Seroprevalence of Evaluation of Immunoglobulins for HSV-1, HSV-2, and CMV Viruses in Latency and Reactivation.

Studies published over the past 3 years have tracked the incidence and course of human immunodeficiency virus (HIV) infection in relation to cardiac illness in both children and adults.1 These studies show that subclinical echocardiographic abnormalities independently predict adverse outcomes and identify high-risk groups to target for early intervention and therapy. The Joint United Nations Program on HIV/AIDS estimates that 36.1 million people were living with HIV infection at the end of the year 2000.2 If 8% to 10% of patients develop symptomatic heart failure over a 2- to 5-year period,3 then 3 million cases of HIV-related heart failure will present during that period.1 Cardiovascular manifestations of HIV have been altered by the introduction of highly active antiretroviral therapy (HAART) regimens. On one hand, HAART has significantly modified the course of HIV disease, lengthened survival, and improved the quality of life of HIV-infected patients. On the other hand, the early data have raised concerns that HAART is associated with an increase in both peripheral and coronary arterial diseases.1 The HAART-associated changes are relevant only to the minority of HIV-infected individuals worldwide who have access to HAART. Thus, studies conducted before HAART became available remain globally applicable. In this review article, the principal HIV-associated cardiovascular manifestations will be discussed, with an emphasis on new knowledge about prevalence, pathogenesis, and treatment. HIV disease is recognized as an important cause of dilated cardiomyopathy, with an estimated annual incidence of 15.9 in 1000 before the introduction of HAART3 (Table 1). The importance of cardiac dysfunction is demonstrated by its effect on survival in acquired immunodeficiency syndrome (AIDS). Median survival to AIDS-related death is 101 days in patients with left ventricular dysfunction and 472 days in patients with a normal heart as shown by echocardiography at a similar infection …

Hepatitis viruses and human immunodeficiency virus co-infection: pathogenisis and treatment

Repeated exposure to HIV does not necessarily result in infection and HIV infection does not inevitably lead to the development of the AIDS. Multiple immunological and genetic features can confer resistance to HIV acquisition and progression at different steps in viral infection; a full understanding of these mechanisms could result in the development of novel therapeutic and vaccine approaches for HIV infection. In this review, we focus on the genetic mechanisms associated with resistance to HIV infection and to the progression to AIDS.

The Uncertain Significance of Anti–Glomerular Basement Membrane Antibody Among HIV-Infected Persons With Kidney Disease

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Human Immunodeficiency Virus: The Initial Physician-Patient Encounter

With the development of effective therapies against human immunodeficiency virus (HIV), hepatitis C virus (HCV) infection has become a major cause of morbidity and mortality among patients with both infections (coinfection). In addition to the high prevalence of chronic HCV, particularly among HIV-infected injection drug users, the rate of incident HIV infections is increasing among HIV-infected men who have sex with men, leading to recommendations for education and screening for HCV in this population. Liver disease is the second leading and, in some cases, a preventable cause of death among coinfected patients. Those at risk for liver disease progression are usually treated with a combination of interferon (IFN) and ribavirin (RBV), which is not highly effective; it has low rates of sustained virologic response (SVR), especially for coinfected patients with HCV genotype 1 and those of African descent. Direct-acting antivirals might overcome factors such as immunodeficiency that can reduce the efficacy of IFN. However, for now it remains challenging to treat coinfected patients due to interactions among drugs, additive drug toxicities, and the continued need for combination therapies that include pegylated IFN. Recently developed HCV protease inhibitors such as telaprevir and boceprevir, given in combination with pegylated IFN and RBV, could increase the rate of SVR with manageable toxicity and drug interactions. We review the latest developments and obstacles to treating coinfected patients.

HAART and the HCV-infected liver: friend or foe?

HIV disease: Working Group Report of the First World Congress of Pediatric Gastroenterology, Hepatology, and Nutrition.

Patients with human immunodeficiency virus (HIV) infection have sustained alterations in metabolism (lipids and insulin/glucose homeostasis) and body composition (fat distribution) that are proatherogenic (the Figure). HIV infection itself and/or its therapies may contribute to these alterations (the Table); although most effects are reversible, there are some possibly irreversible consequences of treatment. With the relative restoration to health seen in the era of highly active antiretroviral therapy (HAART), many traditional risk factors and promoters of dyslipidemia and diabetes also are present; they interact with HIV-specific inducers to worsen dyslipidemia and to increase the prevalence of insulin resistance and diabetes. Figure. Overview of the effects of HIV and its therapies on CVD risk. The contribution of traditional risk factors must be kept in mind, and they may occur with increased prevalence in people with HIV infection (eg, smoking). HIV, likely through the inflammatory response, and antiretroviral therapies independently affect many of the mediators of CVD risk. The effects on lipids are a prominent but complex example; HIV infection lowers LDL levels, but antiretroviral therapy raises LDL back up to normal levels. The bidirectional arrows indicate associations, but there is not yet adequate proof of causality. The dotted arrow between body composition and CVD indicates that body fat is known to affect the mediators such as dyslipidemia and insulin resistance but may also have a direct effect. FFA indicates free fatty acids; ARV, antiretroviral. View this table: Table. Effects of HIV Treatment These disturbances in lipid and glucose metabolism and renal disease may contribute, at least in part, to the excess cardiovascular disease (CVD) morbidity and mortality observed in HIV-infected individuals (the Figure). However, the relative contribution to excess CVD risk of traditional CVD risk factors, especially smoking, compared with these infection- and treatment-specific complications requires clarification. More prospective data with multivariable modeling are needed. …

Human Immunodeficiency Virus Pre-Exposure Prophylaxis: Is it the Answer?

Human immunodeficiency virus (HIV) infection is under global attention due to its rapid spread and high rate of morbidity and mortality. HIV gets an access into the mucosa of genital epithelium through binding to Langerhans cells. While viral load and CD4+ cell count are the main parameters to detect disease activity, new biomarkers are introduced as a potential parameter for monitoring of disease activity in HIV infected patients. Calcitonin Gene Related Peptide (CGRP) is a neuropeptide that is secreted by peripheral neurons at genital epithelia and plays an important role in limitation of HIV transmission and spread to infected CD4+ cells through its effect onto Langerhans cells. This study aimed to evaluate the serum level of CGRP in HIV infected patients and to determine whether CGRP can serve as an indicator of HIV infection activity. The study included 104 HIV patients and 24 normal controls. Patients were divided into four groups. Serum levels of CGRP were measured by ELISA and correlated to viral load and CD4+ cells count for patients in the four groups: primary HIV infection (PHI), chronic HIV infection (CHI) before combinational antiretroviral therapy (cART-naïve), chronic HIV infection after one year of cART-initiation, and chronic HIV infection after two years of cART. Serum levels of CGRP were also measured in sera of controls and compared to patients' groups. Serum levels of CGRP were significantly lower in cART naïve PHI and CHI patients in comparison with normal controls (p < 0.05), Also, serum CGRP levels were positively correlated with CD4+ cells count (p < 0.01), but negatively correlated with viral load (p>0.05). In conclusion, CGRP could be proposed as an indicator of disease activity in HIV patients.

Dear Editor, Human immunodeficiency Virus (HIV) and hepatitis B are prevalent and important viral infectious throughout the world and are considered as an important problem (1) HIV related immunosuppressive increases significantly the risk of acquiring opportunistic infections due to hepatitis B. The opportunistic infection is a major source of mortality and mobility in HIV-related patients. Globally an estimated 350-400 million people are chronically infected with HBV and 33 million are living with HIV infection today (2). In Iran, it was estimated that HIV cases are approximately 22000 to 30000 and over 35% of the Iranians have been exposed to HBV, about 3% are chronic carries and its frequency ranges from 2 to 3 percent (3), despite of known efficacy of highly Active Antiretroviral Therapy (HAART) of HIV infected patients (4). Various international studies have been conducted to demonstrate the rate of co-infection with HBV and the result are naturally sought according to subpopulation and country (5). Recently, hepatitis B co-infection was associated with a poor overall survival in patients with HIV (6). On the other hand, few studies investigated the chronic HBV prevalence and correlated factors among HIV patients. The aim of this study was to determine seroprevalence of HBV infection and associated risk factors among HIV patients referral to Imam Khomeini hospital of Tehran, the capital of Iran. This was a cross-sectional study which was done on 213 patients with HIV referred to Imam Khomeini Hospital Complex at Tehran University of Medical Sciences for evaluation of HBV serologic markers from October 2008 to October 2010. Our samples were all of HIV patients who referred to Imam Khomeini hospital after getting the informed consent data sheet completed by interviews. Data included (gender, education, occupation, marital status), clinical characteristics (CD4 count through flocymetry, opportunistic infection, antiretroviral treatment), risk behavior pattern (blood transfusion, alcohol consumption, high risk sexual activities, Intravenous Drug User (IDU)). The serum sample 5 cc of venous blood from confirmed HIV positive patients were measured by commercially available Enzyme Linked Immunosorbet Assay (ELISA) and the HBsAg kit (Biokite Spanish). Participation in the study was done voluntarily after obtaining informed consent. We used mean + SD (standard deviation) or proportions for continuous or categorical variables. Independent risk factor for HBV infection was assessed using multivariate logistic regression model. P values of 0.05 or less were considered statistically significant. All statistical analyses were performed using Statistical Package for Social Sciences Software (SPSS, version, 16). Two hundred thirteen HIV infected patients had referred to Imam khomeini hospital from 2008 to 2010 .The range of HIV patients’ age was between 16-58 old years with average of 35 + 8/1. Their mean CD4 count was 202.9 + 9.5 cell/ml. Our samples were 91.5% male and 8.5% female. The seroprevalence of HBS Ag among 213 HIV/AIDS patients was 11.2%. CD4 counts (cells/ml) were categorized into 3 groups: CD4 500 (cells/ml). Majority of patients had CD4 count 200-499 cell/ml. Mean of CD4 count in HIV/HBV were 207.89 + 29.21. Most common risk factors for HIV infection were injection, drug use (46. 4%) and sexual transmission (28.6%) (Table 1).There was significant relationship only between seroprevalence in case of HBs Ag and HIV drug users (P = 0.001). Table 1. Risk factors of Patients for HIV Infection In our study, it is indicated that the average prevalence of HBV among HIV infected patients was 11.3 %, Rahimi-Movaghar et al. indicated that HBV infection among those infected with HIV reached to 7.8% (7). Also, according to Zago and her Colleagues, the overall estimated HBV prevalence among patients infected with HIV was 3.8% (7). Our present study indicates that the frequency of HBSAg was significant in IV drug users. Drug user was an important route of transmission of HBV. Dimitrakopoulos et al. found a higher frequency of HBSAg among IV drug users than among homo/bisexuals and also, the prevalence of HBV markers in that group was 67.4%: 71.8% in homo/bisexuals, 35.3% in heterosexuals, 91.7% in IDUs and 90.9% in blood transfusion recipients (8). Alavi et al. reported the co-infections of HBV in 104 HIV positive drug addicts who were hospitalized in the infectious ward between 2001-2003 in Razi hospital, Ahvaz, Iran, it was estimated to 44.35% (9). The results of this research showed that only Intravenous drug abuse (IVDA) had a significant risk factor for HBV/HIV. In a similar study performed on 130 HIV positive patients in Iran, none of these patients showed significant difference for co-infection with HIV/HBV (10). According to these results, it is defined that IDU is the highest risk factor for acquisition of HBV/HIV infections. We recommend screening for HBSAg positive in HIV infected patients, especially for patients with high risk behaviors.

Gastrointestinal Disease in Simian Immunodeficiency Virus-Infected Rhesus Macaques Is Characterized by Proinflammatory Dysregulation of the Interleukin-6-Janus Kinase/Signal Transducer and Activator of Transcription3 Pathway

Background: Co - infection of hepatitis E virus (HEV) and hepatitis D virus (HDV) in human immunodeficiency virus (HIV) infected patients can develop and increase hepatic complications in the world, particularly in developing countries. Objectives: The purpose of this study was to assess and compare the sero - virological prevalence of HEV and HDV in patients bearing HIV infection and HIV/HCV co - infection, as well as their relation to clinical and demographic data. Methods: Cross - sectional study testing IgM/IgG anti - HEV and total antibodies HDV in serum samples belong to 73 HIV infected patients and co - infected HIV - HCV patients were evaluated. Demographic, lifestyle, and laboratory data such as CD4 counts and viral load were prospectively collected on each patient with the HIV infection. Results: There were 26 HEV infected patients IgG positive, two HEV infected patients IgM positive, two HDV infected patients total antibodies positive, and only one HDV infected patient IgM among the 73 HIV infected patients. The prevalence of HDV positive IgG and total anti - HDV among co - infected patients were 2.2% and 2.2%. In addition 18 (69.2%) and 2.2% were positive for anti - HEV IgG and IgM, respectively. Furthermore, HIV viral load among HIV co - infected patients with HEV or HDV were shown higher compared to patients solely infected with only HIV. Also, the numbers of HEV or HDV positive were high in low levels of CD4. Conclusions: According to the results, frequency of occurrence of hepatitis E was higher than hepatitis D in HIV infected patients. Severity of HIV infection and liver damage caused by HEV and HDV infections were in a direct relationship. Hence, HIV and HCV screening should be implemented in HIV - infected patients with liver damage.