CD4 Lymphocyte Count Research Articles

Predicting immune risk in treatment-naïve HIV patients using a machine learning algorithm: a decision tree algorithm based on micronutrients and inversion of the CD4/CD8 ratio.

Micronutrients have significant functional implications for the human immune response, and the quality of food is a major factor affecting the severity and mortality caused by HIV in individuals undergoing antiretroviral therapy. A decrease in CD4 lymphocyte count and an increase in CD8 lymphocyte count are the hallmarks of HIV infection, which causes the CD4/CD8 ratio to invert from a normal value of >1.6 to <1.0. In this study, we tried to analyze whether the nutritional status of HIV-positive patients has an impact on the CD4/CD8 ratio inversion by utilizing a machine learning (ML) algorithm. In this study, 55 confirmed HIV-positive patients who had not started their anti-retroviral therapy were included after obtaining their informed, written consent. Moreover, 55 age-and sex-matched relatives and caregivers of the patients who tested negative in the screening were enrolled as controls. All individual patient data points were analyzed for model development with an 80-20 train-test split. Four trace elements, zinc (Zn), phosphate (P), magnesium (Mg), and calcium (Ca), were utilized by implementing a random forest classifier. The target of the study was the inverted CD4/CD8 ratio. The data of 110 participants were included in the analysis. The algorithm thus generated had a sensitivity of 80% and a specificity of 83%, with a likelihood ratio (LR+) of 4.8 and LR-of 0.24. The utilization of the ML algorithm adds to the limited evidence that currently exists regarding the role of micronutrients, especially trace elements, in the causation of immune risk. Our inherent strength lies in the fact that this study is one of the first studies to utilize an ML-based decision tree algorithm to classify immune risk in HIV patients. Our study uniquely corroborated the nutritional data to the immune risk in treatment-naïve HIV patients through the utilization of a decision tree ML algorithm. This could subsequently be an important classification and prognostic tool in the hands of clinicians.

Evaluation of the Tissue Immune Microenvironment in the Diabetic Patients with Dental Implant

Long-term hyperglycemia in people with diabetes very frequently leads to damage and/or dysfunction of many tissues and organs of the human body, causing increased clinical morbidity. There is, however, an increased correlation between glycemic control and the onset of these consequences and in particular microvascular and macrovascular complications. The results of some studies have suggested that diabetes exerts an influence on the failure rates of implants compared to non-diabetic patients. One study demonstrates that HbA1c level (higher or lower than the threshold of 8.1) also influences the survival rate of dental implants. Biopsy fragments from 8 consecutive patients who had a titanium dental implant as well as diabetes were included in our study. The control group was represented by 4 patients with dental implants and who did not have diabetes. After the histological processing of the tissues, cell counts of CD4, CD8, CD20 and CD3 lymphocytes were performed by using QuPath. The findings characterize the composition of lymphocyte populations in the oral mucosa surrounding dental implants. In diabetic patients, poor glycemic control has been associated with a decreased CD4/ CD8, contrary to our findings in tissue. The decreased number of CD20 positive lymphocytes could be associated with the dysfunction of humoral immunity generally observed in patients with diabetes. In our study, a 2.5 x higher value of TCD4+ lymphocytes was noted compared to the average of TCD8+ type lymphocytes. These results support the involvement of these types of inflammatory cells in the potimplant bone healing processes. This process starts on the 10th day post-implant. Different studies raise, in these cases, the question of innate immune response vs adaptive immune response. Suppression of processes induced by CD8+ lymphocytes is associated with stimulation of bone formation. Our results support this hypothesis.

Association between immune system parameter and clinical characteristics among patients with solid cancer

BACKGROUND Lymphopenia has been reported to be a major predictor of chemotherapy-related toxicity. This study aimed to investigate the correlation between neutrophils, lymphocytes, CD4, and CD8 in solid cancer patients and cancer clinical characteristics. METHODS This was a cross-sectional study of patients who will undergo chemotherapy at the Hematology and Medical Oncology Clinic, Cipto Mangunkusumo Hospital, from June to September 2023. Clinical characteristics, CD4 and CD8 levels, and neutrophil and lymphocyte counts were assessed at the first visit. A comparative test was carried out on the patients’ average CD4, CD8, neutrophil, and lymphocyte counts. RESULTS Types of cancer were associated with CD4 levels. Patients with head and neck cancer had lower CD4 levels (411.3 [119.3–1,427.5] cells/mm³) compared with colorectal (514.7 [129.2–861.3] cells/mm³), breast and gynecological (567.5 [180.1–939 cells/mm³), and other cancers (681.4 [175.1–2,056.9] cells/mm³), with p = 0.009. Patients aged ≥40 years had higher CD8 levels than those aged &lt;40 years (376.4 [142.8–1,293.1] cells/mm³ versus 565.3 [185.9–1,944] cells/mm³, p = 0.01). Additionally, lymphocyte count was associated with cancer type, with the lowest number in head and neck cancer (1,380 [280–2,660] μl, p = 0.044). CONCLUSIONS CD4 levels and lymphocyte counts were associated with the cancer type, whereas CD8 levels were influenced by age.

Association between CD4 lymphocyte count and the incidence of comorbidities in Human immunodeficiency virus positive patients with virological suppression after antiretroviral treatment.

The incidence of comorbidities is higher in HIV-positive patients than in the general population due to factors, such as HIV-related chronic inflammation. There is no consensus on whether a low CD4 lymphocyte count after virological suppression at long-term follow-up increases the risk of comorbidities. This study evaluates the association between CD4 lymphocyte count and the incidence of comorbidities during the first 5years of virological suppression after highly active antiretroviral treatment. We conducted a cohort study of HIV-positive adults who achieved virological suppression in an HIV program between 2002 and 2016 in Colombia. A generalized equation estimation model was used to estimate the association between CD4 lymphocyte count and the incidence of comorbidities. A follow-up period of at least 1year was completed in 921 HIV-positive patients with virological suppression. We found 71 comorbidities during a maximum of 5 years of follow-up; 41 (59%) were AIDS-defining comorbidities and 19 (46%) of them occurred during the first semester. Thirty cases of non-AIDS- defining comorbidities were diagnosed.We did not find any association between CD4 lymphocyte count and the incidence of comorbidities (OR 0.92, CI 95% 0.45 -1.91 for CD4 201-499 cells/µL vs CD4 ≤200 cells/µL, and OR 0.55, 95% CI 0.21-1.44 for CD4 ≥500 cells/µL vs CD4 ≤200 cells/µL). No association was found between CD4 lymphocyte count and the incidence of AIDS-defining or non-AIDS-defining comorbidities in patients with virological suppression. Further studies are needed to assess the risk of comorbidities in this population to design interventions aimed at improving their prognosis.

Pure red cell aplasia among ABO mismatched hematopoietic stem cell transplant recipients: a 13-years retrospective study and literature review.

Pure red cell aplasia (PRCA) is a possible complication after allogeneic hematopoietic stem cell transplantation (HSCT) with major ABO incompatibility. Patients experience delayed engraftment of the erythroid series, with prolonged transfusion-dependent anemia and iron overload. We performed a revision of the most recent literature about post-HSCT PRCA treatment procedures. Moreover, we conducted a retrospective study, over the last 13-years, which included all consecutive major ABO mismatched HSCT performed in our unit, with the aim to assess PRCA incidence, risk factors, and response to different treatments. Overall, 194 patients received a major ABO mismatched transplant from 2010 to 2022. For each patient, data about demographic and transplant characteristics, engraftment, blood transfusion, and possible treatment received were collected. The literature review returned 23 eligible papers on PRCA treatment, with high success rate using plasma-exchange (PEX) and immunoadsorption procedures, daratumumab, and eltrombopag. Our study identified a total of 24 cases of PRCA. Among risk factors for PRCA development, we have found older recipient age (p=0.01), high pre-HSCT IgG and IgM IHA titer (p<0.0001), major rather than bidirectional ABO incompatibility (p=0.02), low T CD8 lymphocyte count in the graft (p=0.006), relative donor (p=0.02) and bone marrow as stem cell source (p=0.002). However, multivariate analysis confirmed only pre-HSCT IgG IHA titer as the unique risk factor for PRCA occurrence. The optimal cut-off value of pre-HSCT IgG IHA for PRCA development, resulted to be 1/64, with a 100% sensitivity and 68.8% specificity (p<0.0001). All patients with PRCA had received rhEPO and transfusion support and 20 patients received additional treatments like PEX, rituximab, and more recently daratumumab. Comprehensively, PEX and rituximab obtained a response in half of the cases, at a variable time, while the few cases of patients we treated with daratumumab suggest promising results. The overall response rate in our cohort was 75%, with significantly better survival (94.4% vs. 16.7%) and lower transplant-related mortality (6.3% vs. 80%) for PRCA responders. Standardized guidelines on when and how to treat PRCA are necessary because the current treatment is controversial among centers.

HIV-infection in the Russian Federation: current diagnostic trends

The aim of the study: to analyse diagnostic trends of HIV-infection in the Russian Federation in the period 2017–2022. Materials and methods. The study used data obtained from reports from the Federal Register of persons infected with the human immunodeficiency virus (FRHIV). The circumstances in HIV diagnosis and clinical and epidemiological characteristics of newly diagnosed patients, including CD4+ T-lymphocyte counts, were analysed. A likely time window between presumed infection and confirmation of HIV diagnosis was also determined. Categorical data evaluated in the study were presented as proportions and caparisoned using the chi-square test (χ2). In case of multiple comparisons, the Bonferroni correction for multiplicity was used. Quantitative data were tested for normality using the Kolmogorov-Smirnov criterion. In most cases, nonparametric characteristics of distributions — median and interquartile range — were applied, as well as the Mann-Whitney criteria for comparison of two independent groups and the Kraskell-Wallis criteria for comparison more than two groups, followed by pair wise comparisons using the Mann-Whitney criterion with Bonferroni multiplicity correction. A p-value&lt;0.05 was considered statistically significant. Data analysis and graphical visualization was performed using the statistical software R version 4.1.1 and its libraries.Results and discussion. The results showed an increase in HIV detection through voluntary testing, preventive medical examination, and clinical indications. The proportion of injecting drug users (IDUs) decreased over time, while the involvement of women in the epidemic process and heterosexual transmission increased. Additionally, there was an increase in the proportion of patients aged 35 years and older. The analysis of CD4-cell counts revealed significant differences among gender and age subgroups. Women had higher absolute CD4-lymphocyte counts throughout the follow-up period. Patients aged 0–14 years had the highest proportion of CD4-lymphocytes over 500 cells/μL, while patients over 50 years old had the highest proportion of CD4-lymphocytes less than 200 cells/μL. Men who have sex with men and people infected through mother-to-child transmission had the highest mean baseline CD4-cell counts. IDUs and heterosexuals had a statistically significant decrease in CD4-cell counts over the follow-up period and also had the longest median time from infection to disease detection — 24 and 20 months, respectively.Conclusion: Thus, this study helps identify the most significant risk groups of HIV-infected individuals in Russia at present.

Trends of pre-treatment drug resistance in antiretroviral-naïve people with HIV-1 in the era of second-generation integrase strand-transfer inhibitors in Taiwan.

Monitoring the trends of pre-treatment drug resistance (PDR) and resistance-associated mutations (RAMs) among antiretroviral-naïve people with HIV (PWH) is important for the implementation of HIV treatment and control programmes. We analysed the trends of HIV-1 PDR after the introduction of second-generation integrase strand-transfer inhibitors (INSTIs) in 2016 in Taiwan, when single-tablet regimens of non-nucleoside reverse-transcriptase inhibitor (NNRTI-) and INSTI-based antiretroviral therapy became the preferred treatments. In this multicentre study, we included newly diagnosed, antiretroviral-naïve PWH who underwent tests for RAMs between 2016 and 2022. Pre-treatment genotypic resistance testing was performed, along with HIV-1 subtyping and determinations of plasma HIV RNA load and CD4 lymphocyte counts. RAMs were analysed using the Stanford University HIV Drug Resistance Database and only RAMs conferring at least low-level resistance were included. From 2016 to 2022, pre-treatment blood samples from 3001 newly diagnosed PWH, which constituted 24.3% of newly diagnosed PWH in Taiwan during the study period, were tested. Of the PWH with analysable gene sequences, the HIV-1 PDR prevalence to NNRTIs, nucleoside reverse-transcriptase inhibitors (NRTIs), first- and second-generation INSTIs and PIs was 10.0%, 2.1%, 2.5%, 0.6% and 0.4%, respectively. While the trends of PDR remained stable for NRTIs, INSTIs and PIs, there was a significantly increasing trend of PDR to NNRTIs from 6.0% in 2016% to 13.1% in 2022 (P = 0.001). After the introduction of second-generation INSTIs in Taiwan, the trends of HIV-1 PDR to NRTIs and INSTIs remained low. Furthermore, there was no significant decrease of the prevalence of PDR toward NNRTIs between 2016 and 2022.

The causes of TB development in a child with HIV infection

The article represents a clinical observation of the development of disseminated TB in a 12-year-old child with HIV infection, a high CD4 lymphocyte count (1315 cells/μl), and undetectable viral load (&lt;20 copies per ml of blood). Perinatal transmission occurred, HIV infection was diagnosed immediately after birth, ART was administered from the first days of life. The girl has lived in a foster family since the age of 12 months. Poor adherence to treatment resulted in raised viral load. At the same time, the girl got ill with severe measles. ART was corrected with a rapid positive immunological and virological effect. One year later, TB manifested under the guise of acute bronchopulmonary disease. The examination revealed traces of infancy intrathoracic lymph node TB in the form of small calcinates. The patient had not been previously examined for TB infection and never received preventive TB treatment. The development of acute progressive TB in the child with HIV infection and satisfactory immunological and virological indicators was caused by: lack of due interdisciplinary (pediatricians, infectiologists, phthisiologists) and interdepartmental (medical services, children’s services) interactions; poor adherence to treatment; past measles.

Analisis Hasil Pemeriksaan Viral Load Dan CD4 Pada Penderita HIV Di RSUD Pandan Arang Boyolali Periode Tahun 2022

Acquired Immunodeficiency Syndrome disease cause HIV. This disease damages the body's immune system known as CD4. CD4 lymphocyte count is associated with disease progression, increased opportunism, and mortality. Laboratory examination required to determine the CD4 count using this method flowcytometry, and test viralload PCR method. The of research is analyze results of viralload and CD4 in HIV sufferers at RSUD Boyolali . Quantitative research method with analytical descriptive design. Data univariate and bivariate with the chi-square test to see the magnitude of relationship between the independent variables and HIV infection. total of 94 patients in 2022 showed several normal and abnormal results, where values ​​were normal viralload &lt;10,000copy/ml low, &gt;100,000copy/ml high, and &lt;40copy/ml not detected. Normal CD4 results 410 – 1,600 cells/ml and low &lt;500 cells/ml. CD4 research results and viralload normal 43 (46%) patients, CD4 results and viralload abnormal in about 9 (9%), and 1% of patients with normal CD4 countsviral load abnormal patient has not received treatment. CD4 examination uses the method flowcytometry whereas viral load using the PCR method and blood plasma samples. There is relationship viralload method PCR dan CD4 method flowcytrometry with significance value of 0.013. Further research needs to be carried out using experimental methods.

Can ferritin be a surrogate marker for CD4 cells in human immunodeficiency virus patients? A cross-sectional study of association of serum ferritin levels with immunological staging of human immunodeficiency virus patients.

The human immunodeficiency virus (HIV)/AIDS in India came into public view in 1986 with the detection of the first case of HIV in Chennai, Tamil Nadu, and the first AIDS case in Mumbai, Maharashtra in 1987. In acute phase response, iron distribution occurs in the liver and mononuclear phagocytic system. A high prevalence of elevated serum ferritin levels is reported in HIV infection and serum ferritin levels increase with the clinical worsening of infection and with decreasing CD4 lymphocyte counts. This study is designed to find the role of acute phase reactant serum ferritin in the progression of the disease of HIV which is complicated by opportunistic infections, by finding the correlation of serum ferritin with immunological stages of HIV. This cross-sectional study was conducted on 75 patients admitted to various wards of the Department of Medicine or attending medicine outdoor or ART Centre, Maharana Bhupal Government Hospital, RNT Medical College Udaipur. Serum ferritin, total iron binding capacity, and total serum iron were analyzed in Cobas® analyzer. CD4 cells are measured using the flow cytometry technique. The results were tabulated and subjected to statistical analysis. There was a negative correlation among serum ferritin and CD4 cells with r = -0.195 which was statistically significant (P < 0.05). As the CD4 cell count decreased incidence of serum ferritin increased. Elevation of serum ferritin levels is associated with a low count of the CD4+ in HIV-diagnosed patients. In a patient diagnosed with HIV, elevated serum ferritin indicates underlying inflammatory pathology. Serum ferritin can be used as a guide to further evaluation of underlying disease in HIV patients.

Effect of intake of probiotics and probiotic fermented foods on clinical outcomes among people living with HIV: A systematic review and meta-analysis.

The objective of the study was to determine the effect of probiotics and of probiotic-fermented foods on CD4 T-cell count, viral load, anaemia and body mass index (BMI) among people living with HIV (PLHIV). In this article, we systematically reviewed the evidence on the influence of probiotic supplementation on CD4 lymphocyte count, viral load and anaemia among PLHIV on highly active antiretroviral therapy (HAART) and those who were HAART-naive. Medical literature databases identified randomised trials and pre-post studies of probiotic supplementation and HIV-related outcomes, and random effects meta-analysis was conducted. The preponderance of the evidence suggests that probiotic supplementation only improved CD4 lymphocyte count modestly, with quantitatively greater impact among individuals who were HAART-naive compared to HAART-experienced individuals. Probiotic supplementation improved CD4 lymphocyte count by 53 cells/mm3 (95% CI: 22 to 85) from 18 studies. Probiotic supplementation however reduced haemoglobin concentration by -2.1 g/L (95% CI: -4.0 to -0.2). Although viral load remain unchanged in HAART-experienced participants following probiotic supplementation, HAART-naïve participants saw a decrease in viral load. There were too few studies on the impact of probiotic supplementation on viral load (N = 1). Probiotic supplementation resulted in a modest increase in CD4 lymphocyte count among HAART-naive individuals with no significant change observed among HAART-experienced ones. Viral load and haemoglobin concentration also remained unchanged following probiotic supplementation. Further rigorous and well-powered studies may evaluate the effect of probiotic supplementation on important clinical outcomes among PLHIV on HAART.

Interferon-Gamma-Release assay and absolute CD8 lymphocyte count for acquired immunosuppression monitoring in critically ill patients

Guided biomarker-personalized immunotherapy is advancing rapidly as a means to rejuvenate immune function in injured patients who are the most immunosuppressed. A recent study introduced a fully automated interferon-γ release assay (IGRA) for monitoring the functionality of T lymphocytes in patients with septic shock. While a significant decrease in IFN-γ release capacity was observed, a significant correlation with CD8 lymphocyte absolute count was also reported, raising the question of whether ex-vivo IFN-γ production would be only a surrogate marker for lymphocyte count or if these two parameters conveyed distinct and complementary information. In a large cohort of more than 353 critically ill patients following various injuries (sepsis, trauma, major surgery), the primary objective of the present study was to simultaneously evaluate the association between ex vivo IFN-γ release and CD8 cell count with regard to adverse outcome. Our findings provide a clear-cut result, as they distinctly demonstrate that IGRA offers higher-quality information than CD8 count in terms of an independent association with the occurrence of an adverse outcome. These results strengthen the case for incorporating IGRA into the array of biomarkers of interest for defining endotypes in sepsis. This holds especially true given that fully automated tests are now readily available and could be used in routine clinical practice.

Interstitial lung diseases in persons infected with human immunodeficiency virus

Diagnosis of interstitial lung diseases (ILD) in individuals infected with the human immunodeficiency virus (HIV) remains poorly understood.The purpose of the work was to demonstrate approaches to the diagnosis of ILD in HIV-infected patients with different levels of CD4 lymphocytes. An analysis of literature data and clinical observations of ILD in HIV-infected individuals (n = 2) whose CD4 lymphocyte count was 677 (37.5%) and 1 (0.21%) cells/μl are presented. The patients were observed and treated for a long time by pulmonology specialists, including anti-tuberculosis chemotherapy. The patient with CD4 lymphocyte count of 677 cells/μl in the absence of Mycobacterium tuberculosis in the sputum had an established diagnosis of idiopathic pulmonary fibrosis with the progressive development of respiratory failure and progression of the computed tomographic pattern from large areas of “ground glass” to the formation of reticular changes and “honeycomb” lung within 2 years. The patient with CD4 count of 1 cell/μl was diagnosed with nonspecific interstitial pneumonia based on characteristic clinical manifestations of increasing respiratory failure against the background of diffuse interstitial pneumofibrosis in the absence of bacterial excretion, the effects of antimycobacterial, antibacterial and antifungal treatment for 7 months, and excluding other causes of lung damage.Conclusion. The development of interstitial fibrosing pulmonary process of non-infectious etiology in HIV-infected patients with different states of T-helper immunity has been demonstrated. After excluding opportunistic infections, the influence of other factors, and concomitant diseases, these patients were diagnosed with various forms of idiopathic interstitial pneumonia. However, existing reports of the direct damaging effects of the virus on the pulmonary parenchyma also suggest the possibility of HIV-associated interstitial pulmonary fibrosis.

Prevalence of Anxiety, Depression and Social Support Networks in HIV/AIDS Patients: A Cross-Sectional Study

Objective: to determine the prevalence of anxiety, depression, and identify social support networks in patients with hiv/aids during the covid-19 pandemic, in a second-level Hospital of the Mexican Institute of Social Security (imss). Methods: cross-sectional analytical study, 420 hiv-positive patients who attended the hiv Clinic of the grh No.1 Vicente Guerrero, in Acapulco, Mexico, from October 2021 to February 2022. A sociodemographic questionnaire was applied to obtain general information, the Gráffar-Méndez Castellanos scale, the Hospital Anxiety and Depression Scale (hads), and the Duke-unc-11 functional social support questionnaire. Descriptive statistics, bivariate analysis, and logistic regression by the Mantel-Haenszel process were performed with the data obtained. Results: the prevalence of anxiety was 7.1%, and depression 5.2%. 89% of the patients perceived to have sufficient total social support. An association between depression, and cd4 lymphocyte count &lt;500 cells/mm3 (ora 2.54, 95% ci 1.06-6.12) was found, as well as, insufficient perceived total social support (ora 15.98, 95% ci 7.68-33.22). Conclusion: Nine out of ten patients perceived to have sufficient total social support, which may be related to the low prevalence of anxiety and depression. cd4 T lymphocyte counts below 500 cells/mm3 were associated with depression. Social support strategies and adherence to antiretroviral treatment are key to the well-being of the population living with hiv/aids during, and in the new normality of the covid-19 pandemic.

Effects of maternal and child factors on the immunological composition of human milk

Introduction and objective: The relationship between the bioactive components of milk and maternal and child health is not well elucidated yet. The aim of this study was to determine whether maternal factors (diseases and drugs used during pregnancy, method of delivery, age) and child characteristics (age, length and body weight at birth) affect breast milk composition (leukocytes, stem cells, and epithelial cells). Materials and methods: Twenty-three breastfeeding mothers of infants aged 1–6 months were recruited for the study. All the mothers and children were healthy, with no symptoms of respiratory tract infection. Samples of breast milk (20 mL) were collected. Each sample was assessed for its cellular composition (epithelial cells, mesenchymal stem cells, leukocytes). Only a few studies available in the literature have evaluated both immune cells (leukocytes) and cells of non-immune origin (mesenchymal and epithelial cells) in human milk. In this regard, our analysis is innovative. Results: Women receiving pharmacotherapy during pregnancy had a significantly higher percentage of eosinophils in their breast milk compared to women who did not receive any medication when pregnant. The cellular composition of milk correlated inversely with the age of the mother and child. The more advanced the mother’s age, the lower the number of monocytes in the milk. On the other hand, the older the child, the lower CD4 lymphocyte count in milk. Conclusions: The study suggests that the cellular composition of breast milk is influenced not only by the characteristics related to the mother but also by child-depended factors. Research in this area needs to be continued.

Evaluation of peripheral and central olfactory pathways in HIV-infected patients by MRI

To investigate peripheral and central olfactory pathways using cranial magnetic resonance imaging (MRI) in human immunodeficiency virus (HIV)-infected patients. The cranial MRI images of 37 HIV-infected adult patients and 37 adults without HIV infection having normal cranial MRI results were included in the study. In both groups, olfactory bulb (OB) volume and olfactory sulcus (OS) depth; and insular gyrus and corpus amygdala areas were measured using cranial MRI. In the HIV group, disease duration, HIV RNA, and CD4 lymphocyte count and levels as a percentage were also recorded. The HIV group had significantly lower bilateral OB volumes, insular gyrus and corpus amygdala areas compared to the control group. The HIV group showed positive correlations between OB volumes, OS depths, insular gyrus, and corpus amygdala areas bilaterally. Increases in OB volumes and OS depths were associated with an increase in the insular gyrus area. The corpus amygdala and insular gyrus areas increased similarly. There was no significant correlation between age, gender, disease duration, CD4 lymphocyte count and per cent, HIV RNA values, and the measurement values of the central and peripheral olfactory regions. A decrease in olfactory regions of OB, insular gyrus, and corpus amygdala in HIV-infected patients shows that HIV infection may cause olfactory impairment. There is no correlation between disease duration and olfactory impairment. It may be related to neuroinflammation, HIV-related brain atrophy, acquired immunodeficiency syndrome (AIDS) dementia complex, or neurocognitive impairment, which are the other explanations for the olfactory impairment in HIV. The possible toxicity from antiretroviral therapy (ART) may be another cause that should be investigated further.

Comparison of Stress Level, Habitual Physical Activity Level and Immune Profile of People Living With HIV

The objective of this study was to compare the level of stress, the habitual level of Physical Activity and the immunological profile of people living with HIV. The present study had as sample 307 individuals of both sexes, X̅ = 46.8 ± 9.2 years, with positive HIV serology. Socioeconomic information was collected using an instrument, CD4+ lymphocyte count and HIV viral load were collected from the patients' medical records. Stress level was assessed using Lipp's Stress Symptom Inventory (ISSL), and Baecke's questionnaire was used to classify physical activity level. The Man-Whitney test was used to compare the variables and the Spearman test to verify the relationship between the variables adopting p &lt; 0.05 as the significance level. As a result, the study showed that 26.9% of the individuals are in the stress exhaustion phase, in relation to the level of physical activity, 28.2% were identified as "active", 23.1% as "very active", 23.1% as "insufficiently active", and 24.1% as "sedentary". The presence of stress was prevalent in sedentary individuals (13.6%) with longer duration of infection (27.3%) and with lymphocyte counts above 500mm (43.3%). The CD4+ count showed a significant result when compared to the level of stress, (U=1848.50; p=0.02). A relationship between depression/anxiety and stress was identified (r = 0.407; p &gt; 0.001). We conclude that the presence of stress has an effect on TCD4+ count and that the higher the depression/anxiety symptoms the higher the stress level in PLHIV. Keywords: Viral Load, CD4 Lymphocyte Count, Psychological Stress, HIV

Outcomes of Dolutegravir-Based Antiretroviral Therapy in Thai Youth Aged 18 to 24 Years Living with HIV in Bangkok: A Retrospective Cohort Study

Objective: Dolutegravir (DTG) is recommended globally for people living with HIV. The present study aimed to describe the efficacy and safety of DTG-based regimens among youth aged 18 to 24 years. Materials and Methods: A retrospective cohort study was conducted among youth aged 18 to 24 years living with HIV at Chulalongkorn Hospital. Participants were divided into antiretroviral naïve (AN), antiretroviral experienced with treatment failure (AETF), and antiretroviral experienced and virally suppressed (AEVS). DTG was prescribed as a daily individual tablet or as part of a fixed-dose combination. The primary outcome was virological suppression defined as VL of less than 200 copies/mL within 12 months after DTG initiation. Secondary outcomes included body weight and lipid profile changes. Results: Between 2017 and 2022, 87 youth with a median age of 20.6 (IQR 19.6 to 21.9) years were initiated on DTG. Fifty-six (64.3%) were male. Twelve participants were AN, 18 were AETF, and 57 were AEVS. HIV viral suppression was 100% and 96.2% among those AN and AEVS, but only 54.5% amongst the AETF group (p&lt;0.001). CD4 lymphocyte counts increased in all groups at follow-up. Median body weight change was +0.4 (IQR –1.8 to 3.6) kg in males and +0.5 (IQR –2.8 to 1.7) kg in females. Median total cholesterol declined from 167 (IQR 142 to 186) to 152 (IQR 135 to 170) mg/dL, p=0.003. Median triglycerides declined from 83 (IQR 60 to 129) to 66 (IQR 46 to 78), p&lt;0.001. No hospitalizations or mortalities were observed in the study. Conclusion: DTG was effective and well-tolerated in youth living with HIV, with no significant weight gain and improved lipid profiles. DTG implementation among youth living with HIV should be continued. Keywords: Dolutegravir; Antiretroviral therapy; Adolescents living with HIV

Effectiveness of second-generation integrase strand-transfer inhibitor-based regimens for antiretroviral-experienced people with HIV who had viral rebound.

Antiretroviral regimens containing a second-generation integrase strand-transfer inhibitor (INSTI) plus 2 nucleos(t)ide reverse-transcriptase inhibitors (NRTIs) are the recommended therapy for people with HIV (PWH) who are antiretroviral-naïve or on stable antiretroviral therapy (ART) with viral suppression. Real-world data on the virologic effectiveness of co-formulated bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) among PWH with virologic failure while receiving other ART remain sparse. We retrospectively reviewed the medical records of PWH who had viral rebound with plasma HIV RNA >1000 copies/mL and were switched to either dolutegravir combined with 2 NRTIs or BIC/FTC/TAF. The primary end point was re-achieving viral suppression within the first 48 weeks of switch. The association between NRTI-related resistance-associated mutations (RAMs) and virologic effectiveness was examined. Seventy-nine PWH with viral rebound while receiving other antiretroviral regimens were included. Within the first 48 weeks of switch, the overall probability of re-achieving viral suppression was 79.7% (82.5% [33/40] and 76.9% [30/39] for BIC/FTC/TAF and dolutegravir-based regimens, respectively, p=0.78). PWH with a higher CD4 lymphocyte count (adjusted odds ratio, per 100-cell/mm3 increase, 1.41; 95% confidence interval, 1.02-1.95) were more likely to re-achieve viral suppression. Among PWH switching to BIC/FTC/TAF who had pre-existing RAMs to NRTIs before switch, 14 of 15 (93.3%) successfully achieved viral suppression. Switching to BIC/FTC/TAF and dolutegravir-based regimens could re-achieve viral suppression in four-fifth of the PWH who experienced viral rebound during treatment with other antiretroviral regimens. Pre-existing NRTI-related RAMs did not have adverse impact on the effectiveness of dolutegravir combined with 2 NRTIs or BIC/FTC/TAF.

Two vicious circles associated with the aging of the immune system in the development of severe forms of COVID-19.

Background: The immune-inflammatory response is the basis of the pathophysiology of SARS-Cov-2 infection. In severe cases of COVID-19 uncontrolled systemic inflammatory response causes multiorgan dysfunction (MODS), as the most common immediate cause of death. Unfavorable outcome of the COVID-19 most often occurs in elderly patients. The aim of the study was to establish parameters with prognostic significance in severe cases of COVID-19 according to life years, laboratory markers of sepsis and MODS, as well as the number of peripheral CD4+ and CD8+T lymphocytes in 20 consecutively selected critically ill patients. Results: Eleven subjects were male, 9 female, mean age 73.45 ± 11.59, among which the oldest patient was 94 and the youngest 43years. All the patients met the sepsis and MODS criteria. Increased age and low CD4+ and CD8+T cell counts were identified as independent predictors of death. Only the two youngest patients (43 and 50years old) survived 28days, and they are the only ones with a CD4 lymphocyte count above 500 cells/mm3. Conclusion: Senescence of the immune system is mostly characterized by reduced regenerative capacity of adaptive immunity with diminished ability to respond to new antigens and a manifested proinflammatory phenotype. Additional reduction of protective capacity by further deterioration of T cell quantity and quality due to sepsis itself and mutual interaction of senescent T cells and vascular endothelial cells in the induction of cytokine storm represent two complementary vicious cycles in the development of sepsis-related multiorgan dysfunction.