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An exploration of compulsory licensing as an effective policy tool for antiretroviral drugs in India

Jain D, Darrow JJ

Health Matrix Clevel, 2013;23(2):425-57.
PMID: 24341078

Access to affordable drugs for the treatment of HIV/AIDS and other diseases is increasingly challenging in many developing countries such as Brazil, South Africa, and India. These challenges are in part the result of strengthened patent laws mandated by the 1994 Trade-Related Aspects of Intellectual Property Rights (TRIPS) treaty. However, there are underutilized instruments within TRIPS that governments can use to limit the adverse effects of patent protection and thereby ensure a supply of affordable generic drugs to their people. One such instrument is compulsory licensing, which allows generic manufacturers to produce pharmaceutical products that are currently subject to patent protection. Compulsory licensing has been used by a number of countries in the last few years, including the United States, Canada, Indonesia, Malaysia, Brazil, and Thailand, and is particularly significant for countries such as India, where large numbers of people are infected with HIV. This Article explores the feasibility of compulsory licensing as a tool to facilitate access to essential medicines within the current patent regime in India, drawing on the experiences of other countries.

Matched MeSH terms: HIV Infections/drug therapy
Fulltext Towards an HIV cure: science and debate from the International AIDS Society 2013 symposium

Purcell DF, Elliott JH, Ross AL, Frater J

Retrovirology, 2013 Nov 13;10:134.
PMID: 24224983 DOI: 10.1186/1742-4690-10-134

The International AIDS Society convened the multi-stakeholder "Towards an HIV Cure" symposium in Kuala Lumpur, Malaysia in 2013 to address the significant research challenges posed by the search for a cure for HIV infection. Current antiretroviral regimens select for a small reservoir of cells that harbour latent HIV provirus, produce few or no HIV virions, and resist detection or clearance by host immunity. The symposium examined basic molecular science and animal model data, and emerging and ongoing clinical trial results to prioritise strategies and determine the viral and immune responses that could lead to HIV remission without ART. Here we review the presentations that scrutinized the molecular mechanisms controlling virus expression from proviral DNA, and the intrinsic cellular restriction and immune mechanisms preventing viral production. Insights from the basic science have translated into new therapeutic strategies seeking HIV remission without ongoing therapy, and much interest was focused on these ongoing trials. We also summarise the emerging ethical issues and patient expectations as concepts move into the clinic.

Matched MeSH terms: HIV Infections/therapy*
Relative importance of demographic, socioeconomic and health factors on life expectancy in low- and lower-middle-income countries

Mondal MN, Shitan M

J Epidemiol, 2014;24(2):117-24.
PMID: 24390415

BACKGROUND: We attempted to identify the pathways by which demographic changes, socioeconomic inequalities, and availability of health factors influence life expectancy in low- and lower-middle-income countries.
METHODS: Data for 91 countries were obtained from United Nations agencies. The response variable was life expectancy, and the determinant factors were demographic events (total fertility rate and adolescent fertility rate), socioeconomic status (mean years of schooling and gross national income per capita), and health factors (physician density and human immunodeficiency virus [HIV] prevalence rate). Path analysis was used to determine the direct, indirect, and total effects of these factors on life expectancy.
RESULTS: All determinant factors were significantly correlated with life expectancy. Mean years of schooling, total fertility rate, and HIV prevalence rate had significant direct and indirect effects on life expectancy. The total effect of higher physician density was to increase life expectancy.
CONCLUSIONS: We identified several direct and indirect pathways that predict life expectancy. The findings suggest that policies should concentrate on improving reproductive decisions, increasing education, and reducing HIV transmission. In addition, special attention should be paid to the emerging need to increase life expectancy by increasing physician density.

Matched MeSH terms: HIV Infections/epidemiology
Fulltext Review on the demographic and social impact of methadone-medication therapy on Malaysian patients

Manan MM, Ali SM, Khan MA, Jafarian S, Hameed MA

Pak J Pharm Sci, 2013 Jul;26(4):841-6.
PMID: 23811468

This study is an observational cross-sectional study aimed to examine the possible demographic and social characteristics of patients enrolled at the Methadone Maintenance Therapy Adherence Clinic (MMTAC) in Malaysia. Medical records from year 2009 - 2011 were Reviewed. Demographic, social characteristics and laboratory examinations such as age, gender, race, clinic attendances and urine analysis were recorded. Subjects were selected by means of convenient sampling but based on the specified inclusion and exclusion criteria. Data were analyzed by either Chi-square test, Fisher's exact test Mann-Whitney U-test, with the limit of significance was set at p < 0.05. Demographically, this study found that the ratio of Malays, Chinese and Indian enrolled to the MMTAC program is similar to the distribution of races in Malaysia. Their starting age for drug use was between 14-35 years and the age to enrolment between 30-58 years. Socially, many are unemployed, lowly educated and married. Most are drug users with a high percentage of HCV accompanied with impaired liver function. Retention rate was 87% but illicit drug use was at 57.50%. However, percentage of employment increased significantly after therapy. The study managed to identify several demographical and social distributions of patients attending the MMTAC. Although attendance rate was high, many were on illicit drug use. Nevertheless, employment rate improved significantly.
Study site: government methadone clinic in Klang, Selangor, Malaysia

Matched MeSH terms: HIV Infections/epidemiology
Responsibility attribution of HIV infection and coping among injection drug users in Malaysia

Chou CC, Chronister J, Chou CH, Tan S, Macewicz T

AIDS Care, 2013;25(12):1551-8.
PMID: 23713718 DOI: 10.1080/09540121.2013.793267

This study explored responsibility attribution (RA) of HIV/AIDS infection (i.e., how an individual perceives the cause of their HIV/AIDS infection) and its relationship to coping styles among injection drug users (IDUs) with HIV/AIDS. In addition, this study investigated whether self-esteem, social support, and religiosity mediate the relationship between RA and coping styles of IDUs with HIV/AIDS. Participants were 201 adult IDUs with HIV/AIDS participating in the National Drug Rehabilitation Center in Malaysia. Five measures were used to assess the above constructs. Cluster analysis, analysis of variance, and mediation analyses were conducted. Results of this study indicated that IDUs with HIV/AIDS in Malaysia can be classified into four homogenous attribution groups: external, fatalistic, internal, and indeterminate. Mediator analyses revealed that combination of self-esteem, social support, and religiosity mediate the relationship between RA and coping behaviors. Clinicians working with IDUs with HIV/AIDS need to address the role of RA, self-esteem, religiosity, and social support as these psychosocial constructs are linked to coping with HIV/AIDS. Future researchers should investigate whether enhancing self-esteem, social support, and religiosity can promote active problem-solving coping and reduce the use of avoidance coping behaviors.

Matched MeSH terms: HIV Infections*
Malaysia makes progress against HIV, but challenges remain

Barmania S

Lancet, 2013 Jun 15;381(9883):2070-1.
PMID: 23776960
Matched MeSH terms: HIV Infections/prevention & control*
Fulltext People living with HIV/AIDS (PLWHA) and HIV/AIDS associated oral lesions; a study in Malaysia

Khan SA, Moorthy J, Omar H, Hasan SS

BMC Public Health, 2012;12:850.
PMID: 23043358 DOI: 10.1186/1471-2458-12-850

The continuous increase in number of people living with HIV/AIDS (PLWHA) represents a serious health and economic burden. HIV positive individuals with oral lesions have significantly lower oral health-related quality of life than HIV positive individuals without oral lesions. The objective of this study was to assess the knowledge, attitude and practices (KAP) within a cohort of HIV/AIDS positive patients towards HIV/AIDS associated oral lesions.

Matched MeSH terms: HIV Infections/complications*
Validity and reliability of the Malay version of WHOQOL-HIV BREF in patients with HIV infection

Saddki N, Noor MM, Norbanee TH, Rusli MA, Norzila Z, Zaharah S, et al.

AIDS Care, 2009 Oct;21(10):1271-8.
PMID: 20024703 DOI: 10.1080/09540120902803216

This study determines the validity and reliability of the Malay version of the World Health Organization Quality of Life (WHOQOL) assessment instrument in patients with human immunodeficiency virus (HIV) infection. A cross-sectional study on 157 patients with HIV seen at the Infectious Disease Unit, Hospital Raja Perempuan Zainab II, Kota Bharu, Kelantan was conducted. Factor analysis identified five major domains: physical needs, spirituality, social relationship, psychological, and environment. Significant correlation was found between each domain scores and the general health questions. The instrument was able to discriminate between asymptomatic and symptomatic HIV positive patients for all domain scores except for the spirituality domain. The internal consistency of the five domains ranged from 0.70 to 0.83. The intraclass correlation coefficient (ICC) ranged from 0.60 to 0.87 across all domains. In conclusion, the Malay version of WHOQOL-HIV BREF is a valid and reliable instrument in assessing quality of life in HIV positive patients.

Matched MeSH terms: HIV Infections/psychology*
Fulltext Improvements of knowledge and perception towards HIV/AIDS among secondary school students after two hours talk

Jahanfar S, Lim AW, Loh MA, Yeoh AG, Charles A

Med J Malaysia, 2008 Oct;63(4):288-92.
PMID: 19385486 MyJurnal

Malaysia is confronted with an increasing incidence of HIV and AIDS among adolescents and young adults. The effectiveness of various programs offered to school going teenagers is unknown. The objective of this study is to measure the effectiveness of two hours talk on sex education offered by a non governmental organization (NGO) in improving youngsters' knowledge and perception towards HIV and AIDS. A cross sectional study was conducted among the adolescent students from a secondary school in Ipoh, Perak, a province of Malaysia. A total of 182 students participated in the study. A standard questionnaire consisting of demographic data, knowledge and perception towards HIV/ADIS were distributed before (pre-test) and after the intervention (post-test). Performance of participants was compared to establish the effectiveness of the intervention. Our findings suggests that there was a significant increase in participants' knowledge and perception after the intervention (p = 0.000). Knowledge improvement was found in both genders however, improvement in perception was higher among female students. Interestingly, 80% of participants disagree that sexual education will encourage sex among youngsters. NGOs are playing a supplementary role in providing sex education programs in schools. This program although of short duration but it is effective in enhancing adolescence awareness about HIV/AIDS.

Matched MeSH terms: HIV Infections; HIV Infections/prevention & control*
Fulltext HIV/AIDS knowledge, attitudes and risk behaviours among Orang Asli in Peninsular Malaysia

Anita S, Zahir WM, Sa'iah A, Rahimah MA, Sha'ari BN

Med J Malaysia, 2007 Aug;62(3):227-33.
PMID: 18246913 MyJurnal

Orang Asli, the indigenous people of Peninsular Malaysia comprises only 0.5% of total Malaysia population but contribute to 0.06% of total notified HIV cases in the country. Their current knowledge, attitude and practice related to HIV was not known. A cross-sectional study on knowledge, attitude and practice among Orang Asli in Peninsular Malaysia was carried out involving 2706 Orang Asli from 33 remote and 47 fringe villages. Generally, the level of knowledge was fair (30%-50%) with mean scores of 55.7% (SD 31.7) while attitudes were negative. There was gender bias towards misconception on HIV transmission and sources of information. HIV seroprevalence of 0.3% was detected while risk behaviors were low. This study provides baseline information for HIV/AIDS preventive programs to the Orang Asli communities.

Matched MeSH terms: HIV Infections*
Fulltext Lactic acidosis in HIV patients receiving highly active antiretroviral therapy

Chow YW, Leong CL, Chow HL, Hooi LS

Med J Malaysia, 2007 Mar;62(1):78-80.
PMID: 17682581

Exposure to highly active antiretroviral therapy (HAART) may lead to adverse effects related to mitochondrial toxicity such as lactic acidosis. We describe two cases of severe lactic acidosis in HIV-positive patients to illustrate the clinical symptoms and abnormal laboratory results associated with this condition. There is a lack of awareness about the risk factors for developing severe lactic acidosis and recognition of its onset with dire consequences.

Matched MeSH terms: HIV Infections/drug therapy*
Fulltext Opportunistic infection associated to HIV/AIDS in Nepal

Arijit G, Shalini C

Med J Malaysia, 2007 Mar;62(1):88.
PMID: 17682586

Nepal is a low prevalence country for HIV/AIDS but has progressed into the category of a "concentrated" epidemic. The epidemic remains concentrated in a few vulnerable populations, namely Female Sex Workers and their clients, Intravenous Drug Users and Seasonal Migrant Workers. There is a big difference between estimated and reported cases for HIV, >60000 and almost 5000 respectively1 . There might be many more undiagnosed cases. Mother–to–child transmission is the largest source of HIV infection in children in Nepal so far.

Matched MeSH terms: HIV Infections/drug therapy
Fulltext Backcalculation of HIV infection rates in Malaysia

Ong HC, Soo KL

Med J Malaysia, 2006 Dec;61(5):616-20.
PMID: 17623964 MyJurnal

It has been almost two decades ago since the first AIDS case was reported in Malaysia. It has also been approximately eight years ago when the method of backcalculation was used to estimate the past HIV infection rate from the AIDS incidence data and an estimate of the incubation period distribution. This method is used because it makes use of the Malaysian AIDS incidence which is fairly reliable and reflects the trend of the epidemic as compared to the HIV infection rate recorded. The latest results generated show a slowdown in the increase of the number of estimated infected HIV+ cases in the late 1990s and this trend is supported by a slowdown in the increase of the number of AIDS cases recorded.

Matched MeSH terms: HIV Infections/epidemiology*
Meta-analysis: the association between HIV infection and extrapulmonary tuberculosis

Naing C, Mak JW, Maung M, Wong SF, Kassim AI

Lung, 2013 Feb;191(1):27-34.
PMID: 23180033 DOI: 10.1007/s00408-012-9440-6

BACKGROUND: Extrapulmonary tuberculosis has been an AIDS-defining condition. Individual studies that highlight the association between HIV and extrapulmonary TB are available. Our objectives were to synthesis evidence on the association between extrapulmonary tuberculosis and HIV and to explore the effective preventive measures of these two diseases.
METHODS: This is a meta-analysis of observational studies reporting effect estimates on how HIV is associated with extrapulmonary tuberculosis. We searched for the eligible studies in the electronic databases using search terms related to HIV and extrapulmonary tuberculosis. Where possible, we estimated the summary odds ratios using random effects meta-analysis. We stratified analysis by the type of study design. We assessed heterogeneity of effect estimates within each group of studies was assessed using I (2) test.
RESULTS: Nineteen studies (7 case control studies and 12 cohort studies) were identified for the present study. The pooled analysis shows a significant association between HIV and extrapulmonary tuberculosis (summary odds ratio: 1.3; 95 % confidence interval (CI) 1.05-1.6; I (2): 0 %). In a subgroup analysis with two studies, a significant association was found between CD4+ count less than 100 and the incidence of extrapulmonary tuberculosis (summary OR: 1.31; 95 % CI 1.02-1.68; I (2): 0 %).
CONCLUSIONS: Findings show evidence on the association between extrapulmonary tuberculosis and HIV, based on case control studies. Further studies to understand the mechanisms of interaction of the two pathogens are recommended.

Matched MeSH terms: HIV Infections/epidemiology*
Common bile duct perforation due to tuberculosis: a case report

Jarmin R, Alwi RI, Shaharuddin S, Salleh KM, Gunn A

Asian J Surg, 2004 Oct;27(4):342-4.
PMID: 15564193

A young man with HIV presented with biliary peritonitis secondary to spontaneous common bile duct perforation. Investigation revealed that the perforation was due to Mycobacterium tuberculosis. Tuberculosis of the bile duct is uncommon and usually presents with obstructive jaundice due to stricture. Bile duct perforation due to tuberculosis is extremely rare. Its management is discussed.

Matched MeSH terms: HIV Infections/complications
Improving access to essential drugs for people living with HIV/AIDS

Balasubramaniam K

Issues Med Ethics, 2000 Jan-Mar;8(1):26-7.
PMID: 16323335
Matched MeSH terms: HIV Infections/drug therapy*
Fulltext Nocardia infection of the mastoid in an immunocompromised patient

Subha ST, Raman R

Med J Malaysia, 2004 Dec;59(5):688-9.
PMID: 15889577

A rare case of Nocardia infection of mastoid is presented in an immunocompromised patient.

Matched MeSH terms: HIV Infections/immunology*
Fulltext A latent trait approach to measuring HIV/AIDS related stigma in healthcare professionals: application of mokken scaling technique

Ahmadi K, Reidpath DD, Allotey P, Hassali MAA

BMC Med Educ, 2016 May 30;16:155.
PMID: 27240562 DOI: 10.1186/s12909-016-0676-3

BACKGROUND: The attitudes of healthcare professionals towards HIV positive patients and high risk groups are central to the quality of care and therefore to the management of HIV/AIDS related stigma in health settings. Extant HIV/AIDS stigma scales that measure stigmatising attitudes towards people living with HIV/AIDS have been developed using scaling techniques such as principal component analysis. This approach has resulted in instruments that are often long. Mokken scale analysis is a nonparametric hierarchical scaling technique that can be used to develop unidimensional cumulative scales. This technique is advantageous over the other approaches; as the scales are usually shorter, while retaining acceptable psychometric properties. Moreover, Mokken scales also make no distributional assumptions about the underlying data, other than that the data are capable of being ordered by item and by person. In this study we aimed at developing a precise and concise measure of HIV/AIDS related stigma among health care professionals, using Mokken scale analysis.
METHODS: We carried out a cross sectional survey of healthcare students at the Monash University campuses in Malaysia and Australia. The survey consisted of demographic questions and an initial item pool of twenty five potential questions for inclusion in an HIV stigma scale.
RESULTS: We analysed the data using the mokken package in the R statistical environment providing a 9-item scale with high reliability, validity and acceptable psychometric properties, measuring and ranking the HIV/AIDS related stigmatising attitudes.
CONCLUSION: Mokken scaling procedure not only produced a comprehensive hierarchical scale that could accurately order a person along HIV/AIDS stigmatising attitude, but also demonstrated a unidimensional and reliable measurement tool which could be used in future studies. The principal component analysis confirmed the accuracy of the Mokken scale analysis in correctly detecting the unidimensionality of this scale. We recommend future works to study the generalisability of this scale in a new population.

Matched MeSH terms: HIV Infections/psychology*
Fine needle aspiration cytology of lymph nodes in HIV-infected individuals

Jayaram G, Chew MT

Acta Cytol., 2000 Nov-Dec;44(6):960-6.
PMID: 11127753

OBJECTIVE: To assess the role of fine needle aspiration cytology (FNAC) in lymphadenopathy in human immunodeficiency virus-infected individuals (HIVII).

STUDY DESIGN: Thirty-nine HIVII presenting with lymphadenopathy at University Hospital, Kuala Lumpur, were subjected to FNAC. Cytologic smears were routinely stained with May-Grünwald-Giemsa stain. Special stains and immunostains were used when necessary.

RESULTS: In nine cases, the cytologic appearance was compatible with HIV type A and in one case with HIV type C lymphadenopathy. In 21 cases, acid-fast bacilli (AFB) were demonstrated in the cytologic smears, enabling a diagnosis of mycobacterial lymphadenitis. In one of these cases there was a concomitant infection with Penicillium marneffei that was overlooked on initial cytologic examination. The cause of granulomatous lymphadenitis could not be ascertained in one case, where neither AFB nor any other organisms were demonstrable. Two cases of histoplasma and one of cryptococcal lymphadenitis were diagnosed, as was one high grade non-Hodgkin's lymphoma that could be immunophenotyped on cytologic material. In three cases the aspirates were inadequate for a cytologic diagnosis.

CONCLUSION: Lymph node FNAC is a valuable investigative modality in HIVII. Most opportunistic infections (bacterial and fungal) can be correctly identified, and high grade lymphoma can be diagnosed and phenotyped.

Matched MeSH terms: HIV Infections/complications*
Malaysia: damages awarded after mother infected through transfusion during pregnancy

Elliott R

Can HIV AIDS Policy Law Rev, 2003 Apr;8(1):77.
PMID: 12924337
Matched MeSH terms: HIV Infections/transmission*

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