Advanced Stages Of HIV Infection Research Articles

Newly Diagnosed HIV Infection in Patients with Progressive Multifocal Leukoencephalopathy (Literature Review and Clinical Cases)

In recent years, in the Kyrgyz Republic, HIV infection is more often detected at an advanced stage based on of advanced opportunistic infections. Late detection of people living with HIV causes disability and death due to untimely initiation of antiretroviral therapy and late prevention of opportunistic infections. The most difficult secondary disease to diagnose in the advanced stage of HIV infection is progressive multifocal leukoencephalopathy, often with an unfavorable outcome. This article presents two newly identified clinical cases of HIV infection in patients with difficult-to-diagnose progressive multifocal leukoencephalopathy, which may increase doctors' alertness to these diseases.

Predicting COVID-19 outcomes in patients at advanced stages of HIV infection: a model-based approach

BACKGROUND: Today, clinicians and their decisions extensively rely on specific treatment algorithms. These algorithms include prognostic models to identify high risk patients requiring hospital admission and clinical monitoring. This study suggests a prognostic model for forecasting COVID-19 outcomes in patients with advanced HIV infection, considering the high risk of unfavorable outcomes and the need for a specialized approach.
 AIM: To develop a prognostic model that combines predictors of unfavorable COVID-19 outcomes in patients with advanced HIV infection.
 MATERIALS AND METHODS: The study was based on 500 medical records of patients with advanced HIV infection admitted for confirmed COVID-19 between March 1, 2020, and December 31, 2022, and inpatient treatment at the Infectious Diseases Hospital in Moscow.
 RESULTS: All 500 patients were evaluated for 167 predictive markers for unfavorable COVID-19 outcomes, outlining 50 indicators that significantly varied across the subgroups of patients with both advanced HIV infection and COVID-19 depending on the presence of favorable or poor outcomes. Oxygen therapy was the most significant factor showing a strong correlation with poor outcomes in patients with advanced HIV infection and COVID-19. Subsequently, predictors were selected stepwise to enhance the predictive accuracy of the resulting model by adding more factors.
 The resulting model included seven factors: oxygen therapy requirements, CD4+ count under 50 cells/μL; manifested CMV infection with lung damage; elevated levels of lactate dehydrogenase, urea, and fibrinogen; and the presence of unspecified encephalitis. Using the available data in the calculations, a prognostic scenario and a receiver operating characteristic (ROC) curve were created to assess the practical significance of the proposed prognostic model. The area under the ROC curve was 90.9%, confirming the prediction accuracy and overall practical significance of the model.
 CONCLUSIONS: The proposed prognostic model enables the assessment of potential outcomes and planning of adequate therapies in patients with HIV and COVID-19 co-infection admitted to hospitals at advanced stages of the disease.

Progressive Multifocal Leukoencephalopathy in AIDS Patients: A Report on 15 Cases

Progressive Multifocal Leukoencephalopathy (PML) is a degenerative disease of the central nervous system (CNS) caused by a polyoma virus called JC polyoma virus (JCPyV). It affects patients with some diseases like lymphoproliferative diseases and patients with advanced AIDS usually with a CD4 count of less than 100 cells/L and carries a poor prognosis. Its clinical and radiological features are suggestive but could be similar to other diseases like toxoplasmosis and tuberculosis that can affect the CNS in AIDS patients. Here we report on 15 cases of PML, attended and managed in Tripoli University Hospital in Tripoli, Libya. All of the patients were in advanced stages of HIV infection, and were not using medications at presentation. All the patients except one died within a period of 2 days- 2 months of presentation possibly due to associated opportunistic infections (OI). PML has not been reported in the Libyan medical literature and here we report its clinical and radiological features and the prognosis of its course.

COVID-19 in patients with HIV: case-series

The article presents a series of clinical observations of confirmed cases of COVID-19 in hospitalized adult patients with HIV infection. The observed group of patients was characterized by a young age, a different spectrum of comorbid pathology, a moderate and comparable clinical and laboratory course, with the exception of a more prolonged clearance of SARS-CoV-2 compared with COVID-19 patients from the general population. Advanced stage of HIV infection with the development of secondary diseases (p=0.08), decrease in the relative number of CD4+T-lymphocytes less than 2% (p=0.03), and CD4+/CD8+ less than 0.05 (p=0.03), the presence of cytomegalovirus infection (p=0.004) distinguished HIV-SARS-CoV-2-coinfected patients with poor outcomes. The presence and similarity of the clinical and radiological course of COVID-19 and cytomegalovirus infection in patients with severe immunodeficiency was noted, which requires an extremely thorough differential diagnosis.

Pilot Study - Impact of Multifaceted Interventional Package to Address the Dietary Pattern, Nutritional Status & Psychosocial Wellbeing among Children Infected with HIV/AIDS in Bagalkot, Karnataka

Background of the study: HIV-infection and malnutrition are strongly linked for many years, the most common malnutrition form observed among HIV-infected children and adolescents worldwide was the acute malnutrition or wasting syndrome, characterized by significant decrease in body fat, and lean and bone mass, that was accompanied by growth retardation.1 Diet plays a crucial role in the immune system of HIV/AIDS patients, as sufficient amounts of macro- and micronutrients are essential for its normal functioning, whereas psychosocial wellbeing has been found to improve the mental ability in HIV-infected children. Therefore, adherence to a healthy diet and achieving an optimal psychosocial wellbeing from the early to advanced stages of HIV infection in this population is essential in order to maintain a good nutritional status, quality of life and self esteem to optimize health outcomes and to prevent future chronic complications. 2 Aims: The aim of the study was to assess impact of multifaceted interventional package on dietary pattern, nutritional status and psychosocial wellbeing among children infected with HIV/AIDS. Objectives: To assess the dietary pattern, nutritional status & psycho-social well being of children To find out the effectiveness of multi-faceted interventional package on dietary pattern, nutritional status & psycho-social well being of children To find out the association between dietary pattern, , nutritional status & psycho-social well being with selected socio-demographic variables To identify the correlation between dietary pattern with nutritional status & psycho-social well being of children To find out the correlation between nutritional status & psycho-social well being of children Methodology: A true experimental research study was conducted to assess the impact of multifaceted interventional package on dietary pattern, nutritional status and psychosocial wellbeing among children infected with HIV/AIDS. 20 children aged between 8-17 years attending Taluka ART Center Hungund, Dist Bagalkot has been selected for the study. Disproportionate stratified random sampling technique was used. Data was collected by using the following tools rating scale for dietary pattern, electronic weighing scale for weight, height measurement board for measuring height and Shakir’s tape for MUAC. Rosenberg Self Esteem Scale and Pediatric Quality of Life Inventory (PEDsQL 4.0) were used to assess the self esteem and quality of life of children. Interventions used in the study are nutrition training intervention and life-skill training programme. Mann Whitney’s U test was used to find the effectiveness of intervention, Spearman’s Rank order Correlation coefficient was used to assess the correlation between variables and frequency, Percentage distribution were used to describe the variables under the study Results: The mean pre post test score of children in experimental group was 29.2 + 4.26 which increased to 34.6 + 3.41in post test whereas the mean pre-test score of control group was 29.9 + 3.6 which increased to 30.8 + 3.77 in post-test. The Mann Whitney U value was 2 and P Value <0.000, which shows that the Nutritional training intervention was effective in improving the dietary pattern of children with HIV/AIDS. Hence the alternative hypothesis the post test dietary pattern scores will be significantly higher than pre-test scores in experimental group than control group was accepted. Spearman’s Rank order correlation coefficient was used to calculate the correlation between dietary pattern and self-esteem of children with HIV/AIDS. A moderate positive correlation (R= 0.300) was found between Dietary pattern and self-esteem of children. Conclusion: The pilot study revealed that both the nutritional training intervention and life-skill training programme are effective in improving the nutritional status, self esteem & quality of life of children with HIV/AIDS. A strong positive correlation (R= 0.85) was found between self esteem and Nutritional status of children. . A strong positive correlation (R= 0.76) was found between quality of life and nutritional status of children. it is also revealed that tools used in the study are highly reliable and the study is feasible and practicable. Further-it will be examined in the main research study with large sample size. Keywords: Impact, Multifaceted Interventional package, effectiveness, HIV children, Self esteem, quality of life, dietary pattern, nutritional status, nutritional training intervention, psycho-social wellbeing, ART center.

HIV Infection in Patients Aged Over 50 in the Infectious Diseases Unit at Brazzaville University Hospital: Prevalence and Associated Factors

Objective: The prevalence of HIV infection in people aged is of significant importance. We determined the prevalence of HIV infection with patients aged over 50 at the Brazzaville University Hospital and look for its associated factors. Patients and Method: Cases of HIV infection in patients over 50 years admitted to the Infectious Diseases Unit of Brazzaville University Hospital were examined under cross-sectional descriptive and analytical study. This survey concerns the period going from January 1, 2019 to June 30, 2021. Results: There were one hundred and ninety-four patients (8.2% of admissions). Their mean age was 57.40 ± 6.4 years [50-93], they were mostly female (n = 113; 58.2%). The most dominant population was the age group between 50-59 years (n = 136; 70.1%). They were single people (n = 80; 41.2%), without profession (n = 87; 44.8%), with a primary education level (n = 81; 41.8%), hypertensive (n = 27; 13.9%), diabetics (n = 15; 7.7%). HIV infection was discovered during hospitalization (n = 111; 57.2%), for deterioration of the general condition (n = 72; 37.1%), long-term fever (n = 56; 28.9%), chronic cough (n = 40; 20.6%). The patients were at WHO stage 3 (n = 133; 68.6%). The mean CD4 were 188.5 ± 11.7 / mm3 [19-433]. In 172 cases (88.7%), the patients had two sexual partners and did not use a condom (n = 189; 97.4%). The main opportunistic infections were tuberculosis (n = 74; 18.1%) and cerebral toxoplasmosis (n = 48; 24.7%). ART was made with the combination of TDF + FTC + EFV (n = 79; 40.7%). The observation was poor in 33% (n = 64) and unfavourable outcome in 47.4% (n = 92). These were IRIS (n = 5; 2.6%) and death (n = 85; 43.8%), due to anaemic shock (n = 17; 20%), septic shock (n = 8; 9.4%). Marital status (P = 0.04), WHO stage (p = 0.02), and non-compliance treatment (p = 0.0001) could have the link with the death patients. Conclusion: HIV infection in people over 50 years is relatively common at Brazzaville University Hospital, especially among single women. The lethality remains high, unrelated to an opportunistic infection but rather with the notion of non-compliance with treatment and the advanced stage of HIV infection according to the WHO classification. This shows the interest in raising awareness among this population for early detection and the treatment of HIV.

Characteristics of new HIV diagnoses over 1995-2019: A clinic-based study in Montréal, Canada.

Characterization of populations at risk of acquiring HIV is required to inform the public health response to HIV. To identify potential changing needs in HIV prevention and care cascade, we aim to describe how the demographic profiles and exposure categories of newly diagnosed HIV positive individuals attending a large sexual health clinic in Montréal (Canada) evolved since the beginning of the antiretroviral therapy era in the mid-1990s. Using diagnosis data from participants of the Clinique médicale l'Actuel cohort of HIV-positive patients, we examined the distribution of exposure categories (sexual orientation, sexual behaviours, injection drug use, being born in an HIV-endemic country) by gender and year of diagnosis. Time trends in mean age and in the proportion of patients with late (CD4 <350 cells/μL) or advanced stage (CD4 <200 cells/μL) of HIV infection at diagnosis were assessed through meta-regressions. A total of 2,612 patients diagnosed with HIV between January 1st, 1995 and December 31st, 2019 were included. Overall, mean age was 35 years (standard deviation: 10 years) and remained stable over time. The proportion of patients with advanced stage of HIV infection decreased from 16% in 1995 to 4% in 2019. Although men who have sex with men (MSM) consistently accounted for the highest proportion of new diagnoses (77%, 2,022/2,612 overall), their proportion decreased since 2013. There was also a concomitant decrease in the proportion of people who inject drugs, with none of the newly diagnosed participants reporting injection drug use since 2017, and an important increase in the proportion of patients born in an HIV-endemic country (24%, 7/29 in 2019), especially among women. Compared to patients from non-endemic countries, those from HIV-endemic countries were characterized by higher proportions of heterosexuals (88% vs 17%) and of women (52% vs 7%), and were twice likely to get diagnosed at an advanced stage of HIV infection (32% vs 15%). In absolute numbers, MSM continue to account for the largest exposure category. However, patients from HIV-endemic countries, who tend to be diagnosed at later stages of HIV infection, constitute an increasing proportion of newly diagnosed individuals. These persons could face distinct barriers to rapid diagnosis. Tailoring HIV testing strategies and other prevention interventions to the specific unmet prevention needs of these individuals is warranted.

Factors affecting the TB screening indicators in people living with HIV in the regions of Northwestern Federal District of the Russian Federation

The aim of the study is to know the tuberculosis screening measures and factors affecting their effectiveness among people living with HIV in the Northwestern District of the Russian Federation. In the study the data obtained from federal statistical surveys on HIV and tuberculosis during 2007–2018 have been used. In several regions of the Northwestern District there is a significant decrease in the results of the screening measures (p&lt;0,05): in Kaliningrad, Leningrad, Pskov regions and Karelia Republic, which is associated with the density of cumulation of patients with advanced stages of HIV-infection (s=0,81, p&lt;0,001) and with the share of subjects tested positively for HIV, but not registered at the AIDS Centers in the year of obtaining the positive results. In the regional TB/HIV programs it is necessary to take into account the level of cumulation of HIV cases on advanced stages in the region and the resources should be directed towards the tuberculosis screening among the patients who are on advanced HIV stages.

Системная красная волчанка или волчаночноподобный синдром при ВИЧ-инфекции: обзор клинических случаев

Background. Due to multi-organ lesions and a wide range of clinical manifestations, human immunodeficiency virus (HIV infection) resembles systemic connective tissue diseases, particularly systemic lupus erythematosus (SLE). Similarity of immune disorders in patients with HIV infection and SLE may lead to misdiagnosis resulting in wrong tactics of treatment (prescribing immunosuppressive therapy instead of high-dose antiretroviral therapy). Aim. To report the HIV infection and SLE differential diagnosis challenges. Results. By January 2021, the analysis of national literature revealed two cases of HIV infection in young women, initially misdiagnosed with suspected SLE. In addition to two patients described in literature, one more female patient with SLE manifestations combined with advanced stage of HIV infection was examined. Conclusion. HIV and SLE differential diagnosis is the ultimate challenge for clinicians. Physicians should be especially apprehensive about HIV infection when making the diagnosis of SLE. SLE therapy in patients with HIV infection should be appointed according to strict indications.

Editorial Note on HIV Stigma in the World

HIV stands for human immunodeficiency virus, which is the virus that causes HIV infection. The abbreviation “HIV” can refer to the virus or to HIV infection. AIDS stands for acquired immunodeficiency syndrome. AIDS is the most advanced stage of HIV infection. HIV attacks and destroys the infection-fighting CD4 cells of the immune system. The loss of CD4 cells makes it difficult for the body to fight off infections and certain cancer Without treatment, HIV can gradually destroy the immune system and advance to AIDS. This article deals with the Key facts related to the Disease.

Mobile team performance in integrated palliative care for patients with HIV infection

The article presents the experience of the mobile team as an integral component of palliative care for patients with HIV infection. Objective: To analyze the effectiveness of the mobile team as a key component of palliative care for patients with advanced stages of HIV infection and comorbid conditions. Materials and methods: In 2018, a joint project of the St. Petersburg AIDS Center and the BF (charity foundation) «Humanitarian Action» created a mobile team to provide onsite medical and social assistance to patients with HIV infection. The article presents the results of the project for 2018–2019. We studied the composition of patients, their needs for various types of support, as well as assessing the problems in providing this type of service to patients with HIV infection. The analysis of the work of the mobile team for 2018–2019. The composition of patients in need of medical and social assistance was studied. Results. In the supervision of the mobile team were 79 patients with HIV. The main tasks of the mobile team were to identify patients with HIV infection who suffered from severe opportunistic diseases, for various reasons they could not come to the doctor’s center for antiretroviral therapy, and also monitor the effectiveness of treatment and psychological support for sedentary and hard-to-reach groups of patients. Conclusion : Given the increase in the number of patients with advanced HIV infection and comorbid conditions, the creation of mobile teams that are part of palliative care is an essential part of comprehensive medical and social care.

Assessment of awareness and knowledge regarding HIV/AIDS among first year MBBS students in a Medical College in Maharashtra India

AIDS is a complex of illnesses caused by HIV. AIDS is the most advanced stage of HIV infection. According to recent reports by NACO, as many as 21.40 lac people are living with HIV (PLHIV) in India. Prevention of new HIV infections continues to be the mainstay of India’s national AIDS response. The lack of awareness and misconceptions about HIV/AIDS in the general population is mostly responsible for rapid spread of the disease and also with the social stigma attached with PLHIV in our country. Hence the present study was conducted to assess awareness regarding HIV/AIDS in newly admitted (First Year) medical students. This was a cross-sectional study done on 122 First Year MBBS students of Shri Bhausaheb Hire Govt. Medical College, Maharashtra. Data was collected by pretested questionnaires and analyzed using percentage. All students (100%) mentioned unsafe sex and infected blood transfusion as a risk behavior. Most of the respondents believed HIV infection can be transmitted from: HIV infected pregnant woman to her baby (93%), breast feeding (62%), contaminated syringes, needles and razors (98%), tattooing (64%) and IV drug abuse (66%). Students were aware that it does not spread through wearing clothes of HIV-infected persons (92%), mosquito bite (77%), hugging and shaking hands with an infected person (97%), sharing common toilets (81%), sharing common utensils like plates, cups and spoons (84%), saliva (81%), contact with urine (48%) and feces (51%), coughing and sneezing (75%) and sharing a meal (93%). Awareness regarding prevention of HIV/AIDS was also found to be high with percentage of students responding for oral contraceptive pills (84%), IUCD (61%), condoms(98%), health education(99%), avoiding untested blood transfusion(100% boys and 95% girls), use of disposable syringe (85%), avoiding breastfeeding (44%) and use of latex gloves (41%). 82% of respondents are willing to assist with the delivery of a baby born to a mother with HIV/AIDS. All students believed that a separate educational programme for awareness and sensitization towards HIV/AIDS for people engaged in healthcare is needed. The present study shows that the medical students have somewhat better awareness and knowledge regarding HIV/AIDS than the general population. Still, there is a need for specific educational modules for imparting positive attitudes in medical students and healthcare providers in relation to people living with HIV/AIDS.

Shedding Light on the Role of Extracellular Vesicles in HIV Infection and Wound Healing.

Extracellular vesicles (EVs) play an important role in intercellular communication. They are naturally released from cells into the extracellular environment. Based on their biogenesis, release pathways, size, content, and function, EVs are classified into exosomes, microvesicles (MVs), and apoptotic bodies (ApoBDs). Previous research has documented that EVs, specifically exosomes and MVs, play an important role in HIV infection, either by promoting HIV infection and pathogenesis or by inhibiting HIV-1 to a certain extent. We have also previously reported that EVs (particularly exosomes) from vaginal fluids inhibit HIV at the post-entry step (i.e., reverse transcription, integration). Besides the role that EVs play in HIV, they are also known to regulate the process of wound healing by regulating both the immune and inflammatory responses. It is noted that during the advanced stages of HIV infection, patients are at greater risk of wound-healing and wound-related complications. Despite ongoing research, the data on the actual effects of EVs in HIV infection and wound healing are still premature. This review aimed to update the current knowledge about the roles of EVs in regulating HIV pathogenesis and wound healing. Additionally, we highlighted several avenues of EV involvement in the process of wound healing, including coagulation, inflammation, proliferation, and extracellular matrix remodeling. Understanding the role of EVs in HIV infection and wound healing could significantly contribute to the development of new and potent antiviral therapeutic strategies and approaches to resolve impaired wounds in HIV patients.

Problems of differential diagnosis of focal brain lesions in patients with HIV infection

Currently, the leading cause of social disadaptations and disability of patients at advanced stages of HIV infection, as well as adverse outcomes, is the presence of severe comorbid variants of the course of HIV infection: HIV and co-infection of chronic viral hepatitis, tuberculosis, HIV and malignant tumors, and HIV-associated neurological diseases. In pediatric practice, the combination of HIV-induced and perinatal CNS lesions is the most relevant. The differential diagnosis of these conditions is complicated due to the polymorphism of clinical manifestations and the possibility of combining several pathological conditions simultaneously in patients. Neuroimaging data does not always have clear criteria for determining the exact cause of cerebral damage. The article presents data of own clinical neuroimaging observations of two patients with perinatal and parenteral HIV infection. The nervous system damage was polyetiological in nature and was presented in one case by a combination of HIV-encephalitis, cerebral toxoplasmosis and CNS lymphoma, in the second by the presence of Bourneville-Pringle disease (tuberous sclerosis) with the formation of giant-cell astrocytoma and HIV-induced brain damage. It should be noted that the optimization of the antiretroviral therapy regimen in the case of a combination of B-cell lymphoma and cerebral toxoplasmosis in a child with perinatal HIV infection led to clinical and laboratory remission

Особенности клинических проявлений и диагностики сочетания туберкулеза органов дыхания с оппортунистическими инфекциями легких у взрослых больных на поздних стадиях ВИЧ-инфекции с иммунодефицитом

Aim. To study the features of clinical manifestations and diagnostics of a combination of pulmonary tuberculosis (PTB) and opportunistic lung infections (OLI) in patients in advanced stage of HIV infection with immunodeficiency. Materials and methods. The study included 338 patients with newly diagnosed PTB with isolation of Mycobacterium tuberculosis, aged 25–60 years, having stage 4B and 5 HIV infection in a stage of progression, with no antiretroviral therapy, who were divided into 2 groups: 169 patients with a combination of PTB and OLI (main group) and 169 – with PTB (comparison group). All patients underwent clinical and laboratory, radiation and bronchological examination, as well as microbiological, immunological, molecular and genetic, cytological and histological examination of the diagnostic material from the respiratory tract, cere-brospinal and pleural fluid, blood, urine and feces in order to reveal OLI. Statistical analysis was carried out using Microsoft Office Excel 2010, data are presented as mean and standard deviation, the confidence interval. Results. It was found that tuberculosis in patients of the main group and the comparison group was generalized with multiple lesions and extrapulmonary phe-nomena, which include severe intoxication syndrome, bronchopulmonary lesions and symptoms of other organs and systems disorders. These made it difficult to differentiate between the PTB+OLI combination and PTB, and their diagnosis is possible only when M. tuberculosis and causative agents of other OLI are de-tected. If there is a combination of several lung diseases, chest computed tomography shows dissemination syndrome, adenopathy syndrome and lung pattern pathology syndrome, which looks like ground-glass opacity. In these cases, the PTB+OLI combination played not the least role, which together with direct lung lesions by HIV, made it impossible to differentiate these pathologies. The difference was possible only when M. tuberculosis and causative agents of other OLI were identified. Conclusion. With study data, an algorithm for the sequential etiological diagnosis of the PTB and OLI combination in patients with advanced stages of HIV infection with immunodeficiency was proposed.

Early mortality after late initiation of antiretroviral therapy in the TREAT Asia HIV Observational Database (TAHOD) of the International Epidemiologic Databases to Evaluate AIDS (IeDEA) Asia-Pacific.

Early mortality among those still initiating antiretroviral therapy (ART) with advanced stages of HIV infection in resource-limited settings remains high despite recommendations for universal HIV treatment. We investigated risk factors associated with early mortality in people living with HIV (PLHIV) starting ART at low CD4 levels in the Asia-Pacific. PLHIV enrolled in the Therapeutics, Research, Education and AIDS Training in Asia (TREAT Asia) HIV Observational Database (TAHOD) who initiated ART with a CD4 count<100cells/μL between 2003 and 2018 were included in the study. Early mortality was defined as death within 1 year of ART initiation. PLHIV in follow-up for > 1 year were censored at 12months. Competing risk regression was used to analyse risk factors with loss to follow-up as a competing risk. A total of 1813 PLHIV were included in the study, of whom 74% were male. With 73 (4%) deaths, the overall first-year mortality rate was 4.27 per 100 person-years (PY). Thirty-eight deaths (52%) were AIDS-related, 10 (14%) were immune reconstituted inflammatory syndrome (IRIS)-related, 13 (18%) were non-AIDS-related and 12 (16%) had an unknown cause. Risk factors included having a body mass index (BMI)<18.5 [sub-hazard ratio (SHR) 2.91; 95% confidence interval (CI) 1.60-5.32] compared to BMI 18.5-24.9, and alanine aminotransferase (ALT)≥5 times its upper limit of normal (ULN) (SHR 6.14; 95% CI 1.62-23.20) compared to ALT<5 times its ULN. A higher CD4 count (51-100cells/μL: SHR 0.28; 95% CI 0.14-0.55; and >100cells/μL: SHR 0.12; 95% CI 0.05-0.26) was associated with reduced hazard for mortality compared to CD4 count≤25cells/μL. Fifty-two per cent of early deaths were AIDS-related. Efforts to initiate ART at CD4 counts > 50cell/μL are associated with improved short-term survival rates, even in those with late stages of HIV disease.

The Broad Clinical Spectrum of Disseminated Histoplasmosis in HIV-Infected Patients: A 30 Years' Experience in French Guiana.

Histoplasmosis is a common but neglected AIDS-defining condition in endemic areas for Histoplasma capsulatum. At the advanced stage of HIV infection, the broad spectrum of clinical features may mimic other frequent opportunistic infections such as tuberculosis and makes it difficult for clinicians to diagnose histoplasmosis in a timely manner. Diagnosis of histoplasmosis is difficult and relies on a high index of clinical suspicion along with access to medical mycology facilities with the capacity to implement conventional diagnostic methods (direct examination and culture) in a biosafety level 3 laboratory as well as indirect diagnostic methods (molecular biology, antibody, and antigen detection tools in tissue and body fluids). Time to initiation of effective antifungals has an impact on the patient’s prognosis. The initiation of empirical antifungal treatment should be considered in endemic areas for Histoplasma capsulatum and HIV. Here, we report on 30 years of experience in managing HIV-associated histoplasmosis based on a synthesis of clinical findings in French Guiana with considerations regarding the difficulties in determining its differential diagnosis with other opportunistic infections.

AUTOCHTHONOUS CASE OF CUTANEOUS LEISHMANIASIS IN HIV INFECTED PATIENT

Single cases of autochthonous visceral leishmaniasis are registered in the Crimea and Dagestan. The article presents the first case of autochthonous cutaneous leishmaniasis in an HIV infected resident of the Republic of Dagestan, where this disease had not previously been registered. The diagnosis was made on the basis of a parasitological study of material taken from an ulcer on the border between the upper lip and the right nostril. Examination of the patient revealed a high burden of HIV (4 473 014 copies/ml) and a low level of CD4+ (76×106/l; 9%), which indicated an advanced stage of HIV infection. The patient underwent antiretroviral therapy (treatment with amphotericin B), against which a good result was obtained. A decrease in viral load and an increase in the content of CD4 lymphocytes in the blood were noted. A scar has formed on the site of a leishmaniasis ulcer.

MINI-REVIEW ON MALARIA AND HUMAN IMMUNODEFICIENCY VIRUS (HIV) IN SUB-SAHARA AFRICA

HIV is the virus that causes HIV infection. AIDS is the most advanced stage of HIV infection. HIV is spread through contact with the blood, semen, pre-seminal fluid, rectal fluids, vaginal fluids, or breast milk of a person with HIV. In the United States, HIV is spread mainly by having anal or vaginal sex or sharing injection drug equipment, such as needles, with a person who has HIV. Meanwhile, Malaria is a life-threatening mosquito-borne blood disease caused by a Plasmodium parasite that infects a type of mosquito which feeds on humans. Once an infected mosquito bites a human, parasites multiply in the host‟s liver before infecting and destroying their red blood cells. Malaria patients are usually very sick with symptoms such as high fevers, shaking chills, and flu-like illness. Globally, WHO estimated that 212 million clinical cases of malaria occurred, and 429,000 people died of malaria, most of them children in Africa. Since many countries with malaria are already among the poorer nations, the disease maintains a vicious cycle of disease and poverty.

HIV incidence in Indigenous and non-Indigenous populations in Australia: a population-level observational study

Australia has set a national target of ending HIV by 2020, achieving this will require the inclusion of priority populations (eg, Indigenous Australians) in strategies to reach elimination. To assist in evaluating the target of elimination, we analysed HIV notification data for Indigenous and non-Indigenous Australians. Using the National HIV Registry at The Kirby Institute at UNSW, Sydney, NSW, Australia, we collated and analysed annual HIV notification data for 1996-2015. Patients who were not born in Australia were excluded. We calculated the rates of HIV diagnoses with annual trends in notification rates for Indigenous versus non-Indigenous Australians by demographic characteristics, exposure categories, and stage of HIV at diagnosis. For missing data, assumptions were made and verified through sensitivity analyses. Annual rate ratio (RR) and 4 year summary rate ratio (SRR) trends were calculated to determine patterns of HIV diagnosis in the two populations. Between Jan 1, 1996, and Dec 31, 2015, 11 492 people born in Australia were reported with a diagnosis of HIV, of whom 461 (4%) were recorded as Indigenous Australians and we classified the remaining 11 031 (96%) as non-Indigenous Australians. For exposure to HIV, among Indigenous Australians a higher proportion of diagnoses occurred among women, and through injecting drug use and heterosexual sex than among non-Indigenous Australians (p<0·0001). Among Indigenous Australians, we found a significantly higher SRR of HIV diagnoses among men in the period 2012-15 than in previous periods (SRR 1·53, 95% CI 1·28-1·83; p<0·0001), and significantly higher diagnosis among Indigenous women (4·92, 4·02-6·02; p<0·0001) for the entire study period than among non-Indigenous women. Concurrently, a decrease in HIV diagnoses of 1% per annum (RR 0·99, 95% CI 0·98-0·99; p<0·0001) across the study period was seen among non-Indigenous people. Indigenous Australians were more likely to be diagnosed at an advanced stage of HIV infection than non-Indigenous Australians (20·8% vs 15·1%; p=0·0088). Greater efforts should be made to include Indigenous people in prevention strategies, particularly newer biomedical interventions, such as scale up of pre-exposure prophylaxis and treatment as prevention initiatives in Australia. More involvement of Indigenous Australians in these approaches is also required to prevent widening of the gap in HIV diagnosis rates between non-Indigenous and Indigenous Australians. None.