Pre-exposure prophylaxis (PrEP) is an experimental approach to HIV prevention and consists of antiretroviral drugs to be taken before potential HIV exposure in order to reduce the risk of HIV infection and continued during periods of risk. An effective PrEP could provide an additional safety net to sexually active persons at risk, when combined with other prevention strategies. Women represent nearly 60% of adults infected with HIV and PrEP can be a female-controlled prevention method for women who are unable to negotiate condom use. Two antiretroviral nucleoside analog HIV-1 reverse transcriptase inhibitor drugs are currently under trial as PrEP drugs, namely tenofovirdisoproxilfumarate (TDF) alone and TDF in combination with emricitabine (FTC), to be taken as daily single dose oral drugs. There are 11 ongoing trials of ARV-based prevention in different at risk populations across the world. The iPrex trial showed that daily use of oral TDF/FTC by MSM resulted in 44% reduction in the incidence of HIV. This led to publication of interim guidance by CDC to use of PrEP by health providers for MSM. Few other trials are Bangkok Tenofovir Study, Partners PrEP Study, FEM-PrEP study, and VOICE (MTN-003) study. Future trials are being formulated for intermittent PrEP (iPrEP) where drugs are taken before and after sex, "stand-in dose" iPrEP, vaginal or rectal PrEP, etc. There are various issues/concerns with PrEP such as ADRs and resistance to TDF/FTC, adherence to drugs, acceptability, sexual disinhibition, use of PrEP as first line of defense for HIV without other prevention strategies, and cost. The PrEP has a potential to address unmet need in public health if delivered as a part of comprehensive toolkit of prevention services, including risk-reduction, correct and consistent use of condoms, and diagnosis and treatment of sexually transmitted infections.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]  [PubMed]

Human immunodeficiency virus (HIV) testing with pre and postcounseling aiming behavior change communication (BCC) for core/bridge population is the main element of holistic model of health care. Voluntary counseling and testing center (VCTC) remodeled as integrated counseling and testing center (ICTC)-general is the 'gateways to care'. It was hospital-based cross sectional study of 811 clients registered at VCTC of Kesar SAL Hospital from January to December 2007. These patients either came voluntarily or by referral. Anonymous and unlinked information was collected on predesigned schedule and data was analyzed to find out the seropositivity, demographic characteristics (among attendees and HIV positives), and epidemiological vulnerability of different segments of population. Among the attendees, 64% were males, 75% in the age group of 20-49 years, 80% were currently married, and 70% were literate (<10 ^th standard). Also, 66% clients were gainfully employed, while one-fourth were housewives; 98% lived with families, 75% were referred by doctors, and only 19% walked in directly. Dominant reason for visiting ICTC was the history/presence of high risk behavior (HRB) (34%). 35% indulged in heterosexual route; other HRB (men having sex with men or MSM and injecting drug users or IDU) were rare. There were more positive among males, 20-49 years of age group, those living singly, unmarried, divorcee, widow(er) and separated. Similarly positives were more amongst illiterates, less educated and those engaged in unskilled and semi skilled jobs. Adolescent students (>14 years) accounted for one-fifth of the total positives. Direct walk in clients were more positive compared to those referred by doctors. Those who confessed of history/presence of HRB accounted for all except 3 (85%) positives. 51% indulged in heterosexual sex followed by MSM (8%). Overall sero positivity was 4.8%; high in males, 30-49 years age, unmarried and divorcee etc. Sero prevalence decreased with improvement in education and also with improvement in job nature. It was also high in those living alone compared to those staying with their family. Such study shall in evaluating the performance of ICTC and designing the information, education, and communication (IEC) to increase the client uptake in terms of quality and quantity.

[ABSTRACT]  [FULL TEXT]  [PDF] [CITATIONS]  [PubMed]

Developing a researchable question is one of the challenging tasks a researcher encounters when initiating a project. Both, unanswered issues in current clinical practice or when experiences dictate alternative therapies may provoke an investigator to formulate a clinical research question. This article will assist researchers by providing step-by-step guidance on the formulation of a research question. This paper also describes PICO (population, intervention, control, and outcomes) criteria in framing a research question. Finally, we also assess the characteristics of a research question in the context of initiating a research project.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]  [PubMed]

Background and Objectives: The availability of baseline information on the epidemiology of sexually transmitted infections (STIs) and other associated risk behaviors is essential for designing, implementing, and monitoring successful targeted interventions. Also, continuous analysis of risk assessment and prevalence-based screening studies are necessary to evaluate and monitor the performance of syndromic management. The aim of the present study was to document the pattern of common STIs and to evaluate the performance of syndromic case management against their laboratory diagnoses. Materials and Methods: Three hundred consecutive patients who attended the STI clinic of a tertiary care hospital at Delhi, with one or more of the complaints as enunciated by WHO in its syndromic approach for the diagnosis of STIs, were included as subjects. Detailed history, demographical data, and clinical features were recorded and screened for common STIs by standard microbiological methods. Results: The mean age was 24 years and most of the male patients were promiscuous and had contact with commercial sex workers (CSWs 63.9%). Majority came with the complaint of genital discharge (63 males; 54 females) followed by genital ulcer (61 males; 30 females). Genital herpes accounted for the maximum number of STI (86/300) followed by syphilis (71/300). The sensitivity of genital discharge syndrome (GDS) was high for Neisseria gonorrhoeae and Chlamydia trachomatis (96% and 91%, respectively) while specificity was low (76% and 72%, respectively). The sensitivity of genital ulcer syndrome for herpes simplex virus-2 (HSV-2) and Treponema pallidum was 82.65% and 81.2%, respectively, while specificity reached 99% approximately. Conclusions: Viral STIs constitute the major burden of the STI clinic and enhance the susceptibility of an individual to acquire or transmit HIV through sexual contact. Syndromic algorithms have some shortcomings, and they need to be periodically reviewed and adapted to the epidemiological patterns of STI in a given setting.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]  [PubMed]

Background: This study analyzes the social, economic and behavioral factors most frequently associated with adherence to Highly Active Antiretroviral Treatment (HAART) in urban India. Materials and Methods: Data was collected in a metropolitan teaching hospital in Mumbai using a cross-sectional survey design. Face-to-face interviews were conducted with 152 patients. The semistructured survey included both open and closed ended questions on socio-demographic, economic and behavioral factors. Factors affecting treatment adherence were analyzed. Results: The median age of patients was 40.5 years, 73% were males and all were heterosexual. Patients had been given ART from six months to five years (median is equal to 3.5). Ninety per cent lived at home and commuted to the clinic by bus or train. Behaviorally, 37% were sexually active, but only 55% used condoms. In assessing adherence, income, education, knowledge of their drugs, transportation, side effects, cost of treatment, distance from clinic and personal clinic satisfaction were analyzed. We found that 75% of patients reported cost of HAART to be the single greatest obstacle to adherence (p less than 0.01). Additionally, those claiming knowledge of their drugs were 2.3 times more likely to be adherent (p less than 0.03), while those who abused drugs or alcohol were 53% less likely to be adherent (p less than 0.03). There was no correlation with other factors. Conclusions: Our study population was representative of the lower middle class of India. It found that an educated, employed group considered the cost of treatment to be a significant obstacle for successful therapy. Additionally, it showed a significant increase in adherence when patients had knowledge of their HAART medications. Therefore, reducing the cost of medication as well as teaching about antiretroviral medications are both likely to improve adherence.

[ABSTRACT]  [FULL TEXT]  [PDF] [CITATIONS]  [PubMed]

Context: Infectious diseases including HIV and viral hepatitis constitute a major health issue, with high prevalence among injecting drug users (IDUs). Aims: The present study assessed the frequency of HIV, and hepatitis B and C viruses (HBV and HCV) among 200 IDUs, hospitalized between 2001 and 2006, in Shahid Beheshti Hospital of Kashan, Iran. Setting and Design: A population-based cross-sectional study in Iran. Materials and Methods: A total of 200 subjects participated in this study. Serological markers including HBsAg, anti-HCV antibodies and HIV were assessed by ELISA method using Monobid kits made in US. Demographic data was collected by using a questionnaire, which was designed by a researcher. Statistical Analysis Used: Frequencies were determined by employing SPSS:PC version 15.0, and Chi-square and Fisher's exact tests were used to compare proportions. Results: The mean age of subjects was 36.5 ± 10.2 years. Approximately 88.5% (177 cases) were male and 11.5%. (23 cases) were female. The frequency of positive infection test results for males with respect to HBV, HCV, and HIV was 4% (8 cases), 10.5% (21 cases), and 1.5% (3 cases); and for females it was 0.5% (1 case), 1.5% (3 cases), and 0% (0 case), respectively. Conclusion: This study demonstrates that the frequency of HBV, HCV, and HIV infection in the IVD user in Kashan, Iran, is relatively high and this condition is more serious in male than female drug addicts. It is very important, especially for health providers and policy makers, to recognize the risk factors of HBV, HCV and particularly HIV infection in this area and design effective preventive programs.

[ABSTRACT]  [FULL TEXT]  [PDF] [CITATIONS]  [PubMed]

Aims: To determine the seroprevalence of herpes simplex type 2 (HSV-2) infection in pregnant females, assess the frequency of unrecognized infection and identify the demographic profile and risk factors associated with the seroprevalence. Materials and Methods: Two hundred randomly selected, asymptomatic pregnant females attending the Obstetrics and Gynecology Outpatient Department for a routine antenatal check-up constituted the study group. Serum specimens were screened for HSV-2 infection by detecting IgG class antibodies against HSV-2-specific glycoprotein G-2 using an enzyme-linked immunosorbent assay kit. Results: A seroprevalence of 7.5% was found in our study. Seropositivity was maximum in the age group ≥30 years (22.20%), followed by 26-30 years (9.7%), 21-25 years (2.20%) and ≤20 years (0%). HSV-2 seropositivity was found to be significantly associated with increasing age, parity, number of sexual partners, duration of sexual activity and history of abortions (P < 0.05). No statistically significant correlation was observed between seropositivity and other demographic variables such as place of residence, education, annual family income and occupation (P > 0.05). No statistically significant association of seropositivity with present or past history suggestive of other sexually transmitted infections was found. None of our cases tested positive for human immunodeficiency syndrome (HIV). Conclusion: A relatively low prevalence of HSV-2 seropositivity was found in our study, with a high frequency of unrecognized and asymptomatic infections. Our findings suggest that type-specific serotesting could be an efficient strategy to diagnose clinically asymptomatic HSV-2 infections and, therefore, to reduce the risk of HSV-2 and HIV sexual transmission by prophylactic counseling against unprotected intercourse. It may also be a useful adjunct in detecting cases who present with symptoms not directly suggestive of genital herpes.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]  [PubMed]

Hidradenitis suppurativa (HS) is a disorder of the terminal follicular epithelium in the apocrine gland-bearing skin, characterized by comedo-like follicular occlusion, chronic relapsing inflammation, mucopurulent discharge, and progressive scarring. In this study, we report a case of 35-year-old HIV-positive man with recurrent nodular skin lesions with foul smelling discharge over face, gluteal region, thighs, and axilla. This case is unique because of its association with HIV leading to atypical manifestations and therapeutic challenges.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]  [PubMed]

Given the longevity achievable with current prophylactic and therapeutic strategies for persons with HIV infection, quality of life (QOL) has emerged as a significant medical outcome measure, and its enhancement has an important goal. This review highlights the relevance and complexity of physical, psychological, and social factors as determinants of health-related quality of life in HIV-infected persons. Existing data suggest that physical manifestations, antiretroviral therapy, psychological well-being, social support systems, coping strategies, spiritual well-being, and psychiatric comorbidities are important predictors of QOL in this population. Consequently, the impact of HIV infection on the dimensions of QOL, including physical and emotional well-being, social support systems, and life roles, has emerged as a key issue for persons infected with HIV.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]  [PubMed]

Inroduction: Of the "top ten" sexually transmitted infections, Chlamydia trachomatis and Neisseria gonorrhoeae are ranked second and fifth, respectively, worldwide. Aim: The aim of this study was to screen the pregnant women for C. trachomatis and N. gonorrhoeae infections and to detect antimicrobial resistance pattern of N. gonorrhoeae. Materials and Methods: This study was a prospective, hospital-based analysis of a random sample of pregnant women visiting the antenatal clinic of a tertiary hospital in eastern Saudi Arabia. Endocervical and high vaginal swabs were collected both from pregnant women and female patients attending gynecology clinic with lower genital tract infection (control group). C. trachomatis antigen was detected using enzyme-linked immunosorbent assay (ELISA). N. gonorrhoeae was detected by culture and identification of isolates, and antimicrobial susceptibility testing was performed. Statistical Package for Social Sciences (SPSS) version 13.0 and Chi-square test were used for statistical analysis. Results: C. trachomatis antigen was detected in 10.5% (10/95) and 34.4% (35/102) of pregnant women and control group, respectively (P < 0.001). The isolation rate of N. gonorrhoeae among pregnant women was 0.0% compared to 7.8% (8/102) among the control group (P < 0.01). N. gonorrhoeae were resistant to penicillin (62.5%), tetracycline (50%), ampicillin (25%), amoxycillin-clavulinic acid (25%) and ciprofloxacin (37.5%), while they were susceptible to cefepime, ceftriaxone, ceftazidime, spectinomycin, and cefuroxime. Conclusion: Screening of pregnant women for C. trachomatis infection should be included in the antenatal care in this area. The detection rate of both organisms among the control group highlights the importance of preventive strategies. Certain antibiotics previously used in treating gonorrhea are no longer effective.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]  [PubMed]

Background: Many studies have examined the inter-relationship between different STI. There are, however, a few data on patients presenting with more than one concurrent sexually transmitted infection (STI). The aim of the study was to determine the burden of patients with more than one concurrent STI and to characterize factors associated with such infections. Materials and Methods: Two hundred seventy five patients with one or more of the complaints, as enunciated by the World Health Organization (WHO) in its syndromic approach for the diagnosis of STI, were included as subjects. Detailed history, demographical data, and clinical features were recorded. All the patients were screened for common STIs. Multivariate analysis was performed taking all significant risk factor obtained from univariate analysis. Results: A total of 102 (37%) patients were identified as having multiple STIs amongst whom 72% (73/102) were male, 70% were married, and except one none reported regular use of condom The age of first sexual exposure was 13-17 years, 31.3% had more than three sexual partners in the past 6 months, and 76.4% had contact with commercial sex workers (CSWs). Multivariate analysis revealed statistical significance in relation to marital status, number of sexual partners exposed in the past 6 months, age of first sexual exposure, and age of patient at the time of presentation. Syphilis (48%) was the most common infection associated with multiple STI followed by HIV (45%) and HSV-2 (39.2%). None of the patients with multiple infections were detected and managed accurately by syndromic approach. Conclusion: Pattern of concurrent multiple STIs and the clinical severity of such multiple infections may serve as an indicator of the type of host-pathogen interaction determining the outcome of infection. When patient had multiple STIs, syndromic approach was not axiomatic and thus underscores the need for laboratory diagnosis.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]  [PubMed]

Background and Objectives: Risk of vertical transmission (largest source of HIV in children) reduces from 33% to 3% with effective prevention of mother to child transmission (PMTCT) interventions. NACP-III has got an objective of testing all pregnant women for earliest linkage with PMTCT. Study was carried out to find out PPTCT service coverage, dropouts, intervention efficacy with other determinants. Materials and Methods: At ICTCs, registered ANCs are counseled and tested for HIV. HIV +ve ANCs are additionally linked to services and followed-up for institutional delivery, sdNVP, nutrition and children testing. HIV +ve ANCs since 2005 subsequently delivered till June 2008 and their exposed children in Gujarat's category A, B districts constituted study cohort. Results: 259622 pregnant women registered, 72.1% were counseled pre-test, 83.4% of them tested, 74.4% received post-test counseling. 541 ANCs were detected HIV+ve. 45.5% delivered institutionally, 12.8% were unregistered. 12.1% were cesarian section and 66% delivered vaginally. 96.8% were live births, 92.13% mother-baby pair received sdNVP. 35% children could be traced till 18 months, 89% were alive. 90% were tested, 3 were found HIV +ve. Of them, none received MB Pair. Two were delivered vaginally, two received mixed feeding, two children's mothers were not linked with ART. Conclusions: PMTCT services - counseling and testing should be provided to all ANCs. EDD-based tracking, institutional deliveries, postnatal counseling to be encouraged along with complete MB pair coverage, capacity building of concerned staff regarding delivery of HIV+ve ANCs and exposed children tracking.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]  [PubMed]

Background: Human immunodeficiency virus (HIV) infection primarily affects women during their reproductive years, and the coexistence of reproductive tract infections (RTIs) is not surprising given the fact that HIV is mainly acquired via heterosexual contact. Aim: The aim of the study was to compare the occurrence of RTIs among infected and noninfected women. Materials and Methods: A case control study of 83 HIV positive women, tested by two enzyme linked immunosorbent assay (ELISA) and a matched control of 87 HIV negative women were screened for RTIs. They were submitted to gynecological examination and cervical cytology. Results: The mean age for HIV positive women was 30 years and that for HIV negative women was 27 years. 18% HIV positive women had menstrual irregularities compared to 6% in seronegative group ( P = 0.024). Vaginal infections including sexually transmitted infections (STIs) were found in 47 (57%) HIV positive women and 30 (34%) HIV negative women ( P = 0.0037). Vaginal candidiasis was the most common infection (34%) in HIV positive women, followed by trichomoniasis (12%). Human papilloma virus (HPV) infection was seen in nine HIV positive women versus none in HIV negative women. Cervical cytology showed inflammation in 53 (64%) HIV positive women compared to 27 (31%) HIV negative women ( P = 0.000023). Genital neoplasia, including carcinoma in situ was observed in 2 (2.5%) HIV positive women and in none of the HIV negative women. Conclusion: It is seen that reproductive tract morbidities are common in HIV positive women. So it is imperative that HIV positive women have a complete gynecological evaluation including a Papanicolaou (PAP) smear with aggressive screening of STIs.

[ABSTRACT]  [FULL TEXT]  [PDF] [CITATIONS]  [PubMed]

Mycetoma is a chronic, granulomatous disease of the skin, and subcutaneous tissue, which sometimes involves muscle, bones, and neighboring organs. It is characterized by tumefaction, abscess formation, and fistulae with discharge of grains from sinuses. Mycetoma can be caused by various species of fungi (eumycetoma) and aerobic actinomycetes (actinomycetoma), which occur as saprophytes in soil or plants. A tentative diagnosis sufficient to initiate treatment may be made on the basis of grain color. For instance, melanoid grains are always caused by fungi and ochroid or pale grains by actinomycetes. Although this is not the thumbrule, there are exceptional reports too. As trauma favors infection, most lesions are on the foot and lower leg but they may occur anywhere on the body mimicking actinomycosis. However, lab investigations and culture are important tool to differentiate apart from the clinical picture. We are reporting atypical case with unusual site of presentation (perineum and thigh) of mycetoma.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]  [PubMed]

Cutaneous leishmaniasis and human immunodeficiency virus (HIV) co-infection is emerging as increasingly frequent and serious new disease. Leishmaniasis may be acquired before or after HIV infection. We describe two cases of post-kala-azar dermal leishmaniasis in HIV-positive patients. Both the patients had papulonodular lesions on upper extremities and back with low CD4 count. Slit skin smear with giemsa stain revealed Leishman Donovan (LD) bodies and skin biopsy of both the patients revealed lymphohistiocytic infiltrate with numerous intracytoplasmic LD bodies.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]  [PubMed]

Among the myriad manifestations of HIV, non-Hodgkin's lymphomas (NHL) are considered as the second most common malignancies after Kaposi's sarcoma. HIV-associated NHLs are extranodal and have a predilection for sites in the head and neck region in 50-60% of cases. Of all the extranodal NHLs, oral cavity constitutes only 25%. It is now considered that oral NHL serves as the first indicator of HIV infection.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]  [PubMed]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]  [PubMed]

[FULL TEXT]  [PDF] [CITATIONS]  [PubMed]

[FULL TEXT]  [PDF] [CITATIONS]  [PubMed]

[FULL TEXT]  [PDF] [CITATIONS]  [PubMed]

Herpes Zoster (HZ) lesions are well known to heal with keloids. As immunity plays an important role in the development of abnormal scars and keloids, the latter is unusual in HIV where immunity is low. We report a rare case of recurrent HZ in an HIV-positive male where the lesions have healed with formation of keloids in both episodes. Within 50 days of last episode, he had an attack of herpes progenitalis.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]  [PubMed]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]  [PubMed]

Viral infections in pregnancy are a major cause of morbidity and mortality for both mother and fetus. Viral STIs occur as surface infection and then gradually infect immunologically protected sites. Therefore, these are asymptomatic, hidden and hence underdiagnosed, persistent and difficult to treat. HSV, HPV, HBV, HIV and CMV (cytomegalovirus) are the common ones. Most of these are transmitted during intrapartum period. Proper screening, identification and treatment offered during prenatal period may help in preventing their complications. Twenty five percent of women with a history of genital herpes have an outbreak at some point during the last month of pregnancy. Acyclovir is the accepted efficacious and safe therapy for HSV in pregnancy. Globally, HPV infection is the most common sexually transmitted infection. Neonatal transmission can occur in the absence of clinically evident lesions. HPV 6 or 11 may lead to Juvenile Onset Recurrent Respiratory Papillomatosis (JORRP). TCA, liquid nitrogen, laser ablation or electrocautery can be used to treat external genital HPV lesions at any time during pregnancy. Cesarean section is recommended only if the lesions are obstructing the birth canal. Mother to child transmission (MTCT) in HIV accounts for 15-30% during pregnancy and delivery, and a further 5-20% of transmission occurs through breastfeeding. HBV infection during pregnancy does not alter the natural course of the disease. In women who are seropositive for both HBsAg and HBeAg, vertical transmission is approximately 90%. Pregnancy is not a contraindication for HBV vaccination. Cytomegalovirus (CMV) is the most common intrauterine infection. Cytomegalic inclusion disease (CID) is the most severe form of congenital CMV infection. Treatment is supportive.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]  [PubMed]

Objectives: To identify the reproductive health issues associated with adolescence and their readiness to avail services like Adolescent Friendly Clinic (AFC) among rural school going children. Materials and Methods: A quantitative survey was carried out using a self-administered structured questionnaire among 768 (428 boys and 340 girls) students from 15 schools by systematic random sampling from schools (3 schools from 5 talukas). Focus group discussions, 5 each with adolescent boys and girls and teachers were held. Results and Discussion: Only 31% of the boys and 33% of the girls mentioned that they had heard about contraception. More than half of the adolescent boys and girls knew correctly about various modes of transmission of HIV/AIDS. A large proportion of boys and girls have mentioned changes in the opposite sex such as increase in height, change in voice, breast development, and growth of facial hair, growth of hair in private parts, onset of menstruation in girls, etc. Nearly 70% of adolescents were ready to use AFC. Teachers perceived that adolescents become curious about the changes taking place in them, but they lack information and opportunities for open-discussions to get answers to their queries related to reproductive health. They are willing to take help from teachers but teachers are not equipped with knowledge nor are they comfortable discussing these issues with their students. Recommendations: Information on the human reproductive system and related issues on reproductive health need special attention. Teachers' sensitization to "adolescent health care" is required.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]  [PubMed]

Adolescence (10- 19 years) is a phase of physical growth and development accompanied by sexual maturation, often leading to intimate relationships. Adolescent HIV/AIDS is a separate epidemic and needs to be handled and managed separately from adult HIV. The adolescents can be subdivided into student, slum and street youth; street adolescents being most vulnerable to HIV/AIDS. Among various risk factors and situations for adolescents contracting HIV virus are adolescent sex workers, child trafficking, child labor, migrant population, childhood sexual abuse, coercive sex with an older person and biologic (immature reproductive tract) as well as psychological vulnerability. The most common mode of transmission is heterosexual, yet increasing number of perinatally infected children are entering adolescence. This is due to "bimodal progression" (rapid and slow progressors) among the vertically infected children. Clinically, the HIV infected adolescents present as physically stunted individuals, with delayed puberty and adrenarche. Mental illness and substance abuse are important co-morbidities. The disclosure and declaration of HIV status to self and family is challenging and guilt in sexually infected adolescents and tendency to blame parents if vertically affected need special consideration and proper counseling. Serodiscordance of the twins and difference in disease progression of seroconcordant twins are added causes of emotional trauma. Treatment related issues revolve around the when and what of initiation of ART; the choice of antiretrovirals and their dosages; issues related to long term ADRs; sense of disinhibition following ART commencement; adherence and resistance.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]  [PubMed]