AIDS-related Opportunistic Infections Research Articles

AIDS cases in Ottawa: A review of simultaneous HIV and AIDS diagnoses.

ObjectivesIn Canada, HIV diagnoses continue unabated, with many of these cases being identified at a late stage of infection. While current public health surveillance data does not capture timing of diagnoses, locally, we identified a number of patients concurrently diagnosed with AIDS and HIV.DesignTo understand the key characteristics, presenting symptoms, and risk factors associated with an AIDS diagnosis, we undertook a prospective chart review of HIV and AIDS diagnoses in Ottawa, Canada.SampleSixty seven charts of persons diagnosed with HIV and AIDS between 2015 and 2021 were reviewed.MeasurementsData were analyzed using descriptive statistics.ResultsResults show some inconsistencies regarding HIV risk factors identified in published literature compared to those for persons diagnosed with AIDS in this study. Namely, patients in this review were more likely to be male, Black (from HIV‐endemic regions), and heterosexual, and were diagnosed at critical stage in infection (total average CD4+ count of 92.9 cells/mm3) with 44.8% of patients concurrently diagnosed with one or more AIDS‐related opportunistic infections.ConclusionsThe findings can be applied to strengthen HIV screening efforts in primary care settings, particularly among patients who present with persistent symptoms or illnesses related to chronic HIV infection. Additional considerations should be made for public health nurses to provide counseling and linkage to HIV testing/prevention services for patients at the time of an STI or Tuberculosis diagnosis and to increase AIDS‐specific data collection.

Incidence and impact of immune reconstitution inflammatory response syndrome associated with tuberculosis regarding the initiation of antiretroviral treatment during antituberculosis therapy in adult patients co-infected with tuberculosis and HIV: A systematic review

Antiretroviral therapy (ART) is a fundamental key in the fight against HIV, it allows the patient to have a prolonged and high quality life, however in coinfection with opportunistic diseases such as tuberculosis, the initiation of ART can generate a greater risk of immune reconstitution inflammatory syndrome when associated with antituberculosis treatment, generating an exacerbated inflammatory response in tissues rich in Mycobacterium tuberculosis, characterized by the clinical worsening of the patient. The picture ranges from mild and self-limited symptoms to more severe effects and even death.Objectives: This systematic review aims to describe and evaluate the impact, incidence, severity and morbidity of immune reconstitution syndrome (IRRS) on the condition of HIV-positive patients, taking into account the time of ART initiation during antituberculosis treatment. Material and methods: Randomized clinical studies, case-control studies, prospective and retrospective cohorts of the last 11 years, without language limits, obtained from search bases such as PubMed, Cochrane, Embase, performed in adult humans co-infected with mycobacterium tuberculosis and human immunodeficiency virus ( HIV) were evaluated. Results: TO total of 22 scientific articles were selected and analyzed, 8 of which report that early, immediate and integrated ART of HIV in patients co-infected with TB improved survival despite the higher incidence of TB-SIRI, on the other hand 5 clinical studies affirm that integrated ART generated severe clinical pictures of SIRI-TB and increased mortality, however 5 studies observed that it is more beneficial to initiate ART at any time of anti-tuberculosis treatment, than not to initiate it. Conclusion:our analysis considers it necessary to implement antiretroviral treatment (ART) early in patients coinfected with HIV and TB regardless of the CD4 + cell / mm count, despite the risk of developing another complication such as LRTI associated with TB, taking into account the adequate management of prevention with the corresponding treatment of the opportunistic infection that precedes it, as well as the early diagnosis of LRTI-TB and its consequent treatment, which is not addressed in this review .Keywords: "Immune reconstitution syndrome", "tuberculosis-HIV coinfection", "antiretroviral therapy", "Tuberculosis AND AIDS-Related Opportunistic Infections", "tuberculosis

Macular Structure and Microvasculature Changes in AIDS-Related Cytomegalovirus Retinitis Using Optical Coherence Tomography Angiography.

Background: Cytomegalovirus retinitis (CMVR) is a crucial blind-causing disease of AIDS-related ocular opportunistic infection. The CMVR lesions produced retinal necrosis. It is not entirely clear whether CMVR eyes without macular-involved necrotic lesions may have subtle macular damage. In this study, we conducted a cross-sectional study using optical coherence tomography angiography (OCTA) to evaluate macular microvasculature and structure in eyes with AIDS-related CMVR.Methods: Acquired immune deficiency syndrome (AIDS)-related CMVR patients (active and inactive CMVR) and healthy controls treated in the Department of Ophthalmology, Beijing Youan Hospital, Capital Medical University between August 25, 2019, and October 18, 2019, were recruited. All OCTA parameters, including the foveal avascular zone (FAZ), retinal vessel density (VD), choroidal vascularity index (CVI), retinal thickness, and choroidal thickness, were compared between groups after the signal strength was corrected.Results: Signal strength in the 3 × 3 and 6 × 6 mm scan patterns was significantly weaker in the inactive CMVR group than in the control group (both p < 0.001). After adjusting for signal strength, heterogeneity in the central fovea and parafoveal quadrants was present with a shift toward lower macular chorioretinal vasculature, decreased full choroidal thickness, and thicker retinal thickness in the active and inactive CMVR groups. The retinal nerve fiber layer (RNFL) and inner nuclear layer (INL) were significantly thicker in the active and inactive CMVR groups than in the control group (all p < 0.05). For photoreceptor-retinal pigment epithelium (PR-RPE) thickness, no significant differences were found in any quadrant between groups. Foveal avascular zone areas were not significantly different among the three groups (p = 0.053).Conclusions: Subtle macular structure and microvasculature damage still existed in CMVR eyes without macular-involved necrotic lesions. The results of our study are helpful for a deep understanding of the damage caused by CMVR.

A Mouse Model That Mimics AIDS-Related Cytomegalovirus Retinitis: Insights into Pathogenesis.

With the appearance of the worldwide AIDS pandemic four decades ago came a number of debilitating opportunistic infections in patients immunosuppressed by the pathogenic human retrovirus HIV. Among these was a severe sight-threatening retinal disease caused by human cytomegalovirus (HCMV) that remains today a significant cause of vision loss and blindness in untreated AIDS patients without access or sufficient response to combination antiretroviral therapy. Early investigations of AIDS-related HCMV retinitis quickly characterized its hallmark clinical features and unique histopathologic presentation but did not begin to identify the precise virologic and immunologic events that allow the onset and development of this retinal disease during HIV-induced immunosuppression. Toward this end, several mouse models of experimental cytomegalovirus retinitis have been developed to provide new insights into the pathophysiology of HCMV retinitis during AIDS. Herein, we provide a summary and comparison of these mouse models of AIDS-related HCMV retinitis with particular emphasis on one mouse model developed in our laboratory in which mice with a murine acquired immunodeficiency syndrome (MAIDS) of murine retrovirus origin develops a reproducible and well characterized retinitis following intraocular infection with murine cytomegalovirus (MCMV). The MAIDS model of MCMV retinitis has advanced the discovery of many clinically relevant virologic and immunologic mechanisms of virus-induced retinal tissue destruction that are discussed and summarized in this review. These findings may extend to the pathogenesis of AIDS-related HCMV retinitis and other AIDS-related opportunistic virus infections.

Atypical cytomegalovirus retinal disease in pyroptosis-deficient mice with murine acquired immunodeficiency syndrome

Pyroptosis is a caspase-dependent programmed cell death pathway that initiates and sustains inflammation through release of pro-inflammatory cytokines interleukin (IL)-1β and IL-18 following formation of gasdermin D (GSDMD)-mediated membrane pores. To determine the possible pathogenic contributions of pyroptosis toward development of full-thickness retinal necrosis during AIDS-related human cytomegalovirus retinitis, we performed a series of studies using an established model of experimental murine cytomegalovirus (MCMV) retinitis in mice with retrovirus-induced immunosuppression (MAIDS). Initial investigations demonstrated significant transcription and translation of key pyroptosis-associated genes within the ocular compartments of MCMV-infected eyes of mice with MAIDS. Subsequent investigations compared MCMV-infected eyes of groups of wildtype MAIDS mice with MCMV-infected eyes of groups of caspase-1−/− MAIDS mice, GSDMD−/- MAIDS mice, or IL-18−/− MAIDS mice to explore a possible contribution of pyroptosis towards the pathogenesis of MAIDS-related MCMV retinitis. Histopathologic analysis revealed typical full-thickness retinal necrosis in 100% of MCMV-infected eyes of wildtype MAIDS mice. In sharp contrast, none (0%) of MCMV-infected eyes of MAIDS mice that were deficient in either caspase-1, GSDMD, or IL-18 developed full-thickness retinal necrosis but instead exhibited an atypical pattern of retinal disease characterized by thickening and proliferation of the retinal pigmented epithelium layer with relative sparing of the neurosensory retina. Surprisingly, MCMV-infected eyes of all groups of deficient MAIDS mice harbored equivalent intraocular amounts of infectious virus as seen in MCMV-infected eyes of groups of wildtype MAIDS mice despite failure to develop full-thickness retinal necrosis. We conclude that pyroptosis plays a significant role in the development of full-thickness retinal necrosis during the pathogenesis of MAIDS-related MCMV retinitis. This observation may extend to the pathogenesis of AIDS-related HCMV retinitis and other AIDS-related opportunistic virus infections.

Impact of biological sex on cryptococcal meningitis mortality in Uganda and South Africa.

We examined the role of biological sex in cryptococcal meningitis mortality in a large cohort. Our findings reveal significant differences in inflammatory markers by biological sex. Women have significantly higher mortality due to cryptococcal meningitis that is attributable to anemia at baseline.

Opportunistic fungal infections in persons living with advanced HIV disease in Lagos, Nigeria; a 12-year retrospective study.

Nigeria has a large estimated burden of AIDS-related mycoses. We aimed to determine the proportion of patients with AIDS-related opportunistic fungal infections (OFIs) at an urban antiretroviral treatment (ART) centre in Nigeria. A retrospective analysis of a cohort of ART-naïve, HIV-infected patients, assessed for ART eligibility and ARTexperience at the PEPFAR outpatient clinic at Lagos University Teaching Hospital over a 12-year period (April 2004-February 2016) was conducted. During this period, 7,034 patients visited the clinic: 4,797 (68.2%) were female; 6161 patients had a recorded baseline CD4 count, and the median CD4 count was 184 cells/µl (IQR, 84-328). A baseline HIV-1 viral load (VL) was recorded for 5,908 patients; the median VL was 51,194 RNA copies/ml (IQR, 2,316-283,508) and 6,179/7046(88%) had initiated ART. Some 2,456 (34.9%) had a documented opportunistic infections, of whom 1,306 (18.6%) had an opportunistic fungal infection. The total number of OFI episodes was 1,632: oral candidiasis (n=1,473, 90.3%), oesophageal candidiasis (n=118; 8%), superficial mycoses (n=23; 1.6%), Pneumocystis pneumonia (PJP) (n=13; 0.8%), and cryptococcal meningitis(CM) (n=5; 0.4%). 113 (1.6%) were known to have died in the cohort. Approximately 1 in 5 HIV-infected patients in this retrospective cohort, most of whom had initiated ART, were clinically diagnosed with an OFI. Improved access to simple accurate diagnostic tests for CM and PJP should be prioritised for this setting.

Risk factors of Toxoplasma encephalitis among people living with HIV/AIDS at Wangaya hospital in Denpasar, Bali, Indonesia: a case control study

Background: Toxoplasma encephalitis (TE) is the most frequent AIDS-related opportunistic infection. T. gondii infects the human population in both developed and developing countries. Toxoplasmosis among PLWHA manifests primarily as a life-threatening condition, TE, brain abscesses and death. Objective was to identify the risk factors of Toxoplasma encephalitis (TE) among people living with HIV/AIDS (PLWHA). Methods: A case control study was conducted during May to November 2018. The study participants consisted of 90 PLWHA; 30 PLWHA with history of TE (cases) and 60 PLWHA without history of TE (controls). Data such as: socio-demographic, laboratory results, head CT scan findings were collected from the medical record and was analyzed using SPSS version 18.Results: A total of 90 participants PLWHA were enrolled, 30 participants as cases and 60 participants as a control. 49 (54.4%) participants were males and 41 (45.6%) participants were females. Among the risk factors evaluated; the lower lymphocyte level (p=0.016), the lower cluster differentiation (CD) 4 level (p=0.003), no taking highly active antiretroviral therapy (HAART) (p=0.000) were observed to be an independent associated risk factor of TE.Conclusions: Our findings suggest lower lymphocyte levels, lower CD4 count and no taking HAART may constitute a significant associated risk factor for TE in PLWHA.

Screening for invasive fungal disease using non-culture-based assays among inpatients with advanced HIV disease at a large academic hospital in South Africa.

Despite widespread access to antiretroviral therapy (ART), the burden of advanced HIV disease in South Africa is high. This translates into an increased risk of AIDS-related opportunistic infections, including invasive mycoses. Using a limited number of non-culture-based diagnostic assays, we aimed to determine the prevalence of invasive mycoses and tuberculosis among hospitalised adults with very advanced HIV (CD4 counts<100cells/µL) at a large academic hospital. We conducted interviews and prospective medical chart reviews. We performed point-of-care finger stick and serum cryptococcal antigen lateral flow assays; serum (1 → 3) ß-D-glucan assays; urine Histoplasma galactomannan antigen enzyme immunoassays and TB lipoarabinomannan assays. We enrolled 189 participants from 5280 screened inpatients. Fifty-eight per cent were female, with median age 37years (IQR: 30-43) and median CD4 count 32cells/µL (IQR: 13-63). At enrolment, 60% (109/181) were receiving ART. Twenty-one participants (11%) had a diagnosis of an invasive mycosis, of whom 53% (11/21) had cryptococcal disease. Thirteen participants (7%) had tuberculosis and a concurrent invasive mycosis. ART-experienced participants were 60% less likely to have an invasive mycosis than those ART-naïve (adjusted OR: 0.4; 95% CI 0.15-1.0; P=.03). Overall in-hospital mortality was 13% (invasive mycosis: 10% [95% CI 1.2-30.7] versus other diagnoses: 13% (95% CI 8.4-19.3)). One in ten participants had evidence of an invasive mycosis. Diagnosis of proven invasive fungal disease and differentiation from other opportunistic infections was challenging. More fungal-specific screening and diagnostic tests should be applied to inpatients with advanced HIV disease.

Pathogenesis, clinical course, and recent issues in HIV-1-infected Japanese hemophiliacs: a three-decade follow-up.

Nearly 30% of Japanese hemophiliacs were infected with HIV-1 in the early 1980s. They have unique characteristics compared to HIV-1-infected individuals through other routes, including date of infection of 1986 or earlier, mean age of nearly 50 years, and common co-infection with hepatitis C, but rarely with other sexually transmitted diseases. Antiretroviral therapy (ART) was introduced in Japan in 1997. The clinical courses before and after 1997 were quite different. Careful analysis of the pre-1997 clinical data allowed expansion of our knowledge about the natural course and pathogenesis of the disease. Switching to the second receptor agents proved critical in subsequent disease progression. HIV-1 continued to escape immune pressure, pushing disease progression faster. In contrast, ART was effective enough to overcome the natural course. Prognosis improved dramatically and cause of death changed from AIDS-related opportunistic infections and malignancies before 1997, to hepatitis C virus-related cirrhosis and hepatocellular carcinoma (HCC) around 2010, and again to non-AIDS defining malignancies recently. In most cases, hepatitis C was cured with direct acting antiviral therapy. However, HCV progressed to cirrhosis in some cases and risk of HCC is still high among these patients. Together with improvement in anticoagulants and aging of the patients, risk of myocardial infarction has increased recently. In addition, the numbers of patients with life-style related co-morbidities, such as diabetes mellitus, hypertension, and chronic kidney disease have been also increasing. Finally, stigma is still an important barrier to a better life in HIV-1-positive individuals.

Febrile Syndrome in HIV positive patients

Fever is one of the accompanying symptoms of HIV, mainly in the advanced stages of the disease, but its occurrence is related to a number of factors such as CD4+ Lymphocyte level, accompanying opportunistic infections; causative microorganisms etc. Fever accompanies HIV from the initial stage of the “acute retroviral syndrome” infection and during the evolution of the pathology towards the AIDS stage, even in IRIS. Fever-related opportunistic infections are divided into two groups by infectious or non-infectious causes3,4. In our study, we included 355 HIV-positive cases who had febrile episodes in different stages of immunodeficiency. In the HIV stage (to which we referred lymphocytes CD4+ over 500 cells/mm3, and without AIDS-related opportunistic infections) there were 39 cases. In the AIDS stage, there were 143 cases with a CD4 + level of 200-400 cells/mm3: pulmonary manifestations 85 cases, gastrointestinal 58 cases. With a level of CD4+ lymphocytes below 200 cells/ mm3 123 cases; pulmonary involvement 45 cases, intestinal 32 cases, CNS 11 cases, hematological.13 cases, disseminated 15 cases, FUO 7 cases. With CD4+ level below 50 cells mm3, 50 cases: non-Hodgkin’s lymphoma 9 cases. MAC 3 cases, TBC.19 cases, CNS lymphoma. 6 cases, retinal CMV 3 cases, Kaposi’s sarcoma 10 cases.

Predicting of the development of aids-indicating opportunistic infections in HIV-infected patients on antiretroviral therapy (retrospective cohort study)

HIV remains one of the actual problems of modern medicine. The search for predictors of the development of AIDS-associated opportunistic infections (OI) in patients on antiretroviral therapy (ART) is an urgent scientific and practical task.The aim of the study was to investigate the predictors of progression and to create a prognostic model for the development of AIDS-related opportunistic infections in HIV-infected patients receiving ART based on the determination of clinical genetic markers.Materials and methods. A retrospective cohort study of 181 HIV-infected patients was conducted. Logistic regression and ROC analysis were used for statistical data processing.Results. As a result of the analysis of 27 potential predictors of the development of AIDS-associated OIs in patients on ART, 10 significant predictors were identified in HIV-infected patients, on which the progression of HIV depends, namely: male sex (OR = 3.30 [95% СΙ 1.21 –9.0], p = 0.020), injecting drugs (OR = 2.49 [95% SO 1.02–6.07], p = 0.044), incarceration experience (OR = 2.29 [95% CI 1.07–4.91], p = 0.033), smoking (OR = 2.46 [95% CI 1.14–5.27], p = 0.021), immunological failure of ART (OR = 4 , 48 [95% CI 1.98–10.13], p = 0.000), low adherence to ART (OR = 3.03 [95% CI 1.13–8.09], p = 0.027), BMI less 18.5 (OR = 6.13 [95% СΙ 2.77–13.56], p = 0.000), haemoglobin level lower than 100 g/L (OR = 2.99 [95% CI 1.41–6.32], p = 0.004), the 299Gly allele of the TLR4 gene carrying (OR = 3.38 [95% CI 1.41–8, 12], p = 0.006) and the normal genotype (Gln11Gln, 11Gln/-) of the TLR7 gene (OR = 2.90 [95% CI 1.06–7.95], p = 0.038).Conclusions. A prognostic model of 5 predictors (male sex, immunological failure of ART, haemoglobin level lower than 100 g/L, BMI below 18.5 kg/m2 and carrier of the allele 299Gly of the TLR4 gene) was created (statistically significant (χ² = 59.88, g &lt;0.001) with operational characteristics: sensitivity - 73.0%, specificity - 79.0% and had a high predictive efficiency (area under the ROC curve - 0.8580)

Cytomegalovirus Viremia Associated With Increased Mortality in Cryptococcal Meningitis in Sub-Saharan Africa.

Cryptococcal meningitis and tuberculosis are both important causes of death in persons with advanced human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS). Cytomegalovirus (CMV) viremia may be associated with increased mortality in persons living with HIV who have tuberculosis. It is unknown whether concurrent CMV viremia is associated with mortality in other AIDS-related opportunistic infections. We prospectively enrolled Ugandans living with HIV who had cryptococcal meningitis from 2010-2012. Subsequently, we analyzed stored baseline plasma samples from 111 subjects for CMV DNA. We compared 10-week survival rates among those with and without CMV viremia. Of 111 participants, 52% (58/111) had detectable CMV DNA (median plasma viral load 498 IU/mL, interquartile range [IQR] 259-2390). All samples tested were positive on immunoglobin G serology. The median CD4+ T cell count was 19 cells/µL (IQR 9-70) and did not differ by the presence of CMV viremia (P = .47). The 10-week mortality rates were 40% (23/58) in those with CMV viremia and 21% (11/53) in those without CMV viremia (hazard ratio 2.19, 95% confidence interval [CI] 1.07-4.49; P = .03), which remained significant after a multivariate adjustment for known risk factors of mortality (adjusted hazard ratio 3.25, 95% CI 1.49-7.10; P = .003). Serum and cerebrospinal fluid cytokine levels were generally similar and cryptococcal antigen-specific immune stimulation responses did not differ between groups. Half of persons with advanced AIDS and cryptococcal meningitis had detectable CMV viremia. CMV viremia was associated with an over 2-fold higher mortality rate. It remains unclear whether CMV viremia in severely immunocompromised persons with cryptococcal meningitis contributes directly to this mortality or may reflect an underlying immune dysfunction (ie, cause vs effect). NCT01075152.

Chemotherapeutic Activities of Selected Medicinal Plant Extracts Used in Management of AIDS-Related Opportunistic Infections in The Lake Victoria Basin of Kenya

Chemotherapeutic Activities of Selected Medicinal Plant Extracts Used in Management of AIDS-Related Opportunistic Infections in The Lake Victoria Basin of Kenya

Pneumocystis pneumonia in HIV-1-infected patients.

Pneumocystis pneumonia (PCP) is an opportunistic disease that mainly affects patients with a deficiency of cell-mediated immunity, especially acquired immunodeficiency syndrome (AIDS). The incidence of PCP in these patients has declined substantially owing to the widespread use of antiretroviral therapy and PCP prophylaxis. However, PCP is still a major AIDS-related opportunistic infection, particularly in patients with advanced immunosuppression in whom human immunodeficiency virus type 1 (HIV-1) infection remains undiagnosed or untreated. The clinical manifestations, diagnosis, treatment, and prevention of PCP in patients with HIV-1 infection are addressed in this review.

Analysis of AIDS epidemic and clinical features in some part regions of Henan province during 2006-2015

Objective To discuss the epidemiology and clinical characteristics of AIDS in some part of Henan regions. Methods Retrospective analysis was conducted based on the clinical and epidemic information collected from AIDS patients who were treated in the Sixth People's Hospital of Zhengzhou between 2006 and 2015 in He'nan province. Results Between 2006 and 2015, the number of hospitalization increased every year.The average growth rate was 20.31%.The average age of patients was (43.91±13.56) years old.The patients from 40 to 60 years old group occupied 54.06% of total patients, and 71.12% of patients were farmers.During 2006 to 2015, the propagation path changed a lot.Before 2008, blood transmission was the major propagation path (72.72%), but after 2013, the major propagation path was sexual activity (59.69%).40.41% of patients were infected by two or more opportunistic infections.The top five opportunistic infections were bacterial pneumonia (32.68%), tuberculosis (19.29%), fungal infection (18.65%), pneumocystis carinii pneumonia (12.96%), extra pulmonary tuberculosis (7.45%). The death rate was 5.79%.The number of CD4 cells in peripheral blood was closely related to the severity of illness. Conclusion Early anti-virus treatment and opportunistic infection control are key factors to relieve the severity of illness and reduce the death rate. Key words: Acquired immunodeficiency syndrome; AIDS-related opportunistic infection; Epidemiology

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

Evaluation of opt-out inpatient HIV screening at an urban teaching hospital

ABSTRACTThis study evaluated opt-out inpatient HIV screening delivered by admitting physicians, and compared number of HIV tests and diagnoses to signs and symptoms-directed HIV testing (based on physician orders) in the emergency department (ED). The opt-out inpatient HIV screening program was conducted over a one year period in patients who were admitted to the 386-bed University of California San Diego (UCSD) teaching hospital. Numbers of HIV tests and diagnoses were compared to those observed among ED patients who underwent physician-directed HIV testing during the same time period. Survey data were collected from a convenience sample of patients and providers regarding the opt-out testing program. Among 8488 eligible inpatients, opt-out HIV testing was offered to 3017 (36%) patients, and rapid antibody testing was performed in 1389 (16.4%) inpatients, resulting in 6 (0.4% of all tests) newly identified HIV infections (5/6 were admitted through the ED). Among 27,893 ED patients, rapid antibody testing was performed in 88 (0.3%), with 7 (8.0% of all tests) new HIV infections identified. HIV diagnoses in the ED were more likely to be men who have sex with men (MSM) (p = 0.029) and tended to have AIDS-related opportunistic infections (p = 0.103) when compared to HIV diagnoses among inpatients. While 85% of the 150 physicians who completed the survey were aware of the HIV opt-out screening program, 44% of physicians felt that they did not have adequate time to consent patients for the program, and only 30% agreed that a physician is best-suited to consent patients.In conclusion, the yield of opt-out HIV rapid antibody screening in inpatients was comparable to the national HIV prevalence average. However, uptake of screening was markedly limited in this setting where opt-out screening was delivered by physicians during routine care, with limited time resources being the major barrier.

Cardiovascular Complications of HIV in Endemic Countries.

Effective combination antiretroviral therapy (ART) has enabled human immunodeficiency virus (HIV) infection to evolve from a generally fatal condition to a manageable chronic disease. This transition began two decades ago in high-income countries and has more recently begun in lower income, HIV endemic countries (HIV-ECs). With this transition, there has been a concurrent shift in clinical and public health burden from AIDS-related complications and opportunistic infections to those associated with well-controlled HIV disease, including cardiovascular disease (CVD). In the current treatment era, traditional CVD risk factors and HIV-related factors both contribute to an elevated risk of myocardial infarction, stroke, heart failure, and arrhythmias. In HIV-ECs, the high prevalence of persons living with HIV and growing prevalence of CVD risk factors will contribute to a growing epidemic of HIV-associated CVD. In this review, we discuss the epidemiology and pathophysiology of cardiovascular complications of HIV and the resultant implications for public health efforts in HIV-ECs.

Brief Report: Role of Thymic Reconstitution in the Outcome of AIDS-Related PML.

Implications of thymopoiesis in AIDS-related opportunistic infections remain unexplored. We used progressive multifocal leukoencephalopathy (PML), caused by JC virus (JCV), as an opportunistic infection model, and we simultaneously investigated thymic output and T-cell responses against JCV in 22 patients with PML treated with combined antiretroviral therapy. Thymic output was significantly associated with JCV-specific CD4⁺ and CD8⁺ T-cell responses and improved survival. Our data suggest that patients with AIDS-related PML and impaired thymopoiesis are less likely to develop a robust JCV-specific cellular immune response and consequently are at an increased risk for a poor clinical outcome.