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.

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Prozone phenomenon is a false negative response resulting from high antibody titer which interferes with formation of antigen- antibody lattice, necessary to visualize a positive flocculation test. We present a case of secondary syphilis who presented to us with features of contact irritant dermatitis. She initially tested non- reactive for VDRL testing but tested positive with higher dilution. The prozone phenomenon is attaining importance because of increasing prevalence of Acquired immune deficiency syndrome. So one needs to be familiar with the occurrence of prozone phenomenon.

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Cerebral toxoplasmosis is an acquired immunodeficiency syndrome (AIDS)-related infection and is one of the causes of CNS mass lesions in AIDS. Toxoplasmosis is the most common cerebral mass lesion encountered in HIV-infected patients, and its incidence has increased markedly since the beginning of the AIDS epidemic. Cerebral toxoplasmosis is associated with high mortality and morbidity in patients with acquired immunocopromised state. We are reporting a case of cerebral toxoplasmosis presented with status epileptics and treated with cotrimoxazole. Refractory status epilepsy was controlled with intravenous levetiracetam, which has a unique drug profile.

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Aim: To study level of satisfaction among patients attending ART centre using Patient Satisfaction Questionnaire (PSQ - 18). Materials and Methods: A cross-sectional interview based technique was used to study the level of satisfaction. Results: A total of 59 patients attending ART centre were included in the study. The mean score for general satisfaction was 3.22 (SD 0.86), for technical quality 3.03 (SD 0.92), for the interpersonal manner 3.25 (SD 0.93), for communication (SD 0.90), for financial aspects was 2.38 (SD 1.00) and for time spent during the visit, the mean score was 2.97 (SD 0.98) Interpretation: Patient satisfaction is the key in planning and formulating guidelines for treatment and care.

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Average risk of acquiring HIV infection after a percutaneous exposure to HIV infected blood is 0.3%. Post exposure prophylaxis (PEP) for HIV refers to a set of comprehensive services to prevent HIV infection in exposed individuals where the exposure can be occupational/ non occupational and a provision of short term (28 days) antiretroviral drugs are given depending on the risk assessment. It also includes counselling and relevant laboratory investigations after taking informed consent of the exposed person and source. PEP inhibits the replication of the initial inoculum of virus and thereby prevents establishment of chronic HIV infection, and is best effective when initiated within 2 hours but certainly within 72 hours. Present communication deals with the registry of 278 cases of PEP from Gujarat in terms of various determinants, their status and the outcome in terms of HIV sero positivity.

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Late congenital syphilis is a rare entity and its early diagnosis and treatment is essential to prevent significant morbidity. We are reporting a case of late congenital syphilis presenting with Hutchinson's triad at an age of 14 years.

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Nocardiosis is an acute, subacute or chronic bacterial infection caused by several species of geophilic aerobic bacteria of the genus Nocardia. Cutaneous nocardiosis is an uncommon infectious disease that presents as primary cutaneous infection or as a sequale of disseminated pulmonary nocardiosis. Its rarity and as nocardiosis is not an AIDS defined disease it is often underreported. The global incidence of cutaneous nocardiosis is not exactly known. The frequency of nocardiosis in HIV patients has increased from 0.3 to1.85%. In Immunocompetent persons Primary Cutaneous Nocardiosis is more commonly seen among gardeners and agriculturists. We report a case of extensive primary facial cutaneous nocardiosis due to Nocardia asteroides, in an adult immunocompromised lady who had no pulmonary focus. The lesions were seen as sinus tracts on the zygomatic arch, preauricular and Infraauricular regions. Bacteriological examination of the pus confirmed the presence of N. asteroides. The rarity of the presentation and Cutaneous nocardiosis in India is reviewed.

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Context: Human Immunodeficiency Virus (HIV) infection progresses in almost all infected persons to Acquired Immunodeficiency Syndrome (AIDS). The aim of the study was to find out the determinants of rapid progression of immunodeficiency among people infected with HIV in Thiruvananthapuram district of Kerala, India. Settings and Design: The study design used was case control. The setting of the study was antiretroviral treatment (ART) centre of Government Medical College and the self-help group of HIV patients located at Thiruvananthapuram, Kerala. Materials and Methods: Cases were people having any one or more of the AIDS defining clinical conditions within 3 years from the diagnosis of HIV infection. Controls were people diagnosed as having HIV at least 3 years ago and with no AIDS-defining clinical conditions till the date of the study. Sample size was 149 with a control case ratio of 1.5:1. Statistical analysis used: Mean (standard deviation) and proportions were used to describe the data. Chi-square test and t test were done to test the hypotheses. Binary logistic technique was used to find out the predictors of the outcome. Results: A regression (Binary Logistic) model was used to predict the progression. Fungal infection of nail [adjusted Odds Ratio (OR), 6.4 (1.4, 28.9)] and oral candidiasis [adjusted OR, 2.6 (1.1, 6.4)] were the clinical conditions significantly associated with rapid progression. The significant social factors included non-exposure to professional counseling [adjusted OR, 7.1 (2.0, 24.5)] and the feeling of being stigmatized - felt as preoccupation with thoughts that they are gossiped about and the increase in visitors to "check them out" [adjusted OR, 26.1 (4.9, 138.4)]. The protective nutritional factors in the model were frequent consumption of legumes [adjusted OR, 0.12 (0.04, 0.36)], eggs [adjusted OR, 0.29 (0.09, 0.93)], and plenty of oral fluids [adjusted OR, 0.18 (0.07, 0.47)]. Conclusions: An approach incorporating the clinical, social, and nutritional factors may retard the progression of HIV infection.

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Genital lesions are common in HIV positive patients and aetiology for these are mainly due to HSV, HPV or bacterial. They usually respond to HAART, antiviral or antimicrobials. We are presenting a young patient on HAART with non-healing genital ulcer lesions for sixteen months. He responded well to a change in ART regimen within a period of 15 days. This happened after a change to a more potent ART regimen.

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Context: Improved antiretroviral treatment (ART) access reduces AIDS mortality and lowers HIV incidence by reducing the viral load at the individual/community level. Aims: To find out the epidemiological profile of the patients at ART Centre of Civil Hospital, Ahmadabad. Settings and Design: Centre-based cross-sectional study. Materials and Methods: 132 AIDS patients (on ART) during Jan­-Aug, 2009. Statistical analysis used: Proportions and Chi-square test. Results: Out of 132 cases, 60% were males, 70% from 15-44 years of age, 80% married, 78% literate, and 43% were gainfully employed. Sexual route accounted for infection in 63% cases while in 22% cases mode of transmission could not be elicited. Less common routes were injecting drug use (9%) and blood transfusion (6%). Heterosexual route was more common (70%) among migrants than the locals (50%). Half of them were diagnosed by VCTC. Thirteen clients did not receive pre-test counseling; 9 (6.6%) did not inform their spouse. Proportion of discordant couple was 42%. Conclusions: Comparing these determinants of patients on ART with those detected at ICTC can help in identifying the characteristics helpful in sending people to ART centers and bridging the gap between those detected at ICTC and those who reach at ART centers.

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To identify clinical parameters in association with human papilloma virus (HPV) genotypes and histopathology diagnosis in HIV-positive patients with external condylomata acuminata (ECA), 400 Chilean HIV-positive patients were included in the study. Forty-seven patients presented ECA. Clinical parameters and socio demographic data were recorded. Histopathology study and HPV linear array genotyping assay were performed. Intraepithelial neoplasia (IEN) grade 2 or 3 was found in 8.5% of patients, associated to HPV-16. Patients were mainly single, MSM, with history of sexually transmitted disease (STD), multiple sexual partners, receiving antiretroviral therapy and with recurrent lesions. All ECA were mainly perianal, grey or pink colored, exophytic with less than two years evolution. No clinical parameter could predict the development of high grade IEN in HIV patients with ECA. It seems necessary to perform biopsy and genotype all HIV positive patients with ECA.

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