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Lerebours-Nadal L, Beck-Sague CM, Parker D, Gosman A, Saavedra A, Engel K, Dean AG. Severe, Disfiguring, Pityriasis Rubra Pilaris in a Woman in the Dominican Republic: Histopathologic Diagnosis and Response to Antiretroviral Therapy. J Int Assoc Provid AIDS Care 2015; 15:11-4. [PMID: 26514629 DOI: 10.1177/2325957415614649] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Pityriasis rubra pilaris (PRP) is a poorly understood dermatologic condition usually accompanied by keratoderma and intense erythroderma with islands of unaffected skin. The PRP categories include HIV-associated PRP VI. A 23-year-old HIV-infected, dark-skinned woman in the Dominican Republic developed an extremely severe, disfiguring process characterized first by a dry scaly rash involving her face, trunk, and extremities with hyperpigmentation and islands of spared skin and minimal erythroderma, followed by alopecia and development of a thick horny layer on the scalp and face. The condition, histologically proven to be PRP, was accompanied by fever, wasting, and decline in CD4 count. Initiation of combination antiretroviral therapy (cART) was followed by rapid and sustained resolution of PRP. Nine years after ART initiation, she remains well, with viral suppression and immune recovery, without PRP recurrence but with sparse hair regrowth and facial scarring. In some dark-skinned patients, severe PRP may not feature characteristic erythroderma but will respond to combination ART.
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Affiliation(s)
| | - Consuelo M Beck-Sague
- Clínica de Familia La Romana, La Romana, Dominican Republic Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Douglas Parker
- Department.of Pathology, Emory University School of Medicine, Atlanta, GA, USA
| | - Amanda Gosman
- Department.of Pediatric Plastic Surgery, University of California, San Diego Health System, San Diego, CA, USA
| | - Arturo Saavedra
- Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - Kristy Engel
- Hospital Buen Samaritano, La Romana, Dominican Republic
| | - Andrew G Dean
- Clínica de Familia La Romana, La Romana, Dominican Republic Department of Epidemiology and Public Health, Miller School of Medicine, University of Miami, Miami, FL, USA
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Beck-Sagué C, Pinzón-Iregui MC, Abreu-Pérez R, Lerebours-Nadal L, Navarro CM, Ibanez G, Soto S, Halpern M, Nicholas SW, Malow R, Dévieux JG. Disclosure of their status to youth with human immunodeficiency virus infection in the Dominican Republic: a mixed-methods study. AIDS Behav 2015; 19:302-10. [PMID: 25186784 DOI: 10.1007/s10461-014-0888-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
A mixed-methods study was conducted to determine the proportion of HIV-infected children who knew their status, identify characteristics associated with children's knowledge of their status, and describe caregivers' and adolescents' experiences relevant to disclosure in the Dominican Republic (DR). Of 327 patients aged 6-18 years treated in the principal DR pediatric HIV facilities, 74 (22.6 %) knew their status. Patients aged 13 years or older and/or who had participated in non-clinical activities for HIV-infected children were more likely to know their status. Caregivers who had disclosed cited healthcare providers' advice, children's desire to know and concerns that children might initiate sexual activity before knowing or discover their status by accidental or malicious disclosure. Non-disclosing caregivers worried that children would be traumatized by disclosure and/or stigmatized if they revealed it to others. Adolescents supported disclosure by 10-12 years of age, considered withholding of children's HIV diagnosis ill-advised, and recommended a disclosure process focused initially on promoting non-stigmatizing attitudes about HIV.
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Affiliation(s)
- Consuelo Beck-Sagué
- Robert Stempel College of Public Health and Social Work, Florida International University (FIU), 11200 SW 8th Street, Miami, FL, 33199, USA,
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Beck-Sagué CM, Dévieux JG, Pinzón-Iregui MC, Abreu-Pérez R, Lerebours-Nadal L, Gaston S, Dean AG, Halpern M, Rouzier V, Bertrand R, Rosenberg R, Pape JW, Nicholas SW, Blasini I. Depression in caregivers of status-naïve pediatric HIV patients participating in a status disclosure study in Haiti and the Dominican Republic: preliminary report. J Trop Pediatr 2015; 61:65-8. [PMID: 25389181 PMCID: PMC4375385 DOI: 10.1093/tropej/fmu060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A pilot study is underway to assess safety and acceptability of an intervention to disclose their HIV infection status to status-naïve pediatric antiretroviral therapy patients in Hispaniola [the island shared by Haiti and the Dominican Republic (DR)]. Of 22 Haiti and 47 DR caregivers recruited to date, 68.2% Haiti and 34.0% DR caregivers had clinically significant depressive symptomatology at the time of enrollment (p = 0.008). Depressive symptom prevalence was higher in Haiti caregivers who were female (81.3% vs. 0 in males; p = 0.02) and in DR caregivers who were patients' mothers (50.0%) or grandmothers (66.7%; 56.0% combined) than others (9.1%), (p < 0.001). Internalized stigma was more commonly reported by Haiti (85.7%) than DR (53.2%; p = 0.01) caregivers; 56.4% of Haiti and DR caregivers reporting internalized stigma vs. 26.1% of caregivers denying it had depressive symptoms (p = 0.02). Depression is common in Hispaniola caregivers possibly affecting disclosure timing. Study participation presents opportunities for addressing caregiver depression.
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Affiliation(s)
- Consuelo M Beck-Sagué
- Department of Health Promotion and Disease Prevention, Florida International University, Robert Stempel College of Public Health and Social Work, Miami, FL, USA 33199
| | - Jessy G Dévieux
- Department of Health Promotion and Disease Prevention, Florida International University, Robert Stempel College of Public Health and Social Work, Miami, FL, USA 33199
| | - María Claudia Pinzón-Iregui
- Department of Health Promotion and Disease Prevention, Florida International University, Robert Stempel College of Public Health and Social Work, Miami, FL, USA 33199
| | - Rosa Abreu-Pérez
- Robert Reid Cabral Children's Hospital, Santo Domingo, Dominican Republic (DR)
| | | | - Stephanie Gaston
- Groupe Haïtien d'Etude du Sarcoma de Kaposi et des Infections Opportunistes (GHESKIO), Department of Adolescent Medicine, Port-au-Prince, Haiti
| | - Andrew G Dean
- Department of Epidemiology Voluntary Faculty, University of Miami, Miami, FL, USA 33136
| | - Mina Halpern
- Clínica de Familia La Romana, Department of Research, La Romana, DR
| | - Vanessa Rouzier
- Groupe Haïtien d'Etude du Sarcoma de Kaposi et des Infections Opportunistes (GHESKIO), Department of Adolescent Medicine, Port-au-Prince, Haiti
| | - Rachel Bertrand
- Groupe Haïtien d'Etude du Sarcoma de Kaposi et des Infections Opportunistes (GHESKIO), Department of Adolescent Medicine, Port-au-Prince, Haiti
| | - Rhonda Rosenberg
- Department of Health Promotion and Disease Prevention, Florida International University, Robert Stempel College of Public Health and Social Work, Miami, FL, USA 33199
| | - Jean William Pape
- Groupe Haïtien d'Etude du Sarcoma de Kaposi et des Infections Opportunistes (GHESKIO), Department of Adolescent Medicine, Port-au-Prince, Haiti Cornell University School of Medicine, Cornell Medical College Center for Global Health, New York, NY, USA 10065
| | - Stephen W Nicholas
- Clínica de Familia La Romana, Department of Research, La Romana, DR Columbia College of Physicians and Surgeons, New York, NY, USA 10032
| | - Ileana Blasini
- Department of Pediatrics Voluntary Faculty, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico 00931-1839
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