Asymptomatic Human Immunodeficiency Virus Research Articles

The impact of asymptomatic human immunodeficiency virus (HIV)-positive disease status on inpatient complications following total joint arthroplasty: a propensity score-matched analysis.

The number of patients with asymptomatic human immunodeficiency virus (AHIV) is increasing as the efficacy of antiretroviral therapy improves. While there is research on operative risks associated with having HIV, there is a lack of literature describing the impact of well-controlled HIV on postoperative complications. This study seeks to elucidate the impact of AHIV on postoperative outcomes after total hip (THA) and knee (TKA) arthroplasty. The Nationwide Inpatient Sample was retrospectively reviewed for patients undergoing TKA and THA from 2005 to 2013. Subjects were subdivided into those with AHIV and those without HIV (non-HIV). Patient demographics, hospital-related parameters, and postoperative complications were all collected. One-to-one propensity score-matching, Chi-square analysis, and multivariate logistical regressions were performed to compare both cohorts. There were no significant differences between AHIV and non-HIV patients undergoing TKA or THA in terms of sex, age, insurance status, or total costs (all, p ≥ 0.081). AHIV patients had longer lengths of stay (4.0days) than non-HIV patients after both TKA (3.3days) and THA (3.1days) (p ≤ 0.011). Both TKA groups had similar postoperative complication rates (p > 0.081). AHIV patients undergoing THA exhibited an increased rate of overall surgical complications compared non-HIV patients (0 vs. 4.5%, p = 0.043). AHIV was not associated with increased complications following both procedures. Despite lengthier hospital stays among AHIV patients, baseline AHIV was not associated with adverse outcomes following TKA and THA. This adds to the literature and warrants further research into the impact of asymptomatic, well-controlled HIV infection on postoperative outcomes following total joint arthroplasty.

HIV AND SYPHILIS CO-INFECTION IN NORTHEAST BRAZIL: A GENDER ASSESSMENT

Introduction: The human immunodeficiency virus (HIV) and syphilis co-infection is highly common, especially in Brazil, which recorded a high number of cases in 2020. Due to its high prevalence and morbidity, this study aimed to determine the frequency and the clinical-epidemiological profile of HIV and syphilis co-infection between genders in specialized care services in Northeast Brazil. Methods: An analytical cross-sectional study was conducted with secondary data from 171 individuals with HIV and syphilis co-infection. Data were collected in a reference center for acquired immunodeficiency syndrome (AIDS) in Northeast Brazil from 2015 to 2020. Welch’s test compared the means of independent samples; the chi-square and Fisher’s exact test assessed the association between categoric variables. The significance level was set at 5%. This study has ethical approval. Results: The HIV and syphilis co-infection frequency was 15.4%. Individuals with co-infection had a mean age of 34.2 (± 11.0) years and were predominantly men. The women sample started their sex life earlier, had a lower education level and per capita family income, used more illicit drugs, and were mostly heterosexual, married or in a stable union, and unemployed. Men had more anal sex. Moreover, most individuals had syphilis in the asymptomatic phase and HIV with undetectable viral load; CD4 T cells were greater than 350 cells/mm³. Conclusion: The high prevalence of HIV and syphilis co-infection in specialized care services, especially in MSM, highlights the need to improve counseling to reduce sexual risk behavior and improve prevention and care strategies to control these diseases.

High resting energy expenditure, less fat-free mass, and less muscle strength in HIV-infected children: a matched, cross-sectional study.

Many improvements have been made in the treatment of human immunodeficiency virus (HIV) in pediatric patients; however, challenges remain in terms of achieving normal growth, body composition, and metabolism during treatment, etc. Current nutritional recommendations are based on studies performed in adults, with limited data on the HIV-infected pediatric population. Therefore, this study aimed to compare the resting energy expenditure (REE) of asymptomatic HIV-infected pediatric patients with healthy counterparts and to compare body composition, dietary intake, and physical activity between the two groups. This was a cross-sectional study of asymptomatic HIV-infected children who were receiving antiretroviral therapy; the infected group was compared with the uninfected group, matched by age (± 6 months), sex, and body mass index (± 0.5 z-score). Participants were recruited between 2021 and 2022, as outpatients. In both groups, REE was determined by indirect calorimetry and body composition by bioelectrical impedance analysis and hand strength, measured using a hydraulic hand dynamometer. Seventy-eight participants were enrolled, where n = 39 HIV-infected children and n = 39 controls, with a mean age of 11.6 ± 3.4 years old. REE was significantly higher in the HIV group (1254.4 ± 334.7 kcal/day vs. 1124.7 ± 321 kcal/day, p = 0.013) than in the control group. Fat-free mass (FFM) was lower in the HIV group (28.2 ± 10.5 kg vs. 32 ± 11.2 kg, p = 0.001); this trend continued when the index skeletal muscle was evaluated (7.2 ± 1.2 vs. 7.6 ± 1.5, p = 0.04). The strength of the dominant hand was also lower in the HIV group (12 (8-18) kg vs. 20 (10.5-26) kg, p < 0.0001). Children with asymptomatic HIV infection have higher REE than their uninfected peers. They also present decreased FFM, skeletal muscle mass index, and muscle strength. These parameters should be considered during nutritional assessment in this population to have a favorable impact on nutritional status and growth.

DENSIDAD MINERAL ÓSEA BAJA EN VARONES JÓVENES CON INFECCIÓN ASINTOMÁTICA POR EL VIRUS DE LA INMUNODEFICIENCIA HUMANA EN TRATAMIENTO ANTIRRETROVIRAL

The aim of this study was determine the frequency of low bone mineral density (BMD) in young men with asymptomatic Human Immunodeficiency Virus (HIV) infection on antiretroviral therapy for less than 2 years, as well as to compare the frequency of low and normal BMD according to antiretroviral treatment (ART) scheme and level of physical activity. 39 young men with asymptomatic HIV infection and ART less than 2 years were included. A bone densitometry was performed, and the following areas were evaluated: lumbar spine, left femoral neck and total left hip. 12 patients (31%) with low BMD and 27 patients (69%) with normal BMD were found. No differences were found between patients with normal and low BMD according to type of ART and level of physical activity. The frequency of low BMD is high in young men with asymptomatic HIV infection under antiretroviral treatment for less than 2 years.

Gender-Based Comparison of Anthropometric and Hematological Parameters in Asymptomatic HIV Subjects at Nnamdi Azikiwe Teaching Hospital (NAUTH), Nnewi, Anambra State, Nigeria

Human Immunodeficiency Virus (HIV) has posed a severe global issue with over thirty years of its epidemic. Nigeria is one of the African countries with higher number of HIV cases with over 1,700,000 cases in 2022. 43 adult female and 57 adult male asymptomatic HIV subjects, aged 18-65 years were randomly recruited at the voluntary counselling and Testing (VCT) Centre Nnamdi Azikiwe University Teaching Hospital (NAUTH) Nnewi. The anthropometric parameters such as Body Mass Index (BMI), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), and the hematological parameters such as CD4+ cell count, Packed Cell Volume (PCV), Erythrocyte Sedimentation Rate (ESR), Hemoglobin (Hb), and Absolute Neutrophil (Ab.neu) were analyzed using routine laboratory analyses. The data were analyzed using Statistical Product and Service Solution (SPSS) version 21, independent Students’-test and one way analysis of variance (ANOVA) were used to compare means. The SBP and DBP were significantly elevated in the female asymptomatic HIV subjects than in the male asymptomatic HIV subjects with p&lt;0.05. There was no significant difference in the values of BMI, CD4+, WBC, ESR, Hb, and Ab.neu among the female and male asymptomatic HIV subjects with p&gt;0.05. In conclusion, there are no difference in the hematological parameters.

Intrinsic Apoptotic Pathway Genes of Circulating Blood Neutrophils Triggered during HIV Infection and Remained Stimulated in ART Patients.

The intrinsic apoptotic pathway of neutrophils in Human Immunodeficiency Virus (HIV) infection results in spontaneous neutrophil death. There is a scarcity of data regarding the gene expression of an intrinsic apoptotic pathway of neutrophils in HIV patients. The objective of this study was to observe the differential expression of some important genes involved in the intrinsic apoptotic pathway of HIV patients, including those who were receiving antiretroviral therapy (ART). Blood samples were collected from asymptomatic, symptomatic, HIV, ART receivers HIV patients, and healthy individuals. Total RNA was extracted from neutrophils and subjected to quantitative real-time PCR assay. CD4+T cells and an automated complete blood count were performed. Among the asymptomatic, symptomatic, and ART receivers HIV patients (n=20 in each group), median CD4+T counts were 633, 98, and 565 cells/ml, and the length of HIV infection in months (±SD) was 24.06±21.36, 62.05±25.51, and 69.2±39.67, respectively. Compared with healthy controls, intrinsic apoptotic pathway genes, i.e., BAX, BIM, Caspase-3, Caspase-9, MCL-1, and Calpain-1, were upregulated to 1.21±0.33, 1.8±0.25, 1.24±0.46, 1.54±0.21, 1.88±0.30, and 5.85±1.34 fold in the asymptomatic group, and even more significantly, i.e., 1.51±0.43, 2.09±1.13, 1.85±1.22, 1.72±0.85, 2.26±1.34, and 7.88±3.31 fold in symptomatic patients, respectively. Despite CD4+ T-cell levels increased in the ART receiver group, these genes did not approach the level of healthy or asymptomatic and remained significantly upregulated. The genes involved in the intrinsic apoptotic pathway in circulating neutrophils during HIV infection were stimulated in vivo, and ART reduced the expression of those upregulated genes but did not return to the level of asymptomatic or healthy individuals.

Estimation of Serum Levels of AST, LDH, CKMB AND TCK Among HIV Patients on HAART, HAART Naïve and Controls

Human Immunodeficiency virus (HIV) infection is associated with increased of developing heart disease. Information on the cardiac status of HIV-infected Nigerians is lacking. HIV/AIDS infection is a global pandemic and poses a serious health challenge in sub-Saharan Africa, Nigeria inclusive. The cardiac disease may occur at any stage of HIV infection, but important manifestations are more frequent with advanced immunodeficiency. Moreover, it has been reported that complications from HIV infection include arrhythmias, heart failure myocardial infarction and coronary heart disease. This study aimed to estimate serum levels of AST, LDH, CKMB and TCK among HIV patients on HAART, HAART naïve and controls subjects attending Bauchi State Tertiary hospital, Nigeria. The results showed that the mean serum total Creatine kinase, CK-MB, LDH and AST were significantly higher in HIV participants not on HAART compared with HIV participants on HAART at P&lt;0.05 respectively. Similarly, the mean serum total Creatine kinase, CK-MB, LDH and AST were significantly higher in symptomatic HIV participants not on HAART compared with HIV seronegative control subjects at P&lt;0.05 in each case. Once again, the mean serum total Creatine kinase, CK-MB, LDH and AST were significantly higher in asymptomatic HIV participants compared with HIV seronegative control subjects at P&lt;0.05 respectively. Increased levels of some cardiac markers were seen in HIV-infected participants. The study reveals that there is a need to monitor these parameters to prevent sudden cardiovascular complications in HIV seropositive patients. Hence, it is recommended that more investigations need to be carried out to further evaluate the levels of CK-MB (cardiac-specific) isoenzyme of CK and other cardiac biomarkers such as troponins I and T, and myoglobin, among others.

Human Immunodeficiency Virus Status Does Not Independently Predict 2-Year Complications Following Total Knee Arthroplasty.

With improved treatment for human immunodeficiency virus (HIV), the demand for total knee arthroplasty (TKA) in this population has increased. Studying the relationship between HIV and postoperative complications following TKA will allow orthopaedic surgeons to accurately assess their patients' surgical risk and provide appropriate counseling. This study aims to understand how HIV impacts surgical and medical complications following TKA for osteoarthritis (OA). Patients identified in a national insurance database who underwent TKA for OA from 2010 to 2019 were divided into three cohorts: no HIV, asymptomatic HIV, and acquired immunodeficiency syndrome (AIDS). Univariate and multivariable regression analyses were performed to determine 90-day postoperative complications as well as 2-year surgical complications (revision surgery, prosthetic joint infection, aseptic loosening, and manipulation under anesthesia). A total of 855,373 patients were included, of whom 1,338 had asymptomatic HIV and 268 had AIDS. After multivariable regression analysis, patients with HIV had no difference in 2-year surgical complications relative to the control cohort. Within 90 days postoperatively, patients with asymptomatic HIV had increased odds of arrhythmia without atrial fibrillation and lower odds of anemia. Patients with AIDS had increased odds of anemia and renal failure. Patients with HIV and AIDS are at an increased risk for developing 90-day medical complications and 2-year surgical complications. However, after accounting for their comorbidities, the risk of 90-day complications was only mildly increased and the risk of 2-year surgical complications approximated the control cohort. Surgeons should pay particular attention to these patients' overall comorbidities, which appear to be more closely associated with postoperative risks than HIV status alone. Level of evidence: III.

KORUNMASIZ CİNSEL İLİŞKİ SONUCU ÜRETRİT TANISI ALAN SÜNNETLİ HASTALARDA ASEMPTOMATİK HIV, HEPATİT B, HEPATİT C VE SİFİLİZ GÖRÜLME SIKLIĞI

Aim: In this study, it was aimed to determine the frequency of asymptomatic Human Immunodeficiency Virus (HIV), Hepatitis B, Hepatitis C, and syphilis in circumcised patients diagnosed with urethritis transmitted by sexual intercourse because of unprotected sexual contact. Material and Methods: We retrospectively investigated the serological results of HIV, Hepatitis B, Hepatitis C, and Syphilis diseases in 364 male patients diagnosed with urethritis, all of them were circumcised during childhood. The study included patients who applied to the urology outpatient clinic of secondary state hospital between January 2017 and December 2019 with symptoms or signs of urethritis. In the examination, only urethral discharge could be seen without symptoms. After the patients were examined, first void urine samples were taken. Also at the first examination, peripheral blood samples were tested for HIV, Hepatitis B, Hepatitis C, and syphilis antibodies. Results: As a result of retrospective screening of the serological results of 364 male patients diagnosed with urethritis, Hepatitis B positivity was 1.09% with 4 cases, Hepatitis C positivity was found as 0.27% in 1 case and the Syphilis positivity rate was 1.92% with 7 cases in 364 patients. None of the patients had HIV positivity. Conclusions: The fact that there was not any encounter of HIV-positive patients in patients diagnosed with urethritis because of unprotected sexual contact led to the thought that circumcision had a protective contribution in these patients with urethritis, who were all circumcised. Also, screening tests, especially syphilis, should be performed on all patients diagnosed with STI infection.

Impact of Human Immunodeficiency Virus on Postoperative Outcomes following Osteonecrosis-Indicated Total Hip Arthroplasty

AbstractOsteonecrosis (ON) of the femoral head in human immunodeficiency virus (HIV)-positive patients is often treated with total hip arthroplasty (THA). The purpose of this study was to determine the effect that HIV positive status and acquired immunodeficiency syndrome (AIDS) have on postoperative complication rates and outcomes in patients with ON treated with THA. Patients who underwent primary ON-indicated THA with a minimum of 2-year follow-up were identified in a national database (PearlDiver Technologies) using Current Procedural Terminology and International Classification of Diseases codes. These patients were stratified into two cohorts: those who were HIV-positive and those who were HIV-negative (control). The HIV-positive cohort was further stratified into those with AIDS and those with asymptomatic HIV at the time of THA. Univariate and multivariate analyses were conducted to determine associations between the three cohorts and their 90-day, and 2-year outcomes were each compared with HIV-negative patients. In this study, 1,163 patients were in the HIV-positive cohort and 34,288 were in the HIV-negative cohort. In the HIV-positive cohort, there were significantly higher 90-day rates of renal failure (odds ratio [OR] = 1.874; p &lt; 0.001), pneumonia (OR = 1.682; p = 0.002), and sepsis (OR = 1.975; p &lt; 0.001). The asymptomatic HIV cohort and AIDS cohort followed similar associations as the HIV cohort; however, the AIDS cohort also had significantly higher rate of blood transfusion (OR = 1.692; p = 0.012) and deep vein thrombosis (OR = 1.765; p = 0.036). HIV infection, whether symptomatic or not, and AIDS are associated with a higher risk of short-term complications after THA. Physicians must consider this risk and discuss with their patients to reduce future complications.

Congenital and Placenta Malaria and Newborn Birth Weight in Asymptomatic HIV Positive Pregnant Women at Term

Background: Human Immuno-deficiency Virus (HIV) and Malaria infection independently are major contributors to adverse perinatal outcomes in sub-Saharan Africa. A co-infection of both in pregnancy has been associated with more deleterious birth weight- related neonatal outcomes. We assessed for congenital malaria and evaluated the birth weights of babies born to HIV positive mothers with and without evidence of placenta malaria at term delivery. Methods: This was a comparative cross-sectional study in which 90 low-risk, HIV positive pregnant women on highly active retroviral therapy (HAART), asymptomatic for malaria, with uncomplicated delivery, at the Lagos State University Teaching Hospital, were consecutively recruited to have their maternal venous, placenta and newborn blood samples assessed following delivery for malaria. A placenta biopsy was also done to assess for features of placenta malaria. Data obtained were expressed in frequencies and percentages and variables were tested as appropriate using an independent t-test, chi-square and spearman’s correlation. The level of significance was set at p&lt;0.05. Findings: The prevalence of placenta malaria and congenital malaria in the study was 11.1% and 0.0% respectively. Only 3.3% of the asymptomatic HIV positive, pregnant women at delivery had positive malaria tests of their venous blood samples. The mean neonatal packed cell volume at birth for women with and without placenta malaria was 43.6% and 44.9% respectively (p=0.044). The mean birth weight of the babies born to HIV positive women with and without placenta malaria was 2.7±0.2kg and 3.0±0.4kg respectively (p=0.008). The correlation between birth weight and CD4 count was positive but insignificant (r=0.069, p=0.515). Conclusion: Although, irrespective of placenta malaria status, congenital malaria is a rarity in babies of HIV positive pregnant women, the birth weight and packed cell volume of babies born to HIV positive women is significantly lower in this group of women with features of placenta malaria than in women without placenta malaria.

Association of Micronutrients with Tuberculosis Development in HIV Infected Patients.

Human immunodeficiency virus (HIV) infection associated with weakened immune system due to decreased CD4 T cell count favors development of tuberculosis. Effector immune responses are also associated with micronutrient status due to their prominent role in maintaining immune functions. Micronutrient deficiencies are quite common among HIV patients that further result into compromised immunity thus making the conditions even more favorable for mycobacteria to establish disease. So, current study was designed to assess association of different micronutrients with development of TB in HIV patients. Micronutrient levels were measured in asymptomatic HIV patients who were monitored for the development of TB during follow up period (incident TB) within one month to one year and also in symptomatic microbiologically confirmed HIV-TB patients. Among various micronutrients assessed, levels of ferritin were found to be significantly increased (p < 0.05) with significant decreased zinc (p < 0.05) and selenium (p < 0.05) levels in incident TB group as well as in HIV-TB subjects compared to asymptomatic HIV patients who did not develop TB in the follow up period. Importantly, increased levels of ferritin and decreased levels of selenium were significantly associated with development of tuberculosis in HIV patients.

Seronegative Infection with Toxoplasma gondii in Asymptomatic Human Immunodeficiency Virus Type 1 (HIV-1)-Infected Patients and in Blood Donors.

Background: Toxoplasmosis is a common opportunistic infection in AIDS patients. The routine diagnostics is based on serologic testing and IgG avidity index, but it may have limited utility in immunodeficient patients; thus, it is recommendable to detect T. gondii DNA in subjects with advanced HIV disease. The results of the studies published so far focused on patients with clinical symptoms of toxoplasmosis. Our study encompassed a group of HIV-infected subjects on cART therapy, without immunological disturbances and clinical symptoms of T. gondii infection. Methods: The study was retrospective, and samples were collected between 2013 and 2016. We evaluate the prevalence of serological (IgM, IgG, and avidity IgG) and molecular (DNA) T. gondii infection markers in asymptomatic HIV-infected patients and the control group using serologic (ELISA) and quantitative (real-time PCR) molecular testing. Results: Of 152 HIV-infected in routine follow-up tested for T. gondii IgM and IgG, 6 (3.9%) and 50 (32.9%) were positive, respectively. Of 168 serum samples from blood donors, 1 (0.6%) and 49 (29.2%) were IgM+ and IgG+ positive, respectively. IgM seroprevalence in HIV-infected patients was significantly higher than in blood donors. T. gondii DNA (genotype II) was identified in 47 (30.9%) HIV-infected patients, with 13 (8.6%) IgM−IgG− samples. In blood donors, T. gondii DNA was present in 15 (8.9%) IgM−IgG−. Conclusions: In both groups, T. gondii DNA was detectable in seronegative subjects, implying the need to supplement the routine serological testing via the molecular method. It can help the accurate monitoring of the reactivation of infection in asymptomatic HIV-infected persons, and the quick introduction of specific therapy, in blood donors, would be of high importance for safe blood donations.

Impact of human immunodeficiency virus on 2-year revision rates following lumbar fusion for degenerative spinal conditions: a retrospective cohort study.

To our knowledge, no studies exist that evaluate the impact of human immunodeficiency virus (HIV) on long-term revision rates following lumbar fusion. This study aims to understand how HIV impacts 2-year revision rates and 90-day postoperative complication rates following primary lumbar fusion for degenerative spine conditions. Data collection was done using PearlDiver Patient Records Database, a national insurance database from 2010-2019. Patients who underwent primary lumbar fusion for degenerative diseases were divided into a cohort of patients that are HIV positive (HIV), have asymptomatic HIV (AHIV), acquired immune deficiency syndrome (AIDS), and HIV-negative at the time of their procedure. Univariate and multivariable regression analyses were performed to determine rates of revision surgery, surgical site infection (SSI), neurological complications, sensory deficits, bowel/bladder dysfunction and myelopathies within two years of surgery as well as 90-day postoperative complications. In total, 216,587 patients were included in this study. Of these, 631 patients (0.29%) had HIV including 502 patients (0.23%) with asymptomatic HIV and 129 patients (0.06%) with AIDS. Relative to the control cohort, patients with HIV had no difference in odds of two-year revision surgery, SSI, neurological complications, sensory deficits, bowel/bladder dysfunction and myelopathies. Patients with HIV did have increased odds of postoperative pneumonia (OR 1.592; 95% CI: 1.048-2.314; P=0.021). AIDS patients had greater odds of respiratory complications (OR 2.585; 95% CI: 1.075-5.264; P=0.017) and septic complications (OR 2.702; 95% CI: 1.122-5.514; P=0.013) 90-day postoperatively. Our study found that HIV positive status did not significantly affect two-year revision rates compared to the control group. However, there is a higher rate of pneumonia and respiratory complications among HIV positive patients. Before deciding to proceed with surgical intervention in HIV positive individuals, surgeons must carefully consider each patient's specific diagnosis, comorbidities, and risk factors.

Asymptomatic Human Immunodeficiency Virus-1 Infection with High CD4+ T Cell Count Does Not Alter Iron Metabolism or Hepcidin Levels: The Pilot Study

IntroductionThe purpose of the study was to assess hepcidin levels and iron metabolism in otherwise healthy human immunodeficiency virus-1 (HIV-1)-infected males and the influence of antiretroviral therapy on hepcidin production, as data in this group are scarce.MethodsA total of 89 HIV-1-infected males, 42 on effective antiretroviral therapy (ART)—group A, 47 treatment-naïve—group B, and 27 healthy controls—group C, were enrolled. Erythrocytes parameters, iron metabolism parameters, hepcidin, highly sensitive C-reactive protein (hsCRP), interleukin 6 (IL-6), and soluble transferrin receptor (sTfR) levels were assessed. Conditions related to inflammatory activity, systemic metabolic diseases and iron supplementation were exclusion criteria. Convenience sampling was used.ResultsMedian age in HIV-1 group was 33 years, and 27 years in the control group. Median CD4+ T-cell count was 724 cells/μl in group A, and 488 cells/μl in group B (p = 0.0000). Nadir CD4+ T-cell count was 397 cells/μl in group A and 475 cells/μl in group B (p = 0.0001). Median value of HIV-1 viral load (VL) in group B was 16 900 copies/mL. The hepcidin value was lower in group A than in groups B (p = 0.0008) or C (p = 0.0004), without differences between groups B and C. The hepcidin value correlated with ferritin in groups A (r2 = 0.16; p = 0.008) and B (r2 = 0.39; p = 0.000), but not in group C (r2 = 0.11; p = 0.09). In group A, the hepcidin value correlated with current CD4+ count (r = 0.48, p = 0.0012), but there was no correlation in group B. There were no correlations of hepcidin values with CD4+ T cell nadir in group A (p = 0.371) or in group B (p = 0.477); ART period (p = 0.614); VL in group B (p = 0.71). No abnormalities of iron metabolism, hsCRP, IL-6, or sTfR were noted.ConclusionsAsymptomatic HIV-1 infection does not cause clinically important iron metabolism alterations or increased hepcidin production. Hepcidin values decrease on effective antiretroviral therapy.

Symptomatic human immunodeficiency virus infection is associated with advanced presentation and perioperative mortality in patients undergoing surgery for peripheral arterial disease

ObjectivePrior studies have demonstrated an increased risk of developing cardiovascular and peripheral arterial disease (PAD) in patients with human immunodeficiency virus (HIV). However, the effect of chronic HIV infection in patients with preexisting PAD and requiring vascular intervention is unclear. In the present study, we assessed the differences in clinical presentation and perioperative outcomes for patients with PAD who had undergone revascularization or amputation with and without HIV infection. MethodsInternational Classification of Diseases, 9th and 10th Revisions, Clinical Modification, codes were used to identify patients with a prior diagnosis of PAD who had undergone lower extremity revascularization or amputation in the National Inpatient Sample (2003-2017). From this group, the patients were divided for analysis into those with and without HIV infection. Of the patients with HIV infection (PWHs), we identified additional subsets of patients: those with any prior or current diagnosis of an HIV-related illness, including acquired immunodeficiency syndrome, designated as symptomatic HIV, and those without such a diagnosis, designated as asymptomatic HIV infection. Propensity score matching was performed to create matched cohorts. Population-based comparative analyses were performed of the clinical characteristics of the HIV-infected and HIV-uninfected groups. Univariate and multivariate logistic regression analyses of the perioperative in-hospital outcomes were performed on the matched cohorts. ResultsA total of 224,912 patients aged 18 to 85 years were identified who had been admitted with an established diagnosis of PAD and had undergone a lower extremity procedure. Of these patients, 1264 (0.56%) also had a diagnosis of HIV infection. Symptomatic PWHs were more likely to present with critical limb ischemia than were the HIV-uninfected patients or asymptomatic PWHs (66.2% vs 46.3% and 43.6%; P < .01). However, both asymptomatic and symptomatic PWHs were more likely to have required minor (7.5% and 6.7% vs 2.6%; P < .01) and major (12.9% and 27.4% vs 7.0%; P < .01) amputations than were matched HIV-uninfected controls. Although adjusted multivariate logistic regression analysis demonstrated symptomatic HIV infection to be a significant, independent predictor of in-hospital mortality (odds ratio, 2.46; 95% confidence interval, 1.37-4.40; P = .003), the perioperative mortality for the asymptomatic PWH was comparable to that of matched HIV-uninfected controls. ConclusionsSymptomatic PWHs, including patients living with acquired immunodeficiency syndrome, who had required a PAD-related procedure had presented with more advanced vascular disease and were most at risk of early perioperative mortality. However, the presentation and mortality between asymptomatic PWHs with well-controlled disease and HIV-uninfected patients were comparable. All PWHs with PAD were more likely to undergo lower extremity amputations than were HIV-uninfected matched controls. Asymptomatic, well-controlled HIV infection should not be a contraindication to elective PAD-related procedures because the mortality was similar to that of HIV-uninfected controls. However, the limb salvage rates might be lower for all PWHs with PAD, regardless of HIV disease severity. Taken together, these findings can improve perioperative risk stratification and surgical management of PAD in this high-risk population.

HIV Pozitif Kişilerde Cinsel Yolla Bulaşan Etkenlerin Sıklığı

Objective: Sexually transmitted infections are frequently seen and significant infections for public health. Prevention, early diagnosis and treatment of sexually transmitted infections have an important role in controlling the transmission of Human Immunodeficiency Virus (HIV). The investigation of the frequency of other sexually transmitted pathogens in asymptomatic HIV- positive individuals was aimed in the present study. Method: Vaginal and urethral swab samples were collected by 90 HIV- positive asymptomatic individuals themselves aged between 20-69 (median=36, SD=10.48) years, between September 2015 and April 2016. The samples were assessed for the presence of Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, Mycoplasma genitalium, Mycoplasma hominis, Ureaplasma urealyticum, Ureaplasma parvum, Herpes simplex virus type 1 and 2, and Human papillomavirus using real-time polymerase chain reaction (PCR) method. Results: At least one or more than one sexually transmitted pathogen was identified in 49 (54.4%) of 90 HIV-positive individuals. Human Papillomavirus was found in 31 (34.4%), Ureaplasma urealyticum in 20 (22.2%), Ureaplasma parvum in 15 (16.6%), Mycoplasma genitalium in 8 (8.8%), Mycoplasma hominis in 8 (8.8%), Neisseria gonorrhoeae in 5 (5.5%) and Chlamydia trachomatis in 2 (2.2%) individuals. Trichomonas vaginalis, Herpes simplex virus type 1 and 2 were not detected in any of the clinical specimens. Conclusion: Approximately 55% of 90 HIV- positive individuals were found to be positive for sexually transmitted pathogens, and . Human Papillomavirus was the most frequently detected pathogen. This condition reveals the necessity of screening even asymptomatic individuals for the presence of this pathogen. Studies are needed to increase awareness in our country on this issue.

Impact of the Human Immunodeficiency Viruses Status on Outcomes in Patients Hospitalized With Acute Pancreatitis: A Propensity-Matched Analysis.

We aimed to examine the clinical characteristics and outcomes of patients admitted for acute pancreatitis (AP) in the population with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS). The National Inpatient Sample from 2010 to 2014 was used to identify adult patients admitted with AP. Patients were grouped based on the HIV status. Primary outcomes were mortality, length of stay (LOS), disposition and total hospitalization charges. Secondary outcomes included acute kidney injury, septic shock, respiratory failure and pancreatic procedures. After matching and weighting, a total of 14,152 HIV-positive patients (6904 with AIDS and 7248 with asymptomatic HIV [aHIV]) with AP were identified. Acute pancreatitis with AIDS were associated with a higher rate of acute kidney injury, longer LOS, higher hospitalization charges, and less routine disposition compared with HIV-negative AP. Patients with aHIV had less septic shock, shorter LOS, and less hospitalization charges compared with HIV-negative patients and less respiratory failure, shorter LOS, and less hospitalization charges compared with AIDS patients. Patients admitted for AP with AIDS have worse outcomes. On the contrary, aHIV status was not only associated with better outcomes when compared with AIDS, but to HIV-negative status as well.

19. Does asymptomatic human immunodeficiency virus (AHIV)-positive status in patients undergoing spinal fusion for degenerative disc disease (DDD) increase risk for adverse postoperative outcomes?

BACKGROUND CONTEXT Considering rapidly advancing HIV care and medications, very little is reported regarding how HIV-positive patients with asymptomatic, well-controlled disease (AHIV) fare postoperatively following spinal fusion for degenerative disc disease (DDD). PURPOSE Evaluate the impact of AHIV status on postoperative outcomes in DDD patients. STUDY DESIGN/SETTING Retrospective review of the National Inpatient Sample (NIS) database. PATIENT SAMPLE Adult patients undergoing 2-3-level spinal fusion for DDD. OUTCOME MEASURES Frequency of postoperative medical, surgical, and total complications. METHODS The NIS was reviewed from 2005-13 to identify all ≥18-year-old patients who underwent 2- to 3-level spinal fusion for DDD. Subsequently, those diagnosed with AHIV (ICD V08) were identified and 1:1 propensity score-matched to patients without any HIV disease by age, sex, race, and insurance status. All other HIV diagnoses were excluded, as were surgical indications for other reasons. Univariate comparison of postop medical/surgical/total complications was performed. Multivariate logistic regressions identified independent predictors of these outcomes. RESULTS Included were 570 patients (n=285 each). Age, sex, race and insurance status were comparable between AHIV and no-HIV cohorts, as were length of stay (4 vs 3.8 days), total charges (97,194 vs $89,877), and in-hospital mortality (0.4 vs 0%), p>0.05. AHIV cohort experienced higher postoperative respiratory complications (4.3 vs 0.4%, p 0.05. Regression revealed that AHIV status was not a predictor for postoperative respiratory, medical, surgical, or total complications, all p>0.05. CONCLUSIONS Aside from respiratory complications, AHIV status did not adversely impact the overall perioperative course of DDD patients undergoing spinal fusion. This data highlights that control of active HIV infection to establish an asymptomatic status may be protective against poor outcomes in this patient population. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

MuSK Myasthenia Gravis in an HIV-infected Chinese old man successfully treated with pyridostigmine

MuSK Myasthenia Gravis in an HIV-infected Chinese old man successfully treated with pyridostigmine