Concomitant HIV Research Articles

Possibilities of Adding Pulmonary Surfactant to Comprehensive Therapy of Patients with Respiratory Tuberculosis: Results of a Prospective Comparative Study

The objective: to assess effectiveness and safety of the surfactant as part of comprehensive anti-tuberculosis therapy in pulmonary tuberculosis patients depending on the drug resistance pattern and HIV status.Subjects and Methods. 184 patients with pulmonary tuberculosis were enrolled in the study, of them 130 (70.7%) were men and 54 (29.3%) were women. All patients were randomized into Main Group (MG) and Control Group (CG). Surfactant therapy was added to comprehensive anti-tuberculosis therapy of the patients from Main Group. Additionally, each group was divided into subgroups based on HIV status.Results. The addition of surfactant therapy to comprehensive anti-tuberculosis therapy increases effectiveness of treatment improving such parameters as sputum conversion and cavity healing regardless of drug susceptibility pattern including patients with concomitant HIV infection. At the same time, the agent used for surfactant therapy demonstrated good tolerability.

Analysis of heart rate variability in assessing the autonomic status of tuberculosis patients and in combination with HIV infection

In this study, a comprehensive instrumental assessment of the autonomic status of tuberculosis patients and those with concomitant HIV infection at the beginning and during treatment was conducted, revealing the structure of dysfunction through heart rate variability analysis. Correcting the identified disorders will enhance the effectiveness of treatment through a comprehensive individualized approach.The aim of the study: to assess the autonomic status of patients with tuberculosis and concomitant HIV infection during the course of treatment using spectral analysis of heart rate variability and to determine its clinical significance.Materials and methods. The study involved 195 participants. They were divided into two groups: a control group of 70 healthy individuals and an observation group of 125 newly diagnosed patients with infiltrative and disseminated pulmonary tuberculosis, further divided into two subgroups. The first subgroup included 64 patients with pulmonary tuberculosis, and the second subgroup included 61 patients with tuberculosis combined with HIV infection. The structure of the autonomic nervous system was studied using the computer complex «Varicard 2.51» for processing variocardiograms and analyzing heart rate variability (Registration certificate for medical device dated 10.12.2007 No. FSR 2007/01390). All patients were examined under identical conditions. Calculations were performed using SPSS Statistics v. 23.Results and discussion. The data on the assessment of the state and dynamics of the total power spectrum of RR intervals (TP) in the control group and in patients with tuberculosis and concomitant HIV infection in subgroups 1 and 2 of the observation group during treatment are presented. When comparing the frequency of TP above the «normal zone» in the control group and subgroup 1 of the observation group (t1= 3.30; p1<0.01; t2=1.70; p2>0.05), in the control group and subgroup 2 of the observation group (t1=3.51; p1<0.01; t2=2.64; p2<0.01), statistically significant differences were found in subgroup 1 before treatment and in subgroup 2 before and after treatment. The significant decrease in TP levels above the «normal zone» in patients of subgroups 1 and 2 before treatment indicated significant mobilization of the body’s regulatory system reserves needed to maintain vital functions. By the end of the hospital treatment stage, TP levels had not recovered in patients of subgroup 2, marking more pronounced regulatory disturbances in patients with pulmonary tuberculosis combined with HIV infection.Conclusion. The assessment of the state of regulatory systems and the body’s reserves based on heart rate variability indicators showed that in healthy individuals, these systems were at levels ensuring the body’s normal homeostatic balance with the regulatory systems functioning normally without excessive stress and high resource mobilization. In patients with pulmonary tuberculosis, the state of regulatory systems was at a lower level, especially in patients with concomitant HIV infection.

Evaluating the modulation of peripheral immune profile in people living with HIV and (Neuro)cysticercosis.

The parasitic infection caused by Taenia solium represents a significant public health concern in developing countries. Larval invasion of body tissues leads to cysticercosis (CC), while central nervous system (CNS) involvement results in neurocysticercosis (NCC). Both conditions exhibit diverse clinical manifestations, and the potential impact of concomitant HIV infection especially prevalent in sub-Saharan Africa on peripheral and CNS immune responses remains poorly understood. This study aimed to identify the potential impact of HIV coinfection in CC and NCC patients. A nested study within a cross-sectional analysis in two Tanzanian regions was performed and 234 participants (110 HIV+ and 124 HIV-) were tested for cysticercosis antibodies, antigens, CD4 counts and serum Th1 and Th2 cytokines via multiplex bead-based immunoassay. 127 cysticercosis seropositive individuals underwent cranial computed tomography (CCT) and clinical symptoms were assessed. Multiple regression analyses were performed to identify factors associated with cytokine modulation due to HIV in CC and NCC patients. Serologically, 18.8% tested positive for cysticercosis antibodies, with no significant difference HIV+ and HIV+. A significantly higher rate of cysticercosis antigen positivity was found in HIV+ individuals (43.6%) compared to HIV- (28.2%) (p = 0.016). CCT scans revealed that overall 10.3% had active brain cysts (NCC+). Our study found no significant changes in the overall cytokine profiles between HIV+ and HIV- participants coinfected CC and NCC, except for IL-5 which was elevated in HIV+ individuals with cysticercosis. Furthermore, HIV infection in general was associated with increased levels of pro-and some anti-inflammatory cytokines e.g. TNF-α, IL-8, and IFN-γ. However, based on the interaction analyses, no cytokine changes were observed due to HIV in CC or NCC patients. In conclusion, while HIV infection itself significantly modulates levels of key cytokines such as TNF-α, IL-8, and IFN-γ, it does not modulate any cytokine changes due to CC or NCC. This underscores the dominant influence of HIV on the immune system and highlights the importance of effective antiretroviral therapy in managing immune responses in individuals coinfected with HIV and CC/NCC.

Risk factors underlying racial and ethnic disparities in tuberculosis diagnosis and treatment outcomes, 2011–19: a multiple mediation analysis of national surveillance data

Despite an overall decline in tuberculosis incidence and mortality in the USA in the past two decades, racial and ethnic disparities in tuberculosis outcomes persist. We aimed to examine the extent to which inequalities in health and neighbourhood-level social vulnerability mediate these disparities. We extracted data from the US National Tuberculosis Surveillance System on individuals with tuberculosis during 2011-19. Individuals with multidrug-resistant tuberculosis or missing data on race and ethnicity were excluded. We examined potential disparities in tuberculosis outcomes among US-born and non-US-born individuals and conducted a mediation analysis for groups with a higher risk of treatment incompletion (a summary outcome comprising diagnosis after death, treatment discontinuation, or death during treatment). We used sequential multiple mediation to evaluate eight potential mediators: three comorbid conditions (HIV, end-stage renal disease, and diabetes), homelessness, and four census tract-level measures (poverty, unemployment, insurance coverage, and racialised economic segregation [measured by Index of Concentration at the ExtremesRace-Income]). We estimated the marginal contribution of each mediator using Shapley values. During 2011-19, 27 788 US-born individuals and 57 225 non-US-born individuals were diagnosed with active tuberculosis, of whom 27 605 and 56 253 individuals, respectively, met eligibility criteria for our analyses. We did not observe evidence of disparities in tuberculosis outcomes for non-US-born individuals by race and ethnicity. Therefore, subsequent analyses were restricted to US-born individuals. Relative to White individuals, Black and Hispanic individuals had a higher risk of not completing tuberculosis treatment (adjusted relative risk 1·27, 95% CI 1·19-1·35; 1·22, 1·11-1·33, respectively). In multiple mediator analysis, the eight measured mediators explained 67% of the disparity for Black individuals and 65% for Hispanic individuals. The biggest contributors to these disparities for Black individuals and Hispanic individuals were concomitant end-stage renal disease, concomitant HIV, census tract-level racialised economic segregation, and census tract-level poverty. Our findings underscore the need for initiatives to reduce disparities in tuberculosis outcomes among US-born individuals, particularly in highly racially and economically polarised neighbourhoods. Mitigating the structural and environmental factors that lead to disparities in the prevalence of comorbidities and their case management should be a priority. US Centers for Disease Control and Prevention National Center for HIV, Viral Hepatitis, STD, and Tuberculosis Prevention Epidemiologic and Economic Modeling Agreement.

Fungal Infections in Hospitalized Patients of Systemic Lupus Erythematosus: A United States Nationwide Cohort Analysis.

Introduction/objective Immunosuppressive therapy is the cornerstone of management in patients with systemic lupus erythematosus (SLE). Patients on immunosuppressive therapy are at increased risk of developing opportunistic fungal infections. We conducted this analysis to describe the epidemiology, including incidence, risk factors, and outcomes, of fungal infections in hospitalized patients with SLE in the United States. Method A retrospective cohort study was performed by analyzing the National Inpatient Sample (NIS) 2016-2020 for all patients with a discharge diagnosis of SLE and fungal infections, including histoplasmosis, pneumocystosis, cryptococcosis, aspergillosis, and blastomycosis, as a primary or secondary diagnosis via ICD-10 (International Classification of Diseases 10th Revision) codes. Frequencies, demographics, and trends were determined and compared between hospitalized patients with SLE and those without SLE. STATA version 17 was used for data analysis. A p-value of ≤0.05 was considered statistically significant. Results In hospitalized SLE patients, there were lower odds of developing fungal infections in females (odds ratio (OR): 0.63 (95% confidence interval (CI): 0.49-0.80)) and higher odds in Hispanic (OR: 1.52 (95% CI: 1.16-1.98) and Asian (OR: 1.78 (95% CI: 1.15-2.75) populations. Steroid use (OR: 1.96 (95% CI: 1.58-2.42)), concomitant HIV infection(OR: 22.39 (95% CI: 16.06-31.22)), and the presence of leukemias (OR: 3.56 (95% CI: 1.67-7.59)) and lymphomas (OR: 3.29 (95% CI: 1.78-6.09)) in hospitalized SLE patients were significant predictors of fungal infection (p < 0.01). There were differences in the incidence of fungal infections based on geographical areas in the US, with blastomycosis being more common in the Midwest. From 2016 to 2020, there was a decline in the incidence rate of hospitalization per 100,000 for non-SLE patientswith fungal infections (10.7 per 100,000 hospitalizations in 2016 versus 9.6 per 100,000 hospitalizations in 2020), whereas this rate remained steady for the SLE cohort (0.1 per 100,000 hospitalizations in 2016 versus 0.2 per 100,000 hospitalizations in 2020). Conclusions Hospitalized patients with SLE are at an increased risk of developing fungal infections, and this risk is increased further in patients who are males, are on steroid therapy, and have HIV or leukemia and lymphomas. Further studies can be done to explain the increased risk of fungal infections associated with these patient characteristics.

Photogallery. Combination of syphilis and HIV infection

In recent decades, the world has seen an increase in the number of patients suffering from syphilis and HIV infection at the same time. There is a traditional opinion that concomitant HIV infection can aggravate the clinical manifestations and course of syphilis. However, in the era of widespread use of antiretroviral therapy, most people living with HIV have a typical course of syphilis. However, with quantitative and/or qualitative HIV-associated immune dysfunction, deviations in the clinical picture of syphilitic infection from its classical patterns are possible. This is evidenced by annual publications in Russian and foreign specialized publications. We present to your attention a photo gallery of cases of syphilis in HIV-positive patients with characteristic and atypical manifestations.

Performance of an Electronic Medical Record-Based "Syphilis Flag" in Identifying At-Risk Patients in an Emergency Department.

The United States has seen a > 40% increase in syphilis cases since 2017. Early disease identification and treatment are crucial. This review sought to identify emergency department (ED) patients at risk for syphilis. A 30-day retrospective review was conducted of visits to a single ED. Patient visits were assessed for predetermined syphilis "flags" to include a history of sexually transmitted infection (STI), current chief complaint or reason for visit (RFV) keyword(s) suggestive of potential STI or a positive pregnancy test result. Flagged charts were assessed for STI testing results within 6 months of ED visit. Data were analyzed using χ2 . There were 5537 total patient encounters, resulting in 455 flagged visits from 408 (8.4%) unique individuals, majority of whom were female (282, 69.1%; P < 0.001), Black (251, 61.5%; P < 0.001), aged 15 to 44 years (308, 75.5%; P < 0.001). Chief complaint was the most frequent flag (65.3%), followed by RFV (37.4%), prior STI (31.0%), and pregnancy (12.3%). Syphilis testing data were available for 120 flagged patients; 29 (24.2%) screened positive, including 11 (2.7% of total flagged cohort) with evidence for active infection. Among those, most were Black (90.9%), male (72.7%), aged 25 to 34 years (63.6%), and 9 (81.8%) had concomitant HIV. In active infection, prior STI flag was most common (72.7%), followed by chief complaint (54.5%) and RFV (45.5%). This review demonstrates the performance of an electronic medical record-based "syphilis risk flag" screener applied to ED patients. Sex- and race-based discrepancies exist in flag rates, which may be reflective of sex- and race-based epidemiologic discrepancies in STI incidence.

In-hospital outcomes of pulmonary hypertension in HIV patients: A population based cohort study

BackgroundPulmonary hypertension (PH) is a known complication of HIV infection. Outcomes of HIV-infected patients with PH (HIV-PH) have not been well established. We aim to assess various in-hospital outcomes such as mortality, resource utilization, and health care burden associated with HIV patients with concurrent PH. Materials and methodsWe used National Inpatient Sample (NIS) 2015 Quarter 4 through 2019 for this study. We identified patients using International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) diagnostic codes with both HIV and pulmonary hypertension. Cohorts were weighted by NIS-provided algorithm which allows for national estimates. Univariate and multivariate regression analyses were used to determine odds ratios. ResultsA total of 910,120 patients were identified with HIV, among which 28,175 (3.19%) were identified to have concurrent PH. When compared to HIV alone, HIV-PH patients were older (54.53(±11.61) vs. 49.44(±13.11), predominantly black (64.45% vs. 51.8%%), more often male (57.2%), all p < 0.001. HIV-PH cohort had higher comorbidities with higher Charlson Comorbidity Index (CCI) (7.07(±3.53) vs. 5.17(±3.65), had slightly longer LOS [adjusted mean difference (aMD) 0.79], higher healthcare burden corrected for inflation (aMD $17,065); all p < 0.001.In univariate regression analysis, patients with HIV-PH had significantly higher rates of developing heart failure (aOR 10.44), cardiogenic shock (aOR 5.67), cardiomyopathy (aOR 4.97), in-hospital cardiac arrest (aOR 1.94), respiratory failure (aOR 3.29), invasive mechanical ventilation (aOR 1.71), aspiration pneumonia (aOR 1.29), acute kidney injury (aOR 2.14). Lastly, patients with HIV-PH had higher in-hospital mortality within 30 days of admission (aOR 1.28) & overall in-hospital mortality (aOR 1.23); p < 0.005). ConclusionIn patients with concomitant HIV and PH, there is a higher burden of comorbidities, and is associated with worse outcomes including mortality. Through this study, we highlight outcomes that will better risk stratifying patients with concurrent HIV and PH.

Clinical case of COVID-19 in an HIV-infected teenager

The problem of non-smooth course of COVID-19 in people with severe comorbidities is topical. The greatest number of deaths from a new coronavirus infection was noted in the presence of such diseases as: obesity, chronic bronchopulmonary, cardiovascular diseases, HIV infection, diabetes mellitus, oncohematology, etc. Due to the focus of the healthcare system on the COVID-19 pandemic, less attention is paid to the fight against the immunodeficiency virus, despite the fact that the epidemiological situation with HIV infection in the Russian Federation continues to be tense. Individuals with HIV infection may be at increased risk of complications and death associated with COVID-19. The stage of HIV infection, indicators of the immune status, viremia, and taking antiretroviral therapy correlate with the severity of the course of COVID-19/HIV and have prognostic value. A clinical observation of the course of a new coronavirus infection in a 15-year-old teenager born to an HIV infected mother (who hid her HIV status at the time of hospitalization of a child) who was not at a dispensary observation at the AIDS Center was presented. The child was hospitalized with a new coronavirus infection (COVID-19), complicated: acute community-acquired (interstitial) bilateral pneumonia. The low index body mass of the child, the presence of concomitant pathology, the non-smooth course of the disease made it possible to suspect the patient of an immunodeficiency condition and identify concomitant HIV infection in the secondary disease stage (4B), the progression phase with the absence of antiretroviral therapy. Conclusion: the non-smooth course and severity of the disease were mainly due to secondary infections pathology. Severe immunosuppression detected in a child due to HIV infection contributed to the long-term persistence of the SARS-CoV-2 virus. In this case, it was not established that HIV infection in the patient was a factor predisposing to the severe course of COVID-19 and contributing to a prognostically unfavorable outcome. Complex therapy including antiretroviral therapy prevented further progression of immunosuppression and led to recovery from new coronavirus infection and management of comorbidity. The increase in the number of HIV-infected persons in the late stages of infection, often detected by chance, only during hospitalization, presents difficulties for therapy due to late diagnosis, the presence of a combined secondary pathology and the severity of its course against the background of low immune status parameters.

Assessment of the state of autonomic dysfunction in patients with tuberculosis of the respiratory system and in combination with HIV infection in modern conditions

The autonomic nervous system (ANS) is an important part of the human nervous system responsible for regulating internal organs and maintaining the internal environment of the body. Adequate functioning of the ANS supports homeostasis is the internal stability of the body and regulates many functions in it, such as cardiac activity, breathing, etc. TB-related stress and inflammation affect have influence at the balance of sympathetic and parasympathetic activity. Affecting the work of the peripheral nervous system, it becomes possible to influence at the system of homeostasis of the body through its regulatory systems. Improving the diagnostics of autonomic dysfunction and identifying its dysfunction will provide an integrated individualized approach to treatment and will make a significant contribution to increasing the effectiveness of therapy for patients with tuberculosis.Aim. Diagnosis of the state of the autonomic nervous system by its main indicators using available informative methods for assessing its functional state in patients with respiratory tuberculosis, including in combination with HIV infection at the beginning of treatment and detecting the level of its damage for further correction with the prescription of pathogenetic therapy.Materials and methods. The functional state of the autonomic nervous system has been investigated in 260 people. In the study, 2 groups were formed: a control group (CG) of 70 healthy persons and a monitoring group (MG) of 190 newly diagnosed patients with tuberculosis. There are 3 subgroups in MG. The 1 subgroup included 65 patients with pulmonary tuberculosis, in whom the function of ANS was studied by conventional examination methods, and in 64 patients with tuberculosis 2 subgroups and 61 patients with tuberculosis in combination with HIV infection 3 subgroups using Varikard 2.51. Calculations were carried out in the program SPSS Statistics v. 23.Results and discussion. Comparison of the frequency of autonomic dysfunction in patients with MG, subgroup 1 with that in the CG according to questionnaires No. 1 (χ2=36.346; p&lt;0.001) and No. 2 (χ2=50.885; p&lt;0.001), HR per minute (χ2=31.989; p&lt;0.001), Kerdo index (χ2=30.008; p&lt;0.001), cold sample (χ2=36.549; p&lt;0.001) revealed high reliability of differences and indicated the predominance of sympathicotension, which was determined 7 times more often in patients. At the beginning of treatment, in patients with concomitant HIV infection was detected a more pronounced dysfunction of ANS with a predominance of its sympathetic link, which was found 9.3 times more often than in healthy persons and 2.3 times more often than in patients without HIV infection. Comparing the frequency of PARS in the «normal zone» in the CG and in the 2 subgroup of MG (t1=5.01; p1&lt;0,001; t2=3,69; p2&gt;0.001), in CG and in MG subgroup 3 (t1=3.61; p1&lt;0.001; t2=3.61; p2&lt;0.001) high significant differences were identified, indicating a significant predominance of regulatory process disorders in patients with tuberculosis and especially when combined with HIV infection.Conclusion. The revealed disorders in the work of ANS patients with tuberculosis and in combination with HIV infection are associated with intoxication and asthenovegetative syndrome. Monitoring of heart rate variability can be used in medical research, as well as in clinical practice to assess the state of the autonomic nervous system in patients with tuberculosis and when combined with HIV infection, determine the application point for the effects of pathogenetic therapy in order to improve the results and effectiveness of the treatment.

Mathematical prognosis of the outcome of the disease of a patient with tuberculosis with HIV infection upon admission to the hospital of the Federal Penitentiary Service

Objective. To identify a mathematical pattern for the subsequent calculation of the prognosis of the outcome of a tuberculosis patient with HIV infection upon admission to the hospital of the Federal Penitentiary Service.Materials and methods. The object of the study was 363 patients with tuberculosis and HIV infection who were admitted for treatment at the hospital of the Federal Penitentiary Service. Discriminant analysis was used to evaluate the features most associated with the discrimination of observations, a priori divided into groups, and reclassify them. As a result, new discriminant axes were obtained, in the space of which the compared groups have the maximum difference.Results and discussion. Formulas were obtained for predicting the outcome of a tuberculosis patient with HIV infection upon admission to a medical institution of the Federal Penitentiary Service: favorable outcome =–91.2138+4.2971×(body mass index)+0.4426×(«experience» of smoking, years)+0.5143×(hemoglobin level, g/l)+0.6158×(stab neutrophils, %)+ 0.4913×(leukocyte T-cell index);unfavorable outcome =–81.8053+3.9467×(body mass index)+0.4071×(«experience» of smoking, years)+0.4724×(hemoglobin level, g/l)+0.6861×(stab neutrophils, %)+0.6630×(leukocyte T-cell index); progression or chronicity =–91.9349+4.2025×(body mass index)+0.5119×(smoking experience, years)+0.5103×(hemoglobin level, g/l)+0.5901×(stab neutrophils, %)+0.5×(leukocyte T-cell index).Conclusion. Simple formulas have been obtained that can be successfully used to calculate the prognosis of the course of the disease upon admission to a hospital in a patient with tuberculosis with concomitant HIV infection.

Orogenital and anal infection by Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, and other sexually transmitted infections in men who have sex with men in Lisbon.

Men who have sex with men (MSM) are at risk for sexually transmitted infections (STIs), but more data on extragenital carriage are needed. We assessed the genital and extragenital prevalence of bacterial and other STIs in MSM in a Lisbon sexual health clinic. We screened oral, anal, and urine samples of MSM visiting the GAT-CheckpointLX clinic June 2017-December 2021 for Chlamydia trachomatis (including lymphogranuloma venereum, LGV), Neisseria gonorrhoeae, Mycoplasma genitalium, Trichomonas vaginalis, Mycoplasma hominis, Ureaplasma urealyticum, and U. parvum. Ano-oro-genital lesions were tested for LGV, Treponema pallidum, and Herpes Simplex Virus. Blood was tested for HIV and T. pallidum antibodies. N. gonorrhoeae was found in 16.6% of the MSM followed by C. trachomatis (13.2%), M. genitalium (10.3%) and T. vaginalis (0.2%). The most frequent occurrence was anorectal (C. trachomatis, M. genitalium) and oral (N. gonorrhoeae). We found high carriage of U. urealyticum (36.1%) and M. hominis (22.1%). LGV was detected in 21.8% of chlamydia-positive anorectal swabs. Syphilis was detected in 22.6% of tested MSM, while 13.8% had HIV. Gonorrhoea and chlamydia were significantly more prevalent in MSM with concomitant HIV or syphilis. The substantial extragenital prevalence of bacterial STIs in MSM, and HIV and syphilis coinfections, suggest screening has value in identifying hidden carriage and in contributing for providing better care.

Применение полуколичественного экспресс-теста на прокальцитонин в диагностике внебольничной пневмонии у пациентов с ВИЧ-инфекцией

Timely diagnosis of community-acquired pneumonia (CAP) and optimal timing of initiation of antibiotic therapy are important for reducing mortality in patients with HIV infection. It is reported that the assessment of procalcitonin (PCT) levels in this category of patients can be a useful diagnostic tool. Aim. To determine the levels of a new semi-quantitative rapid test (RT) for PCT in patients with CAP depending on the presence or absence of HIV infection. Design. Cross-sectional comparative study. Material and methods. The study involved 123 patients hospitalized with a diagnosis of CAP. 15 (12.2%) patients, including 10 (66.7%) men and 5 (33.3%) women (average age 59.3 ± 22.4 years), were diagnosed with HIV infection 3th stage. The comparison group included 108 people (48 (44.4%) men and 60 (55.6%) women, average age 48.1 ± 20.5 years) who did not have HIV infection. Before starting antibacterial therapy, all patients underwent a general clinical examination, the concentration of PCT in plasma was determined quantitatively using the enzyme-linked immunosorbent assay, as well as using a new semi-quantitative ET method using a one-step immunochromatographic analysis. Results. In the group of patients with CAP without HIV infection, borderline values of PCT ET (0.5 to &lt; 2 ng/ml) were encountered 3.3 times more often than in patients with concomitant HIV infection (0.5 to &lt; 2 ng/ml) — 22.2% versus 6.7 %; p = 0.030. High levels of PCT ET (from 2 to &lt;10 ng/ml) were 7 times more likely to be detected in patients with CAP and HIV infection than without it - 13.3% versus 1.9%; p = 0.030. The quantitative content of PCT in the blood was also 4.5 times higher in patients with CAP in the presence of HIV infection (0.49 [0.11; 0.76] and 0.11 [0.01; 0.52] ng/ml; p = 0.038) relative to the comparison group. In the group of patients with CAP and HIV infection, a positive correlation was established between PCT RT and the degree of respiratory failure (r = 0.656; p = 0.008) and quantitative PCT (r = 0,453; р = 0,048), test negative correlations with the content of platelets (r = –0.542; p = 0.037), sodium (r = –0.700; p = 0.016 ) and saturation level (r = 0.335; p = 0.022). Conclusion. Patients with CAP and HIV infection in comparison with persons without HIV infection are characterized by higher PCT values determined by both classical quantitative and new semi-quantitative RT, which makes it possible to use the latter for rapid diagnosis of CAP in this group of patients. Key words: community-acquired pneumonia, HIV infection, diagnostics, procalcitonin, procalcitonin rapid test

Frequency of red blood cell allo-immunization in patients undergoing blood transfusion at the Uganda Cancer Institute.

There is limited data on red blood cell (RBC) alloimmunization in patients with cancer in sub-Saharan Africa (SSA). We examined the frequency of RBC alloimmunization in transfused patients with cancers in Uganda. A randomized control trial was conducted on participants at the Uganda Cancer Institute. Eligible participants were age ≥15 years and required blood transfusion. Participants were randomized to receive either leucoreduced or non-leucoreduced blood transfusion. Participants' plasma samples were screened for RBC alloantibodies at enrolment and 3-4 weeks after blood transfusion using a 2-cell panel of reagent group O RBCs using the tube method. Antibody identification was performed using a 10-cell panels of reagent RBCs. Participants were considered alloimmunized if antibodies to RBC antigens were identified. A total of 277 participants were randomized (leucoreduced blood, n=137; non-leucoreduced blood, n=140). Overall, the most represented diagnoses were gynaecological cancers (n=88, 31.8%), acute leukaemia (n=35, 12.6%), and gastrointestinal cancers (n=25, 9.0%). Concomitant HIV infection was present in 26 (9.4%) participants. Most participants received <5 units of blood during the study. No study participant developed allo-antibodies. There was no RBC alloimmunization in participants with cancers. Routine RBC allo-antibody screening in all patients with cancer in SSA requires further research.

Multimodal Imaging Features of the Posterior Segment in Ocular Syphilis and HIV Co-Infection: A Single Center Case Series

ABSTRACT Objective To analyze the frequent multimodal imaging features in posterior syphilitic uveitis. Purpose Syphilis infection has re-emerged as a global health problem. Multimodal imaging approach has been proposed for diagnosis and follow-up; there are not previous reports dedicated to the anatomic and visual outcomes in patients diagnosed with ocular syphilis and concomitant HIV infection. Methods All demographic information was recovered; a complete ophthalmological examination and multimodal imaging evaluation (retinal fluorescein angiography (FA), autofluorescence (AF), optical coherence tomography (OCT)) were performed on initial visit and 1 month after antibiotic therapy. Results 18 eyes of 9 patients were included. The most frequent features observed were: Hyperfluorescence on optic disk on FA, Hyperautofluorescence punctate pattern on AF, Vitritis on SD-OCT. After treatment, there was a functional and anatomical improvement. Conclusion Ocular syphilis represents a diagnostic challenge. Multimodal imaging approach allows identification of structural changes, follow-up and early detection of complications.

Risk Factors for Pneumocystis jirovecii Pneumonia in Non-HIV Patients Hospitalized for COVID-19: A Case-Control Study.

Very few cases of Pneumocystis jirovecii pneumonia (PJP) have been reported in COVID-19 so far, and mostly in patients with concomitant HIV infection or in solid-organ transplant recipients. Despite COVID-19 being associated with lymphopenia and the use of steroids, there are no studies specifically aimed at investigating the risk factors for PJP in COVID-19. A retrospective case-control study was performed. We matched PJP cases with controls with a 1:2 ratio, based on age ± 10 years, solid-organ transplantation (SOT), hematological malignancies, and in the setting of PJP development (ICU vs. non-ICU). A direct immunofluorescence assay on bronchoalveolar lavage fluid was used to diagnose PJP. We enrolled 54 patients. Among 18 cases of PJP, 16 were diagnosed as "proven". Seven of the eighteen cases were immunocompromised, while the other patients had no previous immunological impairment. Patients with PJP had significantly lower median lymphocyte values (p = 0.033), longer COVID-19 duration (p = 0.014), a higher dose of steroid received (p = 0.026), higher CRP values (p = 0.005), and a lower SARS-CoV-2 vaccination rate than the controls (p = 0.029). Cumulative steroid dose is the independent risk factor for PJP development (OR = 1.004, 95%CI = 1-1.008, p = 0.042). PJP develops in COVID-19 patients regardless of immunosuppressive conditions and the severity of disease, and it is correlated to the corticosteroid dose received.

Clinical use of densitometric analysis of lung pathology and digital data processing programs for determining surgical tactics in phthisiosurgical patients with HIV status

Objective — to determine the possibilities of using densitometric indicators of computed tomography (CT) and digital software processing of CT data in lung pathology for the formulation of personalized treatment tactics for phthisiosurgical patients with concomitant HIV pathology, and to justify the indications for surgical treatment. &#x0D; Materials and methods. A retrospective analysis was conducted on the results of the examination and treatment of 11 patients with specific tuberculous lesions of the lungs. Specific therapy was initiated 2—3 months after the initial visit to the medical institution, and immunochromatographic tests for HIV and hepatitis, which were performed in advance, yielded doubtful (questionable) or negative results. Patients underwent a general clinical examination, echocardiogram, fibrobronchoscopy with examination of bronchoalveolar lavage for Mycobacterium tuberculosis, and molecular genetic tests of sputum or bronchoalveolar lavage. Express tests for HIV, hepatitis B, and hepatitis C, as well as routine blood and urine tests, were carried out. The Aquilion TSX-101A Toshiba (Japan) tomography was used as the main research tool. Densitometric analysis of lung parenchyma was performed using DICOM-VIEWER PHILIPS in the areas of interest. Digital analysis of images obtained from CT slices was conducted using the Dragonfly program. &#x0D; Results and discussions. The clinical manifestation of patients’ «radiological findings» was asymptomatic in 81.8 % of cases and mostly perceived as a «post COVID-19 syndrome». The analysis of the laboratory data did not indicate specific signs of the disease in 72.7 % of cases. The study of the verified focal lesions without signs of destruction of the lung parenchyma during densitometric analysis of CT revealed densities that characterize exudative processes in the lung parenchyma (0—15 HU), which is a characteristic sign of a specific inflammatory process in the context of HIV infection. Histologically, high activity of a specific inflammatory process was detected in operated patients. During digital software processing, we observed a shift in densitometric indicators that are characteristic of the exudative phase of inflammation. Situations of HIV-associated infection and alteration-exudative reactions were noted, which were 100 % determined by densitometric analysis and digital software processing of the chest CT scan. Six patients underwent surgery on (2 lobectomies, 1 combined resection and 3 sublobar resections). Among the non-operated patients, 3 experienced a recurrence of a specific inflammatory process, and 1 patient still exhibits significant morphological changes in the parenchyma.&#x0D; Conclusions. Densitometric analysis and digital software processing of CT scan allows you to objectify the patient's condition and reasonably prescribe personalized therapy. Identified patients with X-ray lesions of the lungs require a mandatory consultation with a thoracic surgeon and consideration of the issue of surgical treatment within 2—3 months after the start of specific therapy.

Delayed positivity of serological reactions in secondary syphilis against the background of severe HIV-induced immunosuppression

In recent decades, there has been an increase in syphilis associated with HIV infection cases, especially among men who have sex with men. The global prevalence of syphilitic infection among people living with HIV exceeds population rates. Concomitant HIV infection can affect not just the clinical course of syphilis, but also the production of antibodies to Treponema pallidum. In the presence of severe immunodeficiency in patients with HIV infection associated with secondary syphilis, the results of non-treponemal and/or treponemal tests may be false-negative or may become positive at a later date. Such cases are known, they occur infrequently and cause some diagnostic difficulties. The article presents a clinical observation of delayed positivity of serological reactions in secondary syphilis in a 23-year-old HIV-positive man from the authors' practice. The tactic of managing HIV-infected patients with clinical symptoms of syphilis and negative results of serological tests is discussed.

Immune checkpoint inhibitors for the treatment of solid tumors in HIV-infected patients: is it worth the risk?

Objective. To present the available data regarding the tolerance of immune checkpoint inhibitors (ICIs) in cancer patients with concurrent HIV.Material and Methods. A literature search was conducted in the electronic databases PubMed, Cochrane Library and UpToDate up to February 2022.Results. The article outlines the background and experience of using ICIs for the treatment of malignant tumors in patients with concomitant HIV infection.Conclusions. Until recently, the presence of chronic infections, including HIV infection, was one of the key contraindications for prescribing immunotherapy. However, the recent scientific publications demonstrate the efficacy and good tolerability of ICIs in cancer patients with concurrent HIV. Future prospective clinical trials will help to predetermine the potential of immunotherapy in clinical practice in this patients.

ПРИЧИНИ РЕЦИДИВІВ ТУБЕРКУЛЬОЗУ ЛЕГЕНЬ

Being a significant source of tuberculosis (TB) spread and the factor adversely affecting its epidemiological parameters, the relapses of TB remain a relevant problem. Aim: to establish the causes of pulmonary TB relapse (PTBR) and to evaluate its significance. Materials and methods – 80 phthisiologists have been interviewed using a special PTBR questionnaire. According to the results, the causes were divided into medical, organizational and social ones. Statistical analysis determined the degree of their significance (low, medium, high). Results. The most significant medical causes of PTBR were inadequate treatment, immunodeficiency, HIV infection, comorbidities, advanced TB, extensive residual lesions, drug adverse reactions. The organizational causes included low coverage of the population with fluorography, lack of follow-up, active detection and prophylaxis of cases in groups of risk, financial and infrastructure difficulties, poor medical-social support and population TB awareness, lack of fast diagnostics, poor management of comorbidities, lack of closed-type hospitals, stigma of TB patients, imperfect legislative base. The list of social causes consisted of low compliance to therapy, poor living and working conditions, low sanitary culture, migration of population and low social support. Among the significant (1-3 ratings) of social causes of RTBL respondents are: interrupted treatment (91,2 %), low commitment to treatment (83,7 %) and poor working conditions (71,2 %); p &lt;0.05, among the average significant-unsatisfactory financial conditions, stay in prison and unemployment (65,0–35,0 %); p &gt; 0,05, among others – careless attitude to one’s own health, low sanitary culture of the population, loneliness, low informative level of social institutions, migration of the population, homelessness, bad habits, poor nutrition, stress. Conclusions. The most significant medical factors of RTB development are: inadequate treatment of TB, immunodeficiency states, HIV infection, concomitant diseases, abandoned TB, major residual changes, side effects of medicines; organizational: low coverage of fluorography, lack of dispensary and active detection and prevention of TB in risk groups, financial and infrastructure difficulties, insufficient medical and social support, inaccessibility of rapid diagnosis absence of closed-type hospitals, stigma patients with TB, imperfect legislative framework; social: the disadvantage of treatment, unsatisfactory social and living conditions, low sanitary culture, population migration, social insecurity. Since the most threatening causes of PTBR were the limitations with the treatment of the newly detected TB cases we proposed considering “completion of the treatment course” as a conditionally effective treatment outcome and continue follow-up until final cure confirmation. Identifying a significant number of organizational limitations, as indicated by phthisiologists, raises the doubts about the transfer of out-patient management and follow-up of TB risk groups patients to primary care practitioners, who are not ready for this, mainly psychologically, and refusing from follow-up of newly detected TB and a significant reduction of the TB service. We believe that it would be advisable to restore dispensary follow-up (1 to 5 years) in the presence of such risks of PTBR as the extensive residual lesions, various immunodeficiency states, severe concomitant diseases and HIV infection. A considerable number of social factors for PTBR, aggravated by current war, will lead to a deterioration of the epidemic situation with TB, including the increase in the number of PTBR. In order to prevent a significant deterioration of the epidemiological situation with TB due to PTBR, we plan to develop the preventive organizational measures. Key words: tuberculosis, relapses, causes, questionnaires.