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Biomedical subjects

W Schrooten

Publications and source records attributed to W Schrooten.

At least 19 recordsLinked to original sources
PubMed2005

Pediatric human immunodeficiency virus screening in an African district hospital.

In order to evaluate alternative tests and strategies to simplify pediatric human immunodeficiency virus (HIV) screening at the district hospital level, a cross-sectional exploratory study was organized in the Democratic Republic of the Congo. Venous and capillary phlebotomies were performed on 941 Congolese children, aged 1 month to 12 years (153 children under 18 months and 788 children more than 18 months old). The HIV prevalence rate was 4.7%. An algorithm for children more than 18 months old, using serial rapid tests (Determine, InstantScreen, and Uni-Gold) performed on capillary blood stored in EDTA tubes, had a sensitivity of 100.0% (95% confidence interval [CI], 88.9 to 100.0%) and a specificity of 100.0% (95% CI, 99.5 to 100.0%). The results of this study suggest that the ultrasensitive p24 antigen assay may be performed on capillary plasma stored on filter paper (sensitivity and specificity, 100.0%; n=87) instead of venous plasma (sensitivity, 92.3%; specificity, 100.0%; n=150). The use of glucolets (instruments used to perform capillary phlebotomies), instead of syringes and needles, may reduce procedural pain and the risk of needle stick injuries at a comparable cost. Compared to the reference, HIV could have been correctly excluded based on one rapid test for at least 90% of these children. The results of this study point towards underutilized opportunities to simplify phlebotomy and pediatric HIV screening.

AIDS Serodiagnosis↗
PubMed2004

Prevalence and factors associated with sexual dysfunction among HIV-positive women in Europe.

Little is known on female sexual dysfunction (FSD) among HIV-positive women. A cross-sectional survey in seven European HIV centres was performed and data on medical history, antiretroviral treatment and laboratory results were collected. Sexual function was evaluated by the Female Sexual Function Index (FSFI). The data from 166 women were available (response rate=77%). The non-respondents had a lower CD4 cell count, were older and more frequently of sub-Saharan African origin. The overall median FSFI was 25.2 (interquartile range=19.3). Thirty-six women (25%) had a FSFI score < or = 10. Depression, irritability and anxiety were associated with a low FSFI score. The participants reported a significant decrease in sex functioning since HIV diagnosis but not since the start of antiretroviral treatment. Sexual dysfunction in women with HIV infection is frequent and is mainly driven by psychological factors and by the HIV diagnosis.

Adult↗
PubMed2004

The role of non-viral load surrogate markers in HIV-positive patient monitoring during antiviral treatment.

Monitoring the efficacy of highly active antiretroviral treatment (HAART) is crucial if disease progression and the emergence of viral mutants are to be avoided. Classical viral load monitoring is too expensive for large-scale use in resource-limited settings. Three alternative measures, CD4 count, total lymphocyte count (TLC) and haemoglobin, were evaluated as surrogate markers of treatment success (viral load below detection level) among 710 HIV-positive patients who started HAART in an HIV treatment centre in Belgium. TLC correlated well with changes in CD4 counts during HAART, but an increase in TLC alone was a poor predictor of treatment success. A combination of increases in both haemoglobin levels and TLC proved a reliable predictor of successful treatment outcome comparable to the increase in CD4 count, but its specificity and sensitivity were low.

Adult↗
PubMed2004

Five-year immunological outcome of highly active antiretroviral treatment in a clinical setting: results from a single HIV treatment centre.

Our objective was to study the evolution of CD4 cell count five years after starting highly active antiretroviral treatment (HAART) in a clinical setting. The study was performed at the HIV outpatient clinic, Institute of Tropical Medicine, Antwerp. All patients (n = 225) who started HAART in 1997, who had a CD4 cell count within six months prior to starting HAART and who were subsequently followed for at least two years were included. Change in CD4 cell count after start of HAART and the influence of patient and clinical factors were investigated using graphical exploration, endpoint analysis and mixed-effects linear regression. The mean CD4 cell count at start of HAART was 280 cells/mm(3). At the five-year endpoint of the study the mean increase in CD4 cell count was 333 cells/mm(3), while 79% of the patients had a viral load less than 400 copies/mL. There was a significant negative correlation between increase in CD4 cell count at five years and time since first positive HIV test at start of HAART (P = 0.021). Patients who ever had a HAART interruption of more than seven days had a significantly lower increase in CD4 cell count than those who did not (225 cells/mm(3) compared with 438 cells/mm(3); P < 0.001). A mixed-effects linear regression model additionally suggested a significant impact of exposure to antiretrovirals prior to HAART (P = 0.03). Overall, the recovery of CD4 cell count after five years of HAART is good, although therapy interruptions have an important negative impact.

Adult↗
PubMed2003

The use of complementary and alternative medicine by persons with HIV infection in Europe.

Between June 1996-September 1997 and December 1998-December 1999, two surveys using an anonymous questionnaire were carried out in Europe among persons living with HIV infection. The questionnaire included questions on use of antiretrovirals, complementary or alternative medicines. Vitamins/minerals were taken by 528 (58%) of the 1996-97 participants, compared to 326 (63%) of the 1998-99 participants (P =0.06). Homeopathy was taken by respectively 176 (21%) and 55 (14%) (P =0.003) participants and herbal products respectively by 213 (25%) and 77 (20%) (P =0.06). In multiple regression analysis a longer time since HIV diagnosis, having a higher education level and having a lower CD(+) lymphocyte count were associated with the use of homeopathy. A longer time since HIV diagnosis and a more advanced stage of the disease were associated with the use of herbal products. The study shows that despite the availability of highly active antiretroviral therapy many people with HIV infection still take complementary and alternative medicine.

Adult↗
PubMed2002

Rheumatological complications associated with the use of indinavir and other protease inhibitors.

Several cases are reported of rheumatological pathology (temporomandibular dysfunction, frozen shoulder, Dupuytren's disease, and tendinitis) most probably related to the intake of indinavir in HIV positive patients. A survey using an anonymous questionnaire of 878 people with HIV infection treated with antiretroviral drugs suggests that other protease inhibitors may also cause arthralgia.

Adult↗
PubMed2002

Self-reported signs of lipodystrophy by persons living with HIV infection.

OBJECTIVE: To identify risk factors for the development of lipodystrophy in HIV infected patients on highly active antiretroviral therapy. METHODS: A survey among patients with HIV infection using an anonymous questionnaire was conducted in 10 European countries between December 1998 and December 1999. Nine hundred and four people receiving antiretrovirals, were included in the analyses. RESULTS: 368 (41%) people reported an increase in abdominal girth since commencing current antiretroviral treatment. Breast enlargement was reported by 106 people (12%). Lipoatrophy signs were reported by approximately one-third of the people: 291 (32%) complained about decrease in facial fat and 300 (33%) reported decrease in buttock fat. One hundred and thirty-one (15%) people reported both lipoatrophy signs and an increase in abdominal girth (mixed lipodystrophy syndrome). In multivariate analysis, the development of the mixed lipodystrophy syndrome was associated with a longer use of indinavir (OR=1.03, 95% CI: 1.00-1.06), ritonavir (OR=1.06, 1.02-1.09) and stavudine (OR=1.05, 1.02-1.08) and also with age, a longer duration of HIV seropositivity and an advanced stage of HIV infection. CONCLUSIONS: This study suggests that multiple factors are associated with the occurrence of lipodystrophy, including the prolonged use of protease inhibitors.

Adult↗
PubMed2002

Financial situation of people living with HIV in Europe.

The objective was to investigate the financial situation of people living with HIV in Europe. Two surveys using an anonymous questionnaire were organized in Europe among people living with HIV, the first in 1996-97 and the second in 1998-99. One thousand one hundred and sixty-one people from the 1996-97 survey and 899 from the 1998-99 survey were included. Four hundred and fifty-seven (42%) of the 1996-97 participants reported that their income had decreased since HIV diagnosis. The latter participants reported significantly more often difficulties in paying for housing (27% vs 20%), food (18% vs 12%) and transport (17% vs 12%) compared to 1998-99 participants. In multiple regression analysis, severity of HIV disease, not being on highly active antiretroviral therapy (HAART), younger age, lower education level and living in the South of Europe were associated with having financial difficulties. We concluded that since the introduction of HAART, the financial situation of persons living with HIV in Europe has improved, but a relatively large percentage of them still have financial difficulties.

Adult↗
PubMed2001

Sexual dysfunction associated with protease inhibitor containing highly active antiretroviral treatment.

BACKGROUND: A high proportion of individuals receiving highly active antiretroviral treatment (HAART) complain of sexual dysfunction (SD), encompassing a lack of desire or erectile dysfunction. OBJECTIVE: To determine whether SD was associated with particular components of the HAART regimens and to identify risk factors for the development of SD in patients on HAART. METHODS: A survey among patients with HIV infection using an anonymous questionnaire was conducted in 10 European countries between December 1998 and December 1999. A total of 904 individuals currently receiving antiretroviral agents were included in the analyses. RESULTS: A decrease in sexual interest was significantly more frequently reported by subjects (men and women) using HAART containing protease inhibitors (PI) (308/766, 40%), compared with PI-naive patients (22/138, 16%; OR 3.55; 95% CI 2.15--5.89). In addition, a significantly larger number of PI-experienced men reported a decrease in sexual potency (216/628, 34%) compared with PI-naive men (12/99, 12%; OR 2.56; 95% CI 1.33--5.03). In multivariate analyses the following factors were associated with a decrease in sexual interest: a current PI-containing regimen, a history of a PI regimen, symptomatic HIV infection, age and homosexual contact as HIV transmission mode. Factors associated with a decrease in sexual potency were: current use of a PI-containing regimen, symptomatic HIV disease, age and the use of tranquillisers. CONCLUSION: SD appears to be a common side-effect of HAART regimens containing a PI. The potential association between SD and other side-effects of HAART, such as lipodystrophy syndrome and neuropathy, should be investigated further.

Adult↗
PubMed2001

Euthanasia: from the perspective of HIV infected persons in Europe.

BACKGROUND: In the debate about legalization of euthanasia very little attention has so far been given to the opinion of the patient. OBJECTIVE: To assess the opinion of persons with HIV infection in Europe. METHODS: A cross-sectional survey of persons with HIV infection attending HIV/AIDS treatment centres or HIV support organizations in 11 European Union Member States was performed. A total of 2751 anonymous patient self-administered questionnaires were distributed between August 1996 and September 1997. The questionnaire contained 108 questions concerning a variety of topics about HIV care, including five questions on euthanasia. RESULTS: One thousand three hundred and seventy-one people with HIV infection completed the questionnaire, of whom 1341 (98%) responded to the questions concerning euthanasia. Seventy-eight percent of respondents agreed with the legalization of euthanasia in case of severe physical suffering, 47% if there was severe psychological suffering and 24% simply at the patient's request. For physical suffering and at a clear patient's request, accepted practices were: alleviation of pain with double effect (81%), medical euthanasia (62%) and physician assisted suicide (45%). Fifty percent would consider euthanasia for themselves if all treatment options were exhausted. Social indicators such as educational level and employment seemed to play a more significant role in determining attitudes towards legalization, and personal interest in, euthanasia than indicators related to disease status. CONCLUSION: In this study a majority of HIV infected persons in Europe favoured the legalization of euthanasia.

Adolescent↗
PubMed2001

Receiving a positive HIV test result: the experience of patients in Europe.

OBJECTIVE: To describe HIV-infected people's experience of the HIV test procedure in Europe. METHODS: Between August 1996 and September 1997, anonymous self-administered questionnaires were distributed to HIV-infected people in 11 European countries. RESULTS: A total of 1366 people completed the questionnaire (50% response rate). Of these, 194 (16%) had more than five negative HIV tests before being diagnosed as HIV positive, 179 (14%) were tested without consent and 192 (15%) were informed about the HIV positive test result by mail or by telephone. Of the 963 people who received a positive test result during a consultation, 247 (26%) reported that this visit lasted less than 10 min, 336 (35%) between 10 and 20 min, and 289 (30%) more than 20 min. Over half the total respondents (591, 54%) felt they did not receive adequate support when they were informed about being HIV positive, with 249 (19%) experiencing feelings of rejection. People who were diagnosed as HIV positive after 1994 reported more frequently receiving adequate support, information and understanding when the positive test result was revealed compared with those diagnosed before 1990. CONCLUSION: A large number of our study participants did not endorse the way HIV tests were conducted and positive test results revealed. Although there was an improvement over time in the way HIV tests were conducted, they often did not conform to international guidelines.

AIDS Serodiagnosis↗
PubMed2001

Antiretroviral treatments used among adults with HIV infection in Europe.

International guidelines for the treatment of human immunodeficiency virus (HIV) infection change rapidly. They are mainly based on results from large-scale randomized clinical trials, but also on hypotheses. The objective of the study was to look at the use of antiretrovirals (ARVs) in different HIV treatment centres in Europe. Between August 1996 and September 1997 self-administered anonymous questionnaires were distributed to persons with HIV infection at inpatient and outpatient departments in 11 European countries; 1,366 people completed the questionnaire. Important differences in use of ARVs were noted between different centres. Zidovudine was the drug that was used predominantly in all countries and by 77% of all patients; the use of didanosine, zalcitabine and stavudine differed widely. Use of ARVs was found to be lower for people who reported intravenous drug use (compared to homosexual transmission), people with a low education level, and those with a monthly income lower than 992 Euro. The use of a protease inhibitor containing ARV treatment regimen was significantly lower in the centres in the south of Europe. Between 1996 and 1997, many persons with HIV infection in Europe received a suboptimal ARV treatment regimen. Use of ARVs should be improved for intravenous drug users, persons with lower educational level and lower income.

Adolescent↗
PubMed2001

Hospital services for people with HIV infection in Flanders: patients' satisfaction.

Two questionnaire surveys about satisfaction with hospital services were carried out among HIV-infected people in Flanders. In a first survey (CIRCA '93 study) between 1993 and 1995, before highly active antiretroviral treatment (HAART) was available, questionnaires were distributed by HIV treatment centres, general practitioners and HIV support organizations: 315 people with HIV infection completed the questionnaire. The level of patient satisfaction was generally higher with services at university hospitals than at general hospitals. Most patients preferred to be hospitalized in a ward specialized in HIV care. Contact with other HIV-infected patients was generally experienced as supportive. The second survey included 34 patients with HIV-infection and 83 patients with lung disease. They were admitted to the same ward at the Antwerp University Hospital, between July 1996 and July 1997. Patients with HIV infections were expecting more services than patients with lung disease. Both studies showed that HIV-infected patients wanted to be actively involved in diagnostic and treatment decisions. The multidisciplinary approach, offered by the Antwerp University Hospital, was widely appreciated by patients and could be used as an example for organizing patient care for other diseases.

Adult↗
PubMed2001

Participants in HIV clinical trials in Europe.

In recent years an increasing number of antiretrovirals have become available. In order to define the optimal treatment regimens an increasing number of clinical trials are needed. Our objective was to study the profile of participants in HIV clinical trials in Europe and learn from their experience and views. Between August 1996 and September 1997, self-administered anonymous questionnaires were distributed to people with HIV infection at inpatient and outpatient clinics in 11 European countries. One thousand three hundred and sixty-six people completed the questionnaire (50% response rate). Four hundred and twenty (31%) of the respondents reported that they had previously participated in at least one HIV clinical trial. The percentage of people who had taken part in a clinical trial varied widely between the different centres, from 12% in Athens to 61% in Antwerp and Brussels. A significantly higher participation rate was observed in the northern and central part of Europe compared with the south (respectively 40% vs 18%) and also among people with a higher income. Most people (92%) stated that they were 'well' or 'very well' informed prior to enrolment in the trial. However, 4% reported that they had not given written approval and 22% felt that they were pushed into participating. Only 21% stated that they were informed about the outcome of the study on its completion. The most important reason for non-participation (37% of the non-participants) was because a clinical trial had never been proposed. In conclusion, a majority of people with HIV infection in European HIV treatment reference centres were willing to participate in clinical trials. HIV clinical trials in Europe should adhere more strictly to universal ethical standards.

Adult↗
PubMed2000

Utilization of healthcare services by people living with HIV/AIDS in Europe. Eurosupport Group.

Our objective was to compare the utilization of healthcare/support services for people with HIV infection in Europe. Between August 1996 and September 1997 self-administered anonymous questionnaires were distributed by reference HIV treatment centres and HIV support organizations. The questionnaire was completed by 1366 people living with HIV/AIDS. A small number of people had received influenza or pneumococcal vaccinations (34% and 19% respectively). Many patients did not receive dental care (48% of participants from the southern countries) and only 72% of the women had a gynaecological examination. More participants from the south reported insufficient access to healthcare/support services, particularly for nursing care (19%), psychological support (33%), nutritional advice (45%), access to support organizations (36%), and legal advice (46%). In conclusion, many people living with HIV/AIDS in Europe do not benefit from certain annual medical procedures proposed by international guidelines and consider themselves to have insufficient access to health/support services.

Acquired Immunodeficiency Syndrome↗