Concomitant HIV Infection Research Articles

Incidence and Properties of Neurologic Disorders Recovered from Iranian Patients with HIV Infection: A Case Series

Background: In the pre-antiretroviral era, the frequency of neurologic complications was associated with low baseline CD4+ T-cell counts. Introduction of antiretroviral therapy (ART) has largely decreased the incidence of opportunistic infections and CNS neoplasia in the recent two decades; however, virus replication persists in the cerebrospinal fluid (CSF) and neuronal tissues due to variable drug penetration as well as development of drug resistance. Although many previous studies have addressed the presence of neurologic manifestations in the course of HIV infection; an update on the type of neurologic involvement, presenting signs and symptoms, radiologic findings, and response to treatment is essential. Methods: In a case series, we recruited 42 patients presenting with neurologic symptoms/signs and concomitant HIV infection in 12 months during 2015 and 2016 at a tertiary academic hospital. Information regarding the course of diagnosis, laboratory findings, radiologic findings, and final diagnosis were documented and analyzed in relation to the survival status of each patient during up to one month of hospitalization. Results: The mean age of the patients was 39.7; 25 were men, 19 were newly diagnosed. Thirteen patients (31%) died during treatment; from them, six were newly diagnosed. Median CSF white blood cell counts were significantly higher in nonsurvivors; the most common diagnosis was focal brain lesions; toxoplasmosis and tuberculosis were the first common etiologies; 79% recovered with the intended treatment regimen. History of drug abuse, not receiving antiretrovirals, low baseline CD4 counts, and loss of consciousness at the time of admission has been seen more among deceased patients. Conclusions: Neurologic presentations or complications of HIV infection lead to high mortality rates. Early diagnosis of infection and improvement of patient compliance with antiretroviral treatment can reduce the mortality associated with neurologic diseases.

Characteristics of chronic HBV-infection in HIV-infected

Objective: to evaluate the course of hepatitis B in HIV-infected patients and the effectiveness of standard therapy for such patients, to establish the features of the formation of liver fibrosis, to determine the prevalence of present, transmitted or "hidden" HBV infection markers, as well as the incidence of concomitant hepatitis D (GD) in patients for HIV infection.Material and methods. The course of chronic hepatitis B (HGV) is analyzed in 100 people: 50 patients — diagnosed with HBV-monoinfection (1st group) and the same number with HGV and concomitant HIV infection (2nd group). Hepatitis B and D screening, clinical and biochemical studies, established the degree of liver fibrosis using the METAVIR score. In addition, in order to determine the prevalence of current, delayed or "hidden" HBV markers in HIV-infected patients, medical records of 114 patients were analyzed.Results. HGV on the background of HIV infection is more frequent than with HBV-monoinfection accompanied by clinical manifestations of astenovegetative dyspeptic syndromes and hepatosplenomegaly, as well as the tendency to a more significant syndrome of cytolysis. In this case of HIV infection HBV HBV is higher than in patients with only HGV. In 6.7% of the patients with HIV, HBV DNA was detected along with the markers of the transmitted HBV infection without the simultaneous detection of HBsAg, which may indicate the presence of "hidden" hepatitis B. Therefore, even with the detection of anti-HVsor, anti-HBe and and a negative result of the HBsAg study, it is advisable to examine the patient for HBV genetic material using PCR. ART according to the tenofovir dizoproxil + emtricitabine + efavirenz scheme, is effective in case of concomitant HGV, because after 6–9 months it provides a reduction in the level of replication of the DNA of NVB up to its disappearance, HBeAg seroconversion, HBsAg sero-reversion, and in 4 of 27 patients, the appearance of anti-HBs. In 4.0% of patients with COPD with HIV infection co-infected or superinfected HDV, accompanied by high cytolysis in the absence of jaundice. Conclusions. Significant influence on the degree of liver fibrosis with concomitant HIV infection has a level of immunodeficiency — the smaller the number of CD4 + -T‑lymphocytes, the deeper the fibrosis and vice versa. There is a strong reverse correlation between the number of CD4 + -T‑lymphocytes in patients with COPD in HIV-infected patients and the degree of hepatic fibrosis according to the METAVIR score (r = – 0.77–0.89, p <0.001).

Ultrasonic cavitation in treatment of soft tissue purulent diseases in HIV-infected patients

The aim — improvement of a soft tissue purulent diseases treatment in HIV­infected patients by a surgical treatment with ultrasound cavitation combination.Materials and methods. The analysis of complex surgical treatment of soft tissues apostasies and phlegmon in 124 HIV­infected patients was conducted. Patients were divided into 2 groups, depending on the strategy of treatment. In the first (main) group (n = 26) the combination of surgical treatment with ultrasonic cavitation was applied. Ultrasonic cavitation was used in post­operative period during I (exudative) phase of wound process before incarnation appeared. By comparison, in the second group (n = 62) only surgical treatment was applied.Results and discussion. The ultrasonic cavitation in treatment of soft tissue purulent diseases in HIV­infected patients allowed to stop local inflammation and achieve partial incarnation of wound surface on the average in 13.2 ± 0.5 days in the first group and in 15.9 ± 0.6 days in the second group. The level of bacterial titer of wound secretion by 15.5 ± 0.6 days was not higher than the commonly accepted critical one in comparison to the classic situation, in the second group it was on the 16.8 ± 0.7 days. Terms of inpatient treatment were: 16.2 ± 0.8 days in the first group and 21.2 ± 0.9 days in the second group accordingly.Conclusions. The usage of ultrasonic cavitation in the complex surgical treatment of soft tissue purulent diseases in HIV­infected patients significantly increases the time of wound cleaning, accelerates incarnation by 1.2, reduce the time of treatment of patients with concomitant HIV infection by 1.3 times in comparison to the classical approach of cleaning, by means of mechanical cleaning of the wound from purulence and necrotic tissue by ultrasound of low frequency in combination with antiseptic.

Perinatal transmission of hepatitis C virus: an update.

Infection with hepatitis C virus (HCV) is a major health problem worldwide. A large proportion of perinatal HCV infections are silent and may present later in adulthood with long-term complications. HCV has no effective immune prophylaxis and hence appropriate follow-up of all infants born to HCV-infected mothers is necessary. Universal antenatal screening for HCV is largely debatable. Intrauterine and partum transmission of HCV are both possible and higher rates are associated with a high maternal serum viral load (> 106 copies per milliliter), concomitant HIV infection, prolonged or difficult delivery, and invasive fetal monitoring during delivery. Infection during pregnancy and infancy needs to be investigated more in order to design management strategies for perinatal transmission of HCV most effectively. The recently approved new-generation, oral, direct-acting antiviral drugs may open a new era in HCV therapy for pregnant women and infected infants if proved to be safe during conception and infancy.

Operative Therapy Practices in Tubercular Patients with Bone and Joint Effects of Different Etiologies

Introduction.A decrease in the number of patients with tuberculosis of the bone system coincides with an increase in the number of indications and methods for operational treatment. The continuing development in skeletal tuberculosis surgery techniques determines the search for a material capable of replacing autologous bone. Therefore, the main purpose of this paper is to enhance the results of treatment of spinal caries to speed up treatment of tuberculous osteomyelitis by applying collagen material and to solve the issues of orthopedic alignment for TB patients.Materials and methods.Surgical treatment was carried out on 32 patients in 2016–2018. The patients were divided into several groups: 18 underwent transpedicular fixation of the spine, 2 had concomitant HIV-infection, 2 underwent necrectomy of vertebral bodies with anterior spondylodesis lift system, 1 underwent necrectomy of vertebral bodies with bone autoplasty and with plate fixation, 2 had cervical spine fixation, while 2 patients with pulmonary tuberculosis in the humerus traumatic fracture received intramedullary surgery.Results.31 patients reported a positive dynamic following surgery, while a fatal outcome not connected with the surgery was experienced in one case. Complications included allergic reaction in one case, while three patients developed postoperative wound seroma (both patients having HIV infection). One patient reported pain in the lower extremities following TPF. 3 patients with osteitis underwent necrectomy and filling of cavities with collagen material. Wounds were healed by secondary healing, while no rejection of collagen material took place.Conclusions.Introduction of collagen material in osteitis treatment can speed up fistula healing. The research work demonstrated the possibility of providing trauma care to patients under the conditions of an antitubercular centre.

Speed kills: Associations between methamphetamine use, HIV infection, tobacco use, and accelerated mortality among gay and bisexual men in Los Angeles, CA 20years after methamphetamine dependence treatment

BackgroundTo better characterize mortality among methamphetamine users, we estimated rates of all-cause mortality by HIV serostatus and smoking history in gay and bisexual men (GBM) treated for methamphetamine dependence, and explored associated clinical and socio-behavioral characteristics. MethodsWe searched public records to identify deaths among men screened between 1998–2000 for a trial of outpatient therapy for GBM with methamphetamine dependence. Crude mortality rates (CMRs) were calculated, and standardized mortality ratios (SMRs) estimated, comparing data with historical information from CDC WONDER. Associations of mortality with HIV infection, tobacco use, and other factors were explored using Kaplan-Meier survival analysis and Cox proportional hazards models. ResultsOf 191 methamphetamine-dependent GBM (median age 35 years; majority Caucasian), 62.8% had HIV infection, and 31.4% smoked tobacco at baseline. During the 20-year follow-up period, 12.6% died. Relative to controls, methamphetamine-dependent GBM had a three-fold higher 20-year SMR: 3.39, 95% CI: 2.69-4.09. Especially high mortality was observed among participants reporting tobacco use (adjusted HR 3.48, 95% CI: 1.54–7.89), club drug use prior to starting methamphetamine (2.63, 1.15–6.00), or other clinical diagnoses at baseline (3.89, 1.15–13.22). At 20 years, the CMR for HIV infected participants (7.7 per 1000 PY) was 1.5 times that for men without HIV (5.2 per 1000 PY; p = 0.22) and there was a 5-fold difference in CMRs for HIV infected tobacco smokers (16.9 per 1000 PY) compared to non-smokers (3.4 per 1000 PY; p < 0.01). ConclusionIn our sample of methamphetamine-dependent GBM, concomitant HIV infection and tobacco use were associated with dramatic increases in mortality.

SYPHILIS AND HIV COMORBIDITY: NEGATIVE CLINICAL AND EPIDEMIOLOGIC SYNERGY

Recently, management of patients co-infected with syphilis and HIV infection is becoming an increasingly important problem. Similarity of circumstances and ways of HIV and syphilis transmission as well as populations at risk of infection suggests that in the coming years the number of cases of co-infection will increase. The .negative synergy. of HIV infection and syphilis has been proven. This means a mutual reinforcement of the negative effect, when each of the diseases in their combination is more unfavorable than the separately existing disease. Syphilis increases the likelihood of HIV acquisition and transmission during unprotected sexual intercourse and contributes to the progression of HIV infection. On the other hand, it is traditionally believed that concomitant HIV infection can significantly change clinical features and course of syphilis and make its diagnosis and treatment more complicated. However, the widespread use of antiretroviral therapy has allowed to significantly reduce this negative effect. The review article is devoted to the problem of the biological and epidemiological .synergy. of these two infections, as well as to the analysis of modern data on the clinical features of syphilis developing against the background of HIV infection.

The clinical course of abscesses and soft tissue phlegmon in HIV-infected patients

The aim — to study the features of the clinical course of abscesses and soft tissue phlegmon in HIV‑infected patients.Materials and methods. The clinical course analysis of the abscesses and soft tissues phlegmon in 90 HIV‑infected patients (main group) who were on treatment at the Surgery and Proctology Department for the period from 2013 to 2017 was done. The comparison group consisted of 90 patients with abscesses and soft tissues phlegmon without concomitant HIV infection. The average age of patients was 31.0 ± 1.2 years. The abscesses and phlegmons localization were shoulder, forearm, gluteal region, inguinal region, thigh, shin. Clinical criteria, such as the fever response expression and purulent discharge duration, wound cleansing term were used to evaluate the clinical course of the postoperative period. Immunological status of patients was also investigated.Results and discussion. When analyzing the clinical picture, it was found that after the opening of the abscess and adequate drainage, the duration and severity of fever response expression, the purulent discharge from the wound and the time of wound clearance compared to those without HIV infection were statistically significantly higher in patients with HIV infection. In patients with HIV infection, a marked change in immunoregulation in favor of the predominance of T‑suppressors and a decrease in the number of T‑helpers revealed. Therefore, immunocorrection with retroviral drugs in accordance with existing protocols is indicated to these patients.Conclusions. The clinical course of abscesses and phlegmon in HIV‑infected patients compared with a group of patients without HIV infection is characterized by longer periods of purulent discharge and wound cleansing, hospital stay, especially in HIV‑infection of III — IV stages, which is confirmed by immunologic disorders, level of T‑helpers, requires a longer and more intensive both general and local treatment in combination with retroviral therapy.

HIV infection and sex in sex-on-premises venues are associated with a higher risk of syphilis reinfection among men who have sex with men.

IntroductionRecent outbreaks of syphilis occurred predominantly in men who have sex with men (MSM). A significant proportion of syphilis cases occur in MSM who had more than one episode of syphilis. This group may play an important role in syphilis transmission.AimTo identify factors associated with the risk of syphilis reinfection.Material and methodsForty-four MSM patients with the first episode of syphilis who were treated at the Department of Dermatology at the Jagiellonian University School of Medicine in Krakow, Poland were included in this study. After completing the treatment, the RPR testing was done every 3 months for 2 years in every patient. In the study period, we identified 12 (22%) cases of syphilis reinfection, eight of which were asymptomatic. Clinical, demographic and behavior data from patients with only one episode of syphilis were compared with those collected from repeaters.ResultsIndividuals with syphilis reinfection had concomitant HIV infection more frequently, reported a higher number of sexual partners and had sex in sex on premises venues more frequently (p < 0.05). In the multivariate analysis, we found that being HIV-infected MSM and having sex in sex on premises venues independently correlated with a higher risk of syphilis reinfection (OR = 9.6, 95% CI: 2.2–42.5 and OR = 5.6, 95% CI: 1.4–22.5, respectively).ConclusionsResults of our study highlight a strong need for frequent and repeated screening among MSM patients (especially those with concomitant HIV infection) with the first episode of syphilis and taking detailed patient’s history regarding also demographic and behavior data. We should also improve prevention policies to reduce risk behaviors in this population.

ИСПОЛЬЗОВАНИЕ МОДИФИКАЦИЙ ОБЩЕПРИНЯТЫХ СХЕМ ЛЕКАРСТВЕННОГО ЛЕЧЕНИЯ У БОЛЬНЫХ ЗЛОКАЧЕСТВЕННЫМИ ЛИМФОМАМИ (ПРОГНОЗ И КАЧЕСТВО ЖИЗНИ)

The analysis of the results of a study investigating the effectiveness of various modifications of prevailing drug treatment regimens of malignant lymphomas (non-Hodgkin's lymphoma and Hodgkin's lymphoma) is presented. The choice of optimal treatment is a complex problem, especially in patients with a high degree of tumor cells chemoresistance. The authors discuss the treatment options of different types of lymphomas using not only standard regimens, but also those that include drugs, depending on the age characteristics and individual tolerance, which allows in some cases significantly reduce the time of a relapse-free course and lower incidence of side effects of cytostatics on different organs and tissues. Intensified therapy for all aggressive non-Hodgkin's lymphomas with a high proliferative index allows 90% of the time to obtain a complete clinical and hematological remission. In Hodgkin's lymphomas the use of such programs helps to increase the duration of recurrence-free interval by persistent complete remission. The proposed regimen is highly effective in the treatment of patients with concomitant viral hepatitis and HIV infection. Drug therapy with the use of the proposed programs is a safe method of drug exposure, its side effects are minimal, and it is well tolerated by patients.

Prevalence of Occult Hepatitis B in HIV Positive Patients (Adolescents and Adults) in Kermanshah- Iran

Background Occult hepatitis B infection (OBI) is considered a risk factor for progression of liver disease in patients with hepatitis B virus (HBV) infection. This disease progression is reported to be more significant in those with concomitant HIV infection. We aimed to determine the prevalence rate of OBI in a sample of HIV-positive patients. Materials and Methods: Sixty-six HIV-infected patients with positive Hepatitis B core antigen (HBcAb) and negative Hepatitis B surface antigen HBsAg were included. HBV DNA was measured by real time polymerase chain reaction PCR method. Those with positive HBV viral load were considered as seropositive OBI. Then, the patients were studied regarding age, gender, intravenous drug use (IVDU), CD4 count, and concomitant infection by hepatitis C virus (HCV), available in their medical records. Results: Seventy-seven patients (38.5%) had positive HBc antibody (HBcAb). Of 66 patients who were positive for both HIV and HBc antibody, eight patients (12.12%) had OBI. About 3.7% in age group younger than 40 years and 5.3% in age group older than 40 years, OBI was detected. Forty-four patients (54.5%) were male. OBI rate was 22.2% in males and zero in females (P 350/mL, 4.1% had OBI. In those who were IV drug user, 17.94% and in those who were not IV drug user, 3.57% gad OBI. Conclusion The prevalence of OBI in the studied sample of HIV-infected patients is considerable. As we did not find any significant association between OBI and studied factors except for gender, we think that screening for OBI would be useful for HIV-infected patients, especially male patients.

Concomitant HIV infection in newly diagnosed multiple myeloma patients is hard to recognise and should be tested for routinely in areas of high endemicity.

Over the past three decades much has changed in the treatment and outcomes of patients suffering concurrently from both multiple myeloma (MM) and HIV. While the prevalence of MM appears to be higher in HIV-positive individuals than in those who are uninfected, early recognition of patients suffering from both diseases is difficult and little information is available on their demographics and clinical presentation. To compare the presenting features of HIV-positive patients diagnosed with MM with those of HIV-negative patients. A single-centre, retrospective cohort study included 16 HIV-positive and 73 HIV-negative patients diagnosed with MM, in order to compare variables related to the clinical presentation of both conditions. HIV-positive patients presented with MM at a significantly younger age, and had fewer osteolytic lesions, less renal impairment and lower neutrophil counts. Disease stage, gender, pathological fractures, bone marrow plasmacytosis, plasmacytomas and lymphocyte counts were comparable, emphasising the difficulty of identifying these patients. The HIV-positive patients had relatively high CD4 counts and a low prevalence of abnormal Freelite kappa/lambda ratios. All HIV-positive patients presented with paraproteins of the immunoglobulin G (IgG) type, implying a possible relationship between MM and an IgG response to HIV antigens. On the basis of our findings and literature on the treatment of both diseases, we suggest that HIV be tested for routinely in younger MM patients, especially in areas with a high prevalence of HIV. The integration of our results into the sparse knowledge on the role of HIV infection-related MM provides possible new insights into the interaction between these diseases.

Treatment of a patient with HIV and metastatic melanoma with consequitive ipilimumab and nivolumab

Recently new therapeutic agents were developed leading to a paradigm shift in melanoma treatment by the approval of checkpoint inhibitors and targeted therapies. However, in clinical trials HIV-infected melanoma patients have been excluded due to their condition and no randomized double-blind placebo-controlled studies have been published to evaluate the efficacy of these therapies in melanoma patients with concomitant HIV infection. We report on a HIV-positive melanoma patient treated sequentially with ipilimumab and nivolumab whose CD4 count and virus replication have been monitored closely. This article is protected by copyright. All rights reserved.

Vulval Tuberculosis: The Histomorphological Spectrum in Patients with HIV Co-Infection and AIDS

Objective: Vulval tuberculosis (TB) is reported rarely. The histomorphological spectrum and diagnostic mimicry thereof in patients with concomitant HIV infection/ AIDS is unreported to date. This study aimed to appraise the histopathologic spectrum of vulval TB in HIV co-infected patients and to identify histopathological diagnostic challenges, mimicry and pitfalls. Methods: Ten year retrospective study that reappraised the histomorphological features of vulval TB in HIV-infected patients. Results: The clinical descriptions of the biopsied lesions from 19 patients that form the study cohort encompassed nodules (9), ulcers (5), hypertrophy/edema (3) and abscesses (2). The main microscopic features included necrotizing and non-necrotizing granulomatous inflammation, ulceration with a zoned inflammatory response and chronic suppurative inflammation. The necrotizing component had the typical morphology of caseative necrosis or of suppuration/karyorrhexis or an admixture of both necrosis types. Vasculitis, of varied histomorphology, was present in 15 biopsies. Infective special stains were pivotal diagnostic tools. The presence of mycobacteria on Ziehl Neelsen stains (ZNs) and absence of nonmycobacterial infective agents on additional infective stains, underpinned TB diagnosis, especially in biopsies that lacked prototypical granulomatous inflammation or of infective mimickers that manifest with a granulomatous phenotype. ZNs also confirmed mycobacteria in vasculitic foci. The absence of mycobacteria on ZNs facilitated the diagnosis of tuberculids. Conclusion: Lesions with a common clinical appearance had heterogeneous histomorphological features, while lesions with common histopathological features demonstrated divergent clinical morphology. Infective, especially Ziehl Neelsen, stains are pivotal in the histopathological work-up of infective/inflammatory vulval biopsies. It is possible that the rarely reported anergic mononuclear or abscessing features, pseudotumoral spindle cell reactions, ulcers with a zoned inflammatory response and the presence of vasculitis of varied type, are clues to the HIV-TB tissue partnership. Increased clinicopathological investigation of and reporting on vulval TB in the HIV/AIDS afflicted population is pivotal to ascertain this.

HCV Ag quantification as a one-step procedure in diagnosing chronic hepatitis C infection in Cameroon: the ANRS 12336 study.

Introduction: The diagnostic procedure for chronic hepatitis C infection (CHC) usually combines anti-HCV antibody (HCV-Ab) and HCV-RNA measurement. Quantifying HCV core antigen (cAg) as a one-step procedure could shorten the diagnostic process. We aimed to assess the performance of cAg quantification in diagnosing CHC and how it is influenced by concomitant HIV or HBV infections.Methods: The cAg was quantified by an automated assay (Abbott Diagnostics) in 465 HCV-Ab negative serum samples and 544 HCV-RNA positive serum samples (n = 1009) collected in patients from the Pasteur Center in Cameroon, some of whom were infected by HBV or HIV. Its performance was evaluated in comparison to the gold standard (ELISA or PCR) by estimating its sensitivity (Se) and specificity (Sp), and by comparing the area under ROC (AUROC) curves in each patient population: HCV mono-infected, HCV-HBV and HIV-HCV co-infected.Results: Among the 465 HCV-Ab negative patients, 51 and 79 were HIV- and HBV-infected, respectively, whereas among the 544 patients with CHC, 27 and 28 were HIV- and HBV-infected, respectively. The Spearman ρ correlation coefficient between cAg and HCV-RNA was 0.75 (p < 0.00001). The assay had a sensitivity of 95.7% (95% CI: 93.2–97.5) and a specificity of 99.7% (95% CI: 98.1–10) in diagnosing CHC, corresponding to an AUROC of 0.99 (95% CI: 0.98–1.0). Being HIV- or HBV-infected did not impact the performance of cAg (Se = 96.4%, Sp = 96.2% and AUROC = 0.98 (95% CI: 0.95–1.0) in the HBV group, Se = 100%, Sp = 88.2% and AUROC = 0.99 (95% CI: 0.97–1.0) in the HIV group, p between AUROC = 0.69).Conclusions: The cAg quantification displayed a high specificity and sensitivity for the diagnosis of CHC in Cameroon, and its performance was not significantly modified by a concomitant HIV or HBV infection. In the context of CHC elimination on a global scale, using cAg quantification as a screening tool to directly identify CHC could be a reliable tool in a “test and treat” strategy.

Randomised controlled trial testing the effect of cotrimoxazole prophylaxis on morbidity and mortality outcomes in breastfed HIV-exposed uninfected infants: study protocol.

IntroductionNo randomised controlled trial (RCT) has examined the efficacy of cotrimoxazole (CTX) prophylaxis in HIV-exposed uninfected (HEU) infants during the breastfeeding period, in this new era of effective prevention of mother-to-child transmission (PMTCT) prophylaxis. The efficacy of CTX prophylaxis has presently been demonstrated only in HIV-infected children. The absence of proven benefits in HEU breastfed infants associated with infectious diseases justifies an RCT as proposed. Herewith lies the rationale for conducting the proposed study.MethodsA partially blinded RCT is proposed to evaluate the efficacy of CTX prophylaxis administered from 6 weeks of age to HEU infants receiving a PMTCT regimen. A non-inferiority design will be used, randomising 1298 infants to receive CTX or not to receive CTX. Participants will be reviewed at the following time points: 6 weeks (enrolment and randomisation), 10 weeks, 14 weeks, 4 months and monthly thereafter until 12 months of age. They will be evaluated for anthropometric growth, interval illness, CTX adherence, signs and symptoms of study drug toxicity, concomitant medication use, breastfeeding status and HIV infection status. The study will compare the incidence of grade 3 and grade 4 common childhood illnesses (focusing on pneumonia and diarrhoea) and all-cause mortality until 12 months of age. In a subset of participants, we will compare grade 3 and grade 4 haemoglobin and alanine aminotransferase results as well as investigate gut integrity.Ethics and disseminationThe study has ethical approval from the University of KwaZulu-Natal Biomedical Research Ethics Committee (BFC212/13).Trial registration numbersPACTR201311000621110 and DOH-27-0614-4728; Pre-results.

Paradoxical reaction in tuberculous meningitis: presentation, predictors and impact on prognosis.

BackgroundAwareness about paradoxical reactions in tuberculous meningitis is crucial as a paradoxical reaction may lead to certain wrong conclusions (for example, an erroneous diagnosis, and a possibility of treatment failure, mycobacterial drug-resistance, drug toxicity, or presence of a malignancy). The present study was planned to evaluate the incidence and predictive factors of paradoxical reactions in light of clinical, cerebrospinal fluid, and neuroimaging characteristics.MethodsIn this prospective cohort study, consecutive patients fulfilling the International Consensus criteria of tuberculous meningitis were included. Patients were subjected to clinical evaluation, cerebrospinal fluid evaluation, and neuroimaging. Patients were treated with anti-tuberculosis drugs along with corticosteroids. Patients were regularly followed up at 3 monthly intervals. At each follow up patients were evaluated clinically and repeat cerebrospinal fluid analysis was performed along with repeat neuroimaging. Disability assessment was done using Barthel index.ResultsWe enrolled 141 patients of tuberculous meningitis. Approximately one-third of patients (44/141; 31.2 %) developed a paradoxical reaction. Twenty-seven patients developed hydrocephalus, 26 developed tuberculomas, 12 developed optochiasmatic arachnoiditis and 4 patients had spinal arachnoiditis. In 41 patients (out of 44) cerebrospinal fluid paradoxically worsened (increase in cells and/or protein); 2 demonstrated a decrease in cells with polymorph predominance while in one it was normal. In 3 patients, paradoxical cerebrospinal fluid changes were not associated with neuroimaging changes. On multivariate analysis, predictors of paradoxical reaction were female gender (p = 0.013), HIV positivity (p = 0.01) and a shorter duration of illness (p = 0.049). Development of paradoxical reactions did not predict the disability status of the patients.ConclusionsParadoxical reaction occurs in approximately one-third of patients with tuberculous meningitis. Female gender, concomitant HIV infection, and a shorter duration of illness were significant predictors. Paradoxical reactions did not adversely affect the outcome.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1625-9) contains supplementary material, which is available to authorized users.

Histopathologic identification of Trypanosoma cruzi (Chagas') encephalitis in an AIDS patient

Trypanosoma cruzi (Chagas') encephalitis is an uncommon manifestation of T. cruzi infection, typically seen in immunocompromised patients. Encephalitis results from the reactivation of chronic infection predominately in individuals from endemic areas. Increased awareness of this complication is essential especially with increased migration of patients from endemic areas with concomitant HIV infection. Here we report a case of Chagas' encephalitis in an AIDS patient from Mexico in which there was no evidence of acute serologic, CSF, or blood infection by T. cruzi trypomastigotes.

Decentralized control of human visceral leishmaniasis in endemic urban areas of Brazil: a literature review.

ObjectivesHuman migration and concomitant HIV infections are likely to bring about major changes in the epidemiology of some parasitic infections in Brazil. Human visceral leishmaniasis (HVL) control is particularly fraught with intricacies. It is against a backdrop of decentralized health care that the complex HVL control initiatives are brought to bear. This comprehensive review aims to explore the obstacles facing decentralized HVL control in urban endemic areas in Brazil.MethodA literature search was carried out in December 2015 by means of three databases: MEDLINE, Google Scholar, and Web of Science.ResultsAlthough there have been many strides that have been made in elucidating the eco-epidemiology of Leishmania infantum, which forms the underpinnings of the national control program, transmission risk factors for HVL are still insufficiently elucidated in urban settings. Decentralized HVL epidemiological surveillance and control for animal reservoirs and vectors may compromise sustainability. In addition, it may hamper timely human HVL case management. With the burgeoning of the HIV-HVL co-infection, the potential human transmission may be underestimated.ConclusionHVL is a disease with focal transmission at a critical juncture, which warrants that the bottlenecks facing the control program within contexts of decentralized healthcare systems be taken into account. In addition, HIV-driven HVL epidemics may substantially increase the transmission potential of the human reservoir. Calculating the basic reproductive number to fine-tune interventions will have to take into consideration the specific socio-economic development context.

Prevalence of Lymphatic Filariasis and Treatment Effectiveness of Albendazole/ Ivermectin in Individuals with HIV Co-infection in Southwest-Tanzania.

BackgroundAnnual mass treatment with ivermectin and albendazole is used to treat lymphatic filariasis in many African countries, including Tanzania. In areas where both diseases occur, it is unclear whether HIV co-infection reduces treatment success.MethodologyIn a general population study in Southwest Tanzania, individuals were tested for HIV and circulating filarial antigen, an indicator of Wuchereria bancrofti adult worm burden, before the first and after 2 consecutive rounds of anti-filarial mass drug administration.Principle FindingsTesting of 2104 individuals aged 0–94 years before anti-filarial treatment revealed a prevalence of 24.8% for lymphatic filariasis and an HIV-prevalence of 8.9%. Lymphatic filariasis was rare in children, but prevalence increased in individuals above 10 years, whereas a strong increase in HIV was only seen above 18 years of age. The prevalence of lymphatic filariasis in adults above 18 years was 42.6% and 41.7% (p = 0.834) in HIV-negatives and–positives, respectively. Similarly, the HIV prevalence in the lymphatic filariasis infected (16.6%) and uninfected adult population (17.1%) was nearly the same. Of the above 2104 individuals 798 were re-tested after 2 rounds of antifilarial treatment. A significant reduction in the prevalence of circulating filarial antigen from 21.6% to 19.7% was found after treatment (relative drop of 8.8%, McNemar´s exact p = 0.036). Furthermore, the post-treatment reduction of CFA positivity was (non-significantly) larger in HIV-positives than in HIV-negatives (univariable linear regression p = 0.154).Conclusion/SignificanceIn an area with a high prevalence for both diseases, no difference was found between HIV-infected and uninfected individuals regarding the initial prevalence of lymphatic filariasis. A moderate but significant reduction in lymphatic filariasis prevalence and worm burden was demonstrated after two rounds of treatment with albendazole and ivermectin. Treatment effects were more pronounced in the HIV co-infected subgroup, indicating that the effectiveness of antifilarial treatment was not reduced by concomitant HIV-infection. Studies with longer follow-up time could validate the observed differences in treatment effectiveness.