Co-infections In HIV-infected Patients Research Articles

İnsan immün yetmezlik virüsü ile enfekte hastalarda sifiliz ko-enfeksiyonunun değerlendirilmesi ve rapid plasma reagin (RRP) titresinin sifiliz evresine göre takibi

Aim: Syphilis co-infection in HIV-infected patients is associated by a delayed serological response. The aim of this study is to obtain current data on the frequency of HIV/syphilis co-infection, the monitoring of rapid plasma reagin (RPR) titer after treatment, and factors affecting the serologic response. Methods: Serological tests for syphilis of HIV patients followed between January 2015 and March 2023 were evaluated retrospectively. Demografic data (age, sex), level of HIV RNA, RPR, Treponema pallidum haemagglutination test (TPHA), and syphilis stage were obtained from hospital electronic database. Serological response was defined according to Centers for Disease Control and Prevention (CDC) criteria. Results: Syphilis co-infection was detected in 36.2% of the patients, all of them were male. Distribution of syphilis stage was primary 2.9%, secondary 9.7%, latent 80.6%, and neurosyphilis 6.8%, respectively. All patients with primary, secondary, and neurosyphilis had ≥4-fold decrease in RPR titer within 12 months after treatment, while two patients with latent syphilis didn’t have a decrease in titer within 12-24 months. Overall serologic response was 95.8%. Comparing the time to a 4-fold decrease in the RPR titer in terms of syphilis stage, there was no statistically significant difference. Patients with initial RPR titer >1: 32 achieved faster serologic response than those with initial RPR titer ≤1: 32. Conclusion: HIV/syphilis coinfection rate was notably high. It is promising that most patients had a serologic response within the time-frame defined by the CDC. It should be considered that treatment response may take longer in patients with an initial RPR titer ≤32. Further prospective studies are needed to understand the factors associated with serologic response in HIV/syphilis co-infected patients.

Diagnostic Value of Metagenomic Next-Generation Sequencing for Multi-Pathogenic Pneumonia in HIV-Infected Patients.

To evaluate the value and challenges of real-world clinical application of metagenomic next-generation sequencing (mNGS) for bronchoalveolar lavage fluid (BALF) in HIV-infected patients with suspected multi-pathogenic pneumonia. Fifty-seven HIV-infected patients with suspected mixed pneumonia who were agreed to undergo the bronchoscopy were recruited and retrospectively reviewed the results of mNGS and conventional microbiological tests (CMTs) of BALF from July 2020 to June 2022. 54 patients were diagnosed with pneumonia including 49 patients with definite pathogens and five patients with probable pathogens. mNGS exhibited a higher diagnostic accuracy for fungal detection than CMTs in HIV-infected patients with suspected pulmonary infection. The sensitivity of mNGS in diagnosis of pneumonia in HIV-infected patients was much higher than that of CMTs (79.6% vs 61.1%; P < 0.05). Patients with mixed infection had lower CD4 T-cell count and higher symptom duration before admitting to the hospital than those with single infection. The detection rate of mNGS for mixed infection was significantly higher than that of CMTs and more co-pathogens could be identified by mNGS. The most common pattern of mixed infection observed was fungi-virus (11/29, 37.9%), followed by fungi-virus-bacteria (6/29, 20.7%) coinfection in HIV-infected patients with multi-pathogenic pneumonia. mNGS improved the pathogens detection rate and exhibited advantages in identifying multi-pathogenic pneumonia in HIV-infected patients. Early performance of bronchoscopy and mNGS are recommended in HIV-infected patients with low CD4 T cell counts and long duration of symptoms. The most common pattern of mixed infection observed was fungi-virus, followed by fungi-virus-bacteria coinfection in HIV infected patients with multi-pathogenic pneumonia.

Uracil-Containing Heterodimers of a New Type: Synthesis and Study of Their Anti-Viral Properties.

Widespread latent herpes viral infections within a population can lead to the development of co-infections in HIV-infected patients. These infections are not particularly dangerous for healthy individuals and often occur with minimal symptoms, but for those who are immunocompromised, these infections can accelerate the acute phase of HIV infection and AIDS. Thus, the idea of designing compounds that could combine activity against HIV and co-infections would seem promising. In that regard, eleven compounds were synthesized that represent conjugates of non-nucleoside HIV reverse transcriptase inhibitors and nucleoside inhibitors of the herpes family viruses with the hope that these novel heterodimers will result in dual activity against HIV and concomitant herpes virus infections.

Study of Prevalence of Hepatitis B, Hepatitis C, and Other Opportunistic Coinfections in HIV-infected Patients in a Tertiary Care Hospital of North India

Study of Prevalence of Hepatitis B, Hepatitis C, and Other Opportunistic Coinfections in HIV-infected Patients in a Tertiary Care Hospital of North India

Prospective study of tubercular co-infection in HIV infected patients in VIMSAR, Burla, Sambalpur, Odisha, India

Background: Tuberculosis is the most common opportunistic infection in HIV positive patient. This is a major challenge faced by HIV positive patient. Methods: This study was carried out at Medicine Department and ART Centre, VIMSAR, Burla to know the epidemiology and clinical profile of HIV and TB co-infection. This is a prospective study in which all adult patients attending to our hospital for period of one year with HIV-TB co infection are enrolled. There were 269 patients. The clinical parameters are studied after all detailed history and clinical examination. The diagnosis of Tuberculosis was made by relevant investigation like Sputum AFB, Chest X-ray, CSF Study, CT Scan, Pleural Fluid Study, Ascitic fluid study etc.Results: The results indicate majority of the patients out of 211 patients 74 (82.52%), were male 34(16.35%)were female and TGTS were-3(1.42%). Age group mostly affected were 26-35 years (38.1%) and 36-45 years (38.1 %). Extra-pulmonary TB constituted 56.28% and Pulmonary TB-43.72%. 41.99% completed anti-TB treatment and mortality was 12.99%. Mean CD4 count at the time of diagnosis-218iu/l; and patients with low CD4 cell count at the time of diagnosis had high mortality.Conclusions: Extra-pulmonary TB is predominant among HIV TB co-infection and the working-class population affected more than the rest TB Meningitis and Disseminated TB are associated with a bad prognosis when compare to other forms of TB. A low CD4 count at the time of Tuberculosis diagnosis is associated with a higher mortality and early suspicion diagnosis of tuberculosis and early initiation of ATT in HIV patients reduces mortality and morbidity significantly.

CD4+ T Cell Recovery and Hepatitis B Virus Coinfection in HIV-Infected Patients from Côte d'Ivoire Initiating Antiretroviral Therapy.

Immunorecovery could be attenuated in HIV-hepatitis B virus (HBV) coinfection versus HIV monoinfection during antiretroviral therapy (ART), yet, whether it also occurs in individuals from sub-Saharan Africa without severe comorbidities is unknown. In this study, 808 HIV-infected patients in Côte d'Ivoire initiating continuous ART were included. Six-month CD4+ count trajectories and the proportion reaching CD4+ T cell counts >350/mm3, HIV-RNA <300 copies/mL, still alive and not lost to follow-up within 18 months ("optimal immunorecovery") were compared between coinfected groups. At inclusion, 80 (9.9%) patients were HIV-HBV coinfected, 40 (50.0%) of whom had high HBV-DNA viral load (VL) (>104 copies/mL). Coinfected patients with high HBV-DNA replication initiated ART with significantly lower median CD4+ T cell counts [216/mm3, interquartile range (IQR) = 150-286] compared to coinfection with low HBV-DNA replication (268/mm3, IQR = 178-375) or HIV monoinfection (257/mm3, IQR = 194-329) (p = .003). These patients had significantly faster rates of CD4+ cell count increase from baseline after adjusting for baseline age, World Health Organization stage III/IV, and CD4+ cell counts (p = .04), yet, were not more likely to exhibit optimal immunorecovery (82.5% vs. 80.0% and 77.9%, respectively) (p = .8). In conclusion, change in CD4+ cell counts after ART-initiation was accelerated in coinfected patients with high HBV DNA VLs, but this did not lead to increased rates of optimal immunorecovery.

Acute Kidney Injury, Risk Factors, and Prognosis in Hospitalized HIV-Infected Adults in South Africa, Compared by Tenofovir Exposure.

There are limited data describing acute kidney injury (AKI) in HIV-infected adult patients in resource-limited settings where tenofovir disoproxil fumarate (TDF), which is potentially nephrotoxic, is increasingly prescribed. We describe risk factors for and prognosis of AKI in HIV-infected individuals, stratified by those receiving and those naive to TDF. A prospective case cohort study of hospitalized HIV-infected adults with AKI stratified by TDF exposure. Adults (≥18 years) were recruited: clinical and biochemical data were collected at admission; their renal recovery, discharge, or mortality was ascertained as an in-patient and, subsequently, to a scheduled 3-month follow-up. Among this predominantly female (61%), almost exclusively black African cohort of 175 patients with AKI, 93 (53%) were TDF exposed; median age was 41 years (interquartile range 35–50). Median CD4 count and viral load and creatinine at baseline were 116 cells/mm3 and 110,159 copies/ml, respectively. A greater proportion of the TDF group had severe AKI on admission (61% vs. 43%, p = .014); however, both groups had similar rates of newly diagnosed tuberculosis (TB; 52%) and nonsteroidal anti-inflammatory drug (NSAID; 32%) use. Intravenous fluid was the therapeutic mainstay; only seven were dialyzed. Discharge median serum creatinine (SCr) was higher in the TDF group (p = .032) and fewer in the TDF group recovered renal function after 3 months (p = .043). Three-month mortality was 27% in both groups, but 55% of deaths occurred in hospital. Those that died had a higher SCr and more severe AKI than survivors; TB was diagnosed in 33 (70%) of those who died. AKI was more severe and renal recovery slower in the TDF group; comorbidities, risk factors, and prognosis were similar regardless of TDF exposure. Because TB is linked to higher mortality, TB coinfection in HIV-infected patients with AKI warrants more intensive monitoring. In all those with poor renal recovery, our data suggest that a lower threshold for dialysis is needed.

Liver Function Tests Abnormalities and Hepatitis B Virus & Hepatitis C Virus Co-infection in Human Immunodeficiency Virus (HIV)-infected Patients in India

BackgroundWhile highly active anti-retroviral therapy (HAART) has improved survival of HIV-infected patients, there is increasing liver disease and progressive Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) related liver disease. AimsTo study the liver function tests (LFT) and HBV and HCV co-infection in HIV-infected patients. Material and MethodsAll HIV-positive patients presenting to a tertiary level hospital from April 2009 to April 2011 were evaluated. Baseline LFT, CD4/CD8 counts, ultrasound abdomen, HBsAg, IgG anti-HBc, HBVDNA, Anti-HCV and HCVRNA were done in all patients. LFT was repeated monthly or more frequently with anti-tubercular therapy (ATT)/HAART. ResultsAbnormal LFT were seen in 143/320 (44.6%) HIV-infected patients (n=320; M-282, F-38; mean age-35.4±7.3 years). Baseline LFT was abnormal in 48 (15%) [hepatotropic viruses-19, alcohol-24, NAFLD-1, disseminated TB-1, idiopathic-03). Subsequent LFT derangement developed in 95/272 (34.9%). In the majority, the LFT abnormality was mild (119/143–83.2%) and multi-factorial [HAART 132 (76.4%), alcohol 69 (48.2%), ATT 31 (21.7%), HBV 16 (11.2%), HCV 15 (10.4%)]. Using multivariate analysis, abnormal LFT were associated with HAART (OR, 5.92; 95%CI, 2.83–12.37), ATT (OR, 2.06; 95%CI, 1.06–3.99) or HCV infection (OR, 2.54; 95%CI, 1.03–6.26). Significant hepatotoxicity requiring drug modification was seen in only 7 cases.HBV, HCV and HBV+HCV co-infection were seen in 37 (11.6%), 28 (8.8%) and 2 (0.6%) respectively. Occult co-infections were rare [HBV-1 (0.3%); HCV-3 (0.9%)]. ConclusionWhile LFT abnormalities in HIV are common, they are usually mild and multifactorial. HBV and HCV co-infections were seen in 11.6% and 8.8%, respectively. Occult HBV and HCV infections were rare.

CMV+ Serostatus Associates Negatively with CD4:CD8 Ratio Normalization in Controlled HIV-Infected Patients on cART.

Cytomegalovirus (CMV) infection is common among HIV-infected patients but its repercussion on the course of CD4+ and CD8+ T cells after cART initiation remains elusive. The French Dat'AIDS cohort enrolled 5,688 patients on first-line cART, from which we selected patients who achieved HIV suppression for at least 12 months without modification of cART, and for whom CMV serostatus was available. Five hundred and three patients fulfilled the selection criteria (74% male, median age 43 yrs, 15.5% CDC stage C), of whom 444 (88.3%) were seropositive for CMV (CMV+). Multivariate analyses using mixed-linear models adjusted for the time from HIV suppression, sex, age, transmission risk group, duration of HIV follow-up, the interaction between time from HIV suppression and CMV+ serology, and the nadir CD4 count revealed a negative correlation between CMV+ and CD4:CD8 ratio (coeff. = -0.16; p = 0.001). This correlation was also observed among patients displaying optimal CD4 recovery (≥500 cells/mm3 at M12; coeff. = -0.24; p = 0.002). Hence, CMV+ serostatus antagonizes normalization of the CD4:CD8 ratio, although further analyses of the impact of co-morbidities that associate with CMV serostatus, like HCV infection, are needed to elucidate this antagonism formally. However, this might reflect a premature T cell senescence, thus advocating for a close monitoring of T cells in CMV co-infected patients. In addition, our results raise the question of the benefit of treatment for asymptomatic CMV co-infection in HIV-infected patients.

Hepatitis B co-infection in HIV-infected patients receiving antiretroviral therapy at the TC Newman Anti Retroviral Treatment Clinic in Paarl, Western Cape.

BackgroundHepatitis B virus (HBV) and human immunodeficiency virus (HIV) co-infection in South Africa is estimated to be between 5% and 23%; however, only limited evidence is available. Co-infection increases the risk of chronification of HBV, liver cirrhosis and death.ObjectiveTo assess the HBV and/or HIV co-infection rate amongst the adult antiretroviral treatment cohort at the TC Newman ART Clinic in Paarl, Western Cape.MethodsIn a retrospective, cross-sectional study, the routine hepatitis B surface antigen screening results for all adult HIV patients who were started on antiretroviral treatment over a period of 19 months were collected and analysed for gender, CD4 count and age.ResultsAmongst the 498 participants (60% female participants), the Hepatitis B surface Antigen positivity rate was 7.6%. Male gender, age between 50 and 59 years and a low CD4 count were correlated with higher rates.ConclusionUseful insight could be obtained by analysing routine data. The prevalence of almost 8% confirms the need for testing of HIV-positive patients for hepatitis B.

Hepatitis B co-infection in HIV-infected patients receiving antiretroviral therapy at the TC Newman Anti Retroviral Treatment Clinic in Paarl, Western Cape

Background: Hepatitis B virus (HBV) and human immunodeficiency virus (HIV) co-infection in South Africa is estimated to be between 5% and 23%; however, only limited evidence is available. Co-infection increases the risk of chronification of HBV, liver cirrhosis and death. Objective: To assess the HBV and/or HIV co-infection rate amongst the adult antiretroviral treatment cohort at the TC Newman ART Clinic in Paarl, Western Cape. Methods: In a retrospective, cross-sectional study, the routine hepatitis B surface antigen screening results for all adult HIV patients who were started on antiretroviral treatment over a period of 19 months were collected and analysed for gender, CD4 count and age. Results: Amongst the 498 participants (60% female participants), the Hepatitis B surface Antigen positivity rate was 7.6%. Male gender, age between 50 and 59 years and a low CD4 count were correlated with higher rates. Conclusion: Useful insight could be obtained by analysing routine data. The prevalence of almost 8% confirms the need for testing of HIV-positive patients for hepatitis B. Keywords: hepatitis B; prevalence; HIV-infected; adults; co-infection

Seroprevalence of Hepatitis B and C Co-infection in HIV Infected Patients: A Study in a Teritiary Care Centre From South India

Seroprevalence of Hepatitis B and C Co-infection in HIV Infected Patients: A Study in a Teritiary Care Centre From South India

Hepatitis E virus co-infection in HIV-infected patients in Foggia and Naples in southern Italy

Background: Hepatitis E virus (HEV) infection represents an emerging infection in developed countries and is thought to be a zoonotic infection. It has recently been described as a new causative agent of acute and chronic hepatitis in immunosuppressed subjects, including HIV-infected patients. The aim of this study was to assess the sero-virological prevalence of HEV in HIV patients and in the general population as control group. Methods: A prospective and observational cohort study was carried out in two hospitals in southern Italy. The seroprevalence of HEV was determined in a cohort of 959 subjects, 509 (53%) of whom were HIV-positive patients and 450 were from the general population. Serum samples were tested for anti-HEV antibodies; repeatedly positive results were confirmed by a Western blot assay. In positive patients HEV RNA and genotypes were also determined. Results: A total of 46 (4.8%) of the 959 serum samples examined were reactive to anti-HEV Ig and confirmed by Western blotting. The prevalence of HEV antibodies (IgG and/or IgM) was 2.7% in the control group and 6.7% in HIV-infected patients. Anti-HEV IgM was found in 6/46 (13.0%) of the anti-HEV Ig-positive serum samples, in 5/34 HIV patients and in 1/12 of the general population. No HIV-infected patient presented chronic hepatitis with HEV infection alone. Conclusions: This study indicates a higher circulation of HEV in HIV-infected patients, whereas a low prevalence of HEV antibodies in the general Italian population was shown. Chronic hepatitis with HEV alone was absent, while it was present in subjects with HIV-HEV, co-infected with hepatitis B virus (HBV) and/or hepatitis C virus (HCV).

Prevalence and molecular characterization of Hepatitis B in HIV infected individuals in Botswana

Hepatitis B Virus (HBV) is a major coinfection in HIV infected patients and it has emerged as an important cause of morbidity and mortality in this group since the start of Highly Active Antiretroviral Therapy (HAART).HIV/HBV coinfection prevalence varies by geographic region even within the same country. In Botswana the coinfection prevalence data is very sparse and what is reported varies. Ten HBV genotypes with some subgenotypes have been described differing by geographic distribution, course of disease, response to treatment and development of mutations. Even though data have shown that genotypes are predictive of disease outcome, the circulating HBV genotypes in Botswana remains unknown. Therefore this study aims at determining the HIV\HBV coinfection prevalence rate and the circulating HBV genotypes in Botswana.

Hepatitis B coinfection in HIV-infected patients

Results HIV-HBV coinfection prevalence was 19.9%. We noticed a slightly higher frequency of coinfection in males (53.2%), most patients belonging to the age group 20-29 (86.5%), the median age of the group being 25.56 years. The predominant route of transmission was parenteral (57.5%), heterosexual being found in a significant proportion (40.1%). The mean CD4 cell count was 246.20 cells/cmm, over 41% of the cases had levels between 200-499 CD4 cells/ cmm. Individual values of plasma HIV viral load varied from undetectable levels up to a maximum of 4,600,000 copies/mL, with a median value of 142,906 copies/mL. ALT levels in HIV and HBV coinfection varied between 10-323 U/L, the average being 49.90 U/L, more than 65% of subjects with pathological levels; 218% of the total cholesterol values were pathological, the mean for the group was 182.58 mg/dL. Only 16.8% in the coinfected group had serum triglyceride levels below the reference (160 mg/dL). All patients in the HIV-HBV coinfected group had antiretroviral therapeutic agents with dual action anti-HIV and anti-HBV, 87.3% receiving lamivudine alone or in coformulation; in a small number of cases (3.6%) we opted for tenofovir.

Update on HIV and Hepatitis Virus Coinfection: The South American Perspective

Liver disease related to hepatitis B (HBV) or hepatitis C (HCV) infections among HIV infected patient population are currently a major cause of morbidity and mortality. They are extremely frequent, intravenous drug use being the most commonly documented route of transmission despite this practice is not a major concern in South America. Sexual transmission route is more prevalent in HBV coinfected patients. In South America, the most frequent HCV genotype identified in HIV patients is genotype 1a; genotypes A and F being the most prevalent among the HBV population. Even though effective therapy based on tenofovir regimens for HBV/HIV coinfected patients have been available for some years now, treatment recommendations still vary from country to country. Although novel, oral, more efficient drugs are being developed for HCV/HIV treatment, these options are very expensive and not yet available worldwide. This is especially so in regions such as South America. This review will discuss epidemiology, diagnosis and management of HBV and HCV coinfection in HIV infected patients with special focus in South America.

Prevalence of hepatitis B virus and hepatitis C virus in patients with human immunodeficiency virus infection in central China

Co-infection of hepatitis B virus (HBV) and/or hepatitis C virus (HCV) with human immunodeficiency virus (HIV) has an adverse effect on liver disease progression. This study investigated the prevalence of HBV and/or HCV co-infection in HIV-infected patients in Central China. A total of 978 HIV-infected patients from Hunan Province were enrolled. HBV serum markers, anti-hepatitis-C-virus antibody (anti-HCV), HBV DNA, and HBV genotypes were analyzed. The prevalence of hepatitis B surface antigen (HBsAg) and anti-HCV in HIV-infected patients was 19.4% and 62.4%, respectively. The prevalence of anti-HCV in HIV-positive intravenous drug users was 93.6%. Among HBsAg-positive patients, 88.1% were found to have at least one HBV serum marker. The rates of HIV mono-infection, HBV/HIV dual infection, HCV/HIV dual infection, and HBV/HCV/HIV triple infection were 30.4%, 7.2%, 50.2%, and 12.2%, respectively. Antibody to HBsAg (Anti-HBs) was more common in anti-HCV-positive than anti-HCV-negative patients (53.3% vs 40.2%, P=0.000), but isolated hepatitis B core antibody (anti-HBc) was more common in anti-HCV-negative than anti-HCV-positive patients (24.2% vs 12.3%, P=0.000). Hepatitis B e antigen (HBeAg) and sexual transmission were independent risk factors for active HBV replication. Intravenous drug use and male sex were independent risk factors, but old age and presence of HBeAg were independent protective factors for anti-HCV. Co-infection of HBV and/or HCV with HIV infection is common in central China. HCV status is associated with anti-HBs and isolated anti-HBc in co-infected patients.

Plasmodium falciparum and intestinal parasitic co-infections in HIV-infected patients in Benin City, Edo State, Nigeria

Human co-infection with Plasmodium falciparum and helminthes is ubiquitous throughout Africa. This study aimed to determine the co-infections of Plasmodium falciparum infection in HIV and intestinal parasitic infections, and their immunological distribution, in Benin City, Nigeria. A total of 2,000 stool specimens from HIV-positive patients and 500 controls (HIV-negative individuals) were examined for ova, cysts, or parasites using standard procedures. In addition, patients' blood samples were analyzed for CD4 counts by flow cytometry and examined for Plasmodium falciparum by microscopy. The prevalence of single parasitic infection among HIV patients was 18.1% in males and 16.9% among females with no significant difference (p = 0.536) while gender was a risk factor in multiple parasitic infections (male versus female: 4.2% and 1.8% OR = 2.384; 95% CI = 1.371, 4.147) (p = 0.0025). Increasing age was not associated with increased risk of both single and multiple parasitic infections (p = 0.083; p = 0.248). CD4 + T cell count less than 200 cells/µl was a risk factor for acquiring single and multiple parasitic infections among HIV patients (OR = 5.565; 95% CI = 4.136, 7.486; p = 0.0001; OR = 4.283; 95% CI = 2.424, 7.566; p = 0.0001). The most common co-infection observed was between Plasmodium falciparum and Ascaris lumbricoides 43% (10) among HIV patients. This study provides evidence of co-infections between Plasmodium falciparum and intestinal parasites. Diagnosis of parasitic infections among HIV patients is advocated as this will enhance better management of HIV-infected patients.

Adverse Outcome in Lamivudine Resistant HBV-related Cirrhotic Patient Co-infected with HIV

© 2011, INASL 5 12 patients, 9 were of CC genotype and 3 were CT. Finally 8 (66.66%) patients with CC genotype and 1 (8.33%) patient with CT genotype have achieved SVR besides 1 (8.33%) patient with CC genotype and 2 (16.66%) patients with CT genotype have not achieved SVR. Limitations: Small sample size and association of host genotype (IL28β) with the SVR of different viral genotypes is not classified. Conflict of Interest: None Prevalence of Coinfection of Hepatitis B in HIV-infected Patients of North Kerala TM Ramachandran*, G Ayyappan**, N Sona†, K Soopy‡, T Varghese¶ *Additional Professor of Gastroenterology, **Senior Resident, Department of Gastroenterology and Presenting Author, †Senior Medical Officer, ‡ART Center, Associate Professor of Medicine, ¶Professor and Head of Gastroenterology, Medical College, Calicut Background: Patients with HIV infection are likely to have high risk of HBV infection which share the same route of transmission with HIV. HBV coinfection has been shown to decrease the life expectancy in the HIV-infected patients and also influences the management of these patients. There are no studies from Kerala regarding the prevalence of hepatitis B coinfection in HIV-infected patients. Aim: To assess the prevalence of hepatitis B coinfection in HIV-infected patients in North Kerala. Materials and Methods: HIV-infected patients attending the ART Clinic, Medical College, Calicut from December 2009 to December 2010 were screened for hepatitis B infection using HBsAg ELISA test. History regarding risk factors was taken. LFT was done for all patients. Results: Five hundred and twenty six HIV-positive patients were screened (male 317, M:F = 1.5). Mean age was 39.1 (range 20–85) years. History of high-risk sexual behavior was present in 376/526 (71.4%), prior surgery and blood transfusions in 66/526 (12.5%) and 35/526 (6.6%). History of i.v. drug abuse in 8/526 (1.5%). 489/526 (93.1%) of patients were on anti-retroviral therapy. Mean bilirubin level was 0.54 mg/dL. Mean albumin level was 3.6 g/dL. ALT was elevated in 321/526 (61%) of patients. 6/526 patients (1.14%) were found to be HBsAg positive (males – 4). Intravenous drug abuse was present in 1/6 (16.6%) and high risk sexual behavior in 3/6 (50%). ALT elevation was present in 4/6 (66.6%) of HBsAg positive patients. Conclusion: The prevalence of hepatitis B infection in HIV-infected patients of North Kerala is 1.14%. The prevalence is low compared to other regions of India. However the prevalence of HBV infection was 2-fold higher in this high-risk group when compared to our general population (0.52%). The LFT abnormalities seen in HIV patients need to be evaluated by further studies. Conflict of Interest: None Adverse Outcome in Lamivudine Resistant HBV-related Cirrhotic Patient Co-infected with HIV R Maheswari, R Rai, R Trimukhe Department of Medicine, NSCB Medical College, Jabalpur Background: An estimated 360 million persons worldwide are chronically infected with HIV; nearly 10% of them are co-infected with chronic HBV. These individuals tend to have higher levels of HBV DNA, lower rates of spontaneous HBeAg seroconversion, more severe liver disease and increased rates of liver related mortality. Until few years lamivudine was frequently prescribed for chronic HBV infection and as component of HAART. However lamivudine was frequently associated with development of resistance, more so in patients with HIV co-infection and is associated with adverse outcomes. Aim: To describe the clinical sequel of lamivudine resistance in HBV-related cirrhotic patient co-infected with HIV on HAART. Methods: A HIV co-infected HBV related HBe-Ag-negative cirrhotic patient was followed for 2 years on HAART (Stauvudine/ Lamivudine-300 mg daily/Efavirenz). Routine hematological, biochemical tests, LFT, PT, HBV-DNA and radiological investigations were done on follow-up. Results: A 40-year-old male, non-alcoholic, presented on July 2010 with oral candidiasis, appetite loss and fever for 3 months. Two years back he had raised bilirubin (4 mg/dL), ALT: 144U/L, HBV-DNA: 27160 IU/mL and CD4 count: 300 cells/cumm. Anti-HCV and HDV RNA were negative. After 1 year he had normal bilirubin and ALT; HBV-DNA: 266 IU/mL and CD4 count: 410 cells/cumm. In July 2010 there was a virological breakthrough (HBV-DNA: 34258 IU/mL) with bilirubin: 3 mg/dL, ALT levels: 345 U/L and CD4 count: 278 cells/cumm. This patient probably developed lamivudine resistance. Tenofovir was added but patient died after 2 months. Conclusion: Few years back patients with HBV HIV co-infection in resource constrained settings received lamivudine as the only drug active against HBV and as a part of HAART which has led to emergence of lamivudine-resistant HBV. Despite newly licensed drug like tenofovir for HBV; treatment of co-infection is difficult especially when there is suspected failure of HAART and has to be addressed. Conflict of Interest: None 03_JCEH-Abstract.indd 5 3/18/2011 11:13:03 AM

Syphilis and HIV co-infection in Ghana

Syphilis and HIV co-infection is common in Africa and frequently presents atypically with earlier progression to tertiary syphilis. Screening for and treating syphilis prevents complications of the disease and reduces transmission of both syphilis and HIV, and congenital syphilis. The aims of this study were: 1. To determine the seroprevalence of syphilis co-infection in HIV infected patients attending a large Teaching Hospital in Kumasi, Ghana; 2.To evaluate the sensitivity and specificity of three different tests (RPR and 2 EIAs) in this population, and 3.