Blood CD4 Count Research Articles

Comparison of three leukapharesis machines for harvest of stem cells for autologous transplantation: A prospective study.

8024Background: Collection efficiency (CE) of an apharesis machine refers to the proportion of cells passing through it that is harvested. A higher collection efficiency reduces the need for repeated apharesis sessions and is a good measure for comparison of individual machines. Methods: Patients who underwent first harvest after G-CSF mobilization between Jan 2014 and Sept 2015 were included in the study. G-CSF was given at 10mcg/kg/day for 4 days and harvest was started from d5. Peripheral blood CD34 (PBCD34) counts were enumerated on d4. The 3 apharesis machines used were Haemonetics MCS+, Fresenius Com.Tec and Cobe Spectra. Standard volume apharesis (2-3 times patient blood volume) with recommended MNC protocols were employed. CE (as%) is calculated as total number of CD34+ cells collected×10-4 divided by D4-PBCD34/µL×blood vol. processed (lt). Oneway ANOVA with post hoc analysis was used to compare CE of individual machines. Simple logistic regression was used to look for peri-apharesis factors which...

Rectal HSV-2 Infection May Increase Rectal SIV Acquisition Even in the Context of SIVΔnef Vaccination.

Prevalent HSV-2 infection increases the risk of HIV acquisition both in men and women even in asymptomatic subjects. Understanding the impact of HSV-2 on the mucosal microenvironment may help to identify determinants of susceptibility to HIV. Vaginal HSV-2 infection increases the frequency of cells highly susceptible to HIV in the vaginal tissue of women and macaques and this correlates with increased susceptibility to vaginal SHIV infection in macaques. However, the effect of rectal HSV-2 infection on HIV acquisition remains understudied. We developed a model of rectal HSV-2 infection in macaques in combination with rectal SIVmac239Δnef (SIVΔnef) vaccination and our results suggest that rectal HSV-2 infection may increase the susceptibility of macaques to rectal SIVmac239 wild-type (wt) infection even in SIVΔnef-infected animals. Rectal SIVΔnef infection/vaccination protected 7 out of 7 SIVΔnef-infected macaques from SIVmac239wt rectal infection (vs 12 out of 16 SIVΔnef-negative macaques), while 1 out of 3 animals co-infected with SIVΔnef and HSV-2 acquired SIVmac239wt infection. HSV-2/SIVmac239wt co-infected animals had increased concentrations of inflammatory factors in their plasma and rectal fluids and a tendency toward higher acute SIVmac239wt plasma viral load. However, they had higher blood CD4 counts and reduced depletion of CCR5+ CD4+ T cells compared to SIVmac239wt-only infected animals. Thus, rectal HSV-2 infection generates a pro-inflammatory environment that may increase susceptibility to rectal SIV infection and may impact immunological and virological parameters during acute SIV infection. Studies with larger number of animals are needed to confirm these findings.

Bone marrow manifestations in multicentric Castleman disease.

This study aimed to document the morphological and immunophenotypic features, and describe the diagnostic features of bone marrow (BM) involvement in human herpes virus 8 Multicentric Castleman disease (HHV8-MCD). BM trephine biopsy (BMTB) specimens from 28 patients were revisited. Samples were evaluated for expression of CD3, CD20, CD138, CD68R, glycophorin C, CD42b, HHV8-latency-associated nuclear antigen (LANA1), Epstein-Barr virus-encoded small RNA and light chains. Presence of significant numbers of HHV8-LANA1(+) lymphoid/plasmacytic cells, noted in 10/28 cases, was indicative of BM involvement and was associated with low CD4 and CD8 counts in peripheral blood. The characteristic morphological appearance of MCD seen in lymph nodes is a rare finding in BMTB. 4/5 cases with lymphoid aggregates were involved by MCD, whereas 6/23 cases without lymphoid aggregates were involved by MCD (P = 0·023). 9/18 cases with hypercellular marrow were involved by MCD, whilst only 1/8 cases with normo/hypocellular marrow showed involvement by MCD (P = 0·070). While 9/21 cases with increased marrow reticulin were involved by MCD, none of the cases with no increase in reticulin were involved by MCD (P = 0·080). Reactive plasmacytosis is a frequent finding. We conclude that bone marrow is involved in a significant proportion of patients with MCD (36%), and involvement can be identified by HHV8-LANA1 immunohistochemistry.

Thrombocytopenia during pregnancy in women with HIV infection receiving no treatment.

Background. Thrombocytopenia (TCP) complicates 5 - 8% of pregnancies. Most cases of TCP are gestational, and the condition is usually mild and occurs in the latter part of pregnancy. Apart from pregnancy-associated medical complications such as pre-eclampsia, HIV infection is a recognised cause of TCP, and a relatively high prevalence of TCP during pregnancy would be expected in a setting with a high antenatal seroprevalence of HIV. This was a sub-analysis of the data from a prospective trial in which the incidence of postpartum sepsis in HIV-infected women was compared with that in HIV-uninfected women. Women who were considered at low risk and eligible for vaginal delivery were recruited at 36 weeks' gestation, and followed up for 6 weeks after delivery. Full blood counts and CD4counts of HIV-infected women were obtained at baseline and repeated 6 weeks after delivery. The prevalence of TCP was 5.3% during pregnancy and 1.2% 6 weeks after delivery. The prevalence was similar among HIV-infected (6.0%) and HIV-uninfected women (4.7%) (p=0.292). Among the HIV-infected women, who were not receiving antiretroviral therapy (mean CD4 cell count of 453 cells/µL), there was no significant association between immunosuppression and the severity of TCP. Most of the TCP seen during pregnancy is of the gestational variety, and in this study HIV infection did not increase its prevalence or its severity.

Assessment of Blood CD4 Count and Antibiogram Profile of Bacteria Isolated from HIV Patients

In this study, the blood CD4 count and the bacterial profile in the stool of Human Immunodeficiency Virus (HIV) positive individuals attending Antiretroviral therapy (ART) clinic in a tertiary health institution in Ekiti State, Nigeria was investigated. In addition, the antibiogram of the bacterial isolates was also investigated. A total of 150 HIV patients was recruited for the study. Samples of their blood and stool were collected for the investigation. Their blood was used to determine their CD4 count using cytometry method while their stools were cultured on microbiological media and pure isolates were identified using standard microbiological techniques. The antibiogram of the isolates was determined using disk diffusion method. HIV negative individuals were used as control. The results showed that the CD4 count of HIV patients ranged from 5 to 1278 cells/mm3, while the most frequently encountered bacteria in their stool are Pseudomonas aeruginosa, Morganella morganii, Aeromonas sp, Enterococcus sp. and Lactobacillus sp. All these bacterial spp however are absent from the stool of the control subjects. Pathogenic bacteria such as Salmonella typhi [6 (40% and 4 (26%)], Shigella species [7 (41%) and 5 (28%)], Pseudomonas aeruginosa [3(37.5%) and 4(50%)] were prevalent among patients with CD4 count level 200-350 cellmm3 and 200 cell/mm3 respectively but are statistically insignificant (p>0.05). The isolated bacterial spp., were resistant to most of the conventional antibiotics tested and the resistance was plasmid mediated in 95.2% of the isolates. This study shows the importance of investigating associated bacterial pathogens in HIV patients and evaluating the antibiogram profile of such pathogens before prescribing antibiotics to such patients in order to checkmate bacterial infections that may complicate the infection.

Growth of Infants Born to HIV-Infected Women in Madurai, South India

Objective: To compare the growth patterns of HIV-infected and HIV-exposed, uninfected infants. Methods: Design: Prospective cohort study. Setting: Clinic of National Institute for Research in Tuberculosis, Madurai located in the Governement Rajaji Hospital (GRH) campus. Participants: Infants born to HIV-infected women in GRH, Madurai between January 2006 to October 2008. Infants were excluded if they were too ill, or had congenital abnormalities. Intervention: Baseline socio-demographic details and feeding patterns were recorded. Clinical assessment, anthropometric measurement, complete blood count, CD4 and CD8 counts and DNA PCR testing were performed. Anthropometric assessments and immunology profile were repeated once in 3 months till 24 months of age. Main outcome: Rate of change of weight and CD4% in HIV exposed and infected infants. Results: Of 76 infants enrolled, 25 were found to be HIV-infected by DNA PCR and fourteen of them died (11 before their first birthday). Weight gain in HIV-infected infants was 0.144 kg ((95% CI: -0.237, -0.051), P=0.003) less per month compared to negative infants, after adjusting for age, gender and feeding practice. Similarly, when compared to HIV negative infants, the decline in CD4 percentage was 3.1% ((95% CI: -4.735, -1.461), P<0.001) more in HIV positive infants. Changes in height, CD4 count, head circumference and haemoglobin were not associated with HIV status. Conclusion: Growth faltering occurs early in life in HIV-infected infants and its identification is important for developing appropriate treatment and nutritional management strategies. Mortality is high in the absence of early antiretroviral treatment.

T-lymphocyte subsets in lung transplant recipients: association between nadir CD4 T-cell count and viral infections after transplantation

BackgroundLittle is known about the kinetics of T-cell subsets in lung transplant recipients (LTR) and their association with the occurrence of opportunistic infections (OI). ObjectivesTo analyze the kinetics of T-lymphocyte subsets in LTR and the association between nadir CD4 T-cell count and viral infections after transplantation. Study designSerial measurements of peripheral blood CD4 and CD8 T-cell counts obtained during the first year post-transplantation from 83 consecutive LTR and their correlation with both viral OI and community-acquired infections post-transplantation were retrospectively analyzed. ResultsLTR with a nadir CD4 T-cell count <200 cells/μl had consistently lower CD4 and CD8 T-cell counts than LTR with a nadir CD4 T-cell count >200 cells/μl (p<0.001). In LTR with a nadir CD4 T-cell count <200 cells/μl, the cumulative incidence of viral infections detected in peripheral blood and in bronchoalveolar lavage (BAL) samples was higher than in LTR with a nadir CD4 T-cell count >200 cells/μl (p=0.0012 and p=0.0058, respectively). A nadir CD4 T-cell count <200 cells/μl within the first three months post-transplantation predicted a higher frequency of viral infectious episodes in BAL samples within the subsequent six month period (p=0.0066). ConclusionsStratification of patients according to nadir CD4 T-cell count may represent a new and simple approach for early identification of patients at risk for subsequent virus infections.

CD4 signaling and Pneumocystis clearance: a critical role of IL-21R and STAT3 for effector function (MPF2P.745)

Abstract Pneumocystis jirovecii is an opportunist infection that is a significant cause of disease in immunocompromised patients. Patients whose blood CD4 counts drop below 200 cell/μl due to HIV infection or immunosuppressive therapies are at high risk of developing Pneumocystis jirovecii pneumonia (PJP). However, the exact role of CD4 cells and the specific effector subtype that is required for clearance has yet to be determined. We investigated this question with several cytokine and STAT knock out mice using both in vivo infection as well as the assessment of effector CD4+ T-cell function by adoptive transfer into Pneumocystis infected Rag1-/- mice. We observe that classical Th1, Th2, Th17, and Tfh cell effector functions are dispensable for organism clearance. However we found an essential role for both IL21 receptor signaling on CD4 cells as well as CD4+ T-cell intrinsic STAT3 activation are required for clearance. These data are consistent with the recent identification of human IL21R deficiency and susceptibility to PJP. We are currently examining potential novel downstream mechanisms that may mediate immunity against Pneumocystis pneumonia in this context.

Evaluation of total lymphocyte count (TLC) as a surrogate marker for CD4 count in HIV-positive patients for resource-limited settings

Context: The immunity in HIV-infected patients becomes low due to involvement of CD4 cells. The single best predictor of AIDS onset identified is the percentage or absolute number of circulating CD4+ T cells. However, providences in resource-constraint settings may not have access to this laboratory measurement, or its cost may be prohibitive resulting in the need for an alternative, surrogate marker. Hence, total lymphocyte count (TLC) was evaluated as a probable surrogate marker for CD4 count in this study. Aims: To evaluate the correlation of CD4 counts with the TLC for predicting the progression of HIV infection, and to determine a range of TLC cut-offs for predicting CD4 count <200 cells/μl, which is important for the initiation of antiretroviral therapy (ART) and opportunistic infection (OI) prophylaxis. Settings and Design: This study was conducted in the Department of Microbiology at Government Medical College, Aurangabad. Materials and Methods: A total of 250 HIV-positive patients were included in the study. Their Complete Blood count and CD4 count were measured and the TLC was computed. Statistical Analysis Used: SPSS software version 10.0. Results: A positive correlation between TLC and CD4 count was observed in our study, highlighting the role of this surrogate marker in resource-limited settings. Further, a TLC cut-off of ≤1700 cells/μl was found to be the best predictor for a CD4 count <200 cells/μl. Conclusions: A general correlation between the surrogate marker TLC and expensive CD4 counts could be elicited for the population under study. A TLC cut-off of ≤1700 cells/μl was the best predictor of CD4 count <200 cells/μl. This study demonstrates the ability of TLC, whether used as a continuous or dichotomous data, to predict CD4 count or a CD4 count <200 cells/μl, respectively.

Serum ferritin levels in human immunodeficiency virus infected children and its relation with severe immunodeficiency

Background: Ferritin is an acute phase protein which is often elevated in acute and chronic inflammation. In adults with human immunodeficiency virus (HIV) infection, elevated serum ferritin levels indicate advanced or progressive disease. In the present study, ferritin levels were evaluated in HIV infected children to find out its relation with the immune deficiency. Methods: The children who were HIV positive (confirmed by ELISA for HIV-1 and HIV-2), and attending the OPD of ART Centre and of tertiary care center during period of one year were included in the study. The study population consisted of 47 patients, belonging to both sexes and age of 18 months to 19 years. Detailed history was taken and full clinical examination done in all cases. Blood sample for Complete blood count, serum ferritin and CD4 count was taken. Absolute CD4 count of each patient was obtained and immunological staging was done on the basis of WHO immunological staging criteria. Serum ferritin level 7-140 ngm/mL was considered normal. Results: Hyperferritenimia (&gt;140 ngm/ mL) is a feature of advanced stages of HIV infection. 11.1% patients of stage 3 and 40.0% patients of stage 4 are showing hyperferritinemia (r = 0.890), irrespective of anemia. Low serum ferritin level (&lt;7 ngm/mL) is an unusual feature in HIV infected children. Conclusions: High Serum ferritin levels are not uncommon in children with HIV disease and they are related with immunological progression of the disease.

Prevalence of thrombocytopenia and its relation with WHO clinical and immunological staging among human immunodeficiency virus-infected children

Objective: The aim was to study the thrombocytopenia in human immunodeficiency virus (HIV) infected children and its relation with WHO clinical and immunological HIV/AIDS staging. Study Design: Observational analytic cross-sectional study. Materials and Methods: 47 ambulatory and clinically stable HIV-infected children (confirmed by enzyme-linked immunosorbent assay for HIV-1 and HIV-2) aged 18 months-18 years attending the out-patient Department of anti-retroviral therapy center at tertiary care setting, were included in this study. Detailed history was taken, and thorough clinical examination was done in all cases. Blood samplefor complete blood count and CD4 count was taken. Primary Outcome: Thrombocytopenia in HIV-infected children. Secondary Outcome: WHO clinical and immunological HIV/AIDS staging in HIV-infected children and its relation to thrombocytopenia. Results: Of 47 studied children, thrombocytopenia was found in 14 (29.78%) cases. Patients with thrombocytopenia were found in all stages of the disease; however, it was strongly associated with increasing immunological stages (correlation coefficient, r = 0.948). Conclusion: Thrombocytopenia commonly occurs in children with HIV and its occurrence increases with an increase in WHO clinical and immunological HIV/AIDS staging.

Peripheral Neuropathy in Primary HIV Infection Associates With Systemic and Central Nervous System Immune Activation

Peripheral neuropathy (PN) is a frequent complication of chronic HIV infection. We prospectively studied individuals with primary HIV infection (<1 year after transmission) to assess the presence of and laboratory associations with PN in this early stage. Standardized examination and analysis of blood and cerebrospinal fluid (CSF) was performed in participants with laboratory-confirmed primary HIV infection. PN was defined as ≥1 of the following unilateral or bilateral signs: decreased distal limb position, vibration, or temperature sense or hyporeflexia; symptomatic PN (SPN) was defined as the presence of these signs with symptoms. Analysis used nonparametric statistics. Overall, 20 (35%) of 58 antiretroviral-naive male subjects without diabetes evaluated at a median of 107 days post HIV transmission met criteria for PN. Thirteen (65%) of 20 PN subjects met criteria for SPN; 6 (30%) of 20 had bilateral findings. PN subjects and no PN subjects (NPN) did not differ in median age, days post HIV transmission, blood CD4 or CD8 counts, CSF or plasma HIV RNA levels, CSF white blood cell counts, or CSF to blood albumin ratio. PN and SPN subjects had elevated CSF neopterin (P = 0.003 and P = 0.0005), CSF monocyte chemoattractant protein-1 (P = 0.006 and P = 0.01), and blood neopterin (P = 0.006 and P = 0.009) compared with NPN subjects. PN subjects had a higher percentage of activated phenotype CSF CD8 T lymphocytes than NPN subjects (P = 0.009). Signs of PN were detected by detailed neurologic examination in 35% of men enrolled in a neurological study at a median of 3.5 months after HIV transmission. PN during this early period may be mediated by systemic and nervous system immune responses to HIV.

Normal CD4 Count Range among Healthy Nigerian Population in Ilorin.

For the establishment and monitoring of the immune status, CD4 count is critical. To determine the CD4 count range of apparently healthy Nigerians resident in Ilorin and compare with the national value. An automated blood analyzer was used to determine the full blood count and CD4 count. The percentage of CD4 count was derived by using other variables. Of the 1205 participants, the reference CD4 count (percentage of CD4) range for adult was 400 to 1288 cells/mm3 (19%-48%) and for children was 582 to 3652 cells/mm3 (17%-50%). CD4 count and percentage of CD4 were significantly ( P = .001) higher in females than in males, and the CD4 count declined significantly with increasing age ( r = -.174, P ≤ .0001). The percentage of CD4 count shows less variation with age ( r = -.051, P = .076). Adult residents of Ilorin had significantly lower absolute mean CD4 count (808 ± 260) than that of the national reference values of 847.0 ± 307.0 cells/mm3 ( P = .001). We therefore advocate the use of CD4 count range derived in this study is lower than that of the national reference values.

Changes in PINCH levels in the CSF of HIV+ individuals correlate with hpTau and CD4 count

Several studies report associations between the particularly interesting new cysteine histidine-rich (PINCH) protein and HIV-associated CNS disease. PINCH is detected in the CSF of HIV patients, and changes in levels during disease may be indicative of changes in disease status over time. PINCH binds hyperphosphorylated Tau (hpTau) in the brain and CSF, but little is known about the relevance of these interactions to HIV CNS disease. In this study, PINCH and hpTau levels were assessed in three separate CSF samples collected longitudinally from 20 HIV+ participants before and after initiating antiretroviral therapy or before and after a change in the treatment regimen. The intervals were approximately 1 (T2) and 3-7 (T3) months from the initial visit (baseline, T1). Correlational analyses were conducted for CSF levels of PINCH and hpTau and other variables including blood CD4 T-cell count, plasma and CSF viral burden, CSF neopterin, white blood cell (WBC) count, and antiretroviral CNS penetration effectiveness (CPE). Values for PINCH and hpTau were determined for each patient by calculating the fold changes between the second (T2) and third measurements (T3) from the baseline measurement (T1). Statistical analyses showed that the fold changes in CSF PINCH protein from T1 to T2 were significantly higher in participants with CD4 counts >200 cells/mm(3) at T2 compared to those with CD4 counts <200 cells/mm(3) at T2. This trend persisted irrespective of plasma or CSF viral burden or antiretroviral therapy CPE scores. The fold changes in PINCH levels between T1 and T2, and T1 and T3 were highly correlated to the fold changes in hpTau at T2/T1 and T3/T1 (correlation coefficient = 0.69, p < 0.001; correlation coefficient = 0.83, p < 0.0001, respectively). In conclusion, in these HIV participants, changes in CSF levels of PINCH appear to correlate with changes in blood CD4 count and with changes in CSF hpTau levels, but not with plasma or CSF viral burden, neopterin, WBC, or antiretroviral regimen CPE.

Nitazoxanide Is Effective Therapy For Norovirus Gastroenteritis After Chemotherapy and Hematopoietic Stem Cell Transplantation (HSCT)

Norovirus infection is a major cause of nonbacterial gastroenteritis and is a self-limited infection in immunocompetent patients. However, in immune compromised patients, norovirus has been reported to cause prolonged infection resulting in complications such as graft versus host disease and sepsis due to mucosal breakdown. Supportive care is the only current therapy for norovirus as attempts to treat norovirus with ribavirin or oral immunoglobulin have been unsuccessful. Nitazoxanide is a thiazolide antimicrobial with broad activity against anaerobic bacteria, protozoa, and a range of viruses in cell culture models. The antiviral activity of nitazoxanide may relate to activation of natural host antiviral defenses, but there is also evidence for a direct-acting antiviral effect on cellular processes possibly through inhibition of virus protein production/maturation and/or assembly. We report our experience treating norovirus gastroenteritis occurring in 12 patients after (9) or prior to (3) HSCT with Nitazoxanide. From November 2012 to July 2013, 12 patients (2 receiving chemotherapy, 1 autologous HSCT and 9 allogeneic HSCT) developed norovirus gastroenteritis. Ages ranged from 1 to 21 years (median 10) diagnoses included ALL/AML (6), aplastic anemia (2), and 1 each for osteopetrosis, Wiskott Aldrich, neuroblastoma, and brain tumor. Norovirus was detected by RNA RT-PCR test of stool performed by Focus Diagnostics, Cypress, Ca. The dose of Nitazoxanide was 100 mg po BID for ages 1 to 4 years, 200 mg po BID for age 4 to 11 years, and 500 mg po BID for greater than 11 years. One patient, 33 months post HSCT with normal immune studies was not treated as his symptoms resolved prior to availability of test results. All other patients clinically responded with improvements in diarrhea, nausea, and abdominal pain within 2-4 days (median 2 days). Three patients were pre-HSCT on chemo/immunotherapy and 8 patients were 1 day to 34 months after HSCT. All of the treated patients were on immune suppression or chemotherapy. Eight allogeneic HSCT patients were on immunosuppression and four of these patients had GVHD at onset of symptoms. Immune suppression included tacrolimus/solumedrol (3), cellcept/solumedrol (2) plus infliximab (1), tacrolimus (1), cyclosporine (1). Three patients were receiving immunotherapy (1), or chemotherapy for solid tumors (2) prior to planned HSCT. Clearance of stool virus was variable. Two of 3 patients treated prior to HSCT became negative on stool study within 3-14 days of treatment (1 unknown duration). Among patients treated after HSCT 5 of 8 had persistent viral shedding, 2 received drug until death (1 adenovirus, 1 congestive heart failure) both were treated greater than 2 months, 3 with GVHD continue to shed virus after 6 months of treatment, and 3 have come off therapy and remain negative for norovirus RNA. One HSCT patient with clinical resolution but persistent viral shedding stopped treatment resulting in re-occurrence of clinical symptoms. This patient responded clinically to reinstitution of therapy within 2 days but continues to shed virus. UGI endoscopy and colonoscopy were performed in 5 patients at the time of clinical infection, all showed inflammation and edema but no GVHD was seen on histology. Peripheral blood CD4 counts among those with persistent viral shedding ranged from&lt;50-445/ul and for those that cleared virus 143-1222/ul. Nitazoxinide is effective therapy for norovirus gastroenteritis in immune compromised patients. Therapy needs to be continued until stool RNA studies become negative. Disclosures: Off Label Use: Nitazoxide is a thiazolide antimicrobial that is FDA approved for treatment of cryptosporidium and is known to have broad spectrum activity to bacteria and viral infections. We used it to treat norovirus infections in immune compromised SCT patients.

Rapid diagnostic tests for neurosyphilis

In their Review of rapid diagnostic tests for neurological infections in central Africa,1Yansouni CP Bottieau E Lutumba P et al.Rapid diagnostic tests for neurological infections in central Africa.Lancet Infect Dis. 2013; 13: 546-558Summary Full Text Full Text PDF PubMed Scopus (43) Google Scholar Cedric Yansouni and colleagues highlighted the needs to validate the currently available rapid syphilis tests with cerebrospinal fluid (CSF) for detection of non-treponemal antibodies in neurosyphilis. In the past decades, incidence of neurosyphilis has been on the rise, largely because of an increasing pool of patients infected with syphilis and HIV at increased risk for neurosyphilis.2Wilcox RD From our consultation files. The challenge of neurosyphilis in HIV.HIV Clin. 2009; 21 (5,6.): 1Google Scholar Neurosyphilis is more commonly noted in patients infected with HIV, with a prevalence of 23·5% in HIV-positive patients with untreated late-latent syphilis.3Bordón J Martínez-Vázquez C Alvarez M et al.Neurosyphilis in HIV-infected patients.Eur J Clin Microbiol Infect Dis. 1995; 14: 864-869Crossref PubMed Scopus (46) Google Scholar Undoubtedly, introduction of CSF-based rapid tests, if they are available, can improve access to diagnosis of neurosyphilis in areas not served by laboratories. However, in many resource-limited settings, the acquisition of CSF samples through lumbar puncture is more challenging than doing the traditional venereal disease research laboratory test. Lumbar puncture is invasive and time consuming, requires additional resources and training, and might be difficult to do in many outpatient settings, such as sexually transmitted disease clinics or HIV counselling and testing clinics in which syphilis and HIV infections are commonly diagnosed. Additionally, it might be difficult to convince an asymptomatic patient to take a lumbar puncture if his or her condition is not indicative of having any neurological abnormality. Moreover, possible complications related to lumbar puncture are also a concern. In low-resource settings where syphilis and HIV are prevalent, we might need a screening approach to identify the potential of an asymptomatic patient to have a neurological infection with Treponema pallidum. This identification can then lead to further CSF-based tests of the antibodies, proteins, and white blood cells. The approach should integrate rapid and simple tests with less invasive and more acceptable approaches of specimen collection. Recent studies in HIV-uninfected and HIV-infected patients have shown that patients with a serum rapid plasma reagin (RPR) titre ≥1/32 or a peripheral blood CD4 count ≤350 cells per mL, or both, were significantly more likely to have neurosyphilis, indicating use of criteria based on these tests may improve the ability and efficiency to identify asymptomatic neurosyphilis.4Libois A De Wit S Poll B et al.HIV and syphilis: when to perform a lumbar puncture.Sex Transm Dis. 2007; 34: 141-144Crossref PubMed Scopus (121) Google Scholar, 5Marra CM Maxwell CL Smith SL et al.Cerebrospinal fluid abnormalities in patients with syphilis: association with clinical and laboratory features.J Infect Dis. 2004; 189: 369-376Crossref PubMed Scopus (358) Google Scholar The rapid finger-prick tests for simultaneously detecting treponemal and non-treponemal antibodies have been available with use of a reader that measures the density of the non-treponemal test line, correlating with RPR titre.6Ghanem KG Moore RD Rompalo AM et al.Lumbar puncture in HIV-infected patients with syphilis and no neurologic symptoms.Clin Infect Dis. 2009; 48: 816-821Crossref PubMed Scopus (81) Google Scholar The rapid finger-prick tests that provide results for CD4 cell count within an average of 30 min have been reported to be as accurate as laboratory-based testing and highly acceptable to patients in the field.7Herbert S Edwards S Carrick G et al.Evaluation of PIMA point-of-care CD4 testing in a large UK HIV service.Sex Transm Infect. 2012; 88: 413-417Crossref PubMed Scopus (27) Google Scholar, 8Manabe YC Wang Y Elbireer A et al.Evaluation of portable point-of-care CD4 counter with high sensitivity for detecting patients eligible for antiretroviral therapy.PLoS One. 2012; 7: e34319Crossref PubMed Scopus (51) Google Scholar Since screening with CSF-based tests for neurosyphilis is difficult in many resource-limited settings, scaling-up of the current rapid finger-prick diagnostic tests, with selective criteria for further performing lumbar puncture and CSF-based tests, can be one of the feasible strategies to improve diagnosis of neurosyphilis without compromising treatment of patients. We declare that we have no conflicts of interest. Rapid diagnostic tests for neurological infections in central AfricaInfections are a leading cause of life-threatening neuropathology worldwide. In central African countries affected by endemic diseases such as human African trypanosomiasis, tuberculosis, HIV/AIDS, and schistosomiasis, delayed diagnosis and treatment often lead to avoidable death or severe sequelae. Confirmatory microbiological and parasitological tests are essential because clinical features of most neurological infections are not specific, brain imaging is seldom feasible, and treatment regimens are often prolonged or toxic. Full-Text PDF

African ethnicity can influence immunological responses to highly active antiretroviral therapy and immunological success at 48 months: a retrospective pilot study

To assess whether African ethnicity is independently associated with a poorer CD4 reconstitution with highly active antiretroviral therapy (HAART) compared to Caucasian ethnicity. We conducted a retrospective epidemiological study among 575 HIV-1-positive patients at our center and defined immunological success as the presence of blood CD4 lymphocyte counts>500 cells/mm3 in more than 50% of the values collected from 6 to 48 months after beginning HAART. Patients displaying an HIV-1 viral load>200 copies/ml or more than one HIV-1 viral load between 20 and 200 copies/ml during follow-up, were excluded. Patients with baseline blood CD4 counts>500 cells/mm3 were also excluded. Two hundred and eighty patients met the inclusion criteria and no exclusion criteria. After 48 months of HAART, blood CD4 lymphocyte counts were lower in Africans than in Caucasians: 449 (65-975) vs. 569 (131-1698) cells/mm3 (p=0.02). Immunological success was present in 142/220 (64.5%) Caucasians vs. 29/60 (48.3%) Africans (p=0.02). African ethnicity was independently associated with the absence of immunological success (odds ratio 2.22, 95% confidence interval 1.097-4.504; p=0.02) despite similar baseline blood CD4 counts (219 vs. 204 cells/mm3, p=0.72). Our findings suggest that African ethnicity is independently associated with a poorer CD4 reconstitution during HAART than Caucasian ethnicity.

Anemia and Risk Factors in HAART Naïve and HAART Experienced HIV Positive Persons in South West Ethiopia: A Comparative Study

BackgroundHuman immunodeficiency virus (HIV) infection and its treatment cause a range of hematological abnormalities. Anemia is one of the commonly observed hematologic manifestations in HIV positive persons and it has multifactorial origin.ObjectiveWe aimed to determine the prevalence and risk factors of anemia in highly active antiretroviral therapy (HAART) naïve and HAART experienced HIV positive persons.MethodsA facility-based comparative cross sectional study was conducted in Jimma University Specialized Hospital from February 1 to March 30, 2012. A total of 234 HIV positive persons, 117 HAART naïve and 117 HAART experienced, were enrolled in this study. Blood and stool specimens were collected from each participant. Blood specimens were examined for complete blood count, CD4 count and blood film for malaria hemoparasite; whereas stool specimens were checked for ova of intestinal parasites. Socio-demographic characteristics and clinical data of the participants were collected using pre-tested questionnaire. Statistical analysis of the data (Chi-square, student’s t-test, logistic regression) was done using SPSS V-16.ResultsThe overall prevalence of anemia was 23.1%. The prevalence of anemia in HAART naïve and HAART experienced persons was 29.9% and 16.2%, respectively (P = 0.014). Presence of opportunistic infections (P = 0.004, 95% CI = 1.69–15.46), CD4 count <200 cells/µl (P = 0.001, 95% CI = 2.57–36.89) and rural residence (P = 0.03, 95% CI = 1.12–10.39) were found to be predictors of anemia for HAART naïve participants. On the other hand, HAART regimen (ZDV/3TC/NVP) (P = 0.019, 95% CI = 0.01–1.24) and the duration of HAART (P = 0.007, 95% CI = 0.003–0.40.24) were found to be predictors of anemia for HAART experienced groups.ConclusionThe prevalence of anemia in HAART naïve persons was higher than HAART experienced persons. Risk factors for anemia in HAART naïve and HAART experienced HIV positive persons were different. Hence, there is a need for longitudinal study to further explore the causes of HIV associated anemia and the pattern of hemoglobin changes with initiation of HAART.

HIV‐specific T‐cell responses detected in the genital tract of chronically HIV‐infected women are largely monofunctional

HIV-specific T cells that produce interferon-γ (IFN-γ) are present in the genital tract of HIV-infected women although these do not provide protection against genital HIV shedding. Because polyfunctional HIV-specific T cells have been implicated in better HIV control than those with a single function, this study aimed to investigate whether polyfunctional T cells were present at the female genital mucosa. Cervical cytobrush-derived T cells were obtained from chronically HIV-infected women and compared with blood. CD3(+) T cells from both compartments were expanded with Dynal anti-CD3/CD28 expander beads for 14 days and flow cytometry was used to evaluate four T-cell functions (CD107a, IFN-γ, tumour necrosis factor-α and macrophage inflammatory protein-1β) from 16 women. The majority of Gag-specific T-cell responses in the female genital tract were monofunctional, although low frequencies of HIV Gag-specific polyfunctional CD8(+) T cells were detected at the cervix in 81·3% (13/16) of women. The ability of CD8(+) T cells at both the cervix and in blood to express CD107a and to exhibit polyfunctional responses (two or more functions) following Gag stimulation was inversely associated with plasma viral load and positively associated with blood CD4 counts, suggesting that clinical status impacted on the functionality of HIV-specific T cells at the mucosa, in a similar way to blood. HIV Gag-specific cervical T cells were largely monofunctional. Polyfunctional T cells were detected at the cervix in women with high blood CD4 count and low plasma viral load but these did not protect from HIV genital shedding.

STUDY ON ENDOCRINOLOGICAL PROFILE OF HIV INFECTED MALE PATIENTS FROM EASTERN INDIA

H uman Immunodeficiency virus (HIV) infection is associated with a variety of endocrine prob lems. Hypoadrenalism, hypothyroidism and hypogonadism are commonly found singly or in combination. Especially, male hypogonadism is very common in this population and may lead to weight loss, lethargy and other co morbidities. W e undertook this cross secti onal observational study to evaluate endocrine profile in HIV infected males in a sample Eastern Indian population . We also studied for any correlation of the endocrine dysfunctions with their immune status. We studied the blood hormone profiles along with blood CD4 counts. The bloods were drawn in fasting state and analysed using suitable high sensitivity assays. Standard statis tical methods were used. W e had 48 patients in our study. Among them, 33% had hypogonadism, 20% had hypothyroidism and 15 patients had diabetes. The hypogonadism was mainly hypogonadotropic. In other studies across the globe also, hypogonadism in HIV positive males is found to be significant. Our diabetic patients were not on protease inhibitors. We found some patients who had multip le endocrine dysfunctions. HIV infection is often associated with endocrine abnormalities. This aspect of the disease must be addressed during routine care of these patients. Hormone replacement must be individualized and may be needed for prolonged