Acquired Immunodeficiency Syndrome Patients Research Articles

Clinical characteristics and cerebro-spinal fluid cytokine changes in patients with acquired immunodeficiency syndrome and central nervous system infection.

Clinical characteristics and the cerebro-spinal fluid (CSF) cytokine changes in acquired immunodeficiency syndrome (AIDS) patients with tuberculous meningitis and cryptococcal meningitis in central nervous system (CNS) infections before and after treatment were investigated. The clinical records of 80 AIDS patients with CNS infections and 40 non-CNS infection patients hospitalized in the Infection Department of the First Hospital of Changsha from February 2013 to March 2016 were retrospectively analyzed. Forty-one cases of AIDS complicated with tuberculous meningitis were enrolled as group A, 39 cases of AIDS complicated with cryptococcal meningitis as group B, and 40 cases of non-CNS infection with lumbar puncture indication as group C. The general data, clinical symptoms, CSF examination and prognosis of the three groups of patients were collected. Of the 80 patients, 56 patients were discharged from hospital (improvement group) and 24 died (death group) after treatment. The concentrations of interferon-γ (IFN-γ), interleukin-6 (IL-6), interleukin-10 (IL-10) and tumor necrosis factor-α (TNF-α) in CSF were detected by enzyme-linked immunosorbent assay. There were significant differences in clinical manifestations, CSF pressure, CSF leucocyte count, CSF glucose, CSF chloride and CSF protein between group A, group B and group C (P<0.05). The concentrations of IFN-γ, IL-6, IL-10 and TNF-α in CSF of group A and group B increased significantly compared with group C (P<0.001). The IL-6, IL-10 and TNF-α levels in CSF in the improvement group were significantly lower than those in the death group (P<0.001), while the concentration of IFN-γ increased significantly (P<0.001). CSF biochemistry is characterized by increased pressure, leucocyte count and protein, and decreased chloride and glucose. IFN-γ, IL-6, IL-10 and TNF-α in CSF have certain predictive value for poor prognosis of AIDS patients with CNS infection.

The Effects of an AIDS Education Program on the Knowledge and Attitudes of Physical Therapy Students

AIDS (acquired Immunodeficiency syndrome) is a fast spreading pandemic with global affection and has affected lives of multitudes in recent years. The purpose of this paper was to determine the effect of an AIDS education program on physical therapy students’ knowledge about AIDS, attitudes towards people with AIDS and willingness to treat AIDS patients. A sample of 50 physical therapy students’ aged 22 to 28 volunteered to participate in this study. All subjects were pretested and posttested together with an AIDS study questionnaire. The subject group demonstrated an improvement in knowledge about AIDS (56%) and positive attitudes towards AIDS patients (16%), although the students’ willingness to provide services for AIDS patients remained unchanged following the AIDS education program. Further study of other levels of physical therapists or physical therapy students, measurement of actual clinical behaviours and comparisons of different educational interventions are needed.

Candida and Oral Candidosis—A Review

AbstractOral candidiasis (also called candidosis) is an opportunistic infection affecting the oral mucosa. These lesions are very common and caused by yeast Candida albicans. C. albicans are normal component of oral microflora and around 30 to 50% carry these organisms. The rate of carriage increases with advancing age of the patient. C. albicans are recovered from patient’s mouth over the age of 60 years. Other species such as C. glabrata, C. tropicalis, C. guilliermondii, and C. krusei are infrequently but consistently isolated. Oral candidosis can be classified into primary and secondary candidiasis. The factors involved in the pathogenicity of C. albicans have been reviewed. The pathogenesis of different biotypes and strains of C. albicans varies. A relationship has been suggested between the adherence of C. albicans to surfaces and its ability to colonize and cause disease. An important aspect of the pathogenicity of C. albicans may be its nonspecific affinity and binding to acrylic resin and other plastics. The factors affecting adhesion of yeasts, related to yeast cells, related to host cells and environmental factors, and the main factors which increase the susceptibility of oral candidiasis have been reviewed. The different types of oral lesions, their identification by different methods, management, and treatment of oral candidiasis also have been highlighted.Oral candidosis as a common opportunistic infection has gained importance after the discovery of human immunodeficiency virus infection. Candidiasis was always an endogenous infection. There are few cases of exogenous infection in intravenous drug abusers and contact lens users. Esophageal candidiasis is the earliest and most cases of lesions seen in acquired immunodeficiency syndrome patient. The diagnosis and reporting of oral candidiasis should be done with utmost care. The finding of yeast cells in large numbers and presence of pseudohyphae indicate invasion and causative agent of infection. The diagnosis of Candida infection can be confirmed by various techniques and recently discovered advanced methods.The confirmation of Candida infection depends on clinical diagnosis, proper collection of specimen, and careful evaluation in methodology and reporting.

Observation on cataract surgery of patients with acquired immunodeficiency syndrome

Objective To observe the efficacy of cataract surgery for patients with acquired immunodeficiency syndrome (AIDS). Methods The data of 21 eyes of 20 patients with AIDS from Jan. 2018 to Dec. were analyzed retrospectively. All cases underwent cataract extraction and intraocular implantation. The efficacy and safety were observed. Results After surgery, the visity acuity was 0.6 in 7 eyes. No infection was detected. Conclusion To strictly obey the medial practice standard, cataract surgery for AIDS patients can be safe with satisfactory prognosis. Key words: Syndrome, acquired immunodeficiency; Cataract; Lens, intraocular

The prevalence of microsporidia in China : A systematic review and meta-analysis

Microsporidia are a diverse parasite phylum infecting host from all major taxa in all global biomes. This research was conducted to conclude the prevalence of microsporidia in China. All published articles up to February 16, 2018 were considered, including descriptive, cross-sectional, case-control and epidemiology studies. A total of 1052 articles were separated after literature search. After a strict selection according to our criteria, 82 articles were included in qualitative synthesis and ultimately 52 studies were included in quantitative synthesis. Three species of microsporidia were confirmed to exist in China, including Enterocytozoon bieneusi (E. bieneusi), Nosema and Encephalitozoon cuniculi (E. cuniculi). The highest overall estimated prevalence of E. bieneusi in humans was 8.1%, which was observed in acquired immunodeficiency syndrome patients (AIDS). Moreover, the prevalence of E. bieneusi in animals including the cattle, dogs, pigs, deer, sheep and goats were analyszed in this study. The overall estimated prevalence of E. bieneusi acquired by using the random effects model in meta-analysis in cattle, dogs, pigs, sheep and goats and deer was 20.0% (95% confidence intervals: 0.133–0.266, I2 = 98.031%, p < 0.0001), 7.8% (95% CI: 0.050–0.106, I2 = 60.822%, p = 0.0537), 45.1% (95% CI: 0.227–0.674, I2 = 98.183%, p < 0.0001), 28.1% (95% CI: 0.146–0.415, I2 = 98.716%, p < 0.0001) and 19.3% (95% CI: 0.084–0.303, I2 = 96.995%, p < 0.0001) respectively. The overall detection rate of E. bieneusi in water acquired by using the random effects model in meta-analysis was 64.5% (95% CI: 0.433–0.857, I2 = 98.486%, p < 0.0001). Currently, 221 genotypes of E. bieneusi, 1 genotype of E. cuniculi and 6 Nosema were detected in China. The most prevalent genotype of E. bieneusi was genotype D, followed by BEB6 and EbpC.

Species distribution characteristics of nontuberculous mycobacteria isolated from patients with acquired immunodeficiency syndrome in Shanghai

Objective To investigate the species distribution characteristics of nontuberculous mycobacteria (NTM) in acquired immunodeficiency syndrome(AIDS) patients in Shanghai, and to provide evidences for clinical treatment. Methods A total of 775 Mycobacteria strains were isolated from patients (including 129 isolates from AIDS patients and 646 isolates from HIV-negative patients) admitted to Shanghai Public Health Clinical Center during 2015. All the species were identified by the sequence analysis of 16S rRNA gene and hsp65 gene. Differences in the species distribution were compared between patients with and without HIV infection. CD4+ T lymphocyte count was detected by flow cytometry and its relation with mycobacteria infection was also analyzed. Chi-square test was used for comparison between groups. Results The ratio of NTM isolation from HIV-negative patients was 15.79% (102/646), while that was 46.51% in AIDS patients (60/129), and the difference was statistically significant (χ2=61.38, P 50 cells/μL (20.00% and 15.38%, respectively) (χ2=4.048 and 6.524, respectively, both P 50 cells/μL. Conclusions The prevalence of NTM isolation is significant higher in AIDS patients than HIV-negative patients in Shanghai, and the most prevalent NTM species is MAC. The NTM infection in AIDS patients is related with low CD4+ T lymphocyte counts. Key words: Acquired immunodeficiency syndrome; Nontuberculous mycobacteria; Species identification

CORRELATIONS BETWEEN CLUSTER DIFFERENTIATION 4 COUNTS, HUMAN IMMUNODEFICIENCY VIRUS CLINICAL STAGES, AND HEMOGLOBIN LEVEL AMONG HUMAN IMMUNODEFICIENCY VIRUS PATIENTS WITH ANEMIA IN MERPATI CLINIC, WANGAYA HOSPITAL, DENPASAR, BALI, INDONESIA: A CROSS-SECTI

Objective: The objective of this study was to determine the correlation between cluster of differentiation 4 (CD4) counts, human immunodeficiency virus (HIV) clinical stages, and hemoglobin (Hb) level among HIV-infected patients with anemia.&#x0D; Methods: A cross-sectional study was conducted in November 2017 at Merpati Clinic of Wangaya Hospital, Denpasar, Bali, Indonesia. We selected 79 HIV patients with anemia to participate in our study. We grouped CD4 counts into two categories: &lt;200 cells/μL and ≥200 cells/μL, and we classified the HIV clinical stages into HIV and acquired immunodeficiency syndrome (AIDS).&#x0D; Results: About 55.7% (44) of men and 44.3% (35) of women were participated in this study. As many as, 91.1% (72) of participants were AIDS patients. The mean Hb was 8.77 g/dl with SD 1.79 g/dl. 81% (64) of study participants were suffered from anemia on chronic disease or inflammatory anemia, and 19% (15) of study participants were suffered from iron deficiency anemia. The median for CD4 counts was 94 cells/μL (3–309 cells/μL) with as many as 78.5% (62) of participants were found to have low CD4 counts (&lt;200 cells/μL). Spearman analysis revealed a positive correlation between CD4 counts and Hb level (r=0.427, p&lt;0.001). Independent sample t-test analysis found a correlation between the HIV clinical stages and Hb level. There was a difference between the mean of Hb level in each stage with the average difference of 0.8 g/dl (95% confidence interval 0.04–1.6; p&lt;0.04).&#x0D; Conclusions: There is a correlation between CD4 counts, HIV clinical stages, and Hb level among HIV patients with anemia.

Epithelial Inclusions in Gallbladder Specimens Mimic Parasite Infection: Histologic and Molecular Examination of Reported Cystoisospora belli Infection in Gallbladders of Immunocompetent Patients.

Recent publications have described epithelial cytoplasmic vacuoles and inclusions incidentally noted within gallbladder epithelium and concluded that they represent coccidian parasite infection, in particular, Cystoisospora belli. We identified 8 gallbladder specimens from our institution in the past 3 years in which this diagnosis was suggested or in which similar epithelial alterations were prominent. Molecular analysis was performed on the 8 gallbladder specimens and on 3 positive control specimens: small bowel biopsies from acquired immunodeficiency syndrome patients with diarrhea. Polymerase chain reaction using primers designed to amplify an internal transcribed spacer (ITS2) in the C. belli ribosomal gene cluster was performed on the DNA samples. All 8 gallbladder specimens were negative for amplification, while a product consistent with C. belli was amplified from all 3 positive controls. Histologically, the gallbladder cytoplasmic inclusions stained diffusely positive for Grocott-Gomori's methenamine silver and Periodic acid-Schiff with diastase. In contrast, sections from a positive control small bowel biopsy demonstrated organisms that were negative for Grocott-Gomori's methenamine silver and showed a distinct capsular and punctate internal staining on Periodic acid-Schiff with diastase in various parasite forms. Together, the lack of molecular evidence of C. belli and the distinct morphologic and special staining patterns in these gallbladders compared with positive control small bowel suggest that these epithelial changes do not represent true C. belli infection. Our results suggest that gallbladders of immunocompetent patients may occasionally show epithelial changes that can morphologically mimic C. belli infection. Pathologists should be aware of this histologic variant to minimize unnecessary treatment, testing, and patient anxiety.

Infection in Immunocompromised Hosts: Imaging.

Immunocompromised patients are encountered with increasing frequency in clinical practice. In addition to the acquired immunodeficiency syndrome (AIDS), therapy for malignant disease, and immune suppression for solid organ transplants, patients are now rendered immunosuppressed by advances in treatment for a wide variety of autoimmune diseases. The number of possible infecting organisms can be bewildering. Recognition of the type of immune defect and the duration and depth of immunosuppression (particularly in hematopoietic and solid organ transplants) can help generate a differential diagnosis. Radiologic imaging plays an important role in the detection and diagnosis of chest complications occurring in immunocompromised patients; however, chest radiography alone seldom provides adequate sensitivity and specificity. High-resolution computed tomography (CT) can provide better sensitivity and specificity, but even CT findings may be nonspecific findings unless considered in conjunction with the clinical context. Combination of CT pattern, clinical setting, and immunologic status provides the best chance for an accurate diagnosis. In this article, CT findings have been divided into 4 patterns: focal consolidation, nodules/masses, small/micronodules, and diffuse ground-glass attenuation/consolidation. Differential diagnoses are suggested for each pattern, adjusted for both AIDS and non-AIDS immunosuppressed patients.

Research on the causes of death associated with combined effects of HBV and HCV infection in patients with acquired immunodeficiency syndrome

Objective: To investigate the combined effects of hepatitis B virus and hepatitis C virus (HBV/HCV) infection on the cause of death in patients with acquired immunodeficiency syndrome (AIDS). Methods: The causes of death of 111 cases of AIDS with HBV/HCV (combined infection group) and 210 AIDS patients (single infection group) admitted to our hospital from 2012 to 2016 data were compared using chi-square test. Results: There was no statistically significant difference in gender composition and age in the combined infection groups (P > 0.05). The main causes of death in the combined infection group were severe pneumonia (44.1%), end-stage liver disease (18.9%), and central nervous system infection (14.4%). The main causes of death in the single infection group were severe pneumonia (47.6%) and central nervous system infection (14.3%) and tumor (13.3%). There was no case of end-stage liver disease. The ratio of end-stage liver disease in the former group was significantly higher than that in the latter group (χ(2) = 42.511, P < 0.001). The main cause of death in 12 HIV/HBV/HCV triple-infected patients was end-stage liver disease, accounting for 41.7%, which was significantly higher than 18.9% of end-stage liver disease in HIV/HBV or HIV/HCV dual infection (99 cases). And the difference was statistically significant (χ(2) = 4.539, P = 0.033); however, the ratio of end-stage liver disease in 50 HIV/HBV co-infected patients and 49 HIV/HCV co-infected patients was 16.0% vs. 16.3%, respectively, and the difference was not statistically significant (χ(2) = 0.002, P = 0.965). In the co-infected group, 36 patients had CD4(+) cell counts >100/μl, the primary cause of death was end-stage liver disease, accounting for 38.2%. 75 patients with CD4(+) ≤ 100/μl died due to end-stage liver disease, accounting for 9.3% and the difference was statistically significant (χ(2) = 13.852, P < 0.05). Conclusion: End-stage liver disease is the main cause of death in patients with AIDS combined with HBV or HCV, especially triplet infection and CD4(+) cell count > 100/μl. An early diagnosis and treatment of HBV or HCV infection should commence as soon as possible.

The research of inflammatory cytokines and T cell activation in peripheral blood of opportunistic infections and death in HIV

Objective The plasma levels of interleukin 6 (IL-6), high sensitive C reactive protein (hs-CRP) and the level of T cell activation were detected in the peripheral blood inflammatory factors of acquired immunodeficiency syndrome (AIDS) patients, and the relationship with opportunistic infection and prognosis was analyzed. Methods 79 human immunodeficiency virus (HIV)-positive/aids cases from May 2014 to January 2015 in first hospital of Changsha were enrolled in the study. They were divided into three groups: HIV-infected without opportunistic infections group (n=20), HIV-infected with infections group (n=43, including HIV-infected with tuberculosis group, HIV-infected with merge fungus group. HIV combined hepatitis C), death group (n=16). Serum IL-6 and the concentration of hs-CRP were detected by enzyme-linked immunosorbent assay (ELISA). Flow cytometry was used to test the CD3+ CD4+ cell count, the percentage of CD4+ CD38+ cell and CD8+ CD38+ cell in peripheral blood mononuclear cell (PBMC). Compare the differences among the three groups. Results The results showed that: the concentration of hs-CRP and IL-6 in peripheral blood of HIV death group was significantly higher than that in other three groups (P<0.05). The concentration of hs-CRP and IL-6 in the peripheral blood of the HIV-infected with tuberculosis group and HIV-infected with merge fungus group were significantly higher than that in the HIV-infected without opportunistic infections group (P<0.05), and the hs-CRP in the peripheral blood of the HIV combined with the hepatitis C group was higher than that in the HIV-infected without opportunistic infections group (P<0.05). The number of CD3, CD4T lymph nodes in the death group and the combined opportunistic infection group was significantly lower than that in the HIV-infected without opportunistic infections group (P<0.05). The HIV-RNA expression in peripheral blood of the death group and the combined opportunistic infection group was significantly lower than that in the HIV-infected without opportunistic infections group (P<0.05). The expression of CD8+ CD38+ on PBMC in the HIV-infected without opportunistic infections group was significantly lower than that in the death group, the tuberculosis group, the fungus group and the hepatitis C group (P<0.05). The expression of CD4+ CD38+ on PBMC in the HIV-infected without opportunistic infections group was higher than that in the death group (P< 0.05). Conclusions The concentration of inflammatory cytokines (IL-6, hs-CRP) and the expression level of T cell surface CD8+ CD38+ related to immune activation were associated with opportunistic infection and prognosis of AIDS. Key words: Acquired immunodeficiency syndrome/ME/CO/IM; Interleukin-6/ME; C-reactive protein/ME; Antigens, CD38; AIDS-related opportunistic infections; Prognosis

Study on the prevalence and influencing factors of depression and anxiety symptoms in HIV/AIDS patients

Objective To understand the prevalence of depression and anxiety symptoms in human immunodeficiency virus/anxiety symptoms in acquired immunodeficiency syndrome (HIV/AIDS) patients, and the possible factors of depression and anxiety symptoms, to provide the basis for promoting the physical and mental health of HIV/AIDS patients. Methods Cross-sectional survey of 1384 cases of HIV/AIDS outpatient and inpatient in Changsha Hospital affiliated to University of South China were carried out by using the the self-rating depression scale (SDS) and the self-rating anxiety scale (SAS), and the influencing factors of depression and anxiety symptoms were analyzed with logistic regression. Results In 1384 HIV/AIDS patients, the detection rate of depression and anxiety symptoms was 36.6%, and 198 patients was diagnosed the depression and anxiety (14.3%). Multi-factor regression analysis showed sex (OR=2.632, 95% CI: 1.814-3.817), cognitive function (OR=3.006, 95% CI: 2.043-4.424), combined diseases (OR=4.009, 95% CI: 3.036-5.295), adverse drug reactions (OR=2.580, 95% CI: 1.736-3.834), opportunistic infections (OR=6.994, 95% CI: 4.863-10.060) are the risk factors of depression and anxiety symptoms in HIV/AIDS patients. Platelet count (OR=0.610, 95% CI: 0.390-0.954) is the protective factor of depression and anxiety symptoms in HIV/AIDS patients. Conclusions Depression and anxiety are common in HIV/AIDS patients. Women, HIV associated neurocognitive dysfunction (HAND), combined with other diseases, opportunistic infections, and adverse drug reactions to HIV/AIDS patients are more likely to have depression and anxiety, and should be paid attention to in the follow-up process. Key words: Acquired immunodeficiency syndrome/CO; HIV infections/CO; Depression/ET; Anxiety/ET; Factor analysis, statistical

Megestrol acetate for cachexia-anorexia syndrome. A systematic review.

In 1993, megestrol acetate (MA) was approved by the US Food and Drug Administration for the treatment of anorexia, cachexia, or unexplained weight loss in patients with acquired immunodeficiency syndrome. The mechanism by which MA increases appetite is unknown, and its effectiveness for anorexia and cachexia in neoplastic, elderly, and acquired immunodeficiency syndrome patients is under investigation. This is an updated version of a Cochrane systematic review first published in 2005 and later updated in 2013 entitled ‘Megestrol acetate for the treatment of anorexia–cachexia syndrome’. MA vs. placebo: in studies where MA was compared with placebo, the overall results showed that MA patients gained weight (mean difference, MD 2.25 kg, 95% CI [1.19, 3.3]) but did not gain quality of life (QOL) (standarized mean difference, SMD 0.5, 95% CI [−0.13, 1.13]), with more adverse events (relative risk, RR 1.46, 95% CI [1.05, 2.04]), but no difference in deaths (RR 1.26, 95% CI [0.70, 2.27]). MA vs. no treatment: MA patients gained weight (MD 1.45 kg, 95% CI [0.15, 2.75]) but did not gain QOL (standardized mean difference 3.89 95% CI [−14, 6.28]). There was no increase in adverse events (RR 0.90, 95% CI [0.39, 2.08]) or deaths (RR 1.01, 95% CI [0.42, 2.45]). MA vs. active drugs: MA patients gained weight (MD 2.5 kg, 95% CI [0.37, 4.64]) but did not gain QOL (MD 0.20 95% CI [−0.02, 0.43]) and did not report an increase in adverse events (RR 1.05 95% CI [0.95, 1.16]) or in deaths (RR 1.53, 95% CI [1.02, 2.29]) Different doses of MA: in studies where lower doses of MA were compared with higher doses of MA, we did not find differences either in weight gain (MD −0.94 kg, 95% CI [−3.33, 1.45]), QOL (MD 0.31 95% CI [−0.19, 0.81]), or adverse events (RR 1.34, 95% CI [0.65, 2.76]). Thus, we cannot reach a conclusion for an optimal dose of MA.

Opportunistic and non-opportunistic intestinal parasites in HIV/ AIDS patients in relation to their clinical and epidemiological status in a specialized medical service in Goiás, Brazil

ABSTRACTPatients infected with the Human Immunodeficiency Virus (HIV) often have opportunistic infections, among which strongyloidiasis and coccidiosis are the most common parasitic infections that aggravate their health status. This study examined the prevalence of intestinal parasites, particularly of Strongyloides stercoralis and intestinal coccidia in patients with the Human Immunodeficiency Virus (HIV)/ Acquired Immunodeficiency Syndrome (AIDS) who were treated at the Specialized Assistance Service (SAE) of Jataí, State of Goiás, Brazil, and analyzed its correlation with clinical, laboratory, and socio-epidemiological parameters. A total of 270 stool samples were analyzed by the Lutz technique, Rugai’s method, Agar Plate Culture, Ritchie’s method and specific staining, Ziehl-Neelsen modified technique, Kinyoun’s method and the rapid safranin method. The prevalence of intestinal parasites was 28.88% including 3.8% of S. stercoralis, Cryptosporidium sp. and Cystoisospora belli. There was a significant positive correlation between intestinal parasites and the clinical status and the use of antiretroviral therapy (ART), smoking, CD4+ lymphocyte counts and sexual orientation. In conclusion, the widespread use of antiretroviral therapy and health assistance contributed to the low prevalence of S. stercoralis and coccidiosis in patients with HIV/ AIDS who were followed up at the SAE.

Epidemiology, determinants, and management of AIDS cholangiopathy: A review.

Diseases of the liver and biliary tree have been described with significant frequency among patients with human immunodeficiency virus (HIV), and its advanced state, acquired immunodeficiency syndrome (AIDS). Through a variety of mechanisms, HIV/AIDS has been shown to affect the hepatic parenchyma and biliary tree, leading to liver inflammation and biliary strictures. One of the potential hepatobiliary complications of this viral infection is AIDS cholangiopathy, a syndrome of biliary obstruction and liver damage due to infection-related strictures of the biliary tract. AIDS cholangiopathy is highly associated with opportunistic infections and advanced immunosuppression in AIDS patients, and due to the increased availability of highly active antiretroviral therapy, is now primarily seen in instances of poor access to anti-retroviral therapy and medication non-compliance. While current published literature describes well the clinical, biochemical, and endoscopic management of AIDS-related cholangiopathy, information on its epidemiology, natural history, and pathology are not as well defined. The objective of this review is to summarize the available literature on AIDS cholangiopathy, emphasizing its epidemiology, course of disease, and determinants, while also revealing an updated approach for its evaluation and management.

CD4 cell counts and oral manifestations in HIV infected and AIDS patients.

Context:Acquired immunodeficiency syndrome (AIDS) is an acronym for AIDS caused by a retrovirus known as human immunodeficiency virus (HIV) which breaks down the body's immune system leaving a patient vulnerable to a host of life-threatening opportunistic infections, neurological disorders or unusual malignancies. According to estimates by the World Health Organization and UNAIDS, 35 million people were living with HIV globally at the end of 2013. The first AIDS case in India was detected in 1986. Seldom studies have been conducted correlating these parameters with oral manifestations in the Indian population.Aim:The present study was carried out to evaluate the CD4 cell counts and oral manifestations in HIV-infected and AIDS patients and to correlate them with the seronegative controls.Methodology:This was a cross-sectional, hospital-based study on individuals who were divided into three groups, Group A consisting of 500 patients who were healthy controls without any systemic illness; Group B consisting of 500 patients who were diagnosed as HIV infected and Group C consisting of 500 patients diagnosed as AIDS patients depending on their CD4 cell counts. The permission from the Ethical Committee of the Institution as well as Superintendent of Government Hospital was obtained. Evaluation of CD4 cell counts in HIV-infected and AIDS patients was done using CyFlow Counter.Results:The results were found to be statistically significant with the P < 0.001 for the CD4 cell counts. Oral manifestations revealed varied results with different levels of significance.Conclusion:CD4 cell counts were significantly altered in HIV-infected and AIDS patients when compared with the controls while oral manifestations revealed varied results with different levels of significance.

Butyrylcholinesterase Levels on Admission Predict Severity and 12-Month Mortality in Hospitalized AIDS Patients.

Background Butyrylcholinesterase (BChE) is synthesized mainly in the liver and an important marker in many infectious/inflammatory diseases, but its role in acquired immunodeficiency syndrome (AIDS) patients is not clear. We wished to ascertain if BChE level is associated with the progression/prognosis of AIDS patients. Methods BChE levels (in U/L) were measured in 505 patients; <4500 was defined as “low” and ≥4500 as “normal.” Associations between BChE level and CD4 count, WHO stage, body mass index (BMI), C-reactive protein (CRP) level, and duration of hospitalization were assessed. Kaplan–Meier curves and Cox proportional hazards model were used to assess associations between low BChE levels and mortality, after adjustment for age, CD4 count, WHO stage, and laboratory parameters. Results A total of 129 patients (25.5%) had a lower BChE level. BChE was closely associated with CD4 count, WHO stage, CRP level, and BMI (all P < 0.001). Eighty-four patients (16.6%) died in the first year of follow-up. One-year survival was 64.5 ± 4.5% for patients with low BChE and 87.6 ± 1.8% for those with normal BChE (log-rank, P < 0.001). After adjustment for sex, age, BMI, WHO stage, and CD4 count, as well as serum levels of hemoglobin, sodium, and albumin, the hazard ratio was 1.8 (95% confidence interval, 1.0–3.2) for patients with a low BChE compared with those with a normal BChE (P = 0.035). Conclusion BChE level is associated with HIV/AIDS severity and is an independent risk factor for increased mortality in AIDS patients.

Virulence of Mycobacterium avium Subsp. hominissuis Human Isolates in an in vitro Macrophage Infection Model

Mycobacterium avium subsp. hominissuis (MAH) is an environmental opportunistic pathogen for humans and swine worldwide; in humans, the vast majority of MAH infections is due to strains belonging to specific genotypes, such as the internal transcribed spacer (ITS)-sequevars Mav-A and Mav-B that mostly cause pulmonary infections in elderly patients and severe disseminated infections in acquired immunodeficiency syndrome patients, respectively. To test whether the different types of infections in distinct patients' populations might reflect a different virulence of the infecting genotypes, MAH human isolates, genotyped by ITS sequencing and MIRU-VNTR minisatellite analysis, were studied for the capacity to infect and replicate in human macrophages in vitro. Cultures of human peripheral blood mononuclear cells and phagocytic human leukemic cell line THP-1 cells were infected with each MAH isolate and intracellular colony-forming units (CFU) were determined. At 2 h after infection, i.e., immediately after cell entry, the numbers of intracellular bacteria did not differ between Mav-A and Mav-B organisms in both phagocytic cell types. At 5 days, Mav-A organisms, sharing highly related VNTR-MIRU genotypes, yielded numbers of intracellular CFUs significantly higher than Mav-B organisms in both phagocytic cell types. MIRU-VNTR-based minimum spanning tree analysis of the MAH isolates showed a divergent phylogenetic pathway of Mav-A and Mav-B organisms. Mav-A and Mav-B sequevars might have evolved different pathogenetic properties that might account for their association with different human infections.

Prevalence and factors associated with the use of traditional medicines among human immunodeficiency virus and acquired immunodeficiency syndrome patients in Sokoto, Nigeria.

Background:In resource-scarce settings like Nigeria, access to conventional drugs and antiretroviral therapy (ART) is highly limited, hence the resort to use of traditional herbal medicine by a significant number of people living with human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS) (PLWHAs). Traditional medicine (TM) continues to provide health coverage for most of the people in developing countries, and it is equally becoming increasingly popular in western countries.Aim:This study aims to present the status and use of TM and determine the factors associated with its use among patients with HIV/AIDS on highly active ART in a tertiary health institution in Sokoto, Northwest Nigeria.Methodology:This was a descriptive, cross-sectional study involving HIV/AIDS patients attending antiretroviral treatment center of the Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, Nigeria. The study population comprised PLWHAs attending the ART clinic of the hospital (UDUTH). A total of 271 respondents were recruited into the study and administered a set of pretested structured questionnaire. Ethical approval for this study was obtained from the ethical committee of the teaching hospital.Results:Only 11 (4.2%) of the respondents had used TM before, of whom 9 (5%) were females and 2 (2.7%) were males with P = 0.399. Only one of the respondents had side effects following the use of TM, and the most common reason for the use of TM was as a result of too much weight loss.Conclusion:Although the use of TM among the study participants in Sokoto was low, there is need to educate PLWHAs about the possible risks of interactions following the concurrent use of TM and ART.

Study of ocular manifestations in pediatric human immunodeficiency virus according to national acquired immunodeficiency syndrome patients in a tertiary care hospital

Introduction: Ocular involvement in children with HIV AIDS most commonly include allergic conjunctivitis, herpes zoster ophthalmicus,molluscum contagiosum, retinal vasculitis, CMV retinitis and isolated cotton wool spots. Materials and Methods: Non comparative prospective study was conducted at a tertiary care hospital from January 2015 to December 2015. A total of 506 patients of upto 12 years of age, affected with HIV AIDS, attending ART centre of the institute, were thoroughly examined for ocular involvement. Preliminary history which includes blurring of vision , deviation of eyes, night blindness or any other ocular complaints was documented. Detailed ocular examination was done thoroughly. Patient's ART case sheet was also referenced to know about any systemic conditions like tuberculosis, pneumocystis pneumonia, kaposi's sarcoma etc. Patients' most recent CD4 count was also documented. Results: Out of 506 children examined, 140 were found to have ocular involvement (27.6%). Anterior segment findings were found in 14.8% whereas retinal and optic nerve findings were found in 12.45% of patients. Ocular manifestations were also co-related with the CD4 count of the patients which showed that lower CD4 counts is significantly associated with increased ocular involvement. Conclusion: Our study concludes that the most common ocular manifestations in paediatric HIV patients include retinal perivasculitis, allergic conjunctivitis, herpes zoster ophthalmicus and dry eye and also demonstrates that ocular involvement is significantly associated with lower CD4 counts.