Treatment outcomes by drug resistance and HIV status among tuberculosis patients in Ho Chi Minh City, Vietnam.

OBJECTIVE: To assess the combined effects of drug resistance, HIV infection and treatment regimen on treatment outcomes of smear-positive tuberculosis patients in Ho Chi Minh City, Vietnam. METHODS: A representative sample of patients diagnosed in 1998-2000 in 12 urban districts was offered HIV testing and submitted sputum for Mycobacterium tuberculosis culture and drug susceptibility testing. New patients were treated with 2SHRZ/6HE in nine districts and with 2SHRZ/4RH in three districts. RESULTS: The cure rate was 87% (1240/1430) among new patients compared to only 73% (287/391) among previously treated patients. Failure was associated with multidrug resistance (adjusted odds ratios [aOR] 49.6 and 16.6, respectively) and combined resistance to isoniazid (INH) and streptomycin (SM) (aOR 13.4 and 4.8), but not with HIV infection. New patients had an increased risk of failure on treatment with 2SHRZ/4RH compared to 2SHRZ/6HE if the isolate was resistant to INH and SM (aOR 2.8, P = 0.016). Death during treatment occurred in 15 of 50 HIV-infected patients (30%). Mortality was significantly associated with HIV infection (aOR 29.9), multidrug resistance (aOR 4.7) and other resistance to two or more drugs (aOR 2.1). CONCLUSION: In Vietnam, adaptation of treatment regimens should be considered, and interventions are needed to reduce the high mortality among HIV-infected patients.     

Prevalence and risk factors for diabetes in Ho Chi Minh City, Vietnam.

AIMS: To determine the prevalence of diabetes and associated risk factors in Ho Chi Minh City, Vietnam. METHODS: A total of 2932 participants aged 15 and above in Ho Chi Minh City were screened for diabetes in a cross-sectional study. The study was conducted from March-May 2001. Demographic, occupation, anthropometry and blood pressure were recorded. Blood glucose was calculated on fasting capillary and venous blood. The classification of diabetes and impaired fasting glucose (IFG) was carried out according to WHO and American Diabetes Association criteria. RESULTS: The crude prevalence of diabetes and IFG were 6.6 and 3.2%, respectively. After age, sex-adjustment to the Vietnam population census, the prevalence was 3.8 and 2.5%, respectively; approximately 40% of cases were found to be newly diagnosed diabetes. The crude prevalence of diabetes in the urban area was approximately 2.8 times higher than that recorded in the 1993 study (6.9 vs. 2.5%, respectively). In this study, there was a positive association between diabetes and sex, age, overweight, waist hip ratio (WHR), and having a history of delivering large for gestational age child; there was a negative association between diabetes and physical activity and occupation. CONCLUSIONS: This study found that the age, sex-adjusted prevalence of diabetes and IFG in Ho Chi Minh City were 3.8 and 2.5%, respectively, a rapid increase in the recent decade. Our study also indicates that ageing, a high WHR level, overweight and a sedentary lifestyle may be important determinants of the increased prevalence of diabetes during this transition period in Vietnam.     

Drug resistance among smear-positive tuberculosis patients in Ho Chi Minh City, Vietnam.

OBJECTIVES: To assess the pattern of drug resistance among smear-positive tuberculosis (TB) patients in an inner city area in Vietnam. METHODS: A random sample of patients diagnosed by the national TB programme (NTP) were offered HIV testing and submitted sputum for Mycobacterium tuberculosis drug sensitivity testing. RESULTS: Of 1433 isolates from new patients, 360 (25%) were resistant to isoniazid (INH), 57 (4.0%) to rifampicin (RMP), 421 (29%) to streptomycin (SM) and 28 (2.0%) to ethambutol. Among 401 previously treated patients, this was 218 (54%), 109 (27%), 217 (54%) and 26 (7%), respectively. Multidrug resistance (MDR) was observed in 55 (3.8%) new and 102 (25%) previously treated patients. RMP resistance was strongly associated with resistance to INH (OR 46) and INH plus SM (OR 91, P = 0.004). Prevalence of drug resistance tended to decrease with age. Neither any resistance nor MDR was significantly associated with HIV infection. CONCLUSIONS: In this inner city area, levels of drug resistance, in particular of MDR among previously treated patients, are high. This may be related to the use of NTP regimens in the context of highly prevalent combined SM and INH resistance which may favour acquisition of RMP resistance.     

The Syndemic Condition of Psychosocial Problems and HIV Risk Among Male Sex Workers in Ho Chi Minh City,Vietnam

In Vietnam, the co-occurrence (i.e., “syndemic”) of psychosocial factors (e.g., depression and substance use) may disproportionately burden male sex workers and increase their HIV risk. A comprehensive survey was conducted among 300 male sex workers in Ho Chi Minh City, Vietnam in 2010. We performed logistic regression to examine the association between the syndemic variable—a count score of the number of five psychosocial conditions endorsed—and unprotected anal sex (UAS) in the past. One-third of participants reported any UAS, and 42 % reported ≥2 psychosocial health problems. In multivariable models, experiencing ≥4 psychosocial health problems was significantly associated with UAS. Every unit increase in number of psychosocial health problems was associated with a 25–30 % increase in odds of UAS. Understanding the syndemic condition and its association with HIV risk among male sex workers in Vietnam may lead to the development of more effective, comprehensive interventions.     

A Qualitative Study of Stigma and Discrimination against People Living with HIV in Ho Chi Minh City,Vietnam

Stigma and discrimination against people living with HIV/AIDS (PLHIV) are a pressing problem in Vietnam, in particular because of propaganda associating HIV with the “social evils” of sex work and drug use. There is little understanding of the causes and sequelae of stigma and discrimination against PLHIV in Vietnam. Fifty-three PLHIV participated in focus group discussions in Ho Chi Minh City. Nearly all participants experienced some form of stigma and discrimination. Causes included exaggerated fears of HIV infection, misperceptions about HIV transmission, and negative representations of PLHIV in the media. Participants faced problems getting a job, perceived unfair treatment in the workplace and experienced discrimination in the healthcare setting. Both discrimination and support were reported in the family environment. There is a need to enforce laws against discrimination and provide education to decrease stigma against PLHIV in Vietnam. Recent public campaigns encouraging compassion toward PLHIV and less discrimination from healthcare providers who work with PLHIV have been encouraging.     

Risk factors for delayed HIV diagnosis at the Hospital of Tropical Diseases in Ho Chi Minh City, Vietnam

The objective was to identify factors associated with delayed diagnosis of HIV infection in Vietnam, defined as having a CD4 cell count of <200/mm(3) at the time of the first positive test. Data were collected retrospectively from the medical records of HIV-infected outpatients who received their initial care at the Hospital for Tropical Diseases in Ho Chi Minh City between July 2004 and August 2005. Among the 204 included patients, 58.3% had a delayed diagnosis. Independent factors associated with a delayed diagnosis were male gender (adjusted odds ratio [AOR] = 2.10; 95% confidence interval [CI] = 1.03-4.41) and having an opportunistic infection at the time of the first positive HIV test (AOR = 3.07; 95% CI = 1.71-5.53). Counselling for early HIV screening is important in populations at risk of infection. Facilitating access to care should be reinforced for symptomatic patients.     

Community, Family, and Partner-Related Stigma Experienced by Pregnant and Postpartum Women with HIV in Ho Chi Minh City, Vietnam

Pregnant and postpartum women with HIV often face stigma and discrimination at home and in the community. In Vietnam, associations between HIV and the “social evils” of drug use and sex work contribute to stigmatization of people with HIV. We conducted a qualitative study to explore discrimination experienced by HIV-positive pregnant and postpartum women in Ho Chi Minh City at home and in the community. We conducted 20 in-depth interviews and two focus group discussions. Participants described managing disclosure of their HIV infection because of fear of stigma and discrimination, particularly to the wider community. In cases where their HIV status was disclosed, women experienced both discrimination and support. The findings highlight the need for targeted interventions to support pregnant and postpartum women with HIV, particularly during this period when they are connected to the healthcare system and more readily available for counseling.     

Symptoms of Depression in People Living with HIV in Ho Chi Minh City,Vietnam: Prevalence and Associated Factors

This cross-sectional study investigated the prevalence and correlates of symptoms of depression among 400 people living with HIV/AIDS (PLHIV) from two HIV clinics in Ho Chi Minh City, Vietnam. Based on the Center for Epidemiologic Studies—Depression scale, 36.5% of participants were classified as likely to be clinically depressed. Factors independently associated with symptoms of depression included self-report of poor or fair health (aOR 2.16, 95% CI 1.33–3.51), having a low body mass index (aOR 1.85, 95% CI 1.13–3.04), reporting recent problems with family (aOR 1.97, 95% CI 1.21–3.19), feeling shame about being HIV-infected (aOR 1.90, 95% CI 1.20–3.00), and reporting conflict with a partner (aOR 2.21, 95% CI 1.14–4.26). Participants who lived with family (aOR 0.48, 95% CI 0.25–0.90) or who received emotional support from their families or supportive HIV networks (aOR 0.45, 95% CI 0.25–0.80) were less likely to experience symptoms of depression. Screening for and treatment of depression among Vietnamese PLHIV are needed.     

Clinical features of HIV/AIDS patients presenting to an inner city clinic in Ho Chi Minh City, Vietnam

An outpatient HIV clinic was opened in March 2005 in Binh Thanh District, a poor section of Ho Chi Minh City, Vietnam. Over 1500 patients were seen in the first year. The average age of patients was 27 years. Men represented 77% of the clinic population, women, 23% and children under the age of 16 years of age, 5% of the population. The most common risk factor among men was being an injecting drug user (IDU), 76%, and among women, being married to an IDU HIV-positive man, 35%. Physical signs of disease were uncommon: lymphadenopathy in 24% and hepatomegaly and splenomegaly in 4% and 3%, respectively. Men and women were anaemic at presentation, with a mean haemoglobin of 11.9 g/dL and 11.1 g/dL, respectively. An overwhelming majority of patients had profound immunodeficiency. The mean CD4+ cell count was 164 cells/mL and the median was 69 cells/mL. No correlation was found between the World Health Organization's stage of disease and the CD4+ cell count. Thus, the former is a poor predictor of immunity in this population. Data regarding opportunistic infections diagnosed at the first visit were studied. Candidiasis of the oral pharynx, oesophagus or vagina was found in 34.5% of the patients, and pulmonary and extrapulmonary tuberculosis was found in 32% of the patients. Pneumocystis carinii pneumonia (PCP) was diagnosed in only 3% of the patients. Cotrimoxazole prophylaxis is advocated for HIV-infected Vietnamese, but the incidence of PCP is negligible and resources could be spent elsewhere. The various opportunistic infections seen in this resource-poor clinic setting is likely to be a pattern of presentation of HIV-infected Vietnamese for some time to come.     

Prevalence of multiresistant Gram-negative organisms in a surgical hospital in Ho Chi Minh City, Vietnam

OBJECTIVE: To determine resistance patterns of multiresistant Gram-negative organisms at a surgical hospital in Ho Chi Minh City, Vietnam, in order to guide appropriate antibiotic prescribing and improve infection control procedures. METHOD: All samples sent in for microbiological analysis over a 3-month period were included. A resource neutral double disc-diffusion test was introduced to detect the presence of extended-spectrum beta-lactamase (ESBL) production. RESULTS: We obtained 350 bacterial isolates from clinical specimens; 87.4% were Gram-negative bacteria (GNB). Of these, 88.9% were Enterobacteriaceae, of which 14.7% produced ESBL. Fifteen (37.5%) of these were isolated within 48 h of admission. Resistance to gentamicin and ciprofloxacin occurred in 70.0% and 72.5% of those organisms that produced ESBL and in 39.5% and 38.7% of those that did not. Resistance to third-generation cephalosporins was common: 36.7% of all GNB were resistant to ceftriaxone, 34.0% to cefotaxime, 19.6% to ceftazidime and 36.7% to cefoperazone. CONCLUSION: Multiresistant Gram-negative organisms are common and pose a challenge to antibiotic therapy. Successful implementation of a simple test to detect ESBL production allowed reporting of these organisms, appropriate antibiotic prescribing and infection control interventions. Development of antibiotic-prescribing guidelines must take into account these resistance patterns.     

HIV,Hepatitis C,and Other Sexually Transmitted Infections Among Male Sex Workers in Ho Chi Minh City,Vietnam

There is little data on the burden of HIV and other infections that affect male sex workers (MSW) in Vietnam. We conducted behavioral and biological sexual health surveys with 300 MSW in Ho Chi Minh City. Generalized estimating equation models were built to assess factors associated with HIV, hepatitis C, and other sexually transmitted infections (STI). Of 300 MSW, 19 (6.3 %) were diagnosed seropositive for HIV, 11 (3.7 %) had hepatitis C, and 26 (8.7 %) had at least one prevalent STI. In a multivariable model, opiate use was significantly associated with HIV infection (aOR 6.46, 95 % CI 1.28–32.7) and hepatitis C (aOR = 19.6, 95 % CI 2.35–163.6). Alcohol dependency was associated with increased odds of hepatitis C (aOR = 4.79, 95 % CI 1.02–22.5) and decreased odds of other STI (aOR = 0.30, 95 % CI 0.10–0.97). These findings suggest that MSW in Vietnam would benefit from regular HIV and STI testing, as well as linkage to care and substance use rehabilitation services.     

Evaluation of STD/HIV Prevention Needs of Low- and Middle-Income Female Sex Workers in Ho Chi Minh City, Vietnam

The Ho Chi Minh City (HCMC) AIDS Committee is concerned about providing prevention and sexually transmitted disease (STD) services to increasing numbers of female sex workers (FSWs). We interviewed 250 non-brothel-based FSWs in HCMC in 1997, including 100 detained women at a rehabilitation center, and 150 women soliciting on the street (low income) and in bars (middle income). The majority of women came from provinces bordering Cambodia. The self-reported HIV prevalence was 2.9%. One third of women (37.5%) were greater than 30 years old, 47.7% were divorced/widowed, 19.3% were married, and 41.2% were in persistent financial debt. Most women did not undergo regular gynecological exams and were reluctant to go to public clinics because of lack of money or not being treated with respect. Attitudes toward community-based cafés providing peer education and STD services were better. The results of this survey have been used to improve a peer education program for FSWs that includes free STD care in a supportive environment.     

Steep increase in HIV prevalence among tuberculosis patients in Ho Chi Minh City

In Vietnam the spread of HIV infection is thought to be limited. In 12 urban districts of Ho Chi Minh City representative samples of tuberculosis patients have undergone HIV testing since 1995. HIV prevalence increased steeply from 0.5% in 1995 to 4% in 2000, with a doubling time of approximately 21 months. This study highlights the need to intensify HIV/AIDS prevention and control in Vietnam.     

High HIV Prevalence and Risk Among Male Clients of Female Sex Workers in Hanoi and Ho Chi Minh City,Vietnam

In Vietnam’s concentrated HIV epidemic, female sex workers (FSWs) are at increased risk for acquiring and transmitting HIV, largely through their male clients. A high proportion of males in Vietnam report being clients of FSWs. Studying HIV-related risk factors and prevalence among male clients is important, particularly given the potential for male clients to be a ‘bridge’ of HIV transmission to the more general population or to sex workers. Time-location sampling was used to identify FSW in Hanoi and Ho Chi Minh City, Vietnam’s largest cities, in 2013–2014. Recruited FSWs were asked to refer one male client to the study. Demographic and risk behavior data were collected from FSWs and male clients by administered questionnaires. Biologic specimens collected from male clients were tested for HIV and opiates. Sampling weights, calculated based on the FSWs probability of being selected for enrolment, were applied to prevalence estimates for both FSWs and male clients. Logistic regression models were developed to obtain odds ratios for HIV infection among male clients. A total of 804 male clients were enrolled. Overall, HIV prevalence among male clients was 10.2%; HIV prevalence was 20.7% (95% confidence interval (CI) 15.0–27.9%) among those reporting a history of illegal drug use and 32.4% (95% CI 20.2–47.7%) among those with opioids detected in urine. HIV prevalence among male clients did not differ across ‘bridging’ categories defined by condom use with FSWs and regular partners over the previous 6 months. HIV among male clients was associated with a reported history of illegal drug use (OR 3.76; 95% CI 1.87–7.56), current opioid use (OR 2.55; 95% CI 1.02–6.36), and being referred by an FSW who self-reported as HIV-positive (OR 5.37; 95% CI 1.46–19.75). Self-reported HIV prevalence among enrolled FSWs was 2.8%. Based on HIV test results of male clients and self-reported status from FSWs, an estimated 12.1% of male client-FSW pairs were sero-discordant. These results indicate high HIV prevalence among male clients of FSWs, particularly among those with a history of drug use. Programs to expand HIV testing, drug-use harm reduction, and HIV treatment for HIV-infected male clients of FSWs should be considered as key interventions for controlling the HIV epidemic in Vietnam.     

Clinical and biological characteristics of human immunodeficiency virus-infected and uninfected intravascular drug users in Ho Chi Minh City, Vietnam.

To define the medical characteristics of intravascular drug users in Ho Chi Minh City, Vietnam, we examined 280 men, of whom 235 were infected with human immunodeficiency virus (HIV), being treated in a rehabilitation center. The patients used mainly opium, often in shooting galleries (50%). The prevalence of oral candidiasis (58%) and zoster infection (20%) was high in HIV-seropositive patients, whereas oral hairy leukoplasia and Kaposi's sarcoma were absent. The prevalence of acquired immunodeficiency syndrome was 24%. More than 80% of the patients had infections with hepatitis C virus, hepatitis B virus, cytomegalovirus, or human T cell lymphotropic virus type-1. The CD4+ cell counts correlated well with viral load. Only HIV-1 subtype E was detected in the 30 patients tested. A cohort study of HIV-infected subjects in this population seems feasible, and would permit introduction of anti-retroviral therapy The large number of HIV-seronegative subjects sharing the same at-risk practices as the HIV-infected subjects raises the possibility of natural protection in this population.     

Opportunistic infections in hospitalized HIV-infected adults in Ho Chi Minh City, Vietnam: a cross-sectional study

The HIV epidemic is emerging rapidly in Vietnam. We studied the prevalence of opportunistic infections by performing clinical and microbiological investigations in 100 hospitalized HIV-infected adults in Ho Cho Minh City, Vietnam. The median CD4 count was 20 cells/mm(3) and in-hospital mortality was 28%. The most frequent diagnoses were oral candidiasis (54), tuberculosis (37), wasting syndrome (34), lower respiratory tract infection (13), cryptococcosis (9), and penicilliosis (7). Bacterial (other than tuberculosis) and parasitic infections were uncommon. Regional differences should be considered when deciding which diagnostic procedures and prophylactic measures to implement. In Vietnam, routine mycobacterial blood cultures do not provide greater yield than chest radiography and sputum and lymph node aspirate smears. Prophylactic trimethoprim/sulphamethoxazole against Pneumocystis jiroveci pneumonia may confer little benefit, and high rates of isoniazid resistance may affect the efficacy and feasibility of tuberculosis chemoprophylaxis. However, the usefulness of itraconazole prophylaxis for cryptococcosis and penicilliosis merits further consideration.     

Correlation of prospective and cross-sectional measures of HIV type 1 incidence in a higher-risk cohort in Ho Chi Minh City, Vietnam

The primary aim of this study was to estimate HIV incidence within a high-risk population in Ho Chi Minh City (HCMC), Vietnam using both cross-sectional and prospective methodologies. A secondary aim was to develop a local correction factor for the BED and avidity index incidence assays. The research study design consisted of three phases: (1) cross-sectional, (2) prospective, and (3) BED false recent (BED FR). A total of 1619 high-risk, sexually active individuals were enrolled in the cross-sectional phase and 355 of the opiate-negative, HIV-negative women were subsequently enrolled in the prospective phase. Four-hundred and three men and women with known HIV infection duration of greater than 12 months were enrolled in the BED FR phase. The HIV prevalence for all participants in the cross-sectional phase was 15.8%. HIV incidence in the cross-sectional group was estimated using the BED IgG capture assay and AxSYM avidity index assay for recent HIV infection and incidence within the prospective cohort was determined by observations of HIV seroconversion. HIV incidence in opiate-negative women was estimated using the BED assay to be 0.8% unadjusted and 0.5% after applying the locally derived BED false recent rate of 1.7%; no seroconversions were observed in the prospective cohort. We also screened the cross-sectional samples for evidence of acute infection using nucleic acid testing, 4th generation HIV EIA, and SMARTube coupled with Genscreen and Determine diagnostic tests; no confirmed acute infections were identified by any method. HIV incidence within this opiate-negative study population was low and incidence estimates from the two methods compared favorably with each other. Incidence estimates and false recent rates using the AxSYM assay were higher: AI FRR of 2.7% and adjusted incidence of 1.7% per year (95% CI, 0.6, 2.8). By comparison, both HIV prevalence and incidence estimates for the opiate-positive group were higher.     

Prevalence and Risk Factors Associated with HIV Infection Among Men Having Sex with Men in Ho Chi Minh City, Vietnam

To learn more about risk behaviors among men who have sex with men (MSM) in Vietnam and their prevalence of HIV, we conducted a study among MSM in Ho Chi Minh City (HCMC) to determine HIV-1 prevalence and behaviors associated with infection. This consisted of formative (35 MSM) and cross-sectional (600 MSM) studies at 72 sites, including 75 transvestites, 55 bisexuals, 10 sex workers, and 460 other MSM. Only 5.3% cohabited with a wife/girlfriend, but 30% reported ever having sex with a female. Prevalence of HIV was 8%, ranging from 33% in sex workers to 7% among transvestites and other MSM. Injecting drugs, selling sex, being 20–40 years old, having less than 6 years of education, and having more than five male anal sex partners in the past month were associated with being HIV-infected. MSM are an HIV bridge group, and should be included in sentinel surveillance. Targeted interventions should be implemented.     

How knowledge of hepatitis B disease and vaccine influences vaccination practices among parents in Ho Chi Minh City,Vietnam

Objective: To assess the influences of the knowledge of parents about hepatitis B virus(HBV) infection and the benefit of HBV vaccination on the practice of HBV vaccination among children. Methods: A prospective cross-sectional study recruited parents whose children, aged 12-24 months, received HBV vaccination at Commune Health Centers(CHCs) in Ho Chi Minh City from Feb. 2016 to Jul. 2017. Parents were interviewed using a questionnaire that included 11-item binary knowledge questions and checked their children's vaccination cards. Results: A total of 768 parents had a mean age of(30.8±5.1) years. The mean knowledge score of the 11-item questions was(7.0±2.4). The knowledge score was positively associated with full and timely HBV vaccination. In addition, children who received complete and timely HBV vaccination were significantly more likely to live in rural areas(Adjusted OR 4.02, 95% CI 2.79-5.79, P0.001). Also, children whose parents received vaccination information from health care providers, and had knowledge about HBV risk, had a higher rate of full and timely HBV vaccination(Adjusted OR 1.60, 95% CI 1.13-2.29, and Adjusted OR 1.47, 95% CI 1.01-2.13, P all0.05).Conclusions: Parents possessed a great deal of incorrect knowledge about HBV. More health education from health care providers should target parents living in specific locations and focus on the benefits of HBV vaccine.