Acquired Immune Deficiency Syndrome Patients Research Articles

The prevalence and incidence of epiretinal membranes in eyes with inactive extramacular CMV retinitis.

To determine the prevalence and incidence of epiretinal membranes (ERM) in eyes with inactive extramacular cytomegalovirus (CMV) retinitis in patients with acquired immune deficiency syndrome (AIDS). A case-control report from a longitudinal multicenter observational study by the Studies of the Ocular Complications of AIDS (SOCA) Research Group. A total of 357 eyes of 270 patients with inactive CMV retinitis and 1084 eyes of 552 patients with no ocular opportunistic infection (OOI) were studied. Stereoscopic views of the posterior pole from fundus photographs were assessed at baseline and year 5 visits for the presence of macular ERM. Generalized estimating equations (GEE) logistic regression was used to compare the prevalence and 5-year incidence of ERM in eyes with and without CMV retinitis at enrollment. Crude and adjusted logistic regression was performed adjusting for possible confounders. Main outcome measures included the prevalence, incidence, estimated prevalence, and incidence odds ratios. The prevalence of ERM at enrollment was 14.8% (53/357) in eyes with CMV retinitis versus 1.8% (19/1084) in eyes with no OOI. The incidence of ERM at 5 years was 18.6% (16/86) in eyes with CMV retinitis versus 2.4% (6/253) in eyes with no OOI. The crude odds ratio (OR) (95% confidence interval, CI) for prevalence was 9.8 (5.5-17.5) (P < 0.01). The crude OR (95% CI) for incidence was 9.4 (3.2-27.9) (P < 0.01). A history of extramacular CMV retinitis is associated with increased prevalence and incidence of ERM formation compared to what is seen in eyes without ocular opportunistic infections in AIDS patients.

Effect of glutamine fortifying enteral nutrition on nutritio and immunity in children with acquired immune deficiency syndrome

Objective To investigate the effect of glutamine(GLN) fortifying enteral nutrition (EN) intervention on nutrition status and lymphocytes-mediated immune function in children with acquired immune deficiency syndrome(AIDS). Methods According to random number table, the 58 cases of AIDS patients conformed to the standard were divided into observation group (GLN improved group, 30 cases) and control group (conventional EN, 28 cases). Nutrition related index, index of cellular immunity and serum GLN concentration change of the 2 groups were detected before intervention and after intervention for 28 days. Results Body mass in the observation group after intervention for 28 days[(29.9±7.4) kg vs(28.0±8.3) kg, t=3.216, P=0.006], body mass index [(17.8±1.9) kg/m2vs(16.9±1.9) kg/m2, t=3.339, P=0.002], total lymphocyte count [(2.81±0.25)×109/L vs(2.53±0.24)×109/L, t=3.064, P=0.004], serum level of GLN[(7.2±2.1) μmol/L vs(5.5±1.2) μmol/L, t=2.496, P=0.012] were notably increased compared with those of control group.In observation group albumin [(40.5±3.1) g/L vs(38.6±2.1) g/L, t=3.82, P=0.001], pre-albumin [(182.0±38.6) mg/L vs(175.1±40.0) mg/L, t=2.917, P=0.007], hemoglobin [(115.7±8.5) g/L vs (104.8±11.5) g/L, t=3.022, P=0.005], CD4+ %(39.0±7.5)% vs (35.3±9.9)%, t=3.138, P=0.004], CD4+ /CD8+ ratio[(1.6±0.8) vs (1.2±0.6), t=3.198, P=0.001]were significantly higher than those of the control group.Incidence rate of gastrointestinal complications of the observation group were lower than that of the control group(16.7% vs 32.1%, χ2 =11.25, P=0.001). Conclusions Enhanced GLN EN intervention can improve nutritional status in AIDS children, raise the level of lymphocyte immunity, reduce gastrointestinal complications and new infections, shorten hospitalization time, and improve the prognosis of children with AIDS, So it is worthy of clinical promotion and application. Key words: Glutamine; Enteral nutrition; Acquired immune deficiency syndrome; Nutrition and immunity

Modeling Survival After Diagnosis of a Specific Disease Based on Case Surveillance Data

Motivated by a study assessing the impact of treatments on survival of AIDS (Acquired Immune Deficiency Syndrome) patients, we developed a semi-parametric method to estimate the life expectancy after diagnosis using data from case surveillance. With the proposed method, the life expectancy is estimated based on the traditional non-parametric life table method, but the age-specific death rates are estimated using a parametric model to derive more robust estimates from limited numbers of deaths by single year of age. The uncertainties associated with the semi-parametric estimates are provided. In addition, the life expectancy among people with the disease is compared with the life expectancy among those with similar demographic characteristics in the general population. The average years of life lost is used to measure the impact of the disease or the treatment on the survival after diagnosis. The trend of impact over time can be evaluated by the annual estimates of life expectancy and average years of life lost in the past.

Evaluation of chromium and manganese in biological samples (scalp hair, blood and urine) of tuberculosis and diarrhea male human immunodeficiency virus patients.

The consequence of trace elements deficiency has been associated with an increased risk of human immunodeficiency virus type 1 (HIV-1) disease progression and mortality. This study examined the association between high concentrations of chromium (Cr) and manganese (Mn) in scalp hair, blood, and urine and opportunistic infections in hospitalized patients with the acquired immune deficiency syndrome (AIDS). The study was performed on 62 male HIV+ patients (HIV-1) from different cities of Pakistan. The patients were divided in two groups according to secondary infections (tuberculosis, diarrhea, or high fever). The biological samples (scalp hair, blood and urine) were collected from AIDS patients, and for comparative study 120 healthy subjects (males) of same age group (31 - 45 years), socio-economic status, localities, and dietary habits were also included. The elements in the biological samples were analyzed by electrothermal atomic absorption spectrophotometry after microwave-assisted acid digestion. The validity and accuracy of the methodology was checked by using certified reference materials (CRMs) and with the values obtained by conventional wet acid digestion method on the same CRMs. The results indicated significantly lower concentrations of Cr and Mn in the biological samples (scalp hair, blood, and urine) of male HIV-1 patients, compared with control subjects. It was observed that the lower levels of these trace elements may be predictors for secondary infections in HIV-1 patients. There was a significant decrease in mean values of Cr and Mn in whole blood and scalp hair, whilst higher concentrations were observed in urine samples of the three groups of AIDS patients as compared to a controlled healthy male group (p < 0.001). Low Cr and Mn levels may be due to increased Cr and Mn losses. These data present guidance to clinicians and other professional investigating deficiencies of Cr and Mn in biological samples of AIDS patients.

Prevalence and factors associated with lipodystrophy in AIDS patients

The published literature shows an increased occurrence of adverse events, such as human immunodeficiency virus (HIV)-associated lipodystrophy syndrome, that are associated with the continuous use of antiretroviral therapy. This study was performed to estimate the prevalence and factors associated with lipodystrophy in acquired immune deficiency syndrome (AIDS) patients. We conducted a cross-sectional study between October 2012 and February 2013. The sample consisted of patients with AIDS who attended the Outpatient Treatment Center for Infectious Diseases at Nereu Ramos Hospital, Florianópolis, State of Santa Catarina, Brazil. We collected information on demographics, lifestyle, HIV infection, and clinical aspects of the disease. Self-reported signs of lipodystrophy and body measurements were used for lipodystrophy diagnosis. We studied 74 patients (mean age 44.3±9.2 years; 60.8% men). Among the patients, 45.9% were smokers, 31.1% consumed alcoholic beverages, and 55.4% were sedentary. The prevalence of lipodystrophy was 32.4%, and sedentary subjects had a higher prevalence of lipodystrophy compared with physically active individuals. The prevalence of lipodystrophy was 32.4%. Physical activity was considered an independent protective factor against the onset of HIV-associated lipodystrophy.

Invasive trichosporonosis in an AIDS patient: case report and review of the literature

Invasive Trichosporon infection is a rare, life-threatening infection in immunocompromised patients. It has been reported as an emerging opportunistic infection in those with acquired immune deficiency syndrome (AIDS). Only 12 cases of invasive trichosporonosis in patients with HIV have been documented, none in Southeast Asia. We report a case of fatal, disseminated trichosporonosis in a Filipino AIDS patient with severe cutaneous and pulmonary involvement. Invasive trichosporonosis should be considered in HIV-positive patients with disseminated fungal infection since this may be refractory to conventional antifungal treatment.

P3.188 Cytomegalovirus and HIV Co-Infection Among Patients Accessing Care in a Tertiary Care Centre in Nigeria

BackgroundCytomegalovirus (CMV) is one of the commonest viral opportunistic infections in persons with Acquired Immune Deficiency Syndrome (AIDS). In AIDS patients, progressive loss of immune function, and in particular, loss...

Bilateral ischemic maculopathy in acquired immune deficiency syndrome

BackgroundThis brief report aims to report a case of bilateral macular ischemia as a cause of sudden decreased vision in a patient with acquired immune deficiency syndrome (AIDS).FindingsA 26-year-old male with disseminated cryptococcal meningitis, Candida thrush, Pneumocystis jiroveci pneumonia, and positive human immunodeficiency virus (HIV) infection with CD4 count of 4 cells/μl complained of sudden blurred vision in both eyes while on treatment with systemic antiviral, antifungal, and antibiotic medications. Ocular examination revealed HIV retinopathy changes with significant macular ischemia in both eyes, which was confirmed by fluorescein angiography. One dose of intravitreal foscarnet (1.2 mg/0.1 cc) was injected in both eyes. Laboratory work-up of serum and vitreous samples showed negative cytomegalovirus (CMV) titers. At 2 weeks of follow-up, he was started on treatment with atripla, a combination anti-retroviral therapy for AIDS. At 6 weeks of follow-up, there was an improvement in visual acuity and clinical findings.ConclusionsNoninfectious HIV retinopathy in AIDS is common, but bilateral macular ischemia is a rare presentation. It is important to rule out CMV retinitis as it is a major cause of visual morbidity among AIDS patients.

Gastrointestinal Kaposi′s sarcoma presenting as ileocolic intussusception

Context:Kaposi's sarcoma (KS) is the most common neoplasm in patients with acquired immune deficiency syndrome (AIDS). Gastrointestinal (GI) involvement with KS commonly occurs in association with cutaneous lesions or lymph node involvement, with GI tract involvement alone occurring in only 3.5% of cases. There are several case reports described in the literature about asymptomatic intestinal KS with skin manifestations. Although GI KS is usually asymptomatic, hemorrhages from the oral cavity, esophagus, stomach, and large bowel have been reported in this disease.Case Report:Our case is unique, in a way that the patient does not have skin manifestation, and also is that the first manifestation presented as acute intestinal intussusception and obstruction with nodular mass lesions of the stomach and GI tract due to GI KS.Conclusion:As a differential diagnosis of KS, nonHodgkin lymphomas frequently involve the gut in AIDS patients. Furthermore, tumors of the gut with spindle-shaped cells such as leiomyomas, rhabdomyosarcomas, high-grade pleomorphic sarcomas, or GI stromal tumors have to be considered in the differential diagnosis. Overall, the visceral involvement of the KS is usually associated with poor prognosis. Our case illustrates the importance of physicians to recognize GI KS as a differential diagnosis for HIV positive patients with recurrent abdominal pain. It is commonly occurs in association with cutaneous lesions or lymph node involvement and rarely presents with GI involvement alone, which is makes it a challenge to the physician.

Solitary cavitary pulmonary nodule may be a common CT finding in AIDS-associated pulmonary cryptococcosis

Previous studies have demonstrated that the most common chest radiologic finding in acquired immune deficiency syndrome (AIDS)-associated pulmonary cryptococcosis (PC) is diffuse interstitial infiltrates. The aim of this study was to provide additional radiologic characterization of PC in AIDS patients. AIDS patients from the Second Affiliated Hospital of the Southeast University who were diagnosed with cryptococcosis between February 2009 and May 2012 and who had undergone chest computed tomography (CT) scans before or at the time of diagnosis were retrospectively analyzed. Twelve patients met eligibility criteria. The median CD4 T-cell count was 23 cells/μl (range 2-79 cells/μl). Eleven patients had pulmonary abnormalities on imaging. Initial chest CT scans demonstrated solitary cavitary pulmonary nodules in 9 patients, pleural effusions in 2 patients, bilateral ground-glass opacities in 6 patients, patchy opacities in 1 patient, and bronchiectasis in 1 patient. Bilateral ground-glass opacities appeared to be associated with Pneumocystis pneumonia, while the presence of a pleural effusion was predictive of PC. Of the 9 solitary cavitary pulmonary nodules, 7 were PC and the other 2 were probable cases of PC. These nodules were predominantly in the peripheral lung and were either asymptomatic or caused only mild pulmonary symptoms. Solitary cavitary pulmonary nodule may be a common CT finding in AIDS-associated PC. All AIDS patients with solitary cavitary pulmonary nodules on chest CT should be screened for Cryptococcus infection.

Fundus characteristics of acquired immune deficiency syndrome in human immunodeficiency virus retinopathy

Objective To observe the fundus characteristics of acquired immune deficiency syndrome (AIDS) with human immunodeficiency virus (HIV) retinopathy.Methods Eighty eyes of 52 AIDS patients with HIV retinopathy were enrolled in this study.The patients included 42 males (67 eyes) and 10 females (13 eyes).The patients ages ranged from 16 to 78 years,with a mean age of (43±12) years.All patients' visual acuity,intraocular pressure,slit-lamp microscopy and mydriatic indirect ophthalmoscopy,fundus color photography and CD4+ T cell count was documented.Experienced ocular fundus doctors carried out fundus examinations.Retinopathy characteristics were recorded.Seventeen patients (24 eyes) were followed for a period between two days to two years,with a median of 125 days.We failed to follow up the remaining 35 patients (56 eyes) due to death or moving away.Results Among 52 patients (80 eyes),28 patients (56 eyes,70.0％) had bilateral HIV retinopathy and 24 patients (24 eyes, 30.0％) had unilateral HIV retinopathy.Cotton-wool spots (CWS),mostly located close to temporal peripapillary vessels,were found in 46 patients (72 eyes,90.0％).Six patients (eight eyes,10.0％) were found to have flaming or spotting hemorrhage located in posterior pole.Among 72 eyes with CWS,57 eyes were found to have CWS only and 15 eyes were found to also have retinal hemorrhage,mostly located near CWS.Among 24 eyes of 17 followed-up patients,three eyes of three patients were found with no significant changes during the less than two week follow-up.In 18 eyes of 11 patients,CWS or hemorrhage disappeared after one to three months without treatment and in five eyes new CWS or hemorrhage were found in other parts of the posterior pole.Three eyes of three patients initially considered as lint plaque-like lesions were eventually detected with CMVR as lesions during one to five months follow-up.Conclusion CWS are the most common ocular lesions in HIV retinopathy. Key words: Acquired immunodeficiency syndrome/complications; HIV infections/complications; Retinal degeneration/diagnosis; Disease attributes

Impact of Individual-Level Social Capital on Quality of Life among AIDS Patients in China

BackgroundWith growing recognition of the social determinants of health, social capital is an increasingly important construct in international health. However, the application of social capital discourse in response to HIV infection remains preliminary. The aim of this study was to assess the impact of social capital on quality of life (QoL) among adult patients with acquired immune deficiency syndrome (AIDS).MethodsA convenient sample of 283 patients receiving antiretroviral treatment (ART) was investigated in Anhui province, China. QoL data were collected using the Medical Outcomes Study HIV Survey (MOS-HIV) questionnaire. Social capital was measured using a self-developed questionnaire. Logistic regression models were used to explore associations between social capital and QoL.ResultsThe study sample had a mean physical health summary (PHS) score of 50.13±9.90 and a mean mental health summary (MHS) score of 41.64±11.68. Cronbach's α coefficients of the five multi-item scales of social capital ranged from 0.44 to 0.79. When other variables were controlled for, lower individual levels of reciprocity and trust were associated with a greater likelihood of having a poor PHS score (odds ratio [OR] = 2.02) or PHS score (OR = 6.90). Additionally, the factors of social support and social networks and ties were associated positively with MHS score (OR = 2.30, OR = 4.17, respectively).ConclusionsThis is the first report to explore the effects of social capital on QoL of AIDS patients in China. The results indicate that social capital is a promising avenue for developing strategies to improve the QoL of AIDS patients in China, suggesting that the contribution of social capital should be fully exploited, especially with enhancement of QoL through social participation. Social capital development policy may be worthy of consideration.

English

Several studies have been performed in which the severity of&nbsp;human immunodeficiency virus&nbsp;(HIV)&nbsp;infection is correlated with skin manifestations. The state of Amazonas-Brazil has a high incidence of HIV infection (2008, 26/100.000 hab), and this state is located in the tropics, a climate that promotes the development of mycoses; however, few studies have been published in the literature that discuss the prevalence of superficial mucocutaneous fungal infections in&nbsp;acquired immune deficiency syndrome&nbsp;(AIDS) patients from this region. The objective of this study was to investigate clinical forms and etiologic agents of mucocutaneous mycoses in AIDS patients hospitalised in a tertiary healthcare centre in the state of Amazonas-Brazil. Specifically, the following factors were investigated: a) the frequency of patients with mucocutaneous mycoses, b) the clinical forms and c) the main etiological agents from the mucocutaneous mycoses. One hundred and seventy patients&nbsp;were submitted to a dermatological examination to search for&nbsp;predictive&nbsp;manifestations&nbsp;of mucocutaneous mycoses.Laboratory tests&nbsp;(micromorphological studies and culturing) were performed&nbsp;on the biological samples. The samples of&nbsp;skin scrapings, hair and&nbsp;nails and&nbsp;theoropharyngeal swabs&nbsp;were transported&nbsp;to the&nbsp;mycology&nbsp;laboratory of&nbsp;the FMT-HVD for&nbsp;micromorphological&nbsp;testing&nbsp;(slides,&nbsp;40%&nbsp;KOH&nbsp;and&nbsp;cotton&nbsp;blue) and&nbsp;culture assays. Among the 170 patients, 116 presented clinical signs. Most of the patients were male (68%) between the ages of 31 and 40 years old (60%).&nbsp;Of the&nbsp;137&nbsp;sitessuspected of&nbsp;mucocutaneous mycoses,&nbsp;only 52&nbsp;were positive according to the laboratory tests.&nbsp;The most important clinical forms of mucocutaneous mycosis were oral candidiasis (58%) and onychomycosis (31%).&nbsp;Candida albicans&nbsp;andTrichophyton rubrum&nbsp;were the main causes of oral candidiasis and onychomycosis, respectively. &nbsp; Key words:&nbsp;Mycoses,&nbsp;acquired immune deficiency syndrome&nbsp;(AIDS), Amazonas-Brazil.

Penicillium marneffei chylous ascites in acquired immune deficiency syndrome: a case report.

Penicillium marneffei (P. marneffei) infection usually occurs with skin, bone marrow, lung or hepatic involvement. However, no cases of P. marneffei infection with chylous ascites have been reported thus far. In this report, we describe the first case of acquired immune deficiency syndrome (AIDS) which has been complicated by a P. marneffei infection causing chylous ascites. We describe the details of the case, with an emphasis on treatment regimen. This patient was treated with amphotericin B for 3 mo, while receiving concomitant therapy with an efavirenz-containing antiretroviral regimen, but cultures in ascitic fluid were persistently positive for P. marneffei. The infection resolved after treatment with high-dose voriconazole (400 mg every 12 h) for 3 mo. P. marneffei should be considered in the differential diagnosis of chylous ascites in human immunodeficiency virus patients. High-dose voriconazole is an effective, well-tolerated and convenient option for the treatment of systemic infections with P. marneffei in AIDS patients on an efavirenz-containing antiretroviral regimen.

AIDS patients with tuberculosis: characteristics and trend of cases reported to the National AIDS Registry in Italy--1993-2010

The co-infection of tuberculosis (TB) and human immunodeficiency virus (HIV) continue to be a severe problem in the European region. We estimated the extent of this phenomenon in Italy, describing and analysing the characteristics of persons with acquired immune deficiency syndrome (AIDS) and TB reported to the National AIDS Registry. We analysed the cases of TB reported to the National AIDS Registry in Italy since 1993, the year in which TB was introduced as an AIDS-defining disease. From 1993 to 2010, 45,403 cases of AIDS were reported; among these, 4075 (8.9%) had TB (any location). Since 1993, there has been a progressive increase in the proportion of persons with TB, from 6.8% in 1993 to 11.0% in 2010. Men accounted for 76.3%; the median age at diagnosis was 35 years (interquartile range: 31-42 years), and 34.1% were non-nationals. Compared with AIDS cases without TB, AIDS cases with TB were significantly associated with young age (≤33 years), being non-Italian, having heterosexual contacts, living in the south of Italy, being a late tester and being alive at the time of data analysis. The proportion of non-nationals increased from 10.8% in 1993 to 64.6% in 2010. The incidence of AIDS and TB among non-nationals for the whole study period was 2.97 cases per 100,000 non-nationals, compared with 0.11 cases per 100,000 Italians. These data suggest that the occurrence of TB among persons with AIDS is also increasing in Italy, with an increasing proportion of non-nationals, and emphasize the need to undergo HIV screening for all persons diagnosed with TB.

Prognosis and management of cryptococcal meningitis in patients with human immunodeficiency virus infection

Prognosis and management of cryptococcal meningitis in patients with human immunodeficiency virus infection Joshua Rhein, David R BoulwareDivision of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, USAAbstract: Cryptococcal meningitis has emerged as one of the most frequent and deadly opportunistic infections in patients with human immunodeficiency virus (HIV). Cryptococcosis has become the most common cause of adult meningitis in many parts of Africa, where it now rivals tuberculosis in all-cause mortality. While expanding access to antiretroviral therapy in many resource-limited settings has led to improvements in long-term prognosis, early mortality from HIV-associated cryptococcal meningitis remains unacceptably high. Successful management of cryptococcal meningitis is often hindered by unsatisfactory antifungal regimens or by poor control of elevated cerebrospinal fluid pressures. Immune reconstitution inflammatory syndrome also frequently complicates cryptococcal meningitis in patients with acquired immune deficiency syndrome (AIDS) initiating antiretroviral therapy, and the optimal timing of antiretroviral therapy remains unclear. The optimal initial regimen of amphotericin B and flucytosine is difficult to administer and is often not available in resource-limited settings, where cryptococcal meningitis is most prevalent. Fluid and electrolyte coadministration with amphotericin B is essential to minimizing iatrogenic comorbidities. Fortunately, several new approaches have been leading the way toward improving care for cryptococcal meningitis patients in resource-limited settings. Innovative trials utilizing different combinations of antifungal therapy are reviewed, and we summarize the efficacy of different induction regimens. Universal cryptococcal antigen screening of AIDS patients, combined with new point-of-care testing, has the potential to improve the early diagnosis of cryptococcal meningitis markedly in resource-limited settings.Keywords: human immunodeficiency virus, acquired immune deficiency syndrome, cryptococcal meningitis, immune reconstitution inflammatory syndrome, antiretroviral therapy, antifungal therapy

Main clinical features and prognosis of AIDS patients with the predominance of thrombocytopenia

To summarize the major clinical features, treatment, follow-up and outcomes of acquired immune deficiency syndrome (AIDS) patients with prominent thrombocytopenia. The manifestations, signs, anti-virus regimens, CD4 cell count, platelet count, prognosis and outcomes of 10 AIDS patients with prominent thrombocytopenia were collected and analyzed. After the administration of highly active antiretroviral therapy, platelet count and CD4 significantly improved during a follow-up period up to 12 months. No opportunistic infections and HIV-related deaths occurred. The HIV/AIDS patients with prominent thrombocytopenia should start highly active antiretroviral therapy so as to effectively improve the prognosis and outcome.

Screening for Cryptococcal Antigenemia in Anti-Retroviral Naïve AIDS Patients in Benin City, Nigeria

Cryptococcus neoformans is the most incriminated fungal pathogen causing meningitis in acquired immune deficiency syndrome (AIDS) patients, and is known to constitute a major cause of deaths in AIDS patients. This study thus aimed to determine the baseline sero-prevalence of Cryptococcus neoformans infection in anti-retroviral naïve (ART-naïve) AIDS patients using the serum Cryptococcal antigen (crag) detection method. Baseline effect of variation in CD4 counts, as well as sex and age with sero-positivity for crag were also determined. This descriptive cross-sectional study included 150 (61 males and 89 females) ART-naïve AIDS patients attending the Human Immunodeficiency Virus clinic (HIV) at the University of Benin Teaching hospital, Benin City, Nigeria, within the period from February 2011- July 2011. Forty (18 males and 22 females) HIV positive outpatients with CD4 counts >200 cells/µl who were ART-naive were recruited and used as controls. The sero-prevalence of crag in the patients and the control group was measured using the cryptococcal antigen latex agglutination system (CALAS) (Meridian Bioscience, Europe) and CD4 counts were measured using flow cytometry (Partec flow cytometer, Germany). Of the 150 ART-naïve AIDS patients with CD4 counts ≤200 cells/µL; 19 (12.7%) were positive for serum Cryptococcal antigen. ART-naïve AIDS patients with CD4 count ≤50 cells/µl had the highest prevalence of serum crag. Lower CD4 counts were significantly associated with positivity for serum crag (p<0.001). Age and sex had no significant effect on the sero-positivity for serum crag. One (2.5%) of the controls was sero-positive for crag. Thus, serum crag was significantly associated with AIDS but not with HIV (p<0.001). This study uncovers a high prevalence of crag in ART- naïve AIDS patients in Benin City. The prevalence of crag was higher in ART-naïve AIDS patients with lower CD4 counts. There is an urgent need to introduce routine screening for crag in ART- naïve AIDS patients in our locality to reduce the rapid mortality from Cryptococcal meningitis which accounts for a majority of the morbidity factor if undiagnosed during ART therapy.

Features of varicella zoster virus myelitis and dependence on immune status

BackgroundMyelitis is a rare complication of varicella zoster virus (VZV) infection and is more prevalent in immunocompromised individuals. Clinical features, outcomes, and presentations vary. The aim of the current study was to compare the clinical presentations of our patients with those reported in the literature, and to evaluate the differences in clinical features between immunocompromised and immunocompetent patients. MethodsA review of the literature on VZV myelitis was carried out by searching PUBMED from 1980 to 2012. Clinical features of our cases and those in the literature were compared. ResultsThere were 5 cases at our hospital and 26 were reported in the literature. Seventeen patients were immunocompromised (54.8%), and most had acquired immune deficiency syndrome (AIDS). Typical presentations (skin lesions followed by myelopathy at the corresponding level) were observed in 14 patients (45.2%). The immunocompromised patients were prone to atypical presentations (p<0.05). Outcomes were good in immunocompetent patients and relatively poor in immunocompromised patients (p<0.05). Anti-herpetic agents had no statistically significant effect on outcomes in immunocompromised patients (p=0.280), but could reduce mortality rate in AIDS patients (p<0.05). ConclusionImmunocompromised individuals are susceptible to this disease, and prone to atypical presentations and poorer outcomes. Timely recognition and anti-herpes therapy may be beneficial to the outcomes. In the AIDS patients, anti-herpes therapy can reduce mortality effectively.

In vitro anti-HIV activity of crude extracts from Tinospora cordifolia

Background Human immunodeficiency virus (HIV) infection causes acquired immune deficiency syndrome (AIDS) and is a global public health issue. Anti-HIV therapy involving chemical drugs has improved the life quality of HIV/ AIDS patients. However, emergence of HIV drug resistance, side effects and the necessity for long-term antiHIV treatment are the main reasons for failure of antiHIV therapy. Therefore, it is essential to isolate novel anti-HIV therapeutics from natural resources. The aim of the present study was to evaluate the invitro antiHIV activity of T. cordifolia plant extracts.