Clinical Features Of HIV Infection Research Articles

Epidemiological and clinical characteristics of HIV infection in the Spanish VACH Cohort: a descriptive study.

knowledge of the present features of the HIV epidemic is relevant, especially to develop management programmes directed to poorly controlled patients. to describe the epidemiological and clinical features of HIV infection in a large multicentre cohort. cross-sectional study. data of the Spanish VACH Cohort of HIV infected patients. a total of 53 variables were included. Descriptive statistics were used to report the results. Bivariable statistics were used to assess variation along time on prescribed antiretroviral treatment and on causes of death. a total of 30,843 patients belonging to most regions of Spain were included: 23,682 (76.78%) were male, mean and standard deviation of age of all patients was 34.03 ± 9.55 years in their first visit and 43.68 ± 10.52 years in their last visit; 12,677 (41.10%) were smokers, 3,521 (11.42%) had diabetes mellitus, 15,351 (49.77%) had acquired HIV via sexual route and 12,714 (41,22%) via parenteral route, 16,057 (52.06%) had positive hepatitis C virus serology. Their median and interquartile range of CD4 lymphocyte count, per cubic millimetre, were: lowest available 198 (79-337) and last available 510 (299-745). Last available HIV viral load was suppressed (<200 RNA copies per mL) in 23,485 (76.14%). Modalities of prescribed antiretroviral treatment varied substantially over time, with integrase inhibitor combinations predominating the last years. Causes of death changed from AIDS defining conditions early in the epidemic to non-AIDS defining conditions more recently. patients in the Spanish HIV VACH Cohort are predominantly middle-aged men. They acquired HIV via sexual or parenteral routes in similar proportions. Most of them are taking antiretroviral treatment and have their HIV infection properly controlled.

Application of media technologies in prevention of HIV infection among the young people of the Republic of Khakassia

This article analyzes the previously unknown aspects of using media technologies as tools for preventing the spread of HIV infection among young people in the Siberian region. Accordingly, the purpose of this article is to analyze the effectiveness of video cases in the prevention of HIV infection among young people. The authors rely on the idea of social prevention of dangerous diseases as a social institution that is functionally focused on the development, active assimilation and use of socio-cultural norms and skills, the risk of spreading diseases. The theoretical and methodological basis of the work is the approaches of well-known foreign scientists related to the issues of preserving society, stability of social systems, and coordination of the interests of the state and the individual. This article is based on materials of the monitoring study, which was conducted in 2019-2020 in the framework of preventive measures of HIV infection specialists of the “Center for Preventing and Fighting AIDS” in conjunction with volunteers. The authors of this article analyze the results of the survey: the questions were aimed at studying the awareness of young people about possible transmission routes, potential risk groups, clinical features of HIV infection and AIDS, as well as the awareness of young people about the HIV infection in general before and after preventive measures with the help of video sessions. This study makes a number of conclusions concerning the dynamics of students’ general awareness and their relationship to the HIV infection, as well as the effectiveness of media in preventing the HIV infection among the youth of the Republic of Khakassia. The results show that in the contemporary period of active usage of digital technologies, it is advisable to prevent HIV infection in the youth environment by using video cases. At the same time, educational organizations and educational institutions are the most optimal platform for performing HIV prevention work with young people. Finally, the main priority of HIV prevention should be to understand and understand the possibility of infection due to risky behavior of young people.

Prevalence of HIV related oral lesions in people living with HIV and on combined antiretroviral therapy: a Nigerian experience.

Introductionoral lesions comprise significant clinical features of HIV infection and are often indicators of immune suppression. However, the advent of antiretroviral therapy has significantly reduced its prevalence. The aim of this study was to relate the prevalence of oral lesions of HIV to treatment outcome of Combined Antiretroviral Therapy (cART) in a Nigerian HIV adult population.Methodsa cross- sectional study was conducted on 491 People Living with HIV (PLWHIV) on cART from two HIV centres in Lagos state, Nigeria. The EC-clearing house guidelines were employed to categorise oral lesions. Presence or absence of these lesions was reconciled with CD4+ cell count as a measure of efficacy of cART treatment.Resultsa total of 491 PLWHIV on cART were enrolled, 366 (74.5%) were females and 125 (25.5%) were males. Age ranged between 18-80 years, with a mean of 41.2 ± 9.1 years. On examination, 12 (2.4%) patients presented with HIV oral lesions. Oral hyperpigmentation (10, 2.0%) was the most common lesion seen, followed by oral ulcers (2,0.4%). Majority (75%) of the affected patients were on a Lamivudine containing regimen. 7 out of the 12 patients with oral lesions had CD4+ cell count between 200-500 cell/mm3 prior to cART initiation. Eleven (92%) of the patients with oral lesions had significant improvement of their CD4+ cell count after cART administration.Conclusionthe prevalence of oral lesions in HIV patients on cART therapy in Lagos is low. Oral hyperpigmentation and oral ulcers are the most frequent lesions seen. The presence or absence of oral lesions were not associated with CD4+ cell count. Therefore, we conclude that the oral lesions seen in HIV patients on cART may not be a direct manifestation of the disease.

Relationship of Oral Lesions and CD4 Count in Female HIV Patients in South Western Nigeria

ABSTRACT Background: Oral lesions have been reported to be early clinical features of HIV infection. Objective: The purpose of this study was to establish the prevalence of oral lesions in HIV Seropositive female patients and correlate the CD4 count with the appearance of oral lesions in the female patients attending Lagos University Teaching Hospital (LUTH) and University of Benin Teaching Hospital, Benin (UBTH). Methods: A prospective study was undertaken in 172 newly diagnosed adult HIV infected female patients (not on antiretroviral therapy), who attended the PEPFAR clinic at LUTH and the HIV Clinic of the University of Benin Teaching Hospital, Benin City, Nigeria. They were assessed for oral lesions which were evaluated using EEC/WHO (2003) – Classification on the diagnostic criteria for oral lesions in HIV. Data were collected using an interviewer administered questionnaire. Following Oral examination undertaken, oral lesions were detected, recorded and Original Research Article

Prevalence of oral lesions and the effects of HAART in adult HIV patients attending a tertiary hospital in Lagos, Nigeria

Background: Oral lesions have been reported to be early clinical features of HIV infection. The objective of this study was to establish the prevalence of oral lesions and the management outcome using HAART in HIV Seropositive patients attending a tertiary hos- pital in Lagos, Nigeria. Methods: This was a prospective study in 114 newly diagnosed adult HIV infected patients (not on antiretroviral therapy), who attended the PEPFAR clinic at Lagos University Teaching Hospital. They were assessed for oral lesions which were evaluated using EEC/WHO—Classification on the diagnostic criteria for oral lesions in HIV. Data were collected using an interviewer administered questionnaire. Oral examination was carried out and oral lesions detected were recorded. Presence or absence of oral lesions was evaluated following 3 months use of HAART. Results: 114 patients were enrolled into the study, 49(43.0%) males and 65(57.0%) females, with age range of 18-63 years. 42 (36.8%) presented with oral lesions, 19 (45.2%) of which had multiple lesions. Oral Candidiasis which accounted for 47.7% was the most common oral lesion observed followed by Oral Hairy Leukoplakia (21.6%) and oral hyperpigmentation (10.8%). Pseudomembraneous Candidiasis was the most common variant of oral Candidiasis seen. Prevalence of oral lesions was significantly associated with low CD4 count and high viral load. Eighty four percent (84%) of oral lesions disappeared following 3 months of HAART treatment. Conclusion: Oral lesions are common features of HIV and a marker for progression of the disease to AIDS. There was significant reduction in oral lesions following 3 months treatment with HAART.

Tuberculous pericarditis and HIV infection in Africa

1report the results of an observational study on the mortality rate and its predictors in patients with a presumptive diagnosis of tuberculous pericarditis in sub-Saharan Africa. By enrolling patients with presumed tuberculous pericarditis from 15 referral hospitals in Cameroon, Nigeria and South Africa, and not insisting on gold-standard diagnostic criteria, the investigators have managed to enroll 185 patients within a 6month period between March and October 2004. Patients were eligible for enrolment if the attending physician felt sufficiently confident with the diagnosis of tuberculous pericarditis to commence antituberculosis treatment, and the management of each patient was at the discretion of the attending physician, in keeping with the observational nature of the study. In the majority of patients, HIV status was based on serological testing for HIV, but due to the fact that, at the time of the study, voluntary and confidential testing for HIV was not always offered at the participating medical institutions, the investigators included the category of suspected HIV infection based on clinical grounds, and classified each patient as either having evidence of ‘clinical HIV disease’ or ‘no clinical HIV disease’, without regard to the HIV serological status of the patient. The HIV assessment was left to the discretion of the collaborating physician, and no criteria were specified. This approach may lack some scientific rigour but it allowed rapid enrolment of all suspected cases and reflects the real-life experience of clinicians across Africa who do not always have access to diagnostic facilities and who do not find it difficult to diagnose tuberculous pericarditis on clinical grounds, however difficult it may be to confirm the diagnosis in the laboratory. 2,3 Using Cox regression, they assessed the effect of baseline clinical and therapeutic characteristics on mortality during a 6month period of follow-up. In a group of 174 patients (median age 33; range 14 - 87 years), the overall mortality rate was 26%, and it was significantly higher in patients who had clinical features of HIV infection than in those who did not (40% v. 17%, p=0.001). Independent predictors of death during followup were: (i) a proven non-tuberculosis final diagnosis (hazard ratio (HR) 5.35, 95% confidence interval (CI) 1.76 - 16.25), (ii) the presence of clinical signs of HIV infection (HR 2.28, CI 1.14 - 4.56), (iii) coexistent pulmonary tuberculosis (HR 2.33, 1.20 - 4.54), and (iv) older age (HR 1.02, CI 1.01 - 1.05). There was also a trend towards an increase in death rate in patients with haemodynamic instability (HR 1.80, CI 0.90 - 3.58) and a decrease in those who underwent pericardiocentesis (HR 0.34, CI 0.10 - 1.19). The strength of the study is that it reflects what clinicians experience in the field and what they perceive to be HIVand tuberculosis-related deaths. This experience may differ substantially from statistics captured by national tuberculosis control programmes. This study by Mayosi and colleagues 1

Contemporary use of adjunctive corticosteroids in tuberculous pericarditis

There is controversy concerning the effectiveness of adjunctive corticosteroids in reducing mortality in tuberculous pericarditis. To assess the impact of this controversy on contemporary clinical practice, we studied the use of adjunctive corticosteroid in 185 consecutive patients with suspected pericardial tuberculosis from 15 hospitals in Cameroon, Nigeria, and South Africa. 109 (58.9%) patients received steroids with significant variation in corticosteroid use ranging from 0% to 93.5% per centre ( P < 0.0001). The presence of clinical features of HIV infection was the independent predictor of the non-use of adjunctive corticosteroids (OR 0.39, 95% CI 0.20–0.75, P = 0.005). We have demonstrated marked variation in the use of corticosteroids by practitioners, with nearly half of all patients not receiving this intervention. Taken together with the statistical uncertainty regarding the effectiveness of adjunctive steroids in tuberculous pericarditis, these observations probably reflect a state of genuine uncertainty or clinical equipoise among practitioners who care for patients with tuberculous pericarditis in sub-Saharan Africa. These data provide a justification for the establishment of adequately powered randomised clinical trials to assess the effectiveness of adjunctive corticosteroids in patients with tuberculous pericarditis.

Co-trimoxazole as prophylaxis against opportunistic infections in HIV-infected Zambian children (CHAP): a double-blind randomised placebo-controlled trial

No trials of co-trimoxazole (trimethoprim-sulfamethoxazole) prophylaxis for HIV-infected adults or children have been done in areas with high levels of bacterial resistance to this antibiotic. We aimed to assess the efficacy of daily co-trimoxazole in such an area. We did a double-blind randomised placebo-controlled trial in children aged 1-14 years with clinical features of HIV infection in Zambia. Primary outcomes were mortality and adverse events possibly related to treatment. Analysis was by intention to treat. In October, 2003, the data and safety monitoring committee recommended early stopping of the trial. 541 children had been randomly assigned; seven were subsequently identified as HIV negative and excluded. After median follow-up of 19 months, 74 (28%) children in the co-trimoxazole group and 112 (42%) in the placebo group had died (hazard ratio [HR] 0.57 [95% CI 0.43-0.77], p=0.0002). This benefit applied in children followed up beyond 12 months (n=320, HR 0.48 [0.27-0.84], test for heterogeneity p=0.60) and across all ages (test for heterogeneity p=0.82) and baseline CD4 counts (test for heterogeneity p=0.36). 16 (6%) children in the co-trimoxazole group had grade 3 or 4 adverse events compared with 18 (7%) in the placebo group. These events included rash (one placebo), and a neutrophil count on one occasion less than 0.5x10(9)/L (16 [6%] co-trimoxazole vs seven [3%] placebo, p=0.06). Pneumocystis carinii was identified by immunofluorescence in only one (placebo) of 73 nasopharyngeal aspirates from children with pneumonia. Our results suggest that children of all ages with clinical features of HIV infection should receive co-trimoxazole prophylaxis in resource-poor settings, irrespective of local resistance to this drug.

Correction: Clinical Features of HIV Infection

Correction: Clinical Features of HIV Infection

Treatment of oral candidiasis in HIV infection

Oral candidiasis is one of the most common clinical features of HIV infection. The lesion occurs in three predominant forms, and the two intraoral examples, pseudomembranous and erythematous, are equally predictive of the development of AIDS, independent of CD4 counts. The predominant species is C. albicans, although other species are occasionally found. Some studies claim correlation of salivary Candida counts with CD4 numbers or clinical stage of HIV-related disease, but this approach has not been used widely in HIV staging. Therapy with a variety of antifungal agents, including both topical and systemic drugs, is effective. New slow-release oral topical drug delivery systems may prove to be useful. Recently, examples of resistance to some drugs have been reported. Resistance may be associated with the emergence of different species.

Gastrointestinal and Nutritional Manifestations of the Acquired Immunodeficiency Syndrome

Part 1 Background: biological and clinical features of HIV infection, Donald P. Kotler introduction to gastrointestinal immunology - host defense immune system in the gut, Hidenori Kawanishi, et al nutrition and immunity, Chitra Prasad and Ranjit Kumar Chandra. Part 2 Clinical manifestations of AIDS: oral complications of HIV infection, Andrew J. Zakarian diagnosis and treatment of gastrointestinal infections in AIDS, E. Rene, et al gastrointestinal neoplasms in AIDS, Milayna Subar, et al hepatobiliary disease in AIDS, Gail M. Comer gross and microscopic pathology of AIDS in the gastrointestinal tract, Frederic Clayton radiologic changes in AIDS, Jeanne Baer and Susan Hilton. Part 3 Nutritional aspects of AIDS: mechanisms of wasting in infection and cancer - an approach to cachexia in AIDS, Carl Grunfeld studies of nutritional status in patients with AIDS, Donald P. Kotler, et al AIDS - enteral and parenteral nutrition support, Steven B. Heymisfield, et al practical dietary recommendations in HIV infection, Cade Fields Newman. Part 4 Other considerations: psychosocial aspects pertaining to nutrition, Kristin E. Weaver establishing a gastrointestinal unit, Sharon Gallagher and William P. Winkler.

Children born to women with HIV-1 infection: natural history and risk of transmission

600 children born to HIV-infected mothers by June 15, 1990, in ten European centres were followed to study the natural history of HIV infection and the vertical transmission rate. They were seen at birth, every 3 months up to 18 months of age, and every 6 months thereafter. At last follow-up, 64 children were judged to be HIV infected and 343 had lost antibody and were presumed uninfected. The initial clinical feature in infected children was usually a combination of persistent lymphadenopathy, splenomegaly, and hepatomegaly, though 30% of children presented with AIDS, or with oral candidosis followed rapidly by AIDS. An estimated 83% of infected children show laboratory or clinical features of HIV infection by 6 months of age. By 12 months, 26% have Al DS and 17% die of H IV-related disease. Subsequently, the disease progresses more slowly and most children remain stable or even improve during the second year. The vertical transmission rate, based on results in 372 children born at least 18 months before the analysis, was 12·9% (95% Cl 9·5-16·3%). Virus has been repeatedly isolated in an additional small proportion of children (2·5%, 95% Cl 0·7-6·3%) who lost maternal antibody and have remained clinically and immunologically normal. Without a definitive virological diagnosis, the monitoring of immunoglobulins, CD4/CD8 ratio, and clinical signs could identify HIV infection in 48% of infected children by 6 months, with a specificity of more than 99%.

The Oral Clinical Features of HIV Infection

Patients with HIV infection and AIDS frequently experience one or more oral lesions at some time during the course of their disease. Recognition and management of these oral manifestations is an important component of AIDS care.

The Eye and Systemic Disease.

This book is a practical guide to ambulatory management of HIV-infected patients. It also provides a survey of relevant clinical background information, such as testing methodology, management of life-threatening complications, and clinical manifestations of HIV infection. The most popular AIDS texts currently on the market all attempt a comprehensive discussion on the virological, immunological and clinical features of HIV infection but do not emphasize practical management issues confronted by the practitioner. Case studies illustrating the major points covered in the text are provided. The organization provides a logical sequence of topics for those who wish to review the entire book as well as a convenient breakdown for finding specific information.