Disease In HIV-infected Patients Research Articles

Acceptance of chronic disease in patients living with HIV infection: one centre's cross-sectional study

Background: Despite effective treatment, the quality of life of patients infected with Human Immunodeficiency Virus (HIV) can be diminished by factors both directly and indirectly related to the infection.Aim of the study: Determination of factors affecting the acceptance of HIV infection as a chronic disease in HIV-infected patients. Material and methods: A survey was conducted on 83 HIV-infected adults undergoing antiretroviral (ARV) treatment. The impact of social and medical factors on the acceptance of a chronic disease such as HIV infection was analyzed. Factors such as age, gender, education, route of HIV infection, living with family or a close person, professional activity, length of ARV therapy, history of an indicator disease, treatment breaks, markers of HBV infection, and current comorbidities requiring treatment, which may affect self-acceptance, were included in the analysis. Information about the patients was obtained from the Acceptance of Illness Scale (AIS) survey and medical records.Results: On average, in the AIS survey, patients scored 33.98 points, with a maximum of 40, which proves a very good acceptance of their infection. Among the many analyzed factors, only two variables showed statistical significance. Professionally active people accept their infection better, while lower acceptance was observed in patients who discontinued ARV therapy in the past.Conclusions: The analysis of the data from the study shows the need to consider many factors influencing the acceptance of HIV infection in HIV-infected patients. This will allow the introduction of programs to improve care for people with a chronic disease and thus improve their quality of life. The high assessment of acceptance of their disease was undoubtedly influenced by professional activity, the effectiveness of ARV treatment, and good access to ARV drugs.

A Retrospective Study of the Presentation and Management of Perianal Disease in HIV-Positive Patients Referred to a Surgical Outpatient Unit in Turkey.

BACKGROUND The incidence of human immunodeficiency virus (HIV) infection is on the rise, and perianal region diseases in HIV-infected patients have become increasingly prevalent. This study aimed to analyze the surgical treatment outcomes of HIV-infected patients presenting with perianal concerns. MATERIAL AND METHODS We included 311 HIV-positive patients admitted to the Infectious Diseases Clinic of Samsun Training and Research Hospital between January 2014 and December 2022. From this group, we selected those who sought care at the general surgery outpatient clinic for perianal and anal concerns, retrospectively reviewing their medical records. RESULTS Out of 311 patients, 54 (17.3%) were referred to the general surgery outpatient clinic with anal and/or perianal region complaints. Of these cases, 38 (70.3%) had a single disease, while 16 (29.6%) had combined diseases. There were 20 males (95%) and 1 female (5%). Among these 54 patients, 33 (61.1%) received medical treatment from the outpatient clinic, while 21 (38.9%) underwent surgical intervention. The diagnoses included 22 hemorrhoidal diseases, 24 anal condylomas, 15 anal fissures, 11 anal abscesses, and 4 anal fistulas. We evaluated the postoperative results and recurrence status of these patients. CONCLUSIONS Perianal diseases in HIV-positive patients can be categorized as isolated or combined. The management of patients with postoperative follow-up compliance problems and combined diseases with low CD4 counts may pose treatment challenges.

Prognostic Factors in Hospitalized Patients with HIV-Associated Burkitt's Lymphoma - Real World Data Analysis

Introduction Burkitt Lymphoma (BL) is a highly aggressive and rare B-cell non-Hodgkin Lymphoma, characterized by translocation and dysregulation of the MYC gene. BL comes in three distinct forms: endemic, sporadic, and immunodeficiency related, which is most commonly secondary to HIV. Despite improvements in antiretroviral therapy (ART), the reported incidence of BL has remained stable over time. BL is a highly curable disease in patients able to tolerate aggressive therapies. However, little is known about real-world outcomes in United States patients with HIV- related BL. Our study highlights multiple factors associated with inpatient mortality and morbidity. Methods The National Inpatient Sample database was queried from October 2015 to December 2020. Adults aged >= 18 with a primary diagnosis of BL were identified and stratified into those with and without HIV. Complications included were queried using ICD codes most found in the secondary diagnosis variables. Baseline characteristics, inpatient complications, and outcomes were compared using chi-squared and Wilcoxon rank-sum tests. Logistic regression analysis was performed to assess the risk of death before and after adjusting for multiple risk factors. Results We found 3,650 admissions with a primary diagnosis of BL, 400 (11%) of whom had HIV. Patients with HIV were younger, 49% were younger than 40 years old as compared to 29% in patients with no HIV. There was a higher percentage of black patients 115 (29%), and most had Medicaid 170 (44%), there was no difference between income, hospital bed size or geographical region. Interestingly, in multivariable analysis, there were no significant differences in length of stay, race, or mortality between patients with and without HIV. The factors associated with mortality in HIV patients included acute renal failure OR 11.4 (1.22 to 107) and Sepsis OR 38.6 (1.62 to 921) Conclusion BL is an increasingly important disease in HIV-infected patients given that the incidence remains high despite advances in ART. This nationwide data analysis demonstrates the demographic characteristics of patients with HIV-associated BL in the US and the encouraging findings that outcomes are not significantly different between patients with and without HIV. Yet our study demonstrates the disproportionate distribution of HIV-BL in females and black patients. Further studies are needed to examine gender and racial disparities.

Features of Tat Protein in HIV-1 Sub-Subtype A6 Variants Circulating in the Moscow Region, Russia.

Tat, the trans-activator of transcription, is a multifunctional HIV-1 protein that can induce chronic inflammation and the development of somatic diseases in HIV-infected patients. Natural polymorphisms in Tat can impact the propagation of the inflammatory signal. Currently, Tat is considered an object for creating new therapeutic agents. Therefore, the identification of Tat protein features in various HIV-1 variants is a relevant task. The purpose of the study was to characterize the genetic variations of Tat-A6 in virus variants circulating in the Moscow Region. The authors analyzed 252 clinical samples from people living with HIV (PLWH) with different stages of HIV infection. Nested PCR for two fragments (tat1, tat2) with subsequent sequencing, subtyping, and statistical analysis was conducted. The authors received 252 sequences for tat1 and 189 for tat2. HIV-1 sub-subtype A6 was identified in 250 samples. The received results indicated the features of Tat1-A6 in variants of viruses circulating in the Moscow Region. In PLWH with different stages of HIV infection, C31S in Tat1-A6 was detected with different occurrence rates. It was demonstrated that Tat2-A6, instead of a functional significant 78RGD80 motif, had a 78QRD80 motif. Herewith, G79R in Tat2-A6 was defined as characteristic amino acid substitution for sub-subtype A6. Tat2-A6 in variants of viruses circulating in the Moscow Region demonstrated high conservatism.

Prevalence of and prognosis for poor immunological recovery by virally suppressed and aged HIV-infected patients.

Antiretroviral therapy (ART) prolongs lifespan and decreases mortality of HIV infected patients. However, many patients do not achieve optimal immune reconstitution. The influence of non-optimal immune recovery on non-AIDS related diseases is not well defined in aged HIV-infected patients receiving ART. A retrospective study was conducted at Tianjin Second People's Hospital, China to evaluate the association of an inadequate immunological response and non-AIDS diseases in HIV infected patients ≥60 years of age and virally suppressed for at least 2 years by ART. The study included patients (n = 666) who initiated ART between August 2009 and December 2020. The prevalence of patients with an inadequate immunological response was 29.6%. The percentage of non-AIDS diseases such as hypertension, cardiovascular disease (CVD), diabetes, tumor, and chronic kidney disease (CKD) was 32.9, 9.9, 31, 4.1, and 13%, respectively. In addition to baseline CD4+ T cell counts, CVD and tumor were associated with poor immune reconstitution in aged Chinese HIV-1 infected patients. The adjusted odds ratios (95% confidence interval) were AOR 2.45 (95% CI: 1.22-4.93) and 3.06 (95% CI: 1.09-8.56, p = 0.03). Inadequate immunological response was associated with greater mortality (AOR: 2.83, 95% CI: 1.42-5.67, p = 0.003) in this cohort. These results tend to demonstrate appropriate drug selection at ART initiation and prevention of non-AIDS complications during ART decreased mortality of and an inadequate immunological response in aged HIV infected patients.

Advances in the diagnosis and treatment of invasive fungal disease in HIV-infected patients

Advances in the diagnosis and treatment of invasive fungal disease in HIV-infected patients

Standard diagnostics with and without urine-based lipoarabinomannan testing for tuberculosis disease in HIV-infected patients in a high-burden setting-A cost-effectiveness analysis.

Recent clinical findings reported the reduced mortality associated with treatment guided by sputum-based molecular test with urine-based lipoarabinomannan (LAM) assay for tuberculosis (TB) disease in HIV-infected individuals. We aimed to evaluate the cost-effectiveness of sputum-based Xpert tests with and without urine-based LAM assays among HIV-infected individuals with signs and symptoms of TB disease (TBD) from the perspective of South African healthcare providers. A one-year decision-analytic model was constructed to simulate TB-related outcomes of 7 strategies: Sputum smear microscope (SSM), Xpert, Xpert Ultra, Xpert with AlereLAM, Xpert Ultra with AlereLAM, Xpert with FujiLAM, and Xpert Ultra with FujiLAM, in a hypothetical cohort of adult HIV-infected individuals with signs and symptoms of TB. The model outcomes were TB-related direct medical cost, mortality, early treatment, disability-adjusted life-years (DALYs) and incremental cost per DALY averted (ICER). The model inputs were retrieved from literature and public data. Base-case analysis and sensitivity analysis were conducted. In the base-case analysis, the Xpert Ultra with FujiLAM strategy showed the highest incidence of early treatment (267.7 per 1000 tested) and lowest mortality (29.0 per 1000 tested), with ICER = 676.9 USD/DALY averted. Probabilistic sensitivity analysis of 10,000 Monte Carlo simulations showed the cost-effective probability of Xpert Ultra with FujiLAM was the highest of all 7 strategies at the willingness-to-pay (WTP) threshold >202USD/DALY averted. Standard sputum-based TB diagnostic Xpert Ultra with urine-based FujiLAM for TBD testing in HIV-infected individuals appears to be the preferred cost-effective strategy from the perspective of the health service provider of South Africa.

Assessment of Cardiovascular Risk and Arterial Stiffness in Patients With Human Immunodeficiency Virus.

Several studies suggest that patients infected with the human immunodeficiency virus (HIV) under highly active antiretroviral therapy (HAART) have a higher cardiovascular risk than the general population. Arterial stiffness is an independent predictor of cardiovascular events and can be measured through carotid-femoral pulse wave velocity (PWV). The objectives of this study were to characterize a sample of HIV-infected patients under HAART regarding cardiovascular risk, compare PWV values of this group with those of uninfected controls,and investigate predictors of PWV in the HIV-infected group. PWV was measured, and data was collected from a sample of 125 HIV-infected patients under HAART. PWV measurements in the study group were compared with those in a control group of 250 subjects similar in sex, age, prevalence of hypertension, and type 2 diabetes mellitus (DM). A linear regression model was constructed to identify predictors of PWV in the HIV-infected group. In the HIV-infected group, composed mostly of men, the mean age and respective standard deviation were 48.6 ± 11.6 years. In this group, 112 individuals (89.6%) presented moderate to very high cardiovascular risk. Significant differences were found in median PWV between HIV-infected and control groups (8.56 vs. 8.00 m/s,p= .002). Age, peripheral systolic blood pressure, presence of DM, amount of alcohol consumed, and current CD4+T cell count were independent predictors of PWV in the HIV-infected group. Conclusions: The HIV-infected group showed higher cardiovascular risk and arterial stiffness measurements than the general population. PWV may be an important predictor of subclinical cardiovascular disease in HIV-infected patients.

Pneumocytosis: An Emerging Opportunistic Mycosis of Public Health Importance

Opportunistic mycoses have become a significant causee of morbidity and mortality in both sexes and in all age groups throughout the world. Pneumocytosis caused by Pneumocystis jiroveciiis, a potentially fatal fungal disease, is significant for public health. Pneumocytosis is often the AIDS-defining disease in HIV-infected patients, usually occurring when CD4 count drops below 200 cells/μL. However, the disease is a growing concern to immune compromised patients without HIV infection, such as those who are undergoing organ transplantation, receiving novel immunosuppressive therapeutics or those who have connective tissue diseases. Pneumocytosis is recognized to affect patients all over the world, and is transmitted from person to person through the airborne route. Patients with and without HIV infections have substantially distinct clinical presentations of Pneumocytosis. Disease has a bad prognosis in individuals who are HIV-negative, rapidly progresses, is challenging to correctly diagnose, and produces severe respiratory failure. Interstitial pneumonia in immune compromised patient a patient is the most common clinical symptom. Due to non-specific signs and symptoms, diagnosis of disease poses a problem. Since chest radiographs are not pathognomonic for disease and the organism cannot be cultivated routinely, a definitive diagnosis must be made using histopathology or cytopathology evidence of organisms in tissue, bronchoalveolar lavage (BAL) fluid, or artificial sputum samples. Trimethoprim-sulfamethoxazole (TMP-SMX) is the treatment of choice. Intravenous pentamidine, clindamycin-primaquine, daps one, atovaquone, and echinocandins are among the second-line treatment options in Pneumocytosis.

Diagnostics of allergic diseases in HIV-infected patients using actual computer technologies

Purpose. Development of complex diagnostic methods and assessment of the course of allergic diseases in immunocompromised individuals with HIV infection based on the use of actual computer technologies to improve the quality of diagnostics and treatment measures in these patients.Materials and methods. Methods for calculating the relative increase and average growth rate used to estimate the annual increase in the number of diagnosed cases of allergic diseases in the Novgorod region. During the studying of the comorbidity of HIV and allergy we used information about a burdened allergic history. Additional parameters of the analysis were data, obtained in clinical laboratory. For analysis of the data we used Student’s t test (t) and Pearson’s x². The study used the principle of a diagnostic matrix, which allows transferring medical experience to IT solutions, such as DSS and their variants.Results. In the Novgorod region there has been an increase in the number of diagnosed cases of individual allergic diseases. Over 1020 registered cases of HIV infection among residents of the Novgorod region considered to study the comorbidity of HIV infection and allergies. Information about aggravated allergic anamnesis is indicated in 12% cases. Statistically significant (p<0.012) correlation between high viral load and the development of drug allergy in HIV-infected patients with identified allergic pathology were shown. The indicators of the immune status showing specific markers of allergy in patients with HIV were studied. We developed the clinical decision support system (CDDS), which used to organize medical knowledge and optimize the diagnostics.>˂ 0.012) correlation between high viral load and the development of drug allergy in HIV-infected patients with identified allergic pathology were shown. The indicators of the immune status showing specific markers of allergy in patients with HIV were studied. We developed the clinical decision support system (CDDS), which used to organize medical knowledge and optimize the diagnostics.

Features of the clinic and course of cutaneous and sexually transmitted diseases in HIV infected patients from the Volgograd region of Russia

HIV infection still remains an urgent problem of modern medicine. The incidence has continued to rise in recent years. The variety of clinical manifestations of the infection, not pathognomonic in the early stages, leads to misdiagnosis for an extended time period. The aim of the study was to assess the structure of skin diseases and sexually transmitted diseases in patients with HIV infections in the Volgograd region, to identify the features of the clinic and the course of these pathologies. A retrospective analysis of case histories of 306 HIV-infected patients who applied for medical care to dermatological institutions in Volgograd over the past 5 years was carried out. The authors describe the diverse features of the clinic, the course of skin diseases, syphilis and urogenital infections in patients with HIV infection. Knowledge of these signs of related specialties will allow for doctors to avoid treatment, diagnostic and tactical errors and will contribute to the early diagnosis of HIV infection and skin diseases and sexually transmitted diseases alike.

Microalbuminuria and its associated risk factors among human immunodeficiency virus-infected patients attending a tertiary care facility in Kano, Northwest Nigeria

Background: Human immunodeficiency virus (HIV) infection affects multiple organs and the kidney is a common target, thereby making renal disease one of the recognised complications of HIV infection. Microalbuminuria represents an early, important marker of kidney damage in several disease conditions including HIV-infected highly active antiretroviral therapy (HAART)-naïve patients. Early detection of microalbuminuria is critical to slowing down the progression of kidney dysfunction to chronic kidney disease in HIV-infected patients. Determination of predictive factors for microalbuminuria in these group of patients may serve as avenues for intervention to prevent HIV-associated renal diseases. Aim: The aim of the study was to determine the prevalence and risk factors of microalbuminuria in HIV/AIDS-infected adults on HAART at Aminu Kano Teaching Hospital, Kano, Nigeria. Patients, Materials and Methods: A descriptive cross-sectional study was carried out among 500 subjects including 250 HAART-treated and 250 HAART-naïve HIV/AIDS participants. An interviewer-administered structured questionnaire was used to collect relevant demographic and clinical information. Blood and urine samples were collected for serum creatinine and urinary albumin and creatinine measurements, respectively, and the results were collated and analysed. Comparison of categorical variables was done using Chi-square/Fisher's exact test, where applicable with level of significance set at P < 0.05. Results: The prevalence of microalbuminuria among the two groups studied was found to be high (22.8% for HAART naïve versus 18.4% for HAART treated, respectively) while the risk factors identified were estimated glomerular filtration rate, low CD4 count, and duration of HIV treatment. Conclusion: The major predictors of microalbuminuria include low CD4 count, duration of HIV infection (<30 months), and duration of HAART treatment (<30 months).

Study of indicators of the immune status in HIV-infected patients with concurrent allergic pathology

Aim. To study the indicators of the immune status and manifestations of allergic diseases in HIV-infected patients in the Novgorod region. Methods. We studied the data of HIV-infected patients living in the Novgorod region for the years 20002021. A total of 1020 cases of HIV infection were studied, in which 121 (12%) patients were diagnosed with allergic reactions. In patients with allergic manifestations, the human immunodeficiency virus type 1 ribonucleic acid content was measured by the polymerase chain reaction method, and the indicators of the immune status (the content of lymphocytes, eosinophils, basophils, the levels of CD3+, CD3+CD4+, CD3+CD8+ cells, immunoregulatory index) were assessed. For statistical analysis, the Student's test (t) was used to assess the statistical significance of differences in immune status indicators, and the Pearson 2 test to assess the statistical significance of differences in allergic manifestations in patients with HIV. Results. The subjects of the study were divided into 2 groups based on the levels of HIV viral load. Analysis of these groups using the Pearson 2 test showed a statistically significant (p 0.012) correlation between high viral load and the development of drug hypersensitivity reaction in HIV-infected patients. The following etiology of allergic reactions was determined among the subjects: drug (59%), food (19%), pollen (5.7%), household (5.7%), chemical (1.9%), unspecified (6.7%). The study of the immune status in two groups did not reveal statistically significant differences (p 0.05). The study of the immune status indicators in HIV-infected patients with drug hypersensitivity reactions and different levels of viral load revealed a significantly higher level of CD3+ cells (p 0.003) in patients with drug hypersensitivity reactions and detectable viral load. Conclusion. The study revealed statistically significant differences in the immune status of HIV-infected patients with drug hypersensitivity reactions living in the Novgorod region compared with HIV-infected patients without drug allergies.

Estimation of Burden of Kidney Dysfunction in HIV-Infected Pediatrics and Adolescents by Use of Urinary Neutrophil Gelatinase-Associated Lipocalin: A Single Center Experience in Kenya

Abstract Background: About 75% of patients infected with human immunodeficiency virus (HIV) live in sub-Saharan Africa. In Kenya, about 1.5 million Kenyans are living with HIV, of whom almost 100,000 are children and adolescents. Highly active antiretroviral therapy (HAART) has converted HIV infection to a chronic illness with its attendant complications. Kidney disease is a common complication of HIV infection and its treatment. Kidney disease in HIV-infected persons can be asymptomatic, insidious onset and may lack specific clinical features. It can only be detected on active screening. The urine albumin-to-creatinine ratio and estimated glomerular filtration rate (eGFR) using serum creatinine are not sensitive in identification of early kidney injury. Urinary neutrophil gelatinase-associated lipocalin (uNGAL) has been used as marker of early kidney injury. Methods: This cross-sectional study used uNGAL and serum creatinine to determine the prevalence of kidney dysfunction in HIV-infected children and adolescents with HAART at Gertrude's Children's Hospital, Nairobi, Kenya, from March 2016 to February 2017. Urine samples were assayed for uNGAL using the Bio Porto® enzyme-linked immunosorbent assay. Serum creatinine was assayed using the Jaffe reaction in the Cobas® 6000 biochemistry analyzer and eGFR calculated using the Schwartz formula. Scatter plot of eGFR against log uNGAL levles was performed by Statistical Package for Social Sciences and Pearson correlation coefficeint between log uNGAL levles and eGFR was analyzed. Results: Ninety-three patients were recruited. Their mean age was 11.8 ± 3.6 years and the median duration on HAART was 72.6 months. Males were 47 (50.5%). The prevalence of kidney dysfunction using uNGAL was 15.1% (95% CI 7.6%–22.5%) and 5.4% (95% CI 1.8%–12.1%) by eGFR. The mean eGFR was 131 ± 25 mL·min−1·1.73 m−2 and median uNGAL was 10 ng/mL. For every one ng/mL increase in uNGAL value above the normal value, eGFR decreases by 4.8 mL·min−1·1.73 m−2 (P = 0.038). Patients with elevated uNGAL were older when compared with those with normal uNGAL (13.5 vs. 11.5 years). Conclusion: Urinary NGAL picked up to three times more patients with kidney dysfunction than eGFR derived from serum creatinine. All the patients were asymptomatic. Older children and adolescents were more likely to manifest with kidney dysfunction. Further studies are necessary to evaluate if uNGAL can be utilized routinely to evaluate for early kidney disease in HIV-infected patients.

Endovascular and Open Surgical Treatment of Peripheral Artery Disease inPatients with HIV

<h3>Objective</h3> Peripheral artery disease (PAD) is a highly prevalent disease world-wide that can ultimately result in limb loss. In the HIV infected population, the condition can present at a younger age and result in a significant level of morbidity and remains understudied. The purpose of this study is to evaluate outcomes related to endovascular and open surgical management of occlusive disease in HIV infected patients at a single- center. <h3>Methods</h3> A retrospective, single-center review of peripheral vascular interventions in HIV infected patients at a tertiary vascular referral center was performed between January 1, 2010 and December 31, 2019. Data collected included patient demographics including CD4 counts, highly active antiretroviral therapy (HAART), statin use, antiplatelet and/or anticoagulation status, pre and post intervention ankle-brachial indices, limb loss, number of re-interventions, follow up in vascular clinic, and 30-day mortality. <h3>Results</h3> During the study period, 27 patients (70.4% men) underwent peripheral vascular interventions while infected with HIV. Two patients had interventions on both lower extremities which were treated as separate occurrences resulting in an N of 29. The mean age was 55 years old (range, 33-67 years, median 57). Types of interventions employed included endovascular attempts (n=11[37.9%])), open surgery (n=16 [55.2%]) or hybrid operations including endovascular and open components (n=2 [6.9%]). One third of patients (n=10[34.5%]) required an initial reintervention within 30 days of their index operation and 13 patients (45%) required more than 1 reintervention on their lower extremity. A majority of patients (n=19[66%]) required reintervention on their lower extremity. Two patients (6.9%) required amputation within 30 days of their index case. Overall amputation rate regardless of time interval was 31% for this cohort. The 30-day mortality was 3.4%(n=1). Seventeen patients (58.6%) presented for their 1-year follow-up. While data was missing for five patients, a majority of the cohort had a CD4 count >500 prior to their index operation (n=12[50%]) while 13.8% of patients (n=4) had a CD4 count of less than 200 prior to their index case. There was a significant association, as expected, with number of reinterventions performed and an increased risk of amputation (p=0.0003). Additionally, open surgery as an index operation was significantly associated with increased risk of amputation (p=0.014). Mean hospital length of stay was 8.3 days (range, 0-40). The most common indications for surgery were claudication (n=9 [31%]) and acute limb ischemia (n=9 [31%]). Interestingly, there was no significant association between indication for surgery and resulting limb loss. The limb salvage rate for this patient cohort was 69%. <h3>Conclusions</h3> Peripheral artery disease continues to be a highly prevalent condition associated with significant morbidity for patients impacted and this impact tends to be greater in patients infected with HIV. Overall, HIV infected patients at our institution had a higher limb salvage rate than those reported in the literature with a significant association with limb loss in those whohad multiple re-interventions. More studies are needed to fully categorize recommendations regarding limb salvage as it pertains to HIV infected individuals.

Clinical and morphological characteristic of kidney damage in HIV/HCV co-infected patients who did not receive antiretroviral therapy

In the era of antiretroviral therapy (ART), the development of chronic kidney disease in HIV-infected patients is a significant complication not directly related to acquired immunodeficiency syndrome (AIDS), the risk of which is increased with co-infection with hepatitis C virus (HCV). The pathogenetic pathways of the development of kidney tissue damage and the formation of a morphological substrate for each of the viruses are different, but the immune-mediated mechanisms are a common link for the development of immune complex diseases. We studied renal necropsy samples in 20 patients with HIV/HCV co-infection who did not receive ART, and the dependence of the identified morphological substrate on the level of CD4+ in the blood, to assess and predict their morphogenesis. We observed predominantly segmental mesangial proliferation with an expansion of the mesangial matrix and glomerular involvement ≥50 % in 15 (75 %) cases and glomerular involvement &lt;50 % in 3 (15 %) cases. Endocapillary proliferation (E), infiltration of glomeruli with monocytes, neutrophil leukocytes, segmental macrophages were found in 2 (10 %) cases with the involvement of ≥ 50 % of glomeruli, which was regarded as an exudative component of the inflammatory response. In all cases, sclerosis of capillary loops was verified, which was mainly accompanied by their collapse, thickening of the capillary walls, namely the basement membranes of capillaries and segmental sclerosis of capillary loops of the glo­meruli of varying severity. Initial interstitial stromal fibrosis was found in 5 (25 %) cases, degenerative changes in the convoluted tubules — in 9 (45 %), mainly with the T0–T1 level. Positive expression of IgA, IgM, IgG, and C3 complement fractions in the form of linear and granular deposits along the capillary endothelium was detected with an intensity of “+” to “++”. We compared the verified morphological pattern and the level of CD4+ in the blood and found that patients with deeper immunosuppression show fewer changes, mainly characterized as sclerotic. Moreover, with an increase in the level of CD4+, the morphological substrate is enriched with a proliferative component. Expression of immunoglobulins and components of the complement system in immonohistochemical assay, in particular in areas of sclerotic changes, verifies the presence of prolonged immune complex associated lesions. To determine the detailed morphogenesis, it is advisable to perform a further correlation analysis of the data obtained with the control.

Immune reconstitution inflammatory syndrome-associated Graves disease in HIV-infected patients: clinical characteristics and response to radioactive iodine therapy.

We aimed to describe the clinical characteristics and the response to radioactive iodine (RAI) treatment of immune reconstitution inflammatory syndrome-associated Graves disease (IRIS-GD) in comparison to Graves disease (GD) seen in HIV-uninfected patients. We retrospectively reviewed the medical records of patients treated with RAI for GD. We obtained clinical, biochemical and HIV-related information of patients from their medical records. We compared patient characteristics and response to RAI treatment between patients with IRIS-GD and GD seen in HIV-uninfected patients. A total of 253 GD patients, including 51 patients with IRIS-GD, were included. Among IRIS-GD patients, CD4 cell nadir was 66 cells/µL (range:37-103) with a peak HIV viral load of 60900 copies/mL (range:36542-64500). At the time of diagnosis of IRIS-GD, all patients had a completely suppressed HIV viraemia with a CD4 cell count of 729 cells/µL (range:350-1279). The median interval between the commencement of HIV treatment and the onset of GD was 63months. At 3months follow-up, the proportion of patients with IRIS-GD achieving a successful RAI treatment outcome (euthyroid/hypothyroid state) was lower than that of HIV-uninfected patients (35.3% vs. 63.4%, respectively; p<0.001). The response rate remained lower (60.8%) among patients with IRIS GD than among HIV-uninfected GD patients (80.2%, p=0.004) at 6months follow-up. After correcting for differences in age, gender and pre-treatment thyroid-stimulating hormone level, there was no significant difference in RAI treatment response between the two groups. After correcting for possible confounders, the response to RAI treatment was not different between patients with IRIS-GD and GD in HIV-uninfected patients.

Features and explainable methods for cytokines analysis of Dry Eye Disease in HIV infected patients

Clinical Decision Support Systems (CDSS) that use machine learning techniques and their broadest sense of artificial intelligence (AI) must be interpretable and transparent. The lack of transparency instead of providing support could instead become a factor of indecision and obstacle. In this work, a very complex and important problem from a clinical point of view is tackled, namely the pathology known as Dry Eye Disease (DED), starting from a case-control study on a HIV-positive population and a healthy part of it. The case study is faced on two fronts, the first in which an ensemble-based clustering algorithm is built. Secondly, this algorithm is broken down to analyze each component, making the analysis method transparent and interpretable. Specifically, an ensemble of clustering algorithms is presented, such as k-means, agglomerative, spectral, and birch, which are combined and used in two levels: in the first, the labels are obtained from each clusterizer to recognize significant patterns of the two populations affected by the DED pathology, in the presence of HIV and not. Subsequently, the labels obtained at the first level are used as inputs on which the clusterizers are used again, whose outputs in the final phase serve as a training data set for a supervised method (i.e., logistic regression, decision trees, neural network, etc.), to evaluate every single component separately, through the use of features importance techniques (i.e., decision trees, LASSO regression, Gini Importance (GI), Variable Importance (VI), etc.). In this way, each clustering algorithm used at the first level can be considered a new feature in the next one and evaluate its individual contribution. Furthermore, each characteristic is interpreted through specific methods of the relevance of the characteristics to make the decision support tool as complete as possible. The performance of the methods used in training, both supervised and unsupervised, is evaluated through appropriate metrics, such as the well-known measures of precision, recall, accuracy, and homogeneity. Clustering methods provide results on the groups created and on the influence of features (cytokines) in the two populations examined. The experimental results obtained concerning the association between the development of the DED pathology and the presence or absence of HIV in these patients, and the influence that certain factors have on this problem, are interpreted with methods that are part of that branch known as Explainable AI (i.e., Local Interpretable Model-agnostic Explanations (LIME), Shapley, Individual Conditional Expectation (ICE), etc.). Besides explaining the influence exerted by certain features, the methods used provide both a global and local view on how each factor influences the final probability associated with the possible development of the pathology. The practical implications in using this method can be of support to the clinical diagnoses carried out on the patients examined to evaluate how each factor can be responsible for the possible development of the disease and therefore taken individually in the treatment. To date, the analytical techniques used in the study of this pathology have always provided generalized results, while breaking down the problem and isolating the components could provide valuable information to clinical operators.

Clinical manifestation and initial treatment on infectious respiratory illnesses in HIV-infected patient: a case report

Respiratory illnesses are common complication during the evolution of the disease in HIV-infected patients, mainly of infectious aetiology. Pneumocystis Pneumonia (PCP) is currently the most frequent cause of pulmonary infections in HIV patients, followed by bacterial pneumonia and TB. In this case report involves a 28 years-old male patient with HIV infection presented to the hospital with progressive dyspnoea, fever, non-productive cough and weight loss. Physical examination showed a decreased of oxygen saturation, oral thrush, and respiratory crackles in both lungs. The results of chest x-ray examination suggested a picture of pneumonia. The sputum was examined with Xpert MTB-RIF Assay and the results were negative. This patient was treated with cotrimoxazole in 2 double-strength (DS) tablets three times daily, dual therapy antibiotics combination with a beta-lactam and macrolide, oral fluconazole, also adjuvant corticosteroid of methylprednisolone. This initial treatment based on drug of choice for infectious respiratory illnesses in HIV-infected patient.

Psoriasis and Liver Damage in HIV-Infected Patients.

Background/objectives: Psoriasis is the most frequent skin disease in HIV-infected patients. Nonalcohol fatty liver disease (NAFLD) is more prevalent in patients with psoriasis. We report the prevalence of psoriasis and NAFLD and investigate risk factors of liver damage in HIV-infected patients with psoriasis. Methods: We performed a retrospective observational study. Steatosis was defined as indicative abdominal ultrasound findings, CAP (controlled attenuated parameter by transient elastography) > 238 dB/m, and/or triglyceride and glucose index (TyG) > 8.38. Significant (fibrosis ≥ 2) and advanced liver fibrosis (fibrosis ≤ F3) were studied by transient elastography (TE) and/or FIB-4 using standard cutoff points. FIB-4 (Fibrosis 4 score) results were adjusted for hepatitis C (HCV)-coinfected patients. Results: We identified 80 patients with psoriasis (prevalence, 1.5%; 95% CI, 1.1–1.8). Psoriasis was severe (PASI > 10 and/or psoriatic arthritis) in 27.5% of cases. The prevalence of steatosis was 72.5% (95% CI, 65–85). Severe psoriasis was an independent risk factor for steatosis (OR, 12; 95% CI, 1.2–120; p = 0.03). Significant liver fibrosis (p < 0.05) was associated with HCV coinfection (OR 3.4; 95% CI, 1.1–10.6), total CD4 (OR 0.99; 95% CI, 0.99–1), and time of efavirenz exposure (OR 1.2; 95% CI, 1.0–1.3). Conclusions: The prevalence of psoriasis in HIV-infected patients was similar to that of the general population. Steatosis is highly prevalent, and severe psoriasis is an independent risk factor for steatosis in HIV-infected patients.