Concurrent Human Immunodeficiency Virus Infection Research Articles

Impact of HIV Infection on Liver and Cardiovascular Outcomes in Veterans With Metabolic Dysfunction-Associated Steatotic Liver Disease.

Hepatic steatosis is highly prevalent in people living with HIV. It remains unclear whether HIV in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) is associated with greater risks of liver disease progression and cardiovascular disease (CVD). We aim to evaluate the impact of HIV infection on risks of liver and CVD outcomes among US Veterans with MASLD. Using national Veterans Administration data from 2010 to 2022, we created a propensity score-matched cohort of MASLD patients with vs without HIV. Primary outcomes were incidence of cirrhosis and hepatocellular carcinoma (HCC) among patients with vs without HIV and patients with MASLD-HIV on antiretroviral therapy (ART) vs not on ART. Secondary outcomes included incidence of major adverse cardiovascular events and overall survival. The propensity-matched cohort included 920 MASLD patients with HIV and 920 MASLD patients without HIV and was similar in demographics and comorbidities. Compared with MASLD patients without HIV, incidences of cirrhosis and HCC were similar among MASLD with HIV. Compared with MASLD patients without HIV, incidence of major adverse cardiovascular event was higher among MASLD patients with HIV (5.18 vs 4.48 per 100 person-years, P = 0.03). Overall 5-year survival was significantly lower among MASLD patients with HIV and even lower among those not on ART. Among US Veterans with MASLD, concurrent HIV infection, and particularly not being on ART, is associated with greater risks of CVD and decreased overall survival. No differences in risks of cirrhosis or HCC were observed.

S1361 Evaluating the Association Between Concurrent Human Immunodeficiency Virus Infection and Risk of Cardiovascular Disease in Patients With Metabolic Dysfunction-Associated Fatty Liver Disease

S1361 Evaluating the Association Between Concurrent Human Immunodeficiency Virus Infection and Risk of Cardiovascular Disease in Patients With Metabolic Dysfunction-Associated Fatty Liver Disease

The SSS revolution in fungal diagnostics: speed, simplicity and sensitivity.

Fungal disease has historically presented a diagnostic challenge due to its often non-specific clinical presentations, relative infrequency and reliance on insensitive and time-intensive fungal culture. We present the recent developments in fungal diagnostics in the fields of serological and molecular diagnosis for the most clinically relevant pathogens; developments that have the potential to revolutionize fungal diagnosis through improvements in speed, simplicity and sensitivity. We have drawn on a body of evidence including recent studies and reviews demonstrating the effectiveness of antigen and antibody detection and polymerase chain reaction (PCR) in patients with and without concurrent human immunodeficiency virus infection. This includes recently developed fungal lateral flow assays, which have a low cost and operator skill requirement that give them great applicability to low-resource settings. Antigen detection for Cryptococcus, Histoplasma and Aspergillus spp. are much more sensitive than culture. PCR for Candida spp., Aspergillus spp., Mucorales and Pneumocystis jirovecii is more sensitive than culture and usually faster. Effort must be made to utilize recent developments in fungal diagnostics in clinical settings outside of specialist centres and integrate their use into standard medical practice. Given the clinical similarities of the conditions and frequent co-infection, further study is required into the use of serological and molecular fungal tests, particularly in patients being treated for tuberculosis. Further study is needed to clarify the utility of these tests in low-resource settings confounded by a high prevalence of tuberculosis. The diagnostic utility of these tests may require revision of laboratory work flows, care pathways and clinical and lab coordination, especially for any facility caring for the immunosuppressed, critically ill or those with chronic chest conditions, in whom fungal disease is common and underappreciated.

Clinical Characteristics of Peripheral Neuropathy in Kenyan Patients with HIV Infection Compared with Patients with Concurrent HIV Infection and Diabetes Mellitus.

IntroductionPersons living with human immunodeficiency virus (HIV) are living longer and at risk of non-communicable diseases, including diabetes mellitus (DM). Both HIV and DM place patients at risk of peripheral neuropathy (PN). Our aim was to demonstrate the prevalence and characteristics of PN in our population of patients with HIV infection compared with concomitant HIV and DM.MethodsA prospective cross-sectional study was performed at the Aga Khan Hospital in Nairobi, Kenya. Data were collected on demographics and characteristics of DM and HIV. Symptoms and signs of PN were evaluated by Neuropathy Symptom Score, Neuropathy Disability Score, and 10 g monofilament testing.ResultsTwo groups were recruited, each consisting of 68 patients: (1) HIV only, (2) HIV and DM. The median age of patients was 51 years (IQR 42.8–58.6) and 55% were male. Median duration for HIV was 10 years (IQR 5–12) with a median CD4 count of 524 cells/mm3 (IQR 369–731). Median duration for DM was 1 year with a median glycosylated hemoglobin of 6.7% (IQR 6.6–7.6). Sixty-nine percent of patients with HIV had suppressed viral loads, and 9 patients (6.6%) had a history neurotoxic antiretroviral therapy use. PN was detected in 11 (16%) HIV-only patients, and in 17 (25%) participants who had both HIV and DM (Fisher exact test chi-square = 0.4). Univariate analysis demonstrated older age, high body mass index, and long duration of HIV were associated with an OR of 1.07 (95% CI 1.02–1.11), 1.21 (95% CI 0.46–3.11), and 1.07 (95% CI 0.99–1.15) in the overall group, respectively.ConclusionOur study demonstrates a higher but non-significant prevalence of PN in patients with both HIV and DM when compared to HIV alone. HIV disease control had no association with PN presence.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13300-022-01205-3.

Efficacy of Autologous Stem Cell Transplantation for the Treatment of Multiple Myeloma in HIV-Positive Patients

Prior to the advent of anti-retroviral therapy (ART), autologous stem cell transplant (ASCT) was relatively contraindicated for multiple myeloma (MM) patients with human immunodeficiency virus (HIV) due to issues associated with stem cell harvest and the risk of opportunistic infections. With the widespread use of ART for control of HIV, ASCT is now the preferred treatment for relapsed lymphoma, the leading hematopoietic malignancy associated with HIV/AIDS. Hence, MM patients with HIV controlled by ART may benefit equally from aggressive combination treatment of chemotherapy and ASCT. This study seeks to evaluate the clinical course and treatment outcomes of patients with HIV and MM treated with ASCT. Five male patients with average age 53.2 years were included in this study. Patients were diagnosed with HIV prior to diagnosis of MM and were appropriately treated with ART prior to ASCT. All patients had undetectable HIV viral load (VL) prior to ASCT, and remained undetectable after ASCT. Adequate CD34+ stem cells were collected. Patients received high dose melphalan (200 mg/m2) followed by ASCT. ART was continued during ASCT. Patients experienced usual ASCT toxicities including diarrhea, mucositis, and neutropenic fever. All patients had normal neutrophil and platelet engraftments. 60% of patients had very good partial response or better after ASCT. All patients received post ASCT maintenance until progression/toxicity/patient decision. As of December 2020, 2 patients have died 51 and 85 months from ASCT due to other causes. The 3 remaining patients are alive 5-7 years after ASCT. MM patients with concurrent HIV infection that is controlled on ART would benefit from aggressive treatment with chemotherapy and ASCT, with continued ART as they tolerate ASCT as well as myeloma patients without HIV infection.

The Swiss STAR trial – an evaluation of target groups for sexually transmitted infection screening in the sub-sample of women

In Switzerland, universal health insurance does not cover any routine testing for sexually transmitted infections (STIs), not even in individuals at high risk, and extra-genital swabbing is not standard of care. We compared STI prevalence in a multicentre prospective observational cohort of multi-partner women with/without sex work and evaluated associated risk factors. Between January 2016 and June 2017, we offered free STI testing to women with multiple  sexual partners (three or more in the previous 12 months), with follow-up examinations every 6 months. We used multiplex polymerase chain-reaction testing (for Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, Mycoplasma genitalium) for pooled swabs (pharynx, urethra/vagina, anus), and antibody tests for human immunodeficiency virus (HIV) and Treponema pallidum at every visit, and for hepatitis B and C at baseline. We screened 490 female sex workers (FSWs), including 17 trans women, and 92 other multi-partner women. More than half reported a steady partner. Previously undiagnosed HIV was found in 0.2% vs 0.0%, respectively, and T. pallidum antibodies in 5.9% vs 0.0%. STIs requiring antibiotic treatment comprised: active syphilis 1.2% vs 0.0%; N. gonorrhoeae 4.9% vs 0.0%; C. trachomatis 6.3% vs 5.4%, T. vaginalis 10.4% vs 0.0%; M. genitalium 6.7% vs 6.5%. One in four FSWs vs one in nine other women had one or more of these STIs at baseline. 15.8% vs 3.8% had a history of hepatitis B, 45.5% vs 22.8% had no immunity (HBs-AB <10 IU/l). Two FSWs had hepatitis C virus antibodies (0.4%) without concurrent HIV infection. Non-condom-use (last three months) for anal/vaginal sex was not associated with STIs. Independent risk factors were group sex (adjusted odds ratio [aOR] 2.1, 95% confidence interval [CI] 1.1–4.0), age less than 25 (aOR 3.7, 95% CI 1.6–8.9), and being active in sex work for less than 1 year (aOR 2.7, 95% CI 1.3–5.3). HIV and HCV do not appear to pose a major public health problem among FSWs in Switzerland, whereas vaccination against HBV should be promoted. FSWs showed high rates of STIs requiring treatment to reduce transmission to clients and/or steady partners. FSWs should be offered low-cost or free STI screening as a public health priority.

Human immunodeficiency virus-associated neuroinflammation and CD16+ pathobiological process in concurrent human immunodeficiency virus infection and parkinson disease

Human immunodeficiency virus-associated neuroinflammation and CD16+ pathobiological process in concurrent human immunodeficiency virus infection and parkinson disease

Sexually transmitted infections and human immunodeficiency virus coinfection: Scenario in Western India.

Context:Sexually transmitted infections (STIs) have a well-established synergistic relationship with human immunodeficiency virus (HIV) infection. Coinfection with HIV and STI can increase the probability of HIV transmission to an uninfected partner by increasing HIV concentrations in genital lesions, genital secretions, or both. Concurrent HIV infection alters the natural history of the classic STIs.Aims:The aim was to study the current scenario of STIs with HIV co-infection, and to recognize different manifestations of STIs than the classical presentation in people living with HIV/AIDS (PLHIV).Settings and Design:It was an open, cross-sectional, descriptive study carried out in the setting of state government hospital with attached antiretroviral therapy referral center.Subjects and Methods:The sample size of the study was duration based (30 months).Inclusion Criteria:All PLHIV presenting to the department of dermatology with STIs were included in the study.Exclusion Criteria:Non-STI causes of genital ulceration were excluded in the study.Results:The study includes total (n = 484) patients living with HIV/AIDS, prevalence of different STIs was in the following order, herpes simplex virus infections 24.17%, human papillomavirus infections 8.88%, molluscum contagiosum 7.43%, secondary syphilis 4.33%, gonorrhea 1.85%, chancroid 1.44%, and granuloma inguinale 0.41%. Of all the patients with herpes simplex virus infections, 45.6% (n = 57) had multiple recurrences (>6/year). The incidence of mixed STI was 17.29% in the present study.Conclusions:The study represents decreasing trends in bacterial STIs and the rise of viral STIs. Atypical presentations of classic STIs were more frequent than non-HIV-infected individuals.

330. Survival of HIV-Positive Patients with Hemophagocytic Lymphohistiocytosis

BackgroundHemophagocytic lymphohistiocytosis (HLH) is a rare but life-threatening disorder resulting from dysregulated cytokine production. The diagnosis of HLH requires five of eight abnormalities: fever, splenomegaly, bicytopenia, hypertriglyceridemia and/or hypofibrinogenemia, hyperferritinemia, hemophagocytosis on biopsy, low or absent NK cell activity, or elevated soluble CD25. The link between Human Immunodeficiency Virus (HIV) and HLH is incompletely understood; we sought to further define the characteristics and outcomes of this patient population.MethodsWe performed a retrospective study on HLH patients with and without concurrent HIV infection treated at our institution from January 2008 to July 2018. At the time of HLH diagnosis, we extracted data on the HIV status and associated malignancies. The primary outcome was overall survival from time of diagnosis of HLH in patients with HIV vs. those without HIV. Secondary analysis was performed with survival by HIV and malignancy status. Survival was analyzed by Kaplan–Meier curves with hazard ratios calculated using the log-rank test with significance set at P ≤ 0.05.ResultsForty-three patients were included; 11 had HIV at the time of diagnosis of HLH and all met criteria for AIDS at time of inclusion. Patients with HIV who were diagnosed with HLH had similar survival compared with patients without HIV (Hazard ratio for death (HR) 0.87 [95% confidence interval (CI) 0.37–2.904]). All patients with malignancy had a worse survival (HR for death 3.648 [95% CI 1.804–9.169] P = 0.0009), regardless of HIV status. HLH in HIV patients with malignancy resulted in a trend toward worse survival (HR = 3.86 95% CI 1.09–22.60, P = 0.0578) compared with those without malignancy, although the limited number of patients prohibits a definitive conclusion. In HIV-negative patients, the presence of malignancy is associated with worse survival (HR 3.56 [95% CI 1.475–10.11] P = 0.0063).ConclusionIn this retrospective, single-institution review of HLH patients, HIV was not associated with worse overall survival compared with patients without HIV. The presence of malignancy resulted in worse survival in the overall population. Further investigation is needed to optimize the care of these patients. Disclosures All authors: No reported disclosures.

Lepromatous Leprosy and Human Immunodeficiency Virus: A Rare Co-infection

We report a 23-year-old male with lepromatous leprosy atypically presenting with 5-year history of asymptomatic, verrucous papules, and nodules. Human Immunodeficiency Virus (HIV) testing was positive with depressed CD4 count. In HIV/leprosy co-infection, most of the documented patients were diagnosed with paucibacillary leprosy as immune reconstitution disease (IRD) from treatment-induced immunological recovery. Rarely, multibacillary lepromatous leprosy is encountered in the setting of untreated, severe immunodeficiency. Atypical clinical presentation warrants investigation for concurrent HIV infection.

Immunomodulatory Therapy of Visceral Leishmaniasis in Human Immunodeficiency Virus-Coinfected Patients

Patients with visceral leishmaniasis (VL)–human immunodeficiency virus (HIV) coinfection experience increased drug toxicity and treatment failure rates compared to VL patients, with more frequent VL relapse and death. In the era of VL elimination strategies, HIV coinfection is progressively becoming a key challenge, because HIV-coinfected patients respond poorly to conventional VL treatment and play an important role in parasite transmission. With limited chemotherapeutic options and a paucity of novel anti-parasitic drugs, new interventions that target host immunity may offer an effective alternative. In this review, we first summarize current views on how VL immunopathology is significantly affected by HIV coinfection. We then review current clinical and promising preclinical immunomodulatory interventions in the field of VL and discuss how these may operate in the context of a concurrent HIV infection. Caveats are formulated as these interventions may unpredictably impact the delicate balance between boosting of beneficial VL-specific responses and deleterious immune activation/hyperinflammation, activation of latent provirus or increased HIV-susceptibility of target cells. Evidence is lacking to prioritize a target molecule and a more detailed account of the immunological status induced by the coinfection as well as surrogate markers of cure and protection are still required. We do, however, argue that virologically suppressed VL patients with a recovered immune system, in whom effective antiretroviral therapy alone is not able to restore protective immunity, can be considered a relevant target group for an immunomodulatory intervention. Finally, we provide perspectives on the translation of novel theories on synergistic immune cell cross-talk into an effective treatment strategy for VL–HIV-coinfected patients.

Concomitant systemic lupus erythematosus and HIV infection

Rationale:Coexisting systemic lupus erythematosus (SLE) and human immunodeficiency virus (HIV) infection cases are rare worldwide. Great challenges are posed on the diagnosis and treatment of such concurrent cases.Patient concern:We report the case of a 44-year-old Chinese man with edema, hematuria, and fever who presented at West China Hospital, Sichuan University, Chengdu, Sichuan, China, in 2013.Diagnoses:An initial diagnosis of SLE was made from the clinical manifestations and laboratory findings based on the Systemic Lupus International Collaborating Clinics classification criteria. Immunosuppressant therapy relieved him of the edema and hematuria, but he regained the symptoms after a cold. Workup, including electrochemiluminescence immunoassay, western blot, and polymerase chain reaction analysis, revealed that he was concurrently infected with HIV after hospitalization.Interventions:The treatment plan included methylprednisolone and cyclophosphamide, with gastroprotective and hepatoprotective agents, simultaneously aiming to reduce urinary protein. After HIV infection confirmed, cyclophosphamide was stopped. He was referred to the local Centers for Disease Control and Prevention for combination antiretroviral therapy (ART). He was suggested to continue monitoring CD4 T-cell count for an appropriate dose of immunosuppressive drugs.Outcomes:In the last follow-up in May 2017, he had been stable in terms of both SLE and HIV infection.Lessons:The case highlights the presence of concurrent SLE and HIV infection. Laboratory technicians and clinicians should be cautious on diagnosis, especially in eliminating the false-positive results. Attention should be paid to the dose of immunosuppressants and the ART procedure.

P12.14 Clinical descriptions of pcr positive early syphilis infections

Background Globally, syphilis remains a major and resurgent public health problem with high incidence rates in many settings, including among men who have sex with men (MSM). Left untreated, syphilis can lead to further transmission, morbidity and enhanced Human Immunodeficiency Virus (HIV) transmission. A primary chancre is classically described as an indurated single painless ulcer at the site of Treponema pallidum inoculation. However, recent clinical experience is that primary syphilis can present atypically, as multiple and/or painful ulcers with features suggestive of genital herpes. We aimed to describe serology and Treponema pallidum polymerase chain reaction (Tp PCR) positive lesions of primary syphilis in men, the rates of painful or multiple lesions, whether there was concurrent genital Herpes simplex virus (HSV) infection and whether concurrent HIV infection altered the presentation. Methods Tp PCR positive results with confirmatory syphilis serology and HSV PCR results reported by VIDRL were identified and compared to MSHC medical records over a five-year period from 2010 to 2014. Results 183 patients fulfilled the criteria of Tp PCR positive primary syphilis. Primary syphilis lesions were frequently painful (49.2%) or multiple (37.7%), and were infrequently associated with HSV (2.7%). Presentation was not significantly altered by HIV status. Anal lesions were more common in HIV positive men (34.2%) than in HIV negative men (11.6%). Syphilis reinfections were more common in HIV positive men (39.5%) than in HIV negative men (11.7%). Conclusion Tp PCR is a useful tool to confirm syphilis as a cause of genital lesions and positivity may precede serological markers. Early syphilis lesions may be clinically misidentified as HSV infection if syphilis is not considered. Awareness of the clinical variability of primary syphilis lesions should be included in health promotion messages to the public and health care providers. Disclosure statement There are no conflicts of interest.

The Sordid Affair Between Human Herpesvirus and HIV.

Both human immunodeficiency virus (HIV) and human herpesvirus (HHV) infections persist lifelong, and almost all individuals infected with HIV are also infected with ≥1 HHV. These coinfections are not independent processes or benign. In this review, we discuss how HHVs, and cytomegalovirus in particular, interact with concurrent HIV infection, and we describe the next steps necessary to understand and address these connections.

Severe Myelosuppression and MRSA Infection as the Presentation of Perinatal HIV Infection

Severe Myelosuppression and MRSA Infection as the Presentation of Perinatal HIV Infection

Early versus Delayed Initiation of Antiretroviral Therapy for Concurrent HIV Infection and Cryptococcal Meningitis in Sub‐Saharan Africa

BACKGROUND. Cryptococcal meningitis (CM) remains a leading cause of acquired immunodeficiency syndrome-related death in sub-Saharan Africa. The timing of the initiation of antiretroviral therapy (ART) for human immunodeficiency virus (HIV)-associated CM remains uncertain. The study aimed to determine the optimal timing for initiation of ART in HIV-positive individuals with CM. METHODS. A prospective, open-label, randomized clinical trial was conducted at a tertiary teaching hospital in Zimbabwe. Participants were aged > or = 18 years, were ART naive, had received a first CM diagnosis, and were randomized to receive early ART (within 72 h after CM diagnosis) or delayed ART (after 10 weeks of treatment with fluconazole alone). Participants received 800 mg of fluconazole per day. The ART regimen used was stavudine, lamivudine, and nevirapine given twice daily. The duration of follow-up was up to 3 years. The primary end point was all-cause mortality. RESULTS. Fifty-four participants were enrolled in the study (28 in the early ART arm and 26 in the delayed ART arm). The median CD4 cell count at enrollment was 37 cells/mm(3) (interquartile range, 17-69 cells/mm(3)). The 3-year mortality rate differed significantly between the early and delayed ART groups (88% vs 54%; P < .006); the overall 3-year mortality rate was 73%. The median durations of survival were 28 days and 637 days in the early and delayed ART groups, respectively (P = .031, by log-rank test). The risk of mortality was almost 3 times as great in the early ART group versus the delayed ART group (adjusted hazard ratio, 2.85; 95% confidence interval, 1.1-7.23). The study was terminated early by the data safety monitoring committee. CONCLUSIONS. In resource-limited settings where CM management may be suboptimal, when compared with a delay of 10 weeks after a CM diagnosis, early initiation of ART results in increased mortality. Trial registration. ClinicalTrials.gov identifier: NCT00830856.

Tuberculosis into the 2010s: Is the Glass Half Full?

During the 16 years since the World Health Organization declared tuberculosis (TB) a global emergency, major new challenges have emerged-in particular the spread of extensively drug-resistant (XDR)-TB and its overlap with human immunodeficiency virus infection. However, during this period, we have also witnessed the creation of-and major commitments from-agencies dedicated to TB control, research, and funding, and tangible positive achievements have occurred; these include improvements in both new and existing TB diagnostics, a developmental pipeline of new candidate TB drugs, better treatment outcomes for multidrug-resistant TB and XDR-TB, heightened recognition of the importance of nosocomial transmission, and improved strategies to reduce mortality associated with concurrent human immunodeficiency virus infection and TB. We suggest updates to the 2006 International Standards of Tuberculosis Care to embrace these developments. The incorporation of these recent advances into optimized directly observed treatment, short course (DOTS), programs, in conjunction with more widespread deployment and enhanced political will, all provide grounds for improved control.

Tuberculosis Complicating Hepatitis C Treatment in HIV‐Infected Patients

Tuberculosis characteristics and incidence were assessed among patients with concurrent human immunodeficiency virus infection and chronic hepatitis C virus infection who were receiving interferon-based therapy at 3 hospitals in Spain. Four of 570 patients (0.7 cases per 100 person-years; 95% confidence interval, 0.19-1.78 cases per 100 person-years) received a diagnosis of tuberculosis; all of them presented with a decrease in CD4+ cell count before diagnosis, and 3 of them received a delayed diagnosis. After tuberculosis treatment, all patients were cured.

Lumbar Puncture in HIV‐Infected Patients with Syphilis and No Neurologic Symptoms

The decision to perform lumbar puncture in patients with asymptomatic human immunodeficiency virus (HIV) infection and syphilis is controversial. The Centers for Disease Control and Prevention recommend certain criteria that warrant lumbar puncture. Here, we assess the performance of these criteria for detecting asymptomatic neurosyphilis (ANS). Eligible subjects consisted of all patients with concurrent HIV infection and syphilis in a prospective clinical cohort who had no neurologic symptoms at the time of lumbar puncture. We retrospectively applied different stratification criteria to calculate the performance of lumbar puncture in detecting ANS: (1) lumbar puncture in patients with late latent syphilis or syphilis of an unknown duration, regardless of the CD4 cell count or rapid plasma reagin titer; (2) lumbar puncture if the CD4 cell count was 350 cells/mL and/or the rapid plasma reagin titer was 1:32, regardless of the syphilis stage; and (3) lumbar puncture in the context of serologic nonresponse to syphilis therapy. Two hundred two of 231 patients with syphilis did not have neurologic symptoms. Immediate lumbar puncture was performed for 46 patients, and 10 cases (22%) of ANS were detected. With use of the first criterion, 2 (14%) of 10 cases of ANS in patients with early-stage syphilis would have been missed (sensitivity, 80% [95% confidence interval [CI], 44%-97%]; specificity, 23% (95% confidence interval [CI], 11.4%-40.2%) [corrected] Criterion 2 would not have missed any cases of ANS (sensitivity, 100% [95% CI, 70%-100%]; specificity, 13.2% (95% CI, 4.4%-29.1%) [corrected] but would have required that a lumbar puncture be performed for 88% of patients. Performance of lumbar puncture performed in 13 cases based on serologic nonresponse to syphilis therapy yielded 4 cases (31%) of ANS. In patients with concurrent HIV infection and syphilis, the use of criteria based on rapid plasma reagin titer and CD4 cell count, instead of stage-based criteria, improved the ability to identify ANS.

Lowbury Lecture 2007: infection prevention and control strategies for tuberculosis in developing countries – lessons learnt from Africa

The World Health Organization ranks South Africa among the top ten of high-burden countries for tuberculosis (TB). The Western Cape Province has the highest prevalence of TB in the country. Studies performed in healthcare facilities both at Tygerberg Hospital and from Kwa-Zulu Natal province indicate a significant risk for nosocomial transmission of tuberculosis. An audit of provision for infection prevention and control (IPC) programmes revealed that although there were adequate supplies of protective clothing, the greatest need was for training and understanding of IPC principles among healthcare workers. In establishing national IPC guidelines for TB in South Africa, it has become evident that most of these were derived from existing guidelines in developed countries. Though the principles were sound, the practices were not realistic for developing economies and generally not implemented in healthcare facilities. Factors that influence a robust TB management programme are poverty, concurrent human immunodeficiency virus infection, overcrowding, ignorance of the disease and a varied level of health service delivery. It is recommended that a foundation of sound knowledge should be established upon which best practices should be built within the framework of good IPC principles.