosed HIV and fewer partners, but higher odds of sexual risk behaviour such as having unprotected sex and unmet prevention needs.
In the USA, women who inject drugs experience stigma as well as fear of exposure to authorities because of strict child custody and welfare laws. Both Portugal and the Czech Republic have adopted decriminalisation and de-penalisation of drugs for personal consumption. If other countries in the region followed this could encourage people who inject drugs to engage with HIV prevention and treatment services.
Similarly, decriminalisation of sex work could empower women and men engaged in commercial sex work to seek and utilise HIV prevention and treatment services. Rights for men who have sex with men and people who are LGBT are stronger in Western and Central Europe and North America compared to any region in the world, although transgender rights are less well developed. Even in countries with good levels of HIV prevention coverage, gaps exist. Some services are out of reach, particularly for those in rural areas, while other sites have inconvenient opening times.
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In some countries, young people under 18 cannot access harm reduction services. Moreover, migrants living with HIV frequently go undocumented and the provision of services in rural areas is often underdeveloped. A lack of funding is a significant barrier to the scale-up of harm reduction programmes in North America. A lack of government support in Canada means these services are largely delivered by local authorities, community organisations and NGOs.
Punitive laws also discourage some programmes from making their information public. In Greece, expansion of NSP services has slowed down because of the country's financial difficulties. Funding for HIV responses in the region is mainly domestic due to the high levels of income of most countries, and has increased significantly over the course of the epidemic as more people are living with HIV.
However, as of , the threat of budget cuts to sexual and reproductive health services in countries such as the USA and the UK is looming. However, far too many people are still being diagnosed at a late stage of infection. Early diagnosis and treatment must remain a high priority for the region. Moreover, gaps in the provision of HIV services remain with key affected populations facing a number of barriers, particularly men who have sex with men.
In Western and Central Europe, increasing rates of HIV infection among men who have sex with men suggest that programmes addressing condom use for this group need to be expanded. It is important that countries in this region continue to provide the necessary resources to tackle the epidemic.
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