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Suniti Solomon

Publications and source records attributed to Suniti Solomon.

At least 19 recordsLinked to original sources
PubMed2007

A social cognitive model of health for HIV-positive adults receiving care in India.

In-depth interviews were conducted with 50 HIV-positive adults (23 women, 27 men) with access to care at a non-governmental organization in Chennai, India to gain a broad understanding of how they managed their HIV infection. Using a Social Cognitive Model of Health, we identified factors within the model's three domains--Personal, Environmental, and Behavioral--that are applicable to this socio-cultural context. The Personal domain's factors were a positive self-concept, family-focused goals, and treatment optimism; the Environmental domain comprised family-based support, treatment availability, access and quality, and HIV stigma and discrimination; and the Behavior domain's factors were medication adherence and health habits, sexual behavior, and social relationships and emotional well-being. Significant differences for many of the factors within the three domains were observed across married men and women, widowed women, unmarried men, and female sex workers. Implications for an enhanced intervention for HIV-infected individuals in similar treatment settings are discussed.

Adult↗
PubMed2006

Weight and body shape changes in a treatment-naive population after 6 months of nevirapine-based generic highly active antiretroviral therapy in South India.

BACKGROUND: The nutritional and body shape response after the initiation of highly active antiretroviral therapy (HAART) in resource-limited environments has not been documented. In this environment, nutritional compromise is a common complication of human immunodeficiency virus (HIV) infection. METHODS: We conducted a prospective study of 190 HIV-infected patients who initiated a nevirapine-based HAART regimen. CD4+ T cell count, body weight, body mass index, anthropometry, and bioelectrical impedance data were collected prior to initiation of therapy and after 6 months of therapy. RESULTS: The mean age of participants was 35 years, 85% of participants were male, and 59% received stavudine as 1 of the nucleosides in their initial HAART regimen. The members of the cohort were malnourished before the initiation of therapy and had a mean body mass index of 20.1 (calculated as weight in kilograms divided by the square of height in meters). Overall, body weight increased a mean of 2.8 kg (range, -12.5 to 22.5 kg), and CD4+ T cell counts increased by a mean of 140 cells/mm3. Patients were stratified into those who lost weight (loss of >1 kg, 22%; n=41), those whose weight remained stable (19%; n=37), and those who gained weight (gain of >1 kg, 59%; n=112). Patients in all groups retained body shape symmetry and experienced no change in waist-to-hip ratio or regional body shape by anthropometry. CONCLUSIONS: The group that lost weight and the group whose weight remained stable experienced significant CD4+ T cell count increases at 6 months. Although the majority of HIV-infected patients who received nevirapine-based HAART gained weight, there were participants who lost weight despite initiating their first HAART therapy.

Adult↗
PubMed2006

Effective evaluation of novel low-cost CD4 monitoring assays.

Indian generic pharmaceutical manufacturers have dramatically reduced the price of antiretroviral therapy thus improving access, but monitoring costs of the patients on therapy remain high. Few low-cost monitoring assays are available and validation against gold standard is exceedingly important before implementation. Validity is defined as the degree to which the results of the new technique correspond to the true state of the phenomena being measured by the gold standard. Majority of publications report validation of low-cost CD4 assay using correlation coefficient, which is the best measure of association, and a few publications report intra-class correlation coefficient, which is a measure of reliability. However, Bland-Altman analysis that directly quantifies the difference seen between the novel low-cost CD4 assay and the gold standard is the most ideal approach. Absolute CD4 counts estimated for samples collected from 110 HIV+ and 118 HIV- individuals using novel EasyCD4 assay and the gold standard FACSCount assay were validated using correlation coefficient, intra-class correlation coefficient and Bland Altman analysis. The results from these different analyses have been compared and the significance of each has been explained. Hence, to validate a low-cost assay Bland-Altman analysis and plot is recommended.

Antiretroviral Therapy, Highly Active↗
PubMed2006

Detection of pulmonary Mycoplasma pneumoniae infections in HIV-infected subjects using culture and serology.

OBJECTIVE: The true prevalence of Mycoplasma pneumoniae infections involving the respiratory tracts of HIV-infected individuals is still unclear. This study examined the prevalence of M. pneumoniae in 100 HIV-infected individuals at an AIDS care center in Chennai, India, using conventional laboratory techniques and interpretation criteria. METHODS: Diagnosis was based on culture, cold agglutination test, and commercial enzyme-linked immunosorbent assay (ELISA) for the qualitative determination of IgM antibodies against M. pneumoniae. The efficacies of the different diagnostic procedures used in the study were analyzed. RESULTS: The prevalence of M. pneumoniae was 31% by culture and 21% by IgM ELISA. Cough (p=0.03, OR 3.8, 95% CI 1-17.8), myalgia (p=0.04, OR 2.5, 95% CI 1-6.6), rales (p=0.04, OR 2.4, 95% CI 1-6.6), and cervical adenopathy (p=0.03, OR 2.7, 95% CI 1-7.1) were the symptoms that significantly corroborated culture positivity. Patients positive for M. pneumoniae by culture or IgM antibody had significantly greater CD4+ T-cell depletion and anemia than those without any evidence of infection. CONCLUSIONS: This study provides the means to diagnose M. pneumoniae infection and information on the prevalence of the pathogen in HIV-infected individuals in resource constrained settings. Although modern molecular techniques may provide more insight into the prevalence of M. pneumoniae in HIV-infected individuals, conventional methods can still be used in diagnosis.

AIDS-Related Opportunistic Infections↗
PubMed2006

Risk reduction counseling is associated with decreased HIV transmission-associated behaviors in high-risk Indian heterosexuals.

OBJECTIVE: To estimate the incidence of HIV and study the impact of risk-reduction counseling (RRC) in a cohort of people with high-risk behavior for HIV transmission in Chennai, India. DESIGN: Prospective cohort follow-up of 500 HIV-negative people (250 men and 250 women) at increased risk for HIV acquisition in Chennai, India for a maximum of 1 year was conducted. They received RRC at 0, 6, and 12 months. Generalized estimating equation methodology was used to determine the statistical significance of differences reported in behavior between baseline, 6 months, and 12 months. RESULTS: The overall HIV incidence in this cohort was 0.44 per 100 person-years (95% confidence interval: 0.05-1.60). In the course of the study, both male and female participants reported statistically significant decreases in the number of different sexual partners, the number of new partners, and the proportion of sexual encounters with nonprimary partners. Participants who had more than 3 different partners at baseline and/or exchanged money for sex in the 6 months before enrollment demonstrated the greatest reductions in the number of different sexual partners. CONCLUSIONS: Individualized sexual RRC seems to be a useful intervention to reduce risk-taking behavior among at-risk heterosexuals in India.

Adult↗
PubMed2006

Serosurveillance of acute Mycoplasma pneumoniae infection among HIV infected patients with pulmonary complaints in Chennai, Southern India.

BACKGROUND: The true seroepidemiology of acute Mycoplasma pneumoniae infection in HIV infected individuals is ambiguous. METHODS: This study examined the serosurveillance of IgM antibodies to M. pneumoniae in HIV infected patients presenting with pulmonary symptoms at a tertiary AIDS care center in Chennai, Southern India, using cold-haemagglutination test and commercial enzyme linked immunosorbent assay in acute serum specimens. RESULTS: One hundred HIV infected patients had enrolled in the study; 21 (21%) were positive for M. pneumoniae IgM antibodies by ELISA and 34 (34%) showed evidence of cold hemagglutinins. CONCLUSION: This serosurveillance study reports a 21% prevalence of M. pneumoniae IgM antibody among HIV infected patients with pulmonary symptoms by ELISA and non-specific diagnosis was confirmed in 34% of the cases screened. Determination of cold agglutination titer could be used as a substitute to other expensive procedures in limited resource settings and third-world nations to diagnose M. pneumoniae infections for prompt initiation of therapy, as CAT has been found to be 100% sensitive and 84% specific in the diagnosis of M. pneumoniae infection.

AIDS-Related Opportunistic Infections↗
PubMed2006

Reasons for modification of generic highly active antiretroviral therapeutic regimens among patients in southern India.

OBJECTIVE: To describe reasons for modification and discontinuation of antiretroviral regimens in association with adverse events (AEs), treatment failure, and cost among patients in southern India. METHODS: Secular trends of patients initiating highly active antiretroviral therapy (HAART) between January 1996 and October 2004 at a tertiary HIV referral center in India were analyzed using a previously validated natural history database. RESULTS: All previously antiretroviral therapy-naive patients who initiated HAART (N = 1443) and had at least 1 follow-up visit were evaluated. The median CD4 count at the time of initiating HAART was 108 cells/microL. The most common first-line regimens were stavudine (d4T) plus lamivudine (3TC) plus nevirapine (NVP) (63%), zidovudine (AZT) plus 3TC plus NVP (19%), d4T plus 3TC plus efavirenz (EFV) (9%), and AZT plus 3TC plus EFV (4%). Twenty percent of patients modified their first-line regimen. The most common reason for modifying therapy was the development of an AE (64%), followed by cost (19%) and treatment failure (14%), with median times to modify therapy being 40, 151, and 406 days, respectively. Common AEs were itching and/or skin rash (66%), hepatotoxicity (27%), and anemia (23%). Nine percent of patients discontinued therapy entirely after a median duration of 124 days, primarily because of cost (64%). CONCLUSION: The most common reason for modifying therapy was the occurrence of AEs, whereas cost was the most common reason for discontinuing therapy. Despite increasing access to lower cost generic HAART in India, even less expensive and more tolerable first-line regimens and cost-effective treatment monitoring tools need to be introduced to achieve better treatment outcomes and access in resource-constrained settings.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Why are people getting tested? Self-reported reasons for seeking voluntary counseling and testing at a clinic in Chennai, India.

VCT has been shown to be an important HIV risk reduction strategy; however, little is known about who attends VCT or why people seek VCT. A retrospective analysis was performed on charts of 6330 clients who attended VCT between 1994 and 2002 at Y.R. Gaitonde Centre for AIDS Research and Education, a non-governmental organization in Chennai, Tamil Nadu, India. Most clients reported more than one reason for attending VCT, and the most commonly reported reasons were risk behavior, having symptoms, having a current HIV-positive partner, and reconfirming a previous positive HIV test. Reasons varied by gender and over time, and the likelihood of testing positive for HIV varied by reason reported. Understanding why people seek VCT informs an understanding of knowledge and attitudes about HIV and HIV testing, which has implications for the development of education, outreach and other HIV prevention services.

Adolescent↗
PubMed2006

Perceptions about the acceptability of assessments of HIV medication adherence in Lilongwe, Malawi and Chennai, India.

Little research exists on acceptability issues related to assessments of adherence to ART in resource-poor settings. To help prepare for two large-scale, multisite ART intervention trials, this qualitative study of individuals in Chennai, India (49 men, 11 women; 33 taking ART, 27 not) and Lilongwe, Malawi (5 men, 5 women, all taking ART) examined potential limitations of different types of adherence assessments: an adherence questionnaire, a pill diary, a pillbox, an electronic pill cap, and a medication punch card. Many participants reported that the various assessments would be acceptable. Potential limitations included issues surrounding literacy, the desire to appease one's medical provider, privacy and stigma, and "cheating." These potential limitations are similar to the limitations of these assessments in Western settings. However, the data highlight the need to consider individual patient level concerns when assessing ART adherence in different cultural settings. Innovative ways of monitoring adherence while maintaining standardization across sites are required in multisite trials.

Anti-Retroviral Agents↗
PubMed2006

Neurocognitive consequences of HIV in southern India: a preliminary study of clade C virus.

The neurocognitive impact of the clade C viral strain of human immunodeficiency virus (HIV) has not been determined. The purpose of this study was to examine neurocognitive function in southern India among individuals with the clade C virus with advanced HIV. A battery of cognitive tasks sensitive to the effects of HIV on brain function was translated and administered in Tamil and Telegu, two widely spoken languages in southern India. A sample of 30 treatment-naïve HIV-positive individuals with a median CD4 cell count of 97, and 30 age and education matched healthy controls obtained from the same region of India, were included in the study. Results revealed significant differences on most cognitive tests, with lower performances obtained by the HIV-positive individuals. These results suggest that cognitive difficulties are present among individuals with the clade C virus in India, with as many as 56% of the patients with advanced HIV meeting the criterion for impairment in two cognitive domains. Additional study is needed to determine if clade C HIV infection is more or less prone to cause neurocognitive deficit than the clade B virus. Furthermore, the impact of antiretroviral therapy on neurocognitive dysfunction in clade C virual infection needs to be determined.

Adult↗
PubMed2006

Bacterial vaginosis in women of low socioeconomic status living in slum areas in Chennai, India.

Bacterial vaginosis (BV) is a common cause of vaginitis among women of childbearing age. This study was performed to investigate the prevalence of BV and its association with sexually transmitted infections among 487 women of low socioeconomic status. Blood, vaginal and endocervical swabs were tested for HIV, herpes simplex virus-2 (HSV-2), Treponema pallidum, BV, Chlamydia trachomatis, Neisseria gonorrhoea and Trichomonas vaginalis. Of the women screened for BV, 120 (25, 95% CI 20.8-28.4) were positive and 40 (8.2, 95% CI 5.8-10.6) were intermediate. Bacterial vaginosis was significantly associated with age >25 (P = 0.014) and sexual experience (P = 0.085). Bacterial vaginosis was also related to concurrent infections with T. vaginalis (relative risk (RR) = 6.6, 95% CI 2.8-15.5, P = 0.000) and HSV-2 (RR = 2, 95% CI 1.3-2.9; P = 0.0031). The role of other possible risk factors needs to be explored.

Adolescent↗
PubMed2006

A reliable and inexpensive EasyCD4 assay for monitoring HIV-infected individuals in resource-limited settings.

Serial measurements of absolute CD4+ T-lymphocyte counts are required to initiate and gauge response to therapy and monitor disease progression. Hence, there is an urgent need to evaluate the accuracy and validity of low-cost CD4+ T-cell count assays. Tripotassium EDTA blood specimens from HIV-infected individuals were studied using a novel flow cytometric assay (EasyCD4 assay; Guava Technologies, Hayward, CA) in comparison with standard flow cytometry (FACSCount; Becton Dickinson Immunocytometry Systems, San Jose, CA). The sensitivity, specificity value by EasyCD4 assay in enumerating absolute CD4+ T-cell counts of less than 200 cells/microL were 95% and 100%, respectively. Bland-Altman analysis showed close agreement, with the EasyCD4 assay yielding CD4+ T-cell counts a mean difference of -26 cells/microL (95% confidence interval, -96 to 44 cells/microL) higher than by flow cytometry. Our data suggest that EasyCD4 assay could be a useful alternative assay to conventional flow cytometry, may be appropriate for use in resource-limited settings.

Adolescent↗
PubMed2006

Seroprevalence of Mycoplasma pneumoniae in HIV-infected patients using a microparticle agglutination test.

Mycoplasma pneumoniae is increasingly recognized as a common and important pathogen in community settings, and is responsible for various pulmonary and extrapulmonary conditions in the normal population. However, the seroepidemiology of acute M. pneumoniae infection in HIV-infected individuals is still unclear worldwide. This study examined the seroprevalence of antibodies to M. pneumoniae in HIV-infected patients admitted with respiratory complaints at a tertiary AIDS care centre in Chennai, India. A commercial gelatin microparticle agglutination test (Serodia-Myco II, Fujirebio) was used for the determination of antibodies against M. pneumoniae in acute serum specimens. Of the 200 HIV-infected patients with underlying pulmonary conditions tested, 34 (17 % positivity; 95 % CI 12-23 %) had antibodies specific to M. pneumoniae, while among the 40 patients with no underlying pulmonary symptoms, five (12.5 % positivity; 95 % CI 4-27 %) had evidence of anti-M. pneumoniae antibody. This shows that the incidence of M. pneumoniae seropositivity is greater in patients with underlying pulmonary complaints. Most positive titres were found in the age group 28-37 years in the symptomatic and symptom-free groups (64.7 and 60 %, respectively). The positive titres ranged from 40 to >20 480. High titres (> or =320) were found in 10 out of the 39 patients (25.6 %). This seroprevalence study reports a 16.2 % prevalence of M. pneumoniae infections in HIV-infected patients by a particle agglutination test.

AIDS-Related Opportunistic Infections↗
PubMed2006

A survey of MSM HIV prevention outreach workers in Chennai, India.

The present formative study sought to describe issues relevant to HIV prevention among men who have sex with men (MSM) in South India by surveying 62 MSM outreach workers from three non governmental organizations in Chennai. Although 92% reported having sex with men, only 74% identified as gay and 27% were married. Only half of these men reported having been tested for HIV. More than half of the sample reported that they would rather not know they had HIV until they were sick, and almost half indicated that they would rather end their life than live with the disease. Eighty-five percent of the sample reported having experienced varying levels of harassment from police, and 86% reported varying levels of harassment from others. These data point to several important barriers to HIV prevention among MSM in South India and lay the groundwork for enhancing the use of outreach workers to play a role in HIV prevention in this population.

Adult↗
PubMed2006

AIDS at 25.

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Acquired Immunodeficiency Syndrome↗