Acquired Immunodeficiency Syndrome Patients Research Articles

A Review of the Therapeutical Perspective of Phytochemicals in the Treatment of HIV

Abstract: HIV/AIDS is one of the most widespread global diseases. It is caused by the human immunodeficiency virus (HIV), which leads to the development of acquired immunodeficiency syndrome (AIDS). In AIDS patients, the immune system progressively weakens, making them vulnerable to various infections and cancers. The virus can be transmitted through the exchange of bodily fluids such as blood, semen, vaginal fluid, and breast milk, where HIV can be found in both free virus particles and infected immune cells. Although drug resistance remains a challenge for HIV/AIDS treatment, researchers are exploring the use of natural substances in the development of anti-HIV drugs. Clinical trials based on plant-derived compounds are currently being conducted. Experimental research suggests that plants may have the potential to treat HIV. However, the identification of active compounds, testing of extracts, and creation of suitable bioassays are all complex processes. Natural product scientists face the challenge of separating these complicated extracts into their active components. Various phytochemicals found in Astragalus membranaceus Bunge, Chelidonium majus L, Combretum molle (R. Br. ex. G. Don.) Engl& Diels, Dittrichiaviscosa (L.) Greuter, Helichrysum populifolium, Hoodia gordonii (Masson) Sweet ex Decne, and Hypericumperf, have been investigated pharmacologically and pharmacokinetically. Further research is needed to optimize formulations and production in accordance with preclinical safety and efficacy studies.

Clinical-Laboratory Outcome of Cryptococcus sp. Multifocal Choroiditis in Acquired Immunodeficiency Syndrome Patients

ABSTRACT Purpose This study aims to describe the clinical and laboratory outcomes of patients with Acquired Immunodeficiency Syndrome (AIDS) presenting multifocal choroiditis secondary to Cryptococcus sp. infection. Methods We reviewed the clinical records of AIDS patients diagnosed with cryptococcal multifocal choroiditis at the Laboratory of Infectious Disease in Ophthalmology, Oswaldo Cruz Foundation, from January 2022 to March 2024. Patients meeting the criteria of typical fundus appearance associated with disseminated cryptococcosis laboratory diagnosis were included. Data collected included age, gender, symptoms, plasma HIV viral load, serum T-CD4+ cell count (cells/mm3), initial visual acuity (VA), laboratory methods for cryptococcosis diagnosis, treatment, and final VA. All patients underwent multimodal evaluation including spectral domain optical coherence tomography, fluorescein angiography (FA), and indocyanine green angiography (ICG). Results Six patients were evaluated, comprising five males (83%) and one female (17%), with a mean age of 36.5 years (standard deviation, SD: 10,46). Five patients (83%) presented with meningeal syndrome. Mean HIV plasma viral load was 262.959 copies/mm3 (SD: 209.469), and the mean serum T-CD4 count was 13.33 cells/mL (SD: 14,63). All patients tested positive for serum cryptococcal antigen (CRAG). Four patients (67%) had positive cerebrospinal fluid (CSF) culture and CRAG. Treatment included intravenous Amphotericin B and oral Fluconazole. Among twelve eyes (100%), four (33%) achieved visual recovery, while eight (67%) maintained initial VA. Lesions were more numerous and distinct on ICG compared to fundus examination and FA. Conclusion This study underscores the importance of clinical, laboratory, and multimodal evaluations in AIDS patients presenting with cryptococcal multifocal choroiditis.

Prevalence of opportunistic intestinal coccidian parasites and associated factors in HIV/AIDS patients attending anti-retroviral therapy (ART) clinic at Debre Tabor Comprehensive Specialized Hospital, Northwest Ethiopia: A cross-sectional study.

A growing number of acquired immunodeficiency syndrome (AIDS) patients suffer from opportunistic intestinal coccidian infections. Instead of human immuno deficiency virus (HIV) infection itself, opportunistic infections like intestinal coccidian parasites cause death of over 80% AIDS patients. Factors like exposed drinking water sources and poverty aid the prevalence of opportunistic intestinal coccidian parasitic infections in HIV/AIDS patients. The goal of this study was to determine the prevalence of intestinal coccidian parasites and associated factors in HIV/AIDS patients. A health facility based cross sectional study was conducted from 140 HIV/AIDS patients attending ART clinic in Debre Tabor Comprehensive Specialized Hospital, Northwest Ethiopia from September to December 2023. The sociodemographic characteristics were collected through face-to-face interviews. Stool samples were processed with Modified Acid Fast staining technique. Statistical Package for Social Sciences software version 20 was used to analyze the data. Logistic regression was used to assess factors associated with dependent variable and p < 0.05 was considered significantly associated. The total prevalence of opportunistic intestinal coccidian parasites (OICPs) in HIV/AIDS patients was 16.4% (23/140). Drinking surface water [p = 0.015, COR = 3.4] compared to tape water, drinking alcohol [p = 0.001, COR = 18] compared to not drinking alcohol, diarrhea [p = 0.005, COR = 1] compared to non-diarrheic, drug dropout [p = 0.01, COR = 11] compared to regular drug intake and low CD4 count [p = 0.042, COR = 9] compared to CD4 > 500/µL showed significant association with increased prevalence of OICPs in HIV/AIDS patients. OICPs are still the common causes of morbidity and mortality in HIV/AIDS patients. Surface water consumption, alcoholism, interruption of treatment drugs, diarrhea, and reduced CD4+ T-cells significantly contribute to acquisition and prevalence of OICPs in HIV/AIDS patients. Routine screening of OICPs with sensitive diagnostic techniques in HIV/AIDS patients regardless of symptoms is crucial and has to be practiced in health settings.

Social stigma and discrimination towards people living with HIV infection and AIDS patients

Background: Social stigma and discrimination are major barriers to an effective national response to human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), and there have been repeated calls to transform the current surveillance-focused policy. Serious instances of discrimination and clinical service failings increase the urgency and importance of addressing issues relevant to AIDS-related stigma. Yet, progress in achieving effective and people-centered responses to AIDS is insufficient.Current Concepts: Based on a comprehensive multi-sectoral review of a wide range of literature, this article examines the key features of AIDS-related stigma in South Korea and evaluates governmental and organizational efforts to redress them. Three major areas, of issues and possibilities for change, are identified: (1) addressing discrimination in health care settings, (2) decriminalization of HIV transmission, according to the Undetectable=Untransmittable (U=U) principle, (3) improving the quality of life and social inclusion of people living with HIV.Discussion and Conclusion: An extensive examination of existing evidence on AIDS-related stigma, guided by the authors’ long-term experience of public participation and civic empowerment, suggests that by placing these three issues at the center of the national response to AIDS, significant improvement in the AIDS care continuum is achievable. People-centered service delivery models that focus on dismantling structural barriers and incorporating leadership from key populations will enable high-impact public health responses to AIDS and HIV infection.

Evaluation of tear film in patients with AIDS without opportunistic ocular infections in the era of COVID-19: A case-control study.

The assessment of tear film and ocular surface conditions in patients with acquired immunodeficiency syndrome (AIDS) has been poorly studied thus far. We aim to assess tear film parameters, ocular surface characteristics, and dry eye disease (DED) symptoms of patients with AIDS who did not undergo highly active antiretroviral treatment (HAART). This case-control study included 154 age-, sex-, and ethnicity-matched healthy controls and patients with AIDS. All participants underwent comprehensive ocular surface assessment and subjective DED symptomology evaluation. Data were collected between March 2022 and July 2022. HAART-naïve patients with AIDS had a shorter noninvasive tear film breakup time (median 3.76 vs. 8.54 s), thinner tear film lipid layer thickness (median 73.00 vs. 91.00 nm), and lower Schirmer I test values (median 5.00 mm/5 min vs. 12.00 mm/5 min) (all P < 0.001). Moreover, higher corneal fluorescein staining scores (median 1.00 vs. 0.00) and higher upper, lower, and total meibomian gland grades were observed in AIDS patients (all P < 0.05). Negative correlations between the blood viral load and the Ocular Surface Disease Index score ( r = -3.50, P = 0.027) and the Schirmer I test score ( r = -0.374, P = 0.017) were detected in patients with AIDS. Altered tear film status was observed in individuals with HAART-naïve AIDS, even when there were no other ocular symptoms present. Therefore, patients with AIDS should be encouraged to undergo comprehensive ocular surface examinations to detect any subclinical tear film alterations occurring.

Prevalence of Cryptosporidium and microsporidial infection in HIV-infected individuals.

Microsporidia and Cryptosporidium are obligate intracellular protozoa. These medically important species are recognized as opportunistic organisms in intestinal complications in human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome patients. The current cross-sectional study was designed and conducted from August 2016 to August 2017 to determine intestinal Cryptosporidium and microsporidia spp. in HIV-infected individuals from the Behavioral Diseases Counseling Center, Tabriz, Iran, by modified acid-fast and modified trichrome staining and nested polymerase chain reaction (PCR) and real-time PCR. Of 100 HIV-infected persons, 21.0% (95% confidence interval [CI] 13.0 to 30.0) and 18.0% (95% CI 11.0 to 26.0) were identified as Cryptosporidium and microsporidia, respectively, by the microscopic method. Of these 100 HIV-infected persons, 18.0% (95% CI 11.0 to 26.0) and 14.0% (95% CI 7.0 to 22.0) were positive for Cryptosporidium and microsporidia, respectively, by the molecular method. The predominant species of microsporidia in patients was Enterocytozoon bieneusi (85.7% [95% CI 57.0 to 98.0]) and Encephalitozoon cuniculi (14.3% [95% CI 1.7 to 42.0]), which were found by quantitative real-time PCR and its high-resolution melting tool. As far as we know, this study is the first to estimate the prevalence of infection with Cryptosporidium and microsporidia among HIV-infected persons in northwest of Iran. The prevalence of intestinal microsporidiosis and cryptosporidiosis in this area in HIV-infected people was higher than the global prevalence of infection among immunocompromised patients. In addition to the need for further studies to prove protozoan pathogenicity in the aforementioned group, preventive measures should be considered.

The Role of Cell-Mediated Immunity Deficiency in the Clinical Evolution of Patients with Tuberculosis Associated with HIV Infection

HIV infection induces severe immunosuppression, considered the major risk factor for tuberculosis (TB). Objective — to evaluate the clinical characteristics of patients with TB-HIV co-infection based on the level of immune deficiency to establish recommendations for improving clinical case management. Materials and methods. A prospective, selective study included 86 TB patients, divided into the study group with 38 cases of TB evolved into acquired immunodeficiency syndrome (AIDS), established with a CD4+ level ≤ 200/μL and the control group with 48 TB cases having CD4+ ≥ 200/μL. Results and discussion. The study assessed the impact of the severity of the cell mediated immune deficiency associated with HIV infection on the clinical evolution of TB and the final therapeutic outcome. Laboratory indicators characterizing TB in AIDS included general leukocytosis, lymphocytopenia, eosino­philia, anemia and, in rare cases, thrombocytopenia. All AIDS patients were untreated with ARV, and only one-third were in the early stages of symptomatic HIV infection. Risk factors for TB in AIDS included rural residence, low education levels and mental disorders. Treatment success was low, and the death rate was high in both groups, emphasizing the impact of associated conditions. Despite differences in the serum level of CD4+ cells, the rate of therapeutic success was equally low in both groups, with one-third continuing antituberculosis treatment. The death rate was insignificantly higher in the TB on AIDS group (23.4 %) vs. 18.7 % in early HIV stages due to comorbidities associated with HIV infection. Conclusions. The study identified risk factors for TB in patients diagnosed with AIDS stage of symptomatic HIV infection, including residence in rural areas, low education levels and mental and behavioral disorders associated with multiple causes such as alcohol consumption, drug use and toxoplasmosis of the central nervous system. Recommendations include complex screening for TB and HIV in all socially vulnerable groups, reinforced by primary prevention and an individualized therapeutic approach.

An atlas of immune cell transcriptomes in human immunodeficiency virus-infected immunological non-responders identified marker genes that control viral replication.

Previous studies have examined the bulk transcriptome of peripheral blood immune cells in acquired immunodeficiency syndrome patients experiencing immunological non-responsiveness. This study aimed to investigate the characteristics of specific immune cell subtypes in acquired immunodeficiency syndrome patients who exhibit immunological non-responsiveness. A single-cell transcriptome sequencing of peripheral blood mononuclear cells obtained from both immunological responders (IRs) (CD4 + T-cell count >500) and immunological non-responders (INRs) (CD4 + T-cell count <300) was conducted. The transcriptomic profiles were used to identify distinct cell subpopulations, marker genes, and differentially expressed genes aiming to uncover potential genetic factors associated with immunological non-responsiveness. Among the cellular subpopulations analyzed, the ratios of monocytes, CD16 + monocytes, and exhausted B cells demonstrated the most substantial differences between INRs and IRs, with fold changes of 39.79, 11.08, and 2.71, respectively. In contrast, the CD4 + T cell ratio was significantly decreased (0.39-fold change) in INRs compared with that in IRs. Similarly, the ratios of natural killer cells and terminal effector CD8 + T cells were also lower (0.37-fold and 0.27-fold, respectively) in the INRs group. In addition to several well-characterized immune cell-specific markers, we identified a set of 181 marker genes that were enriched in biological pathways associated with human immunodeficiency virus (HIV) replication. Notably, ISG15 , IFITM3 , PLSCR1 , HLA-DQB1 , CCL3L1 , and DDX5 , which have been demonstrated to influence HIV replication through their interaction with viral proteins, emerged as significant monocyte marker genes. Furthermore, the differentially expressed genes in natural killer cells were also enriched in biological pathways associated with HIV replication. We generated an atlas of immune cell transcriptomes in HIV-infected IRs and INRs. Host genes associated with HIV replication were identified as markers of, and were found to be differentially expressed in, different types of immune cells.

Clinical Characteristics Associated with Poor Prognosis of Acquired Immunodeficiency Syndrome Patients Complicated with Disseminated Talaromycosis marneffei.

To analyze the clinical characteristics of AIDS with dTSM, especially in patients with poor prognosis. One hundred and seventy AIDS patients were enrolled in this single-center retrospective study. The epidemiological characteristics, clinical manifestations, laboratory tests, imaging examination, and treatment outcome were collected. Logistic regression analysis was used to estimate the risk of mortality in AIDS patients with dTSM. The predictive value was evaluated using the receiver operating characteristic (ROC) curve. From 2015 to 2022, the incidence of AIDS with dTSM in the Wenzhou region increased yearly, mainly in young adults. The mortality rate was 16.47%. The most common clinical manifestations were lymph-node enlargement (92.35%) and fever (78.24%). Multivariate logistic regression analysis showed that procalcitonin (PCT), blood urea nitrogen (BUN), shock, and antiretroviral therapy (ART) were the risk factors for poor outcomes. The model comprised four risk factors and showed an excellent prediction performance, with an AUC of 0.987 in the training cohort (95% CI: 0.946-0.999) and 0.976 in the validation cohort (95% CI: 0.887-0.999). This study suggested that PCT, BUN, shock, and ART were associated with the prognosis and outcome of AIDS with dTSM and had a specific predictive value.

An Overview of the Anti-HIV Potential of Thiazolidinone Derivatives

Abstract: Human immunodeficiency virus (HIV) is the cause of acquired immunodeficiency syn-drome (AIDS), an immunosuppressive, life-threatening condition that frequently results in other potentially fatal opportunistic infections in affected patients. Despite advancements in anti-retro-viral therapy, AIDS remains the main reason for worldwide mortality. Although various anti-HIV drugs have profoundly enhanced the quality of life for AIDS patients, some patients develop re-sistance to the drugs, and the long-term anti-HIV treatments, and their adverse effects, prevail as major therapeutic failure causes. Therefore, concerted efforts by the scientific community are cru-cial to identifying new candidates for anti-HIV therapies. In this respect, the thiazolidinone moiety has acquired prominence in drug discovery and development due to its antifungal, antiviral, anti-depressant, anticancer, and antibacterial properties. This moiety also demonstrated significant anti-HIV activity as a core heterocycle or derivative of substituted heterocycles. To expedite the syn-thesis of more novel anti-HIV drugs containing a thiazolidinone nucleus, we compiled a list of thiazolidinone-containing previously documented anti-HIV compounds. We hope that this could serve as a guide for future researchers in their design of effective thiazolidine-containing com-pounds showing anti-HIV activity.

Prevalence of post-operative complications after cataract surgery in patients with acquired immunodeficiency syndrome (AIDS)

To estimate the prevalence of post-operative complications after cataract surgery in AIDS patients having cataract in a tertiary care hospital.This was a prospective and observational study done on 100 eyes of 70 AIDS patients having cataract with CD4+ cell count below 200 cells/mm who underwent cataract surgery from December 2021 to November 2022.All the AIDS patients who are having cataract with CD4 cell count below 200 cells/mm were examined for anterior and posterior segment using Slit lamp biomicroscopy and Indirect ophthalmoscopy.The prevalence of post-operative complications were seen in 3% (3/100) of eyes after cataract surgery. Patients with post-operative complications were in between 46-65 years of age. Post-operative complications were seen in patients with CD4 count between 51-150 cells/mm³. All the patients underwent postoperative visual acuity of better than 6/24.: In emergency cases cataract surgery in HIV patients is generally safe, regardless of CD4 count, but their general and ocular health should be optimized preoperatively.

Revolutionizing Infection Risk Scoring: An Ensemble “From Weak to Strong” Deduction Strategy and Enhanced Point‐of‐Care Testing Tools

The COVID‐19 pandemic exacerbates challenges faced by human immunodeficiency virus patients, who are at heightened risk for infection due to compromised immune systems. This study aims to develop a reliable, home‐based point‐of‐care testing (POCT) tool for early screening of acquired immunodeficiency syndrome (AIDS) coinfected with Talaromyces marneffei infection. Employing a “From weak to strong” deduction strategy for feature selection, data from 464 AIDS patients across four cohorts between February 5th, 2014, and January 8th, 2022, are analyzed. The top three features consistently observed are D‐dimer, cluster of differentiation 4+, and aspartate transaminase. Based on these features, the simplest risk‐scoring model is constructed, with the area under the receiver operating characteristic curve values of 0.91, 0.80, and 0.69 in the hold‐out cohort, external cohort 1, and external cohort 2, respectively. This “From weak to strong” deduction strategy identifies advantageous clinical features, enabling the development of simplified clinical risk scores with multiple biomarkers. To facilitate practical implementation, enhanced POCT tools are introduced, specifically a strip with segmented testing capabilities that demonstrates sensitivity and strong correlation with clinical scoring models. Furthermore, an open‐access website and a free Android mobile app are created to support community utilization. The findings underscore the effectiveness of the innovative deduction strategy and enhanced test strips, which enable bedside measurements without laboratory dependency.

An analysis of time-delay epidemic model for TB, HIV, and AIDS co-infections

This paper presents a time-delay epidemic model for Tuberculosis(TB), Human Immunodeficiency Virus(HIV), and Acquired Immunodeficiency Syndrome(AIDS) co-infection. Our study examines how delay impacts mathematical models of TB, HIV, and AIDS. There are four classes in the proposed system — Susceptibles, TB infectives, HIV infectives (with or without TB), and AIDS patients. A model shows four states of equilibrium: disease-free, HIV-free, TB-free, and endemic. If the reproduction number R0 is less than one, the disease-free equilibrium is locally asymptotically stable. If R0 greater than one, at least one infection will be present in the population Positive endemic equilibrium is always locally stable, but it can become globally stable under certain circumstances, indicating the disease has become endemic. TB and HIV infections drop as a result of recovery, and endemic equilibrium leads to TB free conditions. The number of people living with AIDS declines when TB is not associated with HIV infection. The model is also numerically analyzed to see how some important parameters affect the disease’s progression. Mathematical and numerical methods are employed to study the impact of delay.

Clinical features of Cytomegalovirus retinitis in patients with acquired immunodeficiency syndrome and efficacy of the current therapy.

Cytomegalovirus retinitis (CMVR) is the most common and sight-threatening opportunistic retinal infection in patients with acquired immunodeficiency syndrome (AIDS) and several controversies remain to be settled. We aimed to summarize the current evidence and clarify the clinical features and prognosis of CMVR in AIDS patients. The databases PubMed, EMBASE, and Ovid from inception to April 2022 were searched to identify the relevant studies. R software version 3.6.3 was used to perform the statistical analyses. Results in proportion with 95% confidence interval (CI) were calculated using the Freeman-Tukey variant of arcsine square transformation. We finally included 236 studies comprising 20,214 patients. CMVR in AIDS was male-dominated (88%, 95%CI 86%-89%), with 57% (95%CI 55%-60%) aged <41 years and 44% (95%CI 41%-47%) being bilaterally involved. CMVR was preponderant in AIDS patients with the following characteristics: white and non-Hispanic, homosexual, HIV RNA load ≥ 400 copies/mL, and CD4+ T-cells <50 cells/μL. The positivity of CMV-DNA in blood, aqueous humor, and vitreous humor was 66% (95%CI 52%-79%), 87% (95%CI 76%-96%), and 95% (95%CI 85%-100%), respectively. The most common symptoms were blurred vision (55%, 95%CI 46%-65%), followed by asymptomatic, visual field defect, and floaters. CMVR was first diagnosed and regarded as the clue to AIDS diagnosis in 9% (95%CI 6%-13%) of CMVR patients. Approximately 85% (95%CI 76%-93%) of the CMVR patients have received cART. CMVR remission was observed in 72%-92% of patients depending on the specific category of anti-CMV therapy. The general incidence of CMVR-related RD in the entire course was 24% (95%CI 18%-29%), of which most patients received PPV with SO or gas tamponade and the rate of anatomic success was 89% (95%CI 85%-93%). CMVR is a common opportunistic infection with diverse clinical features in AIDS patients, preponderant in those who are male, homosexual, or with CD4+ T-cells <50 cells/μL. Current therapies for CMVR and CMVR-related RD were shown to be effective. Early detection and routine ophthalmic screening should be promoted in AIDS patients. PROSPERO, identifier CRD42022363105.

Bottlenecks and recent advancements in detecting Mycobacterium tuberculosis in patients with HIV

AbstractTuberculosis (TB) remains a leading cause of deaths among patients with acquired immunodeficiency syndrome patients. Early diagnosis of TB is essential for administering timely anti‐TB therapy and improving health outcomes, particularly in the people living with HIV. However, conventional techniques used to detect Mycobacterium tuberculosis have significant drawbacks: for example, sputum smear microscopy has low sensitivity, and liquid culture is time‐consuming in patients with HIV‐TB co‐infection due to low sputum production. In addition, while immunological‐based methods involving tuberculin skin testing and interferon gamma release assays are commonly used for auxiliary TB diagnosis, they are often inaccurate in immunodeficient patients. Molecular techniques such as line probe assays, Xpert MTB, and lipoarabinomannan assay are recommended for early diagnosis by World Health Organization. However, no single technique is sufficicent for diagnosing HIV/TB co‐infection, suggesting that multiple diagnostic tests should be used to detect TB. Here, we summarize the drawbacks and advantages of existing TB‐diagnostic methods, as well as their applications to diagnosing HIV/TB co‐infection. We describe newly emerging technologies such as whole genome sequencing and mass spectrometry, with the aim of providing updated guidelines and alternative strategies for TB diagnosis, and particularly HIV/TB diagnosis.

Mycobacterium Vaccae Vaccine Improve Incomplete Immune Recovery in AIDS Patients

Background: Mycobacterium seedling is rich in co-antigens and, a good immunomodulator with bidirectional immunomodulatory function. Objectives: The present study aimed to explore whether the Mycobacterium vaccae vaccine can improve the incomplete immune recovery of acquired immunodeficiency syndrome (AIDS) patients. Methods: According to the number of patients receiving human immunodeficiency virus (HIV) long-term treatment in the Ninth People’s Hospital of Chongqing, China, 100 patients with HIV-RNA quantitation of less than 103 cepies/ml, CD4 + T cell count less than 500/UL, and CD4+T cell count of more than 50/UL after 3 years of Haart treatment were selected. In total, they were randomly assigned to one of three groups, one group received an intramuscular injection of M. vaccae vaccine, one group received an intramuscular injection of growth hormone, and the last group received only a placebo injection. The levels and changes of naive T cells, Treg cells, total CD4+ T cells, T helper 1 (Th1), T helper 2 (Th2) cells, and interleukin 7 (IL-7) cytokine were measured at baseline and after 12, 48, and 50 weeks. Results: After 48 weeks of treatment, the total CD4+T cells, Th1 cells, and naive T cells in AIDS patients increased, while IL-7 cytokines, Treg cells, and Th2 cells decreased in M. vaccae vaccine and growth hormone group. There was no change in the placebo group, indicating that M. vaccae vaccine and growth hormone can improve the immune function of AIDS patients. After treatment, in group A (M. vaccae vaccine), there was an increase in the total CD4+T cells, Th1 cells, and naive T cells as well as a decrease in Treg cells, Th2 cells, and IL-7 cytokines. The only significant difference between M. vaccae vaccine and growth hormone groups was a decrease in Th1 cells in the M. vaccae vaccine group. After a 12-week follow-up, it was found that there were no cases of secondary infection in the M. vaccae vaccine group, one case in the growth hormone group, and five cases in the placebo group, demonstrating that the secondary infection rate in M. vaccae vaccine and the growth hormone groups was lower than that in the control group. Conclusion: The M. vaccae vaccine may decrease the levels of IL-7 as well as Treg and Th2 cells by increasing the levels of CD4+T cells, Th1 cells, and pure T cells in AIDS patients, leading to the improvement of immune reconstitution of AIDS patients to some extent.

HIV/AIDS in Combination with Enterocytozoon bieneusi Infection

Acquired immunodeficiency syndrome (AIDS) is a significant public health problem caused by infection with the human immunodeficiency virus (HIV). The most common cause of death in AIDS patients is opportunistic infection with various microorganisms. Intestinal protozoa, such as Enterocytozoon bieneusi, are prevalent yet difficult to treat. This review will provide an overview of HIV/AIDS mixed with Enterocytozoon bieneusi infection by discussing an introduction, epidemiology, detection methodology, and treatment strategies.

Mycoplasma fermentans infection induces human necrotic neuronal cell death via IFITM3-mediated amyloid-β (1–42) deposition

Mycoplasma fermentans is a proposed risk factor of several neurological diseases that has been detected in necrotic brain lesions of acquired immunodeficiency syndrome patients, implying brain invasiveness. However, the pathogenic roles of M. fermentans in neuronal cells have not been investigated. In this study, we found that M. fermentans can infect and replicate in human neuronal cells, inducing necrotic cell death. Necrotic neuronal cell death was accompanied by intracellular amyloid-β (1–42) deposition, and targeted depletion of amyloid precursor protein by a short hairpin RNA (shRNA) abolished necrotic neuronal cell death. Differential gene expression analysis by RNA sequencing (RNA-seq) showed that interferon-induced transmembrane protein 3 (IFITM3) was dramatically upregulated by M. fermentans infection, and knockdown of IFITM3 abolished both amyloid-β (1–42) deposition and necrotic cell death. A toll-like receptor 4 antagonist inhibited M. fermentans infection-mediated IFITM3 upregulation. M. fermentans infection also induced necrotic neuronal cell death in the brain organoid. Thus, neuronal cell infection by M. fermentans directly induces necrotic cell death through IFITM3-mediated amyloid-β deposition. Our results suggest that M. fermentans is involved in neurological disease development and progression through necrotic neuronal cell death.

Fatal Case of Progressive Mpox in a Patient with AIDS—Viral Enteropathy and Malabsorption Demanding the Use of Full Parenteral ARV and Endovenous Cidofovir

We report a fatal case of disseminated mpox infection that progressed over more than three months in an HIV-infected patient with acquired immunodeficiency syndrome (AIDS). Mucocutaneous, pleuropulmonary, central nervous system, and gastrointestinal involvement was documented. This course of disease resembles progressive vaccinia, a formerly reported disease caused by uncontrolled replication of smallpox vaccination orthopoxviruses in immunosuppressed patients. Severe small bowel involvement jeopardized normal oral tecovirimat and antiretroviral therapy absorption. This problem prompted the use of full parenteral antiretrovirals and endovenous cidofovir. Although a remarkable decrease in HIV viral load occurred in six days, mpox infection continued to progress, and the patient died of septic shock. This case offers new clinical insights on the presentation of severe disease in AIDS patients. Moreover, this case alerts for the need for prompt therapy initiation in patients at risk of ominous clinical progression.

High-Flow Nasal Cannula Oxygen Therapy versus Non-Invasive Ventilation in AIDS Patients with Acute Respiratory Failure: A Randomized Controlled Trial.

Acute respiratory failure (ARF) remains the most common diagnosis for intensive care unit (ICU) admission in acquired immunodeficiency syndrome (AIDS) patients. We conducted a single-center, prospective, open-labeled, randomized controlled trial at the ICU, Beijing Ditan Hospital, China. AIDS patients with ARF were enrolled and randomly assigned in a 1:1 ratio to receive either high-flow nasal cannula (HFNC) oxygen therapy or non-invasive ventilation (NIV) immediately after randomization. The primary outcome was the need for endotracheal intubation on day 28. 120 AIDS patients were enrolled and 56 patients in the HFNC group and 57 patients in the NIV group after secondary exclusion. Pneumocystis pneumonia (PCP) was the main etiology for ARF (94.7%). The intubation rates on day 28 were similar to HFNC and NIV (28.6% vs. 35.1%, p = 0.457). Kaplan-Meier curves showed no statistical difference in cumulative intubation rates between the two groups (log-rank test 0.401, p = 0.527). The number of airway care interventions in the HFNC group was fewer than in the NIV group (6 (5-7) vs. 8 (6-9), p < 0.001). The rate of intolerance in the HFNC group was lower than in the NIV group (1.8% vs. 14.0%, p = 0.032). The VAS scores of device discomfort in the HFNC group were lower than that in the NIV group at 2 h (4 (4-5) vs. 5 (4-7), p = 0.042) and at 24 h (4 (3-4) vs. 4 (3-6), p = 0.036). The respiratory rate in the HFNC group was lower than that in the NIV group at 24 h (25 ± 4/min vs. 27 ± 5/min, p = 0.041). Among AIDS patients with ARF, there was no statistical significance of the intubation rate between HFNC and NIV. HFNC had better tolerance and device comfort, fewer airway care interventions, and a lower respiratory rate than NIV. Chictr.org (ChiCTR1900022241).