AIDS-related Complex Research Articles

SP9 The KidzMed project part 1: pill popping heroes

BackgroundThere are large groups of children where families have problems obtaining ongoing supplies of their children’s medicines in primary care due to them being high risk and complex, unlicensed, off label or expensive. The KidzMeds project was established ‘For all children to get the right medicine at the right dose at the right time with the right monitoring with minimum fuss wherever they live.’Tablets are safer, more convenient and cheaper than liquid medications. Children often remain on liquid due to habit, reluctance and parental and staff not knowing how to convert. The idea of converting came from initial HIV medications which were only available in tablets1; children as young as 3 years could be taught.2 3AimQuality improvement project to teach children and young people (CYP) on long term medication how to take tablet medication in an out-patient setting.MethodWorking with families and our teams we created an interactive training package with video (http://northernpaediatrics.com/kidzmed/) and comic poster. We ran interactive hour-long training sessions for staff. Using positive reinforcement and play, the trainer sat facing the learner with sweets or dummy filled capsules of increasing sizes, from size 3 (15 mm) to size 00 (23 mm).Over the next 12 weeks in one team we embedded a process for children ≥5 years attending complex renal clinics to be converted from liquid to tablet medication unless contraindicated (e.g. swallowing or cognitive impairment).Outcome measures included successful conversion rate, patient and staff feedback and cost savings.We overcame practical barriers by placing easily accessible ‘switching kits’ in clinic filled with the necessary dummy pills, awards and certificates. To increase confidence, we created a sealed dosette box with common medications so children could see the size of tablets they needed to swallow. Working with the clinical team we standardised processes (e.g. how to round doses, pre-screening clinic lists and creating prompts).ResultsOver three months, 90 CYP were seen in 13 multi-disciplinary renal clinics, 25 were suitable for conversion to tablet medication. 21 CYP (median age 8.4 years range 5.1 to 15.5) were successfully converted (only one patient required two sessions). 36 medicines were switched, generating £46,500 per year recurrent savings.Feedback was good. Staff liked the opportunity for positive interaction with children and families appreciated the ease of obtaining tablet medications versus liquids. We subsequently trained other teams, including our research team who were recruiting for a study in which swallowing tablets is an inclusion criteria.ConclusionsIn a short timeframe it is possible to embed a system to convert children to tablet medication, improving patient experience and realising considerable cost savings. It requires staff training and cultural change. Pill swallowing is an easy skill to teach and learn and children as young as five can successfully swallow pills. We automatically teach inhaler technique so equally we should teach CYP how to swallow tablets as a skill for life. We would encourage all units to set up pill swallowing training.ReferencesFischl MA, et al. The efficacy of azidothymidine (AZT) in the treatment of patients with AIDS and AIDS-related complex. NEJM 1987;317:185–91Garvie PA. Efficacy of a pill-swallowing training intervention to improve antiretroviral medication adherence in pediatric patients With HIV/AIDS. Pediatrics 2007;119:e893–e899Patel A, et al. Effectiveness of pediatric pill swallowing interventions: a systematic review. Pediatrics 2015;135:883–889

Memantine for dementia.

Memantine for dementia.

Kynurenine pathway metabolism and neuroinflammatory disease.

Immune-mediated activation of tryptophan (TRYP) catabolism via the kynurenine pathway (KP) is a consistent finding in all inflammatory disorders. Several studies by our group and others have examined the neurotoxic potential of neuroreactive TRYP metabolites, including quinolinic acid (QUIN) in neuroinflammatory neurological disorders, including Alzheimer's disease (AD), multiple sclerosis, amylotropic lateral sclerosis (ALS), and AIDS related dementia complex (ADC). Our current work aims to determine whether there is any benefit to the affected individuals in enhancing the catabolism of TRYP via the KP during an immune response. Under physiological conditions, QUIN is metabolized to the essential pyridine nucleotide, nicotinamide adenine dinucleotide (NAD+), which represents an important metabolic cofactor and electron transporter. NAD+ also serves as a substrate for the DNA ‘nick sensor’ and putative nuclear repair enzyme, poly(ADP-ribose) polymerase (PARP). Free radical initiated DNA damage, PARP activation and NAD+ depletion may contribute to brain dysfunction and cell death in neuroinflammatory disease.

Coincidental Observation of Global Hypometabolism in the Brain on PET/CT of an AIDS Patient With High-Grade Pulmonary Non-Hodgkin Lymphoma

AIDS-related dementia complex is the most severe form of cognitive dysfunction in a patient infected with human immunodeficiency virus. The use of FDG PET/CT to diagnose AIDS-related dementia complex has been studied previously and shows various specific metabolic patterns from striatal hypermetabolism in early asymptomatic stage to global hypometabolism in advanced stages. We present a case of a 49-year-old patient with long-standing human immunodeficiency virus infection, where global brain hypometabolism was noted coincidentally on FDG PET/CT done for initial staging of primary pulmonary non-Hodgkin lymphoma.

Association of Tumor Necrosis Factor-α (TNFα) Gene Polymorphisms with HLA Class II Alleles in HIV/AIDS Patients

Aim of Study: To identify the factors of molecular genetic risks during the development of infection in HIV, based on the TNFα cytokine gene polymorphism in combination with HLA DRB1/DQA1/DQB1 genes, as well as to analyse their possible association with the progress of the disease. 185 HIV infected patients and 173 individuals control group have been analysed. The DNA was extracted from peripheral blood, by using QiagenQIAamp DNA kit reagents. The quality and quantity of DNA was checked by using Qubit ® fluorometer HLA typing for HLA DRB1/DQB1/DQA1* was performed by RT-PCR with sequence-specific primers (SSO). TNFα gene G–238A and G–308A polymorphic variant incidence was determined by RT-PCR analysis. Original Research Article Eglite et al.; BJMMR, 13(12): 1-10, 2016; Article no.BJMMR.23065 2 Results: We have detected TNFα gene allele 308A in 11% HIV infected patients, whereas in control group this allele have been detected only in 4% patients. Although the incidence of the TNFα gene –238A allele was twice as high in the control group (6%) as in the HIV infected patients (3%), it did not prove to be statistically valid (p = 0.253). The incidence analysis of three-locus haplotypes DRB1-DQB1-DQA1 – in TNFα position-238A/G -308A/G showed that haplotypes 01:01/05:01/01:01-TNFα-238(GA)/308(GG) and 01:01/03:02/03:01 TNFα-238(AA)/308(GG) are more frequent in the control group in comparison to the groups of infected patients. This means that these haplotypes have a protective function, which significantly affects the progress of infection. The association of 15:01/05:01/01:01 -TNFα-238(GG)/308(GG) and 03:01/05:01/01:01TNFα238(GG)/308(GА) genotypes indicates a high risk of developing a fulminant infection. The genetic factors of AIDS-related complex of syndromes development are associated not only with the HLA complex class II alleles, but also with the SNP polymorphism in the promoter region of cytokine genes.

Causes of Death among HIV-Infected Adults Registered in Selected Anti-Retroviral Therapy Centers in North-Eastern India

Background: Causes of death related studies in HIV infected population are necessary to devise disease specific preventive interventions at both state and national level HIV programs. This study examines the causes of death among HIV-infected individuals registered at selected Anti-Retroviral Therapy (ART) centers in the era of treatment in north-eastern India. Data and Methods: A retrospective chart review of causes of death was undertaken among HIV-infected patients who were treated between January 2006 and November 2012 at three selected ART centers in Assam, a north-eastern state of India. Reported causes of death were coded as per the guidelines of the International Classification of Diseases (ICD-10) to determine the deaths to standard definitions. Results: Among 5612 HIV-infected patients registered over a period of 71 months, 370 deaths have occurred. Tuberculosis (28%) was the leading cause of death followed by death due to AIDS related complex (11%), wasting syndrome and multiple infections (9% each). Deaths due to selected causes were significantly associated with patient’s use of alcohol, WHO clinical stage, CD4 count at the time of diagnosis, presence of opportunistic infections during treatment and ART adherence. Median survival duration was shortest among patients who had CD4 count <50 at the start of ART (2.9 months) and patients who had multiple opportunistic infections during treatment (2.5 months). Discussion: Majority (67%) of deaths in our study were due to AIDS-related causes. Tuberculosis has remained the leading cause of death among the HIV patients on ART. Strengthening the linkages and referral between the HIV and TB program will be crucial to reduce the AIDS-related deaths attributed to tuberculosis.

Serum Concentration of Selenium in Diarrheic Patients with and without HIV/AIDS in Gondar, Northwest Ethiopia

Background: Selenium deficiency is known to be a major public health problem, associated with increased risk of mortality with AIDS and AIDS-related complex, diarrhea included compared to those of healthy controls. In Ethiopia, there are no studies conducted on serum selenium status diarrheic patients with and without HIV infection. Therefore, the present study was aimed at determining the level of serum selenium in HIV infected and sex and aged matched HIV negative diarrheic patients.. Methods: This was a cross-sectional study of 206 (97 HIV seronegative and 109 HIV seropositive) diarrheic patients of both genders seen at University of Gondar Hospital, Gondar, Ethiopia. Serum selenium was measured by inductively coupled plasma-mass spectrometer. Results: The mean and standard deviation of serum selenium levels in HIV seropositives was 5.90 ± 2.78 μg/dl and in HIV seronegatives was 6.99 ± 4.26 μg/dl. Deficiency of selenium was seen in 95.9% and 71.56% of diarrheic patients with and without HIV co-infection, respectively. The over all selenium deficiency was observed in 83.0% of patients included in the study irrespective of their HIV serostatus while 85.3%of the patients infected with HIV and 80.4% of patients without HIV infection had serum selenium level below 7μg/dl. The low serum selenium level was not associated with presence or absence of intestinal parasites neither with sociodemographic variables such as age, residence, marital status, occupation, monthly income. The mean serum selenium level of all male cases was statistically significantly lower than that of the females (P<0.05). Conclusion: Our results show high prevalence of selenium deficiencies in HIV seropositive and seronegative diarrheic patients in Gondar, Ethiopia. Although this is a small group of study subjects, the findings may be used as a tool to suggest further in-depth prospective clinical trials to determine whether selenium supplements may be of public health benefit among HIV-infected populations as a stand-alone therapeutic approach and potentially as an adjuvant to antiretroviral therapy.

Retinal manifestations of patients with human immunodeficiency virus, a multiethnics study in Malaysia.

To investigate the fundus findings of patients infected with human immunodeficiency virus (HIV) in correlation to Highly Active Antiretroviral Therapy (HAART) and CD4 count. Two hundred and two patients of the three major races (Chinese, Malay and Indian) in Malaysia were recruited in this population-based cross-sectional study. This consisted of confirmed HIV sero-positive patients with HAART treatment (n=95) or without HAART therapy (n=107) from December 2007 to March 2008. They were further classified into the HIV infected group, AIDS related complex (ARC) group and AIDS group. Each group was then subdivided according to their CD4 count. Clinical fundus findings were recorded. Sixty six patients (32.7%) showed presence of fundus manifestation, majority of which was HIV microangiopathy (89%) and the rest being Cytomegalovirus (CMV) retinitis (11%). The most common fundus lesion was cotton wool spot (34%). There was a higher incidence of fundus manifestation in the non HAART group than the HAART group (P=0.04) and in patients with CD4 count less than 200 cells/ml in both groups (P=0.01). The HAART therapy had remarkably reduced the percentage of fundus manifestation by 20% but CD4 count remains the marker for fundus manifestations. There were no significant differences noted in the retinal manifestation among the different races. (ANOVA, P=0.25). The fundus manifestations were higher in patients with CD4<200 cells/ml and in the non HAART group. Hence the HAART therapy is capable of reducing the incidence of fundus manifestations, however the CD4 count determines the occurrence of fundus manifestations.

Comparative study of the plasma globulin level, CD21 − B-cell counts and FOXP3 mRNA expression level in CD4 + T-cells for different clinical stages of feline immunodeficiency virus infected cats

Feline immunodeficiency virus (FIV) infection leads to hypergammaglobulinemia through mechanisms that remain poorly understood. We investigated changes in plasma globulin level, B cells, and T cells with progression of the clinical stage of FIV-infected cats. We classified FIV-infected cats into the stage of Asymptomatic carrier (AC) and AIDS-related complex (ARC) based on the clinical symptoms, and measured the plasma globulin level, the CD4 + T-cell counts, and analyzed surface markers of B cells. We investigated the relationship between the plasma globulin level and regulatory T cells (Tregs) using the Forkhead box P3 (FOXP3) mRNA expression level. In FIV-infected cats, the plasma globulin level and the surface immunoglobulin (sIg) + CD21 − B-cell counts were increased, whereas the CD4 + T-cell counts were decreased compared with specific-pathogen free (SPF) cats. The mRNA expression of Blimp-1 (master gene of plasma cells) was increased in peripheral blood, and the FOXP3 mRNA expression level was decreased in CD4 + T-cells. These immunological changes were marked in the ARC stage. These data indicate that the decrease of Tregs and the increase of plasma cells lead to hypergammaglobulinemia.

ChemInform Abstract: Brain Targeting of Anti-HIV Nucleosides: Synthesis and in vitro and in vivo Studies of Dihydropyridine Derivatives of 3′-Azido-2′,3′- dideoxyuridine and 3′-Azido-3′-deoxythymidine.

A significant number of patients with AIDS and AIDS-related complex develop neurological complications. Therefore, it is critical that anti-HIV agents penetrate the blood-brain barrier and suppress viral replication in the brain. In an effort to increase the brain delivery of anti-HIV nucleosides, in vitro and in vivo pharmacokinetics of dihydropyridine derivatives of 3'-azido-2',3'-dideoxyuridine (AzddU, AZDU, or CS-87) and 3'-azido-3'-deoxythymidine (AZT, Zidovudine) have been studied. In vitro studies of the prodrugs (AzddU-DHP and AZT-DHP) in human serum, mouse serum, and mouse brain homogenate indicated that the rates of serum conversion from prodrugs to parent drugs are species dependent: mouse brain homogenate greater than mouse serum greater than human serum. Half-lives in human serum, mouse serum, and mouse brain homogenate are 4.33, 0.56, 0.17 h, respectively, for AzddU and 7.70, 1.40, and 0.18 h, respectively, for AZT. In vivo studies of AzddU-DHP and AZT-DHP showed that the prodrugs have areas under the serum concentration-time curves (AUC) similar to those of the parent drugs. The AUC in serum for AzddU following prodrug administration is 25.79 micrograms h/mL, which is similar to the value of 25.83 micrograms h/mL when AzddU was administered. Analogously, the serum AUCs for AZT when AZT-DHP and AZT were administered are 25.38 and 26.64 micrograms h/mL, respectively. However, the brain AUCs for both AzddU and AZT derived from prodrugs, being 11.43 and 11.28 micrograms h/mL, respectively, are greater than the brain AUCs for AzddU (2.09 micrograms h/mL) and AZT (1.21 micrograms h/mL) when the parent drugs were administered. Thus, the relative brain exposure (re) for AzddU (5.47) and AZT (9.32) indicate a significant increase in exposure to the anti-HIV nucleosides following prodrug administrations. The results of extended half-lives of the synthesized prodrugs in human serum along with the higher re values in vivo warrant studies in larger animals to determine the potential usefulness of the prodrugs in humans.

Idiopathic AIDS Enteropathy and Treatment of Gastrointestinal Opportunistic Pathogens

Diarrhea in patients with acquired immune deficiency syndrome (AIDS) has proven to be both a diagnostic and treatment challenge since the discovery of the human immunodeficiency virus (HIV) virus more than 30 years ago. Among the main etiologies of diarrhea in this group of patients are infectious agents that span the array of viruses, bacteria, protozoa, parasites, and fungal organisms. In many instances, highly active antiretroviral therapy remains the cornerstone of therapy for both AIDS and AIDS-related diarrhea, but other targeted therapies have been developed as new pathogens are identified; however, some infections remain treatment challenges. Once identifiable infections as well as other causes of diarrhea are investigated and excluded, a unique entity known as AIDS enteropathy can be diagnosed. Known as an idiopathic, pathogen-negative diarrhea, this disease has been investigated extensively. Atypical viral pathogens, including HIV itself, as well as inflammatory and immunologic responses are potential leading causes of it. Although AIDS enteropathy can pose a diagnostic challenge so too does the treatment of it. Highly active antiretroviral therapy, nutritional supplementation, electrolyte replacements, targeted therapy for infection if indicated, and medications for symptom control all are key elements in the treatment regimen. Importantly, a multidisciplinary approach among the gastroenterologist, infectious disease physician, HIV specialists, oncology, and surgery is necessary for many patients.

Positron emission tomography in patients suffering from HIV-1 infection

This paper reviews currently available PET studies performed either to improve our understanding of the pathogenesis of HIV-1 infection or to assess the value of PET imaging in the clinical decision making of patients infected with HIV-1 presenting with AIDS-related opportunistic infections and malignancies. FDG PET has shown that HIV-1 infection progresses by distinct anatomical steps, with involvement of the upper torso preceding involvement of the lower part of the torso, and that the degree of FDG uptake relates to viral load. The former finding suggests that lymphoid tissues are engaged in a predictable sequence and that diffusible mediators of activation might be important targets for vaccine or therapeutic intervention strategies. In lipodystrophic HIV-infected patients, limited available data support the hypothesis that stavudine-related lipodystrophy is associated with increased glucose uptake by adipose tissue as a result of the metabolic stress of adipose tissue in response to highly active antiretroviral treatment (HAART). Finally, in early AIDS-related dementia complex (ADC), striatal hypermetabolism is observed, whereas progressive ADC is characterized by a decrease in subcortical and cortical metabolism. In the clinical setting, PET has been shown to allow the differentiation of AIDS-related opportunistic infections and malignancies, and to allow monitoring of side effects of HAART. However, in patients suffering from HIV infection and presenting with extracerebral lymphoma or other human malignancies, knowledge of viraemia is essential when interpreting FDG PET imaging.

Cognitive performance in HIV-1 infection: relationship to severity of disease and brain atrophy.

We examined cognitive performance in 72 HIV-1 infected patients and 34 controls. None of the patients had opportunistic infections or unusual neoplasms of the central nervous system (CNS). Factors other than HIV-1 known to cause cognitive decline were excluded from both groups. Cognitive functioning analysed with special emphasis on the severity of HIV infection was related to neuroradiological and immunological findings. In patients with AIDS-related complex (CDC IVa) or AIDS (CDC IVc,d), a deterioration of memory as well as cognitive speed and flexibility was detected. Furthermore, memory deficits were associated with central cerebral and infratentorial atrophy in those patients, while no association was found between cognitive deficits and immunological abnormalities. Patients at CDC stages II or III showed slight association between altered cognitive speed and flexibility and elevated leukocyte count, suggesting a subclinical CNS disease already at early stages of HIV infection.

P.048 Comparative study in the quality control of viral diagnostic reagents storage temperatures in two laboratories in Abuja, Nigeria

Background: The majority of the human population is infected with two human polyomaviruses BK virus (BKV) and JC virus (JCV) during childhood. After initial infection both viruses persist within renal system. Reactivation of both viruses may be linked with immunodeficiency or immunosuppressive therapy. Objective: To evaluate the relationship between immunodeficiency and viruria, prevalence of BK and JC viruria over time was investigated in a cohort of HIV seropositive individuals at different stages of disease. The excretion in this group was compared with virus excretion in their HIV seronegative partners and in an unselected cohort of patients attending a Genito-Urinary Medicine (GUM) clinic. Study design: The excretion of BKV and JCV DNA in multiple urine samples from HIV-infected patients at different stages of disease and their HIV-negative partners, and in single samples from a cohort of patients at a GUM clinic was investigated. A microplate hybridisation method was developed to increase both the sensitivity and specificity of detection of the PCR product. The method was also applied to estimate the DNA copy numbers of BKV and JCV in urine samples. Results: Within the HIV group, the level of immunosuppression (CD4+ category) was not associated with JCV viruria. By contrast, there was a modest correlation between immunodeficiency as indicated by a decline in CD4+ count and BKV viruria. Shedding of both BKV and JCV DNA together in urine samples of HIV-infected patients was much higher than in control groups (P=0.02), indicating that HIV infection may associate with polyomavirus reactivation. The incidence of flu-like syndrome was much higher in HIV-infected asymptomatic individuals than acquired immunodeficiency syndrome (AIDS)-related complex (ARC)/AIDS patients. In general, the concentration of BKV DNA viruria (DNA copy number) was dependent to CD4+ counts (P=0.008) while concentration of JCV DNA was independent to CD4+ cell count (P=0.54). The prevalence of BKV and JCV DNA in patients who were infected with C. trachomatis was 9/50 (18%) and 11/50 (22%), respectively. BKV and JCV DNA was detected in 3/19 (15%) and 2/19 (10%) of patients who were infected with N. gonorrhoea. Results suggested that persons infected with C. trachomatis were more likely to show BKV and JCV viruria. Conclusion: These results confirm that shedding of BK and JC viruses in urine is not exclusively found in immunosupression, it may also occur in healthy individuals. The frequency of virus excretion is however, apparently increased in HIV-infected patients, although no firm statistical difference could be established. One of the interesting aspects of these findings was the relatively high incidence of BKV and JCV viruria in both control groups, i.e. HIV-negative partners of HIV-infected patients and patients attending a GUM clinic.

Effect of a recombinant HIV gpl60 vaccine on monokine production

An investigation was undertaken to determine whether a recombinant gp160 envelope protein, which is currently being evaluated as a vaccine for AIDS, induces or modulates the production of tumour necrosis factor-alpha (TNF-alpha) or interleukin-1 beta (IL-1 beta). Incubation of monocytes from healthy, HIV-seronegative persons with 0.0001-1.0 micrograms of the recombinant vaccine did not result in the secretion of TNF-alpha or IL-1 beta, nor did the recombinant product augment or suppress monokine production by lipopolysaccharide (LPS) stimulated monocytes. The vaccine was also without a stimulatory or modulatory effect upon TNF-alpha or IL-1 beta secretion by monocytes from a patient with the AIDS-related complex (ARC) and from the monocytic THP-1 cell line. The lack of effect of gp160 on monokine production has important implications for its efficacy as a vaccine for AIDS.

Actuarial rate of clinical and biological progression in a cohort of 250 HIV-1-seropositive subjects

This study was undertaken to define the risk of AIDS in a cohort of 250 HIV-seropositive patients identified by their clinical and biological status. All patients were enrolled between October 1985 and March 1988. They were classified according to clinical classes A, asymptomatic (n = 97); B, lymphadenopathic (n = 123); and C, AIDS-related complex, (n = 30). Also as CD4 cell stages 1 (CD4 greater than or equal to 600/microliters; n = 126); 2 (CD4 less than 600 and greater than or equal to 300/microliters; n = 83); and 3 (CD4 less than 300/microliters; n = 41); and serum p24 antigen positive (n = 48) or negative (n = 202). All patients were evaluated every 3-6 months, until AIDS development or April 1989: 29 cases of AIDS occurred during the follow-up period. The risk of AIDS in class C is very high (64% at 2 years) compared with the 3-year risk of classes A (13%) and B (25%). On the other hand the three CD4 stages have significantly different prognosis (stage 1 6%; stage 2 22%; and stage 3 89%; P less than 10(-2]. Antigen p24 negative and positive patients have also different prognosis (18% and 53%; P less than 10(-4]. Interestingly, p24 antigen conserved its prognostic value in stage 2 (positive 37%, negative 16%) while stages 1 are at low risk of AIDS and stages 3 at high risk whatever their p24 antigen status. We have also identified the risk of becoming stage 3 and/or p24 antigen positive in p24 antigen negative patients at stages 1 and 2 (respectively, 18% and 47%). This classification should serve to design randomized trials better with experimental drugs with earlier end-points than AIDS onset.

T activation marker evaluation in ARC patients treated with AZT. Comparison with CD4+ lymphocyte count in non-progressors and progressors towards AIDS

Reductions in the percentage and absolute number of CD4+ lymphocytes, as well as abnormally high levels of activated peripheral T lymphocytes (CD3+ HLA-DR+ phenotype) and an increased proportion of CD8+ cells coexpressing the CD57 surface antigen (involved in natural killer activity) have been reported in HIV infection and associated with disease progression. We prospectively measured these subsets of lymphocytes in 34 patients with advanced AIDS-related complex (ARC) treated with azidothymidine (AZT). Peripheral blood lymphocyte phenotyping was performed before treatment, then at weeks 12 and 24. A striking fall in the proportion of activated T lymphocytes from baseline was observed (P less than 0.001) at week 24. In contrast, the percentage of CD4+ cells showed a slight and transient rise at week 12 (P less than 0.05). No modification in levels of CD8+ or CD8+ CD57+ cells was detected during the study. Of the 34 patients, 11 developed AIDS, and 23 remained AIDS-free during 51 weeks of follow-up. Similar patterns of change in CD4+ and HLA-DR+ CD3+ lymphocytes were found in the AIDS progressors and nonprogressors. Likewise, HIV p24 antigenaemia showed parallel decreases in both groups of patients. Although changes in CD4+ cells, p24 antigenaemia and HLA-DR-reactive T lymphocytes were not predictive of clinical outcome, large differences existed between the two groups prior to the initiation of therapy. The short-term onset of AIDS was associated with lower CD4+ cell numbers, higher levels of serum p24 antigen and a greater proportion of activated T lymphocytes. Our results suggest that the possible interest of T lymphocyte activation markers, in conjunction with conventional phenotyping, should be investigated further.

Do Positive Psychosocial Factors Predict Disease Progression in HIV-1? A Review of the Evidence

Adding to a traditional stress perspective, behavioral medicine has been focusing increasingly on investigating the potential impact of positive psychosocial factors on disease course in HIV. Dispositional optimism, active coping, and spirituality show the most evidence for predicting slower disease progression, although the data are not entirely consistent. Findings for the role of social support are mixed, although indications are that it may be particularly helpful at later stages of illness. Many of the other constructs (positive affect, finding meaning, emotional expression/processing, openness, extraversion, conscientiousness, altruism, and self-efficacy) have only been examined in one or two studies; results are preliminary but suggestive of protective effects. Plausible behavioral and biological mechanisms are discussed (including health behaviors, neurohormones, and immune measures) as well as suggestions for clinicians, limitations, future directions, and a discussion of whether these constructs can be changed. In conclusion, investigating the importance and usefulness of positive psychosocial factors in predicting disease progression in HIV is in its beginning scientific stages and shows good initial evidence and future promise.

Zidovudine induced bone marrow toxicity: a case report

The treatment of patients with AIDS and AIDS-related complex (ARC) with azidothymidine (Zidovudine) is limited by its major haematological toxicity. This is manifested as anaemia, granulocytopenia and bone marrow aplasia/hypoplasia. Zidovudine, a nucleoside reverse transcriptase inhibitor (NRTI), is one of the earliest antiretroviral agents used as a combination in the highly active antiretroviral therapy (HAART) for the treatment of HIV infection. We report a case of anaemia with bone marrow hypoplasia with a view to suggesting the need for adequate haematological evaluation and adherence to national HIV treatment guidelines in the initiation of HAART. Keywords: Zidovudine, Pure Red Cell Aplasia, Bone Marrow Hypoplasia.Highland Medical Research Journal Vol. 5 (1) 2007 pp. 98-100

Trichosporon asahii infection in an advanced AIDS patient and literature review

Trichosporon asahii infection in an advanced AIDS patient and literature review